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1.
J Surg Oncol ; 121(1): 91-99, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31650565

RESUMO

BACKGROUND: Lymphedema surgery was not widely known in Austria before the introduction of lymphovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT) in 2014. This study shares the experience and process of establishing and institutionalizing lymphedema surgery service in Austria. METHODS: The purpose of introducing reconstructive lymphedema surgery in Austria was to improve lymphedema patients' quality of life and provide them surgical therapy as an adjuvant treatment to complete decongestive therapy. To initialize reconstructive lymphedema surgery in Austria, LVA and VLNT had to be presented and introduced, in the manner of branding and advertizing a new product. Surgeries were performed with quality control by standardized documentation, pre- and postoperatively. RESULTS: Aligned with branding and marketing, presentations were given externally and internally to share knowledge and experience of lymphedema surgery. Lymphedema surgery service was introduced as a new brand in the medical service in Austria. After several communications with the Austrian Health Insurance Fund and with the final application, LVA and VLNT were listed as novel surgical therapies in its 2020 reimbursement catalog. Since 2014, more than 300 lymphedema patients were consulted, and 102 reconstructive lymphedema surgeries were performed. Circumference reduction of extremities after surgery was between 20% and 43%, postoperatively. CONCLUSION: Acceptance of surgery in lymphedema patients varies among continents, hospitals, and surgeons. Evaluation of the requirement of the surgical setup and insurance conditions for lymphedema surgery is essential to establish lymphedema surgery, providing targeted marketing and branding to spread knowledge of the novel technique and grant patients access to therapeutic treatment of their chronic disease.


Assuntos
Cirurgia Geral/organização & administração , Linfedema/cirurgia , Adolescente , Adulto , Idoso , Anastomose Cirúrgica , Áustria , Criança , Feminino , Humanos , Linfonodos/transplante , Vasos Linfáticos/cirurgia , Linfedema/diagnóstico , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Procedimentos Cirúrgicos Reconstrutivos/métodos , Centro Cirúrgico Hospitalar , Adulto Jovem
2.
J Surg Oncol ; 121(1): 8-19, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31309553

RESUMO

The hands-on supermicrosurgery course provided participants a valuable learning experience of in-depth practices of supermicrosurgical skills with experts. Seven live surgeries were successfully demonstrated at 8th World Symposium for Lymphedema Surgery. Variable donor sites for vascularized lymph node transfer were the submental, supraclavicular, groin, and omental; while the recipient sites included the wrist and axilla in upper limb; and popliteal and groin in the lower limb. The therapeutic and preventive lymphovenous anastomosis was also satisfactorily performed.


Assuntos
Linfedema/cirurgia , Microcirurgia/educação , Microcirurgia/métodos , Adulto , Idoso , Feminino , Humanos , Linfedema/diagnóstico , Masculino , Pessoa de Meia-Idade , Adulto Jovem
4.
BMJ Case Rep ; 12(8)2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31471355

RESUMO

We report a preterm neonate who had a large cervical cystic hygroma and right chylothorax. She was operated on day-21 and a near-complete resection of cystic hygroma was done. She developed refractory hypoxemia and shock post surgery and died after 24 hours. During autopsy, the chest cavity was found to be filled with chyle. Histopathological examination showed dilated lymphatics in the pleura, hepatic capsule, serosa of stomach and intestines, peri-pancreatic regions, peri-renal capsule and peri-adrenal tissues suggestive of generalised lymphatic dysplasia. Clinical exome sequencing did not reveal any pathogenic mutation in the genes involved in primary lymphatic dysplasia, noonan syndrome or rasopathies.


Assuntos
Anormalidades Craniofaciais/diagnóstico , Linfangiectasia Intestinal/diagnóstico , Linfedema/diagnóstico , Fenótipo , Vértebras Cervicais , Quilotórax/diagnóstico , Quilotórax/etiologia , Anormalidades Craniofaciais/complicações , Erros de Diagnóstico , Evolução Fatal , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Linfangiectasia Intestinal/complicações , Linfangioma Cístico/diagnóstico , Linfangioma Cístico/etiologia , Linfedema/complicações , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/etiologia
5.
Med Hypotheses ; 131: 109312, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31443775

RESUMO

On evaluating patients with lymphedema, the authors found that obesity is associated with generalized edema of all extremities and the trunk with increased intracellular and extracellular fluids, thus suggesting a new concept of lymphedema that the authors have termed systemic subclinical lymphedema. Animal studies show that obesity and its progression lead to changes in the lymphatic system and microcirculation with alterations in lymphatic motility, inflammatory processes, capillary permeability and immune response. Systemic subclinical lymphedema is diagnosed when above normal fluid levels are detected in all the extremities and the trunk with the progression of obesity; this can lead to the appearance of clinical lymphedema of the extremities.


