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Boki H, Kimura T, Miyagaki T, Suga H, Blauvelt A, Okochi H, Sugaya M, Sato S. Lymphatic Dysfunction Exacerbates Cutaneous Tumorigenesis and Psoriasis-Like Skin Inflammation through Accumulation of Inflammatory Cytokines. J Invest Dermatol 2021; 142:1692-1702.e3. [PMID: 34780714 DOI: 10.1016/j.jid.2021.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 04/20/2021] [Accepted: 05/02/2021] [Indexed: 10/19/2022]
Abstract
Lymphatic transport plays an important role in coordinating local immune responses. However, the biologic effects of impaired lymphatic flow in vivo are not fully understood. In this study, we investigated the roles of the lymphatic system in skin carcinogenesis and psoriasis-like inflammation using k-cyclin transgenic (kCYC+/-) mice, which demonstrate severe lymphatic dysfunction. kCYC+/- mice showed augmented tumor growth in the two-stage skin carcinogenesis model and severe clinical scores in imiquimod-induced psoriasis-like skin inflammation compared with wild-type mice. Although mRNA levels of inflammatory cytokines in skin after topical application of 12-O-tetradecanoylphorbol-13-acetate or imiquimod were comparable between kCYC+/- and wild-type mice, protein levels of inflammatory cytokines, such as IL-17A, IL-22, and IL-23, were significantly upregulated in kCYC+/- mice in both models. Consistently, signal transducer and activator of transcription 3 pathway and NF-κB signaling were augmented in epidermal keratinocytes in kCYC+/- mice. These results suggest that lymphatic dysfunction in kCYC+/- mice caused accumulation of inflammatory cytokines, leading to the exacerbation of two-stage skin carcinogenesis and imiquimod-induced psoriasis-like skin inflammation. These findings add insight into the clinical problems of secondary malignancies and inflammatory dermatoses that may occur with extremity lymphedema.
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Affiliation(s)
- Hikari Boki
- Department of Dermatology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Department of Regenerative Medicine, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takayuki Kimura
- Department of Dermatology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Department of Regenerative Medicine, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tomomitsu Miyagaki
- Department of Dermatology, St. Marianna University School of Medicine, Kanagawa, Japan.
| | - Hiraku Suga
- Department of Dermatology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Department of Regenerative Medicine, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Hitoshi Okochi
- Department of Regenerative Medicine, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Makoto Sugaya
- Department of Dermatology, School of Medicine, International University of Health and Welfare, Chiba, Japan
| | - Shinichi Sato
- Department of Dermatology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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102
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Kumegawa S, Yamada G, Hashimoto D, Hirashima T, Kajimoto M, Isono K, Fujimoto K, Suzuki K, Uemura K, Ema M, Asamura S. Development of Surgical and Visualization Procedures to Analyze Vasculatures by Mouse Tail Edema Model. Biol Proced Online 2021; 23:21. [PMID: 34758723 PMCID: PMC8582144 DOI: 10.1186/s12575-021-00159-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background Because of the high frequency of chronic edema formation in the current “aged” society, analyses and detailed observation of post-surgical edema are getting more required. Post-surgical examination of the dynamic vasculature including L.V. (Lymphatic Vasculature) to monitor edema formation has not been efficiently performed. Hence, procedures for investigating such vasculature are essential. By inserting transparent sheet into the cutaneous layer of mouse tails as a novel surgery model (theTailEdema bySilicone sheet mediatedTransparency protocol; TEST), the novel procedures are introduced and analyzed by series of histological analyses including video-based L.V. observation and 3D histological reconstruction of vasculatures in mouse tails. Results The dynamic generation of post-surgical main and fine (neo) L.V. connective structure during the edematous recovery process was visualized by series of studies with a novel surgery model. Snapshot images taken from live binocular image recording for TEST samples suggested the presence of main and elongating fine (neo) L.V. structure. After the ligation of L.V., the enlargement of main L.V. was confirmed. In the case of light sheet fluorescence microscopy (LSFM) observation, such L.V. connections were also suggested by using transparent 3D samples. Finally, the generation of neo blood vessels particularly in the region adjacent to the silicone sheet and the operated boundary region was suggested in 3D reconstruction images. However, direct detection of elongating fine (neo) L.V. was not suitable for analysis by such LSFM and 3D reconstruction procedures. Thus, such methods utilizing fixed tissues are appropriate for general observation for the operated region including of L.V. Conclusions The current surgical procedures and analysis on the post-surgical status are the first case to observe vasculatures in vivo with a transparent sheet. Systematic analyses including the FITC-dextran mediated snap shot images observation suggest the elongation of fine (neo) lymphatic vasculature. Post-surgical analyses including LSFM and 3D histological structural reconstruction, are suitable to reveal the fixed structures of blood and lymphatic vessels formation. Supplementary Information The online version contains supplementary material available at 10.1186/s12575-021-00159-3.
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Affiliation(s)
- Shinji Kumegawa
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Medical University of Wakayama, Wakayama, Japan
| | - Gen Yamada
- Department of Developmental Genetics, Institute of Advanced Medicine, Medical University of Wakayama, Wakayama, Japan.
| | - Daiki Hashimoto
- Department of molecular Physiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tsuyoshi Hirashima
- The Hakubi Center/Graduate School of Biostudies, Kyoto University, Kyoto, Japan
| | - Mizuki Kajimoto
- Department of Developmental Genetics, Institute of Advanced Medicine, Medical University of Wakayama, Wakayama, Japan
| | - Kyoichi Isono
- Laboratory Animal Center, Wakayama Medical University, Wakayama, Japan
| | - Kota Fujimoto
- Department of Developmental Genetics, Institute of Advanced Medicine, Medical University of Wakayama, Wakayama, Japan
| | - Kentaro Suzuki
- Department of Developmental Genetics, Institute of Advanced Medicine, Medical University of Wakayama, Wakayama, Japan
| | - Kazuhisa Uemura
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Medical University of Wakayama, Wakayama, Japan
| | - Masatsugu Ema
- Department of Stem Cells and Human Diseases Models, Research Center for Animal Life Science, Medical University of Shiga, Otsu, Shiga, Japan
| | - Shinichi Asamura
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Medical University of Wakayama, Wakayama, Japan
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103
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Lymphangitis Carcinomatosa in Neck Soft Tissue. J Comput Assist Tomogr 2021; 46:140-144. [DOI: 10.1097/rct.0000000000001234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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104
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Ye X, Gaucher JF, Vidal M, Broussy S. A Structural Overview of Vascular Endothelial Growth Factors Pharmacological Ligands: From Macromolecules to Designed Peptidomimetics. Molecules 2021; 26:6759. [PMID: 34833851 PMCID: PMC8625919 DOI: 10.3390/molecules26226759] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 12/27/2022] Open
Abstract
The vascular endothelial growth factor (VEGF) family of cytokines plays a key role in vasculogenesis, angiogenesis, and lymphangiogenesis. VEGF-A is the main member of this family, alongside placental growth factor (PlGF), VEGF-B/C/D in mammals, and VEGF-E/F in other organisms. To study the activities of these growth factors under physiological and pathological conditions, resulting in therapeutic applications in cancer and age-related macular degeneration, blocking ligands have been developed. These have mostly been large biomolecules like antibodies. Ligands with high affinities, at least in the nanomolar range, and accurate structural data from X-ray crystallography and NMR spectroscopy have been described. They constitute the main focus of this overview, which evidences similarities and differences in their binding modes. For VEGF-A ligands, and to a limited extent also for PlGF, a transition is now observed towards developing smaller ligands like nanobodies and peptides. These include unnatural amino acids and chemical modifications for designed and improved properties, such as serum stability and greater affinity. However, this review also highlights the scarcity of such small molecular entities and the striking lack of small organic molecule ligands. It also shows the gap between the rather large array of ligands targeting VEGF-A and the general absence of ligands binding other VEGF members, besides some antibodies. Future developments in these directions are expected in the upcoming years, and the study of these growth factors and their promising therapeutic applications will be welcomed.
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Affiliation(s)
- Xiaoqing Ye
- Faculté de Pharmacie de Paris, Université de Paris, CiTCoM, 8038 CNRS, U 1268 INSERM, 75006 Paris, France; (X.Y.); (M.V.)
| | - Jean-François Gaucher
- Laboratoire de Cristallographie et RMN Biologiques, Faculté de Pharmacie de Paris, Université de Paris, CiTCoM, 8038 CNRS, 75006 Paris, France;
| | - Michel Vidal
- Faculté de Pharmacie de Paris, Université de Paris, CiTCoM, 8038 CNRS, U 1268 INSERM, 75006 Paris, France; (X.Y.); (M.V.)
- Service Biologie du Médicament, Toxicologie, AP-HP, Hôpital Cochin, 75014 Paris, France
| | - Sylvain Broussy
- Faculté de Pharmacie de Paris, Université de Paris, CiTCoM, 8038 CNRS, U 1268 INSERM, 75006 Paris, France; (X.Y.); (M.V.)
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105
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Genital Lymphedema and How to Deal with It: Pearls and Pitfalls from over 38 Years of Experience with Unusual Lymphatic System Impairment. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111175. [PMID: 34833393 PMCID: PMC8618468 DOI: 10.3390/medicina57111175] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/18/2022]
Abstract
Background and Objectives: Conservative treatment represents an essential pillar of lymphedema management, along with debulking and physiologic surgeries. Despite the consistent number of treatment options, there is currently no agreement on their indications and possible combinations. When dealing with unusual lymphedema presentation as in the genitalia (Genital Lymphedema—GL), treatment choice becomes even more difficult. The authors aimed to present their targeted algorithm of single and combined treatment modalities for rare GL in order to face this paucity of information. Materials and Methods: Data were collected from a prospectively maintained database since January 1983, and cases of GL that were managed in the authors’ department were selected. Only patients that were treated in the authors’ institution and presented a minimum follow-up of 3 months were admitted to the current study. Results: From January 1983 to July 2021, 19 patients with GL were recruited. All the patients were male, and their ages ranged from 21 to 73 years old (average: 52). Ten cases (52.6%) presented with ISL (International Society of Lymphology) stage I, five (26.3%) were stage II and four (21.1%) were stage III. GL was managed with conservative treatment (12 cases), LVA (LymphaticoVenous Anastomosis) (3) or surgical excision (4). In a mean follow-up of 7.5 years (range: 3 months—11 years), no major complications occurred, and all cases reached improvements in functional and quality of life terms. Conclusions: Contrary to the predominant thought of the necessity to avoid surgery in unusual lymphedema presentations such as GL, they can be managed using targeted multimodal approaches or by adapting well-known procedures in unusual ways to achieve control of disease progression and improve patients’ quality of life.
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106
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Wagner JM, Grolewski V, Reinkemeier F, Drysch M, Schmidt SV, Dadras M, Huber J, Wallner C, Sogorski A, von Glinski M, Schildhauer TA, Lehnhardt M, Behr B. Posttraumatic Lymphedema after Open Fractures of the Lower Extremity-A Retrospective Cohort Analysis. J Pers Med 2021; 11:jpm11111077. [PMID: 34834429 PMCID: PMC8620266 DOI: 10.3390/jpm11111077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022] Open
Abstract
Secondary lymphedema is a very common clinical issue with millions of patients suffering from pain, recurrent skin infections, and the constant need for a decongestive therapy. Well-established as a consequence of oncologic procedures, secondary lymphedema is also a well-known phenomenon after trauma. However, precise epidemiological data of lymphedema progress upon severe extremity injuries are still missing. In the present work, we analyzed a patient cohort of 94 individuals who suffered open fractures of the lower extremity and soft tissue injury, of 2nd and 3rd grade according to Tscherne classification, between 2013 and 2019. Typical symptoms of lymphedema have been obtained via interviews and patient medical records in a retrospective cohort analysis. Of all patients, 55% showed symptoms of secondary lymphedema and 14% reported recurrent skin infections, indicating severe lymphedema. Furthermore, comparing patients with and without lymphedema, additional parameters, such as obesity, total number of surgeries, infections, and compartment syndrome, related to lymphedema progress could be identified. According to these data, posttraumatic secondary lymphedema has a highly underestimated clinical prevalence. Further prospective studies are needed to validate this first observation and to identify high-risk groups in order to improve patient’s health care.
