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1.
Anticancer Res ; 40(12): 6609-6612, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33288555

RESUMO

BACKGROUND/AIM: Treatment of gynecologic cancers may lead to the development of lower limb lymphedema. As the course of lymphedema is chronic and progressive, early diagnosis plays a significant role in decreasing morbidity. Therefore, risk assessment is of utmost importance. In this study, we aimed to investigate the impact of age on lymphedema development after treatment for gynecologic cancers. MATERIALS AND METHODS: The search of 3 databases (PubMed, Scopus, and Cochrane) revealed 7 relevant articles, which reported either odds ratios or hazard ratios as an outcome measure. RESULTS: A positive relationship between younger age and lower limb lymphedema was shown by 3 articles, while 2 noted increased incidence with older age. The remaining articles reported no significant relationship. CONCLUSION: Younger age is a risk factor for gynecologic cancer-related lymphedema. However, as individual studies have not included all types of gynecologic cancers, results may not be generalizable.


Assuntos
Neoplasias dos Genitais Femininos/complicações , Linfedema/epidemiologia , Linfedema/etiologia , Fatores Etários , Idoso , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Fatores de Risco
3.
Phys Ther ; 100(12): 2186-2197, 2020 12 07.
Artigo em Inglês | MEDLINE | ID: mdl-32931555

RESUMO

OBJECTIVE: The objectives of this study were to determine whether patients reporting symptoms are more likely to develop lymphedema and to describe the temporal relationship between symptom onset and lymphedema. METHODS: This was a prospective longitudinal cohort study of 647 women treated for breast cancer and screened for lymphedema using arm volume measurements and subjective questionnaires (n = 647; 2284 questionnaires [median 3.5 per patient, range = 1-24]). Primary study outcome was lymphedema (relative volume change ≥10%). The Kaplan-Meier method was used to estimate cumulative lymphedema incidence. Cox proportional hazards models were used to assess the relationship between symptoms, other risk factors, and lymphedema. RESULTS: A total of 64 patients (9.9%) developed lymphedema. On multivariable analysis, patients reporting increased arm size (hazard ratio = 3.09, 95% CI = 1.62-5.89) were more likely to progress to lymphedema than those who did not report this symptom. Of those who developed lymphedema, 37 (58%) reported an increased arm size a median of 6.1 months before lymphedema onset (range = 68.6 months before to 50.2 months after lymphedema onset). CONCLUSION: Patients at risk of lymphedema who report increased arm size might do so prior to lymphedema onset and are at 3 times the risk of lymphedema as patients not reporting this symptom. Even without objective or observable edema, these patients should be followed vigilantly and considered for early intervention. Symptoms should be incorporated into screening and diagnostic criteria for lymphedema. IMPACT: This study shows that patients at risk for breast cancer-related lymphedema who report increased arm size should be considered at high risk for progression to lymphedema-even without edema on measurement or clinical examination-and should be followed vigilantly, with consideration of early intervention. LAY SUMMARY: If you are at risk of lymphedema and you feel as though your arm size has increased, you might develop lymphedema, and you are at 3 times the risk of lymphedema as patients not reporting this symptom. Even without measurable or observable edema, you should be followed vigilantly and consider early intervention.


Assuntos
Braço/patologia , Neoplasias da Mama/complicações , Linfedema/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Avaliação de Sintomas/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/cirurgia , Progressão da Doença , Estudos Epidemiológicos , Feminino , Inquéritos Epidemiológicos , Humanos , Linfedema/epidemiologia , Linfedema/etiologia , Pessoa de Meia-Idade , Tamanho do Órgão , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Fatores de Risco
4.
J Surg Oncol ; 122(8): 1747-1754, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32869304

RESUMO

BACKGROUND: This study investigated the morbidity of the marginal mandibular nerve (MMN) post vascularized submental lymph node (VSLN) harvest. METHODS: The VSLN with sacrifying or preserving the medial platysma was retrospectively classified as group I or II. Midline deviation and horizontal tilt were subjectively evaluated. Horizontal, vertical, and "area distribution" of the lower lip excursions of the surgical site were objectively compared with the nonsurgical site. RESULTS: Seventeen patients in group I and 12 patients in group II were included. At a median follow-up of 48.6 ± 16.8 months in group I and 14.8 ± 7.5 months in group II, no MMN palsy was found in both groups. Median midline deviation and horizontal tilt were 4.53 ± 0.52 and 5 ± 0 in group I and 4.67 ± 0.65 and 5 ± 0 in group II, respectively (P = .419 and 1.000). Median horizontal, vertical and area of distribution of lower lip excursions were 97.5 ± 12.3%, 98.8 ± 14.4% and 87.2 ± 14.7% in group I, and 99.3 ± 15.1%, 95.8 ± 8.2% and 84.2 ± 14.2% in group II, respectively (P = .679, .948 and .711). CONCLUSION: The VSLN flap was a safe procedure with minimal MMN morbidity.


