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Sample records for basic lymphedema management

  1. Feasibility and Effectiveness of Basic Lymphedema Management in Leogane, Haiti, an Area Endemic for Bancroftian Filariasis

    OpenAIRE

    Addiss, David G.; Jacky Louis-Charles; Jacquelin Roberts; Frederic Leconte; Wendt, Joyanna M.; Marie Denise Milord; Lammie, Patrick J; Gerusa Dreyer

    2010-01-01

    BACKGROUND: Approximately 14 million persons living in areas endemic for lymphatic filariasis have lymphedema of the leg. Clinical studies indicate that repeated episodes of bacterial acute dermatolymphangioadenitis (ADLA) lead to progression of lymphedema and that basic lymphedema management, which emphasizes hygiene, skin care, exercise, and leg elevation, can reduce ADLA frequency. However, few studies have prospectively evaluated the effectiveness of basic lymphedema management or assesse...

  2. Feasibility and effectiveness of basic lymphedema management in Leogane, Haiti, an area endemic for bancroftian filariasis.

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    David G Addiss

    Full Text Available BACKGROUND: Approximately 14 million persons living in areas endemic for lymphatic filariasis have lymphedema of the leg. Clinical studies indicate that repeated episodes of bacterial acute dermatolymphangioadenitis (ADLA lead to progression of lymphedema and that basic lymphedema management, which emphasizes hygiene, skin care, exercise, and leg elevation, can reduce ADLA frequency. However, few studies have prospectively evaluated the effectiveness of basic lymphedema management or assessed the role of compressive bandaging for lymphedema in resource-poor settings. METHODOLOGY/PRINCIPAL FINDINGS: Between 1995 and 1998, we prospectively monitored ADLA incidence and leg volume in 175 persons with lymphedema of the leg who enrolled in a lymphedema clinic in Leogane, Haiti, an area endemic for Wuchereria bancrofti. During the first phase of the study, when a major focus of the program was to reduce leg volume using compression bandages, ADLA incidence was 1.56 episodes per person-year. After March 1997, when hygiene and skin care were systematically emphasized and bandaging discouraged, ADLA incidence decreased to 0.48 episodes per person-year (P<0.0001. ADLA incidence was significantly associated with leg volume, stage of lymphedema, illiteracy, and use of compression bandages. Leg volume decreased in 78% of patients; over the entire study period, this reduction was statistically significant only for legs with stage 2 lymphedema (P = 0.01. CONCLUSIONS/SIGNIFICANCE: Basic lymphedema management, which emphasized hygiene and self-care, was associated with a 69% reduction in ADLA incidence. Use of compression bandages in this setting was associated with an increased risk of ADLA. Basic lymphedema management is feasible and effective in resource-limited areas that are endemic for lymphatic filariasis.

  3. Impact of basic lymphedema management and antifilarial treatment on acute dermatolymphangioadenitis episodes and filarial antigenaemia

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    H A El-Nahas

    2011-01-01

    Full Text Available Background: A major factor in the progression of lymphedema is acute dermatolymphangioadenitis (ADLA. Aims : To study ADLA episodes and antigenaemia in patients with different grades of filarial lymphedema at pre- and two years post-treatment. Setting and Design: A prospectively conducted study from May 2008 through May 2010. Patients and Methods: Forty five patients complaining of limb swelling with present or past history of limb redness suggestive of ADLA attacks were included. Patients were clinically examined for lymphedema grading, detection of potential entry points and diagnosis of microfilaraemia. Wuchereria bancrofti antigen titer was estimated by "Trop-Ag W. Bancrofti" ELISA kit. Basic lymphedema management and treatment with antifilarial drugs were applied. Statistical Analysis : Mann−Whitney test and Chi-square test were used. Results: The number of ADLA attacks in the pretreatment period, ranged from one to three per year. Mean duration of the attacks was 3.87±0.79 days. Entry points were detected in 82% of cases. The study revealed statistical significance between extension and grade of lymphedema and number of ADLA attacks per year (P=0.018 and 0.022, respectively. Microfilaraemia was detected in four cases and positive filarial antigenaemia were detected in 29 patients (64.4. The number of ADLA attacks per year significantly decreased from the pre-treatment period (mean: 2.05±0.560 to be 1.23±0.706 after one year and 0.89±0.575 after two years post treatment. There was a significant decrease in the mean antigen titer one year and two years after treatment. Conclusion: Basic lymphedema management is effective for controlling ADLA attacks in areas where lymphatic filariasis is endemic.

  4. Impact of basic lymphedema management and antifilarial treatment on acute dermatolymphangioadenitis episodes and filarial antigenaemia

    OpenAIRE

    H A El-Nahas; A M El-Shazly; Abulhassan, M; N A Nabih; N Mousa

    2011-01-01

    Background: A major factor in the progression of lymphedema is acute dermatolymphangioadenitis (ADLA). Aims : To study ADLA episodes and antigenaemia in patients with different grades of filarial lymphedema at pre- and two years post-treatment. Setting and Design: A prospectively conducted study from May 2008 through May 2010. Patients and Methods: Forty five patients complaining of limb swelling with present or past history of limb redness suggestive of ADLA attacks were included. Patients w...

  5. Histopathologic Improvement with Lymphedema Management, Léogâne, Haiti

    OpenAIRE

    Susan F. Wilson; Guarner, Jeannette; Valme, Alix L.; Louis-Charles, Jacky; Tara L Jones; David G Addiss

    2004-01-01

    In countries where bancroftian filariasis is endemic, lymphedema of the leg is a public health problem, particularly for women, who are disproportionately affected. We investigated the effect of basic lymphedema management (hygiene, skin care, and lower limb movement and elevation) on the histologic features of lymphedema. A total of 118 skin-punch biopsy specimens were collected from the legs of 91 patients enrolled in a lymphedema treatment clinic in Léogâne, Haiti. Follow-up biopsy specime...

  6. THE REHABILITATION MANAGEMENT OF LYMPHEDEMA

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    OJOGA Florina

    2015-05-01

    Full Text Available Lymphedema is an important pathology for rehabilitation medecine, especially for the patients who underwent a mastectomy for breast cancer. His frequency is higher when mastectomy is combined with lymph node disection and irradiation of the lymph nodes. Symptoms include heaviness, numbness, pain, stiffness and weakness in the affected limb. Complications of lymphedema include infections such as cellulitis, erysipelas and lymphangitis. Treatment must be instituted as soon as possible and preventive measures are essential. The rehabilitation treatment consists of skin care measures, manual lymphatic massage, elastic compression of the affected limb and kinetotherapy.

  7. Lymphedema

    Science.gov (United States)

    ... to exclude the presence of a blood clot. Treatment Lymphedema is a chronic condition that can be diagnosed ... can lead normal, active lives. The most important therapy for lymphedema is wearing compression garments such as prescription-strength ...

  8. Lymphedema

    Science.gov (United States)

    Lymphedema is the name of a type of swelling. It happens when lymph builds up in your ... happens in the arms or legs. Causes of lymphedema include Infection Cancer Scar tissue from radiation therapy ...

  9. [Management of secondary lymphedema in patients with cancer].

    Science.gov (United States)

    Wenczl, Enikő

    2016-03-27

    Due to the increased number of cancer patients and the progress in cancer treatment, there are more cases with cancer-related lymphedema. Lymphedema treatment became part of oncological patients' care. Basic therapy for lymphedema is the complex decongestive therapy, which should be embedded into the patient's comprehensive medical care and should always be determined individually. Results of therapy are influenced by the experience of the doctor and the physiotherapist in lymphedema care, patient's complience, tumor behavior and the accompanying diseases. Lymphedema is a chronic disease, requires lifelong follow-up and treatment. For prevention and better care, it would be important to inform patients about lymphedema risk and appropriate life-style (e.g. weight control) preoperatively and during oncological follow-up. Early diagnosis is important. Lymphedema treatment should be integrated into palliative programmes. If therapy is started in time, complications may be avoided, healthcare costs may be reduced and better quality of life may be achieved. PMID:26996895

  10. A Lymphedema Self-Management Programme: Report on 30 Cases

    OpenAIRE

    Tidhar, Dorit; Hodgson, Pamela; Shay, Carol; Towers, Anna

    2014-01-01

    Purpose: Compression therapy is the most important element in the treatment and long-term management of moderate and severe lymphedema, but it is not universally accessible in Canada. For those unable to access private lymphedema treatment, physiotherapists at the McGill University Health Centre (MUHC) Lymphedema Clinic began teaching patients and caregivers how to use compression bandages safely and effectively. Methods: A retrospective chart review was combined with structured telephone or ...

  11. Lymphaticovenular bypass surgery for lymphedema management in breast cancer patients.

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    Chang, D W

    2012-12-01

    Historically, the reported incidence of upper extremity lymphedema in breast cancer survivors who have undergone axillary lymph node dissection has ranged from 9% to 41%. In the past 2 decades, sentinel lymph node biopsy has become popular as a way to minimize the morbidity associated with axillary dissection without compromising the cure rate for breast cancer patients. However, even with sentinel node biopsy, the postoperative incidence of upper limb lymphedema in breast cancer patients remains at 4-10%. Lymphedema occasionally emerges immediately after surgery but most often appears after a latent period. Obesity, postoperative seroma, and radiation therapy have been reported as major risk factors for upper extremity lymphedema, but the etiology of lymphedema is still not fully understood. Common symptoms of upper limb lymphedema are increased volume and weight of the affected limb and increased skin tension. The increased volume of the affected limb not only causes physical impairments in wearing clothes and in dexterity but also affects patients' emotional and mental status. Surgical management of lymphedema can be broadly categorized into physiologic methods and reductive techniques. Physiologic methods such as flap interposition, lymph node transfers, and lymphatic bypass procedures aim to decrease lymphedema by restoring lymphatic drainage. In contrast, reductive techniques such as direct excision or liposuction aim to remove fibrofatty tissue generated as a consequence of sustained lymphatic fluid stasis. Currently, microsurgical variations of lymphatic bypass, in which excess lymph trapped within the lymphedematous limb is redirected into other lymphatic basins or into the venous circulation, have gained popularity.

  12. Impact of a community-based lymphedema management program on episodes of Adenolymphangitis (ADLA) and lymphedema progression--Odisha State, India.

    OpenAIRE

    Mues, Katherine E.; Michael Deming; Kleinbaum, David G.; Budge, Philip J.; Mitch Klein; Leon, Juan S.; Aishya Prakash; Jonathan Rout; Fox, LeAnne M.

    2014-01-01

    Background Lymphedema management programs have been shown to decrease episodes of adenolymphangitis (ADLA), but the impact on lymphedema progression and of program compliance have not been thoroughly explored. Our objectives were to determine the rate of ADLA episodes and lymphedema progression over time for patients enrolled in a community-based lymphedema management program. We explored the association between program compliance and ADLA episodes as well as lymphedema progression. Methodolo...

  13. Self-Care for Management of Secondary Lymphedema: A Systematic Review

    OpenAIRE

    Janet Douglass; Patricia Graves; Susan Gordon

    2016-01-01

    Background Lymphedema is a debilitating and disfiguring sequela of an overwhelmed lymphatic system. The most common causes of secondary lymphedema are lymphatic filariasis (LF), a vector-borne, parasitic disease endemic in 73 tropical countries, and treatment for cancer in developed countries. Lymphedema is incurable and requires life-long care so identification of effective lymphedema management is imperative to improve quality of life, reduce the burden on family resources and benefit the l...

  14. Self-Care for Management of Secondary Lymphedema: A Systematic Review.

    OpenAIRE

    Janet Douglass; Patricia Graves; Susan Gordon

    2016-01-01

    Lymphedema is a debilitating and disfiguring sequela of an overwhelmed lymphatic system. The most common causes of secondary lymphedema are lymphatic filariasis (LF), a vector-borne, parasitic disease endemic in 73 tropical countries, and treatment for cancer in developed countries. Lymphedema is incurable and requires life-long care so identification of effective lymphedema management is imperative to improve quality of life, reduce the burden on family resources and benefit the local commun...

  15. Complexities of Adherence and Post-Cancer Lymphedema Management

    OpenAIRE

    Ostby, Pamela L.; Jane M Armer

    2015-01-01

    Breast cancer survivors are at increased risk for breast cancer-related lymphedema (BCRL), a chronic, debilitating, condition that is progressive and requires lifelong self-management. Up to 40% of 3 million breast cancer survivors in the US will develop BCRL, which has no cure, is irreversible, and requires self-management with regimens that may include multiple components. The complexities of treatment can negatively affect adherence to BCRL self-management which is critical to preventing ...

  16. Surgical Management of Chronic Lymphedema; Introducing an Innovative Procedure

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    Seyed-Reza Mousavi

    2008-09-01

    Full Text Available Objective: Lymphedema is the result of impaired lymphatic drainage from the affected organ. This abnormality can be primary or secondary. Different nonoperative and operative approaches have been introduced to treat chronic lymphedema. In this study, we describe a new surgical technique and compare its results with other more commonplace methods. Methods:Fifty-nine patients with the diagnosis of chronic lower extremity lymphdema who had not responded to nonoperative management for at least 6 months, were included in the study. They were collected during 15 years between March 1987 and March 2002. Doppler ultrasonography of deep venous system to confirm its patency was routinely performed in the most of patients. Then, they underwent surgery and were followed for at least 1 year postoperatively. Findings: All the patients were operated by our new technique which is a modified form of the Homans. The outcome was excellent and 89.2% of patients were devoid of complication. A 10.8% total complication rate was inevitable. The most common complication was wound seroma. Conclusion: According to the difficulties with treatment of chronic lymphedema and variety of surgical options, our method can be an excellent and even the standard operative procedure to treat intractable forms of disease.

  17. Lymphedema and Therapeutic Lymphangiogenesis

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    Yukihiro Saito

    2013-01-01

    Full Text Available Lymphedema is a disorder of the lymphatic vascular system characterized by impaired lymphatic return and swelling of the extremities. Lymphedema is divided into primary and secondary forms based on the underlying etiology. Despite substantial advances in both surgical and conservative techniques, therapeutic options for the management of lymphedema are limited. Although rarely lethal, lymphedema is a disfiguring and disabling condition with an associated decrease in the quality of life. The recent impressive expansion of knowledge on the molecular mechanisms governing lymphangiogenesis provides new possibilities for the treatment of lymphedema. This review highlights the lymphatic biology, the pathophysiology of lymphedema, and the therapeutic lymphangiogenesis using hepatocyte growth factor.

  18. Lymphedema and Therapeutic Lymphangiogenesis

    OpenAIRE

    Yukihiro Saito; Hironori Nakagami; Yasufumi Kaneda; Ryuichi Morishita

    2013-01-01

    Lymphedema is a disorder of the lymphatic vascular system characterized by impaired lymphatic return and swelling of the extremities. Lymphedema is divided into primary and secondary forms based on the underlying etiology. Despite substantial advances in both surgical and conservative techniques, therapeutic options for the management of lymphedema are limited. Although rarely lethal, lymphedema is a disfiguring and disabling condition with an associated decrease in the quality of life. The r...

  19. Complexities of Adherence and Post-Cancer Lymphedema Management

    Directory of Open Access Journals (Sweden)

    Pamela L. Ostby

    2015-11-01

    Full Text Available Breast cancer survivors are at increased risk for breast cancer-related lymphedema (BCRL, a chronic, debilitating, condition that is progressive and requires lifelong self-management. Up to 40% of 3 million breast cancer survivors in the US will develop BCRL, which has no cure, is irreversible, and requires self-management with regimens that may include multiple components. The complexities of treatment can negatively affect adherence to BCRL self-management which is critical to preventing progressive swelling and infection. The aim of this review of contemporary literature published from 2005–2015 is to examine the complexities of BCRL self-management, to identify adherence-focused studies relevant to BCRL, and to summarize barriers to self-management of BCRL. Six electronic indices were searched from which 120 articles were retrieved; 17 were BCRL-focused; and eight met inclusion criteria. Seventeen of 120 articles identified barriers to self-management of BCRL such as complexities of treatment regimens, symptom burden, balance of time for treatment and life demands, and lack of education and support; however, only eight studies included outcome measures of adherence to BCRL treatment regimens with a subsequent improvement in reduced limb volumes and/or perceptions of self-efficacy and self-regulation. A major limitation is the few number of rigorously developed outcome measures of BCRL adherence. In addition, randomized studies are needed with larger sample sizes to establish adequate levels of evidence for establishing best practice standards for improving adherence to BCRL self-management treatment regimens.

  20. Complexities of Adherence and Post-Cancer Lymphedema Management.

    Science.gov (United States)

    Ostby, Pamela L; Armer, Jane M

    2015-01-01

    Breast cancer survivors are at increased risk for breast cancer-related lymphedema (BCRL), a chronic, debilitating, condition that is progressive and requires lifelong self-management. Up to 40% of 3 million breast cancer survivors in the US will develop BCRL, which has no cure, is irreversible, and requires self-management with regimens that may include multiple components. The complexities of treatment can negatively affect adherence to BCRL self-management which is critical to preventing progressive swelling and infection. The aim of this review of contemporary literature published from 2005-2015 is to examine the complexities of BCRL self-management, to identify adherence-focused studies relevant to BCRL, and to summarize barriers to self-management of BCRL. Six electronic indices were searched from which 120 articles were retrieved; 17 were BCRL-focused; and eight met inclusion criteria. Seventeen of 120 articles identified barriers to self-management of BCRL such as complexities of treatment regimens, symptom burden, balance of time for treatment and life demands, and lack of education and support; however, only eight studies included outcome measures of adherence to BCRL treatment regimens with a subsequent improvement in reduced limb volumes and/or perceptions of self-efficacy and self-regulation. A major limitation is the few number of rigorously developed outcome measures of BCRL adherence. In addition, randomized studies are needed with larger sample sizes to establish adequate levels of evidence for establishing best practice standards for improving adherence to BCRL self-management treatment regimens. PMID:26580657

  1. Self-Care for Management of Secondary Lymphedema: A Systematic Review

    Science.gov (United States)

    Graves, Patricia; Gordon, Susan

    2016-01-01

    Background Lymphedema is a debilitating and disfiguring sequela of an overwhelmed lymphatic system. The most common causes of secondary lymphedema are lymphatic filariasis (LF), a vector-borne, parasitic disease endemic in 73 tropical countries, and treatment for cancer in developed countries. Lymphedema is incurable and requires life-long care so identification of effective lymphedema management is imperative to improve quality of life, reduce the burden on family resources and benefit the local community. This review was conducted to evaluate the evidence for effective lymphedema self-care strategies that might be applicable to management of all types of secondary lymphedema. Methodology/Principal Findings Searches were conducted in Medline, CINAHL and Scopus databases in March 2015. Included studies reported before and after measures of lymphedema status or frequency of acute infections. The methodological quality was assessed using the appropriate Critical Appraisal Skills Program checklist. Descriptive synthesis and meta-analysis were used to evaluate effectiveness of the outcomes reported. Twenty-eight papers were included; two RCTs were found to have strong methodology, and overall 57% of studies were rated as methodologically weak. Evidence from filariasis-related lymphedema (FR-LE) studies indicated that hygiene-centred self-care reduced the frequency and duration of acute episodes by 54%, and in cancer-related lymphedema (CR-LE) home-based exercise including deep breathing delivered significant volume reductions over standard self-care alone. Intensity of training in self-care practices and frequency of monitoring improved outcomes. Cultural and economic factors and access to health care services influenced the type of intervention delivered and how outcomes were measured. Conclusions/Significance There is evidence to support the adoption of remedial exercises in the management of FR-LE and for a greater emphasis on self-treatment practices for people

  2. Self-Care for Management of Secondary Lymphedema: A Systematic Review.

    Directory of Open Access Journals (Sweden)

    Janet Douglass

    2016-06-01

    Full Text Available Lymphedema is a debilitating and disfiguring sequela of an overwhelmed lymphatic system. The most common causes of secondary lymphedema are lymphatic filariasis (LF, a vector-borne, parasitic disease endemic in 73 tropical countries, and treatment for cancer in developed countries. Lymphedema is incurable and requires life-long care so identification of effective lymphedema management is imperative to improve quality of life, reduce the burden on family resources and benefit the local community. This review was conducted to evaluate the evidence for effective lymphedema self-care strategies that might be applicable to management of all types of secondary lymphedema.Searches were conducted in Medline, CINAHL and Scopus databases in March 2015. Included studies reported before and after measures of lymphedema status or frequency of acute infections. The methodological quality was assessed using the appropriate Critical Appraisal Skills Program checklist. Descriptive synthesis and meta-analysis were used to evaluate effectiveness of the outcomes reported. Twenty-eight papers were included; two RCTs were found to have strong methodology, and overall 57% of studies were rated as methodologically weak. Evidence from filariasis-related lymphedema (FR-LE studies indicated that hygiene-centred self-care reduced the frequency and duration of acute episodes by 54%, and in cancer-related lymphedema (CR-LE home-based exercise including deep breathing delivered significant volume reductions over standard self-care alone. Intensity of training in self-care practices and frequency of monitoring improved outcomes. Cultural and economic factors and access to health care services influenced the type of intervention delivered and how outcomes were measured.There is evidence to support the adoption of remedial exercises in the management of FR-LE and for a greater emphasis on self-treatment practices for people with CR-LE. Empowerment of people with lymphedema to

  3. Impact of Community-Based Lymphedema Management on Perceived Disability among Patients with Lymphatic Filariasis in Orissa State, India

    OpenAIRE

    Budge, Philip J.; Kristen M Little; Mues, Katherine E.; Kennedy, Erin D.; Aiysha Prakash; Jonathan Rout; Fox, LeAnne M.

    2013-01-01

    BACKGROUND: Lymphatic filariasis (LF) infects approximately 120 million people worldwide. As many as 40 million have symptoms of LF disease, including lymphedema, elephantiasis, and hydrocele. India constitutes approximately 45% of the world's burden of LF. The Indian NGO Church's Auxiliary for Social Action (CASA) has been conducting a community-based lymphedema management program in Orissa State since 2007 that aims to reduce the morbidity associated with lymphedema and elephantiasis. The o...

  4. Multidisciplinary Approaches to the Management of Breast-Cancer-Related Lymphedema

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    Solmaz Fakhari

    2013-07-01

    Full Text Available Breast-cancer-related lymphedema is a significant morbidity mostly observed following primary treatments for breast cancer (surgery, radiation, and chemotherapy (1. Multiple complications might accompany lymphedema including cosmetic deformity, psychological disorders, consistent pain, and consequently decreased quality of life. Treatment  mostly focuses on reducing edema and its subsequent pain; however, no definite treatment has been hitherto introduced (2. Surgical approaches in the management of lymphedema are efficient including physiologic methods (e.g. flap interposition, lymph transfer, and lymphatic bypass and reductive techniques (e.g. liposuction (3. While the former mostly targets at reducing lymphedema through restoring lymphatic drainage, the latter aims at removing fibrofatty tissues which contribute to lymph stasis. Microsurgical variation of lymphatic bypass has gained popularity, in which the accumulated lymph in the lymphedematous limb is redirected. Non-surgical approaches are also practiced in most cases. Comprehensive decongestive therapy, consisting of skin care, exercise, special bandaging and massage, is the most frequently used non-surgical approach efficacy of which could be enhanced in combination with self-management strategies (4. Recently newer techniques have been introduced to tackle lymphedema and its associated pain. Manual lymph drainage, stellate ganglion block, acupuncture, deep oscillation, and pneumatic compression have been efficiently used in several studies. Moreover, significant short-term progress has been reported following other modalities such as low-level laser therapy (5. The complexity of breast-cancer-related lymphedema and its complications necessitates a multidisciplinary approach with the primary goal of easing the burden of the disease on the breast cancer patients. In addition, developing special guidelines encompassing these multidisciplinary approaches and providing educational and

  5. Usability and feasibility of health IT interventions to enhance Self-Care for Lymphedema Symptom Management in breast cancer survivors

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    Mei R. Fu, PhD, RN, FAAN

    2016-09-01

    Conclusions: This usability study provided evidence on breast cancer survivor's acceptance and highly positive evaluation of TOLF's usability as well as feasibility of using technologically-driven delivery model to enhance self-care strategies for lymphedema symptom management.

  6. Impact of community-based lymphedema management on perceived disability among patients with lymphatic filariasis in Orissa State, India.

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    Philip J Budge

    Full Text Available BACKGROUND: Lymphatic filariasis (LF infects approximately 120 million people worldwide. As many as 40 million have symptoms of LF disease, including lymphedema, elephantiasis, and hydrocele. India constitutes approximately 45% of the world's burden of LF. The Indian NGO Church's Auxiliary for Social Action (CASA has been conducting a community-based lymphedema management program in Orissa State since 2007 that aims to reduce the morbidity associated with lymphedema and elephantiasis. The objective of this analysis is to evaluate the effects of this program on lymphedema patients' perceived disability. METHODOLOGY/PRINCIPAL FINDINGS: For this prospective cohort study, 370 patients ≥14 years of age, who reported lymphedema lasting more than three months in one or both legs, were recruited from villages in the Bolagarh sub-district, Khurda District, Orissa, India. The World Health Organization Disability Assessment Schedule II was administered to participants at baseline (July, 2009, and then at regular intervals through 24 months (July, 2011, to assess patients' perceived disability. Disability scores decreased significantly (p<0.0001 from baseline to 24 months. Multivariable analysis using mixed effects modeling found that employment and time in the program were significantly associated with lower disability scores after two years of program involvement. Older age, female gender, the presence of other chronic health conditions, moderate (Stage 3 or advanced (Stage 4-7 lymphedema, reporting an adenolymphangitis (ADL episode during the previous 30 days, and the presence of inter-digital lesions were associated with higher disability scores. Patients with moderate or advanced lymphedema experienced greater improvements in perceived disability over time. Patients participating in the program for at least 12 months also reported losing 2.5 fewer work days per month (p<0.001 due to their lymphedema, compared to baseline. SIGNIFICANCE: These results

  7. Surveillance Recommendations in Reducing Risk of and Optimally Managing Breast Cancer-Related Lymphedema

    OpenAIRE

    Ostby, Pamela L.; Jane M Armer; Dale, Paul S.; Margaret J. Van Loo; Cassie L. Wilbanks; Stewart, Bob R.

    2014-01-01

    Breast cancer survivors are at increased risk for the development of breast cancer-related lymphedema (BCRL), a chronic, debilitating, and disfiguring condition that is progressive and requires lifelong self-management of symptoms. It has been reported that over 40% of the 2.5 million breast cancer survivors in the United States may meet the criteria for BCRL during their lifetimes. Ongoing surveillance, beginning with pre-operative assessment, has been effective in identifying subclinical ly...

