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1.
Medicine (Baltimore) ; 99(11): e19183, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176044

RESUMO

To investigate the effect of evidence-based nursing (EBN) intervention on upper limb function in postoperative breast cancer patients undergoing radiotherapy.A total of 126 breast cancer patients who had received postoperative radiotherapy in the Union Hospital affiliated with Tongji Medical College, Huazhong University of Science and Technology from September 2017 to September 2018 were randomly divided into 2 groups, namely, experimental and control groups, with 63 cases in each group. Both the control and experimental groups received routine postoperative radiotherapy followed by traditional and EBN interventions, respectively. All patients were followed up for 6 months and differences in the upper limb function after nursing intervention were compared between the 2 groups.The scores of self-rating anxiety scale (SAS), self-rating depression scale (SDS), and short form-36 survey (SF-36) in the 2 groups had no statistical significance before intervention. After the EBN intervention, the SAS and self-rating depression scale scores of patients in the experimental group were lower than that of those in the control group. In the experimental group, 90.67% of the patients had an excellent score for the University of California, Los Angeles shoulder score, which was higher than that of the control group (73.92%). The Mayo Elbow Performance Score of the experimental group (95.01) was higher than that of the control group (91.33). The total length of the sum of arm circumference in the experimental group was (128.39 cm) lower than that of the control group (143.66 cm). The scores of SF-36 in the overall health, physical pain, mental health, and physiological functions of the patients in the experimental group were higher than those of the control group. All of these parameters' differences between the 2 groups were of statistical significance (P < .05).EBN can positively influence the negative emotional state of breast cancer patients after radiotherapy. At the same time, it is helpful in reducing the degree of lymph node edema on the affected side of the upper limb, thereby improving the function of the shoulder joint, which has a positive effect on the upper limb function.


Assuntos
Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Enfermagem Baseada em Evidências/métodos , Linfedema/enfermagem , Extremidade Superior/fisiopatologia , Adulto , Idoso , Neoplasias da Mama/patologia , China , Feminino , Humanos , Linfedema/etiologia , Mastectomia/efeitos adversos , Mastectomia/métodos , Pessoa de Meia-Idade , Medição da Dor , Prognóstico , Radioterapia Adjuvante , Valores de Referência , Índice de Gravidade de Doença , Resultado do Tratamento
2.
Hautarzt ; 71(1): 32-38, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31912161

RESUMO

Local edema is a common symptom in many skin diseases, especially in inflammatory or allergic reactions. Diseases of the lymphatic system can also lead to edema with specific changes in the skin. Lymphedema is the result of primary genetic changes, which can also occur in the context of syndromes and can be traced to abnormal development of the lymphatic system. Secondary lymphedema usually develops after surgery, inflammatory reactions or chronic venous insufficiency (CVI). The microfiltrate that is transported in the tissue in healthy individuals via the lymphatic system is rich in proteins and induces fibrosis of the epidermis and dermis. In addition to edema, clinical signs include pachydermia, papillomatosis cutis lymphostatica, hyperkeratosis, lymph cysts, lymph fistulas, nail dystrophies and yellow nails. Basic therapy comprises complex decongestive therapy (CDT: manual lymph drainage, compression, physical exercise/sports, skin care and instructions regarding self-management). Intermittent compression can also be applied. Comorbidities such as obesity and diabetes mellitus may aggravate the situation and must be treated. Adequate therapy can reduce sequelae of the skin.


Assuntos
Linfedema , Drenagem , Edema , Humanos , Linfedema/etiologia , Linfedema/terapia , Massagem , Higiene da Pele
3.
J Surg Oncol ; 121(1): 109-120, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31385308

RESUMO

Secondary lymphedema is associated with impaired lymph fluid drainage and remains incurable. Alternatively, cell-based therapy may pave the way for lymphedema treatment. We found 11 animal and seven human studies had been conducted from 2008 to 2018. Most studies showed great potential for this treatment modality. Emerging studies have focused on novel techniques, such as coupling cell therapy with lymph node transfer, or adding growth factors to cell therapy.


