Hot of the Press April 2021
We have collated some great articles and material published over the last month. Click on the links below to read the abstract or download the full paper.
Prevalence and Risk Factors
Self-reported signs and symptoms of secondary upper limb lymphoedema related to breast cancer treatment: Systematic review - click for abstract
Self-reported signs and symptoms of secondary upper limb lymphoedema related to breast cancer treatment: Systematic review
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.
Non-cancer-related lower limb lymphoedema in complex decongestive therapy: the patient experience - click for abstract
Non-cancer-related lower limb lymphoedema in complex decongestive therapy: the patient experience
OBJECTIVE: Lymphoedema is a debilitating condition that results in the swelling of one or more limbs, leading to a significant impairment of mobility. From a psychosocial perspective, body image and quality of life (QoL) are also adversely affected. To date, non-cancer lymphoedema has been under-researched. The primary objectives of this study were to explore QoL and limb volume in patients with primary and secondary non-cancer-related lower limb lymphoedema during the intensive, maintenance and self-care phases of complex decongestive therapy over a 24-week period. Secondary objectives included exploring patients’ experiences of living with lymphoedema and the challenges of self-care maintenance.
METHOD: A sequential mixed methodology, using quantitative and qualitative methods, was used. The quantitative part of the study involved the use of tape measurements at 4cm intervals to ascertain limb volume alterations. Measurements were taken during the intensive phase at weeks 1, 2, 3 and 4; and during the maintenance phase at weeks 8, 16 and 24. QoL was measured using the lymphoedema QoL (LYMQOL) leg, at baseline and weeks 8 and 24. The qualitative part of the study involved the use of semi-structured interviews with patients at week 8. Interviews explored the experiences of patients living with lymphoedema and their experiences of complex decongestive therapy.
RESULTS: A total of 20 patients were recruited, two male and 18 female, with a mean age of 58.8 years (standard deviation (SD): 16 years), and all receiving complex decongestive therapy. At baseline, for all patients, the mean QoL score was 4.3 (SD: 2.4); and 8 (SD: 1.5) after 8 weeks of complex decongestive therapy. Mean difference was 4.00 (95% confidence interval: 2.76-5.24; p=0.00001) indicating a positive treatment effect. Limb volume measurements demonstrated a reduction in oedema from baseline to week 8. However, there were fluctuations in limb volume over the maintenance period of four months after treatment as the patients endeavoured to engage in self-care. Analysis of the interviews identified themes pertaining to lack of knowledge of lymphoedema among health professionals, a negative impact of living with lymphoedema and the positive therapeutic effect of complex decongestive therapy.
CONCLUSION: Lower limb lymphoedema is a chronic condition that impacts negatively on the individual. Complex decongestive therapy improves QoL and reduces oedema. However, given the fluctuations in oedema post-treatment, individuals need greater support to maintain active engagement in effective self-care strategies.
Prevention of Breast Cancer-Related Lymphedema - click for abstract
Prevention of Breast Cancer-Related Lymphedema
Tremendous progress has been made over the past several decades in the treatment of breast cancer. Mortality and recurrence rates continue to decline. Our ability to tailor patient- and tumor-specific treatments has rapidly advanced. The vast majority of our patients can safely have breast conservation. Unfortunately, for many patients, survivorship is burdened by ongoing quality-of-life issues. Most breast cancer patients are asymptomatic at presentation, and the onus is on us to preserve this. Surgery, radiation, and systemic therapy can result in long-term toxicities that can be amplified with multimodality approaches. We must strive to apply minimally effective therapies rather than a maximally tolerated approach. Breast cancer-related lymphedema (BCRL) is a particularly dreaded chronic complication. This review strives to give the reader a better understanding of BCRL and shed light on wisely choosing an integration of treatment modalities that minimizes BCRL risk. Key literature on emerging concepts is highlighted.