  8. Economic Costs and Benefits of a Community-Based Lymphedema Management Program for Lymphatic Filariasis in Odisha State, India

    Science.gov (United States)

    Stillwaggon, Eileen; Sawers, Larry; Rout, Jonathan; Addiss, David; Fox, LeAnne

    2016-01-01

    Lymphatic filariasis afflicts 68 million people in 73 countries, including 17 million persons living with chronic lymphedema. The Global Programme to Eliminate Lymphatic Filariasis aims to stop new infections and to provide care for persons already affected, but morbidity management programs have been initiated in only 24 endemic countries. We examine the economic costs and benefits of alleviating chronic lymphedema and its effects through a simple limb-care program. For Khurda District, Odisha State, India, we estimated lifetime medical costs and earnings losses due to chronic lymphedema and acute dermatolymphangioadenitis (ADLA) with and without a community-based limb-care program. The program would reduce economic costs of lymphedema and ADLA over 60 years by 55%. Savings of US$1,648 for each affected person in the workforce are equivalent to 1,258 days of labor. Per-person savings are more than 130 times the per-person cost of the program. Chronic lymphedema and ADLA impose a substantial physical and economic burden on the population in filariasis-endemic areas. Low-cost programs for lymphedema management based on limb washing and topical medication for infection are effective in reducing the number of ADLA episodes and stopping progression of disabling and disfiguring lymphedema. With reduced disability, people are able to work longer hours, more days per year, and in more strenuous, higher-paying jobs, resulting in an important economic benefit to themselves, their families, and their communities. Mitigating the severity of lymphedema and ADLA also reduces out-of-pocket medical expense. PMID:27573626

  9. Breast and gynecologic cancer-related extremity lymphedema: a review of diagnostic modalities and management options

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    Tiwari, Pankaj; Coriddi, Michelle; Salani, Ritu; Povoski, Stephen P.

    2013-01-01

    Lymphedema remains a poorly understood entity that can occur after lymphadenectomy. Herein, we will review the pathogenesis of lymphedema, diagnostic modalities and the natural history of extremity involvement. We will review the incidence of upper extremity lymphedema in patients treated for breast malignancies and lower extremity lymphedema in those treated for gynecologic malignancy. Finally, we will review traditional treatment modalities for lymphedema, as well as introduce new surgical ...

  10. Surveillance recommendations in reducing risk of and optimally managing breast cancer-related lymphedema.

    Science.gov (United States)

    Ostby, Pamela L; Armer, Jane M; Dale, Paul S; Van Loo, Margaret J; Wilbanks, Cassie L; Stewart, Bob R

    2014-01-01

    Breast cancer survivors are at increased risk for the development of breast cancer-related lymphedema (BCRL), a chronic, debilitating, and disfiguring condition that is progressive and requires lifelong self-management of symptoms. It has been reported that over 40% of the 2.5 million breast cancer survivors in the United States may meet the criteria for BCRL during their lifetimes. Ongoing surveillance, beginning with pre-operative assessment, has been effective in identifying subclinical lymphedema (LE). A prospective model for surveillance is necessary in order to detect BCRL at an early stage when there is the best chance to reduce risk or slow progression. Physical methods for monitoring and assessment, such as circumferential arm measures, perometry, bioimpedance; exercise programs; prophylactic and early-intervention compression garments; and referral for complete decongestive therapy are all interventions to consider in the development of a BCRL surveillance program. In addition, supportive-educative programs and interactive engagement for symptom self-management should also be implemented. The importance of interdisciplinary collaboration is integral to the success of an effective personalized medicine program in breast cancer-related lymphedema surveillance. PMID:25563360

  11. Surveillance Recommendations in Reducing Risk of and Optimally Managing Breast Cancer-Related Lymphedema

    Directory of Open Access Journals (Sweden)

    Pamela L. Ostby

    2014-08-01

    Full Text Available Breast cancer survivors are at increased risk for the development of breast cancer-related lymphedema (BCRL, a chronic, debilitating, and disfiguring condition that is progressive and requires lifelong self-management of symptoms. It has been reported that over 40% of the 2.5 million breast cancer survivors in the United States may meet the criteria for BCRL during their lifetimes. Ongoing surveillance, beginning with pre-operative assessment, has been effective in identifying subclinical lymphedema (LE. A prospective model for surveillance is necessary in order to detect BCRL at an early stage when there is the best chance to reduce risk or slow progression. Physical methods for monitoring and assessment, such as circumferential arm measures, perometry, bioimpedance; exercise programs; prophylactic and early-intervention compression garments; and referral for complete decongestive therapy are all interventions to consider in the development of a BCRL surveillance program. In addition, supportive-educative programs and interactive engagement for symptom self-management should also be implemented. The importance of interdisciplinary collaboration is integral to the success of an effective personalized medicine program in breast cancer-related lymphedema surveillance.

  12. Increasing compliance with mass drug administration programs for lymphatic filariasis in India through education and lymphedema management programs.

    Directory of Open Access Journals (Sweden)

    Paul T Cantey

    Full Text Available BACKGROUND: Nearly 45% of people living at risk for lymphatic filariasis (LF worldwide live in India. India has faced challenges obtaining the needed levels of compliance with its mass drug administration (MDA program to interrupt LF transmission, which utilizes diethylcarbamazine (DEC or DEC plus albendazole. Previously identified predictors of and barriers to compliance with the MDA program were used to refine a pre-MDA educational campaign. The objectives of this study were to assess the impact of these refinements and of a lymphedema morbidity management program on MDA compliance. METHODS/PRINCIPAL FINDINGS: A randomized, 30-cluster survey was performed in each of 3 areas: the community-based pre-MDA education plus community-based lymphedema management education (Com-MDA+LM area, the community-based pre-MDA education (Com-MDA area, and the Indian standard pre-MDA education (MDA-only area. Compliance with the MDA program was 90.2% in Com-MDA+LM, 75.0% in Com-MDA, and 52.9% in the MDA-only areas (p<0.0001. Identified barriers to adherence included: 1 fear of side effects and 2 lack of recognition of one's personal benefit from adherence. Multivariable predictors of adherence amenable to educational intervention were: 1 knowing about the MDA in advance of its occurrence, 2 knowing everyone is at risk for LF, 3 knowing that the MDA was for LF, and 4 knowing at least one component of the lymphedema management techniques taught in the lymphedema management program. CONCLUSIONS/SIGNIFICANCE: This study confirmed previously identified predictors of and barriers to compliance with India's MDA program for LF. More importantly, it showed that targeting these predictors and barriers in a timely and clear pre-MDA educational campaign can increase compliance with MDA programs, and it demonstrated, for the first time, that lymphedema management programs may also increase compliance with MDA programs.

  13. Ethnodrama: An Innovative Knowledge Translation Tool in the Management of Lymphedema

    OpenAIRE

    Ahmed, Shahid; Quinlan, Elizabeth; McMullen, Linda; Thomas, Roanne; Fichtner, Pam; Block, Janice

    2015-01-01

    Background: Lymphedema can cause significant physical impairment and quality-of-life issues. Yet there is a gap in knowledge about lymphedema among breast cancer survivors (BCS), and health care professionals (HCP). Ethnodrama is an innovative knowledge translation strategy that uses theatrical performances for dissemination of research results. We evaluated the impact of live ethnodrama on HCP' and BCS' awareness and attitudes in relation to impact of lymphedema on BCS' lives. Methods: Ethno...

  14. Breast Cancer-Related Arm Lymphedema: Incidence Rates, Diagnostic Techniques, Optimal Management and Risk Reduction Strategies

    International Nuclear Information System (INIS)

    As more women survive breast cancer, long-term toxicities affecting their quality of life, such as lymphedema (LE) of the arm, gain importance. Although numerous studies have attempted to determine incidence rates, identify optimal diagnostic tests, enumerate efficacious treatment strategies and outline risk reduction guidelines for breast cancer–related lymphedema (BCRL), few groups have consistently agreed on any of these issues. As a result, standardized recommendations are still lacking. This review will summarize the latest data addressing all of these concerns in order to provide patients and health care providers with optimal, contemporary recommendations. Published incidence rates for BCRL vary substantially with a range of 2–65% based on surgical technique, axillary sampling method, radiation therapy fields treated, and the use of chemotherapy. Newer clinical assessment tools can potentially identify BCRL in patients with subclinical disease with prospective data suggesting that early diagnosis and management with noninvasive therapy can lead to excellent outcomes. Multiple therapies exist with treatments defined by the severity of BCRL present. Currently, the standard of care for BCRL in patients with significant LE is complex decongestive physiotherapy (CDP). Contemporary data also suggest that a multidisciplinary approach to the management of BCRL should begin prior to definitive treatment for breast cancer employing patient-specific surgical, radiation therapy, and chemotherapy paradigms that limit risks. Further, prospective clinical assessments before and after treatment should be employed to diagnose subclinical disease. In those patients who require aggressive locoregional management, prophylactic therapies and the use of CDP can help reduce the long-term sequelae of BCRL.

  15. Breast Cancer-Related Arm Lymphedema: Incidence Rates, Diagnostic Techniques, Optimal Management and Risk Reduction Strategies

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Chirag [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Vicini, Frank A., E-mail: fvicini@beaumont.edu [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States)

    2011-11-15

    As more women survive breast cancer, long-term toxicities affecting their quality of life, such as lymphedema (LE) of the arm, gain importance. Although numerous studies have attempted to determine incidence rates, identify optimal diagnostic tests, enumerate efficacious treatment strategies and outline risk reduction guidelines for breast cancer-related lymphedema (BCRL), few groups have consistently agreed on any of these issues. As a result, standardized recommendations are still lacking. This review will summarize the latest data addressing all of these concerns in order to provide patients and health care providers with optimal, contemporary recommendations. Published incidence rates for BCRL vary substantially with a range of 2-65% based on surgical technique, axillary sampling method, radiation therapy fields treated, and the use of chemotherapy. Newer clinical assessment tools can potentially identify BCRL in patients with subclinical disease with prospective data suggesting that early diagnosis and management with noninvasive therapy can lead to excellent outcomes. Multiple therapies exist with treatments defined by the severity of BCRL present. Currently, the standard of care for BCRL in patients with significant LE is complex decongestive physiotherapy (CDP). Contemporary data also suggest that a multidisciplinary approach to the management of BCRL should begin prior to definitive treatment for breast cancer employing patient-specific surgical, radiation therapy, and chemotherapy paradigms that limit risks. Further, prospective clinical assessments before and after treatment should be employed to diagnose subclinical disease. In those patients who require aggressive locoregional management, prophylactic therapies and the use of CDP can help reduce the long-term sequelae of BCRL.

  16. Lymphedema Risk Reduction Practices

    Science.gov (United States)

    ... Manual Lymph Drainage (MLD) Self-Care Contraindications for Treatment Lymphedema for Cancer Patients Measurements Bandaging Stomp Out Lymphedema ... National Lymphedema Network. Position Paper on Diagnosis and Treatment of Lymphedema. /pdfDocs/nlntreatment.pdf . Updated Feb 2011. Werner RS, ...

  17. Three Risk Management Basics

    OpenAIRE

    2008-01-01

    This ongoing column is dedicated to providing information to our readers on managing legal risks associated with medical practice. We invite questions from our readers. The answers are provided by PRMS, Inc. (www.prms.com), a manager of medical professional liability insurance programs with services that include risk management consultation, education and onsite risk management audits, and other resources to healthcare providers to help improve patient outcomes and reduce professional liabili...

  18. Basic Elements of Knowledge Management

    OpenAIRE

    Marcin W. Staniewski

    2007-01-01

    The article is a review of basic knowledge management terminology. It presents such a description as: knowledge resources levels (data, information, knowledge, and wisdom), knowledge sources (internal, external), and knowledge typology (implicit, tacit or individual, social). Moreover the article characterizes knowledge management process, knowledge management system and main knowledge management strategies (codification, personalization). At the end of the article there is mentioned the know...

  19. Multidisciplinary Approaches to the Management of Breast-Cancer-Related Lymphedema

    OpenAIRE

    Solmaz Fakhari; Hadi Mohammad Khanli; Babak Sabermarouf

    2013-01-01

    Breast-cancer-related lymphedema is a significant morbidity mostly observed following primary treatments for breast cancer (surgery, radiation, and chemotherapy) (1). Multiple complications might accompany lymphedema including cosmetic deformity, psychological disorders, consistent pain, and consequently decreased quality of life. Treatment  mostly focuses on reducing edema and its subsequent pain; however, no definite treatment has been hitherto introduced (2). Surgical approaches in the man...

  20. Best Practice Guidelines in Assessment, Risk Reduction, Management, and Surveillance for Post-Breast Cancer Lymphedema

    OpenAIRE

    Jane M Armer; Jennifer M. Hulett; Bernas, Michael; Ostby, Pam; Stewart, Bob R.; Cormier, Janice N.

    2013-01-01

    Breast cancer-related lymphedema (LE) is a progressive, chronic disease that affects millions of cancer survivors and primarily results from surgical lymphatic vessel/node removal and radiation therapy. Patient education and support for importance of early detection is essential in helping health care providers detect lymphedema early, when there is the best chance to prevent progression. Improved imaging and surgical techniques have decreased the incidence of LE; however, effective risk-redu...

  1. Nodular Foot Myxedema Masquerading as Lymphedema

    OpenAIRE

    Couto, Javier A.; Schmidt, Birgitta A. R.; Greene, Arin K.

    2015-01-01

    Summary: Lymphedema results from abnormal development or injury to the lymphatic system. One-fourth of patients with lower extremity enlargement are erroneously labeled with “lymphedema.” We describe a patient with hypothyroidism who developed soft-tissue overgrowth of her foot. She was referred to our Lymphedema Program for management of “lymphedema” and overgrown toes. The patient’s lymphoscintigram showed normal lymphatic function in her extremities, and she was diagnosed with myxedema by ...

  2. Basic Elements of Knowledge Management

    Directory of Open Access Journals (Sweden)

    Marcin W. Staniewski

    2007-10-01

    Full Text Available The article is a review of basic knowledge management terminology. It presents such a description as: knowledge resources levels (data, information, knowledge, and wisdom, knowledge sources (internal, external, and knowledge typology (implicit, tacit or individual, social. Moreover the article characterizes knowledge management process, knowledge management system and main knowledge management strategies (codification, personalization. At the end of the article there is mentioned the knowledge creating process (the concept of knowledge creation spiral and the role of Intelligence Technology (IT and organizational culture as main elements supporting knowledge management implementation in organizations.

  3. Paediatric airway management: basic aspects

    DEFF Research Database (Denmark)

    Holm-Knudsen, R J; Rasmussen, L S

    2009-01-01

    children. This paper aims at providing the non-paediatric anaesthesiologist with a set of safe and simple principles for basic paediatric airway management. In contrast to adults, most children with difficult airways are recognised before induction of anaesthesia but problems may arise in all children...

  4. Breast cancer-related lymphedema: Symptoms, diagnosis, risk reduction, and management

    OpenAIRE

    Fu, Mei R.

    2014-01-01

    The global burden of breast cancer continues to increase largely because of the aging and growth of the world population. More than 1.38 million women worldwide were estimated to be diagnosed with breast cancer in 2008, accounting for 23% of all diagnosed cancers in women. Given that the 5-year survival rate for breast cancer is now 90%, experiencing breast cancer is ultimately about quality of life. Women treated for breast cancer are facing a life-time risk of developing lymphedema, a chron...

  5. National Lymphedema Network

    Science.gov (United States)

    ... and article archives // Knowledge and support National Lymphedema Network News Stay up to date with NLN activities and goings-on. Follow the National Lymphedema Network newsfeed below. Also, see the following links for ...

  6. DESCRIBING LYMPHEDEMA IN FEMALES WITH TURNER SYNDROME.

    Science.gov (United States)

    Rothbauer, J; Driver, S; Callender, L

    2015-09-01

    Turner syndrome (TS) is a chromosomal condition affecting an estimated 1 in 2,500 girls where the second X chromosome is missing, or partially formed. This abnormality affects multiple body systems and can lead to short stature, cardiac, neural, and renal abnormalities. Due to the chronic, non-life threatening nature of lymphedema in comparison to other symptoms of TS, it is often ignored by girls and women with TS and their physicians. Consequently, little is known about how lymphedema affects girls and women with TS across the lifespan. Therefore, the objective of the study was to deliver an online survey for females with TS and caregivers in the US, UK, and Canada to provide a worldwide perspective on their current experience with lymphedema within the spectrum of TS. There were 219 participants who completed the survey, and we were able to identify incidence and characteristics of lymphedema across the lifespan. In addition, we found that females with 45,X karyotyping were more likely to report lymphedema symptoms. Lymphedema is not the most significant concern of females with TS, but education, physician evaluation, and assistance with referrals for treatment and management would improve the ease of managing lymphedema in girls and women with TS.

  7. Quality of Life, Upper Extremity Function and the Effect of Lymphedema Treatment in Breast Cancer Related Lymphedema Patients

    OpenAIRE

    Park, Ji Eung; Jang, Hye Jin; Seo, Kwan Sik

    2012-01-01

    Objective To evaluate quality of life (QOL), upper extremity function and the effect of lymphedema treatment in patients with breast cancer related lymphedema. Method The basic data comprised medical records (detailing age, sex, dominant side, location of tumor, cancer stage, operation record, cancer treatment and limb circumferences) and questionnaires (lymphedema duration, satisfaction, self-massage). Further to this, we measured upper extremity function and QOL, administered the DASH (Disa...

  8. Living with lymphedema: a qualitative study of women's perspectives on prevention and management following breast cancer-related treatment.

    Science.gov (United States)

    Greenslade, M Victoria; House, Colleen J

    2006-01-01

    A phenomenological research method was used to investigate the experience of lymphedema in 13 women following breast cancer-related treatment. The women, ranging in age from 45 to 82, living on the east coast of Canada, had lymphedema of the upper extremity for at least one year, and had no evidence of active cancer disease. Semi-structured interviews were used to examine the physical and psychosocial suffering that women with lymphedema experienced. The lack of appropriate pre-intervention education and post-intervention support by health care professionals as well as the lack of effective protocols to prevent lymphedema combined to intensify the suffering. Data analysis incorporated van Manen's (1990) six research activities which give human science its vigor. These non-sequential steps assisted in identifying five major themes: 1) Constancy; 2) Yearning for Normalcy; 3) Continually Searching; 4) Emotional Impact; and 5) Abandonment. The prevailing thread or essence salient to all five themes in this study is denoted as Existential Aloneness as each participant expressed a sense of isolation, of being on their own, of being set adrift to discover what they could about lymphedema, in the best way that they could. Nursing implications and recommendations for change are highlighted. PMID:17523577

  9. Exemplary management - a basic function of TQM

    OpenAIRE

    Miceski, Trajko

    2001-01-01

    Management, as a basic function carried out by manager - leader, is of a special importance for TQM because it denotes a capacity to influence other people to do their best in realization of the goals of the company. It usually includes the basic activities and functions of the leader, which are important for functioning, quality improvement and efficient work of the organization. The leader as a person who performs the management has a special function and role in the organization, which all...

  10. Linking Theory with Practice in Basic Management

    Science.gov (United States)

    Carroll, Archie B.

    1974-01-01

    Instructors of management in higher education have not been cautious in explaining the relation between practice and theory in their basic courses. The author distinguished between the two in suggesting that management theory is based on observed practices and may or may not have broader application. (AG)

  11. Recent Progress in Cancer-Related Lymphedema Treatment and Prevention

    OpenAIRE

    Shaitelman, Simona F; Cromwell, Kate D.; Rasmussen, John C.; Stout, Nicole L; Armer, Jane M.; Lasinski, Bonnie B.; Cormier, Janice N

    2014-01-01

    This article provides an overview of the recent developments in the diagnosis, treatment, and prevention of cancer-related lymphedema. Lymphedema incidence by tumor site is evaluated. Measurement techniques and trends in patient education and treatment are also summarized to include current trends in therapeutic and surgical treatment options as well as longer-term management. Finally, an overview of the policies related to insurance coverage and reimbursement will give the clinician an overv...

  12. Genetics Home Reference: lymphedema-distichiasis syndrome

    Science.gov (United States)

    ... Understand Genetics Home Health Conditions lymphedema-distichiasis syndrome lymphedema-distichiasis syndrome Enable Javascript to view the expand/ ... boxes. Print All Open All Close All Description Lymphedema-distichiasis syndrome is a condition that affects the ...

  13. INTENSIVE TREATMENT OF LEG LYMPHEDEMA

    OpenAIRE

    Pereira de Godoy Jose; Azoubel Lina; Guerreiro de Godoy Maria de Fatima

    2010-01-01

    Background: Despite of all the problems caused by lymphedema, this disease continues to affect millions of people worldwide. Thus, the identification of the most efficacious forms of treatment is necessary. Aim: The aim of this study was to evaluate a novel intensive outpatient treatment for leg lymphedema. Methods: Twenty-three legs of 19 patients were evaluated in a prospective randomized study. The inclusion criteria were patients with Grade II and III lymphedema, where the difference...

  14. Intravenous Pamidronate for Refractory Lymphedema

    OpenAIRE

    Beigi, A A; Sadeghi, A M; Masoudpour, H; Shirazinejad, S; Mottaghi, P

    2011-01-01

    Background Based on beneficial reports of pamidronate use for reflex sympathetic dystrophy in reduction of pain and swelling, this drug can be studied as a novel treatment for refractory lymphedema. This study aims to determine the effectiveness of pamidronate on lymphedema and its possible side effects. Methods Twelve cases of lower limb refractory lymphedema were enrolled. They received intravenous pamidronate monthly for 3 consecutive months and were followed by measuring any discomfort wi...

  15. Basic components of construction enterprises’ management marketing activities system

    OpenAIRE

    Seleznova Olha Olexandrivna

    2015-01-01

    This article investigated the basic components of construction enterprises’ management marketing activities system. It is developed the model of the construction enterprises’ management marketing activities system. The article explores the essence of the stages of forming the construction enterprises’ management marketing activities system. The article reveals the basic elements of marketing management – mission, goals, strategy. It describes the basic functions of marketing management system...

  16. Lymphedema secondary to filariasis

    Energy Technology Data Exchange (ETDEWEB)

    Leonard, J.C.; Humphrey, G.B.; Basmadjian, G.

    1985-03-01

    A 1-year-old immunodeficient boy developed brawny edema of the left foot. Lymphoscintigraphy revealed no evidence of left inguinal activity following pedal injection of Tc-99m-Sn phosphate. Over the next two months, the patient developed lymphedema on the right and repeat scintigraphy demonstrated no movement of isotope from the dorsum of either foot. Subsequent studies identified microfilaria in a nocturnal blood smear, which were thought to represent Brugia beaveri acquired by mosquito transmission in Oklahoma.

  17. Lymphedema secondary to filariasis

    International Nuclear Information System (INIS)

    A 1-year-old immunodeficient boy developed brawny edema of the left foot. Lymphoscintigraphy revealed no evidence of left inguinal activity following pedal injection of Tc-99m-Sn phosphate. Over the next two months, the patient developed lymphedema on the right and repeat scintigraphy demonstrated no movement of isotope from the dorsum of either foot. Subsequent studies identified microfilaria in a nocturnal blood smear, which were thought to represent Brugia beaveri acquired by mosquito transmission in Oklahoma

  18. Doxycycline Improves Filarial Lymphedema Independent of Active Filarial Infection: A Randomized Controlled Trial

    OpenAIRE

    Mand, S; DEBRAH, A Y; Klarmann, U; Batsa, L.; Marfo-Debrekyei, Y.; Kwarteng, A; S. SPECHT; Belda-Domene, A.; Fimmers, R; Taylor, M; Adjei, O.; Hoerauf, A.

    2012-01-01

    Treatment with doxycycline leads to improvement of filarial lymphedema independent of active infection (ie, patients positive or negative for circulating filarial antigen). Therefore, doxycycline (200 mg/d for 6 weeks) should be considered for patients with stage 1–3 lymphedema to improve morbidity management.

  19. Basic concepts and definitions of clinical management

    OpenAIRE

    Angélica Román

    2012-01-01

    Management is leading, administering resources, and achieving the goals and objectives that have been set. In the Chilean health care system, management can be subdivided in three main levels – macro-management, meso-management and micro-management. Managing health care is also about epidemiological changes, information and technology innovations, patient groups demanding better services, but mostly about a huge escalation in costs that is not necessarily substantiated by evidence on more eff...

  20. Squamous cell carcinoma of the penis and scrotum in a patient with chronic scrotal and penile lymphedema

    OpenAIRE

    Abhyankar Suhas; Kulkarni Ananta; Kulkarni Madhuri; Agarwal Naveen

    2010-01-01

    Squamous cell carcinoma arising from tissue affected by chronic lymphedema is rare, though it is recognized that a variety of malignant tumors can arise in chronic congenital or acquired lymphedema. We describe, a case of scrotal and penile squamous cell carcinoma arising in a patient with a history of chronic scrotal and penile lymphedema of filarial origin. We here discuss the management and possible etiology of this unusual case.

  1. Squamous cell carcinoma of the penis and scrotum in a patient with chronic scrotal and penile lymphedema

    Directory of Open Access Journals (Sweden)

    Abhyankar Suhas

    2010-01-01

    Full Text Available Squamous cell carcinoma arising from tissue affected by chronic lymphedema is rare, though it is recognized that a variety of malignant tumors can arise in chronic congenital or acquired lymphedema. We describe, a case of scrotal and penile squamous cell carcinoma arising in a patient with a history of chronic scrotal and penile lymphedema of filarial origin. We here discuss the management and possible etiology of this unusual case.

  2. Squamous cell carcinoma of the penis and scrotum in a patient with chronic scrotal and penile lymphedema.

    Science.gov (United States)

    Abhyankar, Suhas V; Kulkarni, Ananta; Kulkarni, Madhuri; Agarwal, Naveen Kumar

    2010-10-01

    Squamous cell carcinoma arising from tissue affected by chronic lymphedema is rare, though it is recognized that a variety of malignant tumors can arise in chronic congenital or acquired lymphedema. We describe, a case of scrotal and penile squamous cell carcinoma arising in a patient with a history of chronic scrotal and penile lymphedema of filarial origin. We here discuss the management and possible etiology of this unusual case. PMID:21430898

  3. Evaluating the Burden of Lymphedema Due to Lymphatic Filariasis in 2005 in Khurda District, Odisha State, India

    Science.gov (United States)

    Walsh, Victoria; Little, Kristen; Wiegand, Ryan; Rout, Jonathan; Fox, LeAnne M.