Assuntos
Edema/etiologia , Linfedema/etiologia , Obesidade/complicações , Animais , Cirurgia Bariátrica , Compartimentos de Líquidos Corporais , Progressão da Doença , Edema/fisiopatologia , Extremidades/fisiopatologia , Humanos , Linfedema/diagnóstico , Linfedema/fisiopatologia , Modelos Biológicos , Obesidade/fisiopatologia , Obesidade/cirurgia , Especificidade de Órgãos , Tronco/fisiopatologia , Perda de Peso
6.
Plast Reconstr Surg ; 144(3): 738-758, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31461041

RESUMO

Lymphedema affects up to 250 million people worldwide. The understanding of the pathophysiology of the condition, however, is incomplete and a cure remains elusive. A growing body of evidence supports the effectiveness of modern surgical techniques in ameliorating the long-term disability and functional impairment inflicted by lymphedema on the lives of those affected. These procedures can be broadly categorized as physiologic, including lymphovenous bypass and using a vascularized lymph node transplant; or de bulking, by suction-assisted lipectomy or direct excisional procedures. The lymphovenous bypass procedure involves identification of obstructed lymphatic vessels and targeted bypass of these into neighboring venules. The vascularized lymph node transplant procedure involves microvascular anastomosis of functional lymph nodes into an extremity, either to an anatomical (orthotopic) or nonanatomical (heterotopic) location, to restore physiologic lymphatic function. In patients undergoing postmastectomy breast reconstruction, this may be performed by transferring a deep inferior epigastric artery perforator flap with a chimeric groin lymph node flap. For patients that have undergone breast-conserving surgery, in those for whom a free abdominal flap is contraindicated, or for those with lymphedema affecting the lower extremity, many other vascularized lymph node transplant options are available; these include flaps harvested from within the axillary, inguinal, or cervical lymph node basins, or from within the abdominal cavity. Chronic lymphedema is characterized by fibroadipose soft-tissue deposition that can only be removed by lipectomy, either minimally invasively using liposuction, or by direct excision. This article reviews the techniques and outcomes of surgical procedures used to treat lymphedema.


Assuntos
Procedimentos Cirúrgicos de Citorredução/métodos , Lipectomia/métodos , Linfonodos/transplante , Vasos Linfáticos/cirurgia , Linfedema/cirurgia , Axila , Neoplasias da Mama/cirurgia , Doença Crônica/terapia , Feminino , Retalhos de Tecido Biológico/transplante , Virilha , Humanos , Linfonodos/irrigação sanguínea , Linfedema/diagnóstico , Linfedema/etiologia , Mastectomia/efeitos adversos , Seleção de Pacientes , Retalho Perfurante/transplante
8.
J Plast Reconstr Aesthet Surg ; 72(6): 884-891, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30944074

RESUMO

BACKGROUND: Lymphaticovenous anastomosis (LVA) is a surgical treatment for lymphedema that requires identification and mapping of functional lymphatic channels. This technique was performed blindly for years because of the lack of suitable methods of study. Progress in imaging techniques and the introduction of Indocyanine green lymphography (ICG-L) represented a significant advancement in lymphedema management. Magnetic resonance lymphangiography (MRL) has also helped improve knowledge about lymphedema anatomy and pathophysiology. We now present our protocol based on both ICG-L and MRL for optimal LVA preoperative planning. METHODS: A prospective study between April 2010 and June 2015 was conducted in 82 patients (77 females, mean age 45.5 years) with stage I (9.8%), II (73.2%), and III (17.0%) lymphedema. All patients underwent lymphedema surgical treatment with LVA. Surgery was planned based on preoperative information from ICG- L and MRL. RESULTS: We obtained a mean of 6.87 lymphatic locations per extremity from MRL and selected a mean of 4.04 for LVA. When MRL data coincided with ICG-L data, we found a functional lymphatic vessel in 96.9% of cases and performed LVA successfully in 91.4%. CONCLUSIONS: ICG-L and MRL are noninvasive techniques that provide images of the lymphatic system with sufficient temporal and spatial resolution to depict functional lymphatic vessels. Such knowledge is essential for preoperative planning of LVA microsurgery. We present our protocol for the approach of surgical treatment of lymphedema. This protocol represents a step forward in unifying patient selection criteria and achieving safe, effective, and rational surgery.