Is There a Relationship Between Insulin Resistance and Breast Cancer-Related Lymphedema? A Preliminary Study - click for abstract
Is There a Relationship Between Insulin Resistance and Breast Cancer-Related Lymphedema? A Preliminary Study
High blood insulin levels, insulin resistance (IR), and obesity are components of metabolic syndrome (MetS). The literature has indicated a high risk of breast cancer in patients with MetS. However, no studies have been conducted evaluating the relationship between breast cancer-related lymphedema (BCRL), one of the most frequently encountered postbreast cancer treatment conditions, and IR. Therefore, the aim of this study was to evaluate whether there is a relationship between BCRL and IR. Methods and Results: A total of 28 patients diagnosed with breast carcinoma were included in this preliminary study. Patients were divided into BCRL (n = 15; mean age: 55.2 ± 11.2 years) and non-BCRL (control) groups (n = 13; mean age: 55.17 ± 6.57 years). Body mass index (BMI), waist and hip circumference, and fasting blood glucose and blood insulin levels of all patients were recorded. The Homeostasis Model Assessment (HOMA) test was used for the calculation of IR measurement with a value of 2.5 taken as an indicator of IR. Parameters were compared between groups. BMI, waist circumference measurements, blood insulin, and HOMA-IR levels were statistically significantly higher in the BCRL group than the control group (p < 0.05). HOMA-IR values >2.5 were found in 14 patients in the BCRL group. In the control group, only three patients had IR based on HOMA-IR criteria (p = 0.000). Hip circumference measurements and fasting blood glucose levels were similar between the groups (p > 0.05). Conclusions: BCRL appears to be associated with waist circumference, fasting blood insulin level, and HOMA-IR levels. In routine clinical practice, evaluation of IR may be important in the follow-up of this patient population.
Assessment
Quality of life in breast cancer survivors: An assessment of international breast cancer dragon boat racers - click for abstract
Quality of life in breast cancer survivors: An assessment of international breast cancer dragon boat racers
Resistance exercise is deemed safe for women recovering from conventional breast cancer therapies but few clinicians are aware that dragon boat racing, as a form of resistive exercise, is available to the breast cancer community. The objectives of this study were to 1) increase clinician awareness of dragon boat racing (DBR) in breast cancer survivors as a community-based physical activity, and 2) evaluate quality of life (QOL) in breast cancer survivors with or without lymphedema who participate in DBR. This prospective, observational study surveyed 1,069 international breast cancer dragon boat racers from eight countries to compare function, activity, and participation in women with and without selfreported lymphedema using the Lymph-ICF questionnaire. Seventy-one percent of women (n=758) completed the questionnaires. Results revealed significantly higher Lymph-ICF scores in the lymphedema participants, signifying reduced QOL, when compared to the non lymphedema participants (p<0.05), except for "go on vacation" for which no statistical difference was reported (p=0.20). International breast cancer survivors with lymphedema participating in DBR at an international competition had reduced function, limited activity, and restricted participation compared to participants without lymphedema. Clinicians should consider utilizing DBR as a community-based activity to support exercise and physical activity after a breast cancer diagnosis. [/av_toggle] [/av_toggle_container] [av_hr class='invisible' height='50' shadow='no-shadow' position='center' custom_border='av-border-thin' custom_width='50px' custom_border_color='' custom_margin_top='30px' custom_margin_bottom='30px' icon_select='yes' custom_icon_color='' icon='ue808' font='entypo-fontello'] [av_toggle_container initial='0' mode='accordion' sort='' styling='' colors='' font_color='' background_color='' border_color=''] [av_toggle title='Forearm and biceps circumferential variations in skin tissue dielectric constant and firmness - click for abstract' tags=''] Forearm and biceps circumferential variations in skin tissue dielectric constant and firmness