    2016-01-01

    Background Over 1.1 billion people worldwide are at risk for lymphatic filariasis (LF), and the global burden of LF-associated lymphedema is estimated at 16 million affected people, yet country-specific estimates are poor. Methodology/Principal Findings A house-to-house morbidity census was conducted to assess the burden and severity of lymphedema in a population of 1,298,576 persons living in the LF-endemic district of Khurda in Odisha State, India. The burden of lymphedema in Khurda is widespread geographically, and 1.3% (17,036) of the total population report lymphedema. 51.3% of the patients reporting lymphedema were female, mean age 49.4 years (1–99). Early lymphedema (Dreyer stages 1 & 2) was reported in two-thirds of the patients. Poisson regression analysis was conducted in order to determine risk factors for advanced lymphedema (Dreyer stages 4–7). Increasing age was significantly associated with advanced lymphedema, and persons 70 years and older had a prevalence three times greater than individuals ages 15–29 (aPR: 3.21, 95% CI 2.45, 4.21). The number of adenolymphangitis (ADL) episodes reported in the previous year was also significantly associated with advanced lymphedema (aPR 4.65, 95% CI 2.97–7.30). This analysis is one of the first to look at potential risk factors for advanced lymphedema using morbidity census data from an entire district in Odisha State, India. Significance These data highlight the magnitude of lymphedema in LF-endemic areas and emphasize the need to develop robust estimates of numbers of individuals with lymphedema in order to identify the extent of lymphedema management services needed in these regions. PMID:27548382

  4. Basic concepts and definitions of clinical management

    Directory of Open Access Journals (Sweden)

    Angélica Román

    2012-06-01

    Full Text Available Management is leading, administering resources, and achieving the goals and objectives that have been set. In the Chilean health care system, management can be subdivided in three main levels – macro-management, meso-management and micro-management. Managing health care is also about epidemiological changes, information and technology innovations, patient groups demanding better services, but mostly about a huge escalation in costs that is not necessarily substantiated by evidence on more efficiency in health outcomes.Clinical management is more than a management tool. It is a cultural change that will provide new values to professional practice and to the organization as a whole. However, clinical management demands more commitment on behalf of the human teams that need to learn how to lead and to be led. These teams will be called upon to help in the decision-making process for the betterment of the institution.

  5. A systematic review of care delivery models and economic analyses in lymphedema: health policy impact (2004-2011).

    Science.gov (United States)

    Stout, N L; Weiss, R; Feldman, J L; Stewart, B R; Armer, J M; Cormier, J N; Shih, Y-C T

    2013-03-01

    A project of the American Lymphedema Framework Project (ALFP), this review seeks to examine the policy and economic impact of caring for patients with lymphedema, a common side effect of cancer treatment. This review is the first of its kind undertaken to investigate, coordinate, and streamline lymphedema policy initiatives in the United States with potential applicability worldwide. As part of a large scale literature review aiming to systematically evaluate the level of evidence of contemporary peer-reviewed lymphedema literature (2004 to 2011), publications on care delivery models, health policy, and economic impact were retrieved, summarized, and evaluated by a team of investigators and clinical experts. The review substantiates lymphedema education models and clinical models implemented at the community, health care provider, and individual level that improve delivery of care. The review exposes the lack of economic analysis related to lymphedema. Despite a dearth of evidence, efforts towards policy initiatives at the federal and state level are underway. These initiatives and the evidence to support them are examined and recommendations for translating these findings into clinical practice are made. Medical and community-based disease management interventions, taking on a public approach, are effective delivery models for lymphedema care and demonstrate great potential to improve cancer survivorship care. Efforts to create policy at the federal, state, and local level should target implementation of these models. More research is needed to identify costs associated with the treatment of lymphedema and to model the cost outlays and potential cost savings associated with comprehensive management of chronic lymphedema.

  6. Radiologic evaluation of primary lymphedema

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Jae Joon; Chung, Tae Sub; Oh, Ki Keun; Kim, Ki Wang; Lee, Jong Doo [College of Medicine, Yonsei University, Seoul (Korea, Republic of)

    1989-12-15

    The authors evaluated diagnostic value of non-invasive methods and other modalities in diagnosing primary lymphedema. We also evaluated the radiologic findings. Dirent (N=7) and indirect lymphangiograms (N=7), CT scan (N=4), and ultrasonogram (N=3) were performed on 14 patients with primary lymphedema of the lower extremities. Also, comparison CT scan and ultrasonogram were performed on 50 normal volunteers. The results were as follows: 1. Lymphedema was classified as praecox and tarda according to the onset age of symptoms. Their percentage were 71.4% and 28.6% respectively. 2. Lymphangiogram classification showed the following in the order of frequency; hyperplastic (78.6%), aplasia (14.3%) and hyperplasia (7.1%). 3. The mean midtibial subcutaneous fat ratio of the lymphedema patients was 37.73% on the CT scan, which was greater than that of the normal subjects (20.05 {+-} 14.04%). 4. On the ultrasonogram, men premidibial dermis and subcutaneous fat thickness of the lymphedema patients was 6.3 mm, which was greater than that of the normal subject (2.9 {+-} 2.4 mm). 5. In conclusion, CT scan and ultrasonographic examination were helpful as a non-invasive method for evaluating the follow-up of patients treated for lymphedema.

  7. Basic Project Management Methodologies for Survey Researchers.

    Science.gov (United States)

    Beach, Robert H.

    To be effective, project management requires a heavy dependence on the document, list, and computational capability of a computerized environment. Now that microcomputers are readily available, only the rediscovery of classic project management methodology is required for improved resource allocation in small research projects. This paper provides…

  8. Recent Advancement on Surgical Treatments for Lymphedema

    OpenAIRE

    Koshima, Isao; Narushima, Mitsunaga; Yamamoto, Yusuke; Mihara, Makoto; Iida, Takuya

    2012-01-01

    Treatment for limb lymphedema is challenging. The recent development of the super-microsurgical technique has made lymphaticovenular (LV) anastomosis an easier and more accurate surgical method for lymphedema. A summary of our experience as well as recent developments in surgical treatments for lymphedema are described.

  9. GJC2 Missense Mutations Cause Human Lymphedema

    OpenAIRE

    Ferrell, Robert E; Baty, Catherine J.; Kimak, Mark A.; Karlsson, Jenny M; Lawrence, Elizabeth C.; Franke-Snyder, Marlise; Meriney, Stephen D.; Feingold, Eleanor; Finegold, David N.

    2010-01-01

    Lymphedema is the clinical manifestation of defects in lymphatic structure or function. Mutations identified in genes regulating lymphatic development result in inherited lymphedema. No mutations have yet been identified in genes mediating lymphatic function that result in inherited lymphedema. Survey microarray studies comparing lymphatic and blood endothelial cells identified expression of several connexins in lymphatic endothelial cells. Additionally, gap junctions are implicated in mainta...

  10. A Review of Some Basic Principles in Fishpond Management

    OpenAIRE

    J.F.N. Abowei; C.C. Tawari; E.N. Ezekiel

    2011-01-01

    A review of some basic principles in fishpond management was reviewed to educate fish culturist, private and public sector to effectively manage culture fisheries. Successful pond management requires more than just stocking fish. It is also important to maintain the proper environmental conditions, to monitor fish harvest and growth, check for successful fish reproduction, and to keep out unwanted fish. This is the science of fish management, the solid basis for ensuring good fishing. Good fi...

  11. The Effect of Hygiene-Based Lymphedema Management in Lymphatic Filariasis-Endemic Areas: A Systematic Review and Meta-analysis

    OpenAIRE

    Meredith E Stocks; Freeman, Matthew C.; Addiss, David G.

    2015-01-01

    Background Lymphedema of the leg and its advanced form, known as elephantiasis, are significant causes of disability and morbidity in areas endemic for lymphatic filariasis (LF), with an estimated 14 million persons affected worldwide. The twin goals of the World Health Organization’s Global Program to Eliminate Lymphatic Filariasis include interrupting transmission of the parasitic worms that cause LF and providing care to persons who suffer from its clinical manifestations, including lymphe...

  12. Lymphedema Characteristics and the Efficacy of Complex Decongestive Physiotherapy in Malignant Lymphedema.

    Science.gov (United States)

    Liao, Su-Fen

    2016-08-01

    The aim of this study is to identify the lymphedema characteristics and the efficacy of complex decongestive physiotherapy (CDP) in 29 patients with malignant lymphedema. After CDP, total decreased volume of lymphedema was 306 mL, percentage of excess volume (PEV) changed from 43.4% to 22.7%, and lymphedema severity improved from severe to moderate status. The CDP efficacy-percentage reduction in excess volume (PREV) was 46.6%. The stage of lymphedema (P = .004), range of motion (P lymphedema. PMID:25995325

  13. Aortic dissection. Basic aspects and endovascular management

    International Nuclear Information System (INIS)

    elucidated. The clinical, diagnostic and management perspectives on aortic dissection and its variants, aortic intramural hematoma and atherosclerotic aortic ulcer, are reviewed

  14. Basic chemistry for radioactive waste management

    International Nuclear Information System (INIS)

    To study the mechanism of the corrosion process and to control the corrosion process in relation to the radwaste management, passive films on the metal surfaces and corrosion of iron, carbon steel, and titanium have been studied. Total charges for passivation, breakdown and repassivation process were measured and compared to understand the characteristics of passive films including the growth rate and the stability of the passive films. The bigger the charges for passivation process, the more metal dissolution and corrosion attack were observed. Increasing the concentration of chloride ions, the rate of coverage of exposed metal became slower and the stability of passive fimes were weakened. Corrosion measurements of iron, carbon steel, and titanium were performed. Iron and carbon steels were proven to become passivated in the carbonate media, but pitting corrosion occurred in the presence of chloride ions. From the impedance data, we conclude that an adsorptive reaction forming Fe(OH)2 occurs in the dissolution of iron and carbon steel. In 0.1 M NaHC03 solution, iron and carbon steel showed a corrosion rate of 43-61 μm/yr and 18 μm/yr, respectively. In ground water, iron showed a corrosion rate of 5.8μm/yr and carbon steel showed an even smaller corrosion rate (0.27μm/yr). Titanium was passivated in an air-saturated 1 M KCl solution, but depassivated under N2 saturated solution. However, titanium was passivated in 1 M KCl solution even under N2 saturation. (Author)

  15. Intensive treatment of leg lymphedema

    Directory of Open Access Journals (Sweden)

    Pereira de Godoy Jose

    2010-01-01

    Full Text Available Background: Despite of all the problems caused by lymphedema, this disease continues to affect millions of people worldwide. Thus, the identification of the most efficacious forms of treatment is necessary. Aim: The aim of this study was to evaluate a novel intensive outpatient treatment for leg lymphedema. Methods: Twenty-three legs of 19 patients were evaluated in a prospective randomized study. The inclusion criteria were patients with Grade II and III lymphedema, where the difference, measured by volumetry, between the affected limb below the knee and the healthy limb was greater than 1.5 kg. Intensive treatment was carried out for 6- to 8-h sessions in the outpatient clinic. Analysis of variance was utilized for statistical analysis with an alpha error of 5% (P-value < 0.05 being considered significant. Results: All limbs had significant reductions in size with the final mean loss being 81.1% of the volume of edema. The greatest losses occurred in the first week (P-value < 0.001. Losses of more than 90% of the lymphedema occurred in 9 (39.13% patients; losses of more than 80% in 13 (56.52%, losses of more than 70% in 17 (73.91% and losses of more than 50% were recorded for 95.65% of the patients; only 1 patient lost less than 50% (37.9% of the edema. Conclusion: The intensive treatment of lymphedema in the outpatient clinic can produce significant reductions in the volume of edema over a short period of time and can be recommended for any grade of lymphedema, in particular the more advanced degrees.

  16. Prospective Lymphedema Surveillance in a Clinic Setting.

    Science.gov (United States)

    Chance-Hetzler, Janet; Armer, Jane; Van Loo, Maggie; Anderson, Blake; Harris, Robin; Ewing, Rebecca; Stewart, Bob

    2015-01-01

    The potential impact of breast cancer-related lymphedema (LE) is quite extensive, yet it often remains under-diagnosed until the later stages. This project examines the effectiveness of prospective surveillance in post-surgical breast cancer patients. A retrospective analysis of 49 out of 100 patients enrolled in a longitudinal prospective study at a Midwestern breast center evaluates: (1) time required for completion of bilateral limb measurements and Lymphedema Breast Cancer Questionnaire (LBCQ); (2) referral to LE management with limb volume increase (LVI) and/or LBCQ symptoms; and (3) cost of LE management at lower LVI (≥5%-≤10%) versus traditional (≥10%). Findings revealed a visit timeframe mean of 40.3 min (range = 25-60); 43.6% of visits were ≤30-min timeframe. Visit and measurement times decreased as clinic staff gained measurement experience; measurement time mean was 17.9 min (range = 16.9-18.9). LBCQ symptoms and LVI were significantly (p < 0.001) correlated to LE referral; six of the nine patients referred (67%) displayed both LBCQ symptoms/LVI. Visits with no symptoms reported did not result in referral, demonstrating the importance of using both indicators when assessing early LE. Lower threshold referral provides compelling evidence of potential cost savings over traditional threshold referral with reported costs of: $3755.00 and $6353.00, respectively (40.9% savings). PMID:26308061

  17. Prospective Lymphedema Surveillance in a Clinic Setting

    Directory of Open Access Journals (Sweden)

    Janet Chance-Hetzler

    2015-08-01

    Full Text Available The potential impact of breast cancer-related lymphedema (LE is quite extensive, yet it often remains under-diagnosed until the later stages. This project examines the effectiveness of prospective surveillance in post-surgical breast cancer patients. A retrospective analysis of 49 out of 100 patients enrolled in a longitudinal prospective study at a Midwestern breast center evaluates: (1 time required for completion of bilateral limb measurements and Lymphedema Breast Cancer Questionnaire (LBCQ; (2 referral to LE management with limb volume increase (LVI and/or LBCQ symptoms; and (3 cost of LE management at lower LVI (≥5%–≤10% versus traditional (≥10%. Findings revealed a visit timeframe mean of 40.3 min (range = 25–60; 43.6% of visits were ≤30-min timeframe. Visit and measurement times decreased as clinic staff gained measurement experience; measurement time mean was 17.9 min (range = 16.9–18.9. LBCQ symptoms and LVI were significantly (p < 0.001 correlated to LE referral; six of the nine patients referred (67% displayed both LBCQ symptoms/LVI. Visits with no symptoms reported did not result in referral, demonstrating the importance of using both indicators when assessing early LE. Lower threshold referral provides compelling evidence of potential cost savings over traditional threshold referral with reported costs of: $3755.00 and $6353.00, respectively (40.9% savings.

  18. Management Strategies in Basic Education and Participation of Parents

    OpenAIRE

    Johel Furguerle-Rangel; José Gregorio Pacheco-Barrio; Alba Hernández; Gilberto Bastidas-Pacheco

    2016-01-01

    In the educational process it is necessary to use management paradigms and active participation of parents. The objective was to determine the use of management strategies by the director of basic education and participation of parents in the educational process. It is a descriptive, transversal and field study, whose instrument was a questionnaire of 26 closed-questions.   The sample comprised 16 directors, 52 teachers and 62 parents. For most managers and faculty the technique of brainstorm...

  19. Basic research needs for management and disposal of DOE wastes

    International Nuclear Information System (INIS)

    This document was chartered by the Department of Energy (DOE), Office of Energy Research. It identifies and describes 87 basic research needs in support of advanced technology for management and disposal of Department of Energy radioactive, hazardous chemical, and mixed wastes. A team of scientists and engineers from several DOE laboratories and sites, from academia, and from industry identified and described the basic research needs called out in this report. Special efforts were made to ensure that basic research needs related to management and disposal of any hazardous chemical wastes generated at nonnuclear DOE sites and facilities were properly identified. It is hoped that scientists in both DOE and nongovernment laboratories and institutions will find this document useful when formulating research efforts relevant to waste management and disposal. For management and disposal of DOE radioactive and mixed wastes, basic research needs are identified in nine separate action areas. Basic research needs for management and disposal of DOE hazardous chemical wastes are identified in five action areas. Sufficient description and background information are provided in the report for each particular research need to enable qualified and imaginative scientists to conceive research efforts and programs that will meet the need. 28 refs., 7 tabs

  20. Direct evidence of lymphatic function improvement after advanced pneumatic compression device treatment of lymphedema

    OpenAIRE

    Adams, Kristen E.; Rasmussen, John C.; Darne, Chinmay; Tan, I-Chih; Aldrich, Melissa B.; Marshall, Milton V.; Fife, Caroline E.; Maus, Erik A.; Smith, Latisha A.; Guilloid, Renie; Hoy, Sunday; Sevick-Muraca, Eva M.

    2010-01-01

    Lymphedema affects up to 50% of all breast cancer survivors. Management with pneumatic compression devices (PCDs) is controversial, owing to the lack of methods to directly assess benefit. This pilot study employed an investigational, near-infrared (NIR) fluorescence imaging technique to evaluate lymphatic response to PCD therapy in normal control and breast cancer-related lymphedema (BCRL) subjects. Lymphatic propulsion rate, apparent lymph velocity, and lymphatic vessel recruitment were mea...

  1. Twisting Tourniquet© Technique: introducing Schnogh, a novel device and its effectiveness in treating primary and secondary lymphedema of extremities

    OpenAIRE

    Chanwimalueang, Narumon; Ekataksin, Wichai; Piyaman, Parkpoom; Pattanapen, Gedsuda; Hanboon, Borimas K

    2015-01-01

    Twisting Tourniquet© or in Thai “Schnogh” is a new invention for compression therapy of lymphedema. Twisting Tourniquet© Technique (TTT) is totally noninvasive for lymphedema management. After the amazing successful evidence in the first series of 28 patients, we have conducted preliminary studies in lymphedema clinics. It was found that the combination of gradually increasing constriction force by Schnogh until desired pressure was reached and maintained for 15 min, followed by a 5-min relea...

  2. Amendment I : Basic fur management plan : Stillwater Wildlife Management Area

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This amendment to the fur management plan for Stillwater Wildlife Management area calls for the annual trapping of beaver. The Lower Carson River is overpopulated...

  3. Basic fur management plan : Stillwater Wildlife Management Area

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This fur management plan for Stillwater Wildlife Management Area outlines methods of fur harvest, trapping territories, selection of trappers, trapping equipment,...

  4. [Lymphedema: is there a treatment?].

    Science.gov (United States)

    Barrellier, M T

    1992-01-01

    More than hundred medical treatments for lymphedema have been described. This very high number shows the evidence of difficulties: lymphatics are very small vessels, under low pression and velocity respondent to spontaneous quiet lymphatic contractions. The treatments can be listed in 3 groups: 1) physiotherapeutic methods, increasing lymphatic flow: cold, field stimulation, manual lymph drainage, intermittent compression, heat; 2) drugs: venous agents (flavone, benzo-pyrone), and intraarterial lymphocytes injection, promoting lymphatic flow or increasing normal proteolysis by macrophages in order to remove trapped proteins from interstitial fluid; 3) surgical procedures subdivided in 2 groups: excisional techniques and bridging drainage techniques; radical or partial excision removes involved subcutaneous tissue, recently by the way of liposuction; Efforts to drain lymphedema by subcutaneous implants, pedical flaps, myocutaneous flaps, omental transposition and intestinal flaps are historical. Microsurgical lymphatic anastomosis to vein (nodo-venous then lymphovenous), and to lymphatic themselves are now performed: lymphatic collectors or venous autografts are interpositioned to by-pass lymphatic blockade with end-to end anastomosis. The free transplantation of a lymphatic flap with its own vascularisation from healthy inguinal nodes to axillary blockade is the last described procedure. Lymphatic anastomosis are not needed. Actually, physiotherapy is always first indicated. Benzo-pyrones are additive drugs. Excisional procedures concern monstruous lymphedema. Microsurgical bridging procedures can be attempted only for secondary lymphedemas. They could be of benefit if physiotherapy and elastic bandages, stockings or sleeves, could then be avoided. Studies assessing independently the efficiency of each procedure are needed.

  5. Significant Differences in Nurses’ Knowledge of Basic Wound Management

    DEFF Research Database (Denmark)

    Zarchi, Kian; Latif, Seemab; Haugaard, Vibeke B;

    2014-01-01

    of knowledge of wound management in 136 Danish nurses working in 3 different settings: advanced wound care clinics, home care and general hospital departments. We found that hospital nurses had less theoretical knowledge than home care nurses and nurses working at advanced wound care clinics. We also found......Wounds represent a growing healthcare problem due to an aging population. Nurses play a key role in wound management and their theoretical understanding of basic wound management may be expected to influence the quality of wound therapy fundamentally. In this study, we evaluated the level...... of wound management in Denmark and suggests how improvements might be achieved....

  6. BASICS FOR APPLYING A CONTEMPORARY CONCEPT FOR HUMAN RESOURCE MANAGEMENT

    OpenAIRE

    Camilovic, Slobodan

    2009-01-01

    In the process of organizational adaptation to environmental demands, primarily through the anticipated outputs, human resources play a key role. The procuring of necessary human resources, their working commitment and development, are the basic assignments of the management of human resources. The appliance of a contemporary concept of management of human resources, based on theoretical and practical cognizance of successful organizations, contributes to a successful execution of these an...

  7. Lymphedema in China--experiences and prospects.

    Science.gov (United States)

    Liu, N F

    2007-12-01

    The history of prevention and treatment of lymphedema in China is long. Filarial lymphedema was the most common type of the disease in the past with 5 million patients countrywide in the 1950's. Great efforts have gone into controlling filariasis during the past 50 years, and China now has essentially eliminated filariasis. In contrast to the reduction in filarial lymphedema, there has been a trend of increase in secondary lymphedema cases after malignant tumor surgery. Although there are no precise figures on the incidence of lymphedema nationwide, physicians and therapists are in great clinical demand. Traditional Chinese medicine has shown effectiveness for prevention and treatment of inflammation and alleviating swelling. The combination with Western medicine may offer improved methods for lymphedema treatment. PMID:18365528

  8. Obesity-induced Upper Extremity Lymphedema

    OpenAIRE

    Arin K. Greene, MD, MMSc; Reid A. Maclellan, MD, MMSc

    2013-01-01

    Summary: Obesity increases the risk of upper extremity lymphedema following treatment for breast cancer and can cause lower extremity lymphatic dysfunction in extremely obese individuals. We report the first patient with obesity-induced upper extremity lymphedema. A 62-year-old man with a previous body mass index (BMI) of 105.6, presented with a BMI 60.3 following weight loss. He complained of lymphedema of all 4 extremities, which was confirmed by lymphoscintigraphy. Because the upper limbs ...

  9. Lymphedema and Obesity: Is There a Link?

    OpenAIRE

    Mehrara, Babak J.; Greene, Arin K.

    2014-01-01

    Lymphedema is a chronic disorder that, in developed countries, occurs most commonly after lymph node dissection for cancer treatment. Although the pathophysiology of lymphedema is unknown, the disease is characterized histologically by fibrosis and abnormal adipose deposition. Clinical studies have provided evidence that obesity and postoperative weight gain are significant risk factors for the development of lymphedema. In fact, recent studies have shown that extreme obesity can result in ma...

  10. Fibrosis worsens chronic lymphedema in rodent tissues

    OpenAIRE

    Lynch, Laura L.; Mendez, Uziel; Waller, Anna B.; Gillette, Amani A.; Guillory, Roger J.; Goldman, Jeremy

    2015-01-01

    Secondary lymphedema in humans is a common consequence of lymph node dissection (LND) to treat breast cancer. A peculiar characteristic of the disease is that lifelong swelling often precipitously appears several years after the surgical treatment, often due to an inflammatory stimulus. Although the incidence of secondary lymphedema dramatically increases after radiation therapy, the relationship between fibrotic scarring and the eventual appearance of lymphedema remains unclear. To clarify t...

  11. Gigantic Suprapubic Lymphedema: A Case Study.

    Science.gov (United States)

    Tanhaeivash, Roozbeh; Franiel, Tobias; Grimm, Marc-Oliver; Horstmann, Marcus

    2016-08-01

    We present the first case study of idiopathic gigantic suprapubic lymphedema and buried penis treated with puboscrotal reconstruction in a patient with initial extreme obesity after an extensive weight reduction (120 kg). Massive localized lymphedema of the suprapubic region should be differentiated from the scrotal type. Severe lymphedema could not resolve on its own and weight reduction does not seem to be helpful in such cases. PMID:27574599

  12. Gigantic Suprapubic Lymphedema: A Case Study

    Science.gov (United States)

    Tanhaeivash, Roozbeh; Franiel, Tobias; Grimm, Marc-Oliver

    2016-01-01

    We present the first case study of idiopathic gigantic suprapubic lymphedema and buried penis treated with puboscrotal reconstruction in a patient with initial extreme obesity after an extensive weight reduction (120 kg). Massive localized lymphedema of the suprapubic region should be differentiated from the scrotal type. Severe lymphedema could not resolve on its own and weight reduction does not seem to be helpful in such cases. PMID:27574599

  13. [Secondary malignant lymphedema in head and neck tumors].

    Science.gov (United States)

    Hammerl, Bernhard; Döller, Walter

    2008-01-01

    The occurrence of edema is a serious problem of patients suffering from cancer and may have various causes. Particularly, the secondary malignant lymphedema poses a special threat to patients. In some cases, it indicates the progression of illness, and in fact also results in mutilating physical changes, which add to the already existing impairments caused by the cancer disease. So far therapeutic interventions are limited. Current management consists of physical therapy and pharmacological interventions. There are few powerful studies concerning the efficiency and hardly any concerning combined or comparative treatment in the literature. Most of them focus on the management of lymphedema in breast cancer patients. Preventive measures and supportive therapy are rarely being discussed. In this case report, we describe the successful use of Selen and Sandostatin in treating a facial edema of a patient with advanced head-neck cancer. PMID:19165449

  14. Lymphedema as a Cancer Treatment Side Effect

    Science.gov (United States)

    ... any new symptoms or a change in symptoms. Treatments for lymphedema are designed to reduce swelling, prevent it from ... the head and neck, you may need physical therapy. Reducing your risk of lymphedema Research continues to look into what factors cause ...

  15. Upper limb lymphedema after breast cancer treatment

    International Nuclear Information System (INIS)

    Purpose. - To study the frequency and risk factors for upper limb lymphedema through a series of patients treated for breast cancer. Patients and methods. - It is a retrospective study about 222 patients treated for breast cancer during the period between February 1993 and December 2003 in Sfax hospitals. Average age was 51 years (27-92 years). Tumour was T2 in 59% of cases. All patients had surgery with lymph node dissection. Infiltrating ductal carcinoma was the most frequent histological type (80% of cases), with predominant SBR II grade (62%). The mean number of removed lymph nodes was 12 (2-33). Axillary lymph node metastasis was detected in 124 patients. Radiotherapy was delivered in 200 patients, including axillary irradiation in 30 cases. The mean follow-up was 68 months (12-120). Results. - Lymphedema appeared in 23% of cases (51 patients), 14 months after surgery (mean period). Lymphedema affected the brachium in 17% of cases, the forearm in 12% of cases and all upper limb in 71% of cases. Fifty percent of patients had rehabilitation. However, improvement of lymphedema was obtained in 18 cases. Parameters predicting lymphedema were studied. Significant risk factors were obesity, infection and a number of removed lymph node above 10. The type of surgery, axillary irradiation and shoulder abduction deficit did not predict lymphedema. Conclusion. - Lymphedema of the arm is a frequent consequence of breast cancer treatment. The risk of lymphedema is correlated with obesity, infection and a number of removed lymph node above 10. (authors)

  16. [Treatment of varicose veins and limb lymphedema].

