Hot off the Press November 2022
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.
Anatomy / Physiology /Pathophysiology
A Review of Histopathological Modifications in Lymphedema. - click for abstract
A Review of Histopathological Modifications in Lymphedema.
Elisabetta Weber MA, Eugenio Bertelli, Guido Gabriele, Paolo Gennaro, and Virginia Barone. Lymphatic Collecting Vessels in Health and Disease. Lymphatic research and biology 2022; 20: 468-477.
Secondary lymphedema of the extremities affects millions of people in the world as a common side effect of oncological treatments with heavy impact on every day life of patients and on the health care system. One of the surgical techniques for lymphedema treatment is the creation of a local connection between lymphatic vessels and veins, facilitating drainage of lymphatic fluid into the circulatory system. Successful results, however, rely on using a functional vessel for the anastomosis, and vessel function, in turn, depends on its structure. The structure of lymphatic collecting vessels changes with the progression of lymphedema. They appear initially dilated by excess interstitial fluid entered at capillary level. The number of lymphatic smooth muscle cells in their media then increases in the attempt to overcome the impaired drainage. When lymphatic muscle cells hyperplasia occurs at the expenses of the lumen, vessel patency decreases hampering lymph flow. Finally, collagen fiber accumulation leads to complete occlusion of the lumen rendering the vessel unfit to conduct lymph. Different types of vessels may coexist in the same patient but usually the distal part of the limb contains less affected vessels that are more likely to perform efficient lymphatic–venular anastomosis. Here we review the structure of the lymphatic collecting vessels in health and in lymphedema, focusing on the histopathological changes of the lymphatic vessel wall based on the observations on segments of the vessels used for lymphatic–venular anastomoses.
Evaluation of Circulating MicroRNAs and Adipokines in Breast Cancer Survivors with Arm Lymphedema
Prevalence and Risk Factors
Prediction models for breast cancer-related lymphedema: a systematic review and critical appraisal
Assessment
Lymphedema after pelvic and para-aortic lymphadenectomy-results of a systematic evaluation in patients with cervical and endometrial carcinoma - click for abstract
Lymphedema after pelvic and para-aortic lymphadenectomy-results of a systematic evaluation in patients with cervical and endometrial carcinoma
MRI of Lymphedema - click for abstract
MRI of Lymphedema
Development and psychometric evaluation of a lymphoedema self-management behaviour questionnaire for breast cancer patients - click for abstract
Development and psychometric evaluation of a lymphoedema self-management behaviour questionnaire for breast cancer patients
A new indocyanine green fluorescence lymphography protocol for diagnostic assessment of lower limb lymphoedema
Management Strategies
Patient education for breast cancer-related lymphedema: a systematic review
Effects of preoperative personal education on shoulder function and lymphedema in patients with breast cancer: A consort
Effect of early interventions with manual lymphatic drainage and rehabilitation exercise on morbidity and lymphedema in patients with oral cavity cancer
Does Manual Lymphatic Drainage Add Value in Reducing Arm Volume in Patients With Breast Cancer-Related Lymphedema? - click for abstract
Does Manual Lymphatic Drainage Add Value in Reducing Arm Volume in Patients With Breast Cancer-Related Lymphedema?
OBJECTIVE: The purpose of this study was to investigate the effectiveness of fluoroscopy-guided manual lymph drainage (MLD) versus that of traditional and placebo MLD, when added to decongestive lymphatic therapy (DLT) for the treatment of breast cancer-related lymphedema (BCRL), on the suprafascial accumulation of lymphatic fluid and skin elasticity.
METHODS: In this multicenter, 3-arm, double-blind randomized controlled trial (EFforT-BCRL trial), 194 participants (mean age = 61 [SD = 10] years) with unilateral BCRL were recruited. All participants received standardized DLT (education, skin care, compression therapy, exercises) and were randomized to fluoroscopy-guided, traditional, or placebo MLD. Each day participants received 60 minutes of treatment during the 3-week intensive phase and 18 sessions of 30 minutes during the 6-month maintenance phase. Participants were instructed to wear a compression garment, to perform exercises, and to perform a self-MLD procedure once daily. This study comprises secondary analyses of the EFforT-BCRL trial. Outcomes were the amount of fluid accumulation in the suprafascial tissues (local tissue water, extracellular fluid, and thickness of the skin and subcutaneous tissue) and skin elasticity at the level of the arm and trunk. Measurements were performed at baseline; after intensive treatment; after 1, 3, and 6 months of maintenance treatment; and after 6 months of follow-up.
RESULTS: At the level of the arm, there was a significant improvement over time in the 3 groups for most of the outcomes. At the level of the trunk, no remarkable improvement was noted within the individual groups. No significant interaction effects (between-group differences) were present. Only skin elasticity at the level of the arm, evaluated through palpation, showed a significant interaction effect.
CONCLUSIONS: All 3 groups showed similar improvements in response to DLT, regardless of the type of MLD that was added. The effect of the addition of MLD to other components of DLT for reducing local tissue water and extracellular fluid or skin thickness and for improving skin elasticity and fibrosis in participants with chronic BCRL was limited.
The All-Ireland Guidelines for the diagnosis, assessment and management of lymphoedema - click for abstract
The All-Ireland Guidelines for the diagnosis, assessment and management of lymphoedema
Current Concepts in Surgical Management of Lymphedema - click for abstract
Current Concepts in Surgical Management of Lymphedema