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Affiliation(s)
- Johannes Maximilian Wagner
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, 44789 Bochum, Germany; (J.M.W.); (V.G.); (F.R.); (M.D.); (S.V.S.); (M.D.); (J.H.); (C.W.); (A.S.); (M.v.G.); (M.L.)
| | - Victoria Grolewski
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, 44789 Bochum, Germany; (J.M.W.); (V.G.); (F.R.); (M.D.); (S.V.S.); (M.D.); (J.H.); (C.W.); (A.S.); (M.v.G.); (M.L.)
| | - Felix Reinkemeier
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, 44789 Bochum, Germany; (J.M.W.); (V.G.); (F.R.); (M.D.); (S.V.S.); (M.D.); (J.H.); (C.W.); (A.S.); (M.v.G.); (M.L.)
| | - Marius Drysch
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, 44789 Bochum, Germany; (J.M.W.); (V.G.); (F.R.); (M.D.); (S.V.S.); (M.D.); (J.H.); (C.W.); (A.S.); (M.v.G.); (M.L.)
| | - Sonja Verena Schmidt
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, 44789 Bochum, Germany; (J.M.W.); (V.G.); (F.R.); (M.D.); (S.V.S.); (M.D.); (J.H.); (C.W.); (A.S.); (M.v.G.); (M.L.)
| | - Mehran Dadras
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, 44789 Bochum, Germany; (J.M.W.); (V.G.); (F.R.); (M.D.); (S.V.S.); (M.D.); (J.H.); (C.W.); (A.S.); (M.v.G.); (M.L.)
| | - Julika Huber
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, 44789 Bochum, Germany; (J.M.W.); (V.G.); (F.R.); (M.D.); (S.V.S.); (M.D.); (J.H.); (C.W.); (A.S.); (M.v.G.); (M.L.)
| | - Christoph Wallner
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, 44789 Bochum, Germany; (J.M.W.); (V.G.); (F.R.); (M.D.); (S.V.S.); (M.D.); (J.H.); (C.W.); (A.S.); (M.v.G.); (M.L.)
| | - Alexander Sogorski
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, 44789 Bochum, Germany; (J.M.W.); (V.G.); (F.R.); (M.D.); (S.V.S.); (M.D.); (J.H.); (C.W.); (A.S.); (M.v.G.); (M.L.)
| | - Maxi von Glinski
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, 44789 Bochum, Germany; (J.M.W.); (V.G.); (F.R.); (M.D.); (S.V.S.); (M.D.); (J.H.); (C.W.); (A.S.); (M.v.G.); (M.L.)
| | - Thomas A. Schildhauer
- Department of Traumatology and Orthopedic Surgery, BG-University Hospital Bergmannsheil, 44789 Bochum, Germany;
| | - Marcus Lehnhardt
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, 44789 Bochum, Germany; (J.M.W.); (V.G.); (F.R.); (M.D.); (S.V.S.); (M.D.); (J.H.); (C.W.); (A.S.); (M.v.G.); (M.L.)
| | - Björn Behr
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, 44789 Bochum, Germany; (J.M.W.); (V.G.); (F.R.); (M.D.); (S.V.S.); (M.D.); (J.H.); (C.W.); (A.S.); (M.v.G.); (M.L.)
- Correspondence: ; Tel.: +49-2343443; Fax: +49-2346379
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Biologically active lipids in the regulation of lymphangiogenesis in disease states. Pharmacol Ther 2021; 232:108011. [PMID: 34614423 DOI: 10.1016/j.pharmthera.2021.108011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/31/2021] [Accepted: 09/01/2021] [Indexed: 02/06/2023]
Abstract
Lymphatic vessels have crucial roles in the regulation of interstitial fluids, immune surveillance, and the absorption of dietary fat in the intestine. Lymphatic function is also closely related to the pathogenesis of various disease states such as inflammation, lymphedema, endometriosis, liver dysfunction, and tumor metastasis. Lymphangiogenesis, the formation of new lymphatic vessels from pre-existing lymphatic vessels, is a critical determinant in the above conditions. Although the effect of growth factors on lymphangiogenesis is well-characterized, and biologically active lipids are known to affect smooth muscle contractility and vasoaction, there is accumulating evidence that biologically active lipids are also important inducers of growth factors and cytokines that regulate lymphangiogenesis. This review discusses recent advances in our understanding of biologically active lipids, including arachidonic acid metabolites, sphingosine 1-phosphate, and lysophosphatidic acid, as regulators of lymphangiogenesis, and the emerging importance of the lymphangiogenesis as a therapeutic target.
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108
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Akita S, Unno N, Maegawa J, Kimata Y, Ota Y, Yabuki Y, Shinaoka A, Sano M, Ohnishi F, Sakuma H, Nuri T, Ozawa Y, Shiko Y, Kawasaki Y, Hanawa M, Fujii Y, Imanishi E, Fujiwara T, Hanaoka H, Mitsukawa N. A phase III, multicenter, single-arm study to assess the utility of indocyanine green fluorescent lymphography in the treatment of secondary lymphedema. J Vasc Surg Venous Lymphat Disord 2021; 10:728-737.e3. [PMID: 34592477 DOI: 10.1016/j.jvsv.2021.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/15/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Indocyanine green (ICG) fluorescent lymphography might be useful for assessing patients undergoing lymphatic surgery for secondary lymphedema. The present clinical trial aimed to confirm whether ICG fluorescent lymphography would be useful in evaluating lymphedema, identifying lymphatic vessels suitable for anastomosis, and confirming patency of lymphaticovenular anastomosis in patients with secondary lymphedema. METHODS The present phase III, multicenter, single-arm, open-label, clinical trial (HAMAMATSU-ICG study) investigated the accuracy of lymphedema diagnosis via ICG fluorescent lymphography compared with lymphoscintigraphy, rate of identification of lymphatic vessels at the incision site, and efficacy for confirming patency of lymphaticovenular anastomosis. The external diameter of the identified lymphatic vessels and the distance from the skin surface to the lymphatic vessels using preoperative ICG fluorescent lymphography were measured intraoperatively under surgical microscopy. RESULTS When the clinical decision for surgery at each research site was made, the standard diagnosis of lymphedema was considered correct. For the 26 upper extremities, a central judgment committee who was unaware of the clinical presentation confirmed the imaging diagnosis was accurate for 100.0% of cases, whether the assessments had been performed via lymphoscintigraphy or ICG lymphography. In contrast, for the 88 lower extremities, the accuracy of the diagnosis compared with the diagnosis by the central judgment committee was 70.5% and 88.2% for lymphoscintigraphy and ICG lymphography, respectively. The external diameter of the identified lymphatic vessels was significantly greater in the lower extremities than in the upper extremities (0.54 ± 0.21 mm vs 0.42 ± 0.14 mm; P < .0001). Also, the distance from the skin surface to the lymphatic vessels was significantly longer in the lower extremities than in the upper extremities (5.8 ± 3.5 mm vs 4.4 ± 2.6 mm; P = .01). For 263 skin incisions, with the site placement determined using ICG fluorescent lymphography, the rate of identification of lymphatics vessels suitable for anastomosis was 97.7% (95% confidence interval, 95.1%-99.2%). A total of 267 lymphaticovenular anastomoses were performed. ICG fluorescent lymphography was judged as "useful" for confirming patency after the anastomosis in 95.1% of the cases. CONCLUSIONS ICG fluorescent lymphography could be useful for improving the treatment of patients with secondary lymphedema from the outpatient setting to surgery.
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Affiliation(s)
- Shinsuke Akita
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Naoki Unno
- Department of Vascular Surgery, Hamamatsu Medical Center, Hamamatsu, Japan; Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Jiro Maegawa
- Department of Plastic and Reconstructive Surgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Yoshihiro Kimata
- Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Yusuke Ota
- Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuichiro Yabuki
- Department of Plastic and Reconstructive Surgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Akira Shinaoka
- Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Masaki Sano
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Fumio Ohnishi
- Department of Plastic and Reconstructive Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe City, Japan
| | - Hisashi Sakuma
- Department of Plastic and Reconstructive Surgery, Ichikawa General Hospital, Tokyo Dental College, Tokyo, Japan
| | - Takashi Nuri
- Department of Plastic and Reconstructive Surgery, Osaka Medical College, Takatsuki, Japan
| | - Yoshihito Ozawa
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yuki Shiko
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Michiko Hanawa
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yasuhisa Fujii
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Eri Imanishi
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Tadami Fujiwara
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Nobuyuki Mitsukawa
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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Gimenez AR, Winocour SJ, Chu CK. Reconstructive Techniques in Melanoma for the Surgical Oncologist. Surg Oncol Clin N Am 2021; 29:349-367. [PMID: 32482313 DOI: 10.1016/j.soc.2020.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Wounds resulting from wide local excision of melanoma vary in size and complexity, and require individualized solutions to achieve satisfactory closure. Goals of reconstruction include restoration of form, function, and aesthetics while minimizing donor site morbidity without compromising the effectiveness and safety of oncologic melanoma treatment. Optimal reconstruction relies on an in-depth understanding of the defect, locoregional anatomy and vasculature, available donor tissues, and basic wound healing and surgical principles. This article provides a broad overview of preoperative patient, timing, and wound considerations; various surgical techniques for complex reconstruction throughout the body; and postoperative care and complication management.
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Affiliation(s)
- Alejandro R Gimenez
- Division of Plastic Surgery, Baylor College of Medicine, 6701 Fannin Street, Suite 610, Houston, TX 77030, USA. https://twitter.com/AGimenezMD
| | - Sebastian J Winocour
- Division of Plastic Surgery, Baylor College of Medicine, 1977 Butler Boulevard, Suite E6.100, Houston, TX 77030, USA. https://twitter.com/WinocourMD
| | - Carrie K Chu
- Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, 1400 Pressler Street, Unit 1488, Houston, TX 77030, USA.
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Cellina M, Gibelli D, Martinenghi C, Giardini D, Soresina M, Menozzi A, Oliva G, Carrafiello G. Non-contrast magnetic resonance lymphography (NCMRL) in cancer-related secondary lymphedema: acquisition technique and imaging findings. Radiol Med 2021; 126:1477-1486. [PMID: 34379302 DOI: 10.1007/s11547-021-01410-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/04/2021] [Indexed: 11/24/2022]
Abstract
Cancer-related secondary lymphedema (LE) is a widespread issue, which markedly affects patients' quality of life. Its diagnosis is mainly clinical since there is no consensus on the best imaging technique that should be used to assess this pathology. Even if lymphedema treatment has been traditionally conservative and mainly based on compressive bandages and decongestive therapy, new surgical techniques are proving their effectiveness in the management of the disease and made proper assessment and characterization of lymphedema necessary. In this scenario, non-contrast magnetic resonance lymphography (NCMRL) is acquiring an increasing role, as a non-invasive imaging technique, useful for the analysis of LE. NCMRL is an effective tool in diagnosis confirmation, in providing information about the structural changes of the affected limbs, in grading this disorder, and provides a guide for LE management and treatment planning. This article aims to provide an overview of the literature regarding this examination, analyzing the acquisition technique, the interpretation of the imaging findings and their usefulness, the advantages and limits of this technique, to help the radiologist approach this relatively new investigation in cases of cancer-related LE.