    Science.gov (United States)

    Vignes, S

    2014-02-01

    Two questions arise when considering the treatment of varicose veins and the development of lymphedema: can the treatment cause lymphedema? Can it worsen it? Primary lymphedema is rarely associated with varicose veins except in the lymphedema-distichiasis syndrome. Data available in the literature is essentially based on surgical treatment. Stripping on a normal limb may induce chronic lymphedema in almost 0.1% of cases. The risk of lymphedema after stripping in patients with previous pelvic surgery including lymph node excision and/or radiotherapy remains unknown. In patients with lower limb lymphedema wearing strong elastic compression stockings, stripping provides little clinical improvement and can worsen volume. The main objective is also to avoid venous complications. Lymphatic lesions related to stripping can be evaluated by lymphography or lymphoscintigraphy. New techniques for treating varicose veins (sclerotherapy, endovenous laser treatment, radiofrequency ablation) seem to induce fewer lymphatic complications. Further studies are required to confirm these results. Indications for treatment should be unquestionable and patients must be alerted to the potential risk of lymphedema or its worsening. PMID:24315933

  17. Management Strategies in Basic Education and Participation of Parents

    Directory of Open Access Journals (Sweden)

    Johel Furguerle-Rangel

    2016-05-01

    Full Text Available In the educational process it is necessary to use management paradigms and active participation of parents. The objective was to determine the use of management strategies by the director of basic education and participation of parents in the educational process. It is a descriptive, transversal and field study, whose instrument was a questionnaire of 26 closed-questions.   The sample comprised 16 directors, 52 teachers and 62 parents. For most managers and faculty the technique of brainstorming, involvement in decision-making, continues knowledge management and radical change are crucial in the educational process of children.   But mothers and fathers believe that managerial groups do not use strategies properly except for reengineering.   The mother and fathers are mainly involved in education management but not in the learning process. It is recommended the deepening of policy management training teaching force, through continuous training provided by the government and the promotion of family participation in the teaching-learning process of children.

  18. Evaluation of the effectiveness of kinesio taping application in a patient with secondary lymphedema in breast cancer: a case report

    OpenAIRE

    Taradaj, Jakub; Halski, Tomasz; Zduńczyk, Małgorzata; Rajfur, Joanna; Pasternok, Małgorzata; Chmielewska, Daria; Piecha, Magdalena; Kwaśna, Krystyna; Skrzypulec-Plinta, Violetta

    2014-01-01

    Breast cancer-related lymphedema is one of the complications resulting from treatment. It is defined as arm oedema in the breast cancer patients caused by interruption of the flow of the axillary lymphatic system from surgery or radiation therapy, which results in the accumulation of fluid in the subcutaneous tissue of the arm, with a decrease in tissue distensibility around the joints and an increased weight of the extremity. Decongestive lymphatic therapy is common management for lymphedema...

  19. Creation of distal canine limb lymphedema

    Energy Technology Data Exchange (ETDEWEB)

    Chen, H.C.; Pribaz, J.J.; O' Brien, B.M.; Knight, K.R.; Morrison, W.A.

    1989-06-01

    A canine model of distal limb lymphedema was established in order to study the treatment of this condition by lymph node transfer. This model was more difficult to establish than whole-limb lymphedema. Significant edema was achieved by a combination of preoperative irradiation and circumferential removal of skin from the irradiated areas followed by removal of the contents of the popliteal fossa. Despite these measures, it was not possible to produce lymphedema in every case, possibly because of the presence of lymphaticovenous shunts and panvascular compensation mechanisms.

  20. Angiosarcoma after excisional surgery for chronic lymphedema.

    Science.gov (United States)

    Joh, Jin Hyun; Lee, Byung-Boong; Chun, Young Soo; Chung, Weon Kuu; Lee, Ha Yeon

    2016-07-01

    Angiosarcoma is a rare soft tissue sarcoma of endothelial cell origin. It can arise from the endothelium of lymphatics (lymphangiosarcoma) or blood vessels (hemangiosarcoma). Chronic lymphedema of any origin is associated with its development. Few cases have been reported after surgical procedures for lymphedema. Here, we report one case of angiosarcoma that developed 15 months after excisional surgery for lymphedema. In spite of radical surgery and adjuvant chemoradiotherapy, the patient died of multiple lung metastases and pleural effusion 13 months later. PMID:27318054

  1. The Influence of Arm Swelling Duration on Shoulder Pathology in Breast Cancer Patients with Lymphedema.

    Directory of Open Access Journals (Sweden)

    Dae-Hyun Jang

    Full Text Available To evaluate the pathological effect of the duration of arm swelling on the shoulder pathology in patients with breast cancer-related lymphedema.Forty seven breast cancer patients with unilateral arm lymphedema were assessed. The duration of the arm swelling and shoulder pain were recorded. Ultrasound examination of the shoulder joint was performed in all patients to detect any lesions.Abnormalities were detected by ultrasound in 41/47 (87.2% study participants. Subacromial subdeltoid bursal thickening was found in 26/47 (55.3% participants, distension of the biceps brachii tendon sheath was found in 14/47 (29.8% and a supraspinatus tendon tear was found in 13/47 (27.7%. Patients with a supraspinatus tendon tear were found to have a significantly longer duration of lymphedema (1310 days vs. 398 days, p = 0.032.The duration of arm lymphedema has a progressive pathological effect on rotator cuff. Clinicians should adopt an early management approach of shoulder pain in patients with breast cancer-related lymphedema.

  2. Lymphedema (PDQ®)—Health Professional Version

    Science.gov (United States)

    Expert-reviewed information summary about the anatomy, pathophysiology, clinical manifestations, diagnosis, and treatment of cancer-related lymphedema, a condition in which lymph fluid builds up in tissues and causes swelling.

  3. Systematic review: conservative treatments for secondary lymphedema

    OpenAIRE

    Oremus Mark; Dayes Ian; Walker Kathryn; Raina Parminder

    2012-01-01

    Abstract Background Several conservative (i.e., nonpharmacologic, nonsurgical) treatments exist for secondary lymphedema. The optimal treatment is unknown. We examined the effectiveness of conservative treatments for secondary lymphedema, as well as harms related to these treatments. Methods We searched MEDLINE®, EMBASE®, Cochrane Central Register of Controlled Trials®, AMED, and CINAHL from 1990 to January 19, 2010. We obtained English- and non-English-language randomized controlled trials o...

  4. Systematic review: conservative treatments for secondary lymphedema

    OpenAIRE

    Oremus, Mark; Dayes, Ian; Walker, Kathryn; Raina, Parminder

    2012-01-01

    Background Several conservative (i.e., nonpharmacologic, nonsurgical) treatments exist for secondary lymphedema. The optimal treatment is unknown. We examined the effectiveness of conservative treatments for secondary lymphedema, as well as harms related to these treatments. Methods We searched MEDLINE®, EMBASE®, Cochrane Central Register of Controlled Trials®, AMED, and CINAHL from 1990 to January 19, 2010. We obtained English- and non-English-language randomized controlled trials or observa...

  5. Prospective Lymphedema Surveillance in a Clinic Setting

    OpenAIRE

    Janet Chance-Hetzler; Jane Armer; Maggie Van Loo; Blake Anderson; Robin Harris; Rebecca Ewing; Bob Stewart

    2015-01-01

    The potential impact of breast cancer-related lymphedema (LE) is quite extensive, yet it often remains under-diagnosed until the later stages. This project examines the effectiveness of prospective surveillance in post-surgical breast cancer patients. A retrospective analysis of 49 out of 100 patients enrolled in a longitudinal prospective study at a Midwestern breast center evaluates: (1) time required for completion of bilateral limb measurements and Lymphedema Breast Cancer Questionnaire (...

  6. Lymphedema: What Every Woman with Breast Cancer Should Know

    Science.gov (United States)

    ... saved articles window. My Saved Articles » My ACS » Lymphedema: What Every Woman With Breast Cancer Should Know ... for breast cancer may be at risk for lymphedema in the arm, breast, and chest. Here we ...

  7. Understanding Lymphedema (For Cancers Other Than Breast Cancer)

    Science.gov (United States)

    ... articles window. My Saved Articles » My ACS » Understanding Lymphedema: For Cancers Other Than Breast Cancer Download Printable Version [PDF] » Lymphedema can be caused by surgery or radiation therapy ...

  8. Heavy resistance training and lymphedema

    DEFF Research Database (Denmark)

    Bloomquist, Kira; Karlsmark, Tonny; Christensen, Karl Bang;

    2014-01-01

    BACKGROUND: There is limited knowledge regarding progressive resistance training during adjuvant chemotherapy and the risk of developing breast cancer-related lymphedema (BCRL). Furthermore, no studies have investigated the safety of resistance training with heavy loads (> 80% 1 repetition maximum......) in this population. 'Body and Cancer' is a six-week, nine-hour weekly, supervised, multimodal exercise intervention utilizing progressive resistance training with heavy loads for cancer patients undergoing chemotherapy. The purpose of the present study was to estimate the prevalence of BCRL in former participants......, and identify associations between progressive resistance training with heavy loads, and the development of BCRL. MATERIAL AND METHODS: This was a descriptive study. POPULATION: Women treated for breast cancer (n = 149), who had participated in the 'Body and Cancer' exercise intervention between 1 January 2010...

  9. Regulation of inflammation and fibrosis by macrophages in lymphedema

    OpenAIRE

    Ghanta, Swapna; Cuzzone, Daniel A.; Torrisi, Jeremy S.; Albano, Nicholas J.; Joseph, Walter J.; Savetsky, Ira L.; Gardenier, Jason C.; Chang, David; Jamie C Zampell; Mehrara, Babak J.

    2015-01-01

    Lymphedema, a common complication of cancer treatment, is characterized by inflammation, fibrosis, and adipose deposition. We have previously shown that macrophage infiltration is increased in mouse models of lymphedema. Because macrophages are regulators of lymphangiogenesis and fibrosis, this study aimed to determine the role of these cells in lymphedema using depletion experiments. Matched biopsy specimens of normal and lymphedema tissues were obtained from patients with unilateral upper e...

  10. HGF and MET Mutations in Primary and Secondary Lymphedema

    OpenAIRE

    Finegold, David N.; Schacht, Vivien; Kimak, Mark A.; Lawrence, Elizabeth C.; Foeldi, Etelka; Karlsson, Jenny M; Baty, Catherine J.; Ferrell, Robert E

    2008-01-01

    Background: Lymphedema is the abnormal accumulation of protein-rich fluid in the interstitial space. Primary lymphedema is a rare genetic condition with both autosomal dominant and autosomal recessive modes of inheritance. Three genes, FLT4 (VEGFR3), FOXC2, and SOX18 cause varying forms of primary lymphedema. In industrialized countries, secondary lymphedema is usually associated with cancer therapy and/or trauma. Recent observations suggested that hepatocyte growth factor/high affinity hepat...

  11. Obesity-induced Lymphedema Nonreversible following Massive Weight Loss

    OpenAIRE

    Greene, Arin K.; Grant, Frederick D; Maclellan, Reid A.

    2015-01-01

    Summary: Lymphedema is the progressive enlargement of tissue due to inadequate lymphatic function. Obesity-induced lymphedema of the lower extremities can occur once a patient’s body mass index (BMI) exceeds 50. We report our first patient with obesity-induced lower extremity lymphedema who was followed prospectively before and after weight loss. A 46-year-old woman with a BMI of 80 presented to our Lymphedema Program complaining of bilateral lower extremity swelling. Lymphoscintigraphy showe...

  12. Symptom report in detecting breast cancer-related lymphedema

    OpenAIRE

    Fu, Mei R.; Axelrod, Deborah; Cleland, Charles M.; Qiu, Zeyuan; Amber A. Guth; Kleinman, Robin; Scagliola, Joan; Haber, Judith

    2015-01-01

    Breast cancer-related lymphedema is a syndrome of abnormal swelling coupled with multiple symptoms resulting from obstruction or disruption of the lymphatic system associated with cancer treatment. Research has demonstrated that with increased number of symptoms reported, breast cancer survivors’ limb volume increased. Lymphedema symptoms in the affected limb may indicate a latent stage of lymphedema in which changes cannot be detected by objective measures. The latent stage of lymphedema may...

  13. Diabetic foot ulcers in conjunction with lower limb lymphedema: pathophysiology and treatment procedures

    Directory of Open Access Journals (Sweden)

    Kanapathy M

    2015-08-01

    Full Text Available Muholan Kanapathy,1 Mark J Portou,1,2 Janice Tsui,1,2 Toby Richards1,21Division of Surgery and Interventional Science, University College London, 2Department of Vascular Surgery, Royal Free London NHS Foundation Trust Hospital, London, UKAbstract: Diabetic foot ulcers (DFUs are complex, chronic, and progressive wounds, and have a significant impact on morbidity, mortality, and quality of life. A particular aspect of DFU that has not been reviewed extensively thus far is its management in conjunction with peripheral limb edema. Peripheral limb edema is a feature of diabetes that has been identified as a significant risk factor for amputation in patients with DFU. Three major etiological factors in development of lymphedema with concurrent DFU are diabetic microangiopathy, failure of autonomic regulation, and recurrent infection. This review outlines the pathophysiology of lymphedema formation in patients with DFU and highlights the cellular and immune components of impaired wound healing in lymphedematous DFU. We then discuss the principles of management of DFU in conjunction with lymphedema.Keywords: diabetic foot ulcer, lymphedema, chronic wound, wound management

  14. 乳腺癌术后上肢水肿研究进展%Progress in study on lymphedema of arm after surgery of breast cancer

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    @@ Lymphedema of affected arm is a severe complication after surgery of breast cancer.Quality of life and rehabilitation of patients suffered from breast cancer receive more and more attention with increase of incidence and decrease of mortality,longation of survival time.Lymphedema of arm not only affects esthetics but produce pain,dysfunction,deprivation of work ability,and serious psychological issues.In the current paper,we reviewed progress in study on risk factors associated with surgery,evaluation,prevention and management of lymphedema in arm.

  15. Diphtheria toxin–mediated ablation of lymphatic endothelial cells results in progressive lymphedema

    Science.gov (United States)

    Gardenier, Jason C.; Hespe, Geoffrey E.; Kataru, Raghu P.; Savetsky, Ira L.; Torrisi, Jeremy S.; Nores, Gabriela D. García; Dayan, Joseph J.; Chang, David; Zampell, Jamie; Martínez-Corral, Inés; Ortega, Sagrario; Mehrara, Babak J.

    2016-01-01

    Development of novel treatments for lymphedema has been limited by the fact that the pathophysiology of this disease is poorly understood. It remains unknown, for example, why limb swelling resulting from surgical injury resolves initially, but recurs in some cases months or years later. Finding answers for these basic questions has been hampered by the lack of adequate animal models. In the current study, we used Cre-lox mice that expressed the human diphtheria toxin receptor (DTR) driven by a lymphatic-specific promoter in order to noninvasively ablate the lymphatic system of the hind limb. Animals treated in this manner developed lymphedema that was indistinguishable from clinical lymphedema temporally, radiographically, and histologically. Using this model and clinical biopsy specimens, we show that the initial resolution of edema after injury is dependent on the formation of collateral capillary lymphatics and that this process is regulated by M2-polarized macrophages. In addition, we show that despite these initial improvements in lymphatic function, persistent accumulation of CD4+ cells inhibits lymphangiogenesis and promotes sclerosis of collecting lymphatics, resulting in late onset of edema and fibrosis. Our findings therefore provide strong evidence that inflammatory changes after lymphatic injury play a key role in the pathophysiology of lymphedema.

  16. Yoga protocol for treatment of breast cancer-related lymphedema

    Science.gov (United States)

    Narahari, SR; Aggithaya, Madhur Guruprasad; Thernoe, Liselotte; Bose, Kuthaje S; Ryan, Terence J

    2016-01-01

    Introduction: Vaqas and Ryan (2003) advocated yoga and breathing exercises for lymphedema. Narahari et al. (2007) developed an integrative medicine protocol for lower-limb lymphedema using yoga. Studies have hypothesized that yoga plays a similar role as that of central manual lymph drainage of Foldi's technique. This study explains how we have used yoga and breathing as a self-care intervention for breast cancer-related lymphedema (BCRL). Methods: The study outcome was to create a yoga protocol for BCRL. Selection of yoga was based on the actions of muscles on joints, anatomical areas associated with different groups of lymph nodes, stretching of skin, and method of breathing in each yoga. The protocol was piloted in eight BCRL patients, observed its difficulties by interacting with patients. A literature search was conducted in PubMed and Cochrane library to identify the yoga protocols for BCRL. Results: Twenty yoga and 5 breathing exercises were adopted. They have slow, methodical joint movements which helped patients to tolerate pain. Breathing was long and diaphragmatic. Flexion of joints was coordinated with exhalation and extension with inhalation. Alternate yoga was introduced to facilitate patients to perform complex movements. Yoga's joint movements, initial positions, and mode of breathing were compared to two other protocols. The volume reduced from 2.4 to 1.2 L in eight patients after continuous practice of yoga and compression at home for 3 months. There was improvement in the range of movement and intensity of pain. Discussion: Yoga exercises were selected on the basis of their role in chest expansion, maximizing range of movements: flexion of large muscles, maximum stretch of skin, and thus part-by-part lymph drainage from center and periphery. This protocol addressed functional, volume, and movement issues of BCRL and was found to be superior to other BCRL yoga protocols. However, this protocol needs to be tested in centers routinely managing BCRL

  17. Systematic review: conservative treatments for secondary lymphedema

    Directory of Open Access Journals (Sweden)

    Oremus Mark

    2012-01-01

    Full Text Available Abstract Background Several conservative (i.e., nonpharmacologic, nonsurgical treatments exist for secondary lymphedema. The optimal treatment is unknown. We examined the effectiveness of conservative treatments for secondary lymphedema, as well as harms related to these treatments. Methods We searched MEDLINE®, EMBASE®, Cochrane Central Register of Controlled Trials®, AMED, and CINAHL from 1990 to January 19, 2010. We obtained English- and non-English-language randomized controlled trials or observational studies (with comparison groups that reported primary effectiveness data on conservative treatments for secondary lymphedema. For English-language studies, we extracted data in tabular form and summarized the tables descriptively. For non-English-language studies, we summarized the results descriptively and discussed similarities with the English-language studies. Results Thirty-six English-language and eight non-English-language studies were included in the review. Most of these studies involved upper-limb lymphedema secondary to breast cancer. Despite lymphedema's chronicity, lengths of follow-up in most studies were under 6 months. Many trial reports contained inadequate descriptions of randomization, blinding, and methods to assess harms. Most observational studies did not control for confounding. Many studies showed that active treatments reduced the size of lymphatic limbs, although extensive between-study heterogeneity in areas such as treatment comparisons and protocols, and outcome measures, prevented us from assessing whether any one treatment was superior. This heterogeneity also precluded us from statistically pooling results. Harms were rare ( Conclusions The literature contains no evidence to suggest the most effective treatment for secondary lymphedema. Harms are few and unlikely to cause major clinical problems.

  18. Lymphedema Precautions: Time to Abandon Old Practices?

    Science.gov (United States)

    Ahn, Soojin; Port, Elisa R

    2016-03-01

    The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.A 46-year-old premenopausal woman with a body mass index of 21 was found on screening mammography to have a new, approximately 1-cm spiculated mass with associated calcifications in the upper outer quadrant of the left breast. Stereotactic core biopsy showed a focus of invasive duct carcinoma, strongly positive for estrogen and progesterone receptors and negative for human epidermal growth factor receptor 2, with associated ductal carcinoma in situ. Clinical examination revealed no palpable mass or axillary lymphadenopathy. She underwent a left lumpectomy with seed localization and sentinel lymph node biopsy. Final pathology revealed an 8-mm well-differentiated invasive carcinoma without lymphovascular invasion and intermediate grade ductal carcinoma in situ. The margins were clear, and three sentinel lymph nodes were negative for metastasis. The 21-gene recurrence score was 10, suggesting a 7% risk of 10-year distant recurrence with adjuvant endocrine treatment. After the completion of adjuvant radiotherapy (42.50 Gy in 16 fractions to the breast), the patient has returned for a follow-up visit. She is a professional violinist and would like to know what she can do to prevent lymphedema on her upcoming flight to Vienna. PMID:26712226

  19. Effects of manual lymphatic drainage on breast cancer-related lymphedema: a systematic review and meta-analysis of randomized controlled trials

    OpenAIRE

    Huang Tsai-Wei; Tseng Sung-Hui; Lin Chia-Chin; Bai Chyi-Huey; Chen Ching-Shyang; Hung Chin-Sheng; Wu Chih-Hsiung; Tam Ka-Wai

    2013-01-01

    Abstract Background Lymphedema is a common complication of axillary dissection for breast cancer. We investigated whether manual lymphatic drainage (MLD) could prevent or manage limb edema in women after breast-cancer surgery. Methods We performed a systematic review and meta-analysis of published randomized controlled trials (RCTs) to evaluate the effectiveness of MLD in the prevention and treatment of breast-cancer-related lymphedema. The PubMed, EMBASE, CINAHL, Physiotherapy Evidence Datab...

  20. Kinesiology Taping reduces lymphedema of the upper extremity in women after breast cancer treatment: a pilot study

    Directory of Open Access Journals (Sweden)

    Iwona Malicka

    2014-09-01

    Full Text Available Introduction : Secondary lymphedema affects approximately 40% of women treated for breast cancer and is recognized as a major problem associated with the therapy of malignant tumors. Consequently, new therapeutic methods are constantly being sought to effectively eliminate the condition. One of the new forms of edema management, especially in the initial stages of edematous development, is Kinesiology Taping (KT. Aim of the study : The aim of the study was to assess the effects of KT applications on the extent of lymphedema of the upper extremity in women post cancer treatment. Material and methods: The study group consisted of 28 women after axillary lymphadenectomy due to breast cancer. All the patients were diagnosed with grade I secondary lymphedema. Kinesiology Taping was applied to a total of 14 randomly selected women. The remaining 14 patients constituted a control group. The extent of lymphedema was measured using a centimeter tape and Limb Volumes Professional 5.0 software. Results : A significant reduction in the extent of lymphedema (p = 0.0009 was achieved in the KT group between baseline and post-treatment assessments. No such reduction, however, was found in the control group (p = 0.36. Conclusions : Kinesiology Taping applications are an effective method of early-stage edema management. Kinesiology Taping may be a safe new therapeutic option in patients who are contraindicated for the use of other methods.

  1. Evaluation of the effectiveness of kinesio taping application in a patient with secondary lymphedema in breast cancer: a case report.

    Science.gov (United States)

    Taradaj, Jakub; Halski, Tomasz; Zduńczyk, Małgorzata; Rajfur, Joanna; Pasternok, Małgorzata; Chmielewska, Daria; Piecha, Magdalena; Kwaśna, Krystyna; Skrzypulec-Plinta, Violetta

    2014-03-01

    Breast cancer-related lymphedema is one of the complications resulting from treatment. It is defined as arm oedema in the breast cancer patients caused by interruption of the flow of the axillary lymphatic system from surgery or radiation therapy, which results in the accumulation of fluid in the subcutaneous tissue of the arm, with a decrease in tissue distensibility around the joints and an increased weight of the extremity. Decongestive lymphatic therapy is common management for lymphedema. A program combining skin care, manual lymphatic drainage, exercise, and compression therapy (multilayer bandage or garment) is recognised as the best practice in lymphedema management. Kinesio taping (KT) for lymphatic drainage is a new choice in the field of physical therapy. The material and the original concept of the taping technique were introduced by Dr Kenso Kase in 1973. K-tape had been designed to allow 30-40% longitudinal stretch. It is composed of 100% cotton fibers and acrylic heat sensitive glue. Development of the technique for its administration is still ongoing. The paper discusses the case of a woman with breast cancer, in whom lymphedema occurred. The patient had three weeks of therapy. The treatment consisted of 12 manual lymphatic drainage, 12 pneumatic compressions and 3 applications of the KT method (due to the lack of standard multi-layer bandaging). During the measurement of oedema it was noted that KT had a significant effect on the reduction of lymphedema and accelerates healing effects compared to standard methods.

  2. Evaluation of the effectiveness of kinesio taping application in a patient with secondary lymphedema in breast cancer: a case report

    Science.gov (United States)

    Halski, Tomasz; Zduńczyk, Małgorzata; Rajfur, Joanna; Pasternok, Małgorzata; Chmielewska, Daria; Piecha, Magdalena; Kwaśna, Krystyna; Skrzypulec-Plinta, Violetta

    2014-01-01

    Breast cancer-related lymphedema is one of the complications resulting from treatment. It is defined as arm oedema in the breast cancer patients caused by interruption of the flow of the axillary lymphatic system from surgery or radiation therapy, which results in the accumulation of fluid in the subcutaneous tissue of the arm, with a decrease in tissue distensibility around the joints and an increased weight of the extremity. Decongestive lymphatic therapy is common management for lymphedema. A program combining skin care, manual lymphatic drainage, exercise, and compression therapy (multilayer bandage or garment) is recognised as the best practice in lymphedema management. Kinesio taping (KT) for lymphatic drainage is a new choice in the field of physical therapy. The material and the original concept of the taping technique were introduced by Dr Kenso Kase in 1973. K-tape had been designed to allow 30-40% longitudinal stretch. It is composed of 100% cotton fibers and acrylic heat sensitive glue. Development of the technique for its administration is still ongoing. The paper discusses the case of a woman with breast cancer, in whom lymphedema occurred. The patient had three weeks of therapy. The treatment consisted of 12 manual lymphatic drainage, 12 pneumatic compressions and 3 applications of the KT method (due to the lack of standard multi-layer bandaging). During the measurement of oedema it was noted that KT had a significant effect on the reduction of lymphedema and accelerates healing effects compared to standard methods. PMID:26327833

  3. Basic HR Risk Management Principles in Digital Libraries

    OpenAIRE

    Mirembe, Florence

    2009-01-01

    Human beings are responsible for causing risk as well as mitigating risk. This paper focuses on the human resources management risk remedies for digital libraries. Risk management aims at identifying, assessing and resolving risk items before they become disasters to an organization or digital library. Effective risk management plans should include short-term and long-term risks to project schedules, costs, and the functionality, adequacy and quality of project deliverables. Risks can bec...

  4. Basic concepts of philosophy of management and corporations

    DEFF Research Database (Denmark)

    Rendtorff, Jacob Dahl

    2013-01-01

    This chapter presents some fundamental concepts of the philosophy of management and corporations by addressing the problem of corporate legitimacy and Immanuel Kant’s distinction between theoretical, practical, and aesthetic reason and judgment. This chapter begins with a general definition of...... philosophy of management and corporations and continues by presenting its ontological and epistemological underpinnings. This approach is used to address the relation between economics, business ethics, and philosophy of management. Finally, ethical and aesthetic judgment is presented as the mediator between...... theoretical, aesthetic, and practical reason in philosophy of management....