Assuntos
Anastomose Cirúrgica/métodos , Vasos Linfáticos , Linfedema , Linfografia/métodos , Imagem por Ressonância Magnética/métodos , Veias/cirurgia , Corantes/farmacologia , Feminino , Humanos , Aumento da Imagem/métodos , Verde de Indocianina/farmacologia , Vasos Linfáticos/diagnóstico por imagem , Vasos Linfáticos/fisiopatologia , Vasos Linfáticos/cirurgia , Linfedema/diagnóstico , Linfedema/fisiopatologia , Linfedema/cirurgia , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Resultado do Tratamento
9.
Ann Surg Oncol ; 26(7): 2263-2267, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31011899

RESUMO

BACKGROUND: The majority of patients undergoing sentinel lymph node biopsy (SLNB) for melanoma will have a negative SLN. The long-term sequelae of a negative result are important when discussing this staging investigation with patients. The objective of this study was to assess rates of lymphoedema and quality of life for these patients. METHODS: A prospective, cross-sectional study was performed on patients under routine follow-up with a history of melanoma, who had undergone sentinel lymph node biopsy where no metastasis was found (N0) at a high-volume melanoma centre. Relevant limbs were measured to assess for lymphoedema and patients completed the FACT-M quality of life instrument and a study specific questionnaire. RESULTS: A total of 102 patients were recruited. Wound complications were observed in 25% and lymphoedema in 2% of patients. Physical and functional well-being scores were lowest in patients seen within 3 months of their SLNB. Functional well-being and quality of life improved over the 2 years following the procedure. CONCLUSIONS: SLNB has low complication rates. The procedure is associated with a short-term impact on patient quality of life and well-being. The vast majority of patients are pleased with the outcomes of this procedure and the information that it provides.


Assuntos
Excisão de Linfonodo/efeitos adversos , Linfedema/diagnóstico , Melanoma/patologia , Qualidade de Vida , Biópsia de Linfonodo Sentinela/efeitos adversos , Neoplasias Cutâneas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Seguimentos , Humanos , Linfedema/etiologia , Masculino , Melanoma/cirurgia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Neoplasias Cutâneas/cirurgia , Inquéritos e Questionários
10.
Lymphat Res Biol ; 17(2): 147-154, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30995181

RESUMO

Background and Study Design: Chronic edema (CO) is believed to be a major clinical problem within community nursing services in the United Kingdom. This study was undertaken as part of the LIMPRINT international study to determine the number of people with CO and its impact on health services. Methods and Results: Three urban-based community nursing services participated in the United Kingdom with prospective evaluation for 4 weeks of all patients receiving nursing care using a questionnaire-based interview and clinical assessment using the LIMPRINT tools. Of the total 2541 patients assessed, 1440 (56.7%) were considered to have CO, comprising Leicester City [768/1298 (59.2%)], Nottingham West [124/181 (68.5%)], and Nottingham City [548/1062 (51.6%)]. The mean age for women with CO was 78.6 (standard deviation [SD] 12.8) years and that for men with CO was 72.9 (SD 14.5). More patients with CO suffered from diabetes (32.1% vs. 27.9%, p = 0.027), heart failure/ischemic heart disease (27.3% vs. 14.0%, p < 0.001), and peripheral arterial occlusive disease (5.5% vs. 1.9%, p < 0.001). By far the greatest association was with the presence of a wound (73.6% vs. 37.9%, p < 0.001). Cellulitis affected 628 patients (24.7%) and 688 patients (47.8%) had a concurrent leg ulcer. Rates of reduced mobility (71.6% vs. 61.9%) and obesity were higher in those with CO. Six independent factors associated with CO were service location, age, ethnicity, obesity, heart failure, and the presence of a wound. Conclusion: CO is a major and growing health care problem within primary care that has been previously unrecognized and requires effective service provision.