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Affiliation(s)
- Michaela Cellina
- Department of Radiology, ASST Fatebenefratelli Sacco, Ospedale Fatebenefratelli, Piazza Principessa Clotilde 3, 20121, Milan, Italy.
| | - Daniele Gibelli
- Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Carlo Martinenghi
- Department of Radiology, Ospedale San Raffaele, Via Olgettina 60, 20121, Milan, Italy
| | - Denisa Giardini
- Lymphedema Center, Nursing Home "La Madonnina", Via Quadronno, 29, 20122, Milan, Italy
| | - Massimo Soresina
- Lymphedema Center, Nursing Home "La Madonnina", Via Quadronno, 29, 20122, Milan, Italy
| | - Andrea Menozzi
- Lymphedema Center, Nursing Home "La Madonnina", Via Quadronno, 29, 20122, Milan, Italy
| | - Giancarlo Oliva
- Department of Radiology, ASST Fatebenefratelli Sacco, Ospedale Fatebenefratelli, Piazza Principessa Clotilde 3, 20121, Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Radiology, Policlinico Di Milano Ospedale Maggiore | Fondazione IRCCS Ca' Granda, Via Francesco Sforza, 35, 20122, Milan, Italy
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Schiltz D, Kiermeier N, Müller K, Diesch ST, Wenzel C, Biermann N, Prantl L, Taeger CD. Quality of Life evaluation and lack of correlation with volumetric results after lymphovenous anastomoses in lymphedema therapy of the lower extremity. J Vasc Surg Venous Lymphat Disord 2021; 10:436-444.e1. [PMID: 34352420 DOI: 10.1016/j.jvsv.2021.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Chronic primary or secondary lymphedema has a huge impact on quality of life (QOL) because of associated swelling, pain, decreased range of motion, depression and anxiety, and generally requires numerous adaptations. Many studies have shown a positive objective effect of lymphovenous anastomoses (LVAs) on chronic lymphedema. In this study, we assessed the effect of LVAs on QOL in patients with primary or secondary lymphedema of the lower extremity 6 months after surgery, and examine the correlation between changes in QOL and volumetric measurements. METHOD Only patients with either primary or secondary lymphedema of the lower extremity who had LVAs were included in the study. To assess QOL, a specially designed questionnaire based on the "Lymphedema Quality of Life Inventory" (LyQLI) was used to evaluate the subjective therapeutic results from the patients' perspectives. Objective therapy success was assessed by 3D volumetric measurements of the lower leg. Measuring points, for both subjective and objective measurements, were the day before and 6 months after therapy. RESULTS The mean volume change 6 months after LVAs was -6.5% (sd 5.6, p < 0.001). A significantly better quality of life in terms of physical (37.6%, sd 25.2) and psychosocial (27.0%, sd 43.0) suffering as well as practical restrictions (22.3%, sd 24.8) was found (p values < 0.001). No correlation was found between QOL improvement and volume decrease (p values > 0.05). CONCLUSION In patients suffering from lymphedema of the lower extremity, lymphovenous anastomoses lead to a significant volumetric decrease and quality of life improvement six months after treatment with no demonstrable relationship between QOL improvement and volume reduction.
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Affiliation(s)
- Daniel Schiltz
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Natalie Kiermeier
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Karolina Müller
- Center for Clinical Studies, University Hospital Regensburg, Germany
| | - Sophia T Diesch
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Carina Wenzel
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Niklas Biermann
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Christian D Taeger
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany.
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112
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Pandya P, Giram P, Bhole RP, Chang HI, Raut SY. Nanocarriers based oral lymphatic drug targeting: Strategic bioavailability enhancement approaches. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102585] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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113
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Jarvis NR, Torres RA, Avila FR, Forte AJ, Rebecca AM, Teven CM. Vascularized omental lymphatic transplant for upper extremity lymphedema: A systematic review. Cancer Rep (Hoboken) 2021; 4:e1370. [PMID: 33826249 PMCID: PMC8388172 DOI: 10.1002/cnr2.1370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/20/2021] [Accepted: 03/01/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Vascularized omental lymphatic transplant (VOLT) is an increasingly popular treatment of extremity lymphedema given its promising donor site. While the success of VOLT in the treatment of lymphedema has been reported previously, several questions remain. AIM To further elucidate appropriate use of VOLT in the treatment of lymphedema, specifically addressing patient selection, harvest technique, and operative methods. METHODS AND RESULTS A systematic review of VOLT for upper extremity lymphedema was performed. Of 115 yield studies, seven were included for analysis based on inclusion and exclusion criteria. Included studies demonstrated significant reductions in extremity circumference/volume (average volume reduction, 22.7%-39.5%) as well as subjective improvements using patient-reported outcomes. Though studies are heterogenous and limited, when analyzed in aggregate, suggest the efficacy of VOLT in lymphedema treatment. CONCLUSION This is the largest systematic review of VOLT to date. VOLT continues to show promise as a safe and efficacious surgical intervention for lymphedema in the upper extremity. Further studies are warranted to more definitively identify patients for whom this technique is appropriate as well as ideal harvest and inset technique.
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Affiliation(s)
| | | | | | | | - Alanna M. Rebecca
- Division of Plastic and Reconstructive Surgery, Department of SurgeryMayo ClinicPhoenixArizonaUSA
| | - Chad M. Teven
- Division of Plastic and Reconstructive Surgery, Department of SurgeryMayo ClinicPhoenixArizonaUSA
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114
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Gupta N, Verhey EM, Torres-Guzman RA, Avila FR, Jorge Forte A, Rebecca AM, Teven CM. Outcomes of Lymphovenous Anastomosis for Upper Extremity Lymphedema: A Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3770. [PMID: 34476159 PMCID: PMC8386908 DOI: 10.1097/gox.0000000000003770] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lymphovenous anastomosis (LVA) is an accepted microsurgical treatment for lymphedema of the upper extremity (UE). This study summarizes and analyzes recent data on the outcomes associated with LVA for UE lymphedema at varying degrees of severity. METHODS A literature search was conducted in the PubMed database to extract articles published through June 19, 2020. Studies reporting data on postoperative improvement in limb circumference/volume or subjective improvement in quality of life for patients with primary or secondary lymphedema of the UE were included. Extracted data consisted of demographic data, number of patients and upper limbs, duration of symptoms before LVA, surgical technique, follow-up, and objective and subjective outcomes. RESULTS A total of 92 articles were identified, of which 16 studies were eligible for final inclusion comprising a total of 349 patients and 244 upper limbs. The average age of patients ranged from 38.4 to 64 years. The duration of lymphedema before LVA ranged from 9 months to 7 years. The mean length of follow-up ranged from 6 months to 8 years. Fourteen studies reported an objective improvement in limb circumference or volume measurements following LVA, ranging from 0% to 100%. Patients included had varying severity of lymphedema, ranging from Campisi stage I to IV. The maximal improvement in objective measurements was found in patients with lower stage lymphedema. CONCLUSION LVA is a safe, effective technique for the treatment of UE lymphedema refractory to decompressive treatment. Results of LVA indicate greater efficacy in earlier stages of lymphedema before advanced lymphatic sclerosis.
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Affiliation(s)
- Nikita Gupta
- From the Mayo Clinic Alix School of Medicine, Scottsdale, Ariz
| | - Erik M. Verhey
- University of Notre Dame, Department of Biological Sciences, Notre Dame, Ind
| | - Ricardo A. Torres-Guzman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Jacksonville, Fla
| | - Francisco R. Avila
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Jacksonville, Fla
| | - Antonio Jorge Forte
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Jacksonville, Fla
| | - Alanna M. Rebecca
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Jacksonville, Fla
| | - Chad M. Teven
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Phoenix, Ariz
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Schmitz D, Beier JP, Boos AM. Operative Therapiemöglichkeiten in der Lymphologie. PHLEBOLOGIE 2021. [DOI: 10.1055/a-1521-9867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungDas Lymphgefäßsystem ist essenziell für den Rücktransport interstitieller Flüssigkeit aus dem Gewebe zurück in den Blutkreislauf. Bei Störungen des komplexen Netzwerkes kommt es zur Ausbildung von Ödemen und der Ansammlung und Ablagerung von Proteinen und Lipiden in der betroffenen Region. Obwohl das Lymphsystem schon seit Jahrhunderten Gegenstand der Forschung ist, haben lymphologische Krankheitsbilder wie das Lymphödem als mögliche Folge onkologischer Therapien erst in den vergangenen Jahren an Aufmerksamkeit gewonnen. So liegt die Inzidenz des sekundären Lymphödems, das durch traumatische, infektiöse oder iatrogene Schädigung auftritt, zwischen 0,13 und 2 % und betrifft meist Frauen. Auch das davon abzugrenzende Lipödem ist in den letzten Jahren zunehmend in den Fokus der Öffentlichkeit gerückt. Beide Erkrankungen können mit einer schmerzhaften Umfangsvermehrung, einer beruflichen und alltäglichen Einschränkung und einer Reduktion der Lebensqualität einhergehen. Neben der klinischen Untersuchung und Anamnese gewinnen neue bildgebende Verfahren eine zunehmende Bedeutung zur Verbesserung der Diagnosestellung, Stadieneinteilung und Therapieplanung, wenngleich immer noch oftmals Monate bis Jahre bis zur korrekten Diagnosestellung vergehen. Während konservative Therapiemethoden wie die komplexe physikalische Entstauungstherapie weiterhin die Grundlage der Behandlung bilden, kommen zunehmend auch operative Verfahren bei der Therapie des Lymphödems zum Einsatz. Hierbei unterscheidet man die reduzierenden Verfahren, die hauptsächlich auf die Symptomreduktion abzielen, von den rekonstruktiven Verfahren zur Wiederherstellung des Lymphsystems mittels mikrochirurgischer Techniken. Nachfolgend werden verschiedene operative Therapiemöglichkeiten in der Lymphologie dargestellt.
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Affiliation(s)
- Deborah Schmitz
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Uniklinik RWTH Aachen
| | - Justus P. Beier
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Uniklinik RWTH Aachen
| | - Anja M. Boos
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Uniklinik RWTH Aachen
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116
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Cho HK, Sung WJ, Lee YJ, Kwak SG, Kim KL. Two methods of extracorporeal shock-wave therapy in a rat model of secondary lymphedema: a pilot study. J Int Med Res 2021; 49:3000605211024473. [PMID: 34187210 PMCID: PMC8258771 DOI: 10.1177/03000605211024473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives To compare the effectiveness of two methods of extracorporeal shock-wave therapy (ESWT) in a rat model of forelimb lymphedema, induced by axillary lymph node dissection. Methods Sprague–Dawley rats were randomly allocated to a group that received 500 ESWT shocks only in the lymphedematous forelimb (Forelimb/ESWT) and a group that received 300 ESWT shocks in the axilla and 200 shocks in the lymphedematous forelimb (Axilla+Forelimb/ESWT). The circumferences of each limb were then measured. Immunohistochemistry for a pan-endothelial marker (cluster of differentiation [CD]31) and lymphatic vessel endothelial hyaluronan receptor-1, and western blot analysis for vascular endothelial growth factor receptor-3 (VEGFR3) and VEGF-C were performed. Results The circumferences of the limbs showed significant effects of group and time following surgery. The circumferences at the carpal joint and 2.5 cm above were smallest in the naïve limbs, larger in the Axilla+Forelimb/ESWT group, and the largest in the control group. VEGFR3 tended to be expressed at a higher level in the Axilla+Forelimb/ESWT group (1.96-fold) than in the Forelimb/ESWT group (1.20-fold) versus the opposite non-edematous forelimbs, although this difference was not statistically significant. Conclusions These data suggest that ESWT protocols have differential effects on angiogenesis and lymphangiogenesis in lymphedematous limbs.
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Affiliation(s)
- Hee Kyung Cho
- Department of Physical Medicine and Rehabilitation, 65674Catholic University of Daegu School of Medicine, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - Woo Jung Sung
- Department of Pathology, 65674Catholic University of Daegu School of Medicine, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - Youn Ju Lee
- Department of Pharmacology, 65674Catholic University of Daegu School of Medicine, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - Sang Gyu Kwak
- Department of Medical Statistics, 65674Catholic University of Daegu School of Medicine, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - Kang Lip Kim
- Department of Physical Medicine and Rehabilitation, 65674Catholic University of Daegu School of Medicine, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
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Semkin VA, Nadtochiy AG, Vozgoment OV, Ivanova AA. [Head and neck lymphedema. Literature review]. STOMATOLOGII︠A︡ 2021; 100:103-108. [PMID: 34180633 DOI: 10.17116/stomat2021100031103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The article is a review of the latest literature data on lymphedema of the head and neck, its etiology, pathogenesis, classification and main clinical manifestations. The main methods of diagnosis and treatment of this pathology are indicated.
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Affiliation(s)
- V A Semkin
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - A G Nadtochiy
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - O V Vozgoment
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia.,Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - A A Ivanova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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118
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Supermicrosurgical Suture-Stent Technique for A Lymphaticovenular Bypass. J Clin Med 2021; 10:jcm10122595. [PMID: 34208378 PMCID: PMC8231290 DOI: 10.3390/jcm10122595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Lymphaticovenular anastomosis (LVA) is a challenging procedure and requires a sophisticated supermicrosurgical technique. The aim of this study was to evaluate and establish a discrete supermicrosurgical anastomosis method using the “suture-stent technique”. Methods: Forty-eight LVA sites of twenty patients with lower extremity lymphedema who had undergone LVA between July 2020 and January 2021 were included in this study. LVA was performed with the conventional technique or with the suture-stent technique. The patency of the anastomoses was evaluated using an infrared camera system intraoperatively. The success rate on the first try and the final success rate for each group were compared. Results: After full application of the exclusion criteria, 35 LVAs of 16 patients including 20 limbs were included in the analysis. The ratio of good patency findings after anastomosis in the suture-stent technique group was 100%. The incidences of leakage or occlusion on the first try were statistically greater in the conventional technique group (29.4%) than in the suture-stent technique group (0%) (p = 0.0191). All anastomoses achieved good patency in the final results. Conclusion: With its minimal risk of catching the back wall during the anastomosis, the suture-stent technique can be considered an optimal anastomosis option for LVA.