Assuntos
Linfonodos/transplante , Linfedema/cirurgia , Mandíbula/fisiopatologia , Músculo Masseter/fisiopatologia , Retalhos Cirúrgicos/transplante , Adulto , Idoso , Feminino , Seguimentos , Humanos , Linfonodos/irrigação sanguínea , Linfedema/epidemiologia , Linfedema/patologia , Masculino , Pessoa de Meia-Idade , Morbidade , Prognóstico , Estudos Retrospectivos , Retalhos Cirúrgicos/irrigação sanguínea , Taiwan/epidemiologia
5.
Plast Reconstr Surg ; 146(2): 402-407, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740596

RESUMO

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


Assuntos
Excisão de Linfonodo/efeitos adversos , Linfedema/epidemiologia , Mastectomia/efeitos adversos , Obesidade/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Axila , Índice de Massa Corporal , Neoplasias da Mama/terapia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Linfedema/diagnóstico , Linfedema/etiologia , Linfedema/terapia , Linfocintigrafia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Radioterapia Adjuvante/efeitos adversos , Medição de Risco , Fatores de Risco , Adulto Jovem
6.
J Vasc Surg Venous Lymphat Disord ; 8(4): 676-684, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32444277

RESUMO

OBJECTIVE: Lymphedema (LED) affects an estimated 35 million patients in the United States and a staggering 140,200 million people worldwide, yet LED is the forgotten vascular disease. Whereas the diagnosis and treatment of arterial and venous diseases have been strengthened by the development of clinical practice guidelines (CPGs), few CPGs are available for LED. Moreover, for CPGs to have their greatest impact, they should be both of high quality and developed using the most rigorous evidence-based methods. We performed a systematic review of the available CPGs for LED, which were assessed for breadth of content and methodologic strength. METHODS: A literature search was conducted from National Guideline Clearinghouse (www. GUIDELINES: gov), BMJ Clinical Evidence (http://clinicalevidence.bmj.com), and National Institute for Health and Care Excellence (http://www.nice.org.uk) as well as from MEDLINE and Google, which selected 245 documents. After a horizon scan that identified 13 potential CPGs, 4 satisfied the criteria for LED. These were analyzed for inclusion of key elements of diagnosis and treatment. RESULTS: A horizon scan (abstract review) of the 245 documents identified 10 potential CPGs. Of the 10 documents, 6 claimed to be CPGs, but 2 were limited in scope (rehabilitation or compression only), 2 were consensus statements, 1 was a position statement, and 1 was a systematic review. This process yielded four CPGs: Lymphedema Framework Best Practice for the Management of Lymphedema; Japanese Lymphedema Study Group-A Practice Guideline for the Management of Lymphedema; Clinical Resource Efficiency Support Team Guidelines for the Diagnosis, Assessment and Management of Lymphedema; and Guidelines of the American Venous Forum. Only one of four CPGs was based on a contemporary systematic review (2016 end date of references), whereas the remainder had older systematic reviews (end dates of 2005, 2007, and 2007). Several areas of contemporary diagnosis, treatment, and monitoring of LED were absent. CONCLUSIONS: This systematic review of available LED CPGs demonstrates a limited number of guidelines. The four CPGs identified lack contemporary references while demonstrating low overall study quality. Therefore, it is imperative for our vascular societies to develop contemporary high-quality evidence-based CPGs for LED, as they have for other vascular diseases.


Assuntos
Medicina Baseada em Evidências/normas , Linfedema/terapia , Guias de Prática Clínica como Assunto/normas , Consenso , Humanos , Linfedema/diagnóstico , Linfedema/epidemiologia , Resultado do Tratamento
7.
Plast Reconstr Surg ; 145(6): 1528-1537, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32459781

RESUMO

BACKGROUND: The subfascial compartment (deep to the deep fascia) in extremity lymphedema has not been evaluated. This study investigated the volumetric differences between the suprafascial and subfascial compartments of patients with unilateral lower extremity lymphedema. METHODS: Thirty-two female patients with unilateral lower extremity lymphedema were enrolled, with eight patients in each of Cheng lymphedema grades I to IV. The volumes of the suprafascial and subfascial compartments were calculated after manually drawing the region of interest on computed tomographic images. The volumetric differences and their ratios in the suprafascial and subfascial compartments between each patient's bilateral limbs were compared. RESULTS: The volume of the lymphedematous limbs (9647 ml) was significantly greater than the volume of unaffected limbs (6906 ml), with a median volumetric difference of 2097 ml (30.6 percent) (p < 0.01). The median suprafascial compartment volumetric difference was 1887 ml (56.6 percent) and the subfascial compartment volumetric difference was 208 ml (4.7 percent) (p < 0.01). The median volumetric difference ratio of the thigh and lower leg was 24.6 percent and 40.6 percent, respectively. The median volumetric differences in Cheng lymphedema grades I to IV were 1012, 1787, 2434, and 4107 ml, respectively, which were statistically significant among the four Cheng lymphedema grades using the Kruskal-Wallis test (p < 0.01). CONCLUSIONS: The volumetric differences in the lymphedematous limb were statistically significantly greater than in the unaffected limb, including both suprafascial and subfascial compartments. The volumetric differences are consistent with the Cheng lymphedema grading system as a reliable indicator of unilateral extremity lymphedema. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.