Assuntos
Edema/diagnóstico , Sistema Linfático/patologia , Linfedema/diagnóstico , Serviços de Enfermagem/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/fisiopatologia , Doença Crônica , Estudos Transversais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/fisiopatologia , Diagnóstico Diferencial , Edema/epidemiologia , Edema/patologia , Edema/fisiopatologia , Feminino , Humanos , Úlcera da Perna/diagnóstico , Úlcera da Perna/fisiopatologia , Extremidade Inferior/patologia , Extremidade Inferior/fisiopatologia , Sistema Linfático/fisiopatologia , Linfedema/epidemiologia , Linfedema/patologia , Linfedema/fisiopatologia , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/fisiopatologia , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/fisiopatologia , Prevalência , Fatores de Risco , Inquéritos e Questionários , Reino Unido/epidemiologia
11.
Lymphat Res Biol ; 17(2): 173-177, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30995183

RESUMO

Background and Study Objective: Australia was one of nine participating countries in the epidemiology Phase II Lymphoedema Impact and Prevalence - International (LIMPRINT) project to determine the number of people with chronic edema (CO) in local health services. Methods and Results: Data collection occurred through questionnaire-based interviews and clinical assessment with provided LIMPRINT tools. Four different types of services across three states in Australia participated. A total of 222 adults participated with an age range from 22 to 102 years, and 60% were female. Site 1 included three residential care facilities (54% of participants had swelling), site 2 was community-delivered aged care services (24% of participants had swelling), site 3 was a hospital setting (facility-based prevalence study; 28% of participants had swelling), and site 4 was a wound treatment center (specific patient population; 100% of participants had swelling). Of those with CO or secondary lymphedema, 93% were not related to cancer, the lower limbs were affected in 51% of cases, and 18% of participants with swelling reported one or more episodes of cellulitis in the previous year. Wounds were identified in 47% (n = 105) of all participants with more than half of those with wounds coming from the dedicated wound clinic. Leg/foot ulcer was the most common type of wound (65%, n = 68). Conclusions: Distances between services, lack of specialized services, and various state funding models contribute to inequities in CO treatment. Understanding the high number of noncancer-related CO presentations will assist health services to provide timely effective care and improve referral pathways.


Assuntos
Edema/diagnóstico , Disparidades em Assistência à Saúde/estatística & dados numéricos , Sistema Linfático/patologia , Linfedema/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/fisiopatologia , Doença Crônica , Centros Comunitários de Saúde/economia , Centros Comunitários de Saúde/ética , Diagnóstico Diferencial , Edema/economia , Edema/epidemiologia , Edema/patologia , Feminino , Disparidades em Assistência à Saúde/economia , Humanos , Úlcera da Perna/diagnóstico , Úlcera da Perna/fisiopatologia , Sistema Linfático/fisiopatologia , Linfedema/economia , Linfedema/epidemiologia , Linfedema/patologia , Masculino , Pessoa de Meia-Idade , Prevalência , Instituições Residenciais/economia , Instituições Residenciais/ética , Fatores de Risco , Inquéritos e Questionários , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/fisiopatologia
12.
Lymphat Res Biol ; 17(2): 168-172, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30995186

RESUMO

Background: Chronic edema is a condition that is biologically complex, distressing for patients and sociopolitically weak. Like many other complex and chronic conditions, it has a low status within health care. The result is that it has a low priority in health policy and consequently is undervalued and undertreated. While evidence-based practice promotes a hierarchy of evidence, it is also the case that clinical practice is influenced by a hierarchy of social status. These are as much political as they are scientific. Methods and Results: This article will provide an explanation for why chronic edema is a low priority. It will do this through a critical review of the literature. We examine this through the theoretical lens of Pierre Bourdieu. The sociology of Bourdieu frames an understanding of power relations through habitus, field, and capital. We will employ these theoretical tools to understand the way that chronic edema is situated within the policy arena. We identify a number of social mechanisms that affect the status of chronic edema, including diagnostic uncertainty, social capital, scientific capital, cultural capital and economic capital. Conclusion: We argue that a whole system approach to care, based on human need rather than unequal power relations, is a prerequisite for the delivery of good health care. The specialty of chronic edema is not a powerless group and we identify some of the ways that the social mechanism that acts as barriers to change, can also be employed to challenge them.