  5. Severe lymphedema caused by repeated self-injury.

    Science.gov (United States)

    Mihara, M; Hara, H; Murai, N; Todokoro, T; Iida, T; Narushima, M; Koshima, I

    2011-12-01

    Lymphedema is divided into primary and secondary forms. Primary lymphedema often develops in young people and may be caused by lymphvascular aplasia, hypoplasia, and hyperplasia. The most frequent cause of secondary lymphedema after lymphatic filariasis is regional lymph node dissection for treatment of a malignant tumor, and this complication occurs most frequently in middle aged or older patients. Here, we describe a relatively young patient (27 years old) in whom collecting lymph vessels in the upper limb were disrupted by repeated self-injury, with resultant lymphedema. There have been very few reports on lymphedema caused by self-induced trauma. This case report illustrates that secondary lymphedema should also be considered and evaluated appropriately when diagnosed in a relatively young patient without a history of cancer or infection. PMID:22458120

  6. Essentials of Risk Management. Strategic Decisions. Board Basics.

    Science.gov (United States)

    Sonenstein, Burton; Kumin, Laura A.

    1998-01-01

    This booklet, intended for trustees of institutions of higher education, offers some instruction on the principles of risk management. Introductory information provides a definition of risk management, which is seen as a planning and strategic function, not solely as a financial or safety assessment. Individual sections then address the following…

  7. Lymphatic mapping and lymphedema surgery in the breast cancer patient

    OpenAIRE

    PATEL, KETAN M.; Manrique, Oscar; Sosin, Michael; Hashmi, Mahjabeen Aftab; Poysophon, Poysophon; Henderson, Robert

    2015-01-01

    Upper limb lymphedema can be an unfortunate sequela following the oncologic treatment of breast cancer. The surgical treatment of lymphedema has had a recent renewed clinical interest paralleling innovative descriptions of surgical techniques and imaging modalities. In addition, an improved understanding of the physiology and pathophysiology of lymphedema has allowed improved translation to the clinical condition. Various surgical options exist to decrease the symptom-burden of upper limb lym...

  8. A model for gene therapy of human hereditary lymphedema

    OpenAIRE

    Karkkainen, Marika J.; Saaristo, Anne; Jussila, Lotta; Karila, Kaisa A.; Lawrence, Elizabeth C.; Pajusola, Katri; Bueler, Hansruedi; Eichmann, Anne; Kauppinen, Risto; Kettunen, Mikko I.; Ylä-Herttuala, Seppo; Finegold, David N.; Ferrell, Robert E; Alitalo, Kari

    2001-01-01

    Primary human lymphedema (Milroy's disease), characterized by a chronic and disfiguring swelling of the extremities, is associated with heterozygous inactivating missense mutations of the gene encoding vascular endothelial growth factor C/D receptor (VEGFR-3). Here, we describe a mouse model and a possible treatment for primary lymphedema. Like the human patients, the lymphedema (Chy) mice have an inactivating Vegfr3 mutation in their germ line, and swelling of the limbs because of hypoplasti...

  9. Lymphedema following cancer therapy in Slovenia: a frequently overlooked condition?

    OpenAIRE

    Rucigaj, Tanja Planinsek; Leskovec, Nada Kecelj; Zunter, Vesna Tlaker

    2010-01-01

    Introduction Secondary lymphedema following cancer therapy is a frequent, often painful, quality of life disturbing condition, reducing the patients’ mobility and predisposing them to complications, e.g. infections and malignancies. The critical aspect of lymphedema therapy is to start as soon as possible to prevent the irreversible tissue damage. Patients and methods We performed a retrospective study of patients with lymphedema, treated at the Department of Dermatovenereology, University Me...

  10. Adiponectin‐Mediated Modulation of Lymphatic Vessel Formation and Lymphedema

    OpenAIRE

    Shimizu, Yuuki; Shibata, Rei; Ishii, Masakazu; Ohashi, Koji; Kambara, Takahiro; Uemura, Yusuke; Yuasa, Daisuke; Kataoka, Yoshiyuki; Kihara, Shinji; Murohara, Toyoaki; Ouchi, Noriyuki

    2013-01-01

    Background Obesity is linked with an increased risk of lymphedema, which is a serious clinical problem. Adiponectin is a circulating adipokine that is down‐regulated in obese states. We investigated the effects of adiponectin on lymphatic vessel formation in a model of lymphedema and dissected its mechanisms. Methods and Results A mouse model of lymphedema was created via ablation of tail surface lymphatic network. Adiponectin‐knockout mice showed the greater diameter of the injured tail comp...

  11. Breast Cancer Survivors’ Experiences of Lymphedema-Related Symptoms

    OpenAIRE

    Fu, Mei Rosemary; Rosedale, Mary

    2009-01-01

    The purpose of this study was to explore and describe breast cancer survivors’ lymphedema-related symptom experiences. As a serious chronic condition from breast cancer treatment, lymphedema, or persistent swelling, is caused by chronic accumulation of lymph fluid in the interstitial spaces of the affected limb or surrounding areas. While significant prevalence of ongoing multiple symptoms have been reported, little is known about how survivors with lymphedema perceive and respond to lymphede...

  12. Acupuncture in the Treatment of Upper-Limb Lymphedema

    OpenAIRE

    Cassileth, Barrie R.; Van Zee, Kimberly J.; Yeung, K. Simon; Coleton, Marci I.; Cohen, Sara; Chan, Yi H; Andrew J Vickers; Sjoberg, Daniel D.; Hudis, Clifford A.

    2013-01-01

    BACKGROUND Current treatments for lymphedema after breast cancer treatment are expensive and require ongoing intervention. Clinical experience and our preliminary published results suggest that acupuncture is safe and potentially useful. This study evaluates the safety and potential efficacy of acupuncture on upper-limb circumference in women with lymphedema. METHODS Women with a clinical diagnosis of breast cancer−related lymphedema (BCRL) for 0.5-5 years and with affected arm circumference ...

  13. A New Mouse Model to Study Acquired Lymphedema

    OpenAIRE

    Tabibiazar, Raymond; Cheung, Lauren; Han, Jennifer; Swanson, Jeffrey; Beilhack, Andreas; An, Andrew; Dadras, Soheil S.; Rockson, Ned; Joshi, Smita; Wagner, Roger; Stanley G Rockson

    2006-01-01

    Editors' Summary Background. Lymphedema is the term used to describe the swelling that can occur after surgery, especially after axillary lymph node dissection for breast cancer, when the lymph vessels that carry protein-rich interstitial fluid from the tissues to the heart are damaged. Lymphedema can be extremely unpleasant and is very hard to treat; treatments that are currently used include those aimed to help massage the flow of lymph back to the chest. Lymphedema seems to be more than ju...

  14. The Health Deviation of Post-Breast Cancer Lymphedema: Symptom Assessment and Impact on Self-Care Agency.

    Science.gov (United States)

    Armer, Jane M; Henggeler, Mary H; Brooks, Constance W; Zagar, Eris A; Homan, Sherri; Stewart, Bob R

    2008-01-01

    (38-39% lymphedema occurrence), with symptom report being the earliest predictor of lymphedema occurrence than any other measurement. Findings verify the importance of subjective assessment by symptom report of limb changes and SCD following breast cancer treatment as an essential tool in early detection and treatment of lymphedema. Findings also support the importance of pre-operative baseline measurements, symptom history, and SCA for later post-op comparisons. These preliminary findings underscore the importance of strengthening SCA by educating breast cancer survivors. Self assessment, early detection, and early treatment hold the best promise for optimal management of this chronic condition, limiting detrimental effects on SCA, and improving quality of life and physiological and psychosocial well-being. These findings lay the foundation for a clinical research program in breast cancer lymphedema based on SCDNT in which education in and awareness for self-report of lymphedema-associated symptoms is a first step in screening. Increasing patient knowledge through education will increase SCA by identifying ane providing information to meet self-care requisites (SCR) related to the health deviation of lymphedema. The nurse has the opportunity to assist patients in developing self-care actions as needed to meet universal and health deviation therapeutic requisites to address self-care demands following breast cancer treatment.

  15. Proteomic profiling of lymphedema development in mouse model.

    Science.gov (United States)

    Lee, Joomin; Song, Haeun; Roh, Kangsan; Cho, Sungrae; Lee, Sukchan; Yeom, Chang-Hwan; Park, Seyeon

    2016-07-01

    The lymphatic vascular system plays an important role in tissue fluid homeostasis. Lymphedema is a chronic, progressive, and incurable condition that leads to lymphatic fluid retention; it may be primary (heritable) or secondary (acquired) in nature. Although there is a growing understanding of lymphedema, methods for the prevention and treatment of lymphedema are still limited. In this study, we investigated differential protein expressions in sham-operated and lymphedema-operated mice for 3 days, using two-dimensional gel electrophoresis (2-DE) and mass spectrometry analysis. Male improved methodology for culturing noninbred (ICR) mice developed lymphedema in the right hindlimb. Twenty functional proteins were found to be differentially expressed between lymphedema induced-right leg tissue and normal left leg tissue. Out of these proteins, the protein levels of apolipoprotein A-1 preprotein, alpha-actinin-3, mCG21744, parkinson disease, serum amyloid P-component precursor, annexin A8, mKIAA0098 protein, and fibrinogen beta chain precursor were differentially upregulated in the lymphedema mice compared with the sham-operated group. Western blotting analysis was used to validate the proteomics results. Our results showing differential up-regulation of serum amyloid P-component precursor, parkinson disease, and apolipoprotein A-1 preprotein in lymphedema model over sham-operated model suggest important insights into pathophysiological target for lymphedema. Copyright © 2016 John Wiley & Sons, Ltd. PMID:27151289

  16. Symptom report in detecting breast cancer-related lymphedema

    Directory of Open Access Journals (Sweden)

    Fu MR

    2015-10-01

    Full Text Available Mei R Fu,1 Deborah Axelrod,2,3 Charles M Cleland,1 Zeyuan Qiu,4 Amber A Guth,2,3 Robin Kleinman,2 Joan Scagliola,2 Judith Haber1 1College of Nursing, New York University, 2Department of Surgery, NYU School of Medicine, 3NYU Clinical Cancer Center, New York, NY, 4Department of Chemistry and Environmental Science, New Jersey Institute of Technology, Newark, NJ, USA Abstract: Breast cancer-related lymphedema is a syndrome of abnormal swelling coupled with multiple symptoms resulting from obstruction or disruption of the lymphatic system associated with cancer treatment. Research has demonstrated that with increased number of symptoms reported, breast cancer survivors' limb volume increased. Lymphedema symptoms in the affected limb may indicate a latent stage of lymphedema in which changes cannot be detected by objective measures. The latent stage of lymphedema may exist months or years before overt swelling occurs. Symptom report may play an important role in detecting lymphedema in clinical practice. The purposes of this study were to: 1 examine the validity, sensitivity, and specificity of symptoms for detecting breast cancer-related lymphedema and 2 determine the best clinical cutoff point for the count of symptoms that maximized the sum of sensitivity and specificity. Data were collected from 250 women, including healthy female adults, breast cancer survivors with lymphedema, and those at risk for lymphedema. Lymphedema symptoms were assessed using a reliable and valid instrument. Validity, sensitivity, and specificity were evaluated using logistic regression, analysis of variance, and areas under receiver operating characteristic curves. Count of lymphedema symptoms was able to differentiate healthy adults from breast cancer survivors with lymphedema and those at risk for lymphedema. A diagnostic cutoff of three symptoms discriminated breast cancer survivors with lymphedema from healthy women with a sensitivity of 94% and a specificity of 97

  17. The Effect of Combined Decongestive Therapy and Pneumatic Compression Pump on Lymphedema Indicators in Patients with Breast Cancer Related Lymphedema

    OpenAIRE

    M Moattari; Jaafari, B; Talei, A; Piroozi, S; S. Tahmasebi; Zakeri, Z.

    2012-01-01

    Background Lymphedema treatment is difficult and there is no consensus on the best treatment. This study evaluated the effect of combined decongestive therapy (CDT) and pneumatic compression pump on lymphedema indicators in patients with breast cancer related lymphedema (BCRL). Methods Twenty one women with BCRL were enrolled. The volume difference of upper limbs, the circumference at 9 areas and shoulder joint range of motion were measured in all patients. CDT was done by an educated nurse i...

  18. Cancer pain management: Basic information for the young pain physicians

    Directory of Open Access Journals (Sweden)

    SPS Rana

    2011-01-01

    Full Text Available Cancer pain is multifactorial and complex. The impact of cancer pain is devastating, with increased morbidity and poor quality of life, if not treated adequately. Cancer pain management is a challenging task both due to disease process as well as a consequence of treatment-related side-effects. Optimization of analgesia with oral opioids, adjuvant analgesics, and advanced pain management techniques is the key to success for cancer pain. Early access of oral opioid and interventional pain management techniques can overcome the barriers of cancer pain, with improved quality of life. With timely and proper anticancer therapy, opioids, nerve blocks, and other non-invasive techniques like psychosocial care, satisfactory pain relief can be achieved in most of the patients. Although the WHO Analgesic Ladder is effective for more than 80% cancer pain, addition of appropriate adjuvant drugs along with early intervention is needed for improved Quality of Life. Effective cancer pain treatment requires a holistic approach with timely assessment, measurement of pain, pathophysiology involved in causing particular type of pain, and understanding of drugs to relieve pain with timely inclusion of intervention. Careful evaluation of psychosocial and mental components with good communication is necessary. Barriers to cancer pain management should be overcome with an interdisciplinary approach aiming to provide adequate analgesia with minimal side-effects. Management of cancer pain should comprise not only a physical component but also psychosocial and mental components and social need of the patient. With risk-benefit analysis, interventional techniques should be included in an early stage of pain treatment. This article summarizes the need for early and effective pain management strategies, awareness regarding pain control, and barriers of cancer pain.

  19. [Basic considerations during outsourcing of clinical data management services].

    Science.gov (United States)

    Shen, Tong; Liu, Yan

    2015-11-01

    With worldwide improvements in the regulations of international and domestic clinical trial conductions, the quality of clinical trials and trial data management are receiving a great deal of attention. To ensure the quality of clinical trials, maintain business flexibilities and effectively utilize internal and external resources, the outsourcing model is used in the management of clinical data in operation of pharmaceutical companies. The essential criteria of a successful outsourcing mode in clinical trial are selection of qualified contract research organizations (CRO); establishment of appropriate outsourcing model, and generation of effective quality control systems to ensure the authenticity, integrity and accuracy of the clinical trial data. PMID:26911050

  20. [Basic considerations during outsourcing of clinical data management services].

    Science.gov (United States)

    Shen, Tong; Liu, Yan

    2015-11-01

    With worldwide improvements in the regulations of international and domestic clinical trial conductions, the quality of clinical trials and trial data management are receiving a great deal of attention. To ensure the quality of clinical trials, maintain business flexibilities and effectively utilize internal and external resources, the outsourcing model is used in the management of clinical data in operation of pharmaceutical companies. The essential criteria of a successful outsourcing mode in clinical trial are selection of qualified contract research organizations (CRO); establishment of appropriate outsourcing model, and generation of effective quality control systems to ensure the authenticity, integrity and accuracy of the clinical trial data.

  1. A longitudinal analysis of the effect of mass drug administration on acute inflammatory episodes and disease progression in lymphedema patients in Leogane, Haiti.

    Science.gov (United States)

    Eddy, Brittany A; Blackstock, Anna J; Williamson, John M; Addiss, David G; Streit, Thomas G; Beau de Rochars, Valery M; Fox, Leanne M

    2014-01-01

    We conducted a longitudinal analysis of 117 lymphedema patients in a filariasis-endemic area of Haiti during 1995-2008. No difference in lymphedema progression between those who received or did not receive mass drug administration (MDA) was found on measures of foot (P = 0.24), ankle (P = 0.87), or leg (P = 0.46) circumference; leg volume displacement (P = 0.09), lymphedema stage (P = 0.93), or frequency of adenolymphangitis (ADL) episodes (P = 0.57). Rates of ADL per year were greater after initiation of MDA among both groups (P < 0.01). Nevertheless, patients who received MDA reported improvement in four areas of lymphedema-related quality of life (P ≤ 0.01). Decreases in foot and ankle circumference and ADL episodes were observed during the 1995-1998 lymphedema management study (P ≤ 0.01). This study represents the first longitudinal, quantitative, leg-specific analysis examining the clinical effect of diethylcarbamazine on lymphedema progression and ADL episodes.

  2. Basic Energy Conservation and Management--Part 2: HVAC

    Science.gov (United States)

    Krueger, Glenn

    2012-01-01

    Reducing school district energy expenditures has become a universal goal, and new technologies have brought greater energy efficiencies to the school environment. In Part 1 of this two-part series, the author discussed the steps required to establish an energy conservation and management program with an emphasis on lighting. In this article, he…

  3. FILAR I AL LYMPHEDEMA LOWER LIMB DEBULKING 34 CASES

    Directory of Open Access Journals (Sweden)

    Baburao

    2015-10-01

    Full Text Available There are various treatment options in the management of filarial lymphedema of the lower extremities. The end point, regardless of the method adopted is a reduction of the girth of the limb, prevention of future increases in limb girth, prevention of recurrent episodes of streptococcal cellulitis; more important the treatment method used should not lead to any secondary problems that may far out shadow the primary co Majority of the methods adopted are mainly of the secondary prevention kind; very few of the procedures to date cure the disease condition. A few of the methods have been historically found to be more effective than the others; this may be real or apparent as the methodology of - reporting swelling in the lower limb may not have been consistent and there are too many variables to consider. This study seeks to evaluate the efficacy of one such treatment protocol for the management of filarial lymphedema of the lower limb 80 patients were admitted for filarial lymphedema of the lower limbs from 2005 to 2015 Of these 42 patients underwent surgical treatment; operative records for 8 of these patients was insufficient to analyse; among the remaining 34 patients 19 patients were unavailable for review. This left us a patient population of 15 for the final analysis . The surgical treatment of all of the 15 patients was identical, after preop preparation by using compression ba n dages to soften the edema along with a period of bed rest debulking of excess skin and subcutaneous tissue and primary closure was done. The intro operative application of Esmarch bandages helped in expelling fluid from the tissues and this ensured that closure was obtained with no tension at the margins. Patients were kept for at least 5 days post op before discharge; the routine use of compression crepe bandages postop along with bed rest ensured that we did not have a single case of skin necrosis or wound disruption in the postop period. All patients were given

  4. Development of a framework for pneumatic device selection for lymphedema treatment

    OpenAIRE

    Maul,

    2009-01-01

    Sonja M Maul1, Julie A Devine2, Carolyn R Wincer31St. Luke’s Idaho Elks Rehabilitative Services, Boise, ID, USA; 2Center for Wound Care, Butler Memorial Hospital, Butler, PA, USA; 3Centers for Rehabilitation Services, Gibsonia, PA, USAAbstract: The results of three patients with difficult to manage leg and trunk lymphedema are reported. Patients were treated with the current standard of care: combined decongestive therapy. All three patients met obstacles in achieving independent se...

  5. [Conservative lymphedema therapy - lymphological rehabilitation treatment].

    Science.gov (United States)

    Apich, Gert

    2013-04-01

    The most important column in the conservative lymphedema therapy still represents the complex decongestive physical therapy/KPE.This is a multimodal therapy, which consists of four components. (1) skin restoration and/or skin care, (2) manual lymphatic drainage, (3) compression therapy and (4) decongestive exercises. The KPE is also divided into two phases. Phase 1-the decongestion-serves primarily the mobilization and transporting away the banked protein-rich oedema fluid and seamless transition into the Phase 2-the maintenance phase, which serves to preserve the achieved treatment success. The implementation of the KPE should be stage-adjusted, but depends also on the location (genital, head, face), and on co-existing comorbidities (congestive heart failure, diabetes mellitus, obesity, muscular-skeletal disorders, mental illness, etc.). It should be modified for children, elderly persons and for patients with malignant lymphedema. PMID:23645412

  6. Basic inventory management techniques for the Republic of China

    OpenAIRE

    Cheng, Cheng-Wen

    1989-01-01

    Approved for public release; distribution is unlimited. Lacking further development of mathematical inventory models and well utilized automated records, the Republic of China (ROC) Naval supply system cannot operate efficiently and effectively. The constraints of budget, foreign exchange and unpredictable procurement lead times have resulted in an inventory level higher than optimal. However, the inventory management process and overall supply support performance could be i...

  7. Quality management in radiology: historical aspects and basic definitions.

    Science.gov (United States)

    Erturk, Sukru Mehmet; Ondategui-Parra, Silvia; Ros, Pablo R

    2005-12-01

    In today's extremely competitive economic environment, the quality management processes used by industrial companies have become commonplace at hospitals and are proving successful in improving quality and controlling costs. Continuous quality improvement (CQI) methods provide a relatively new way, compared with quality assurance (QA) and quality control (QC) methods, to improve the quality of health care. Continuous quality improvement should be considered a philosophy rather than simply a methodology; it assumes no endpoints in improvement efforts and does not attempt to replace the older concepts of QA and QC but rather to reap their benefits and take them to a higher conceptual level. Continuous quality improvement has 4 foci: (1) to determine and meet the needs of patients and customers, (2) to approach quality improvement holistically on the basis of the identification of the underlying cause of poor performance, (3) to apply fact-based management and scientific methodology, and (4) to empower its practitioners to improve quality on a daily basis. Health care institutions and radiology departments use a variety of CQI systems or models, including the model of the Joint Commission on Accreditation of Healthcare Organizations, the Six Sigma model, and the Model for Business Excellence of the European Foundation for Quality Management. The International Organization for Standardization 9000, which creates a suitable organizational environment for the implementation of a CQI system, can be considered an effective QA and QC method. PMID:17411981

  8. Quality management in radiology: historical aspects and basic definitions.

    Science.gov (United States)

    Erturk, Sukru Mehmet; Ondategui-Parra, Silvia; Ros, Pablo R

    2005-12-01

    In today's extremely competitive economic environment, the quality management processes used by industrial companies have become commonplace at hospitals and are proving successful in improving quality and controlling costs. Continuous quality improvement (CQI) methods provide a relatively new way, compared with quality assurance (QA) and quality control (QC) methods, to improve the quality of health care. Continuous quality improvement should be considered a philosophy rather than simply a methodology; it assumes no endpoints in improvement efforts and does not attempt to replace the older concepts of QA and QC but rather to reap their benefits and take them to a higher conceptual level. Continuous quality improvement has 4 foci: (1) to determine and meet the needs of patients and customers, (2) to approach quality improvement holistically on the basis of the identification of the underlying cause of poor performance, (3) to apply fact-based management and scientific methodology, and (4) to empower its practitioners to improve quality on a daily basis. Health care institutions and radiology departments use a variety of CQI systems or models, including the model of the Joint Commission on Accreditation of Healthcare Organizations, the Six Sigma model, and the Model for Business Excellence of the European Foundation for Quality Management. The International Organization for Standardization 9000, which creates a suitable organizational environment for the implementation of a CQI system, can be considered an effective QA and QC method.

  9. Recent Advances in Medical Treatment for Lymphedema

    OpenAIRE

    Ogawa, Yoshihiro

    2012-01-01

    As medical treatment for lymphedema, combined physical therapy with guidance regarding daily living is recommended. Recently, training has been conducted on a nationwide scale, and this therapy has gradually and commonly been employed. This therapy consists of daily living guidance to prevent edema deterioration, skin care, manual lymph drainage, compression therapy, and exercise therapy. The number of hospitals in which all procedures can be adequately performed is limited. There is no treat...

  10. Twisting Tourniquet© Technique: introducing Schnogh, a novel device and its effectiveness in treating primary and secondary lymphedema of extremities

    International Nuclear Information System (INIS)

    Twisting Tourniquet© or in Thai “Schnogh” is a new invention for compression therapy of lymphedema. Twisting Tourniquet© Technique (TTT) is totally noninvasive for lymphedema management. After the amazing successful evidence in the first series of 28 patients, we have conducted preliminary studies in lymphedema clinics. It was found that the combination of gradually increasing constriction force by Schnogh until desired pressure was reached and maintained for 15 min, followed by a 5-min release, doing repeatedly this compression-decompression for at least 10 sessions a day, can generate acceptable results. The aim of the study was to evaluate the scientific effectiveness and establish a treatment protocol of TTT proposed as a therapeutic approach for clinical management of lymphedema. During 2006–2013, from over 3500 patients, 647 with primary/secondary lymphedema passed inclusion criteria, 307 for upper, and 340 for lower extremity. In the 5-day course of TTT, each day patients underwent 10 sessions of a 15-min compression followed by a 5-min decompression. Vegan diet was encouraged as an adjuvant therapy. Among lymphedema patients whose spectrum of edema severity ranged from mild to gigantic, TTT yielded an average volume reduction rate (VR) at 50.2% and 55.6%, making the average edema reduction volume attained at 463 and 1856 mL for upper and lower limb, respectively. The uniformed practice by Schnogh which supports a continual compression–decompression maneuver over 3.5 h daily for five consecutive days could induce an average VR at above half of the swelling in extremities of 647 patients. Schnogh is therefore effective in clinical management of lymphedema under TTT treatment of fibroblastic interstitium

  11. Twisting Tourniquet(©) Technique: introducing Schnogh, a novel device and its effectiveness in treating primary and secondary lymphedema of extremities.

    Science.gov (United States)

    Chanwimalueang, Narumon; Ekataksin, Wichai; Piyaman, Parkpoom; Pattanapen, Gedsuda; Hanboon, Borimas K

    2015-10-01

    Twisting Tourniquet(©) or in Thai "Schnogh" is a new invention for compression therapy of lymphedema. Twisting Tourniquet(©) Technique (TTT) is totally noninvasive for lymphedema management. After the amazing successful evidence in the first series of 28 patients, we have conducted preliminary studies in lymphedema clinics. It was found that the combination of gradually increasing constriction force by Schnogh until desired pressure was reached and maintained for 15 min, followed by a 5-min release, doing repeatedly this compression-decompression for at least 10 sessions a day, can generate acceptable results. The aim of the study was to evaluate the scientific effectiveness and establish a treatment protocol of TTT proposed as a therapeutic approach for clinical management of lymphedema. During 2006-2013, from over 3500 patients, 647 with primary/secondary lymphedema passed inclusion criteria, 307 for upper, and 340 for lower extremity. In the 5-day course of TTT, each day patients underwent 10 sessions of a 15-min compression followed by a 5-min decompression. Vegan diet was encouraged as an adjuvant therapy. Among lymphedema patients whose spectrum of edema severity ranged from mild to gigantic, TTT yielded an average volume reduction rate (VR) at 50.2% and 55.6%, making the average edema reduction volume attained at 463 and 1856 mL for upper and lower limb, respectively. The uniformed practice by Schnogh which supports a continual compression-decompression maneuver over 3.5 h daily for five consecutive days could induce an average VR at above half of the swelling in extremities of 647 patients. Schnogh is therefore effective in clinical management of lymphedema under TTT treatment of fibroblastic interstitium. PMID:26247407

  12. Cutaneous Lymphangiosarcoma Following Chronic Lymphedema of Filarial Origin

    OpenAIRE

    Abhijit S Acharya; Sulhyan, K.R; R V Ramteke; V Y Kunghadkar

    2013-01-01

    We are reporting a case of 36 yr old female with chronic filarial lymphedema of both legs. Subsequently she developed lymphangiosarcoma of her left leg which was confirmed histologically and on immunohistochemistry. Only three more cases of lymphagiosarcoma occurring in patients with filarial lymphedema are reviewed from available literature.