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119
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Saneei Totmaj A, Haghighat S, Jaberzadeh S, Navaei M, Vafa S, Janani L, Emamat H, Salehi Z, Izad M, Zarrati M. The Effects of Synbiotic Supplementation on Serum Anti-Inflammatory Factors in the Survivors of Breast Cancer with Lymphedema following a Low Calorie Diet: A Randomized, Double-Blind, Clinical Trial. Nutr Cancer 2021; 74:869-881. [PMID: 34085881 DOI: 10.1080/01635581.2021.1933096] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM Breast cancer-related lymphedema (BCRL) is a treatment-related inflammatory complication in breast cancer survivors (BCSs). This study was aimed to evaluate the effect of synbiotic supplementation on serum concentrations of IL-10, TGF-β, VEGF, adiponectin, and edema volume among overweight or obese BCSs with lymphedema following a low-calorie diet (LCD). METHOD In a randomized double-blind, controlled clinical trial, 88 obese and overweight BCSs women were randomized to synbiotic supplement (n = 44) or placebo (n = 44) groups and both groups followed an LCD for 10 weeks. Pre- and post-intervention comparisons were made regarding the anti-inflammatory markers which included IL-10, TGF-β, VEGF, adiponectin, edema volume, and anthropometric measurements. Also, the same factors were analyzed to find inter-group disparities. RESULTS There were no significant differences among participants in the baseline, except for IL-10 and adiponectin. Post-intervention, no significant differences were observed regarding the anti-inflammatory markers, including IL-10, VEGF, adiponectin, and TGF-β between the groups. After 10 weeks of intervention edema volume significantly decreased in the synbiotic group; additionally, anthropometric measurements (body weight, BMI, body fat percent, and WC) decreased in both groups significantly (P < 0.001 and P < 0.005; respectively). CONCLUSION Synbiotic supplementation coupled with an LCD in a 10-week intervention had beneficial effects on increasing the serum TGF-β, IL-10, and adiponectin levels in women with BCRL. It also reduced arm lymphedema volume. Therefore, synbiotic supplementation can be effective in improving health status in BCRL patients.
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Affiliation(s)
- Ali Saneei Totmaj
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Shahpar Haghighat
- Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Shapour Jaberzadeh
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia
| | - Mehraban Navaei
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Saeideh Vafa
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Janani
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hadi Emamat
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Salehi
- Immunology Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Izad
- Immunology Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Zarrati
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Aksoyler D, Bitik O, Menku Ozdemir FD, Gokoz O, Uzun H, Yeniceri B, Nasir SN. A New Experimental Lymphedema Model: Reevaluating the Efficacy of Rat Models and Their Clinical Translation for Chronic Lymphedema Studies. Ann Plast Surg 2021; 86:707-713. [PMID: 32759623 DOI: 10.1097/sap.0000000000002479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Our aim was to create a new rodent hind limb lymphedema model lacking the fibrosis effect induced by radiotherapy and subjected to the inhibition of lymphangiogenesis via sirolimus (rapamycin) to maintain a chronic lymphedema model and investigate its reliability for human treatment modalities. METHODS Forty-two Sprague-Dawley rats were randomly assigned to 7 groups: (1) surgery control, (2) vehicle-surgery control, (3) vehicle control, (4) rapamycin control, (5) surgery with 1 mg/kg per day rapamycin, (6) surgery with 1.5 mg/kg per day rapamycin, and (7) surgery with 2 mg/kg per day rapamycin. All surgeries were performed on the right hind limbs, with the left hind limbs also considered as a control. The drug and its solvent were administered daily into the relevant groups intraperiteonally. The presence of lymphedema was investigated by weekly limb circumference measurements, microcomputed tomography, fluorescence lymphography using indocyanine green dye, and microscopic evaluation at the end of the sixth week to determine any histological changes in the hind limbs. RESULTS In group 1, lymphedema was observed for 2 weeks (P = 0.032), whereas in groups 5, 6, and 7, lymphedema lasted for 3 weeks (P < 0.05.) Fluorescence using indocyanine green revealed that the edema was totally resolved after 6 weeks of surgery by a well-developed superficial lymphatic organization instead of the normal distinct vessel structure. Histologically, groups 1, 5, 5, and 7 demonstrated a significant increase in both the number of macrophages (P < 0.001) and newly formed lymphatic vessels in the right side surgically treated hind limb (P < 0.05). CONCLUSIONS Despite the extreme surgical destruction and lymphangiogenesis inhibition in the rat model, the sustained lymphedema did not last >3 weeks. Because of the rapid neolymphangiogenesis in murines and a different wound healing mechanism, they should not be considered as an appropriate model for research on human lymphedema in first place.
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Affiliation(s)
| | | | | | - Ozay Gokoz
- Department of Pathology, Hacettepe University Faculty of Medicine
| | - Hakan Uzun
- Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine
| | - Berna Yeniceri
- Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Serdar Nazif Nasir
- Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine
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121
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Gogia SB, Rekha A, Sood S. Chronic Lymphedema Management: Case Series Analysis of 9 Years from a Specialized Clinic in Delhi. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02931-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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122
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NURLU N, BULUT GT. A new approach to lymphedema following breast cancer treatment with lymphatic endothelial cell markers. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.902393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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123
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Gastroepiploic Lymph Node Flap Harvest for Patients With Lymphedema: Minimally Invasive Versus Open Approach. Ann Plast Surg 2021; 85:S87-S91. [PMID: 32530851 DOI: 10.1097/sap.0000000000002460] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Vascularized gastroepiploic lymph node flaps have become a popular option to treat patients with extremity lymphedema. Overall, 2 surgical approaches to harvest this flap have been described: laparoscopic and open. In this study, we analyzed complications, harvesting time, and patient satisfaction scores, comparing these 2 techniques. METHODS Between 2012- and 2018, all patients with extremity lymphedema and candidates for the gastroepiploic flap harvest were included. Two groups were compared: open and laparoscopic approaches. Flap harvest time, postoperative pain, complications, return of gastrointestinal motility, time to discharge, and patient satisfaction scores were assessed. RESULTS A total of 177 patients were included, of which 126 underwent laparoscopic harvest and 51 patients underwent open approach. Only 2 patients in the laparoscopic group had prior abdominal surgery not related to cancer treatment compared with 7 patients in the open approach (P < 0.01). Average surgical completion time for the laparoscopic versus open approach was 136 and 102 minutes, respectively (P < 0.02). Postoperative complications for the laparoscopic versus open were as follows: 1 patient developed pancreatitis and 2 developed ileus in the laparoscopic approach, whereas 3 patients developed ileus, 1 developed small bowel obstruction, 2 developed superficial site infection, and 1 developed minor wound dehiscence in the open approach. No patient required further surgical intervention. Average return of gastrointestinal function was 1 day (laparoscopic) and 2 days (open), respectively. On a pain scale, pain scores at postoperative day 1 and upon discharge were on average 3 versus 7 and 2 versus 5, respectively (P < 0.05). Lengths of hospital stay were on average 2 days in the laparoscopic group and 5 days in the open group (P < 0.001). Patient satisfaction scores based on pain and scars were significantly better in the laparoscopic group versus open group (P < 0.03). CONCLUSIONS These data support that a minimal invasive approach is ideal and efficient when resources are available. In addition, the lower complication rate and high patient satisfaction scores give promising feedback to continue offering this technique.
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Changing the Paradigm: Lymphovenous Anastomosis in Advanced Stage Lower Extremity Lymphedema. Plast Reconstr Surg 2021; 147:199-207. [PMID: 33009330 DOI: 10.1097/prs.0000000000007507] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Traditionally, lymphovenous anastomosis is not routinely performed in patients with advanced stage lymphedema because of difficulty with identifying functioning lymphatics. This study presents the use of duplex ultrasound and magnetic resonance lymphangiography to identify functional lymphatics and reports the clinical outcome of lymphovenous anastomosis in advanced stage lower extremity lymphedema patients. METHODS This was a retrospective study of 42 patients (50 lower limbs) with advanced lymphedema (late stage 2 or 3) that underwent functional lymphovenous anastomoses. Functional lymphatic vessels were identified preoperatively using magnetic resonance lymphangiography and duplex ultrasound. RESULTS An average of 4.64 lymphovenous anastomoses were performed per limb using the lymphatics located in the deep fat underneath the superficial fascia. The average diameter of lymphatic vessels was 0.61 mm (range, 0.35 to 1 mm). The average limb volume was reduced 14.0 percent postoperatively, followed by 15.2 percent after 3 months, and 15.5 percent after 6 months and 1 year (p < 0.001). For patients with unilateral lymphedema, 32.4 percent had less than 10 percent volume excess compared to the contralateral side postoperatively, whereas 20.5 percent had more than 20 percent volume excess. The incidence of cellulitis decreased from 0.84 per year to 0.07 per year after surgery (p < 0.001). CONCLUSION This study shows that functioning lymphatic vessels can be identified preoperatively using ultrasound and magnetic resonance lymphangiography; thus, lymphovenous anastomoses can effectively reduce the volume of the limb and improve subjective symptoms in patients with advanced stage lymphedema of the lower extremity. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Gursen C, Dylke ES, Moloney N, Meeus M, De Vrieze T, Devoogdt N, De Groef A. Self-reported signs and symptoms of secondary upper limb lymphoedema related to breast cancer treatment: Systematic review. Eur J Cancer Care (Engl) 2021; 30:e13440. [PMID: 33733550 DOI: 10.1111/ecc.13440] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 01/15/2021] [Accepted: 02/25/2021] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Breast cancer survivors with secondary upper limb lymphoedema (ULL) may report a wide range of self-reported symptoms. At the moment, no overview of ULL-specific symptoms is available. The first aim, therefore, was to compare the prevalence rates of self-reported signs and symptoms in people with and without secondary ULL due to breast cancer treatment. The second aim was to determine whether symptoms of lymphoedema could be predictive for the development of ULL. The third aim was to describe the association between the presence/severity of symptoms and the presence/severity of ULL. METHODS A systematic search was conducted in Medline, Scopus, CINAHL and EMBASE databases, with key words related to breast cancer, symptoms and ULL. RESULTS Twenty-nine articles were eligible. The most frequently reported signs and symptoms were swelling (80.9%) and heaviness (66.7%) in the ULL group and tenderness (37%) and numbness (27%) in the non-ULL group. Perceived larger arm size, as well as feelings of arm tightness, stiffness, puffiness, pain, sensory disturbances and functional changes were predictive for the development of ULL. Moderate correlations were found between the presence of swelling, firmness in the past year and tightness now and severity of ULL. There was also moderate correlation between the presence of swelling and heaviness now and the presence of ULL. CONCLUSIONS Swelling and heaviness are the most commonly reported symptoms in patients with ULL. The presences of these two symptoms are moderately correlated with the presence and/or severity of ULL. Although limited information regarding the predictive self-reported symptoms for the development of ULL was found. Further research with standardised definitions of ULL and validated questionnaires for self-reported signs and symptoms are needed to confirm which signs and symptoms are related to ULL and which to other upper limb morbidities.