Assuntos
Análise Custo-Benefício/ética , Assistência à Saúde/economia , Edema/psicologia , Linfedema/psicologia , Qualidade de Vida/psicologia , Doença Crônica , Características Culturais , Assistência à Saúde/estatística & dados numéricos , Diagnóstico Diferencial , Edema/diagnóstico , Edema/economia , Edema/patologia , França , Humanos , Sistema Linfático/patologia , Sistema Linfático/fisiopatologia , Linfedema/diagnóstico , Linfedema/economia , Linfedema/patologia , Capital Social , Fatores Socioeconômicos , Sociologia/métodos , Reino Unido
13.
Lymphat Res Biol ; 17(2): 155-162, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30995187

RESUMO

Background and Study Objective: To estimate the prevalence of chronic edema (CO) and wounds within two vulnerable populations, a male high security prison in the East Midlands (United Kingdom) and residential and nursing homes in the United Kingdom and Australia. Methods and Results: Methods for screening for CO and wounds were adapted from the main LIMPRINT methodology. Prison Population: In total, 195 inmates were recruited with 22 (11%) having CO. While the majority were white Caucasian (156/83.4%) a further 20 (10.7%) were dark skinned with 11 (5.95%) from other minority populations. Comorbidities included 123 (63%) smokers, 22 (11%) alcohol dependant, 60 (31%) with mental health problems, and 35 (18%) a history of self-harm. Only three had a current wound with 30 (16%) having had a traumatic stab wound. Residential and Nursing Homes (United Kingdom and Australia): In the United Kingdom, the total population available for inclusion was 189 with only 137 (73%) recruited. Seventy-two of the 137 (52%) suffered from CO and a further 16 (23%) had a history of cellulitis. Results from the Australian residential care facilities have been published in full. In summary, of the 37 participants 20 (54%) experienced CO with 25 (68%) having comorbidities and 11 (30%) having a concurrent wound. Conclusion: Obtaining an accurate picture of the prevalence and impact of CO in vulnerable populations is extremely challenging due to issues of access and consent. Lack of reliable data for these populations will contribute to poor service provision.


Assuntos
Edema/diagnóstico , Sistema Linfático/patologia , Linfedema/diagnóstico , Casas de Saúde , Prisioneiros , Ferimentos Penetrantes/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/fisiopatologia , Austrália/epidemiologia , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/fisiopatologia , Doença Crônica , Fumar Cigarros/fisiopatologia , Comorbidade , Edema/epidemiologia , Edema/patologia , Edema/fisiopatologia , Feminino , Humanos , Sistema Linfático/fisiopatologia , Linfedema/epidemiologia , Linfedema/patologia , Linfedema/fisiopatologia , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/fisiopatologia , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Comportamento Autodestrutivo/diagnóstico , Comportamento Autodestrutivo/fisiopatologia , Inquéritos e Questionários , Reino Unido/epidemiologia , Populações Vulneráveis , Ferimentos Penetrantes/epidemiologia , Ferimentos Penetrantes/patologia , Ferimentos Penetrantes/fisiopatologia
15.
Lymphat Res Biol ; 17(2): 163-167, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30995189

RESUMO

Background: Chronic edema is a condition posing a high burden on patients. The primary aim of the study was to assess the health-related quality of life (QoL) of adult patients living with chronic edema. Methods and Results: As part of an international, multicenter, prospective study, we prospectively assessed the health-related QoL of adult patients living with a chronic edema using a disease-specific tool and a generic one. In total, 1094 patients were included, aged 57 years on average. The average EQ-5D and LYMQOL visual analogue scale (VAS) scores were equal to 63.6 (SD = 20.2) and 6.3 (SD = 2.0), respectively. After adjustment, the EQ-5D VAS was explained by LYMQOL VAS (ß = 7.85; p < 0.001), age (ß = -0.08; p = 0.02), obesity (ß = -1.89; p = 0.001), and male gender (ß = 3.32; p = 0.002). As for the LYMQOL VAS, it was independently associated with EQ-5D VAS (ß = 0.07; p < 0.001), LYMQOL function (ß = -0.21; p < 0.001), and LYMQOL mood (ß = -0.49; p < 0.001). Conclusion: This study confirms that patients living with a chronic edema experience a poor disease-specific and generic health-related QoL.