Assuntos
Fáscia/diagnóstico por imagem , Extremidade Inferior/diagnóstico por imagem , Linfedema/diagnóstico , Idoso , Tomografia Computadorizada de Feixe Cônico , Fáscia/patologia , Feminino , Neoplasias dos Genitais Femininos/patologia , Neoplasias dos Genitais Femininos/cirurgia , Humanos , Processamento de Imagem Assistida por Computador , Extremidade Inferior/patologia , Excisão de Linfonodo/efeitos adversos , Linfedema/epidemiologia , Linfedema/etiologia , Linfedema/patologia , Pessoa de Meia-Idade , Prevalência , Procedimentos Cirúrgicos Reconstrutivos , Índice de Gravidade de Doença
8.
J Med Vasc ; 45(2): 55-61, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32265015

RESUMO

OBJECTIVES: To assess: (1) lower limb primary lymphedema or post-thrombotic syndrome patient's pathway in terms of health care professional use and (2) if aetiology of edema has an impact on this pathway. METHODS: Ancillary survey of the transversal prospective CHROEDEM pilot study. Forty patients with either lower limb primary lymphedema or post-thrombotic syndrome were invited to participate. RESULTS: Seventy-five percent of primary lymphedema patients and 50% of post-thrombotic patients benefited from a multidisciplinary management (P=0.10) including the general practitioner, the vascular medicine physician and either a physiotherapist (particularly in case of primary lymphedema), a registered nurse (particularly in case of post-thrombotic syndrome). Main ambulatory health care professionals' correspondent of hospital-based vascular medicine physicians were general practitioners (80%) in post-thrombotic patients, and general practitioners (60%) and physiotherapists (45%) in primary lymphedema patients. Pharmacists were also involved in patient education. CONCLUSION: Management of primary lymphedema and post-thrombotic related chronic edema is usually multidisciplinary. General practitioners and vascular medicine physicians are the cornerstones of this management, that also involves the physiotherapist in case of primary lymphedema and in a lesser extent the registered nurse and the pharmacist. This suggests that these five healthcare professional should play a key role in case of development of standardized patient pathways for primary lymphedema and post-thrombotic syndrome.


Assuntos
Procedimentos Clínicos , Linfedema/terapia , Equipe de Assistência ao Paciente , Síndrome Pós-Trombótica/terapia , Adulto , Idoso , Doença Crônica , Terapia Combinada , Feminino , França/epidemiologia , Pesquisas sobre Serviços de Saúde , Humanos , Extremidade Inferior , Linfedema/diagnóstico , Linfedema/epidemiologia , Linfedema/fisiopatologia , Masculino , Pessoa de Meia-Idade , Síndrome Pós-Trombótica/diagnóstico , Síndrome Pós-Trombótica/epidemiologia , Síndrome Pós-Trombótica/fisiopatologia , Prognóstico , Fatores de Risco
9.
J Vasc Surg Venous Lymphat Disord ; 8(4): 685-692, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32335331

RESUMO

OBJECTIVE: We assessed the quality of current clinical practice guidelines (CPGs) for lymphedema using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. CPGs provide recommendations for the management of medical conditions such as lymphedema. However, their evidentiary quality and methodology should determine their reliability. The AGREE II instrument was developed to externally and objectively evaluate the quality of CPGs and has been used to assess other nonvascular CPGs. A systematic review identified four CPGs for lymphedema of varying content: Lymphedema Framework's Best Practice for the Management of Lymphedema (LED F); Japanese Lymphedema Study Group-A Practice Guideline for the Management of Lymphedema (J LED); Clinical Resource Efficiency Support Team (CREST) Guidelines for the Diagnosis, Assessment and Management of Lymphedema; and Guidelines of the American Venous Forum (AVF). The quality of these CPGs appeared to vary. METHODS: The four CPGs were analyzed using the AGREE II instrument by three independent graders, who were unaware of each other's scores. Six domains with 23 items were graded using a Likert scale (1, strongly disagree; to 7, strongly agree) regarding whether the CPG had satisfied the requirements of each item. The score for each domain was calculated by summing the scores for each item in that domain and scaling the total as a percentage of the maximum possible score for that domain (ie, obtained score - minimum score/maximum possible score - minimum possible score × 100 = percentage). RESULTS: CREST had the highest overall score (66.8%), as an average of all domains, and J LED had the lowest (37%). CREST also had five of five domains rated >50%. In contrast, J LED had only one and AVF had only two domains that scored >50%. Although two domains, rigor of development and applicability, scored low, with only one CPG scoring >50%, the editorial independence domain scored the lowest of all six domains. CONCLUSIONS: In addition to limitations in content and the lack of contemporary references, the four CPGs studied were judged objectively to be of low quality using the AGREE II instrument. A contemporary CPG for lymphedema, guided by the AGREE II requirements, is needed.