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Affiliation(s)
- Ceren Gursen
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | | | - Niamh Moloney
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium.,Pain in Motion International Research Group
| | - Tessa De Vrieze
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Physical Medicine and Rehabilitation, Centre for Lymphedema, Leuven, Belgium
| | - An De Groef
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Physical Medicine and Rehabilitation, Centre for Lymphedema, Leuven, Belgium
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Mülkoğlu C, Ayhan F, Erel S. Sexual Functions and Quality of Life in Patients Developing Lymphedema After Total Mastectomy: A Pilot Study. Lymphat Res Biol 2021; 20:220-227. [PMID: 33646047 DOI: 10.1089/lrb.2020.0053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Sexual functions in women with lymphedema secondary to breast cancer surgery have not been investigated sufficiently. This study aimed to compare patients with and without lymphedema after total mastectomy in terms of emotional state, sexual functions, and quality of life. We also investigated the factors affecting sexual functions in these patients. Methods: Married women 20-55 years of age, who presented to lymphedema polyclinic of Health Sciences University Ankara Training and Research Hospital after having undergone total mastectomy at least 1 year earlier owing to breast cancer were included. Twenty-five patients with lymphedema were assigned to the lymphedema group, and 20 without lymphedema to the control group. Hospital Anxiety and Depression Scale (HADS) was used to assess emotional state. We evaluated sexual functions of the participants by Female Sexual Function Index (FSFI) and quality of life with European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QOL-C30). Results: There was no statistically significant difference in age and body mass index between the groups (p > 0.05). The mean HADS score was 13.4 ± 6.5 in lymphedema group and 13.4 ± 6.0 in control group. The groups were also similar in aspect of the HADS score (p > 0.05). FSFI and global health and physical function scores of EORTC QOL-C30 were statistically significantly lower in the lymphedema group (p < 0.05). A statistically significant correlation was found between FSFI and age and time elapsed postmenopause (p < 0.05, for both). Conclusion: We evaluated sexual functions of the patients who underwent mastectomy in this study. Although the HADS score is similar in patients with and without lymphedema, both sexual functions and quality of life are adversely affected in patients who undergo mastectomy and develop lymphedema. This study is important for investigating whether lymphedema developing after total mastectomy affects sexual functions of the patients.
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Affiliation(s)
- Cevriye Mülkoğlu
- Department of Physical Medicine and Rehabilitation, Health Sciences University Ankara Training and Research Hospital, Ankara, Turkey
| | - Figen Ayhan
- Physical Medicine and Rehabilitation, Medicana International Hospital, Ankara, Turkey
| | - Serap Erel
- Department of General Surgery, Health Sciences University Ankara Training and Research Hospital, Ankara, Turkey
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Immediate Lymphatic Reconstruction: Technical Points and Literature Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3431. [PMID: 33680675 PMCID: PMC7929616 DOI: 10.1097/gox.0000000000003431] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/23/2020] [Indexed: 11/26/2022]
Abstract
Recent studies have provided evidence that lymphovenous bypass—microsurgical re-routing of divided lymphatics to an adjacent vein—performed at the time of lymph node dissection decreases the rate of lymphedema development. Immediate lymphatic reconstruction in this setting is technically demanding, and there is a paucity of literature describing the details of the surgical procedure. In this report, we review the literature supporting immediate lymphatic reconstruction and provide technical details to demystify the operation for surgeons who wish to provide this option to their patients.
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128
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Sex Hormones in Lymphedema. Cancers (Basel) 2021; 13:cancers13030530. [PMID: 33573286 PMCID: PMC7866787 DOI: 10.3390/cancers13030530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/21/2021] [Accepted: 01/27/2021] [Indexed: 01/15/2023] Open
Abstract
Simple Summary Lymphedema is a life-long disease that affects a large number of patients treated for breast-, gynecological-, and urologic cancers in Western countries. Given that hormone levels are strongly modified in these conditions, and that patients widely undergo through hormone therapy, it is tempting to speculate that hormones might be key regulators in the maintenance of lymphedema. Despite an obvious prevalence for women, the role of sex hormones and gender has been poorly investigated in this pathology. This review aims to decipher how sex hormones interact with lymphatic vessels and whether hormone therapy could participate in lymphedema development. Abstract Lymphedema is a disorder of the lymphatic vascular system characterized by impaired lymphatic return resulting in swelling of the extremities and accumulation of undrained interstitial fluid/lymph that results in fibrosis and adipose tissue deposition in the limb. Whereas it is clearly established that primary lymphedema is sex-linked with an average ratio of one male for three females, the role of female hormones, in particular estrogens, has been poorly explored. In addition, secondary lymphedema in Western countries affects mainly women who developed the pathology after breast cancer and undergo through hormone therapy up to five years after cancer surgery. Although lymphadenectomy is identified as a trigger factor, the effect of co-morbidities associated to lymphedema remains elusive, in particular, estrogen receptor antagonists or aromatase inhibitors. In addition, the role of sex hormones and gender has been poorly investigated in the etiology of the pathology. Therefore, this review aims to recapitulate the effect of sex hormones on the physiology of the lymphatic system and to investigate whetherhormone therapy could promote a lymphatic dysfunction leading to lymphedema.
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129
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Kim SY, Lee CH, Heo SJ, Moon MH. The Clinical Usefulness of Lymphedema Measurement Technique Using Ultrasound. Lymphat Res Biol 2021; 19:340-346. [PMID: 33404351 DOI: 10.1089/lrb.2019.0070] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: We previously invented a new technique to measure the cross-sectional area of soft tissue of a limb (ΔCSA) with lymphedema using ultrasonography. The measurement correlated strongly with both circumference and volumetry in normal subjects. The purpose of this study was to measure the reliability and accuracy of the method in patients with lymphedema. Methods and Results: Ultrasonography was performed on both arms of 69 female patients diagnosed with stage ≥1 lymphedema related to advanced breast cancer. At 10 cm above elbow (AE) and below elbow (BE), soft-tissue thicknesses at various locations were measured by two examiners. Subcutaneous tissue stiffness was also obtained by measuring thickness differences of soft tissue when applying minimal and maximal pressure to the skin (compliance) and its ratio to the initial thickness (compliance ratio). ΔCSA showed a strong positive correlation with circumference (r = 0.758 to 0.951), and a moderate negative correlation with Z at 5 Hz (r = -0.326 to -0.486). Intra- and interclass coefficients of all ultrasonography measurements were moderate to excellent (0.623-0.990). Compliance measured at 10 cm BE on the lesion side was significantly higher than on the normal side (p < 0.001), and compliance measured at 10 cm AE showed no difference between the two sides (p = 0.653). Conversely, compliance ratios measured at 10 cm AE and BE on the lesion side were significantly lower than on the normal side (p < 0.001). Conclusion: Thus, ΔCSA using ultrasonography could be a particularly viable option for determining status in lymphedema patients.
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Affiliation(s)
- Soo-Yeon Kim
- Department of Rehabilitation Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Chang-Hyung Lee
- Department of Rehabilitation Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Sung Jin Heo
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Myung-Hoon Moon
- Department of Rehabilitation Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
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Scaglioni MF, Meroni M, Fritsche E. Combining superficial and deep lymphovenous anastomosis for lymphedema treatment: Preliminary results. Microsurgery 2021; 42:22-31. [PMID: 33394562 DOI: 10.1002/micr.30701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/15/2020] [Accepted: 12/18/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Superficial lymphovenous anastomosis (LVA) is a widely accepted procedure for treatment of mild-to-moderate lymphedema throughout the body. Anyway, not always are the superficial lymphatic vessels suitable for the anastomosis nor do they provide a sufficient drainage to significantly improve the condition. The continuous progress of supermicrosurgical technique over the last few years and the recent anatomical researches about the deep lymphatic network opened new perspectives for those lymphedema cases refractory to conventional procedures. Resorting to deep lymphatic vessels offer an additional opportunity to further improve the result obtained by means of superficial LVA. The aim of this report is to describe our experience treating lymphedema with superficial and deep lymphatic vessels LVA. PATIENTS AND METHODS Eight female patients presenting secondary (seven cases) and primary (one case) lymphedema, previously treated by means of multiple superficial LVAs, were considered eligible for deep lymphatics surgery to further improve their results. The affected area was the upper limb in one case and the lower limbs in seven cases. All the patients were evaluated preoperatively and postoperatively resorting to Campisi criteria. Four cases were initially classified as stage III, two stage IV, and two stage II. Five patients received deep LVA in the groin, two patients in the ankle along the posterior tibial artery and one in the wrist along the radial artery. RESULTS In all eight patients both subjective and objective improvements of the condition were reported with decrease of swelling and relief from heaviness sensation. The postoperative course was always uneventful and at the 9 months follow up none of the patients presented recurrence of the disease, even with the complete removal of compressive therapy. CONCLUSIONS Deep lymphatic vessels LVA might represent a valid alternative to the superficial ones to treat lymphedema when previous results are not satisfactory nor when no superficial lymphatic vessels are available for anastomosis.
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Affiliation(s)
- Mario F Scaglioni
- Depatment of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Matteo Meroni
- Depatment of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Elmar Fritsche
- Depatment of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
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131
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Hattori Y, Hayashi K, Sakamoto S, Doi K. Upper Extremity Volume/Total Body Volume Ratio for Evaluation of Upper Extremity Lymphedema. Ann Plast Surg 2021; 86:35-38. [PMID: 32826440 DOI: 10.1097/sap.0000000000002505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Measurement of extremity volume is the most commonly used method for evaluation of lymphedema. However, volumetry would be inappropriate for comparing patients with different physiques, because body-type significantly affects extremity volume. Thus, we cannot evaluate using absolute values. To overcome this problem, we developed a simple index of proportion of the upper-extremity volume to total body volume (upper-extremity volume/total body volume ratio [UVR]) for body type-corrected volume evaluation of upper-extremity lymphedema. The purpose of this study was to compare upper-extremity volume and UVR in nonedematous upper extremities and to establish normative values of UVR in adult women. METHODS Eighty-five normal female subjects were included in this study. The average age was 38 ± 12 years, and the average body mass index (BMI) was 21.4 ± 2.9. Volumetry of both upper extremities using water displacement method was tested in all subjects. Upper-extremity volume/total body volume ratio was calculated by dividing upper-extremity volume by total body volume. Total body volume was calculated by dividing body weight (g) by body density (g/mL). We used linear regression equation (body density = 1.0560 - 0.0005 × age) to calculate body density. RESULTS UVR of 170 upper extremities averaged 2.580 ± 0.202%. Although there was significant relationship between upper-extremity volume and BMI, there was no relationship between UVR and BMI. CONCLUSIONS Although further studies are necessary to establish usefulness of UVR, UVR has a potential to allow better body type-corrected volume evaluation for upper-extremity lymphedema.
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Affiliation(s)
- Yasunori Hattori
- From the Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
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132
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Yakimov BP, Gurfinkel YI, Davydov DA, Allenova AS, Budylin GS, Vasiliev VY, Soldatova VY, Kamalov AA, Matskeplishvili ST, Priezzhev AV, Shirshin EA. Pericapillary Edema Assessment by Means of the Nailfold Capillaroscopy and Laser Scanning Microscopy. Diagnostics (Basel) 2020; 10:diagnostics10121107. [PMID: 33353241 PMCID: PMC7766602 DOI: 10.3390/diagnostics10121107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 01/09/2023] Open
Abstract
Edema, i.e., fluid accumulation in the interstitial space, accompanies numerous pathological states of the human organism, including heart failure (HF), inflammatory response, and lymphedema. Nevertheless, techniques for quantitative assessment of the edema’s severity and dynamics are absent in clinical practice, and the analysis is mainly limited to physical examination. This fact stimulates the development of novel methods for fast and reliable diagnostics of fluid retention in tissues. In this work, we focused on the possibilities of two microscopic techniques, nailfold video capillaroscopy (NVC) and confocal laser scanning microscopy (CLSM), in the assessment of the short-term and long-term cutaneous edema. We showed that for the patients with HF, morphological parameters obtained by NVC—namely, the apical diameter of capillaries and the size of the perivascular zone—indicate long-term edema. On the other hand, for healthy volunteers, the application of two models of short-term edema, venous occlusion, and histamine treatment of the skin, did not reveal notable changes in the capillary parameters. However, a significant reduction of the NVC image sharpness was observed in this case, which was suggested to be due to water accumulation in the epidermis. To verify these findings, we made use of CLSM, which provides the skin structure with cellular resolution. It was observed that for the histamine-treated skin, the areas of the dermal papillae become hyporefractive, leading to the loss of contrast and the lower visibility of capillaries. Similar effect was observed for patients undergoing infusion therapy. Collectively, our results reveal the parameters can be used for pericapillary edema assessment using the NVC and CLSM, and paves the way for their application in a clinical set-up.
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Affiliation(s)
- Boris P. Yakimov
- Faculty of Physics, Lomonosov Moscow State University, Leninskie Gory 1/2, 119991 Moscow, Russia; (B.P.Y.); (D.A.D.); (A.V.P.)