Assuntos
Edema/psicologia , Sistema Linfático/patologia , Linfedema/psicologia , Qualidade de Vida/psicologia , Adulto , Fatores Etários , Idoso , Ásia/epidemiologia , Canadá/epidemiologia , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/fisiopatologia , Doença Crônica , Diagnóstico Diferencial , Edema/diagnóstico , Edema/epidemiologia , Edema/patologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Sistema Linfático/fisiopatologia , Linfedema/diagnóstico , Linfedema/epidemiologia , Linfedema/patologia , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/fisiopatologia , Prevalência , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Inquéritos e Questionários
16.
Lymphat Res Biol ; 17(2): 178-186, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30995190

RESUMO

Background: Chronic edema/lymphedema is defined as edema present for more than 3 months. It is underrecognized and undertreated. The International Lymphedema Framework developed an international study, Lymphedema Impact and Prevalence International (LIMPRINT), to estimate the prevalence and impact of chronic edema in heterogeneous populations. Canada participated in this study. Methods and Results: Participants were recruited from an outpatient chronic wound management clinic. At a study visit, the following tools were administered: The Core Tool, Demographics and Disability assessment (WHODAS 2.0), Quality-of-life assessment (LYMQOL + EQ-5D), Details of swelling, Wound assessment, and Cancer. Data were entered into an international database (Clindex), and country-specific data were analyzed. Sixty-eight subjects were enrolled. Fifty-seven percent were males and 43% females. More than 90% were older than 45 years. Only 7.35% had primary lymphedema. Most had lower extremity edema (65 of 68). Over half (47.06%) were morbidly obese with body mass index of >40. The most common underlying condition was venous disease. Only 8 of 68 had a history of cancer. While 72.06% had a history of cellulitis, only 10.2% had been hospitalized in the past year. 39.71% had an open wound. More than 75% had received multilayer bandaging, compression garments, wound dressings, and extensive counseling. Few had received manual lymphatic drainage, which is not funded. Disability was less than expected. Conclusion: Chronic edema/lymphedema is an underrecognized condition. These data and the wider LIMPRINT study are important tools to advocate for wider recognition and funding of treatment by health care systems.


Assuntos
Edema/diagnóstico , Sistema Linfático/patologia , Linfedema/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Canadá/epidemiologia , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/fisiopatologia , Doença Crônica , Bandagens Compressivas , Diagnóstico Diferencial , Edema/economia , Edema/epidemiologia , Edema/patologia , Feminino , Humanos , Úlcera da Perna/diagnóstico , Úlcera da Perna/fisiopatologia , Extremidade Inferior/patologia , Extremidade Inferior/fisiopatologia , Sistema Linfático/fisiopatologia , Linfedema/economia , Linfedema/epidemiologia , Linfedema/patologia , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/fisiopatologia , Pacientes Ambulatoriais , Prevalência , Qualidade de Vida , Fatores de Risco , Inquéritos e Questionários
17.
Lymphat Res Biol ; 17(2): 135-140, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30995191

RESUMO

Background: To estimate the prevalence of lymphedema/chronic edema (CO) and wounds in acute hospital inpatients in five different countries. Methods and Results: A point-prevalence study was carried out during working day periods in six general hospitals in four countries (Denmark, France, United Kingdom, and Australia) and one hospital oncology inpatient unit in one other country (Ireland). The study used validated clinical tools for the assessment and collection of data. Data were collected by expert clinicians through interviews and physical examination of the patients present in the wards. A total of 1905 patients could be included and investigated among the 3041 total bed occupancy in the seven hospitals. Lymphedema/CO was present in 723 of them (38%). Main risk factors associated with CO were age, morbid obesity, and heart failure, as well as chair bound immobility and neurological deficiency. History of cellulitis was frequent in patients with CO and wounds (24.8%) and CO alone (14.1%) compared to the 1.5% prevalence in patients without CO. Conclusion: Lymphedema/CO is very frequent in patients hospitalized in hospital acute wards. It is strongly associated with obesity, venous insufficiency, and heart failure. Our results strongly suggest a hidden health care burden and cost linked to CO independently of chronic wounds.