Assuntos
Terapia Baseada em Transplante de Células e Tecidos/métodos , Linfedema/terapia , Animais , Modelos Animais de Doenças , Humanos , Linfedema/etiologia
4.
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
5.
J Surg Oncol ; 121(3): 422-434, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31875981

RESUMO

BACKGROUND: This study was to investigate the lymphoscintigraphy findings for the diagnosis and severity in unilateral gynecological cancer-related lymphedema (GCRL) and to correlate lymphoscintigraphy stages with the clinical findings. METHODS: Patients with unilateral GCRL who underwent lymphoscintigraphy were staged using the presence of ileo-inguinal lymph nodes, distal-lymphatic ducts, and dermal backflow findings. Taiwan Lymphoscintigraphy Staging (TLS) was divided into three patterns and seven stages: normal drainage (L-0); partial obstruction (P-1, P-2, and P-3); and total obstruction (T4, T-5, and T-6). Correlations between clinical lymphedema severity and TLS were evaluated using analysis of variance and multivariable linear regression analyses. RESULTS: A total of 141 patients with unilateral GCRL were divided as follows: 6 (4.3%) in normal drainage, 56 (39.7%) in partial-obstruction, and 79 (56%) in total obstruction. Cellulitis episodes, circumferential difference, and computed tomography (CT) volumetric difference were shown to be statistically different between TLS stages (P < .001 for all). Total obstruction stages were the most significant factors associated with the severity of circumferential difference (ß = 19.72, 25.54, 32.42, respectively; P < .05) and CT volumetric difference (ß = 36.04, 45.12, 52.78, respectively; P < .01). CONCLUSIONS: Total lymphatic obstruction was present in 56% of unilateral GCGL. Lymphoscintigraphy stages were statistically correlated with episodes of cellulitis, circumferential difference and CT volumetric difference in unilateral GCRL.


Assuntos
Neoplasias dos Genitais Femininos/diagnóstico por imagem , Sistema Linfático/diagnóstico por imagem , Linfedema/diagnóstico por imagem , Linfocintigrafia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Neoplasias dos Genitais Femininos/complicações , Humanos , Linfedema/etiologia , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
6.
J Surg Oncol ; 121(5): 766-776, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31879978

RESUMO

This systematic review with meta-analysis addressed late locoregional complications associated with adjuvant radiotherapy (RT) in breast cancer. Among 2120 titles, ten comparative studies in patients undergoing surgery vs surgery and radiotherapy reporting complications were evaluated. RT was associated with an increased risk of capsular contracture and decreased the mobility of the upper limb. A borderline association of lymphedema risk using RT was noted in the random-effects model but was significant in the fixed-effects model.


Assuntos
Neoplasias da Mama/terapia , Contratura/etiologia , Linfedema/etiologia , Radioterapia Adjuvante/efeitos adversos , Feminino , Humanos , Mastectomia
7.
Plast Reconstr Surg ; 144(5): 1197-1201, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31688768

RESUMO

Lymphedema arises from impaired lymphatic function. Quantification of lymphatic contractility has previously been shown using a custom-built near-infrared imaging system. However, to broaden the clinical use of functional lymphatic measurements, these measurements need to be performed using a standard-of-care, clinically available camera. The authors propose an objective, algorithmic, and clinically accessible approach to quantify lymphatic contractility using a 3-minute indocyanine green lymphangiograph recorded with a commercially available near-infrared camera. A retrospective review of the authors' indocyanine green lymphangiography video repository maintained in a Research Electronic Data Capture database was performed. All patients with a newly diagnosed unilateral breast cancer undergoing preoperative indocyanine green lymphangiography were included in the analysis. Patient medical records were then analyzed for patient demographics, and videos were analyzed for contractility. Seventeen consecutive patients with unilateral breast cancers underwent video processing to quantify lymphatic contractility of the ipsilateral extremity in contractions per minute. All patients were women, with an average age of 60.5 years (range, 38 to 84 years). The average lymphatic contractility rate was 1.13 contractions per minute (range, 0.67 to 2.5 contractions per minute). Using a clinically accessible standard-of-care device for indocyanine green lymphangiography, the authors were able to determine lymphatic contractility rates of a normal extremity. The authors' finding falls within the range of previously published data quantifying lymphatic contractility using a research device, suggesting that the authors' technique provides a clinically accessible, time-effective means of assessing lymphatic contractility. Potential future applications include both lymphedema surveillance and evaluation of nonsurgical and surgical interventions. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Diagnostic, IV.