Assuntos
Medicina Baseada em Evidências/normas , Linfedema/terapia , Guias de Prática Clínica como Assunto/normas , Consenso , Humanos , Linfedema/diagnóstico , Linfedema/epidemiologia , Resultado do Tratamento
10.
Eur J Surg Oncol ; 46(7): 1334-1338, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32146054

RESUMO

INTRODUCTION: Late-onset lower limb lymphedema (LLL) is a significant clinical challenge for physicians dealing with patients that undergo treatment involving the pelvic cavity. We aimed to clarify the prevalence of and risk factors for late-onset LLL after treatment for gynecological cancer. METHODS: We conducted a multicenter retrospective study using records of cases in which LLL diagnosed by physical findings and measurement of limbs girths. Patients with LLL after treatment for uterine cervical, endometrial, and ovarian cancer were sequentially enrolled. We examined the timing of LLL onset and the associations between the time to onset and clinical characteristics, including age, type of cancer, lymphadenectomy sites, and performance of radiotherapy. We also investigated the risk factors for late-onset LLL and their effects on the cumulative incidence of late-onset LLL. RESULTS: In total, 711 patients fulfilled the required criteria. Mean age of was 50.2 years old and median follow-up period was 5.05 years. More than half of them (50.5%) presented with LLL ≥5 years after undergoing treatment for gynecological cancer. A substantial number of patients (29.4%) developed LLL ≥10 years after undergoing treatment for gynecological cancer. Being aged <50 years [(odds ratio (OR): 1.919, P = 0.001), cervical cancer (OR: 1.912, P = 0.001), and radiotherapy (OR: 1.664, P = 0.017) were identified as significant risk factors for late-onset LLL in multivariate logistic regression analysis. CONCLUSIONS: A substantial number of patients present with LLL ≥5 years after receiving treatment for gynecological malignancies. Clinicians are required to identify high-risk patients and inform them of the risk of late-onset LLL.


Assuntos
Neoplasias do Endométrio/terapia , Linfedema/epidemiologia , Neoplasias Ovarianas/terapia , Neoplasias do Colo do Útero/terapia , Adulto , Fatores Etários , Idoso , Feminino , Seguimentos , Humanos , Incidência , Extremidade Inferior , Pessoa de Meia-Idade , Radioterapia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
11.
BMC Infect Dis ; 20(1): 48, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31941448

RESUMO

BACKGROUND: Lymphedema is a public health problem in countries with lymphatic filariasis (LF) including Mali. We studied the epidemiology and clinical presentation of lymphedema in three previously LF-endemic health districts of Mali after at least five consecutive rounds of mass drug administration (MDA) with albendazole and ivermectin. METHODS: From 2016 to 2018, we used passive and active case finding methods to identify lymphedema cases in three health districts with high pre-MDA LF prevalence: Kolondieba (66%), Bougouni (44%) and Kolokani (34%). RESULTS: Three hundred and thirty nine cases of lymphedema were identified, 235 (69.32%) through active case finding. Their median age was 56 years (range 2-90) and 286 (84.36%) were women. Lymphedema was reported in 226 (78.5%) people aged 41 years and older compared to 73 (21.5%) people below the age of 41 years (Chi2 = 17.28, df = 5, p = 0.004). One hundred and seventy five cases of lymphedema were found in Kolondieba (66 per 100,000 people), 116 in Bougouni (19 per 100,000) and 48 in Kolokani (16 per 100,000). Stage III lymphedema was observed in 131 (38.64%), stage II in 108 (31.86%), stage IV in 46 (13.57%), stage I in 23 (6.78%), stage V in 21 (6.19%) and stage VI in ten (2.95%). In the three study districts, lymphedema affected the legs in 281 (82.89%), the arms in 42 (12.39%) and both in 16 (4.72%) (Chi2 = 13.63, p = 0.008). CONCLUSION: Health districts in Mali with the highest pre-MDA LF prevalences had the highest prevalence of lymphedema. Efforts to actively identify lymphedema cases should be scaled up in previous LF-endemic areas, and should be supplemented by a morbidity management and disability prevention plan at the peripheral health system level.