  13. Three basic options for the management of PWR waste

    International Nuclear Information System (INIS)

    Relying on the national practices of France, Germany and Belgium, three reference management routes for PWR wastes were drawn up and subsequently evaluated in terms of costs and radiological impact. It was thus demonstrated that safety regulations and technical redundancies, especially for off-gas treatment, liquid waste processing and dry solid waste treatment, play an important part in the cost associated with each route. The analysis of the different treatment options for mixed solid low level waste highlighted the low cost effectiveness of incineration as compared to compaction. Whatever the scenario investigated, the disposal costs of PWR wastes proved to be quite marginal in the overall cost. The radiological impact associated with each route was assessed through individual doses resulting from liquid and gaseous effluents. This theoretical exercise included some sensitivity studies performed on a selection of important parameters

  14. Sodium selenite and cancer related lymphedema: Biological and pharmacological effects.

    Science.gov (United States)

    Pfister, Christina; Dawzcynski, Horst; Schingale, Franz-Josef

    2016-09-01

    A significant percentage of cancer patients develop secondary lymphedema after surgery or radiotherapy. The preferred treatment of secondary lymphedema is complex physical therapy. Pharmacotherapy, for example with diuretics, has received little attention, because they were not effective and only offered short-term solutions. Sodium selenite showed promise as a cost-effective, nontoxic anti-inflammatory agent. Treatment with sodium selenite lowers reactive oxygen species (ROS) production, causes a spontaneous reduction in lymphedema volume, increases the efficacy of physical therapy for lymphedema, and reduces the incidence of erysipelas infections in patients with chronic lymphedema. Besides biological effects in reducing excessive production of ROS, sodium selenite also displays various pharmacological effects. So far the exact mechanisms of these pharmacological effects are mostly unknown, but probably include inhibition of adhesion protein expression. PMID:27267968

  15. Th2 differentiation is necessary for soft tissue fibrosis and lymphatic dysfunction resulting from lymphedema

    OpenAIRE

    Avraham, Tomer; Jamie C Zampell; Yan, Alan; Elhadad, Sonia; Evan S Weitman; Stanley G Rockson; Bromberg, Jacqueline; Mehrara, Babak J.

    2013-01-01

    Lymphedema is a dreaded complication of cancer treatment. However, despite the fact that >5 million Americans are affected by this disorder, the development of effective treatments is limited by the fact that the pathology of lymphedema remains unknown. The purpose of these studies was to determine the role of inflammatory responses in lymphedema pathology. Using mouse models of lymphedema, as well as clinical lymphedema specimens, we show that lymphatic stasis results in a CD4+ T-cell inflam...

  16. Temelji gozdne ureditve revirja Unec 1908: Basic forest management of the Unec district 1908:

    OpenAIRE

    Perko, Franc

    2008-01-01

    The article deals with the basic plan orientations of the Unec district in theyear 1908. Discovering the forests in question were not selection but uniform forests, the planner set a management system based on the clearcuttingprinciples. The plan shows the economical conditions at the beginning of the 20th century and the history of the forest management in the Haasberg estate.

  17. Effects of manual lymphatic drainage on breast cancer-related lymphedema: a systematic review and meta-analysis of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Huang Tsai-Wei

    2013-01-01

    Full Text Available Abstract Background Lymphedema is a common complication of axillary dissection for breast cancer. We investigated whether manual lymphatic drainage (MLD could prevent or manage limb edema in women after breast-cancer surgery. Methods We performed a systematic review and meta-analysis of published randomized controlled trials (RCTs to evaluate the effectiveness of MLD in the prevention and treatment of breast-cancer-related lymphedema. The PubMed, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro, SCOPUS, and Cochrane Central Register of Controlled Trials electronic databases were searched for articles on MLD published before December 2012, with no language restrictions. The primary outcome for prevention was the incidence of postoperative lymphedema. The outcome for management of lymphedema was a reduction in edema volume. Results In total, 10 RCTs with 566 patients were identified. Two studies evaluating the preventive outcome of MLD found no significant difference in the incidence of lymphedema between the MLD and standard treatment groups, with a risk ratio of 0.63 and a 95% confidence interval (CI of 0.14 to 2.82. Seven studies assessed the reduction in arm volume, and found no significant difference between the MLD and standard treatment groups, with a weighted mean difference of 75.12 (95% CI, −9.34 to 159.58. Conclusions The current evidence from RCTs does not support the use of MLD in preventing or treating lymphedema. However, clinical and statistical inconsistencies between the various studies confounded our evaluation of the effect of MLD on breast-cancer-related lymphedema.

  18. Efficacy of complete decongestive therapy and manual lymphatic drainage on treatment-related lymphedema in breast cancer

    International Nuclear Information System (INIS)

    Objective: To evaluate the results of combined decongestive therapy and manual lymphatic drainage in patients with breast cancer-related lymphedema. Methods and Materials: The data from 250 patients were reviewed. The pre- and posttreatment volumetric measurements were compared, and the correlation with age, body mass index, and type of surgery, chemotherapy, and radiotherapy was determined. The Spearman correlation coefficients and Wilcoxon two-sample test were used for statistical analysis. Results: Of the 250 patients, 138 were included in the final analysis. The mean age at presentation was 54.3 years. Patients were stratified on the basis of the treatment modality used for breast cancer management. Lymphedema was managed with combined decongestive therapy in 55%, manual lymphatic drainage alone in 32%, and the home program in 13%. The mean pretreatment volume of the affected and normal arms was 2929 and 2531 mL. At the end of 1 year, the posttreatment volume of the affected arm was 2741 mL. The absolute volume of the affected arm was reduced by a mean of 188 mL (p < 0.0001). The type of surgery (p = 0.0142), age (p = 0.0354), and body mass index (p < 0.0001) were related to the severity of lymphedema. Conclusion: Combined decongestive therapy and manual lymphatic drainage with exercises were associated with a significant reduction in the lymphedema volume

  19. 41 CFR 102-80.10 - What are the basic safety and environmental management policies for real property?

    Science.gov (United States)

    2010-07-01

    ... safety and environmental management policies for real property? 102-80.10 Section 102-80.10 Public... MANAGEMENT REGULATION REAL PROPERTY 80-SAFETY AND ENVIRONMENTAL MANAGEMENT General Provisions § 102-80.10 What are the basic safety and environmental management policies for real property? The basic safety...

  20. Breast Cancer-Related Lymphedema and Resistance Exercise: A Systematic Review.

    Science.gov (United States)

    Nelson, Nicole L

    2016-09-01

    Nelson, NL. Breast cancer-related lymphedema and resistance exercise: a systematic review. J Strength Cond Res 30(9): 2656-2665, 2016-Breast cancer-related lymphedema (BCRL) is characterized by the accumulation of fluid in the interstitial tissues in the arm, shoulder, neck, or torso and attributed to the damage of lymph nodes during breast cancer treatments involving radiation and axillary node dissection. Resistance exercise training (RET) has recently shown promise in the management of BCRL. The aims of this review were twofold: (a) To summarize the results of recent randomized controlled trials (RCTs) investigating the effect of resistance exercise in those with, or at risk for, BCRL. (b) To determine whether breast cancer survivors can perform RET at sufficient intensities to elicit gains in strength without causing BCRL flare-up or incidence. A search was performed on the electronic databases PubMed, MEDLINE, SPORT Discus, and Science Direct, up to July 10, 2015, using the following keywords: breast cancer-related lymphedema, strength training, resistance training, systematic review, and breast cancer. Manual searches of references were also conducted for additional relevant studies. A total of 6 RCTs, involving 805 breast cancer survivors, met the inclusion criteria and corresponded to the aims of this review. The methodological quality of included RCTs was good, with a mean score 6.8 on the 10-point PEDro scale. The results of this review indicate that breast cancer survivors can perform RET at high-enough intensities to elicit strength gains without triggering changes to lymphedema status. There is strong evidence indicating that RET produces significant gains in muscular strength without provoking BCRL. PMID:26840439

  1. Quantitative lymphoscintigraphy in post-mastectomy lymphedema: correlation with circumferential measurements

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Joon Young; Lee, Kyung Han; Kim, Sang Eun; Kim, Byung Tae; Hwang, Jee Hea; Lee, Byung Boong [Samsung Medical Center, Seoul (Korea, Republic of)

    1997-07-01

    An objective measure for the severity and progression is important for the management of lymphedema. To evaluate the usefulness of lympho-scintigraphy in this regard, we compared various quantitative indices from upper extremity lymphoscintigraphy with circumferential measurements, before and after physiotheraphy. Upper extremity lymphoscintigraphy was performed in 38 patients with unilateral postmastectomy lymphedema. Tc-99m antimony sulfide colloid (37 MBq) was injected s.c. into the second and third interdigital spaces. The injection sites were imaged immediately after injection. After standardized exercise for 15 min, upper extremity images were acquired 30 min, 1 hr and 2 hr after injection. The clearance of the injection site (CL), and % uptake in regional lymph nodes (%LN) and soft tissue of the extremity (i.e., the degree of dermal backflow) (%EXT) compared to the initial injection site were calculated. Circumference of each extremity was measured at 7 levels; the severity of lymphedema was expressed as the percentage difference of total circumferential difference (TCD) between healthy and edematous extremities compared to the total circumference of healthy extremity (%TCD). In 19 patients who received physiotherapy, the therapeutic effect was measured by % decrease of TCD (%DTCD) before and after therapy (Raines. et al., 1977). The quantitative indices calculated in the image at 2 hr p.i. had better correlation with either %TCD or %DTCD than those from earlier images (Table). The CL, %LN and %EXT of edematous extremity had a significant correlation with TCD. The %EXT was correlated best with either TCD or %DTCD. The results suggest that the %EXT which corresponds to the degree of dermal backflow may be a simple and useful quantitative index for evaluating the severity and progression in lymphedema and predicting the effect of therapy.

  2. Evaluation of the effectiveness of kinesio taping application in a patient with secondary lymphedema in breast cancer: a case report

    Directory of Open Access Journals (Sweden)

    Jakub Taradaj

    2014-03-01

    Full Text Available Breast cancer-related lymphedema is one of the complications resulting from treatment. It is defined as arm oedema in the breast cancer patients caused by interruption of the flow of the axillary lymphatic system from surgery or radiation therapy, which results in the accumulation of fluid in the subcutaneous tissue of the arm, with a decrease in tissue distensibility around the joints and an increased weight of the extremity. Decongestive lymphatic therapy is common management for lymphedema. A program combining skin care, manual lymphatic drainage, exercise, and compression therapy (multilayer bandage or garment is recognised as the best practice in lymphedema management. Kinesio taping (KT for lymphatic drainage is a new choice in the field of physical therapy. The material and the original concept of the taping technique were introduced by Dr Kenso Kase in 1973. K-tape had been designed to allow 30-40% longitudinal stretch. It is composed of 100% cotton fibers and acrylic heat sensitive glue. Development of the technique for its administration is still ongoing. The paper discusses the case of a woman with breast cancer, in whom lymphedema occurred. The patient had three weeks of therapy. The treatment consisted of 12 manual lymphatic drainage, 12 pneumatic compressions and 3 applications of the KT method (due to the lack of standard multi-layer bandaging. During the measurement of oedema it was noted that KT had a significant effect on the reduction of lymphedema and accelerates healing effects compared to standard methods.

  3. BASIC ACTUAL AND EFFECTIVENESS OF LEADERSHIP STYLES OF CONSTRUCTION PROJECT MANAGERS IN SURABAYA

    Directory of Open Access Journals (Sweden)

    Andi Andi

    2004-01-01

    Full Text Available Leading is one of the most important facets in managing construction projects, and behaving as an effective leader is a vital project manager’s responsibility to ensure that work efforts of other persons are directed toward the accomplishment of organizational objectives. This paper aims to determine basic and actual leadership styles of construction project managers in Surabaya. The effectiveness of the actual leadership style is also examined. To accomplish the objective, the paper first briefly reviews the ways in which leadership is approached. Data were then collected through an empirical survey to 46 project managers, taking Fiedler and Hersey-Blanchard’s models as the point of departure. The results indicate that the basic leadership of project managers in Surabaya falls slightly on task-oriented behavior. Meanwhile selling is the most common style used as actual leadership in practice. The paper discusses the effectiveness of the styles adopted and situational variables affecting.

  4. An Agent-Based Approach for Evaluating Basic Design Options of Management Accounting Systems

    OpenAIRE

    Friederike Wall

    2013-01-01

    This paper investigates the effectiveness of reducing errors in management accounting systems with respect to organizational performance. In particular, different basic design options of management accounting systems of how to improve the information base by measurements of actual values are analyzed in different organizational contexts. The paper applies an agent-based simulation based on the idea of NK fitness landscapes. The results provide broad, but no universal support for conventional ...

  5. Analysis of theoretical basics of internal communications as a necessary condition effective management of enterprise

    Directory of Open Access Journals (Sweden)

    L.Yu. Sager

    2011-01-01

    Full Text Available The article is devoted to the use of communications in terms of management of information and interpersonal interaction in the domestic enterprise level. in the article the basic theoretical aspects of internal communications in the enterprise management system as part of its efficient functioning: clarified the essence of the concept of "communication"; systematized the advantages and disadvantages of internal communications of the enterprises, and their goals on the enterprise; systematized the barriers to effective communication process.

  6. A First-Year, Student-Managed Course to Correlate Basic Sciences with Clinical Medicine.

    Science.gov (United States)

    Saffran, Murray; Yeasting, Richard A.

    1985-01-01

    A course, designed to illustrate the correlation of the biochemistry and physiology content of the curriculum with clinical applications, is described. The entire presentation, from introduction and interview of the patient to the correlation of the clinical application with the basic sciences, was managed by the students. (Author/MLW)

  7. BASIC PRINCIPLES AND SEQUENCE OF MANAGEMENT DECISION-MAKING IN SUBSTANTIATING THE ENTERPRISES'' REAL INVESTMENTS EXPEDIENCY

    OpenAIRE

    Kukhta, P.

    2012-01-01

    There were revealed the basic principles of evaluating the real investments effectiveness, compliance with which will ensure the economic feasibility of projects, simplification of the evaluation process and rational behaviour of economic entities in their implementation. Sequence of forming the components of the systematic approach to the approval of management decisions was defined.

  8. Management of Universal Basic Education Scheme (U.B.E.) for Qualitative Education in Nigeria

    Science.gov (United States)

    Omotayo, Dare Michael; Ihebereme, Chioma; Maduewesi, Sir B. U.

    2008-01-01

    Since independence, Nigeria has been searching diligently for a viable educational system capable of enhancing the socio-economic and political values inherent in the country. This paper discusses concepts such as management, qualitative education and Universal Basic Education. In addition to the above, the paper also examines the National…

  9. Hennekam syndrome: a rare cause of primary lymphedema

    OpenAIRE

    Elmansour, Imane; Chiheb, Soumia; Benchikhi, Hakima

    2014-01-01

    Hennekam syndrome (HS) is an autosomal recessive disorder characterized by the association of lymphedema, intestinal lymphangiectasia, moderate mental retardation, and facial dysmorphism. We describe a 14-year-old girl affected with Hennekam syndrome.

  10. Effect of physical therapy on breast cancer related lymphedema

    DEFF Research Database (Denmark)

    Tambour, Mette; Tange, Berit; Christensen, Robin Daniel Kjersgaard;

    2014-01-01

    BACKGROUND: Physical therapy treatment of patients with lymphedema includes treatment based on the principles of 'Complete Decongestive Therapy' (CDT). CDT consists of the following components; skin care, manual lymphatic drainage, bandaging and exercises. The scientific evidence regarding what...... trial. A total of 160 breast cancer patients with arm lymphedema will be recruited from 3 hospitals and randomized into one of two treatment groups A: Complete Decongestive Therapy including manual drainage or B: Complete Decongestive Therapy without manual lymphatic drainage. The intervention period...

  11. Combined Lymphedema and Capillary Malformation of the Lower Extremity

    OpenAIRE

    Maclellan, Reid A.; Chaudry, Gulraiz; Greene, Arin K.

    2016-01-01

    Background: Primary lymphedema and capillary malformation are independent vascular malformations that can cause overgrowth of the lower extremity. We report a series of patients who had both types of malformations affecting the same leg. The condition is unique but may be confused with other types of vascular malformation overgrowth conditions (eg, Klippel–Trenaunay and Parkes Weber). Methods: Our Vascular Anomalies Center and Lymphedema Program databases were searched for patients with both ...

  12. MR features in lymphedema and phlebedema of extremities

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Jeong Hee; Moon, Tae Myung; Kim, Chang Soo; Chung, Chun Phil [Maryknoll Hospital, Pusan (Korea, Republic of)

    1994-10-15

    Authors analyzed the MR findings of swollen extremities to evaluate the MR features of lymphedema and phlebedema. We reviewed MR imagings of 17 cases of swollen extremities, including 12 lymphedemas and 5 phlebedemas. We obtained axial T1-, T2-, and Gd-DTPA enhanced T1WIs using 1.0 T superconducting magnet and measured cross-sectional areas of subcutaneous and subfascial tissues of a slice with grossly largest cross-sectional area using perimeter. We also analyzed change in the signal intensities of the subcutaneous and subfascial tissues on T2WI, presence of enhancement on Gd-PTDA enhanced T1WI, and presence of skin thickening. Both subcutaneous and subfascial tissues of swollen extremities were increased in the cross-sectional areas than those of contralateral normal side. The subcutaneous compartment in lymphedema was statistically significantly increased in cross-sectional area than subfascial compartment in lymphedema(p<0.005) and subcutaneous tissue in phlebedema (p<0.05). Increased signal intensities and characteristic 'honeycomb appearance' of subcutaneous tissue in the lymphedema were specific findings on T2WI. MR imaging was useful and noninvasive method in the diagnosis of swollen extremities. There were increased cross-sectional area of subcutaneous compartment with 'honeycomb appearance' in lymphedema and increased signal intensities of both subcutaneous and subfascial compartment in phlebedema on the T2WI.

  13. AA amyloidosis as a complication of primary lymphedema.

    Science.gov (United States)

    Beloncle, François; Sayegh, Johnny; Eymerit-Morin, Caroline; Duveau, Agnès; Augusto, Jean-François

    2014-03-01

    Primary lymphedema is a rare disease caused by a disorder of lymphangiogenesis. Clinical presentation and age at onset are variable. AA amyloidosis is usually due to chronic inflammatory diseases, malignant tumors or less frequently chronic infectious diseases. We report here the first two cases of AA amyloidosis present with renal failure and nephrotic syndrome in patients with primary lymphedema-induced chronic leg ulcers. The first patient was a 62-year-old female who presented with chronic untreated leg ulcers for 8 years secondary to primary lymphedema. A kidney biopsy done for nephrotic syndrome allowed the diagnosis of AA amyloidosis. The second patient was a 54-year-old male who presented with hereditary lymphedema and elephantiasis since the age of 12. A salivary gland biopsy allowed the diagnosis of AA amyloidosis. Renal function deteriorated progressively needing chronic haemodialysis. Chronic leg ulcers have been rarely reported to induce AA amyloidosis. Only five other cases have been reported in the literature, but none of them with chronic lymphedema. We believe that the relation between lymphedema, chronic leg ulcers and AA amyloidosis is underestimated. PMID:23964754

  14. Study on process basic requirements of experimental facility of advanced spent fuel management process

    International Nuclear Information System (INIS)

    The advanced spent fuel management process, which was proposed to reduce the overall volume of the PWR spent fuel and improve safety and economy of the long-term storage of spent fuel, is under research and development. Hot cell facilities of α-γ type and inert atmosphere are required essentially for safe hot test and verification of this process. In this study, design basic data are established, and these data include process flow, process condition and yields, mass and radioactivity balance of radionuclides, process safety considerations, etc. And also, these data will be utilized for basic and detail design of hot cell facility, secured conservative safety and effective operability

  15. Treatment of Lymphedema with Saam Acupuncture in Patients with Breast Cancer: A Pilot Study

    OpenAIRE

    Jeong, Young Ju; Kwon, Hyo Jung; Park, Young Sun; Kwon, Oh Chang; Shin, Im Hee; Park, Sung Hwan

    2015-01-01

    Background: Lymphedema is a troublesome complication affecting quality of life (QoL) in many women after breast-cancer treatment. Recent studies have suggested that acupuncture can reduce symptoms of lymphedema in breast-cancer survivors.

  16. RISK FACTORS FOR DEVELOPMENT OF LYMPHEDEMA FOLLOWING BREAST CANCER TREATMENT : A RETROSPECTIVE STUDY

    OpenAIRE

    Mr. Madhusudan; Ashwin Hebbar; Sunil; Mohammed

    2015-01-01

    OBJECTIVES: The aim and objective of this study is to identify the factors associated with secondary lymphedema after breast cancer treatment. BACKGROUND : Lymphedema of the arm is a complication of breast cancer treatment that affects 2 - 40% of breast cancer survivors. The pathophysiology of lymphedema following breast cancer treatment is poorly understood, probably suggesting a multifactor nature. As the breast cancer survival rate increases, lymphedema wil...

  17. Lymphedema after Breast and Gynecological Cancer – a Frequent, Chronic, Disabling Condition in Cancer Survivors

    OpenAIRE

    Tanja Planinšeg Ručigaj; Vesna Tlaker Žunter

    2015-01-01

    ABSTRACT The goal of our study was to determine clinical characteristics of women cancer survivors treated for secondary lymphedema, the time from cancer treatment to the development of lymphedema, and the effect of therapy on reduction of lymphedema and occurrence of erysipelas.We performed a retrospective study of women with secondary lymphedema after breast cancer (BR) and gynecological (cervical, uterine, ovarian, vulvar) cancers (GYN) treated at our Department from 2004 to 2010.The avera...

  18. Complex Decongestive Physiotherapy Treats Skin Changes like Hyperkeratosis Caused by Lymphedema

    OpenAIRE

    Hande Kaba; Yesim Bakar; Özlem Çinar Özdemir; Seda Sertel

    2012-01-01

    Lymphedema is a chronic, progressive, and often debilitating condition. Primary lymphedema is a lymphatic malformation developing during the later stage of lymph angiogenesis. Secondary lymphedema is the result of obstruction or disruption of the lymphatic system, which can occur as a consequence of tumors, surgery, trauma, infection, inflammation, and radiation therapy. Here, we report a 64-year-old woman presenting with hyperkeratosis, a lymphedema due to metastatic uterus carcinoma. In thi...

  19. Chronic Lymphedema of Filarial Origin: A Very Rare Etiology of Cutaneous Lymphangiosarcoma

    OpenAIRE

    Agale, Shubhangi V.; Wasif Ali ZA Khan; Karishma Chawlani

    2013-01-01

    Lymphedema-associated angiosarcoma also known as lymphangiosarcoma is the commonest type of cutaneous angiosarcoma. Post-mastectomy lymphedema is the most frequent cause, while chronic filarial lymphedema is one of the most uncommon etiology for development of lymphangiosarcoma. We report a case of a 50 year old male suffering from chronic filarial lymphedema of right lower extremity, presented with brownish nodules on the right leg, which were diagnosed histopathologically as lymphangiosarcoma.

  20. Managing complex, high risk projects a guide to basic and advanced project management

    CERN Document Server

    Marle, Franck

    2016-01-01

    Maximizing reader insights into project management and handling complexity-driven risks, this book explores propagation effects, non-linear consequences, loops, and the emergence of positive properties that may occur over the course of a project. This book presents an introduction to project management and analysis of traditional project management approaches and their limits regarding complexity. It also includes overviews of recent research works about project complexity modelling and management as well as project complexity-driven issues. Moreover, the authors propose their own new approaches, new methodologies and new tools which may be used by project managers and/or researchers and/or students in the management of their projects. These new elements include project complexity definitions and frameworks, multi-criteria approaches for project complexity measurement, advanced methodologies for project management (propagation studies to anticipate potential behaviour of the project, and clustering approaches...

  1. Kinesiology Taping reduces lymphedema of the upper extremity in women after breast cancer treatment: a pilot study

    OpenAIRE

    Iwona Malicka; Agnieszka Rosseger; Justyna Hanuszkiewicz; Marek Woźniewski

    2014-01-01

    Introduction : Secondary lymphedema affects approximately 40% of women treated for breast cancer and is recognized as a major problem associated with the therapy of malignant tumors. Consequently, new therapeutic methods are constantly being sought to effectively eliminate the condition. One of the new forms of edema management, especially in the initial stages of edematous development, is Kinesiology Taping (KT). Aim of the study : The aim of the study was to assess the effects of KT ap...

  2. Factors Associated With External and Internal Lymphedema in Patients With Head-and-Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Deng Jie, E-mail: jie.deng@vanderbilt.edu [School of Nursing, Vanderbilt University, Nashville, Tennessee (United States); Ridner, Sheila H. [School of Nursing, Vanderbilt University, Nashville, Tennessee (United States); Vanderbilt-Ingram Cancer Center, Nashville, Tennessee (United States); Dietrich, Mary S. [School of Nursing, Vanderbilt University, Nashville, Tennessee (United States); Vanderbilt-Ingram Cancer Center, Nashville, Tennessee (United States); Department of Biostatistics, School of Medicine, Vanderbilt University, Nashville, Tennessee (United States); Wells, Nancy; Wallston, Kenneth A. [School of Nursing, Vanderbilt University, Nashville, Tennessee (United States); Sinard, Robert J.; Cmelak, Anthony J.; Murphy, Barbara A. [Vanderbilt-Ingram Cancer Center, Nashville, Tennessee (United States)

    2012-11-01

    Purpose: The purpose of this study was to examine factors associated with the presence of secondary external and internal lymphedema in patients with head-and-neck cancer (HNC). Methods and Materials: The sample included 81 patients {>=}3 months after HNC treatment. Physical and endoscopic examinations were conducted to determine if participants had external, internal, and/or combined head-and-neck lymphedema. Logistic regression analysis was used to examine the factors associated with the presence of lymphedema. Results: The following factors were statistically significantly associated with presence of lymphedema: (1) location of tumor associated with presence of external (P=.009) and combined lymphedema (P=.032); (2) time since end of HNC treatment associated with presence of external (P=.004) and combined lymphedema (P=.005); (3) total dosage of radiation therapy (P=.010) and days of radiation (P=.017) associated with the presence of combined lymphedema; (4) radiation status of surgical bed was associated with the presence of internal lymphedema, including surgery with postoperative radiation (P=.030) and (salvage) surgery in the irradiated field (P=.008); and (5) number of treatment modalities associated with external (P=.002), internal (P=.039), and combined lymphedema (P=.004). No demographic, health behavior-related, or comorbidity factors were associated with the presence of lymphedema in the sample. Conclusions: Select tumor and treatment parameters are associated with increased occurrence of lymphedema in patients with HNC. Larger and longitudinal studies are needed to identify adjusted effects and causative risk factors contributing to the development of lymphedema in patients with HNC.