Tissue dielectric constant (TDC) and skin firmness assessed via indentation force (FORCE) help quantify lymphedema and track changes. We sought to determine potential differences in these parameters dependent on arm circumferential locations. Thus, TDC and FORCE were measured in 40 healthy women at medial, anterior and lateral locations on forearm and biceps. In five other women with unilateral lymphedema (68.6±7.6 years), TDC was measured at corresponding circumferential forearm positions. Measurements were done in triplicate using compact noninvasive devices. Results for healthy women (23.8±2.7 years) showed forearm medial TDC values (26.7±2.2) were less than anterior (28.0±2.4) or lateral (28.0±2.5) positions (p<0.001). Lymphedema patients had elevated values but similar medialanterior- lateral patterns (33.7±8.0, 39.8±10.2 and 42.9±10.0). Biceps medial TDC values (24.1±2.2) were also less than either anterior (27.0±2.1) or lateral (28.2±3.3). Contrastingly, medial FORCE values at forearm and biceps were less than at anterior and lateral locations (p<0.001) and increased in the order of medialanterior- lateral on forearm (p<0.001). The present findings provide reference values for both TDC and FORCE of commonly measured arm sites with specificity as to circumferential variations. This observed variation indicates the need for care in locating measurement positions for tracking patients with lymphedema. [/av_toggle] [/av_toggle_container] [av_hr class='invisible' height='50' shadow='no-shadow' position='center' custom_border='av-border-thin' custom_width='50px' custom_border_color='' custom_margin_top='30px' custom_margin_bottom='30px' icon_select='yes' custom_icon_color='' icon='ue808' font='entypo-fontello'] [av_toggle_container initial='0' mode='accordion' sort='' styling='' colors='' font_color='' background_color='' border_color=''] [av_toggle title='Use of magnetic resonance imaging lymphangiography for preoperative planning in lymphedema surgery: A systematic review- click for abstract' tags=''] Use of magnetic resonance imaging lymphangiography for preoperative planning in lymphedema surgery: A systematic review
BACKGROUND: In recent years, magnetic resonance imaging lymphangiography (MRL) has emerged as a way to predict if patients are candidates for lymphedema surgery, particularly lymphovenous anastomosis (LVA). Our goal was to conduct a systematic review of the literature on the use of MRL for preoperative planning in lymphedema surgery. We hypothesized that MRL could add valuable information to the standard preoperative evaluation of lymphedema patients.
METHODS: On February 17, 2020, we conducted a systematic review of the PubMed/MEDLINE, Cochrane Clinical Answers, and Embase databases, without time frame or language limitations, to identify articles on the use of MRL for preoperative planning of lymphedema surgery. We excluded studies that investigated other applications of magnetic resonance imaging, such as lymphedema diagnosis and treatment evaluation. The primary outcome was the examination capacity to identify lymphatic anatomy and the secondary outcome was the presence of adverse effects.
RESULTS: Of 372 potential articles identified with the search, nine studies fulfilled the eligibility criteria. A total of 334 lymphedema patients were enrolled in these studies. Two studies compared MRL findings with those of other standard examinations (indocyanine green lymphography [ICG-L] or lymphoscintigraphy). No adverse effects due to MRL were reported. A study shown that MRL had higher sensitivity to detect lymphatic vessel abnormalities compared with lymphoscintigraphy and a statistically higher chance of successful LVA was observed when the results of MRL agreed with those of ICG-L (p < .001). CONCLUSIONS: MRL could be useful for preoperative planning in lymphedema surgery. The scientific evidence has been limited, so further studies with greater numbers of patients and cost analysis are necessary to justify the addition of MRL to current preoperative protocols
Development and validation of a nomogram to predict the risk of breast cancer-related lymphedema among Chinese breast cancer survivors - click for abstract
Development and validation of a nomogram to predict the risk of breast cancer-related lymphedema among Chinese breast cancer survivors
PURPOSE: Breast cancer-related lymphedema (BCRL) is a major long-term complication for post-surgery breast cancer survivors. Although several risk factors have been identified, lifestyle characteristics have been neglected in previous studies. The aim of this study was to develop and validate a nomogram for estimating this population’s risk of developing lymphedema, taking into consideration their demographic, clinical, and personal lifestyle behaviors.
METHODS: In a cross-sectional study, we collected data from 775 post-operative breast cancer survivors who had attended a follow-up session in the recent 10 years (primary cohort). Lymphedema was assessed using the Norman telephone questionnaire, self-reported by patients. Multiple logistic regression was used to identify risk factors for lymphedema, including demographic, clinical, and lifestyle-related factors. A nomogram was constructed based on those factors and was validated using a separate group of 314 breast cancer patients (validation cohort).
