Lymphedemaville

8:11:40 AM EDT

Sensitivity and specificity of combined perimetric and volumetric evaluations in the diagnosis of arm lymphedema

Godoy JM, Silva SH, Godoy MF.
Medicine School, São José do Rio Preto, São Paulo, Brazil.
godoyjmp@riopreto.com.br

The objective of the current study was to evaluate the sensitivity
and the specificity of perimetry combined with volumetry in the
treatment of lymphedema. Ninety women, who had been submitted to breast cancer surgery, were randomly selected in the Government Healthcare Clinic for this study. Only patients who underwent surgical treatment of breast cancer with some degree of
lymphadenectomy were included in the study cohort. Individuals with active disease, whether local or otherwise, functional alterations of the upper limbs before breast cancer surgery were not included.

The following possibilities were considered: 1--the perimetry evaluation was considered positive when the difference between the affected and unaffected sides was > or =2 cm for any one of the seven measurements and volumetry was > or = 100 mL; 2--perimetry > or =2 cm and volumetry > or =200 mL; 3--a difference > 10% between the two limbs in volumetry and perimetry.

Prevalence, sensitivity, specificity, positive predictive value, negative predictive value and accuracy were evaluated statistically with an alpha error of 5% considered acceptable (p-value < 0.05). The mean age of the women was 54.8 +/- 11.7 years. The sensitivity, negative predictive value and accuracy were higher using perimetry when a volume > or =2 cm were considered.

The specificity and positive predictive values were better when the
difference was greater than 10% between the two limbs by both
perimetry and volumetry. Perimetry is a reliable method in the
diagnosis of lymphedema when differences > or =2 cm between the two limbs should be considered.

http://www.ncbi.nlm.nih.gov/pubmed/18399061?
ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pu
bmed_RVDocSum

 

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10:37:18 PM EDT

Erysipelas as a sign of subclinical primary lymphoedema

Br J Dermatol. 2008 Mar 20

Damstra RJ, van Steensel MA, Boomsma JH, Nelemans P, Veraart JC.

Department of Dermatology, Phlebology and Lymphology, Nij Smelinghe Hospital, 9202 NN Drachten, The Netherlands.

Background

Erysipelas is a common skin infection that is usually caused by beta-haemolytic group A streptococci. After having had erysipelas in an extremity, a significant percentage of patients develops persistent swelling or suffers from recurrent erysipelas. We hypothesize that in cases of erysipelas without a clear precipitating agent, subclinical pre-existing congenital or acquired disturbances in the function of the lymphatic system are present. The persistent swelling after erysipelas is then most likely caused by lymphoedema.

Objectives

We designed a study to examine if erysipelas of unknown origin is associated with a pre-existent insufficiency of the lymphatic system. If our hypothesis is correct, patients with erysipelas of unkown cause without previously evident lymphoedema should have evidence of disturbed lymphatic transport in the unaffected extremity.

Methods

A prospective study, in which lymphoscintigraphy of both legs was performed in patients 4 months after presenting with an episode of erysipelas only in one leg. No patient had any known risk factor for erysipelas, such as diabetes mellitus, chronic venous insufficiency or clinical signs of lymphoedema. Lymphoscintigraphy was performed in 40 patients by subcutaneous injection of Tc-99m-labelled human serum albumin in the first web space of both feet. After 30 and 120 min, quantitative and qualitative scans were performed using a computerized gamma camera. During the lymphoscintigraphy, the patients performed a standardized exercise programme. Lymph drainage was quantified as the percentage uptake of Tc-99m-labelled human serum albumin in the groin nodes at 2 h after injection. Groin uptake of < 15% is pathological; uptake between 15-20% is defined as borderline, and uptake of > 20% as normal.

