Physical therapy affects endothelial function in lymphedema patients.

Lymphedema arises due to a malfunction of the lymphatic system and can lead to massive tissue swelling. Complete decongestive therapy (CDT), consisting of manual lymphatic drainage (MLD) and compression bandaging, is aimed at mobilizing fluid and reducing volume in affected extremities. Lymphatic dysfunction has previously been associated with chronic inflammation processes. We investigated plasma ADMA as an indicator of endothelial function/inflammation before-, during- and after-CDT. Also assessed were vascular function parameters such as carotid-femoral pulse wave velocity (PWVcf), flow-mediated dilata-tion (FMD) and retinal microvasculature analysis. 13 patients (3 males and 10 females, 57 ± 8 years old (mean ± SD), 167.2 ± 8.3 cm height, 91.0 ± 23.5 kg weight), with lower limb lymphedema were included. Vascular function parameters were assessed on day 1, 2, 7, 14 and 21 of CDT, pre- and post-MLD. ADMA was significantly lower post-MLD (p=0.0064) and tended to reduce over three weeks of therapy (p=0.0506). PWVcf weakly correlated with FMD (r=0.361, p=0.010). PWVcf, FMD and retinal microvasculature analysis did not show changes due to physical therapy. The novel results from this study indicate that lymphedema does not affect endothelial func-tion and lymphedema patients may therefore not have a higher risk of cardiovas-cular diseases. Our results further suggest that manual lymphatic drainage with or without full CDT could have potentially beneficial effects on endothelial function in lymphedema patients (by reducing ADMA levels), which has not been reported previously.

Effect of weight, smoking, and estrogen use on the risk of hip and forearm fractures in postmenopausal women.

From the practices of approximately two thirds of the orthopedic surgeons in King County, Washington, the authors identified white women ages 50 to 74 who had sustained a fracture of the hip or forearm between 1976 and 1979. The women were interviewed concerning factors associated with levels of endogenous estrogens. Their responses were compared to those of a random sample of white female residents of King County in the same age range. The risk of hip fracture was elevated in thin women and in those who smoked cigarettes, particularly among nonusers of estrogen. Neither weight nor smoking affected the risk of forearm fracture in estrogen users, although among nonusers smoking increased the risk, particularly among those who were thin. The beneficial effect of estrogen use in preventing both types of fracture varied considerably according to the woman's weight and smoking status, being greatest in thin women who smoked cigarettes and near zero in heavy nonsmokers. Body weight and cigarette smoking history offer important information concerning the probable degree of protection against fracture afforded by estrogen use.

Decreased risk of fractures of the hip and lower forearm with postmenopausal use of estrogen.

We interviewed 327 women who had been 50 to 74 years of age when treated for fracture of the hip of lower forearm, to determine their use (or lack of use) of estrogen preparations. Their responses were compared with those in a random sample of 567 women who were of similar age and from the same region. The risk of fracture was 50 to 60 per cent lower in women who had used these drugs for six years or longer than in women who hadnot used them (95 per cent confidence interval of relative risk, 0.3 to 0.6); those using them for shorter periods received less benefit, if any. A decreased risk of fracture was clearly evident only in women still taking estrogens and evident at either common daily dose (0.625 and 1.25 mg). In conjunction with the finding that estrogens can retard the development of osteoporosis in postmenopausal women, our data argue that lowering of the risk of hip and forearm fractures must be weighed as a benefit of long-term estrogen use.

Reproductive history and postmenopausal risk of hip and forearm fracture.

This case-control study was designed to investigate the relation between reproductive history and occurrence of hip and forearm fractures in postmenopausal women. Three hundred and fifty-five King County, Washington women who sustained a fracture between 1976 and 1980 and 562 control women were interviewed regarding their reproductive history and other factors. After controlling for the confounding effects of age, obesity, and use of noncontraceptive estrogens, the authors found that women who gave birth four or more times had a risk of fracture similar to women who had not given birth (odds ratio = 1.2, 95% confidence interval = 0.7-2.2), and women who breastfed for more than two years had a risk of fracture similar to women who had never breastfed (odds ratio = 0.8, 95% confidence interval = 0.4-1.5).

Mortality in women following hip fracture.

The mortality of white female residents of King County (WA) 50-74 yr of age who sustained an isolated fracture of the hip (n = 168) or lower forearm (n = 217) during 1976-79 was monitored during the 2 yr following the fracture. Among the women with hip fracture the (age-adjusted) percentages who died by the end of the first and second year were 5.9 and 10.5%, respectively. Among women with forearm fractures, the corresponding 1- and 2-yr percentages were 1.9 and 2.7%, values similar to that of white women of comparable ages in the population as a whole. The fact that women who broke their hip experienced a higher mortality rate than those who broke their forearm, while women in both groups were similar in having experienced trauma that led to a fracture, argues that it is the hip fracture and its consequences that lead to an increased death rate, rather than the factors that predispose to a fracture.