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Trubetskaya 8-2, 119991 Moscow, Russia
| | - Yury I. Gurfinkel
- Medical Research and Education Center, M.V. Lomonosov Moscow State University, Lomonosovsky Prospect 27/10, 119991 Moscow, Russia; (Y.I.G.); (G.S.B.); (A.A.K.); (S.T.M.)
| | - Denis A. Davydov
- Faculty of Physics, Lomonosov Moscow State University, Leninskie Gory 1/2, 119991 Moscow, Russia; (B.P.Y.); (D.A.D.); (A.V.P.)
| | - Anastasia S. Allenova
- Division of Immune-Mediated Skin Diseases, Sechenov First Moscow State Medical University, Trubetskaya 8-2, 119991 Moscow, Russia;
| | - Gleb S. Budylin
- Medical Research and Education Center, M.V. Lomonosov Moscow State University, Lomonosovsky Prospect 27/10, 119991 Moscow, Russia; (Y.I.G.); (G.S.B.); (A.A.K.); (S.T.M.)
- Institute of Spectroscopy of the Russian Academy of Sciences, Fizicheskaya Street, 5, Troitsk, 108840 Moscow, Russia
| | - Vladimir Yu. Vasiliev
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Delegatskaya Street, 20, 127473 Moscow, Russia; (V.Y.V.); (V.Y.S.)
| | - Vera Yu. Soldatova
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Delegatskaya Street, 20, 127473 Moscow, Russia; (V.Y.V.); (V.Y.S.)
| | - Armais A. Kamalov
- Medical Research and Education Center, M.V. Lomonosov Moscow State University, Lomonosovsky Prospect 27/10, 119991 Moscow, Russia; (Y.I.G.); (G.S.B.); (A.A.K.); (S.T.M.)
| | - Simon T. Matskeplishvili
- Medical Research and Education Center, M.V. Lomonosov Moscow State University, Lomonosovsky Prospect 27/10, 119991 Moscow, Russia; (Y.I.G.); (G.S.B.); (A.A.K.); (S.T.M.)
| | - Alexander V. Priezzhev
- Faculty of Physics, Lomonosov Moscow State University, Leninskie Gory 1/2, 119991 Moscow, Russia; (B.P.Y.); (D.A.D.); (A.V.P.)
| | - Evgeny A. Shirshin
- Faculty of Physics, Lomonosov Moscow State University, Leninskie Gory 1/2, 119991 Moscow, Russia; (B.P.Y.); (D.A.D.); (A.V.P.)
- Medical Research and Education Center, M.V. Lomonosov Moscow State University, Lomonosovsky Prospect 27/10, 119991 Moscow, Russia; (Y.I.G.); (G.S.B.); (A.A.K.); (S.T.M.)
- Correspondence:
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Shah C, Zambelli-Weiner A, Delgado N, Sier A, Bauserman R, Nelms J. The impact of monitoring techniques on progression to chronic breast cancer-related lymphedema: a meta-analysis comparing bioimpedance spectroscopy versus circumferential measurements. Breast Cancer Res Treat 2020; 185:709-740. [PMID: 33245458 PMCID: PMC7921068 DOI: 10.1007/s10549-020-05988-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/20/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Chronic breast cancer-related lymphedema (BCRL) is a potentially serious complication following treatment. Monitoring for progression to BCRL may allow for earlier detection and intervention, reducing the rate of progression to chronic BCRL. Therefore, the purpose of this meta-analysis is to evaluate the impact of monitoring techniques on the incidence of chronic BCRL among patients monitored by bioimpedance spectroscopy (BIS) and circumference as compared to background rates. METHODS Eligible peer-reviewed studies from PubMed, CINHAL, or Google Scholar that were published in English from 2013 onward and conducted in North America, Europe, or Oceania. Incidence rates abstracted from studies were classified by BCRL monitoring method: background (no standardized BIS or circumference assessments), BIS or circumference. A random-effects model was used to calculate a pooled annualized estimate of BCRL incidence while accounting for clinical and methodological heterogeneity. Subgroup analyses examined differences in duration of follow-up as well as breast and axillary surgery. RESULTS 50 studies were included, representing over 67,000 women. The annualized incidence of BCRL was 4.9% (95% CI: 4.3-5.5) for background studies (n = 35), 1.5% (95% CI: 0.6-2.4) for BIS-monitored studies (n = 7), and 7.7% (95% CI: 5.6-9.8) for circumference-monitored studies (n = 11). The cumulative BCRL incidence rate in BIS-monitored patients was 3.1% as compared to 12.9% with background monitoring (69% reduction) and 17.0% with circumference-monitored patients (81% reduction). CONCLUSIONS Evidence suggests that monitoring with BIS allowing for early intervention significantly reduces the relative risk of chronic BCRL with a 69% and 81% reduction compared to background and circumference, respectively. Circumference monitoring did not appear to provide a benefit with respect to chronic BCRL incidence. Based on these results, BIS should be considered for BCRL screening in order to detect subclinical BCRL and reduce rates of chronic BCRL, particularly in high-risk patients.
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Affiliation(s)
- Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
| | | | | | - Ashley Sier
- TTi Health Research and Economics, Westminster, MD, USA
| | | | - Jerrod Nelms
- TTi Health Research and Economics, Westminster, MD, USA
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134
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Ineshina AD, Savchenko SV, Bgatova NP, Soluyanov MY, Nimaev VV. [The morphology of the connective tissue matrix and lymphatic bed of the external genitalia in primary massive localized lymphedema]. Arkh Patol 2020; 82:67-72. [PMID: 33054035 DOI: 10.17116/patol20208205167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify the structural organization of connective tissue and vascular bed of the external genitalia in primary massive localized lymphedema. To analyze a clinical case of the development of massive localized lymphedema of the external genitalia concurrent with primary lymphedema of the lower limb in a patient with a normal body mass index. MATERIAL AND METHODS The samples obtained by resection during volume reduction surgery were used to study the morphological features of the lymphatic bed and extracellular matrix of the scrotal skin and testicular dartos versus the samples without pathological changes. Biological samples were processed using standard techniques for histological, immunohistochemical and ultrastructural analyses. Lymphatic vessels were differentiated using the molecular lymphatic endothelial marker Podoplanin. RESULTS In lymphedema, there was an increase in the thickness of all scrotal skin layers, a decrease in the volumetric lymphatic vessel density, an expansion of the interstitial spaces, and a change in the structure of collagen fibers that were homogenized, loosened, and swollen and did not form a three-dimensional network. The testicular dartos exhibited intermuscular fibrosis, expansion of the interstitial spaces, and perivascular leukocytic infiltration. CONCLUSION Histological and immunohistochemical analyses revealed changes in the structural organization of the connective tissue matrix and lymphatic bed of the scrotal skin and testicular dartos in long-standing massive localized lymphedema. The feature of the described clinical case was the absence of signs of chronic inflammation and severe diffuse fibrosis in primary scrotal massive localized lymphedema in a patient with a normal body mass index.
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Affiliation(s)
- A D Ineshina
- Research Institute of Clinical and Experimental Lymphology of the Federal Research Center Institute of Cytology and Genetics of Siberian Branch of Russian Academy of Science, Novosibirsk, Russia.,V. Zelman Institute of Medicine and Psychology of the Novosibirsk National Research State University, Novosibirsk, Russia
| | - S V Savchenko
- Novosibirsk State Medical University, Novosibirsk, Russia
| | - N P Bgatova
- Research Institute of Clinical and Experimental Lymphology of the Federal Research Center Institute of Cytology and Genetics of Siberian Branch of Russian Academy of Science, Novosibirsk, Russia
| | - M Yu Soluyanov
- Research Institute of Clinical and Experimental Lymphology of the Federal Research Center Institute of Cytology and Genetics of Siberian Branch of Russian Academy of Science, Novosibirsk, Russia.,V. Zelman Institute of Medicine and Psychology of the Novosibirsk National Research State University, Novosibirsk, Russia
| | - V V Nimaev
- Research Institute of Clinical and Experimental Lymphology of the Federal Research Center Institute of Cytology and Genetics of Siberian Branch of Russian Academy of Science, Novosibirsk, Russia.,V. Zelman Institute of Medicine and Psychology of the Novosibirsk National Research State University, Novosibirsk, Russia
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White BN, Lu IM, Kao LS, Dixon JB, Weiler MJ, Frank ND, Binkley J, Subhedar P, Okoli J, Buhariwalla K, Suarez-Ligon A, Gabram-Mendola SGA. An infrared 3D scanning device as a novel limb volume measurement tool in breast cancer patients. World J Surg Oncol 2020; 18:278. [PMID: 33109204 PMCID: PMC7592580 DOI: 10.1186/s12957-020-02043-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/02/2020] [Indexed: 12/24/2022] Open
Abstract
Abstract Background Lymphedema is a common complication of breast cancer treatment that affects one in five breast cancer survivors, yet there is no reliable method to detect lymphedema in the subclinical range. The objective of this study was to determine the feasibility and reliability of using an infrared 3D scanning device (ISD) as a peri-operative limb volume measurement tool. Methods Fifteen patients were analyzed based on inclusion criteria. Peri-operative measurements were obtained using tape measure and an ISD. Volumes were calculated using a standard algorithm for tape measure and a custom algorithm for ISD measurements. Linear regression models were used to assess ISD and tape measurement volume and circumference correlation. One-way ANOVA was used to compare change in percent difference at set time points post-operatively (2–3 weeks, 4–6 weeks, and 7–12 weeks) for both ISD and tape measure. t tests for unequal variances with the Bonferroni correction were performed among these groups. Results There is a positive linear correlation (R2 = 0.8518) between absolute volume measurements by the ISD and tape measure. Analyses over 2–10 weeks post-operatively showed that the ISD was able to detect volume changes in both the unaffected and the affected arm. Furthermore, the affected arm tended to have a greater increase in volume in the majority of patients, indicating these patients could be at risk for lymphedema. Conclusions Technology utilizing infrared 3D scanners can reliably measure limb volume pre- and post-treatment similarly to tape measure in a small sample of patients. Further research using 3D scanning technology with a longer follow up is warranted.
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Affiliation(s)
- Bernadette N White
- Emory University School of Medicine and Grady Memorial Hospital Avon Comprehensive Breast Center, Atlanta, GA, USA
| | - Iris M Lu
- Georgia Institute of Technology, Atlanta, GA, USA
| | - LeslieAnn S Kao
- Emory University School of Medicine and Grady Memorial Hospital Avon Comprehensive Breast Center, Atlanta, GA, USA
| | | | | | | | - Jill Binkley
- TurningPoint Breast Cancer Rehabilitation, Atlanta, GA, USA
| | - Preeti Subhedar
- Emory University School of Medicine and Grady Memorial Hospital Avon Comprehensive Breast Center, Atlanta, GA, USA
| | - Joel Okoli
- Morehouse School of Medicine, Atlanta, GA, USA
| | | | | | - Sheryl G A Gabram-Mendola
- Emory University School of Medicine and Grady Memorial Hospital Avon Comprehensive Breast Center, Atlanta, GA, USA.
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Barki A, Dua-Boateng P, Mhanna T, Houmaidi AE, Souarji A, Allat Oufkir A. Penoscrotal lymphedema revealing a lymphoma: A case report. Urol Case Rep 2020; 33:101308. [PMID: 33102011 PMCID: PMC7573832 DOI: 10.1016/j.eucr.2020.101308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/14/2020] [Accepted: 06/17/2020] [Indexed: 10/31/2022] Open
Abstract
Penoscrotal lymphedema is a rare condition. The authors present an exceptional case of a 60-year-old male patient who presented with a penoscrotal lymphedema leading to the discovery of an underlying lymphoma. The patient underwent chemotherapy followed by an excision of the affected tissues with reconstructive surgery with satisfactory results.