RESULTS: The factors independently associated with lymphedema were higher body mass index (BMI), modified radical mastectomy (MRM), postsurgical infection, chemotherapy, radiotherapy, exercise of the affected arm, and the active participation in physical activity (P<0.05). The area under the curve (AUC) values of the primary and the validation cohorts were 0.721 (95% confidence interval: 0.685-0.756) and 0.702 (95% confidence interval: 0.646-0.759), respectively. CONCLUSIONS: BCRL risk factors include MRM, radiotherapy, chemotherapy, and higher BMI, while the active physical activity behavior of patients appears to be a factor against lymphedema. The nomogram incorporating the patients’ clinical and lifestyle factors might be useful for predicting lymphedema in breast cancer survivors.
Estimates for Assessment of Lymphedema: Reliability and Validity of Extremity Measurements - click for abstract
Estimates for Assessment of Lymphedema: Reliability and Validity of Extremity Measurements
Measuring lymphedema with high accuracy is important for several reasons. The aim of this study was to assess the reliability and validity of three routinely used methods to estimate limb volumes. Methods and Results: Inverse water displacement, girth measurements, and Perometer measurements were executed. Although standard techniques were used, extra precautions were taken to maximize accuracy within and between observers. Water displacement, and girth and Perometer measurements resulted in standard deviations of 0.7%-0.8%, 0.5%, and 0.4%-1.0%, respectively. Conclusion: Measuring limb volumes using routine methods is not easy. Even under optimal conditions, the measurements are quite dependent on the observer. For practical situations, an easy, objective, and reliable method is lacking.
The ICC Compression Questionnaire: A Comprehensive Tool to Evaluate Compression Materials or Devices Applied in Subjects with Lymphedema or Chronic Venous Disease - click for abstract
The ICC Compression Questionnaire: A Comprehensive Tool to Evaluate Compression Materials or Devices Applied in Subjects with Lymphedema or Chronic Venous Disease
Compression therapy is an important part of the treatment of patients with lymphedema or chronic venous disease. However, there is no validated questionnaire evaluating the effect of compression and its acceptance by the patient. Therefore, the aims of this study were to construct a questionnaire evaluating the effect of compression and its acceptance by the patient, that is, the Dutch ICC Compression Questionnaire (ICC-CQ), to investigate its reliability and validity, and to translate it into English. Methods and Results: Eleven experts in applying compression and 51 Dutch patients with experience of using compression were involved in the construction process. One part of the ICC-CQ has to be completed by the patient and evaluates seven domains. The other part has to be completed by the health care provider and comprises three domains. Reliability and validity of the final version was investigated in a new group of 79 Dutch-speaking patients with lymphedema or chronic venous disease, wearing compression garments (N = 52) or bandages (N = 27). Except for one domain, the Intraclass Correlation Coefficients for test-rest/interrater reliability ranged from 0.55 to 0.93. Cronbach’s alpha for internal consistency ranged from 0.71 to 0.97. Eighty-nine percent of the patients fully understood the questionnaire indicating good face validity, and 87% found it complete indicating good content validity. Construct validity was considered good since 10 out of 11 hypotheses were accepted. Conclusion: The ICC-CQ is the first reliable and valid questionnaire evaluating different kinds of compression and the experience by patients with lymphedema or chronic venous disease.
Assessment of Arm Volume Using a Tape Measure Versus a 3D Optical Scanner in Survivors with Breast Cancer-Related Lymphedema- click for abstract
Assessment of Arm Volume Using a Tape Measure Versus a 3D Optical Scanner in Survivors with Breast Cancer-Related Lymphedema
Lymphedema (LE) is a significant clinical problem for breast cancer survivors. While the water displacement test and circumferential assessment using a tape measure (TM) are common methods to assess differences in arm volumes, faster and more reliable methods are needed. Study purposes, in breast cancer survivors (n = 294), were to compare the average total arm volumes and interlimb volume ratios for women with and without a history of LE, using a TM and three-dimensional (3D), whole-body surface scanner (3D scan); compare the level of agreement between arm volumes and interlimb volume ratios obtained using the two devices; and evaluate the percent agreement between the two measures in classifying cases of LE using three accepted thresholds. Methods and Results: Measurements were done using a spring-loaded TM and Fit3D ProScanner. Paired t-tests and Bland-Altman analyses were used to achieve the study aims. For circumference and volume comparisons, compared with the 3D scan, values obtained using the TM were consistently smaller. In terms of level of agreement, the Bland-Altman analyses demonstrated large biases and wide limits of agreement for the calculated arm volumes and volume ratios. In terms of the classification of caseness, using the 200-mL interlimb volume difference criterion resulted in 81.6% overall agreement; using the >10% volume difference between the affected and unaffected arms resulted in 78.5% overall agreement; and using the volume ratio ≥1.04 criterion resulted in 62.5% overall agreement. For all three accepted threshold criteria, the percentage of cases was significantly different between the TM and 3D scan techniques. Conclusions: The 3D technology evaluated in this study has the potential to be used for self-initiated surveillance for LE. With improvements in landmark identification and software modifications, it is possible that accurate and reliable total arm volumes can be calculated and used for early detection.
