Lymphology最新文献

There is little information on the risk for catheter-related thrombosis in patients with upper limb lymphedema following breast cancer treatment. We investigated the association between upper limb lymphedema and the risk of peripherally inserted central catheterrelated thrombosis (PICC-RT) occurring in the contralateral limb of patients with breast cancer. A retrospective review analyzed all patients with breast cancer who underwent PICC insertion at a cancer hospital in Hunan Province from 2015 to 2019. Upper limb lymphedema was indexed from hospital information system (HIS) before the occurrence of PICC-RT developed in the contralateral limb. Cox regression analysis was used to evaluate the association of factors with outcome. A total of 1,262 patient records were found and 50 cases of PICC-RT were identified. Forty of these occurred in patients without lymphedema (n=1,236) and 10 in patients with upper limb lymphedema (n=26). After adjustment for various co-variables, Cox regression analysis showed that upper limb lymphedema was significantly associated with increased risk of PICC-RT (hazard ratio=12.128, 95% confidence interval=5.551-26.501; P<0.001). In breast cancer patients, upper limb lymphedema may be an important predictor for PICC-RT in the contralateral limb and information should be provided to patients.

Functional compressive bandaging (FCB) is a therapeutic resource used to control lymphedema resulting from the treatment of breast cancer. However, the reliability of the technique is unknown. We evaluated intra- and inter-rater reliability of the spiral technique in the four-layer FCB of the arm and forearm in breast cancer survivors with lymphedema. Forty-five breast cancer survivors with a mean age of 64.88±10.01 years participated in the study. Evaluations were performed by two examiners at different times analyzing the pressure exerted (mmHg) by the spiral FCB in the arm and forearm of the upper limb affected by lymphedema. The intraclass correlation coefficient (ICC2,1) was used to determine intraand inter-examiner reliability, with a 95% confidence interval, minimum detectable change, and standard error of the measurement. Intrarater reliability was considered low to high in the arm and forearm region. Inter-rater reliability in the arm region was considered low and in the forearm region low to moderate. Our results indicate that spiral FCB has low to moderate intra-examiner and inter-examiner reliability.

Vascularized lymph node transfer surgery (VLNT) can provide benefit to lymphedema patients. Cytokines may play a role in the development of lymphedema and in the regeneration of lymphatic vessels after VLNT. Our primary aim was to investigate whether the VLNT patients have a specific cytokine profile. Our secondary aim was to see whether the preoperative lymphedema or severity affects the postoperative cytokine response. Wound exudate was gathered from 18 patients undergoing VLNT on the first and sixth postoperative day (POD). The concentrations of IL-10, TNF-α, TGF-β1 and VEGF-C were analyzed using enzymelinked immune-sorbent assays. A general score was generated to assess the benefit of the surgery. The changes in cytokine concentrations (1st POD-6th POD) were correlated with the pre- and postoperative lymphedema related factors. A shorter duration of lymphedema preoperatively correlated with an increase in the concentration of IL-10 and TNF-β during the first six PODs (IL-10: r=0.495, p=0.051; TNF-α: r=0.737, p=0.006) and a decrease in the concentration of TGF-ß1 (r= -0.613, p=0.020). The increase of the concentration of TNF-α during the first six PODs also correlated with a greater total general score (r=0.775, p=0.005) and hence indicated a better response to the surgery. The patients with a shorter duration of lymphedema preoperatively had a more favorable cytokine response during the first six PODs after VLNT.

Covid-19 has physical damage as well as serious impact on the mental health in the community. Symptoms such as anxiety, depression, fear, stress, and sleep problems were more commonly reported during Covid-19 pandemic. The aim of this study was to assess the health status, psychological conditions, quality of life, and possible risk factors of patients with lymphedema during the pandemic. The study included male and female patients aged ≥18 years with primary or secondary upper or lower extremity lymphedema (stage 1, 2, or 3) who were followed in our outpatient clinic. The patients were interviewed by phone. Health and social status were examined using a questionnaire, Covid-19 phobia was assessed using Covid-19 Phobia Scale (C19P-S), and quality of life was assessed using Lymphedema Quality of Life Questionnaire Arm or Leg (LYMQOL). Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS). The HADS scores showed that 35% of the patients had severe risk for depression and 10% had severe risk for anxiety. Factors with negative effect on HADS were lower education level, sedentary lifestyle, failure to perform lymphedema exercises, weight gain, and lymphedema duration. The C19P-S scores were higher indicating greater phobia in the overall score and subscores in patients with primary lymphedema and secondary lymphedema without malignancy, younger patients, those who are not able to walk regularly, and those who are not able to perform self manual lymphatic drainage (self-MLD). Factors with negative effects on LYMQOL were stage 3 lymphedema, female gender, younger age, and longer disease duration. Patients who performed regular self-MLD and lymphedema exercises demonstrated positive effects on LYMQOL. The results of this study suggest that patients with lymphedema affected by the COVID-19 pandemic are mostly younger patients, individuals with primary lymphedema, individuals with non-malignant etiology, individuals who unable to perform regular walking, and those unable to perform self- MLD.

A recent genome-wide association study (GWAS) looking for the genes determining fingerprint and palmar crease patterns disclosed one gene, among many others, which causes lymphedema (CELSR1) while others influencing tissue growth. Since digital fluid influences the height of the volar pads, influences of lymphedema on dermatoglyphics should be sought.

Diagnosing malignant lymphedema is a challenge in daily clinical practice. Clinically, patients may show clear signs of malignancy, but this is not always the case, and at times the diagnosis is not straightforward. In some patients, pain, hardness of the tissues, joint stiffness, proximal involvement, collateral circulation, or an acute onset will provide the clue to determining malignancy. Our aim is to describe several diverse scenarios of Secondary Malignant Lymphedema (SML) with the etiopathogenesis. One possible cause is lymphatic obstruction due to extrinsic compression of lymphatic vessels and/or nodes by either the primary tumor or metastatic masses. Lymphatic obstruction can also be caused by tumoral infiltration. This infiltration can affect both deep and regional nodes as well as cutaneous and subcutaneous vessels and is commonly known as lymphangitis carcinomatosa. Malignant lymphedema can also be secondary to obstruction of the venous flow due to tumoral venous thromboembolism or to extrinsic compression of the veins by tumors or adenopathic masses. Nevertheless, the most frequent cause of this illness is a mixed mechanism of compression of the lymphatic and venous systems. Frequently, SML is the first manifestation of relapse. When lymphedema appears abruptly, is progressive, with intense pain, associated with collateral circulation, or with hard and infiltrated skin or joint stiffness, SML must be ruled out with an urgent referral to the oncologist and an imaging evaluation.

An "incurable" lymphologist reflects on his life, unanswered questions, patients who became friends, and lessons learned during a brief encounter with a lymphatic soul-mate.

Vascular malformations encompass a wide range of complex vascular lesions. Due to the extreme variability of clinical presentation, classification and their related syndromes presents a challenge. Here we describe a case of a boy presenting with Marfanoid habitus, cutaneous vascular malformations, and severe acute anemia due to ileal venous malformations. Although a panel of genetic markers for the Marfan phenotype was negative, we identified a de novo mutation in the TEK gene in the patient. This case supports expansion of the phenotypic spectrum of TEK-related vascular malformations.