Results

The mean +/- SD percentage uptake in the groin nodes in the affected limbs was 9.6 +/- 8.5% vs. 12.1% +/- 8.9% in the nonaffected limbs. The mean paired difference in uptake between the nonaffected vs. affected side was 2.5% (95% confidence interval 1.1-3.9%). This indicates that lymphatic drainage in the nonaffected limb was only slightly better than in the affected limb despite the infectious event in the latter. Of 33 patients with objective impairment of lymph drainage in the affected limb, 26 (79%) also had impaired lymph drainage in the nonaffected limb. Agreement in qualitative measurements between affected and nonaffected leg was less pronounced: 21 patients had abnormal qualitative results in the affected leg of whom nine also had impairment of the nonaffected leg (43%).

Conclusions

Erysipelas is often presumed to be purely infectious in origin, with a high rate of recurrence and a risk of persistent swelling due to secondary lymphoedema. In this study, we show that patients presenting with a first episode of erysipelas often have signs of pre-existing lymphatic impairment in the other, clinically nonaffected, leg. This means that subclinical lymphatic dysfunction of both legs may be an important predisposing factor.

Therefore, we recommend that treatment of erysipelas should focus not only on the infection but also on the lymphological aspects, and long-standing treatment for lymphoedema is essential in order to prevent recurrence of erysipelas and aggravation of the pre-existing lymphatic impairment. Our study may change the clinical and therapeutic approach to erysipelas as well as our understanding of its aetiology.

Blackwell

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12:32:11 PM EDT

For our friends in south Florida:

Living Well with Lymphedema

10 a.m. to 1 p.m. April 12

Ruth Rales Jewish Family Service will host the event at the Jerusalem Room of the Jewish Community Center
9801 Donna Klein Blvd.
Boca Raton, FL.

Seminar will feature Dr. Harvey Mayrovitz, professor, and Susan Lanham, a physical therapist at Boca Raton Community Hospital.

Call (561) 852-3330 to register.

For more information, visit: www.ruthralesjfs.org.

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10:11:22 AM EDT

Dramatic reduction of chronic lymphoedema of the lower limb with sorafenib therapy.

Melanoma Res. 2008 Apr;18

Moncrieff M, Shannon K, Hong A, Hersey P, Thompson J.

Sydney Melanoma Unit, North Sydney, New South Wales, Australia.

This paper describes an interesting case report based on a patient who had a dramatic and astounding reduction in her chronic lymphoedema while on sorafenib.

PMID: 18337654 [PubMed - in process]

Sorafenib

Why is this medication prescribed?

Sorafenib is used to treat advanced renal cell carcinoma (a type of cancer that begins in the kidneys). Sorafenib is in a class of medications called multikinase inhibitors. It works by slowing the spread of cancer cells.

How should this medicine be used?

Sorafenib comes as a tablet to take by mouth. It is usually taken twice a day. Sorafenib is taken without food, one hour before or 2 hours after a meal. Take sorafenib at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take sorafenib exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow the tablets whole with water. Do not split, chew, or crush them.

Your doctor may decrease your dose of sorafenib during your treatment, or may tell you to stop taking sorafenib for a period of time if you experience side effects. Be sure to tell your doctor how you are feeling during your treatment with sorafenib.

Continue to take sorafenib even if you feel well. Do not stop taking sorafenib without talking to your doctor.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

Other uses for this medicine

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before taking sorafenib,

• tell your doctor and pharmacist if you are allergic to sorafenib or any other medications.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: anticoagulants (blood thinners) such as warfarin (Coumadin), bupropion (Wellbutrin, Zyban), carbamazepine (Equetro, Tegretol), cyclophosphamide (Cytoxan, Neosar), dexamethasone, doxorubicin (Doxil, Adriamycin), efavirenz (Sustiva), ifosfamide, irinotecan (Camptosar), methadone (Dolophine, Methadose), phenobarbital, phenytoin (Dilantin, Phenytek), or rifampin (Rifadin, Rimactane). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor what herbal products you are taking, especially St. John's wort.
• tell your doctor if you have or have ever had high blood pressure, bleeding problems, chest pain, a heart attack, kidney disease other than kidney cancer, or heart or liver disease.
• you should know that sorafenib may decrease fertility in men and women. However, you should not assume that you or your partner cannot become pregnant. If you are pregnant or breastfeeding, you should tell your doctor before you begin taking this drug. Use a reliable method of birth control during your treatment and for 2 weeks after you stop taking sorafenib. Talk to your doctor about birth control methods that will work for you. Sorafenib may harm the fetus.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you aretaking sorafenib.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?