Assuntos
Filariose Linfática/epidemiologia , Doenças Endêmicas , Linfedema/tratamento farmacológico , Linfedema/epidemiologia , Administração Massiva de Medicamentos , Suspensão de Tratamento , Wuchereria bancrofti , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Albendazol/uso terapêutico , Animais , Criança , Pré-Escolar , Estudos Transversais , Filariose Linfática/complicações , Filariose Linfática/parasitologia , Feminino , Humanos , Ivermectina/uso terapêutico , Linfedema/etiologia , Masculino , Mali/epidemiologia , Pessoa de Meia-Idade , Morbidade , Prevalência , Saúde Pública , Adulto Jovem
12.
J Surg Oncol ; 121(1): 25-36, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31264724

RESUMO

BACKGROUND: This high volume, single center study investigated the prevalence, bacterial epidemiology, and responsiveness to antibiotic therapy of cellulitis in extremity lymphedema. METHODS: From 2003 to 2018, cellulitis events from a cohort of 420 patients with extremity lymphedema were reviewed. Demographics, lymphedema grading, symptoms, inflammatory markers, cultures and antibiotic therapy regimens were compiled from cellulitis episodes data. Univariate and multivariate analyses were performed for detailed analysis. RESULTS: A total of 131 separate episodes of cellulitis were recorded from 43 (81.1%) lower limb and 10 (19.9%) upper limb lymphedema patients. The prevalence and recurrence rates for cellulitis in lymphedema patients were 12.6% (53 of 420) and 56.6% (30 of 53), respectively. The most common findings were increased limb circumference (127 of 131; 96.9%) and abnormal C-reactive protein (CRP) level (86 of 113; 76.1%). Blood cultures were obtained in 79 (60.3%) incidents, with 9 (11.4%) returning positive. Streptococcus agalactiae was the most isolated bacterium (5 of 9; 55.5%). CONCLUSIONS: The cellulitis prevalence and recurrence rate in extremity lymphedema were 12.6%, and 56.6%, respectively. Strongest indicators of cellulitis were increased affected limb circumference and elevated CRP level. Empiric antibiotic therapy began with coverage for Steptococcus species before broadening to anti-Methicillin-resistant Staphylococcus aureus and anti-Gram negatives if needed for effective treatment of extremity lymphedema cellulitis.


Assuntos
Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/microbiologia , Celulite (Flegmão)/tratamento farmacológico , Celulite (Flegmão)/microbiologia , Linfedema/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/patologia , Celulite (Flegmão)/epidemiologia , Celulite (Flegmão)/patologia , Estudos de Coortes , Extremidades/microbiologia , Extremidades/patologia , Feminino , Humanos , Linfedema/epidemiologia , Linfedema/patologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos
13.
Gynecol Oncol ; 156(1): 147-153, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31780238

RESUMO

OBJECTIVE: To compare the prevalence of patient-reported lower-extremity lymphedema (LEL) with sentinel lymph node (SLN) mapping versus comprehensive lymph node dissection (LND) for the surgical management of newly diagnosed endometrial carcinoma. METHODS: Patients who underwent primary surgery for endometrial cancer from 01/2006-12/2012 were mailed a survey that included a validated 13-item LEL screening questionnaire in 08/2016. Patients diagnosed with LEL prior to surgery and those who answered ≤6 survey items were excluded. RESULTS: Of 1275 potential participants, 623 (49%) responded to the survey and 599 were evaluable (180 SLN, 352 LND, 67 hysterectomy alone). Median BMI was similar among cohorts (P = 0.99). External-beam radiation therapy (EBRT) was used in 10/180 (5.5%) SLN and 35/352 (10%) LND patients (P = 0.1). Self-reported LEL prevalence was 27% (49/180) and 41% (144/352), respectively (OR, 1.85; 95% CI, 1.25-2.74; P = 0.002). LEL prevalence was 51% (23/45) in patients who received EBRT and 35% (170/487) in those who did not (OR, 1.95; 95% CI, 1.06-3.6; P = 0.03). High BMI was associated with increased prevalence of LEL (OR, 1.04; 95% CI, 1.02-1.06; P = 0.001). After controlling for EBRT and BMI, LND retained independent association with an increased prevalence of LEL over SLN (OR, 1.8; 95% CI, 1.22-2.69; P = 0.003). Patients with self-reported LEL had significantly worse QOL compared to those without self-reported LEL. CONCLUSIONS: This is the first study to assess patient-reported LEL after SLN mapping for endometrial cancer. SLN mapping was independently associated with a significantly lower prevalence of patient-reported LEL. High BMI and adjuvant EBRT were associated with an increased prevalence of patient-reported LEL.