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Affiliation(s)
- Ali Barki
- Department of Urology, Mohammed IV University Medical Center, Mohammed the First University Oujda, Morocco
| | - Paapa Dua-Boateng
- Department of Urology, Mohammed IV University Medical Center, Mohammed the First University Oujda, Morocco
| | - Tarik Mhanna
- Department of Urology, Mohammed IV University Medical Center, Mohammed the First University Oujda, Morocco
| | - Amine El Houmaidi
- Department of Urology, Mohammed IV University Medical Center, Mohammed the First University Oujda, Morocco
| | - Ayoub Souarji
- Department of Plastic Surgery, Mohammed IV University Medical Center, Mohammed the First University Oujda, Morocco
| | - Aya Allat Oufkir
- Department of Plastic Surgery, Mohammed IV University Medical Center, Mohammed the First University Oujda, Morocco
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Akgul A, Tarakci E, Arman N, Civi T, Irmak S. A Randomized Controlled Trial Comparing Platelet-Rich Plasma, Low-Level Laser Therapy, and Complex Decongestive Physiotherapy in Patients with Lower Limb Lymphedema. Lymphat Res Biol 2020; 18:439-447. [DOI: 10.1089/lrb.2019.0064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Ahmet Akgul
- Division of Gerontology, Faculty of Health Sciences, Istanbul University Cerrahpaşa, Istanbul, Turkey
- Ist-GETAM, Center of Gerontechnology, Istanbul University Cerrahpaşa, Istanbul, Turkey
- Division of Cardiovascular Surgery, Bakirköy Education and Research Hospital, Istanbul, Turkey
| | - Ela Tarakci
- Ist-GETAM, Center of Gerontechnology, Istanbul University Cerrahpaşa, Istanbul, Turkey
- Division of Physiotherapy and Rehabilitation, Department of Neurologic Physiotherapy and Rehabilitation, Faculty of Health Science, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | - Nilay Arman
- Ist-GETAM, Center of Gerontechnology, Istanbul University Cerrahpaşa, Istanbul, Turkey
- Division of Physiotherapy and Rehabilitation, Department of Neurologic Physiotherapy and Rehabilitation, Faculty of Health Science, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | - Tugba Civi
- Ist-GETAM, Center of Gerontechnology, Istanbul University Cerrahpaşa, Istanbul, Turkey
- Division of Physiotherapy and Rehabilitation, Department of Neurologic Physiotherapy and Rehabilitation, Faculty of Health Science, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | - Selin Irmak
- Division of Gerontology, Faculty of Health Sciences, Istanbul University Cerrahpaşa, Istanbul, Turkey
- Ist-GETAM, Center of Gerontechnology, Istanbul University Cerrahpaşa, Istanbul, Turkey
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138
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Lee KW, Kim SB, Lee JH, Kim YS. Effects of Extracorporeal Shockwave Therapy on Improvements in Lymphedema, Quality of Life, and Fibrous Tissue in Breast Cancer-Related Lymphedema. Ann Rehabil Med 2020; 44:386-392. [PMID: 32986941 PMCID: PMC7655225 DOI: 10.5535/arm.19213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/04/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the effects of extracorporeal shockwave therapy (ESWT) on improving lymphedema, quality of life, and fibrous tissue in patients with stage 2 lymphedema. METHODS Breast cancer-related lymphedema patients referred to the rehabilitation center were recruited. We enrolled stage 2 lymphedema patients who had firmness of the skin at their forearm, a circumference difference of more than 2 cm between each arm, or a volume difference between upper extremities greater than 200 mL, confirmed by lymphoscintigraphy. The patients were randomly divided into the ESWT group and the control group. ESWT was performed for 3 weeks (two sessions per week); both groups received complex decongestive physical therapy. All patients were evaluated at baseline and at 3 weeks after treatment. The measurements performed included visual analog scale score, volume, circumference, QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand) score, bioelectrical impedance, and skin thickness. RESULTS The patients in both groups (n=15 in each group) completed the 3-week therapy experiment. No significant differences were observed in demographic characteristics between groups. After the 3-week treatment period, improvement was noted in the circumference difference below the elbow, volume, ratio of extracellular water to total body water, and skin thickness in the ESWT group. A significant difference was found in all the above-mentioned areas except in circumference below the elbow in the ESWT group. CONCLUSION ESWT reduced edema and skin fibrosis without significant complications. Therefore, ESWT can be used together with complex decongestive physical therapy for treating lymphedema.
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Affiliation(s)
- Kyeong Woo Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Korea
| | - Sang Beom Kim
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Korea
| | - Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Korea
| | - Young Sam Kim
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Korea
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139
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Michelini S, Ricci M, Serrani R, Stuppia L, Beccari T, Veselenyiova D, Kenanoglu S, Barati S, Kurti D, Baglivo M, Basha SH, Krajcovic J, Dundar M, Bertelli M. Possible Role of the RORC Gene in Primary and Secondary Lymphedema: Review of the Literature and Genetic Study of Two Rare Causative Variants. Lymphat Res Biol 2020; 19:129-133. [PMID: 32960152 DOI: 10.1089/lrb.2020.0030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: RAR-related Orphan Receptor C (RORC) is a DNA-binding transcription factor and the key transcription factor responsible for differentiation of T helper 17 cells. The RORC gene plays a role in lymphoid organogenesis, thymopoiesis, and lymph node organogenesis. The aim of our study was to determine the possible role of RORC in the development of lymphatic system malformations by combining data from the scientific literature and next-generation sequencing of RORC in lymphedema patients negative for known causative genes. Methods and Results: We sequenced RORC in 235 lymphedema patients negative for known lymphedema-associated genes. We found two probands carrying nonsense RORC variants. Conclusions: We show that RORC is important for normal function of the lymphatic system and that a rare variant with a possible causative effect may imply predisposition for lymphedema.
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Affiliation(s)
- Sandro Michelini
- Department of Vascular Rehabilitation, San Giovanni Battista Hospital, Rome, Italy
| | - Maurizio Ricci
- Rehabilitative Medicine, University Hospital, Ospedali Riuniti of Ancona, Torrette, Italy
| | - Roberta Serrani
- Rehabilitative Medicine, University Hospital, Ospedali Riuniti of Ancona, Torrette, Italy
| | - Liborio Stuppia
- Aging and Translational Medicine Research Center (CeSI-MeT), University "G. d'Annunzio," Chieti-Pescara, Italy
| | - Tommaso Beccari
- Department of Pharmaceutical Sciences, University of Perugia, Via Fabretti 48, Perugia, Italy
| | - Dominika Veselenyiova
- Department of Biology, Faculty of Natural Sciences, University of Ss. Cyril and Methodius in Trnava, Trnava, Slovakia
- MAGI Euregio, Bolzano, Italy
| | - Sercan Kenanoglu
- MAGI Euregio, Bolzano, Italy
- Department of Medical Genetics, Erciyes University, Kayseri, Turkey
| | | | - Danjela Kurti
- MAGI Euregio, Bolzano, Italy
- MAGI-Balkan, Tirana, Albania
| | | | | | - Juraj Krajcovic
- Department of Biology, Faculty of Natural Sciences, University of Ss. Cyril and Methodius in Trnava, Trnava, Slovakia
| | - Munis Dundar
- Department of Medical Genetics, Erciyes University, Kayseri, Turkey
| | - Matteo Bertelli
- MAGI Euregio, Bolzano, Italy
- EBTNA-Lab, Rovereto, TN, Italy
- MAGI's Lab, Rovereto, TN, Italy
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Abstract
Lymphatic flow plays a notable role in the regulation of bone formation and remodeling. Chronic accumulation of the lymph fluid within tissues may lead to issues with proper bone healing after fractures, emphasizing the importance of proper management of lymphedema after trauma. Many associated risk factors place patients at risk for lymphedema, including previous surgery with nodal dissection, radiation therapy, infection, malignancy, family history of congenital lymphedema, and trauma. The benchmark imaging technique for the diagnosis of lymphedema is lymphoscintigraphy. Other modalities include duplex ultrasonography, CT, and MRI. First-line conservative treatment of lymphedema is compression. Complete decongestive therapy or complex physical therapy, also known as decongestive lymphatic therapy (DLT), has shown positive results in reducing lymphedema. Surgical interventions aim to either reconstruct and restore function of the lymphatic system or debulk and reduce tissues and fluids. Understanding the significance of lymphedema on bone healing and techniques available to recognize it are important factors in preventing delay in diagnosis and ensuring proper management of lymphedema after trauma.
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141
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Dean SM, Valenti E, Hock K, Leffler J, Compston A, Abraham WT. The clinical characteristics of lower extremity lymphedema in 440 patients. J Vasc Surg Venous Lymphat Disord 2020; 8:851-859. [DOI: 10.1016/j.jvsv.2019.11.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 11/13/2019] [Indexed: 02/04/2023]
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142
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Yildirim MEC, Chen SH, Weng HC, Mousavi SA, Chen HC. Treatment of toes as an integrated part of infection control for advanced lower limb lymphedema. J Plast Reconstr Aesthet Surg 2020; 74:168-173. [PMID: 32900654 DOI: 10.1016/j.bjps.2020.08.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 04/02/2020] [Accepted: 08/01/2020] [Indexed: 11/17/2022]
Abstract
The aim of this study was to compare the incidence of infection and verrucous hyperkeratosis in patients who underwent surgery for advanced lymphedema according to the algorithm designed by the senior author, and were treated concurrently with/without toe treatment. A case series (Between 2004-2015) of 46 patients with unilateral advanced lower limb lymphedema was reviewed. Lymphoscintigraphy was used for evaluation of lymphedema severity. The ICG lymphography was used for staging. Fibrosis and skin induration were reflected by the tonicity. They were divided into two groups: (1) patients who underwent further treatment of toes according to the algorithm, and (2) patients who did not have toe-related treatment. Infection episodes and verrucous hyperkeratosis were recorded. There were 21 and 25 patients in Groups 1 and 2, respectively. All lymphoscintigrams showed severe dermal backflow with severe stagnation by 2.5 h after injection of Tc-99 colloid. All patients were stage IV or V. Tonicity values of skin were <60. Group 1 was reduced to an average of 0.6 episodes per year in the past year of follow-up, and Group 2 was reduced to an average of 1.5 episodes per year in the past year of follow-up (p <0.001). The average frequency of preoperative cellulitis was 3.6 episodes per year. The occurrence of verrucous hyperkeratosis was observed in 14.3% and 32% of Groups 1 and 2, respectively. The incidences of cellulitis and verrucous hyperkeratosis were significantly lower in Group 1 than in Group 2 (p <0.001). To achieve successful control of infection, they should be treated carefully according to the strategy described above.
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Affiliation(s)
| | - Shih-Heng Chen
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.
| | - Hui-Ching Weng
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - Hung Chi Chen
- Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan.
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143
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Munir H, Mazzaglia C, Shields JD. Stromal regulation of tumor-associated lymphatics. Adv Drug Deliv Rev 2020; 161-162:75-89. [PMID: 32783989 DOI: 10.1016/j.addr.2020.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/27/2020] [Accepted: 08/06/2020] [Indexed: 02/08/2023]
Abstract
Recent advances have identified a growing array of roles played by lymphatics in the tumor microenvironment, from providing a route of metastasis to immune modulation. The tumor microenvironment represents an exceptionally complex, dynamic niche comprised of a diverse mixture of cancer cells and normal host cells termed the stroma. This review discusses our current understanding of stromal elements and how they regulate lymphatic growth and functional properties in the tumor context.
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Affiliation(s)
- Hafsa Munir
- MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Box 197 Cambridge Biomedical Campus, Cambridge, CB2 0XZ
| | - Corrado Mazzaglia
- MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Box 197 Cambridge Biomedical Campus, Cambridge, CB2 0XZ
| | - Jacqueline D Shields
- MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Box 197 Cambridge Biomedical Campus, Cambridge, CB2 0XZ.
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144
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Treatment of Post-mastectomy Lymphedema with Herbal Medicine: An Innovative Pilot Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2915. [PMID: 32766062 PMCID: PMC7339371 DOI: 10.1097/gox.0000000000002915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/21/2020] [Indexed: 11/25/2022]
Abstract
Background Lymphedema of the arms or legs is a difficult clinical problem yet devoid of effective treatment. Lymphedema is the result of obstructed lymphatic flow secondary to chronic infection, parasitic infestation, or postsurgical obstruction (eg, after axillary dissections). We arranged this clinical trial to investigate whether patients with limb lymphedema can benefit from a standard dose of Astragalus plus Paeoniae rubra to improve the symptomatology, functional capacity, and quality of life (QOL). Method The pilot study was designed as a self-control clinical trial. Patients with post-mastectomy lymphedema were recruited. A double-herb formulation (Astragalus, Paeoniae rubra) with standard dosage was administered orally in a powdered form, 6 times per week for 6 months. Outcome measurements included standard limb volume changes measured by water displacement method; handgrip strength; and QOL for limb lymphedema questionnaire (LYMQOL). Results There were no reported adverse effects or complications; there were no episodes of infection during the period of study. There was a tendency of limb volume reduction by 6 months, which, however, did not reach statistical significance. There was a significant improvement in appearance and symptom scores as was assessed with the LYMQOL questionnaire. Conclusions The oral herbal formula improved the symptomatology and QOL among the pilot group of patients with post-mastectomy lymphedema. Side effects were absent, and there was a trend of lymphedema reduction.