  3. A Basic Strategy to Manage Global Health with Reference to Livestock Production in Asia

    Directory of Open Access Journals (Sweden)

    David C. Hall

    2011-01-01

    Full Text Available Newly emerging infectious diseases (nEIDs have increased rapidly presenting alarming challenges to global health. We argue that for effective management of global health a basic strategy should include at least three essential tactical forms: actions of a directly focused nature, institutional coordination, and disciplinary integration in approaches to health management. Each level of action is illustrated with examples from the livestock sector in Asia. No clear example of all three tactical forms in place can be found from developing countries where food security is a significant threat although Vietnam is developing a comprehensive strategy. Finally, an ecosystem health approach to global health management is advocated; such an approach moves away from the traditional single disciplinary approach. Stronger guidance is needed to direct ecohealth research and application in the management of global health.

  4. The impact of early detection and intervention of breast cancer-related lymphedema: a systematic review.

    Science.gov (United States)

    Shah, Chirag; Arthur, Douglas W; Wazer, David; Khan, Atif; Ridner, Sheila; Vicini, Frank

    2016-06-01

    Breast cancer-related lymphedema (BCRL) has become an increasingly important clinical issue as noted by the recent update of the 2015 NCCN breast cancer guidelines which recommends to "educate, monitor, and refer for lymphedema management." The purpose of this review was to examine the literature regarding early detection and management of BCRL in order to (1) better characterize the benefit of proactive surveillance and intervention, (2) clarify the optimal monitoring techniques, and (3) help better define patient groups most likely to benefit from surveillance programs. A Medline search was conducted for the years 1992-2015 to identify articles addressing early detection and management of BCRL. After an initial search, 127 articles were identified, with 13 of these studies focused on early intervention (three randomized (level of evidence 1), four prospective (level of evidence 2-3), six retrospective trials (level of evidence 4)). Data from two, small (n = 185 cases), randomized trials with limited follow-up demonstrated a benefit to early intervention (physiotherapy, manual lymphatic drainage) with regard to reducing the rate of chronic BCRL (>50% reduction) with two additional studies underway (n = 1280). These findings were confirmed by larger prospective and retrospective series. Several studies were identified that demonstrate that newer diagnostic modalities (bioimpedance spectroscopy, perometry) have increased sensitivity allowing for the earlier detection of BCRL. Current data support the development of surveillance programs geared toward the early detection and management of BCRL in part due to newer, more sensitive diagnostic modalities. PMID:26993371

  5. Providing Basic Needs and Encouragement as Strategies in Managing Aggression in Dementia Clients

    Directory of Open Access Journals (Sweden)

    Retno Lestari

    2014-01-01

    Full Text Available Purpose: The experiences of caregivers in managing dementia clients with aggressive behaviour have been an issue in nursing homes. This study utilized the fact that there is no significant strategy for managing aggression effectively. The aim of the study is to explore the experiences of caregivers in managing dementia clients with aggressive behaviour in nursing home in Jakarta, Indonesia.Method: This study employed a hermeneutic phenomenological approach so that caregivers were able to explore the phenomenon of aggression by dementia residents in the nursing home. Six experienced caregivers were interviewed in this study to uncover caregivers’ strategies they use in managing aggression in dementia residents.Result: The findings in this study were several strategies that have been used by caregivers to manage aggressive behaviour among dementia residents in the nursing home: providing basic needs and encouragement.Conclusion: The findings suggested caregivers to implement the strategies for managing aggression in dementia residents. Due to a limited number of related studies in Indonesia, this study recommended for further research to other nursing homes in Indonesia to determine if other strategies to manage aggression exist.

  6. Pediatric lymphedema caused by diffuse cervical lymphadenopathy: A case report and review of the literature.

    Science.gov (United States)

    Gitomer, Sarah A; Giannoni, Carla M; Cañadas, Karina T

    2016-08-01

    Pediatric head and neck lymphedema is rare and there have not been any reported cases in children. Here we discuss severe, diffuse head and neck lymphedema in a child caused by compression of the internal jugular veins by lymphadenopathy from Kawasaki's disease. With steroid and intravenous immunoglobulin treatment, the lymphadenopathy improved and facial edema slowly resolved. In review of the literature, complications of head and neck lymphedema including airway obstruction and blindness are discussed. This case highlights the importance of the pediatric otolaryngologist considering lymphedema as a cause for facial swelling and monitoring for complications of lymphedema. PMID:27368445

  7. Complex Decongestive Physiotherapy Treats Skin Changes like Hyperkeratosis Caused by Lymphedema

    Directory of Open Access Journals (Sweden)

    Hande Kaba

    2012-01-01

    Full Text Available Lymphedema is a chronic, progressive, and often debilitating condition. Primary lymphedema is a lymphatic malformation developing during the later stage of lymph angiogenesis. Secondary lymphedema is the result of obstruction or disruption of the lymphatic system, which can occur as a consequence of tumors, surgery, trauma, infection, inflammation, and radiation therapy. Here, we report a 64-year-old woman presenting with hyperkeratosis, a lymphedema due to metastatic uterus carcinoma. In this paper, we present the effects of complex decongestive physiotherapy on lymphedema and hyperkeratosis.

  8. An Agent-Based Approach for Evaluating Basic Design Options of Management Accounting Systems

    Directory of Open Access Journals (Sweden)

    Friederike Wall

    2013-12-01

    Full Text Available This paper investigates the effectiveness of reducing errors in management accounting systems with respect to organizational performance. In particular, different basic design options of management accounting systems of how to improve the information base by measurements of actual values are analyzed in different organizational contexts. The paper applies an agent-based simulation based on the idea of NK fitness landscapes. The results provide broad, but no universal support for conventional wisdom that lower inaccuracies of accounting information lead to more effective adaptation processes. Furthermore, results indicate that the effectiveness of improving the management accounting system subtly interferes with the complexity of the interactions within the organization and the coordination mode applied

  9. Lymphedema-related angiogenic tumors and other malignancies.

    Science.gov (United States)

    Lee, Robert; Saardi, Karl M; Schwartz, Robert A

    2014-01-01

    Chronic lymphedema has a permissive effect with certain types of malignancies, particularly angiosarcomas, in what is known as Stewart-Treves syndrome. The presumed mechanism of this effect is an immunocompromised district of the affected area. Most other cutaneous malignancies have also been described in lymphedematous areas, including basal cell carcinoma, squamous cell carcinoma, melanoma, Kaposi sarcoma, Merkel cell carcinoma, and several cutaneous lymphomas. The occurrence of such malignancies suggests a more general immunosuppression within the skin. The formation of collateral lymphatic and vascular vessels in response to lymphedema produces an environment rich in growth factors, which may also play a role. In addition to infection and other general skin care issues, regions affected by lymphedema should be monitored for malignant changes not limited to angiosarcomas. PMID:25160102

  10. Inter-Changeability of Impedance Devices for Lymphedema Assessment.

    Science.gov (United States)

    van Zanten, Malou; Piller, Neil; Ward, Leigh C

    2016-06-01

    Impedance technology is a popular technique for the early detection of lymphedema. The preferred approach is to use bioimpedance spectroscopy (BIS), with measurements being made with the subject lying supine, although attempts have been made to use single or multiple frequency impedance measurements obtained while the subject is standing. The aim of the present study was to determine the equivalence of these different approaches. Impedance measurements of the individual limbs of 37 healthy individuals were determined using both a stand-on, multi-frequency impedance device and a supine impedance spectroscopy instrument. Significant differences were found between the instruments in both absolute impedance values and, importantly, inter-limb impedance ratios. Since impedance ratios in healthy individuals provide the reference standard for detection of lymphedema, these data indicate that the methods are not interchangeable. Consideration of the errors associated with each method indicates that the BIS remains the preferred method for lymphedema detection. PMID:26574711

  11. Barcelona Lymphedema Algorithm for Surgical Treatment in Breast Cancer-Related Lymphedema.

    Science.gov (United States)

    Masià, Jaume; Pons, Gemma; Rodríguez-Bauzà, Elena

    2016-06-01

    Background Breast cancer-related lymphedema is a prevalent condition that has a major impact on quality of life. Surgical treatment has become an alternative to help affected patients with good results. However, there is no consensus on surgical procedure and protocol. Methods We analyzed our data in two periods: from June 2007 to December 2011 and from January 2012 to June 2014. Data included the analysis of the limb circumferences and the subjective symptoms felt by patients. Results Of the 200 patients treated in the study, 81 had lymphaticovenous anastomosis, 7 had autologous lymph node transfer, 16 had total breast anatomy restoration, 52 had vibroliposuction, and 44 had combined reconstructive procedures. In the first period, the circumference of the superior limb showed a decrease of 0.9 to 6.1 cm (average 2.75 cm). In the second period, the circumference of the superior limb showed a decrease of 2.9 to 6.1 cm (average 3.85 cm). Clinical results and data from the questionnaires confirmed the improvement and subjective benefits. Conclusion We have obtained considerable improvements in results of limb circumferences and subjective symptoms after incorporating several modifications into our surgical strategy for lymphedema treatment. A detailed preoperative assessment should be performed to determine whether reconstructive surgery or palliative surgery is indicated. PMID:26975564

  12. Transnodal Lymphangiography in the Diagnosis and Treatment of Genital Lymphedema

    Energy Technology Data Exchange (ETDEWEB)

    Gomez, F. M., E-mail: gomez_fermun@gva.es; Martinez-Rodrigo, J.; Marti-Bonmati, L. [Hospital Universitario y Politecnico La Fe, Servicio de Radiologia (Spain); Santos, E. [University of Pittsburgh, Department of Radiology (United States); Forner, I. [Hospital Universitario y Politecnico La Fe, Servicio de Medicina Fisica y Rehabilitacion (Spain); Lloret, M.; Perez-Enguix, D.; Garcia-Marcos, R. [Hospital Universitario y Politecnico La Fe, Servicio de Radiologia (Spain)

    2012-12-15

    Purpose: To report the success of groin nodal lymphography in the diagnosis and treatment of genital lymphedema. Methods and Materials: We present one female (8 years old [patient no. 1]) and two male (69 and [patient no. 2] 31 years old [patient no. 3], respectively) patients with genital lymphedema in whom conservative treatment failed. The girl also had lymphorrhagia. Genital lymphedema was caused by radical cystectomy (patient no. 2), lymphatic hyperplasia (patient no. 1), and idiopathic lymphangitis (patient no. 3). All of them underwent ultrasound-guided bilateral groin lymph node puncture. Afterward, 4-8 ml Lipiodol Ultra-Fluide (Guerbet) were injected at a rate of 0.2 ml/s. Lipiodol progression was assessed by fluoroscopy. Computed tomography scan of the abdomen and pelvis was performed immediately after and again at 24 h after the procedure to confirm the leak. The follow-up period was 15, 13, and 9 months, respectively. Technical success was considered as bilateral pelvic and abdominal filling of lymphatic vessels. Therapeutic success was considered as improvement or disappearance of genital lymphedema and/or lymphorrhagia. Results: Lipiodol leak to the scrotum was observed in patients no. 2 and 3. Lymphaticopelvic fistula and genital lymphatic hyperplasia were seen in patient no. 1. Genital lymphedema diminished within 1 week and almost disappeared in two cases (patients no. 1 and 3) or significantly improved (patient no. 2). lymphorrhagia also resolved in patient no. 1. No recurrence or worsening was detected during follow-up. Conclusion: Therapeutic lymphangiography by lymph node injection seems to be effective to treat genital lymphedema. Lymph node puncture lymphangiography is feasible and less cumbersome than pedal lymphangiography.

  13. Lymphedema surgery: Patient selection and an overview of surgical techniques.

    Science.gov (United States)

    Allen, Robert J; Cheng, Ming-Huei

    2016-06-01

    Evaluation of the lymphedema patients with appropriate staging is fundamental for further treatment. Treatment includes compressive decongestive therapy for stage 0 and 1 patients, lymphovenous anastomosis for stage 1 and 2 patients, vascularized lymph node transfer for stage 2 and above patients. Wedge resection, liposuction, and the Charles procedure are alternatives or additions to physiological procedures. The selection of donor lymph node flap and recipient site depends on the patient's lymphedema status and surgeon's expertise. J. Surg. Oncol. 2016;113:923-931. © 2016 Wiley Periodicals, Inc. PMID:26846615

  14. Angiosarcoma in a patient with congenital nonhereditary lymphedema.

    Science.gov (United States)

    Shon, Wonwoo; Wada, David A; Folpe, Andrew L; Pittelkow, Mark R

    2012-11-01

    Angiosarcoma is an uncommon but aggressive tumor of endothelial origin that may occur in the upper extremities of patients with postmastectomy lymphedema (Stewart-Treves syndrome) as well as in other regions. We present an unusual case of angiosarcoma associated with congenital nonhereditary lymphedema in an 18-year-old man. Our case underscores the need for a careful clinical examination and shows the importance of appropriate sampling and thorough pathologic examination of suspicious areas to exclude the presence of a malignant process. PMID:23270196

  15. Treatment of lymphedema praecox through low level laser therapy (LLLT

    Directory of Open Access Journals (Sweden)

    Manoochehr Mahram

    2011-01-01

    Full Text Available A 15-year-old girl with right lower extremity lymphedema praecox was treated through Low Level Laser Therapy (LLLT, by means of a GaAs and GaAlAs diodes laser-therapy device. Treatment sessions were totally 24, each cycle containing 12 every other day 15-minute sessions, and one month free between the cycles. The treatment was achieved to decrease the edema and no significant increase in circumference of involved leg was found following three months after the course of treatment. Although LLLT can be considered a beneficial treatment for Lymphedema Praecox, any definite statement around its effectiveness needs more studies on more cases.

  16. Role of physiotherapy and patient education in lymphedema control following breast cancer surgery

    Directory of Open Access Journals (Sweden)

    Lu SR

    2015-02-01

    Full Text Available Shiang-Ru Lu,1 Rong-Bin Hong,2 Willy Chou,3,4 Pei-Chi Hsiao3,4 1Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 2Departments of Physical Medicine and Rehabilitation, Chi-Mei Medical Center Liouying Campus, Tainan, Taiwan; 3Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Tainan, Taiwan; 4Department of Recreation and Health Care Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan Introduction: This retrospective cohort study evaluated whether education in combination with physiotherapy can reduce the risk of breast cancer-related lymphedema (BCRL. Methods: We analyzed 1,217 women diagnosed with unilateral breast cancer between January 2007 and December 2011 who underwent tumor resection and axillary lymph node dissection. The patients were divided into three groups: Group A (n=415, who received neither education nor physiotherapy postsurgery; Group B (n=672, who received an educational program on BCRL between Days 0 and 7 postsurgery; and Group C (n=130, who received an educational program on BCRL between Days 0 and 7 postsurgery, followed by a physiotherapy program. All patients were monitored until October 2013 to determine whether BCRL developed. BCRL risk factors were evaluated using Cox proportional hazards models. Results: During the follow-up, 188 patients (15.4% developed lymphedema, including 77 (18.6% in Group A, 101 (15.0% in Group B, and 10 (7.7% in Group C (P=0.010. The median period from surgery to lymphedema was 0.54 years (interquartile range =0.18–1.78. The independent risk factors for BCRL included positive axillary lymph node invasion, a higher (>20 number of dissected axillary lymph nodes, and having undergone radiation therapy, whereas receiving an educational program followed by physiotherapy was a protective factor against BCRL (hazard ratio =0.35, 95% confidence interval =0.18–0.67, P=0.002. Conclusion: Patient education that begins

  17. Fourth annual workshop on management in basic and applied research environments

    Energy Technology Data Exchange (ETDEWEB)

    Bodnarczuk, M.W. [ed.

    1993-11-01

    The struggle to develop quality management concepts that ``map`` onto the cultural and work practices found in basic and applied research environments has been (for better or for worse) an attempt to differentiate basic and applied research from the nuclear industry. In the first (1990) edition of this ``Music Book`` proceedings, almost every laboratory that participated had a quality program that was traceable to, based on, influenced by, or in reaction to the nuclear quality standard ASME-NQA-1. This 1993 edition of the ``Music Book`` is very different in that almost every laboratory has developed a quality program that is based on, traceable to, or heavily influenced by DOE 5700.6C (Quality Assurance) and the DOE Standard; Implementation Guide for Quality Assurance Programs for Basic and Applied Research (DOE-ER-STD-6001-92). In order to construct a context for what follows and properly introduce the contents of this book, we want to briefly recount some of the highlights of the events that brought about this change, from the perspective of one who participated in the process.

  18. Climate Risk Management in the Anthropocene: From Basic Science to Decisionmaking and Back.

    Science.gov (United States)

    Keller, K.

    2014-12-01

    Burning fossil fuels imposes a complex mixture of benefits and risks on current and future generations. While enabling a tremendous growth in prosperity, the resulting greenhouse gas emissions also drive risks associated with anthropogenic climate change. Managing climate risks has already motivated local, national, and global actions: utilities replace coal-fired power plants with gas turbines, engineers design sea-walls for future climates, companies sequester carbon dioxide into geological reservoirs, and federally as well as privately funded research projects analyze potential geoengineering approaches. These actions raise the question: what are sustainable, scientifically sound, technologically feasible, economically efficient, and ethically defensible climate-risk management strategies? This presentation reviews current and suggests improved approaches to designing and analyzing climate risk management strategies. Choosing a strategy involves complex trade-offs across diverse objectives and risk management instruments. In addition, this problem is imbued with deep uncertainty, where decisionmakers disagree about the appropriate problem framing, model structure, parameter values, and objectives. Neglecting this deep uncertainty can lead to considerable biases in risk assessments. Furthermore, deep uncertainty can render the typically applied model of expected utility maximization a poor description of actual decisionmakers' preferences. Applying a robust decisionmaking framework can improve decision support, identify mission-critical basic science questions, simplify the integration of new scientific findings, and provide avenues to analyze coupled epistemic-ethical questions.

  19. Balancing Lymphedema Risk: Exercise Versus Deconditioning for Breast Cancer Survivors

    OpenAIRE

    Schmitz, Kathryn H.

    2010-01-01

    Lymphedema, a common and feared negative effect of breast cancer treatment, is generally described by arm swelling and dysfunction. Risk averse clinical recommendations guided survivors to avoid use of the affected arm. This may lead to deconditioning and, ironically, the very outcome women seek to avoid. Recently published studies run counter to these guidelines.

  20. MR imaging of primary, secondary, and mixed forms of lymphedema

    Energy Technology Data Exchange (ETDEWEB)

    Aastroem, K.G.O.; Abdsaleh, S.; Ahlstroem, K.H. [Univ. Hospital, Uppsala (Sweden). Dept. of Radiology; Brenning, G.C. [Univ. Hospital, Uppsala (Sweden). Dept. of Internal Medicine

    2001-03-01

    Purpose: To describe the pathological features and assess the diagnostic information of different MR sequences in patients with primary, secondary, and mixed (phlebo-, lipophlebo-, or lipolymphedema) forms of lymphedema of the lower leg. Material and Methods: In 26 patients with clinical diagnoses of primary (n=10), pure secondary (n=4), mixed (n=9) and combined secondary and mixed forms of lymphedema (n=3), MR imaging was performed with coronal and axial T1 SE, T2 TSE, fat-suppressed (SPIR) T2 sequences and axial T1 SE after i.v. injection of Gd-DTPA. Results: In 24 patients there was a honeycomb pattern in the subcutis with a signal intensity corresponding to fluid (n=11), fibrosis (n=3), or both (n=10). Five patients with primary lymphedema showed subfascial fluid accumulation. Dermal edema was noted in 23 patients. Fat or edema components in the muscles were mostly seen in patients with phlebolymphedema. The honeycomb pattern was best seen on coronal T1 images, and fluid accumulations on axial SPIR-T2 images. Fibrosis was only assessable from the T2 TSE sequence. Gd-DTPA did not improve the diagnostic information. Conclusion: For evaluation of lymphedema and its mixed forms, an axial T2-weighted SPIR sequence in conjunction with a coronal T1 SE sequence are sufficient.

  1. Massive localized lymphedema: A case series and literature review

    OpenAIRE

    Evans, Robin James; Scilley, Chris

    2011-01-01

    Massive localized lymphedema (MLL) has received very little attention in the literature, mainly because it is misdiagnosed as well-differentiated liposarcoma. MLL is painless and often malignant, and usually presents in morbidly obese patients. Two cases of MLL are discussed in this article – both in women who weighed more than 200 kg – to assist physicians in decision making.

  2. Breast Cancer-Related Lymphedema: Implications for Family Leisure Participation

    Science.gov (United States)

    Radina, M. Elise

    2009-01-01

    An estimated 20% of breast cancer survivors face the chronic condition of breast cancer-related lymphedema. This study explored the ways in which women with this condition experienced changes in their participation in family leisure as one indicator of family functioning. Participants (N = 27) were interviewed regarding lifestyles before and after…

  3. Bridging the divide between pathogenesis and detection in lymphedema.

    Science.gov (United States)

    Dixon, J Brandon; Weiler, Michael J

    2015-02-01

    While our understanding of the lymphatic system has improved substantially in the past few decades, the translation of this knowledge into improved healthcare solutions for patients suffering from secondary lymphedema has been severely limited. The challenge facing clinicians is two-fold. First, there is no reliable, affordable, diagnostic capable of detecting the disease before symptoms of the lymphedema develop and the efficacy of treatment options becomes limited. Second, our understanding of the disease pathogenesis, its risk factors, and the underlying physiologic mechanisms is still in its infancy. These two challenges go hand in hand as limited diagnostic options have hindered our ability to understand lymphedema progression, and the lack of known underlying mechanisms involved in the disease prohibits the development of new diagnostic targets. This review serves to discuss the recent developments in clinical and lab research settings of both lymphedema diagnostic technologies and our understanding of the mechanisms driving disease risk and progression. We will show how these two lines of research are synergistically working with the ultimate goal of improving patient outcomes for those suffering from this horrible disease, identifying key areas of further research that are warranted to move the field forward and provide clinical relief for this neglected patient population.

  4. Waste management plan for pipeline construction works: basic guideline for its preparation

    Energy Technology Data Exchange (ETDEWEB)

    Serricchio, Claudio; Caldas, Flaviana V. [Petroleo Brasileiro S.A. (PETROBRAS), Rio de Janeiro, RJ (Brazil); Souza, Izabel C.A. de; Araujo, Ronaldo G. de [TELSAN, Rio de Janeiro, RJ (Brazil); Souza, Tania Mara [IMC-SASTE, Sao Paulo,SP (Brazil); Veronez, Fernanda A. [Bourscheid, Porto Alegre, RS (Brazil)

    2009-07-01

    During the stage of implementation of the land pipes enterprise, one of the main environmental aspects to be considered was the creation of solid and liquid waste. To mitigate the possible impacts to the environment, the main adopted mitigate measure was the implementation of a Waste Management Plan - WMP. Thus, the management of waste from pipes construction has the challenge of a great variety of stages and phases for the implementation of pipes and the diversity of local situations related to the topographic and hydro-geologic conditions. Considering the peculiarity of the pipes activities, this article proposes the elaboration of a Basic Guide to be used as reference for the creation of WMP's for similar enterprises, using as foundation the data from the three Gas Pipelines: Cabiunas - Vitoria; Vitoria - Cacimbas and Cacimbas - Catu. After the analysis of the three mentioned enterprises, it was verified that the waste management generated on the building and assembling of the land pipes normally occurs in accord with previous planning, but there's no systematization for the waste to be better recycled and reutilized, thus mitigating their creation. (author)

  5. The Basic Framework for Robot Applicability Enhancement of Nuclear Risk Management in Nuclear Power Plants

    International Nuclear Information System (INIS)

    Beyond-design-basis external events such as the one having occurred at the Fukushima Daiichi Nuclear Power Plant typically pose considerable challenges to the plant personnel because of the harsh environments caused by the events (e.g., extreme terrains, high radiation, radioactive rubbles, high heat, and explosive environment). Therefore, remote response techniques by use of robotic systems are needed to help the plant personnel cope with the extreme events. In this study the basic framework for enhancing robotic applicability to disaster management was developed using the analytic technique of Master Logic Diagram (MLD) and Goal-Tree Success-Tree (GTST). The users of robots have to devise a sound maintenance program, otherwise their unscheduled downtime may increase beyond limit, consequently defeating the purpose of robot applications. In addition, maintainability could be enhanced by designing for ease of diagnosis, and ease of access and repair. Ways to upgrade maintainability could be devised by evaluating maintainability in the design stage. The basic framework discussed herein shall be used by the KAERI's robotics team as a fundamental framework in enhancing the applicability of disaster robots in the hazardous environment caused by extreme events.

  6. The Basic Framework for Robot Applicability Enhancement of Nuclear Risk Management in Nuclear Power Plants

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Young; Jeong, Kungmin [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of); Kim, Inn Seock [bISSA Technology, Inc., Germantown (United States)

    2015-05-15

    Beyond-design-basis external events such as the one having occurred at the Fukushima Daiichi Nuclear Power Plant typically pose considerable challenges to the plant personnel because of the harsh environments caused by the events (e.g., extreme terrains, high radiation, radioactive rubbles, high heat, and explosive environment). Therefore, remote response techniques by use of robotic systems are needed to help the plant personnel cope with the extreme events. In this study the basic framework for enhancing robotic applicability to disaster management was developed using the analytic technique of Master Logic Diagram (MLD) and Goal-Tree Success-Tree (GTST). The users of robots have to devise a sound maintenance program, otherwise their unscheduled downtime may increase beyond limit, consequently defeating the purpose of robot applications. In addition, maintainability could be enhanced by designing for ease of diagnosis, and ease of access and repair. Ways to upgrade maintainability could be devised by evaluating maintainability in the design stage. The basic framework discussed herein shall be used by the KAERI's robotics team as a fundamental framework in enhancing the applicability of disaster robots in the hazardous environment caused by extreme events.

  7. Vascularized Free Lymph Node Flap Transfer in Advanced Lymphedema Patient after Axillary Lymph Node Dissection

    OpenAIRE

    Cook, Kyung Hoon; Park, Myong Chul; Lee, Il Jae; Lim, Seong Yoon; Jung, Yong Sik

    2016-01-01

    Lymphedema is a condition characterized by tissue swelling caused by localized fluid retention. Advanced lymphedema is characterized by irreversible skin fibrosis (stage IIIb) and nonpitting edema, with leather-like skin, skin crypts, and ulcers with or without involvement of the toes (stage IVa and IVb, respectively). Recently, surgical treatment of advanced lymphedema has been a challenging reconstructive modality. Microvascular techniques such as lymphaticovenous anastomosis and vasculariz...