Assuntos
Braço/fisiopatologia , Verde de Indocianina , Linfedema/diagnóstico por imagem , Linfografia/métodos , Mastectomia/efeitos adversos , Adulto , Idoso , Algoritmos , Neoplasias da Mama/cirurgia , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Vasos Linfáticos/diagnóstico por imagem , Linfedema/etiologia , Mastectomia/métodos , Pessoa de Meia-Idade , Contração Muscular/fisiologia , Prognóstico , Estudos Retrospectivos , Gravação em Vídeo
8.
J Hand Surg Asian Pac Vol ; 24(4): 452-455, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690206

RESUMO

Background: The purpose of this study was to develop a reproducible upper limb swelling model and quantify the efficacy of changing elevation posture in swelling reduction using this model. Methods: A manual sphygmomanometer was applied to healthy volunteers' upper arms while in a dependent position for 25 minutes to create venous congestion and swelling. Seven different levels of pressure (250, 120, 100, 80, 50, 40 and 30 mmHg) were tested. Every 5 minutes, the level of swelling was measured using the volumetric method. Any complications were recorded. We then compared the swelling reduction potential among 3 limb postures (arm on head, elevation brace, and simple sling). The significance level was set at p < .05. Results: Thirty to forty milliliters of swelling was created for all pressure levels except the 250 and 30 mmHg. All complications including transient nerve palsy, pain and petechiae were severe at 250 and 120 mmHg, less severe at 100 mmHg, mild at 80 mmHg, and absent below 40 mmHg. Both the on head and elevated brace limb postures markedly and significantly decreased swelling greater than the simple sling posture. Conclusions: We found that 20 ml or greater swelling can be reliably created with a blood pressure cuff inflated to 40 mmHg on the upper limb. The on head and elevated brace postures demonstrated a greater degree of swelling reduction than the simple sling posture.


Assuntos
Linfedema/etiologia , Esfigmomanômetros , Extremidade Superior , Adulto , Axila , Neoplasias da Mama/secundário , Neoplasias da Mama/cirurgia , Feminino , Voluntários Saudáveis , Humanos , Excisão de Linfonodo/efeitos adversos , Metástase Linfática , Projetos Piloto , Pressão
9.
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
10.
BMJ Support Palliat Care ; 9(4): 389-396, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31582383

RESUMO

OBJECTIVES: To consider the type and cost of clinical services delivered for patients with lymphoedema. DESIGN: Clinical cohort. SETTING: Independent hospices in the North East of England. PARTICIPANTS: All those attending lymphoedema services delivered by the independent hospice sector 2017/2018. RESULTS: 13 914 lymphoedema appointments were recorded across four independent hospices. Twelve thousand nine hundred and sixty-five were attended, which equates to an approximate cost of £1.56 million. Those with lymphoedema were predominately aged over 65 (54.5%) years with females across all age groups being more predominant (3.3:1). Where the cause was recorded, 66% of activity related to lymphoedema was not secondary to cancer. CONCLUSION: Independent hospices are providing a specialist lymphoedema service, which is high in volume and largely invisible. This service is delivered at not insignificant cost. In contrast to previous work, in the North East of England, lymphoedema sufferers are more likely to be female and not have the condition in association with cancer. The availability of rigorous data collection will allow the independent hospices to understand better the delivery and associated costs of lymphoedema services.