Sorafenib may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• tiredness
• weakness
• rash
• skin redness
• hair loss
• itching
• dry skin
• nausea
• vomiting
• loss of appetite
• constipation
• diarrhea
• stomach pain
• dry mouth
• mouth sores
• weight loss
• joint pain
• numbness, pain or tingling in hands or feet
• headache

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:

• unusual bruising or bleeding
• black and/or tarry stools
• red blood in stools
• bloody vomit
• vomiting material that looks like coffee grounds
• severe abdominal pain
• chest pain
• shortness of breath
• sudden severe headache
• confusion
• changes in vision
• seizures
• redness, pain, swelling or blisters on the palms of the hands or soles of the feet

Sorafenib may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

What storage conditions are needed for this medicine?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Symptoms of overdose may include:

• diarrhea
• rash or other skin problems

What other information should I know?

Keep all appointments with your doctor. Your doctor will check your blood pressure every week during the first six weeks of your treatment and then from time to time as needed.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

Brand names
Nexavar

MedMaster Patient Drug Information

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6:41:04 AM EST

National Lymphedema Network - The Marilyn Wesstbrook Garment Fund

An Introduction

It is with tremendous pleasure that I introduce the NLN Garment Fund.

This is a dream that has come true not only for me, but for our many patients who do not have insurance or the financial means to purchase the much needed compression stocking(s)/sleeve(s). It was Marilyn Westbrook's choice to make sure that no other patients have to endure the pain and frustrations she went through six months prior to her passing (Dec 23, 2007). Marilyn and her husband Doyle donated a sunstantial amount of money to the NLN which will allow patients who qualify to pay for their garment(s). In order to qualify you will need to be an NLN member and submit an application; an online application will be published very soon. For more information please contact our office.

For those of you that would like to and are able to contribute to the fund, you can make a check directly to the NLN and identify "Marilyn Westbrook Fund". The NLN can also accept donations of other personal assets, such as stocks from your investment portfolio. If you would like to learn more about how you can donate and the substantial benefits to you personally as a donor, please call the NLN.

With the increased restriction of our health insurance and federal laws it is heartwarming to know that we will be able to assist a percentage of the many patients. This fund will help make sure patients wear the much needed garments to maintain their quality of life. Let's all applaud Marilyn and her family and thank them for this
HUGE gift.

- Saskia R.J. Thiadens, R.N., Executive Director

Establishing the Marilyn Westbrook Fund
By Doyle Westbrook

Marilyn was always a fighter. With her first cancer she went the route of traditional treatment including, surgery, chemotherapy and radiation in an effort to beat the cancer quickly so she could be there for her children. Throughout the course of treatment, she remained strong and supportive of her children.

With the latest round, chemotherapy was not an option; her experience with the maximum dose of radiation in the previous battle proved to her that its debilitating affect on her healing made it not an option. Marilyn decided to embark on a non-traditional complimentary method of treatment.

The cancer metastasized; while the alternative therapy was helping her gain amazing physical healing, including helping the surgical scars from her first surgery as well as the latest hysterectomy fade away, she had two more out-patient surgeries to remove cancerous lymph nodes. Now her concern was managing the likely lymphedema and she asked our HMO to let her talk to one of their lymphedema
specialists. The result of her attempt to minimize potential
lymphedema was a wrong prescription for a compression garment that actually accelerated the lymphedema.

The immediate impact was that in early January 2007, she had to stop her complimentary treatment. While we were still searching for a way to treat the cancer, her focus had to be on the more immediate problem of the worsening lymphedema. It was getting so bad that by March I was asking my youngest daughter to schedule her wedding no later than July of 2007. In June, the wedding was scheduled for September 9th.