Assuntos
Celulite (Flegmão)/diagnóstico , Edema/diagnóstico , Sistema Linfático/patologia , Linfedema/diagnóstico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Celulite (Flegmão)/epidemiologia , Celulite (Flegmão)/patologia , Celulite (Flegmão)/fisiopatologia , Doença Crônica , Estudos Transversais , Diagnóstico Diferencial , Edema/epidemiologia , Edema/patologia , Edema/fisiopatologia , Europa (Continente)/epidemiologia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Hospitais , Humanos , Pacientes Internados , Sistema Linfático/fisiopatologia , Linfedema/epidemiologia , Linfedema/patologia , Linfedema/fisiopatologia , Masculino , Pessoa de Meia-Idade , Transtornos Neurocognitivos/diagnóstico , Transtornos Neurocognitivos/fisiopatologia , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/fisiopatologia , Prevalência , Qualidade de Vida , Fatores de Risco
18.
Lymphat Res Biol ; 17(2): 202-210, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30995192

RESUMO

Background: Lymphedema and chronic edema is a major health care problem in both developed and nondeveloped countries The Lymphoedema Impact and Prevelance - International (LIMPRINT) study is an international health service-based study to determine the prevalence and functional impact in adult populations of member countries of the International Lymphoedema Framework (ILF). Methods and Results: A total of 1051 patients from eight centers in Turkey were recruited using the LIMPRINT study protocol. Data were collected using the core and module tools that assess the demographic and clinical properties as well as disability and quality of life (QoL). Most of the Turkish patients were recruited from specialist lymphedema services and were found to be women, housewives, and having secondary lymphedema because of cancer treatment. The duration of lymphedema was commonly <5 years and most of them had International Society of Lymphology (ISL) grade 2 lymphedema. Cellulitis, infection, and wounds were uncommon. The majority of patients did not get any treatment or advice before. Most of the patients had impaired QoL and decreased functionality, but psychological support was neglected. Although most had social health security access to lymphedema centers, nevertheless access seemed difficult because of distance and cost. Conclusion: The study has shown the current status and characteristics of lymphedema patients, treatment conditions, the unmet need for the diagnosis and treatment, as well as burden of the disease in both patients and families in Turkey. National health policies are needed for the prevention, diagnosis, and treatment in Turkey that utilize this informative data.


Assuntos
Neoplasias da Mama/epidemiologia , Diabetes Mellitus/epidemiologia , Edema/epidemiologia , Linfedema/epidemiologia , Obesidade/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Neoplasias da Mama/fisiopatologia , Criança , Doença Crônica , Comorbidade , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/patologia , Diabetes Mellitus/fisiopatologia , Diagnóstico Diferencial , Edema/diagnóstico , Edema/patologia , Edema/fisiopatologia , Feminino , Acesso aos Serviços de Saúde/economia , Humanos , Pacientes Internados , Sistema Linfático/patologia , Sistema Linfático/fisiopatologia , Linfedema/diagnóstico , Linfedema/patologia , Linfedema/fisiopatologia , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/patologia , Obesidade/fisiopatologia , Pacientes Ambulatoriais , Prevalência , Qualidade de Vida/psicologia , Inquéritos e Questionários , Turquia/epidemiologia
19.
Lymphat Res Biol ; 17(2): 187-194, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30995193