Assuntos
Gerenciamento Clínico , Hospitais para Doentes Terminais/organização & administração , Linfedema/terapia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos de Coortes , Inglaterra/epidemiologia , Grupos Étnicos , Feminino , Cuidados Paliativos na Terminalidade da Vida , Hospitais para Doentes Terminais/economia , Humanos , Lactente , Linfedema/economia , Linfedema/etiologia , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Adulto Jovem
11.
Arch Esp Urol ; 72(8): 851-856, 2019 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-31579044

RESUMO

OBJECTIVES: To describe the available techniques to prevent and treat complications related with surgery involving lymphatic nodes and drainage: lymphorrea, lymphocele and lymphedema. METHODS: Bibliographic review and personal experience communication of different image-assisted techniques in the prevention and management of lymphatic related complications. RESULTS: We describe the conventional lymphography with ethiodized oil contrast (lipiodol) by lymphatic catheterization and intranodal percutaneous puncture used in diagnostics and interventional radiology; the gammagraphic lymphography with radioactive isotopes for diagnostic use; and the utilization of colorants/dyes (patent blue, V-blue, methylene blue, indocyanine green) for diagnostic and therapeutic procedures. CONCLUSIONS: Lipiodol lymphography offers well-defined radiologic images and it is useful in interventional radiology procedures. It has the inconvenience of lymphatics catheterization and is not available for surgical dynamic identification of lymphatics. Isotopic techniques are used for diagnostics and sentinel-node procedures. Colorants and dyes have several advantages: no need for catheterization, not expensive technology, price, availability, easy management. It allows the dynamic identification of lymphatics for surgical resolution of lymph-related complications.


Assuntos
Excisão de Linfonodo , Linfedema , Linfocele , Humanos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Linfonodos , Linfedema/etiologia , Linfedema/prevenção & controle , Linfocele/etiologia , Linfocele/prevenção & controle , Linfografia , Biópsia de Linfonodo Sentinela
12.
Eur J Oncol Nurs ; 42: 103-109, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31479846

RESUMO

PURPOSE: This pilot study aimed to evaluate the effect of an 8-weeks-yoga intervention on quality of life and upper extremity edema volume in women with breast cancer related lymphedema. METHODS: This was a controlled trial with pre-post design. A total of 40 women with breast cancer related lymphedema were randomly assigned into an intervention or control groups. The intervention group participated in a yoga exercise class for 8 weeks, in a twice a week instructor-led practice and once a week home practice. Outcomes were EORTC QLQ_C30 to measure quality of life, and water displacement volume-meter to measure upper extremity edema volume. The outcomes were evaluated at baseline, 4th and 8th week. Data were analyzed using SPSS. RESULTS: Four weeks after the intervention, a significant difference was observed between the groups with respect to role functioning of quality of life (P = 0.03). Eight weeks after the intervention, a significant difference was observed between groups concerning physical and emotional functioning of quality of life (P < 0.05). The changing trend in physical, role, emotional, and cognitive functioning had increased, and in some scales such as fatigue, pain, insomnia, and financial difficulties the scores were reduced in the intervention group. Regarding edema volume, no significant difference was found between both groups on the 4th and 8th week after the intervention (P > 0.05). CONCLUSION: As yoga exercise might improve physical, role, and emotional functioning of quality of life as well as reduce fatigue, pain, and insomnia, using this intervention can be suggested amongst women with breast cancer related lymphedema.


Assuntos
Neoplasias da Mama/psicologia , Neoplasias da Mama/terapia , Linfedema/terapia , Qualidade de Vida , Extremidade Superior , Ioga , Adulto , Neoplasias da Mama/patologia , Fadiga/diagnóstico , Fadiga/etiologia , Fadiga/prevenção & controle , Feminino , Humanos , Linfedema/etiologia , Linfedema/patologia , Pessoa de Meia-Idade , Projetos Piloto , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/etiologia , Distúrbios do Início e da Manutenção do Sono/prevenção & controle
13.
Clin Rehabil ; 33(12): 1887-1897, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31495192