We had found a lymphedema massage specialist outside of our HMO, but traveling back from the clinic undid all the benefits of the manual lymph drainage massage. While looking through a year-old ommunity phone book, Marilyn found an ad for Michelle Coxon, who was not only a certified specialist but she was willing to come to our house.

Even so, in between Michelle's daily weekday visits, especially on the weekend, Marilyn's left leg would puff way up. I was getting concerned that she wouldn't be able to attend the wedding even if she did make it to that day.

Early in the treatment provided by Michelle, Marilyn became
practically bedridden; this was due to the lymphedema in her leg.

Michelle knew of a miracle worker named Don Kellogg, and arranged for him to see her. Don brought in a wheelchair pad so she could see the material he would use to make her leg appliance. It brought her so much relief while lying in bed, that she asked to keep it; he let her. Then Don went home and sewed up her leg appliance overnight.

He brought it back the next day. Afterjust one partial day of use, she was back up and walking in our house.

Unfortunately, the treatment for lymphedema was not a treatment for cancer. Marilyn succumbed to the cancer on December 23, 2007 . She was wearing a second much smaller appliance right up until the end as it helped reduce the pain.

Don has stayed in touch as he lost his wife in very similar
circumstances. It was his experiences with her lymphedema that led him to develop these custom appliances and start his own company, Telesto Medtech. They are not compression garments. Their directional stitching literally wicks the lymph away from the impacted area to the healthier portions, even secondary channels, of
the lymph system.

When I asked how I could honor Marilyn by helping, I learned that many insurance companies don't recognize this miracle appliance as a medical device. Even after using profits from the payments he does receive towards helping other people with lymphedema, there are still so many more people who need the help but can't get it. A child born with an impaired lymph system can need as many as 30 appliances
before the growing stops.

Don suggested that I contact Saskia Thiadens, RN at the National Lymphedema Network to see whether something special could be done to help more people get this miracle. Saskia was very receptive and together we formed the Marilyn Westbrook Fund. It has the same charitable donation status as donations to the National Lymphedema
Network do. The National Lymphedema Network will dispense the money the fund has available to deserving individuals to acquire lymphedema appliances, compression sleeves/stockings and alternative garments.

Donations can be made to the fund by giving to the "National
Lymphedema Network for the benefit of Marilyn Westbrook's Fund."   See the mention on page for more information on how to contribute and be a part of the fund.

Thank you Don. Marilyn wouldhave succumbed to an infection from the lymphedema much earlier than she did had you not entered our lives.

You extended, as well improved her quality of life so much that you made it possible for her to attend her daughter's wedding, enjoy Thanksgiving with her daughter's new in-laws, and meet her son's girlfriend's, now fiancée's, mother. She is survived by her three children, two sisters, brother, mother, and husband.

In loving memory,
Doyle Westbrook

http://www.lymphnet.org/patients/westbrookFund.htm

NATIONAL LYMPHEDEMA AWARENESS DAY - MARCH 6TH

Support the National Lymphedema Network

http://www.lymphnet.org/home.htm

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6:33:09 AM EST

Physician Intensive: Lymphedema Management for the Practicing Physician

The following is a wonderful opportunity to bring your physician andthe medical staff at your clinic up on the basics of lymphedema care.

Buy a copy and donate it to your local medical library, give it to your doctor or medical director, view it at your support group, etc.

Possibilities for education are limitless.

"Physician Intensive: LE Mgmt for the Practicing Physician"

This Physician Intensive brings together leaders in the field of Lymphology and related areas to provide a concise review of the principles of lymphedema care. Topics addressed include: anatomy and physiology, differential diagnosis, wound care and lymphedema, and more.

The video runs 3 hrs 30 min on VHS. It is ideal for in-service
presentation during a week of lunch breaks.