Assuntos
Neoplasias do Endométrio/cirurgia , Excisão de Linfonodo/estatística & dados numéricos , Linfedema/epidemiologia , Biópsia de Linfonodo Sentinela/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Endométrio/epidemiologia , Feminino , Humanos , Perna (Membro)/patologia , Excisão de Linfonodo/efeitos adversos , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática , Linfedema/etiologia , Linfedema/patologia , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Prevalência , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia , Biópsia de Linfonodo Sentinela/efeitos adversos , Inquéritos e Questionários
14.
Gynecol Oncol ; 156(2): 467-474, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31837831

RESUMO

OBJECTIVES: To evaluate the incidence and risk factors for lymphedema associated with surgery for gynecologic malignancies on GOG study 244. METHODS: Women undergoing a lymph node dissection for endometrial, cervical, or vulvar cancer were eligible for enrollment. Leg volume was calculated from measurements at 10-cm intervals starting 10 cm above the bottom of the heel to the inguinal crease. Measurements were obtained preoperatively and postoperatively at 4-6 weeks, and at 3-, 6-, 9-, 12-, 18-, and 24- months. Lymphedema was defined as a limb volume change (LVC) ≥10% from baseline and categorized as mild: 10-19% LVC; moderate: 20-40% LVC; or severe: >40% LVC. Risk factors associated with lymphedema were also analyzed. RESULTS: Of 1054 women enrolled on study, 140 were inevaluable due to inadequate measurements or eligibility criteria. This left 734 endometrial, 138 cervical, and 42 vulvar patients evaluable for LVC assessment. Median age was 61 years (range, 28-91) in the endometrial, 44 years (range, 25-83) in the cervical, and 58 years (range, 35-88) in the vulvar group. The incidence of LVC ≥10% was 34% (n = 247), 35% (n = 48), and 43% (n = 18), respectively. The peak incidence of lymphedema was at the 4-6 week assessment. Logistic regression analysis showed a decreased risk with advanced age (p = 0.0467). An exploratory analysis in the endometrial cohort showed an increased risk with a node count >8 (p = 0.033). CONCLUSIONS: For a gynecologic cancer, LVC decreased with age greater than 65, but increased with a lymph node count greater than 8 in the endometrial cohort. There was no association with radiation or other risk factors.


Assuntos
Neoplasias dos Genitais Femininos/cirurgia , Linfedema/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Neoplasias dos Genitais Femininos/diagnóstico , Neoplasias dos Genitais Femininos/epidemiologia , Humanos , Incidência , Perna (Membro)/patologia , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/estatística & dados numéricos , Linfedema/etiologia , Linfedema/patologia , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Regressão , Fatores de Risco
15.
Lymphology ; 52(3): 126-133, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31874124

RESUMO

One common adverse effect following breast-conservation surgery and adjuvant radiation is lymphedema. While lymphedema of the arm has been well-characterized, there has been less investigation into lymphedema of the breast. We sought to characterize rates of breast lymphedema (BLE) in women with early-stage breast cancer and identify potential predictors in its development. Two hundred and thirty consecutive patients treated with lumpectomy and adjuvant whole breast radiation therapy (WBRT) from January 2016 - June 2017 were included. All patients were seen in our lymphedema monitoring clinic for baseline and at least one follow-up lymphedema measurement. BLE grades were assigned by trained nurses in the lymphedema clinic. Data regarding patient demographic and treatment factors were extracted from the electronic medical record. Comparisons between groups were made using Chi-Square analysis performed in SAS. The median age of the sample was 62 (range 31-90). Median follow-up from surgery was 15.3 months. Forty-three patients were diagnosed with lymphedema of the breast (18.7%). Rates of grade 1 and 2 BLE were 93% and 7%, respectively; there were no cases of severe lymphedema. Sixty-three percent of cases resolved by last follow-up with treatment recommendations. There was no association between development of BLE and patient factors investigated, including age, T stage, radiation dose and fractionation, lymph node biopsy, number of lymph nodes removed, development of arm lymphedema, and use of chemotherapy. Tumor subtype was found to be significant (P = 0.04) and there was a trend towards significance for receipt of trastuzumab (P = 0.09). BLE is a distinct entity from arm lymphedema and is a common finding in women treated with breast-conserving surgery and adjuvant WBRT. It is a generally mild and self-limiting process. There were no treatment or patient-related factors that correlated with increased risk of lymphedema development in our sample except for HER-2 positive disease and receipt of trastuzamab.


Assuntos
Neoplasias da Mama/complicações , Neoplasias da Mama/epidemiologia , Linfedema/epidemiologia , Linfedema/etiologia , Glândulas Mamárias Humanas/patologia , Mastectomia Segmentar/efeitos adversos , Radioterapia Adjuvante/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Feminino , Humanos , Incidência , Linfedema/diagnóstico , Mastectomia Segmentar/métodos , Pessoa de Meia-Idade , Prevalência , Prognóstico , Radioterapia Adjuvante/métodos , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
16.
Gynecol Oncol ; 155(3): 452-460, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31679787