Breast Tissue Dielectric Constant as a Potential Breast Edema Assessment Parameter- click for abstract
Breast Tissue Dielectric Constant as a Potential Breast Edema Assessment Parameter
Many methods can quantitatively assess limb lymphedema, but methods to assess breast edema/lymphedema are quite limited. Thus, there is a need for a convenient and accurate way to quantify and track changes in this condition. Herein, breast tissue dielectric constant (TDC) values that depend on tissue water were used to obtain reference TDC values and interbreast TDC ratios.
Methods and Results: TDC was measured in both breasts of 61 women who were about to undergo an ultrasound-guided diagnostic biopsy of a single mass (tumor) in 1 breast. Patient age and body mass index were (mean ± SD) 65.1 ± 11.6 (41-87 years) and 28.9 ± 5.1 (19.1-43.7 kg/m2). TDC was measured at a standardized site (12 o’clock position) with the TDC probe placed with its outer edge at the periphery of the subareolar region. TDC values of healthy breasts versus tumor breasts showed tumor breasts 3% greater (30.4 ± 4.6 vs. 29.5 ± 4.6, p = 0.02). Patients with benign tumors (N = 33) showed no difference between breasts (30.5 ± 4.4 vs. 30.8 ± 4.6 p = 0.434) and had an interbreast TDC ratio (tumor breast/healthy breast) of 1.013 ± 0.077. Patients with malignant tumors (N = 28) had tumor breast values 5% greater (29.8 ± 4.8 vs. 28.4 ± 4.6, p = 0.018) and an interbreast ratio of 1.056 ± 0.117. The overall interbreast ratio (N = 61) was 1.033 ± 0.099.
Conclusion: Breast TDC values from nonedematous breasts provide the basis for calculating potential edematous/lymphedematous threshold values based on the measured means +2.5 standard deviation (SD). Accordingly, a TDC threshold value of 41 and an interbreast ratio of 1.28 were determined. These parameters have potential applicability for early detection in at-risk patients and those suspected of having breast edema/lymphedema.
Tissue Dielectric Constant Combined With Arm Volume Measurement as Complementary Methods in Detection and Assessment of Breast Cancer-Related Lymphedema - click for abstract
Tissue Dielectric Constant Combined With Arm Volume Measurement as Complementary Methods in Detection and Assessment of Breast Cancer-Related Lymphedema
Aim: To investigate the role of tissue dielectric constant (TDC) in the detection and assessment of breast cancer-related lymphedema (BCRL) and to determine whether the TDC could potentially be used as a complementary method for arm volume measurement.
Methods: Sixty-nine patients with BCRL were enrolled in this study. Local tissue water was assessed bilaterally by using the TDC method in four sites: upper arm, forearm, hand, and lateral thorax. Arm circumferences were measured at the 4-cm interval, starting from the shoulder to the wrist by using a tape measure. The arm volume was calculated by a standard formula. Patients’ demographic information and clinical characteristics were also recorded.