The original Price was $45.00
The Remainder Sale Price is $22.50 for non-NLN members
The Adjusted Price is $17.50 for NLN members.

Order it on the NLN web page www.lymphnet.org while stock lasts.

http://www.shop.lymphnet.org/category.sc?categoryId=9

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11:55:28 PM EST

Life Boats

Breast cancer survivor organizes a dragon boat racing team to help others recover

By DAN HOWLEY, Staff writer First published: Sunday, March 2, 2008 The joy LucilleFreeman always derived from paddling a kayak on a quiet lake has found a higher purpose aboard what can truly be called a lifeboat. The 52-year-old Voorheesville mother of three is starting the Capital Region's first breast cancer survivor dragon boat team. With origins rooted in ancient China, dragon boat racing features 40-foot wooden vessels carved like dragons and propelled by crews of 20 paddlers. The crew also includes a ceremonial pace drummer at the bow and someone on the rudder. But it wasn't the sport's history, or the intricate, colorful dragon carvings and symbolism that caught Allegretti-Freeman's attention. It was that there are breast cancer survivor teams in places like Buffalo, Ithaca, Burlington, Vt., Boston and Philadelphia, and medical research shows that the sport can significantly improve the physical and mental health of participants and help them cope with post-recovery trauma. "I think a lot of women are looking for ways to connect with other women who have had breast cancer, but not necessarily a sit-down support group," said Allegretti-Freeman, a clinical social worker at Ellis Mental Health Clinicwhose own breast cancer was detected May 1 during her annual mammogram. "I think this really touches your mind, body and spirit, and it does it without dwelling on the breast cancer." A dragon boat team was exactly the life-enriching activity Allegretti-Freeman was seeking after cancer reminded her of her own mortality. "I think part of it was thinking about how do you live your life with all this uncertainty, and there is something about breast cancer that brings it all real close. "But the fear doesn't grip you like there's no way out. I thought 'How can I live my life differently?' I wanted to do more in nature. I wanted things that might heal me on all different levels, the water, nature, movement, people." Challenging a theory The connection between breast cancer survivors and dragon boating started in 1996 when a Canadian doctor challenged a once-accepted theory about exercise and breast cancer patients. Dr. Don McKenzie, a sports medicine physician at the University of British Columbia, launched Abreast in a Boat to challenge the belief that repetitive upper-body exercise in women treated for breast cancer encourages lymphedema, a buildup of lymphatic fluid. McKenzie believed that by following a special exercise and training program, women could avoid lymphedema and enjoy active, full lives. The women were carefully monitored by a sports medicine physician, a physiotherapist and a nurse. McKenzie's theory was proven correct. No new cases of lymphedema occurred, and none of the existing cases became worse. From that medical study involving one boat of 25 women, the Abreast in a Boat organization has grown to include six boats based in Vancouver and inspired 50 teams in Canada and another 48 worldwide. Allegretti-Freeman first learned about dragon boat teams in early September while exploring activities for breast cancer survivors on the Internet. A couple weeks later, she came across an article about it while glancing through a Women & Cancer magazine in her doctor's office, something she called a happy coincidence. Getting started On Sept. 29 -- she has the date written down -- she e-mailed teams in Buffalo, Philadelphia and Vermont where she found support and encouragement. "I call them my angels, telling me I can do this and I can do that," she said. "I imagined them with their arms around me." Next, she contacted Capital Region Action Against Breast Cancer and another area support and education organization, To Life!, and was invited to write articles in their newsletters seeking crew members. She's has about 15 women aboard, despite not yet having a boat, which will cost about $17,000, a coach or even an official team name. But Allegretti-Freeman, who will attend a weeklong dragon boat training clinic in Florida in April, said she hopes