RESUMO

OBJECTIVE: To explore whether patient-reported lymphedema-related symptoms, as measured by the Gynecologic Cancer Lymphedema Questionnaire (GCLQ), are associated with a patient-reported diagnosis of lymphedema of the lower extremity (LLE) and limb volume change (LVC) in patients who have undergone radical surgery, including lymphadenectomy, for endometrial, cervical, or vulvar cancer on Gynecologic Oncology Group (GOG) study 244. METHODS: Patients completed the baseline and at least one post-surgery GCLQ and LVC assessment. The 20-item GCLQ measures seven symptom clusters-aching, heaviness, infection-related, numbness, physical functioning, general swelling, and limb swelling. LLE was defined as a patient self-reported LLE diagnosis on the GCLQ. LVC was measured by volume calculations based on circumferential measurements. A linear mixed model was fitted for change in symptom cluster scores and GCLQ total score and adjusted for disease sites and assessment time. RESULTS: Of 987 eligible patients, 894 were evaluable (endometrial, 719; cervical, 136; vulvar, 39). Of these, 14% reported an LLE diagnosis (endometrial, 11%; cervical, 18%; vulvar, 38%). Significantly more patients diagnosed versus not diagnosed with LLE reported ≥4-point increase from baseline on the GCLQ total score (p < 0.001). Changes from baseline were significantly larger on all GCLQ symptom cluster scores in patients with LLE compared to those without LLE. An LVC increment of >10% was significantly associated with reported general swelling (p < 0.001), heaviness (p = 0.005), infection-related symptoms (p = 0.002), and physical function (p = 0.006). CONCLUSIONS: Patient-reported symptoms, as measured by the GCLQ, discerned those with and without a patient-reported LLE diagnosis and demonstrated predictive value. The GCLQ combined with LVC may enhance our ability to identify LLE.


Assuntos
Neoplasias dos Genitais Femininos/epidemiologia , Linfedema/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Neoplasias dos Genitais Femininos/patologia , Neoplasias dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Humanos , Perna (Membro)/patologia , Linfedema/etiologia , Linfedema/patologia , Pessoa de Meia-Idade , Autorrelato , Inquéritos e Questionários
17.
Actas dermo-sifiliogr. (Ed. impr.) ; 110(6): 482-489, jul.-ago. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185276

RESUMO

Antecedentes y objetivo: La biopsia selectiva de ganglio centinela (BSGC) no tiene utilidad terapéutica y solo se utiliza por su valor pronóstico. Su beneficio ha sido menor del esperado, por lo que los riesgos cobran más valor y no están claramente definidos. Nos hemos propuesto describir las complicaciones y secuelas sufridas por pacientes con melanoma expuestos a la técnica de BSGC en la práctica clínica habitual. Pacientes y métodos: En este estudio de cohortes retrospectivo unicéntrico hemos recogido los datos de todos los pacientes diagnosticados de melanoma y sometidos a la BSGC en nuestro centro (Vigo) entre enero de 2011 y julio de 2017, revisando sus historias clínicas. Resultados: Se realizaron 124 BSGC. El tiempo de seguimiento medio fue de 52,7 meses (rango 10,8-88,7 meses). El 37,9% de los pacientes presentaron complicaciones. Excluyendo a aquellos en los que se realizó linfadenectomía, el porcentaje de complicaciones fue del 30,9%. De las complicaciones totales, 14 (11,3%) fueron alteraciones en la cicatrización, 13 (10,5%) infecciones de la herida quirúrgica, 12 (9,7%) linfedemas, 11 (8,9%) seromas, 4 (3,2%) hematomas, 4 (3,2%) heridas dehiscentes, 2 (1,6%) linforragias, 2 (1,6%) alteraciones sensitivas y una (0,8%) infección del tracto urinario. El 15,3% de los pacientes presentaron secuelas, siendo el linfedema la más frecuente. Entre los pacientes sin linfadenectomía completa presentaron secuelas el 7,5%. El tabaquismo se asoció con un aumento en el porcentaje de complicaciones de un 33 a un 73%. La principal limitación de este estudio es que pueda haber un sesgo de información que infravalore los resultados por un seguimiento incompleto de los pacientes. Conclusiones: La BSGC es una técnica de estadificación del melanoma no exenta de complicaciones y secuelas. La recomendación de su uso rutinario en las guías de práctica clínica debería revisarse, sopesando los riesgos y los beneficios en cada caso. En especial tienen un alto riesgo de presentar complicaciones los pacientes fumadores. El desarrollo de otras herramientas de estadificación menos invasivas puede ser de gran utilidad para los pacientes con melanoma