RESUMO

OBJECTIVE: To determine the effectiveness of Kinesio taping compared to compression garments during maintenance phase of complex decongestive therapy for breast cancer-related lymphedema. DESIGN: Randomized, cross-over, controlled trial. SETTING: Outpatient tertiary-level hospital rehabilitation setting. SUBJECTS: Randomized sample of 30 women with breast cancer-related lymphedema. INTERVENTIONS: Participants received two interventions, Kinesio taping and compression garment, both lasting four weeks, whose order was randomized by blocks. A four-week washout period was established prior to the interventions and between them. MEASUREMENTS: The main outcome was the lymphedema Relative Volume Change. Secondary outcomes were range of motion of arm joints, self-perception of comfort, and lymphedema-related symptoms (pain, tightness, heaviness, and hardness). RESULTS: The decrease in the Relative Volume Change was greater in the Kinesio taping intervention (-5.7%, SD = 2.0) compared to that observed using compression garments (-3.4%, SD = 2.9) (P < 0.001). The range of motion of five upper-limb movements increased after applying taping (between 5.8° and 16.7°) (P < 0.05), but not after compression (P > 0.05). In addition, taping was perceived as more comfortable by patients (between 2.4 and 3 points better than compression in four questions with a 5-point scale (P < 0.001)) and further reduced lymphedema-related symptoms compared to compression (between 0.96 and 1.40 points better in four questions with a 6-point scale (P < 0.05)). CONCLUSION: Kinesio taping was more effective than compression garments for reducing the lymphedema volume, with less severe lymphedema-related symptoms, better improvement of upper-limb mobility, and more comfort.


Assuntos
Fita Atlética , Neoplasias da Mama/complicações , Bandagens Compressivas , Linfedema/terapia , Extremidade Superior , Idoso , Vestuário , Estudos Cross-Over , Feminino , Humanos , Linfedema/etiologia , Pessoa de Meia-Idade , Amplitude de Movimento Articular
14.
Zhonghua Wai Ke Za Zhi ; 57(9): 713-716, 2019 Sep 01.
Artigo em Chinês | MEDLINE | ID: mdl-31474063

RESUMO

In the surgical treatment of breast cancer, "de-escalating" is becoming more popular, especially in the treatment of axilla. Axillary sentinel lymph node biopsy has become a routine treatment for axillary-negative breast cancer patients because it can effectively reduce the occurrence of upper limb lymphedema, so that some patients with sentinel lymph node negative can be exempted from axillary lymph node dissection. However, in recent years, several international clinical studies, such as AMAROS trial, explored the use of radiotherapy instead of dissection when 1 to 2 sentinel lymph nodes were positive. The results showed that radiotherapy can reduce the incidence of upper limb edema by nearly 50% compared with dissection. How to interpret the results of such non-inferiority studies, and how to treat the impact of axillary dissection and axillary radiotherapy on the occurrence of lymphedema? Based on the review of literature in recent 10 years, the incidence and hazard ratio of edema related to the two axillary treatments were compared. The conclusion is the hazard ratios are close to each other, around 3 for both arms. The results of clinical studies such as radiotherapy instead of axillary dissection need to be carefully interpreted. At the same time, axillary dissection is still suitable for some patients at current stage, and the corresponding prevention of upper limb lymphedema still needs attention.


Assuntos
Axila , Neoplasias da Mama/patologia , Excisão de Linfonodo/efeitos adversos , Linfedema/prevenção & controle , Radioterapia/efeitos adversos , Axila/patologia , Axila/efeitos da radiação , Axila/cirurgia , Humanos , Linfonodos/patologia , Linfonodos/efeitos da radiação , Linfonodos/cirurgia , Metástase Linfática/patologia , Linfedema/etiologia , Biópsia de Linfonodo Sentinela/efeitos adversos , Extremidade Superior/patologia , Extremidade Superior/efeitos da radiação , Extremidade Superior/cirurgia
15.
Surgery ; 166(4): 686-690, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31474490