to have her team ready to compete against other breast cancer survivors at dragon boat festivals in Ithaca in July and Burlington, Vt., in August. The festivals provide boats for teams that don't have their own. "The dots aren't all connected yet," she said, "but I found an Einstein quote a couple weeks ago that really explained it for me. Einstein said, 'Imagination is more important than knowledge,' and so I keep thinking about that and it helps keep me going.' Keeping active Joan Sheehan, 67, is the oldest team member so far. Sheehan is active in Pilates and weight training, and as a 21-year breast cancer survivor noted that survivors have always been encouraged to be physically active. "When I saw someone who shares something with me and who has this idea that is really motivating her, I felt it was something I could really support, and it would be good for me at the same time," said Sheehan, who is co-president of Capital Region Action Against Breast Cancer. "She's inspiring. I think she is a take-charge person who believes you may have cancer, but it doesn't have you. What she's doing is really trying to prove that." Allegretti-Freeman's husband, John, said his wife has an inner strength that helps her through difficult times. "That's what gave her the confidence to begin this whole process and follow her dreams," he said. "These things are reminders that life is precious and short and we have to be active now. I think this dragon boat is a way to help her project that." Being together Allegretti-Freeman, meanwhile, is bringing a refreshing spirit to the endeavor, one that's foreign to the popular team sports mantra of winning at all costs. She's never been on a sports team of any kind, doesn't watch sports on TV, and said that if it weren't for her cancer she would never even consider doing something like this. And she certainly doesn't think her lazy summer days splashing around in a kayak with her family on Pyramid Lake in the Adirondacks will give her any advantage. "One thing that really appealed to me about this is that we'll all have a lot in common, but won't have to have any athletic ability," she said. "Mostly, it's about being together, and training on the water. The competition is really secondary. "And we'll laugh a lot. Can you imagine us the first time in the boat, trying to get it to go forward?" Dan Howley can be reached at 454-5321 or by e-mail at dhowley@timesunion.com. Warding off enemies Dragon boat racing began 2,500 years ago in China, when a group of superstitious farmers believed that the boat racing would ensure prosperous and bountiful crops. Their celebrations took place on the summer solstice -- the time of year typically associated with disease and death and when man felt most helpless against the powers of nature. The race has come to symbolize both man's struggle against nature and his fight against dangerous enemies. Today, there are nearly 50 million people who participate in competitive dragon boat racing worldwide. The majority of the racers are in China and the far East. It is estimated there are 150,000 participants in Europe, 50,000 in North America, and 20,000 in Australia. Source: Dragonheartvermont.org/history For more info Anyone seeking more information or is interested in volunteering or donating to help launch the Capital Region's first breast cancer survivor dragon boat team can contact Lucille Allegretti-Freeman at 765-2307 or by e-mail at LAF644@aol.com. Here are a few related Web sites: http://www.hopechestbuffalo.com; http://www.hopeafloatusa.org (Philadelphia), http://www.dragonheartvermont.org  (Burlington, Vt.) Camaraderie and understanding Following is the mission statement of Abreast in a Boat, the original cancer survivor dragon boating organization base in Vancouver, British Columbia: To help people who have had breast cancer understand that they can lead full, active lives despite the physical limitations imposed by this disease. *To improve the quality of life for people who have had breast cancer while research is being done to find a cure. *To raise awareness about breast cancer. *To encourage the pursuit of a cure. In the boat we: *Paddle together. *Support each other. *Learn from one another. *Laugh together. *Enjoy competition. *Overcome fear. *Encourage others. *Make true friends. *Take pride in our accomplishments. *Break the silence of cancer. Source: Abreastinaboat.com The Times Union