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145
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Kinesio taping and low-level laser therapy in breast cancer-related lymphedema in an arm with arteriovenous fistula for hemodialysis. Turk J Phys Med Rehabil 2020; 66:214-218. [PMID: 32760900 DOI: 10.5606/tftrd.2020.3430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 01/04/2019] [Indexed: 11/21/2022] Open
Abstract
Secondary lymphedema mainly occurs as a result of impairment or obstruction of the lymphatic system. Although complex decongestive therapy is recognized as the best management technique of lymphedema, we encounter various patient profiles in our clinical practice and may need to apply alternative treatment options. In this article, we report a 57-year-old female patient with breast cancer-related lymphedema and arteriovenous (AV) fistula for hemodialysis in the same arm. We performed low-level laser therapy treatment for 12 sessions, kinesio taping, and remedial exercises to the patient as the compression part of complex decongestive therapy was contraindicated in the AV fistula. Self-manual lymphatic drainage training and skin care education were also given. The arm volume difference was decreased from 691 mL to 454 mL after the treatments. Low-level laser therapy and kinesio taping should be kept in mind as alternative techniques for appropriate cases in the treatment of lymphedema.
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146
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Wang D, Lyons D, Skoracki R. Lymphedema: Conventional to Cutting Edge Treatment. Semin Intervent Radiol 2020; 37:295-308. [PMID: 32773955 DOI: 10.1055/s-0040-1713447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Lymphedema of the extremities related to oncologic therapies such as cancer surgery, radiation therapy, and chemotherapy is a major long-term cause of morbidity for cancer patients. Both nonsurgical and surgical management strategies have been developed. The goals of these therapies are to achieve volume reduction of the affected extremity, a reduction in patient symptoms, and a reduction in associated morbidities such as recurrent soft-tissue infections. In this article, we review both nonsurgical and surgical management strategies. Traditional surgical therapy has focused on more ablative techniques such as the Charles procedure and suction-assisted lipectomy/liposuction. However, newer more physiologic surgical methods such as lymphovenous anastomoses and vascularized lymph node transfers have become a more common treatment modality for the management of this complex problem.
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Affiliation(s)
- Duane Wang
- Department of Plastic Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Daniel Lyons
- Department of Plastic Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Roman Skoracki
- Department of Plastic Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
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147
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Will PA, Rafiei A, Pretze M, Gazyakan E, Ziegler B, Kneser U, Engel H, Wängler B, Kzhyshkowska J, Hirche C. Evidence of stage progression in a novel, validated fluorescence-navigated and microsurgical-assisted secondary lymphedema rodent model. PLoS One 2020; 15:e0235965. [PMID: 32701960 PMCID: PMC7377415 DOI: 10.1371/journal.pone.0235965] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/25/2020] [Indexed: 11/19/2022] Open
Abstract
Secondary lymphedema (SL)is a frequent and devastating complication of modern oncological therapy and filarial infections. A lack of a reliable preclinical model to investigate the underlying mechanism of clinical stage progression has limited the development of new therapeutic strategies. Current first line treatment has shown to be merely symptomatic and relies on lifetime use of compression garments and decongestive physiotherapy. In this study, we present the development of a secondary lymphedema model in 35 rats using pre- and intraoperative fluorescence-guided mapping of the lymphatics and microsurgical induction. In contrast to the few models reported so far, we decided to avoid the use of radiation for lymphedema induction. It turned out, that the model is nearly free of complications and capable of generating a statistically significant limb volume increase by water displacement measurements, sustained for at least 48 days. A translational, accurate lymphatic dysfunction was visualized by a novel VIS-NIR X-ray ICG-Clearance-Capacity imaging technology. For the first-time SL stage progression was validated by characteristic histological alterations, such as subdermal mast cell infiltration, adipose tissue deposition, and fibrosis by increased skin collagen content. Immunofluorescence confocal microscopy analysis suggested that stage progression is related to the presence of a characteristic α SMA+/HSP-47+/vimentin+ fibroblast subpopulation phenotype. These findings demonstrate that the in-vivo model is a reliable and clinically relevant SL model for the development of further secondary lymphedema therapeutic strategies and the analysis of the veiled molecular mechanisms of lymphatic dysfunction.
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Affiliation(s)
- P. A. Will
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Centre, BG-Trauma Hospital Ludwigshafen, Ludwigshafen, Germany
| | - A. Rafiei
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Centre, BG-Trauma Hospital Ludwigshafen, Ludwigshafen, Germany
| | - M. Pretze
- Department of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - E. Gazyakan
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Centre, BG-Trauma Hospital Ludwigshafen, Ludwigshafen, Germany
| | - B. Ziegler
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Centre, BG-Trauma Hospital Ludwigshafen, Ludwigshafen, Germany
| | - U. Kneser
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Centre, BG-Trauma Hospital Ludwigshafen, Ludwigshafen, Germany
| | - H. Engel
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Centre, BG-Trauma Hospital Ludwigshafen, Ludwigshafen, Germany
- Ethianum Klinik Heidelberg, Heidelberg, Germany
| | - B. Wängler
- Department of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - J. Kzhyshkowska
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- German Red Cross Blood Service Baden-Württemberg—Hessen, Frankfurt, Germany
| | - C. Hirche
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Centre, BG-Trauma Hospital Ludwigshafen, Ludwigshafen, Germany
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Akita S, Unno N, Maegawa J, Kimata Y, Fukamizu H, Yabuki Y, Shinaoka A, Sano M, Kawasaki Y, Fujiwara T, Hanaoka H, Mitsukawa N. HAMAMATSU-ICG study: Protocol for a phase III, multicentre, single-arm study to assess the usefulness of indocyanine green fluorescent lymphography in assessing secondary lymphoedema. Contemp Clin Trials Commun 2020; 19:100595. [PMID: 32617434 PMCID: PMC7322679 DOI: 10.1016/j.conctc.2020.100595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 06/07/2020] [Accepted: 06/14/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction Secondary lymphoedema of the extremities is an important quality-of-life issue for patients who were treated for their malignancies. Indocyanine green (ICG) fluorescent lymphography may be helpful for assessing lymphoedema and for planning lymphaticovenular anastomosis (LVA). The objective of the present clinical trial is to confirm whether or not ICG fluorescent lymphography using the near-infrared monitoring camera is useful for assessing the indication for LVA, for the identification of the lymphatic vessels before the conduct of LVA, and for the confirmation of the patency of the anastomosis site during surgery. Methods and analysis This trial is a phase III, multicentre, single-arm, open-label clinical trial to assess the efficacy and safety of ICG fluorescent lymphography when assessing and treating lymphoedema of patients with secondary lymphoedema who are under consideration for LVA. The primary endpoint is the identification rate of the lymphatic vessels at the incision site based on ICG fluorescent lymphograms obtained before surgery. The secondary endpoints are 1) the sensitivity and specificity of dermal back flow determined by ICG fluorescent lymphography as compared with 99mTc lymphoscintigraphy—one of the standard diagnostic methods and 2) the usefulness of ICG fluorescent lymphography when confirming the patency of the anastomosis site after LVA. Ethics and dissemination The protocol for the study was approved by the Institutional Review Board of each institution. The trial was filed for and registered at the Pharmaceuticals and Medical Devices Agency in Japan. The trial is currently on-going and is scheduled to end in June 2020. Trial registration number jRCT2031190064; Pre-results. This study will examine the efficacy of a highly safe drug, indocyanine green for evaluating lymphatic anatomy. This is the first, multicentre, prospective, systematised clinical trial of Indocyanine green lymphography. The present clinical trial will not allow the assessment of the therapeutic efficacy of lymphaticovenular anastomosis.
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Affiliation(s)
- Shinsuke Akita
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Naoki Unno
- Department of Vascular Surgery, Hamamatsu Medical Center, Hamamatsu, Japan.,Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Jiro Maegawa
- Department of Plastic and Reconstructive Surgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Yoshihiro Kimata
- Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Hidekazu Fukamizu
- Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuichiro Yabuki
- Department of Plastic and Reconstructive Surgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Akira Shinaoka
- Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Masaki Sano
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yohei Kawasaki
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Tadami Fujiwara
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Nobuyuki Mitsukawa
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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149
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Kayali Vatansever A, Yavuzşen T, Karadibak D. The Reliability and Validity of Quality of Life Questionnaire Upper Limb Lymphedema (ULL-27) Turkish Patient With Breast Cancer Related Lymphedema. Front Oncol 2020; 10:455. [PMID: 32477925 PMCID: PMC7235329 DOI: 10.3389/fonc.2020.00455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/13/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose: Breast cancer is the most common cancer amongst women both in Turkey and in the world. Lymphedema, which negatively affects the quality of life, is one of the most prevalent problems reported by breast cancer survivors. Upper Limb Lymphedama 27 (ULL-27) questionnaire is a valid and reliable tool that assesses the quality of life in patients with breast cancer-related lymphedema. Until now, a Turkish-language version was lacking. The aim of this study was to perform a cross-cultural validation and reliability of the Turkish version of the ULL-27 questionnaire. Methods: This cross-sectional study involved forward- backward translation, and cross-cultural adaptation. 81 women (mean age and body mass index 54.96 ± 11.35 years and 29.50 ± 5.74 kg/m2) who had breast cancer related-upper extremity lymphedema were evaluated using the ULL-27 Quality of life questionnaire-Turkish version. Assessment of limb size was quantified by using circumferential limb measurements. European Organization for Research and Treatment of Cancer (EORTC) 30-item Quality of Life Questionnaire and Quality of Life Questionnaire breast cancer-23 (QLQ-BR23) were analyzed by Pearson's correlation analysis with the ULL-27 Turkish Version to indicate the convergent validity. Cronbach's alpha (internal consistency) and exploratory factor analysis were used to assess the questionnaire's reliability. Results: The mean of lymphedema duration and severity were 23.12 ± 30.88 months. Mild lymphedema was reported in 42% (34 people) of the cases included in the study. It was observed that 33.3% (27 people) had moderate lymphedema and 24.7% (20 people) had severe lymphedema. The alpha coefficient (internal consistency) for the Turkish ULL-27 total score was high (alpha = 0.93). Content validity was good because all questions were understandable for all participants (The alpha coefficient for the subgroups of the scale of physical, psychological, social scores, were 0.90, 0.87, and 0.75, respectively). External construct validity was highly confirmed by expected correlations with comparator scales, EORTC-30, and QLQ-BR23 (p < 0.01). Conclusions: The Turkish version of the ULL-27 Questionnaire is a valid and reliable tool for evaluating QoL in women with upper limb lymphedema related to breast cancer.
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Affiliation(s)
| | - Tuğba Yavuzşen
- Institute for Oncology, Dokuz Eylul University, Izmir, Turkey
| | - Didem Karadibak
- Physiotherapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
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Forte AJ, Huayllani MT, Boczar D, Cinotto G, Ciudad P, Manrique OJ, Lu X, McLaughlin SA. The basics of ultrasound elastography for diagnosis, assessment, and staging breast cancer-related lymphedema: a systematic review of the literature. Gland Surg 2020; 9:589-595. [PMID: 32420294 DOI: 10.21037/gs.2020.02.08] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Breast cancer-related lymphedema (BCRL) incidence has been increasing overtime. Currently, there is not a preferred imaging tool for diagnosis, staging, and assessment of the disease. We aim to review the use of ultrasound elastography (UE) in BCRL patients. A systematic review was performed by querying PubMed, EMBASE, Ovid Healthstar, and Ovid Medline databases for studies that evaluated the use of UE in BCRL. The keywords "elastography" AND "lymphedema" in titles and abstracts were used for the search. The search retrieved 12, 12, 5 and 6 articles in each database, respectively. From these, only 4 met the inclusion criteria. UE methods included two-dimensional strain imaging, shear wave elastography (SWE), and global UE. Two of the studies evaluated the use of UE in the assessment of BCRL, while only 1 considered its use for diagnosis and staging. Based on our systematic review, UE appears to be a great tool in the assessment of BCRL to differentiate affected from non-affected arms.
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Affiliation(s)
- Antonio J Forte
- Division of Plastic Surgery and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA
| | - Maria T Huayllani
- Division of Plastic Surgery and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA
| | - Daniel Boczar
- Division of Plastic Surgery and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA
| | - Gabriela Cinotto
- Division of Plastic Surgery and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA
| | - Pedro Ciudad
- Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru
| | | | - Xiaona Lu
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA
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