RESUMO

BACKGROUND: Certain treatments increase lymphedema risk in breast cancer survivors. The purpose of this study was to determine whether quality of life improved with preoperative teaching by a lymphedema expert. METHODS: Preoperative breast cancer patients were prospectively randomized into intervention group 1 or control group 2. Group 1 had a discussion with the lymphedema expert and at 6 months, in addition to the preoperative surgical discussion and literature given to all. Arm measurements and quality of life evaluation with Functional Assessment of Cancer Therapy-Breast Cancer were completed preoperatively and at intervals for up to 3 years. Lymphedema was verified with a 10% increase in volume or circumference. Univariate and multivariate analysis were performed on data. RESULTS: There were 119 evaluable patients with no differences between groups 1 and 2. The rate of acute lymphedema was 51.5% (33 of 64) for group 1 and 47.2% (26 of 55) for group 2. Chronic lymphedema presented in 13 patients (9.3% group 1 and 12.7% group 2). Lymphedema was significantly associated with number of lymph nodes resected (P < .001). Significant findings in the Functional Assessment of Cancer Therapy-Breast Cancer were at 6 months for all and after diagnosis in lymphedema positive patients. CONCLUSION: Structured lymphedema teaching can help to improve quality of life in lymphedema patients.


Assuntos
Neoplasias da Mama/cirurgia , Sobreviventes de Câncer/psicologia , Excisão de Linfonodo/efeitos adversos , Linfedema/terapia , Mastectomia/efeitos adversos , Educação de Pacientes como Assunto/métodos , Adulto , Idoso , Neoplasias da Mama/patologia , Doença Crônica , Feminino , Seguimentos , Humanos , Excisão de Linfonodo/métodos , Linfedema/etiologia , Linfedema/fisiopatologia , Linfedema/psicologia , Mastectomia/métodos , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Resultado do Tratamento
16.
Int J Radiat Oncol Biol Phys ; 105(4): 852-860, 2019 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-31394167

RESUMO

PURPOSE: Postoperative radiation therapy (RT) delivered to lymphatics is associated with an increased risk of developing lymphedema. Reported effects of RT on lymphatic vessels have varied, however, possibly because of the use of different animal models with varying surgery and radiation schedules and the inability to directly and longitudinally image lymphatics in vivo. Here we report, using noninvasive imaging, changes in lymphatic remodeling and function in response to surgery and RT in a mouse model. METHODS AND MATERIALS: Popliteal lymphadenectomy in mice preceded single-dose gamma irradiation of the lower extremity at a single dose of 0, 20, or 40 Gy. The right hind limb of intact mice was also radiated with 4 fractions (4 × 5 Gy). Near-infrared fluorescence lymphatic imaging with indocyanine green was performed over 6 months to monitor lymphatic vessel remodeling. RESULTS: Postoperative mice treated with 20 Gy showed transient changes in lymphatic drainage, exacerbated vessel remodeling including qualitative vessel dilation and abnormal indocyanine green pooling from week 1 to 2, and initiation of restoration of lymphatic vessels, although dermal backflow was occasionally observed. Mice treated with 40 Gy showed steadily increasing lymphatic impairment until week 3 and extravasation of dye and dermal backflow in weeks 4 to 25. The ankles of mice treated with 40 Gy were significantly swollen from weeks 2 to 4 as compared with mice treated with 0 Gy or 20 Gy. Mice that received fractionated RT exhibited lymphatic vessel remodeling similar to remodeling that occurred when a single 20 Gy dose was given; however, dermal backflow did not resolve as it did in the case of a single 20 Gy dose. CONCLUSIONS: The degree of nonreversing lymphatic damage seen in our mouse model was dependent on RT dose. Our results suggest that near-infrared fluorescence lymphatic imaging detection of early lymphatic changes can be used to predict development of lymphedema in patients with cancer.