Results: Fifty-one of the 69 patients were diagnosed with clinical lymphedema. Using a TDC ratio of 1.2 or a diagnostic reference standard of ≥2 cm arm circumference, the sensitivity of these two methods was found to be identical at 73.9%. The TDC values in four sites on the affected side were significantly higher (p < 0.05) relative to the unaffected side. The inter-side TDC ratio of upper arm and forearm was substantially higher than that of lateral thorax and hand (p < 0.05). The TDC ratio of upper arm, forearm, and hand, especially of the upper arm and forearm, was positively correlated with inter-limb volume difference and stage of lymphedema. Conclusion: The TDC method elucidated a meaningful clinical correlation to the arm volume measurement. Applying those two methods together showed promise in the detection and assessment of BCRL. The forearm and upper arm were reliable examination sites for TDC measurements in the clinic.
Management Strategies
Liposuction of Breast Cancer-Related Arm Lymphedema Reduces Fat and Muscle Hypertrophy - click for abstract
Liposuction of Breast Cancer-Related Arm Lymphedema Reduces Fat and Muscle Hypertrophy
Introduction: Adipose tissue deposition is a known consequence of lymphedema. A previous study showed that the affected arm in patients with nonpitting breast cancer-related lymphedema (BCRL) had a mean excess volume of 73% fat and 47% muscle. This condition impairs combined physiotherapy as well as more advanced microsurgical methods. Liposuction is, therefore, a way of improving the effects of treatment.
Objective: This study aims to evaluate the tissue changes in lymphedematous arms after liposuction and controlled compression therapy (CCT) in patients with nonpitting BCRL.
Methods and Results: Eighteen women with an age of 61 years and a duration of arm lymphedema (BCRL) of 9 years were treated with liposuction and CCT. Tissue composition of fat, lean (muscle), and bone mineral was analyzed through dual energy X-ray absorptiometry (DXA) before, and at 3 and 12 months after surgery. Excess volumes were also measured with plethysmography. The median DXA preoperative excess volume was 1425 mL (704 mL fat volume, 651 mL lean volume). The DXA excess volume at 3 months after surgery was 193 mL (-196 mL fat volume, 362 mL lean volume). At 12 months after surgery, the median excess DXA volume was 2 mL (-269 mL fat volume, 338 mL lean volume). From before surgery to 3 months after surgery, the median DXA excess volume reduced by 85% (p < 0.001) (fat volume reduction 128% (p < 0.001), lean volume reduction 37% (p = 0.016)). From before surgery to 12 months after surgery, it reduced by 100% (p < 0.001) (fat volume reduction 139% [p < 0.001], lean volume reduction 54% [p = 0.0013]). Conclusions: Liposuction and CCT effectively remove the excess fat in patients with nonpitting BCRL, and a total reduction of excess arm volume is achievable. A postoperative decrease in excess muscle volume is also seen, probably due to the reduced weight of the arm postoperatively.
Compression treatment in acute symptomatic proximal deep venous thrombosis - Results of a worldwide survey - click for abstract
Compression treatment in acute symptomatic proximal deep venous thrombosis – Results of a worldwide survey
OBJECTIVES: The aim of this study was to illustrate how compression is performed worldwide in proximal DVT and if compression management has changed recently.
METHODS: A global online survey, consisting of 36 questions, was used. The survey was solicited from membership lists of Union Internationale de Phlébologie (UIP) membership societies. For differences between the continents in comparison to Western Europe odds ratios and 95% Confidence Intervals (95%CI) where calculated.
RESULTS: We received 626 answers from 41 countries. Compression is routinely used in proximal DVT in all regions (82.8%). 81.4% start compression immediately after diagnosis. In the acute phase of DVT reduction of pain and swelling (91.7%) and PTS prevention (66.2%) are the main reasons for compression. 33.2% recently changed their compression management with 43.5% starting compression earlier and 7.0% later.
CONCLUSIONS: Compression is still used routinely in proximal DVT in addition to anticoagulation. The changes in international guidelines towards the non-routine use of compression in proximal DVT have not caused significant changes in DVT management.
Investigation of the Less Known Effects of Manual Lymphatic Drainage: A Narrative Review - click for abstract
Investigation of the Less Known Effects of Manual Lymphatic Drainage: A Narrative Review
Introduction: Manual lymphatic drainage (MLD), one of the components of complex decongestive physiotherapy, which is accepted as the gold standard in the treatment of lymphedema, is used for therapeutic purposes in many diseases. The most well-known feature of MLD is that it helps to reduce edema. In addition to reducing edema, MLD has many effects, such as increasing venous flow, reducing fatigue, and raising the pain threshold. To the best of our knowledge, there is no study examining the effects of MLD other than its effects on edema in detail. The aim of this study is to compile effects of MLD and to provide a better understanding of the effects of MLD.