Background and objective: Sentinel lymph node (SLN) biopsy is a staging, not a therapeutic, procedure. The benefits of SLN biopsy have been more modest than expected and could be outweighed by the risks, which remain unclear. The aim of this study was to describe complications and sequelae observed in patients with melanoma who underwent routine SLN biopsy at our hospital. Patients and methods: In this retrospective cohort study, we performed a chart review of all patients with melanoma who underwent SLN biopsy at our hospital in Vigo, Spain, between January 2011 and July 2017. Results: In the period analyzed, 124 SLN biopsies were performed. Over a mean follow-up of 52.7 months (range 10.8-88.7 months). A percentage of 37.9 of the patients experienced complications. The complication rate after excluding patients who underwent lymph node dissection was 30.9%. In the full chort group, there were 14 scar-related complications (11.3%), 13 surgical wound infections (10.5%), 12 lymphedemas (9.7%), 11 seromas (8.9%), 4 hematomas (3.2%), 4 wound dehiscences (3.2%), 2 cases of lymphorrhagia (1.6%), 2 cases of sensitivity alteration (1.6%), and one urinary tract infection (0.8%). The most common sequela was lymphedema. Sequelae were on record for 15.3% of patients in the full cohort (7.5% of the patients who did not undergo lymphadenectomy). Smoking was associated with a 33 to 73% increased risk of complications. The main limitation of this study is the risk of information bias due to incomplete follow-up. Conclusions: SLN biopsy is a melanoma staging procedure that causes complications and sequelae. Recommendations for its use in clinical practice guidelines should be revised and the risks and benefits carefully evaluated in each case. Smokers in particular seem to have a high risk of complications. Patients with melanoma could benefit greatly from the development of less invasive staging tools


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Metástase Linfática/patologia , Melanoma/secundário , Biópsia de Linfonodo Sentinela/efeitos adversos , Cicatriz/epidemiologia , Linfedema/etiologia , Hemorragia/epidemiologia , Cicatriz/etiologia , Seguimentos , Hemorragia/etiologia , Excisão de Linfonodo , Linfedema/epidemiologia , Melanoma/patologia , Estadiamento de Neoplasias , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela/métodos , Deiscência da Ferida Operatória
18.
PLoS Negl Trop Dis ; 13(7): e0007542, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31306409

RESUMO

BACKGROUND: The Bangladesh Lymphatic Filariasis (LF) Elimination Programme has made significant progress in interrupting transmission through mass drug administration (MDA) and has now focussed its efforts on scaling up managing morbidity and preventing disability (MMDP) activities to deliver the minimum package of care to people affected by LF clinical conditions. This paper highlights the Bangladesh LF Programme's success in conducting a large-scale cross-sectional survey to determine the number of people affected by lymphoedema and hydrocoele, which enabled clinical risk maps to be developed for targeted interventions across the 34 endemic districts (19 high endemic; 15 low endemic). METHODOLOGY/PRINCIPAL FINDINGS: In the 19 high endemic districts, 8,145 community clinic staff were trained to identify and report patients in their catchment area. In the 15 low endemic districts, a team of 10 trained field assistants conducted active case finding with cases reported via a SMS mHealth tool. Disease burden and prevalence maps were developed, with morbidity hotspots identified at sub-district level based on a combination of the highest prevalence rates per 100,000 and case-density rates per square kilometre (km2). The relationship between morbidity and baseline microfilaria (mf) prevalence was also examined. In total 43,678 cases were identified in the 19 high endemic districts; 30,616 limb lymphoedema (70.1%; female 55.3%), 12,824 hydrocoele (29.4%), and 238 breast/female genital swelling (0.5%). Rangpur Division reported the highest cases numbers and prevalence of lymphoedema (26,781 cases, 195 per 100,000) and hydrocoele (11661 cases, 169.6 per 100,000), with lymphoedema predominately affecting females (n = 21,652). Rangpur and Lalmonirhat Districts reported the highest case numbers (n = 11,199), and prevalence (569 per 100,000) respectively, with five overlapping lymphoedema and hydrocoele sub-district hotspots. In the 15 low endemic districts, 732 cases were identified; 661 lymphoedema (90.2%; female 39.6%), 56 hydrocoele (7.8%), and 15 both conditions (2.0%). Spearman's correlation analysis found morbidity and mf prevalence significantly positively correlated (r = 0.904; p<0.01). CONCLUSIONS/SIGNIFICANCE: The Bangladesh LF Programme has developed one of the largest, most comprehensive country databases on LF clinical conditions in the world. It provides an essential database for health workers to identify local morbidity hotspots, deliver the minimum package of care, and address the dossier elimination requirements.


Assuntos
Sistemas de Gerenciamento de Base de Dados , Filariose Linfática/epidemiologia , Filariose Linfática/prevenção & controle , Filariose Linfática/terapia , Objetivos , Animais , Bangladesh/epidemiologia , Controle de Doenças Transmissíveis , Estudos Transversais , Análise de Dados , Gerenciamento de Dados , Doenças Endêmicas , Feminino , Pessoal de Saúde/educação , Humanos , Linfedema/epidemiologia , Masculino , Administração Massiva de Medicamentos , Microfilárias , Morbidade , Prevalência , Telemedicina/métodos , Hidrocele Testicular/epidemiologia
20.
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
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