RESUMO

Background: The International Lymphedema Framework developed an international study, Lymphedema Impact and Prevalence International (LIMPRINT), to estimate the prevalence and impact of chronic edema (CO) in heterogeneous populations. Methods and Results: A validation study using the LIMPRINT methodology was undertaken in Denmark. Participants with CO were identified from inpatient services and compared with those identified within a specialist lymphedema service and three primary care settings. Of 452 inpatients available for screening, CO was present in 177 (39%) and absent in 275 (61%). In addition, 723 participants were found from specialist and primary care services (LPCSs). Inpatients were significantly older and more likely to be underweight or normal weight. They were more likely to suffer from heart failure/ischaemic heart disease (44.6% vs. 23.4%, p < 0.001) and have neurological problems (18.1% vs. 10.9% p = 0.009). Patients in the inpatient group were nearly all suffering from secondary lymphedema and were less likely to have a cancer or venous diagnosis, but more likely to have immobility as the cause of CO (44.0% vs. 17.7%, p < 0.001). No inpatients had midline CO compared with 30 within LPCSs. Fewer in the inpatient group had standard CO treatment (17.1% vs. 73.5%, p < 0.001) and subjective control of swelling was worse (19.9% vs. 66.7%, p < 0.001). While the inpatient group experienced fewer acute infections, when they did so, they were more likely to be admitted to hospital for this (78.6% vs. 51.0%, p = 0.049). Conclusion: The prevalence of CO in inpatient facilities is high and those with CO have multiple comorbidities that vary according to setting. The feasibility study showed that the methodology could be adapted for use in different health systems.


Assuntos
Edema/epidemiologia , Insuficiência Cardíaca/epidemiologia , Sistema Linfático/patologia , Linfedema/epidemiologia , Isquemia Miocárdica/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Doença Crônica , Comorbidade , Dinamarca/epidemiologia , Diagnóstico Diferencial , Edema/diagnóstico , Edema/patologia , Edema/fisiopatologia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/patologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Pacientes Internados , Extremidade Inferior/patologia , Extremidade Inferior/fisiopatologia , Sistema Linfático/fisiopatologia , Linfedema/diagnóstico , Linfedema/patologia , Linfedema/fisiopatologia , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/patologia , Isquemia Miocárdica/fisiopatologia , Prevalência , Atenção Primária à Saúde , Qualidade de Vida/psicologia
20.
Lymphat Res Biol ; 17(2): 195-201, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30995194

RESUMO

Background: This was a part of LIMPRINT (Lymphoedema IMpact and PRevalence-INTernational), an international study aimed at capturing the size and impact of lymphedema and chronic edema in different countries and health services across the world. The purpose of this study was to clarify the prevalence and the impact of chronic edema in Japan. Methods and Results: This was a two-phase facility-based study to determine the prevalence and functional impact of chronic edema in the adult population in Japan between 2014 and 2015. The prevalence study involved a university hospital, an acute community hospital, and a long-term medical facility. The impact study involved six facilities, including two outpatient clinics in acute care hospitals (one led by a physician and the other led by a nurse), inpatient wards in two acute care hospitals, and two nursing home/long-term care facilities. Various questionnaires and clinical assessments were used to gather patient demographic data and assess the functional impact of chronic edema. The results showed that chronic edema was much more prevalent in the long-term care facility than in acute care hospitals; cellulitis episodes occurred in ∼50% of cases in the gynecologist-led outpatient clinic, even though >80.0% of patients received standard management for edema; edema was found in the trunk region, including the buttock, abdomen, and chest-breast areas, in addition to the upper and lower limbs; and subjective satisfaction with edema control was low, even though the quality-of-life scores were good. Conclusions: The prevalence of chronic edema varied according to the facility type, ranging from 5.0% to 66.1%. The edema was located in all body parts, including the trunk region. Subjective satisfaction with control of edema was poor, while general quality of life was good. This large health care issue needs more attention.


Assuntos
Celulite (Flegmão)/epidemiologia , Edema/epidemiologia , Sistema Linfático/patologia , Linfedema/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/patologia , Celulite (Flegmão)/fisiopatologia , Doença Crônica , Comorbidade , Diagnóstico Diferencial , Edema/diagnóstico , Edema/patologia , Edema/fisiopatologia , Feminino , Hospitais Comunitários , Hospitais Universitários , Humanos , Pacientes Internados , Japão/epidemiologia , Assistência de Longa Duração , Extremidade Inferior/patologia , Extremidade Inferior/fisiopatologia , Sistema Linfático/fisiopatologia , Linfedema/diagnóstico , Linfedema/patologia , Linfedema/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Satisfação do Paciente/estatística & dados numéricos , Prevalência , Qualidade de Vida/psicologia , Inquéritos e Questionários
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