Methods: A literature search was conducted in Medline, Embase, and the Cochrane Library in July 2019, to identify different effects of MLD. The articles were chosen by, first, reading the abstract and subsequently data were analyzed by reading the entire text through full-text resources. To undertake the study, we have collected information published about different effects of MLD over the last 30 years (1989-2019). According to our results, 20 studies met inclusion criteria.
Conclusions: This study suggests that MLD can be used in symptomatic treatment of various diseases (multiple sclerosis, Parkinson’s disease) considering the effects of MLD on the system
Use of Vascular Endothelial Growth Factor-D As a Targeted Therapy in Lymphedema Treatment: A Comprehensive Literature Review - click for abstract
Use of Vascular Endothelial Growth Factor-D As a Targeted Therapy in Lymphedema Treatment: A Comprehensive Literature Review
Lymphangiogenic growth factors, such as vascular endothelial growth factor (VEGF)-D, are subjects of interest in studies of targeted therapies in lymphedema treatment. Methods and Results: We conducted a systematic review assessing the use of VEGF-D as a targeted therapy in lymphedema treatment. We hypothesized that VEGF-D was a promising therapy to induce lymphangiogenesis. Our search yielded 90 studies in the literature, but only 4 articles fulfilled our study eligibility criteria, and they were all experimental studies using viral gene transfer. The majority of the studies were conducted on small animals (mice) and investigated the effects of VEGF-D on lymph node transfer. All authors agreed about VEGF-D’s lymphangiogenic potential, but they noticed that VEGF-C induced a superior lymphangiogenesis, and one study noticed that VEGF-D induced seroma. Conclusions: The publications assessing the use of VEGF-D as a targeted therapy in lymphedema treatment were able to demonstrate its lymphangiogenic potential. Nonetheless, further studies are still necessary to investigate VEGF-D’s efficacy and safety in lymphedema treatment on patients.
Improvement of Limb Volumes after Bariatric Surgery in Nine End-Stage Primary, Secondary, and Obesity-Induced Lymphedema Patients: A Multiple Case Report - - click for abstract
Improvement of Limb Volumes after Bariatric Surgery in Nine End-Stage Primary, Secondary, and Obesity-Induced Lymphedema Patients: A Multiple Case Report
Lymphedema (LE) is a chronic condition of swelling due to lymphatic impairment and is characterized by edema and fibro-adipose tissue deposition. LE may be caused by an anomalous development of the lymphatic system, known as primary LE, or may develop secondary to traumatic, infectious, or other external events. Knowledge is increasing about the plural and bidirectional relationship between LE and obesity. The rate of obesity is increasing worldwide, and bariatric surgery offers the most effective and durable treatment, as this surgery exhibits positive effects on many obesity-related diseases. We explored whether bariatric surgery could improve leg volumes in morbidly obese LE patients. Patients: Between 2013 and 2019, 829 patients were hospitalized in our Center of Expertise for Lymphovascular Medicine for intensive treatment of their LE. Nine patients with end-stage primary, secondary, or obesity-induced LE underwent a bariatric procedure related to their morbid obesity. Methods and Results: Data concerning age, gender, medical diagnosis, LE stage, type of bariatric treatment, body weight, body mass index (BMI), and limb volumes were retrospectively collected from the patient files. At the individual patient level, body weight, BMI, leg volumes, and their percent reduction between presurgery and postsurgery were calculated. At the group level, paired sample t-tests were conducted to compare the mean body weight, BMI, and volumes of both legs between postsurgery and presurgery. The data demonstrate a significant decrease in body weight, BMI, and leg volumes in morbidly obese end-stage primary, secondary, and obesity-induced LE patients following bariatric surgery. Conclusions: Our multiple case study indicates that bariatric surgery provides a good indication for concomitant treatment of morbid obesity and LE.
Physical therapy enhances functions and quality of life in older patients with breast cancer-related lymphedema: A prospective experimental study