Tags: dragon boat racing, arm lymphedema, breast cancer, exercise, sports, athletics,

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8:40:14 AM EST

Lymphedema in the morbidly obese patient: unique challenges in a unique population.

Ostomy Wound Manage. 2008 Jan

Fife CE, Carter MJ.

Department of Anesthesiology, University of Texas Health Science Center, Houston, Texas, USA. Caroline.E.Fife@uth.tmc.edu

The population of morbidly obese patients, along with the incidence of lymphedema and massive localized lymphedema associated with this condition, is increasing. A 5-year retrospective review of data (2000-2005) shows that the percentage of patients >350 lb in the authors' clinic population increased from approximately 7% to 11% and 75% of their morbidly obese patients (body mass index >40) had or have lymphedema. After a differential diagnosis between lipedema and lymphedema (primary or secondary) has been made, lymphedema management options include compression bandaging, manual lymphatic drainage, and localized surgeries. The treatment of morbidly obese lymphedema patients requires additional staff time and specialized equipment to move or position them and may be confounded by other conditions (eg, heart failure and venous insufficiency) that contribute to edema. Lymphedema treatments have been found to be useful, providing patients are able to follow treatment guidelines, especially with regard to weight control. In the authors' experience, massive localized lymphedema will recur unless the primary issue of obesity is addressed. Establishing clear criteria and patient participation guidelines before initiating a comprehensive localized lymphedema program will improve outcomes.

PMID: 18250486 [PubMed - in process]

A patient-centered approach to treatment of morbid obesity and lower extremity complications: an overview and case studies.

Ostomy Wound Manage. 2008 Jan

Fife CE, Benavides S, Carter MJ.

University of Texas Health Science Center, Houston, Texas, USA. Caroline.E.Fife@uth.tmc.edu

The prevalence of morbid obesity, along with related comorbidities, is dramatically increasing in the US, confounding wound care for persons at heightened risk for skin compromise. The purpose of this overview is to examine common concerns related to morbid obesity and interrelated lower extremity complications, including wound and skin infections, dermatologic conditions, lymphovenous obstruction syndromes, chronic venous insufficiency, and anatomical abnormalities such as massive localized lymphedema. Treatment may include surgery for massive lymphedema localizations, compression bandaging for chronic venous insufficiency as well as lymphedema, manual lymph drainage for lymphedema, and prompt and aggressive management of wound infection and bioburden. Case studies are presented to illustrate some lower extremity complications of morbid obesity and appropriate protocols of care. Although increasing evidence suggests that morbidly obese patients are predisposed to secondary lymphedema and that primary lymphedema can cause adult-onset obesity, the mechanisms by which these events occur remain unclear. However, unless the underlying problem of morbid obesity is addressed, the problems for which these patients seek care will continue to recur.

PMID: 18250484 [PubMed - in process]

 

 

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7:10:44 AM EST

Experimental study of gene therapy with human vascular endothelial growth factor-c in lymphedema

Zhonghua Zheng Xing Wai Ke Za Zhi. 2007 Nov;

Department of Plastic & Reconstructive Surgery, the 9th Affiliated People's Hospital, Shanghai Jiaotong University Medical School, Shanghai 200011, China.

OBJECTIVE: To study the efficacy of gene therapy with human vascular endothelial growth factor-c (VEGF-C) on obstructive lymphedema.

METHODS: Two animal models of lymphedema were created: one in the right hind limb of adult New Zealand white rabbits and the other in SD mouse tail. Each model was randomly divided into two groups to receive intradermal injection of either VEGF-C gene (experimental group), or saline(control group). In rabbit model, the volume change of affected limb was measured. In mouse model, biopsy was performed after 3 weeks treatment to detect the expression of VEGF-C mRNA and proteins. The lymphangenesis was evaluated by immunohistochemical examination with lymphatic endothelium hyaluronan receptor antibody.

RESULTS: The volume of the affect rabbit limb decreased by (24.40 +/- 1.08) ml in experimental group, compared with (5.80 +/- 1.92) ml in control group (P = 0.0001). The expression of VEGF-C mRNA and protein increased markedly in experiment group, but not in controls. More lymphatic vessels with large caliber were seen in experiment group (P = 0.0004).

CONCLUSIONS: VEGF-C gene therapy may alleviate or treat lymphedema by inducing lymangiogenesis.

PubMed

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11:12:09 PM EST


Written by patoco2 Permalink | Blog about this entry |  Add to del.icio.us |  digg this This entry has 0 comments: Add your own