Assuntos
Excisão de Linfonodo/efeitos adversos , Irradiação Linfática/efeitos adversos , Vasos Linfáticos/efeitos da radiação , Linfedema/etiologia , Animais , Tornozelo/diagnóstico por imagem , Corantes/administração & dosagem , Relação Dose-Resposta à Radiação , Feminino , Raios gama , Verde de Indocianina/administração & dosagem , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/efeitos da radiação , Extremidade Inferior/cirurgia , Linfa/fisiologia , Excisão de Linfonodo/métodos , Vasos Linfáticos/diagnóstico por imagem , Vasos Linfáticos/patologia , Vasos Linfáticos/fisiopatologia , Linfografia/métodos , Masculino , Camundongos , Modelos Animais , Imagem Óptica/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Doses de Radiação , Fatores de Tempo
17.
J Surg Oncol ; 120(6): 911-918, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31376162

RESUMO

BACKGROUND: A new technique named "Selected Lymph Node" ("SeLyN") was evaluated, aiming to identify the most functional groin lymph nodes (LNs) for an effective LN transplantation. METHODS: Bilateral lower-limb SPECT-CT was performed in the upper-limb lymphedema patients, to select the most radioactive inguinal LN. Recorded data included demographics, stage, etiology of lymphedema, flap consistency in accordance to preoperative findings, flap size, number of LN, and harvesting time. Infection episodes per year and volume changes of the upper limbs were documented. Donor-site complications were recorded and lower-limb evaluation was performed through clinical examination, volume analysis, and lymphoscintigraphy. RESULTS: A total of 41 patients underwent a "SeLyN" transfer technique. The mean flap size was 28.34 cm2 containing a mean of 3.4 LNs. The mean time spent on flap harvest was 39 minutes. A mean 56.5% volume reduction (P < .001) and a mean 1.41 to 0.29 infection episodes per patient per year (P < .001) were recorded. Clinical evaluation and lymphography of the donor site advocated no major complications for a mean follow-up period of 42.5 months. CONCLUSIONS: "SeLyN" is a safe and effective technique in selecting the most suitable LNs, minimizing the donor-site morbidity, and decreasing the overall operating time.


Assuntos
Neoplasias da Mama/cirurgia , Virilha/cirurgia , Linfonodos/transplante , Vasos Linfáticos/cirurgia , Linfedema/cirurgia , Linfocintigrafia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Idoso , Neoplasias da Mama/patologia , Feminino , Seguimentos , Humanos , Linfonodos/diagnóstico por imagem , Linfedema/diagnóstico por imagem , Linfedema/etiologia , Masculino , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tomografia Computadorizada por Raios X/métodos
18.
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
19.
Eur J Obstet Gynecol Reprod Biol ; 241: 35-41, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31419694

RESUMO

OBJECTIVES: Secondary lymphedema is a serious and debilitating condition, which may cause a range of cutaneous, infectious and joint complications with major psychological and social consequences. There is no curative treatment available. Initial symptomatic treatment includes Intensive Decongestive Treatment (IDT), which involves the use of multi-layered compression bandages, along with manual lymph drainage, physical exercise and skin care. IDT leads to an average decrease in limb volume of 20-40%, when compared to the contralateral limb. A better reduction may be obtained through the use of new adjuvant techniques, of which endermology is an example. The aim of this phase II study is to validate an IDT protocol combining endermology with standard of care in breast cancer related lymphedema. STUDY DESIGN: A standardised care protocol was proposed by the University Hospital of Toulouse's Lymphology team for the treatment of upper limb lymphedema after breast cancer surgery using Cellu M6 (LPG) Endermologie over 30 min. Every patient benefitted from IDT over 5 consecutive days, within the multidisciplinary Lymphology unit. Patients were randomised into three arms as follows: Arm 1: IDT for 5 days with bandages + manual lymphatic drainage. Arm 2: IDT with bandages + manual lymphatic drainage + Cellu M6 for 5 days. Arm 3: bandages + Cellu M6 for 5 days. During the study, patients will be followed-up for a period of 6 months. Use of LPG's Cellu M6 in combination with IDT may improve upper limb volume reduction compared with standard of care. By improving breast cancer related lymphedema, we expect to minimise further fluid build-up and to improve skin care, thus reducing the number of consultations and hospital admissions caused by this condition. The results of the present research protocol are expected to promote evidence supporting the use of endermology in the field of lymphology.


Assuntos
Linfedema/terapia , Massagem/métodos , Neoplasias da Mama/complicações , Feminino , Humanos , Linfedema/etiologia , Massagem/instrumentação
20.
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
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