  8. Liposuction Normalizes - in Contrast to Other Therapies - Lymphedema-Induced Adipose Tissue Hypertrophy

    OpenAIRE

    Brorson, Håkan

    2012-01-01

    The various types of treatment of lymphedema are under discussion and there has been some controversy regarding liposuction for lymphedema. Although it is clear that conservative therapies such as complex decongestive therapy (CDT) and controlled compression therapy (CCT) should be tried in the first instance, options for the treatment of late-stage lymphedema that is not responding to such treatment is not so clear. Improvements in technique, patient preparation, and patient follow-up have l...

  9. Prevalence and risk factors for development of lymphedema following breast cancer treatment

    OpenAIRE

    Deo S; Ray S; Rath G; Shukla N; Kar M; Asthana S; Raina V

    2004-01-01

    BACKGROUND : Early detection and multimodality therapy has resulted in an overall improvement of survival among breast cancer patients. Despite a significant shift in the treatment approach from radical mastectomy to breast conservation a significant number of patients develop lymphedema. This study was conducted to evaluate the prevalence and risk factors for development of lymphedema. SETTINGS AND DESIGN : Retrospective analysis for prevalence of lymphedema in a tertiary care regional cance...

  10. Godoy & Godoy technique in the treatment of lymphedema for under-privileged populations

    Directory of Open Access Journals (Sweden)

    José Maria Pereira de Godoy, Maria de Fátima Guerreiro de Godoy

    2010-01-01

    Full Text Available The aim of this paper is to report new options in the treatment of lymphedema for under-privileged populations. Several articles and books have been published reporting recent advances and contributions. A new technique of manual lymph drainage, mechanisms of compression, development of active and passive exercising apparatuses and the adaptation of myolymphokinetic activities have been developed for the treatment of lymphedema. This novel approach can be adapted for the treatment of lymphedema in mass.

  11. Study of Incidence of Lymphedema in Indian Patients Undergoing Axillary Dissection for Breast Cancer

    OpenAIRE

    Pillai, Pramod R.; Sharma, Shekhar; Ahmed, Sheikh Zahoor; Vijaykumar, D. K.

    2010-01-01

    Lymphedema of the upper extremity, in addition to being unsightly, can be painful, can limit the arm movements, increases the risk of infection and is psychologically distressing, serving as a constant reminder of cancer. 1. To ascertain the incidence of lymphedema in a hospital based population (in patients undergoing axillary dissection for breast cancer. 2. To determine the clinico-epidemilogical factors associated with the occurrence of lymphedema in these patients. For all patients under...

  12. Concise review on the safety of exercise on symptoms of lymphedema

    OpenAIRE

    Morris, Casie; Wonders, Karen Y.

    2015-01-01

    Lymphedema is an atypical accumulation of high-protein fluid located just beneath the skin, which often occurs in the arm or leg. Exercising with lymphedema was traditionally considered to be unsafe. However, recent research indicates that exercise may be beneficial to individuals with lymphedema. Studies indicate that exercise can improve the range of motion and strength of the afflicted limb(s), as well as overall fitness and functional quality of life, and can be performed without exacerba...

  13. L-Dex Ratio in Detecting Breast Cancer-Related Lymphedema: Reliability, Sensitivity, and Specificity

    OpenAIRE

    Mei R. Fu; Cleland, Charles M.; Guth, Amber A.; Kayal, Maia; Haber, Judith; Cartwright, Francis; Kleinman, Robin; Kang, Yang; Scagliola, Joan; Axelrod, Deborah

    2013-01-01

    Advances in bioelectrical impedance analysis (BIA) permit the assessment of lymphedema by directly measuring lymph fluid changes. The purpose of the study was to examine the reliability, sensitivity, and specificity of cross-sectional assessment of BIA in detecting lymphedema in a large metropolitan clinical setting. BIA was used to measure lymph fluid changes. Limb volume by sequential circumferential tape measurement was used to validate the presence of lymphedema. Data were collected from ...

  14. Prevalence and risk factors for development of lymphedema following breast cancer treatment

    International Nuclear Information System (INIS)

    BACKGROUND: Early detection and multimodality therapy has resulted in an overall improvement of survival among breast cancer patients. Despite a significant shift in the treatment approach from radical mastectomy to breast conservation a significant number of patients develop lymphedema. This study was conducted to evaluate the prevalence and risk factors for development of lymphedema. SETTINGS AND DESIGN: Retrospective analysis for prevalence of lymphedema in a tertiary care regional cancer centre. MATERIAL AND METHODS: Three hundred treated breast cancer patients with a minimum follow up of one year were evaluated for the prevalence and risk factors for lymphedema. Lymphedema was assessed using a serial circumferential measurement method. More than 3 cm difference in circumference is considered as clinical significant lymphedema. Univariate and multivariate analysis were performed for evaluating the risk factors by using the Chi square test and Cox logistic regression analysis. RESULTS: The prevalence of clinically significant lymphedema was 33.5 % and 17.2 % had severe lymphedema. The prevalence of lymphedema was 13.4 % in patients treated with surgery only where as the prevalence was 42.4% in patients treated with surgery and radiotherapy. Stage of the disease, body surface area> 1.5 m2, presence of co-morbid conditions, post operative radiotherapy and anthracycline based chemotherapy were significant risk factors in univariate analysis where as axillary irradiation and presence of co-morbid conditions have emerged as independent risk factors in multivariate analysis (P < 0.001). CONCLUSION: Post treatment lymphedema continues to be a significant problem following breast cancer therapy. Presence of co-morbid conditions and axillary radiation significantly increases the risk of lymphedema. A combination of axillary dissection and axillary radiation should be avoided whenever feasible to avoid lymphedema. (author)

  15. Factors Associated With External and Internal Lymphedema in Patients With Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Purpose: The purpose of this study was to examine factors associated with the presence of secondary external and internal lymphedema in patients with head-and-neck cancer (HNC). Methods and Materials: The sample included 81 patients ≥3 months after HNC treatment. Physical and endoscopic examinations were conducted to determine if participants had external, internal, and/or combined head-and-neck lymphedema. Logistic regression analysis was used to examine the factors associated with the presence of lymphedema. Results: The following factors were statistically significantly associated with presence of lymphedema: (1) location of tumor associated with presence of external (P=.009) and combined lymphedema (P=.032); (2) time since end of HNC treatment associated with presence of external (P=.004) and combined lymphedema (P=.005); (3) total dosage of radiation therapy (P=.010) and days of radiation (P=.017) associated with the presence of combined lymphedema; (4) radiation status of surgical bed was associated with the presence of internal lymphedema, including surgery with postoperative radiation (P=.030) and (salvage) surgery in the irradiated field (P=.008); and (5) number of treatment modalities associated with external (P=.002), internal (P=.039), and combined lymphedema (P=.004). No demographic, health behavior-related, or comorbidity factors were associated with the presence of lymphedema in the sample. Conclusions: Select tumor and treatment parameters are associated with increased occurrence of lymphedema in patients with HNC. Larger and longitudinal studies are needed to identify adjusted effects and causative risk factors contributing to the development of lymphedema in patients with HNC.

  16. Pathological Steps of Cancer-Related Lymphedema: Histological Changes in the Collecting Lymphatic Vessels after Lymphadenectomy

    OpenAIRE

    Mihara, Makoto; Hara, Hisako; Hayashi, Yohei; Narushima, Mitsunaga; Yamamoto, Takumi; Todokoro, Takeshi; Iida, Takuya; Sawamoto, Naoya; Araki, Jun; Kikuchi, Kazuki; Murai, Noriyuki; Okitsu, Taro; Kisu, Iori; Koshima, Isao

    2012-01-01

    Introduction To date, an electron microscopy study of the collecting lymphatic vessels has not been conducted to examine the early stages of lymphedema. However, such histological studies could be useful for elucidating the mechanism of lymphedema onset. The aim of this study was to clarify the changes occurring in collecting lymphatic vessels after lymphadenectomy. Methods The study was conducted on 114 specimens from 37 patients who developed lymphedema of the lower limbs after receiving su...

  17. Worse and worse off: the impact of lymphedema on work and career after breast cancer

    OpenAIRE

    Boyages, John; Kalfa, Senia; Xu, Ying; Koelmeyer, Louise; Mackie, Helen; Viveros, Hector; Taksa, Lucy; Gollan, Paul

    2016-01-01

    Purpose Our study examines the impact of breast cancer-related lymphedema on women’s work and career. Our research addresses a significant knowledge gap regarding the additional impact of lymphedema on breast cancer survivors. Methods An online national survey was conducted with 361 women who either had breast cancer without lymphedema (Group 1, n = 209) or breast cancer with lymphedema (Group 2, n = 152). Participant recruitment was supported by the Breast Cancer Network Australia and the Au...

  18. Regulatory T cell transfer ameliorates lymphedema and promotes lymphatic vessel function

    Science.gov (United States)

    Gousopoulos, Epameinondas; Proulx, Steven T.; Bachmann, Samia B.; Scholl, Jeannette; Dionyssiou, Dimitris; Demiri, Efterpi; Halin, Cornelia; Dieterich, Lothar C.

    2016-01-01

    Secondary lymphedema is a common postcancer treatment complication, but the underlying pathological processes are poorly understood and no curative treatment exists. To investigate lymphedema pathomechanisms, a top-down approach was applied, using genomic data and validating the role of a single target. RNA sequencing of lymphedematous mouse skin indicated upregulation of many T cell–related networks, and indeed depletion of CD4+ cells attenuated lymphedema. The significant upregulation of Foxp3, a transcription factor specifically expressed by regulatory T cells (Tregs), along with other Treg-related genes, implied a potential role of Tregs in lymphedema. Indeed, increased infiltration of Tregs was identified in mouse lymphedematous skin and in human lymphedema specimens. To investigate the role of Tregs during disease progression, loss-of-function and gain-of-function studies were performed. Depletion of Tregs in transgenic mice with Tregs expressing the primate diphtheria toxin receptor and green fluorescent protein (Foxp3-DTR-GFP) mice led to exacerbated edema, concomitant with increased infiltration of immune cells and a mixed TH1/TH2 cytokine profile. Conversely, expansion of Tregs using IL-2/anti–IL-2 mAb complexes significantly reduced lymphedema development. Therapeutic application of adoptively transferred Tregs upon lymphedema establishment reversed all of the major hallmarks of lymphedema, including edema, inflammation, and fibrosis, and also promoted lymphatic drainage function. Collectively, our results reveal that Treg application constitutes a potential new curative treatment modality for lymphedema. PMID:27734032

  19. Identification of relevant ICF (International Classification of Functioning, Disability and Health) categories in lymphedema patients: A cross-sectional study

    OpenAIRE

    Viehoff, Peter; Potijk, F.; Damstra, R. J.; Heerkens, Yvonne; Ravensberg, Dorine; Van Berkel, D.M.; Neumann, Martino

    2015-01-01

    textabstractBackground. To describe functioning and health of lymphedema patients and to identify their most common problems using the International Classification of Functioning, Disability and Health (ICF) as part of the preparatory studies for the development of ICF Core Sets for lymphedema.Methods. Cross-sectional study in a population of lymphedema patients (n = 200), undergoing treatment in a Dutch lymphedema-specialized hospital. The second-level categories of the ICF were used to coll...

  20. Risk factors for self-reported arm lymphedema among female breast cancer survivors: a prospective cohort study

    OpenAIRE

    Togawa, Kayo; Ma, Huiyan; Sullivan-Halley, Jane; Neuhouser, Marian L.; Imayama, Ikuyo; Baumgartner, Kathy B.; Smith, Ashley Wilder; Alfano, Catherine M.; McTiernan, Anne; Ballard-Barbash, Rachel; Bernstein, Leslie

    2014-01-01

    Introduction Lymphedema is a potentially debilitating condition that occurs among breast cancer survivors. This study examines the incidence of self-reported lymphedema, timing of lymphedema onset, and associations between sociodemographic, clinical and lifestyle factors and lymphedema risk across racial-ethnic groups using data from a multicenter, multiethnic prospective cohort study of breast cancer survivors, the Health, Eating, Activity and Lifestyle Study. Methods A total of 666 women di...

  1. Cost of a lymphedema treatment mandate-10 years of experience in the Commonwealth of Virginia.

    Science.gov (United States)

    Weiss, Robert

    2016-12-01

    Treatment of chronic illness accounts for over 90 % of Medicare spending. Chronic lymphedema places over 3 million Americans at risk of recurrent cellulitis. Health insurers and legislators have taken an active role in fighting attempts to mandate the treatment of lymphedema for fear that provision of the physical therapy and compression materials would result in large and uncontrollable claim costs. The author knows of no open source of lymphedema treatment cost data based on population coverage or claims. Published studies compare cost of treatment versus cost of non-treatment for a select group of lymphedema patients. They do not provide the data necessary for insurance underwriters' estimations of expected claim costs for a larger general population with a range of severities, or for legislators' evaluations of the costs of proposed mandates to cover treatment of lymphedema according to current medical standards. These data are of interest to providers, advocates and legislators in Canada, Australia and England as well as the U.S.The Commonwealth of Virginia has had a lymphedema treatment mandate since 2004. Reported data for 2004-2013, representing 80 % of the Virginia healthcare insurance market, contains claims and utilization data and claims-based estimates of the premium impact of its lymphedema mandate. The average actual annual lymphedema claim cost was $1.59 per individual contract and $3.24 per group contract for the years reported, representing 0.053 and 0.089 % of average total claims. The estimated premium impact ranged 0.00-0.64 % of total average premium for all mandated coverage contracts. In this study actual costs are compared with pre-mandate state mandate commission estimates for proposed lymphedema mandates from Virginia, Massachusetts and California.Ten years of insurance experience with a lymphedema treatment mandate in Virginia shows that costs of lymphedema treatment are an insignificant part of insured healthcare costs, and that

  2. Cost of a lymphedema treatment mandate-10 years of experience in the Commonwealth of Virginia.

    Science.gov (United States)

    Weiss, Robert

    2016-12-01

    Treatment of chronic illness accounts for over 90 % of Medicare spending. Chronic lymphedema places over 3 million Americans at risk of recurrent cellulitis. Health insurers and legislators have taken an active role in fighting attempts to mandate the treatment of lymphedema for fear that provision of the physical therapy and compression materials would result in large and uncontrollable claim costs. The author knows of no open source of lymphedema treatment cost data based on population coverage or claims. Published studies compare cost of treatment versus cost of non-treatment for a select group of lymphedema patients. They do not provide the data necessary for insurance underwriters' estimations of expected claim costs for a larger general population with a range of severities, or for legislators' evaluations of the costs of proposed mandates to cover treatment of lymphedema according to current medical standards. These data are of interest to providers, advocates and legislators in Canada, Australia and England as well as the U.S.The Commonwealth of Virginia has had a lymphedema treatment mandate since 2004. Reported data for 2004-2013, representing 80 % of the Virginia healthcare insurance market, contains claims and utilization data and claims-based estimates of the premium impact of its lymphedema mandate. The average actual annual lymphedema claim cost was $1.59 per individual contract and $3.24 per group contract for the years reported, representing 0.053 and 0.089 % of average total claims. The estimated premium impact ranged 0.00-0.64 % of total average premium for all mandated coverage contracts. In this study actual costs are compared with pre-mandate state mandate commission estimates for proposed lymphedema mandates from Virginia, Massachusetts and California.Ten years of insurance experience with a lymphedema treatment mandate in Virginia shows that costs of lymphedema treatment are an insignificant part of insured healthcare costs, and that

  3. Evaluation of the effectiveness of kinesio taping application in a patient with secondary lymphedema in breast cancer: a case report

    OpenAIRE

    Jakub Taradaj; Tomasz Halski; Małgorzata Zduńczyk; Joanna Rajfur; Małgorzata Pasternok; Daria Chmielewska; Magdalena Piecha; Krystyna Kwaśna; Violetta Skrzypulec-Plinta

    2014-01-01

    Breast cancer-related lymphedema is one of the complications resulting from treatment. It is defined as arm oedema in the breast cancer patients caused by interruption of the flow of the axillary lymphatic system from surgery or radiation therapy, which results in the accumulation of fluid in the subcutaneous tissue of the arm, with a decrease in tissue distensibility around the joints and an increased weight of the extremity. Decongestive lymphatic therapy is common management for lymph...

  4. GENITAL LYMPHEDEMA: A NEW TECHNIQUE OF CORRECTION SURGERY.

    Science.gov (United States)

    Kumar, K Leela Praveen; Manokaran, G

    2015-09-01

    Genital lymphedema is a common problem seen by lymphology surgeons in India due to filarial infections. We have developed an innovative operative technique to correct this issue using native skin and have found the results in the first fifteen patients to be encouraging. Gross debulking procedures reduced the size and using native skin allowed a better cosmetic appearance. The patients also reported almost normal sensation and good sexualfunction. This technique deserves further testing with more patients and at additional centers. PMID:26939162

  5. Imaging findings of adiposis dolorosa vs. massive localized lymphedema

    Energy Technology Data Exchange (ETDEWEB)

    Petscavage-Thomas, Jonelle M.; Bernard, Stephanie A.; Bennett, Jennifer [Milton S. Hershey Medical Center, Department of Radiology, H066, 500 University Drive, P.O. Box 850, Hershey, PA (United States); Walker, Eric A. [Milton S. Hershey Medical Center, Department of Radiology, H066, 500 University Drive, P.O. Box 850, Hershey, PA (United States); Uniformed Services University of the Health Sciences, Department of Radiology and Nuclear Medicine, Bethesda, MD (United States)

    2015-06-01

    Adiposis dolorosa (Dercum's disease) is a condition of benign, painful subcutaneous lipomatous lesions associated with weakness, endocrine and lipid abnormalities, and mental disturbances. There is little information documenting the cross-sectional imaging findings that differentiate it from lipomatous and neoplastic soft tissue masses, or massive localized lymphedema. The purpose of this study was to provide a radiological case series of adiposis dolorosa. A 10-year retrospective review of the picture archiving and communications system was performed. Two musculoskeletal radiologists reviewed images to confirm and document imaging features, location, size, and patient demographics. Medical records were reviewed to characterize patients into three groups: one group met at least three of the four criteria of Dercum's syndrome, the second group met less than three criteria, and the third group had clinical diagnosis of cellulitis of the lower extremity. Seventeen cases (25 masses) of adiposis dolorosa were found, nine cases of which met at least three criteria of Dercum's syndrome. All cases in the first two groups demonstrated skin thickening and lymphedema of subcutaneous fat, which was fluid attenuation on CT and low or intermediate T1-weighted and high STIR/T2-weighted MR signal. Two cases with pathology showed mild fatty infiltration with fibrous septa, and the third case showed massive localized lymphedema. The third group of ten cellulitis patients demonstrated non-mass-like subcutaneous edema with similar CT attenuation and MR signal characteristics to the first two groups, but differed by the presence of post-contrast enhancement and non-mass-like appearance in 90 %. Imaging findings of adiposis dolorosa and massive localized lymphedema overlap, as do the symptoms and pathological features. Due to the mass-like engorgement of the soft tissues and pain, patients will often undergo imaging to exclude neoplasm or infection. Knowledge of these

  6. Mutations in KIF11 cause autosomal-dominant microcephaly variably associated with congenital lymphedema and chorioretinopathy

    NARCIS (Netherlands)

    Ostergaard, P.; Simpson, M.A.; Mendola, A.; Vasudevan, P.; Connell, F.C.; van Impel, A.; Moore, A.T.; Loeys, B.L.; Ghalamkarpour, A.; Onoufriadis, A.; Martinez-Corral, I.; Devery, S.; Leroy, J.G.; van Laer, L.; Singer, A.; Bialer, M.G.; McEntagart, M.; Quarrell, O.; Brice, G.; Trembath, R.C.; Schulte-Merker, S.; Makinen, T.; Vikkula, M.; Mortimer, P.S.; Mansour, S.; Jeffery, S.

    2012-01-01

    We have identified KIF11 mutations in individuals with syndromic autosomal-dominant microcephaly associated with lymphedema and/or chorioretinopathy. Initial whole-exome sequencing revealed heterozygous KIF11 mutations in three individuals with a combination of microcephaly and lymphedema from a mic

  7. The Lymphedema and Gynecologic Cancer (LEG) Study: Incidence, Risk Factors, and | Division of Cancer Prevention

    Science.gov (United States)

    DESCRIPTION (provided by applicant): The proposed study, "Lymphedema and Gynecologic cancer (LEG): Incidence, Risk Factors and Impact", will innovatively utilize the cooperative group setting of the GOG (Gynecologic Oncology Group) to prospectively study 1300 women newly diagnosed with cervical, endometrial, or vulvar cancer to determine the incidence and impact of lower extremity lymphedema following surgical treatment of these diseases. |

  8. Lymphaticovenous Bypass Decreases Pathologic Skin Changes in Upper Extremity Breast Cancer-Related Lymphedema

    OpenAIRE

    Torrisi, Jeremy S.; Joseph, Walter J.; Ghanta, Swapna; Cuzzone, Daniel A.; Albano, Nicholas J.; Savetsky, Ira L.; Gardenier, Jason C.; Skoracki, Roman; Chang, David; Mehrara, Babak J.

    2015-01-01

    Introduction: Recent advances in microsurgery such as lymphaticovenous bypass (LVB) have been shown to decrease limb volumes and improve subjective symptoms in patients with lymphedema. However, to date, it remains unknown if these procedures can reverse the pathological tissue changes associated with lymphedema. Therefore, the purpose of this study was to analyze skin tissue changes in patients before and after LVB.

  9. Vascularized Free Lymph Node Flap Transfer in Advanced Lymphedema Patient after Axillary Lymph Node Dissection.

    Science.gov (United States)

    Cook, Kyung Hoon; Park, Myong Chul; Lee, Il Jae; Lim, Seong Yoon; Jung, Yong Sik

    2016-03-01

    Lymphedema is a condition characterized by tissue swelling caused by localized fluid retention. Advanced lymphedema is characterized by irreversible skin fibrosis (stage IIIb) and nonpitting edema, with leather-like skin, skin crypts, and ulcers with or without involvement of the toes (stage IVa and IVb, respectively). Recently, surgical treatment of advanced lymphedema has been a challenging reconstructive modality. Microvascular techniques such as lymphaticovenous anastomosis and vascularized lymph node flap transfer are effective for early stage lymphedema. In this study, we performed a two-stage operation in an advanced lymphedema patient. First, a debulking procedure was performed using liposuction. A vascularized free lymph node flap transfer was then conducted 10 weeks after the first operation. In this case, good results were obtained, with reduced circumferences in various parts of the upper extremity noted immediately postoperation. PMID:27064862

  10. EFFECTS OF MICROWAVE TREATMENT ON THE LYMPHOCYTESUBSETS IN CASES OF CHRONIC LYMPHEDEMA OF EXTREMITIES

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective To determine the immune status of T lymphocyte subsets of patients with chronic lymphedema of extremities and the effects of microwave treatment. Methods Patients with lymphedema of extremities (n=20) and normal volunteers (n=10) were studied by fluorescein isothiocyanate (FITC) or phycoerythrin (PE)-conjugated monoclonal antibo dies (MoAbs) and dual color flow cytometry to examine the changes of lymphocyte phenotypes in them before and after treat ment. Results The percentage of CD4+ T lymphocytes and CD4+ /CD8+ T cell ratios in lymphedema group were less than those in control group before treatment. They increased significantly and restored to nearly normal level after microwave treatment. The percentage of CD8+ and HLA-DR + T lymphocytes in lymphedema group also demonstrated significant decline after treat ment. Conclusion Disorder of T lymphocyte subsets existed in patients with chronic lymphedema of extremities, and mi crowave treatment can improve the states and enhance the cellular immunity of the patients.

  11. Basic diagnosis of solid waste generated at Agua Blanca State Park to propose waste management strategies.

    Science.gov (United States)

    Laines Canepa, José Ramón; Zequeira Larios, Carolina; Valadez Treviño, Maria Elena Macías; Garduza Sánchez, Diana Ivett

    2012-03-01

    State parks are highly sensitive areas of great natural importance and tourism value. Herein a case study involving a basic survey of solid waste which was carried out in 2006 in Agua Blanca State Park, Macuspana, Tabasco, Mexico with two sampling periods representing the high and low tourist season is presented. The survey had five objectives: to find out the number of visitors in the different seasons, to consider the daily generation of solid waste from tourist activities, to determine bulk density, to select and quantify sub-products; and to suggest a possible treatment. A daily average of 368 people visited the park: 18,862 people in 14 days during the high season holiday (in just one day, Easter Sunday, up to 4425 visitors) and 2092 visitors in 43 days during the low season. The average weight of the generated solid waste was 61.267 kg day(-1) and the generated solid waste average per person was 0.155 kg person(-1 ) day(-1). During the high season, the average increased to 0.188 kg person(-1 ) day(-1) and during the low season, the average decreased to 0.144 kg person(-1 ) day(-1). The bulk density average was 75.014 kg m(-3), the maximum value was 92.472 kg m(-3) and the minimum was 68.274 kg m(-3). The sub-products comprised 54.52% inorganic matter; 32.03% organic matter, 10.60% non-recyclable and 2.85% others. Based on these results, waste management strategies such as reuse/recycling, aerobic and anaerobic digestion, the construction of a manual landfill and the employment of a specialist firm were suggested. PMID:21945990

  12. Behavioral data management using Visual Basics for Applications to automate data capture and analysis.

    Science.gov (United States)

    Sipos, Maurice L; Sweeney, Richard E

    2003-09-30

    Many researchers are familiar with the spreadsheet capabilities of Microsoft Excel, but have never explored using customized VISUAL BASIC FOR APPLICATIONS (VBA) macros embedded in the program. At the United States Army Medical Research Institute of Chemical Defense (USAMRICD), the implementation of VBA program code to carry out repetitive operations has resulted in a tremendous savings in both the time and manpower required to reliably capture, analyze, and plot data from research protocols. A set of "template" workbooks was developed and is used to organize data from different types of studies. At the heart of the concept is a "setup information" worksheet onto which the user enters information about the study (i.e. the number of subjects, groups, graphs). Clicking a control button on this worksheet launches the VBA code that creates worksheets for each subject, group and chart specified. A "pairmatch" function allows the user to create groups either randomly or by pair matching based on user-specified variables. Controls are provided that run VBA program code to parse subject data files into the proper worksheets and perform group averages. Charts are updated automatically whenever group averages change so that the researcher always has an up-to-date plot available. The ability to reformat the captured data onto a "statistical output" worksheet allows data to be imported easily to statistical software packages. The concept is being used for several different types of studies at USAMRICD and has significantly reduced not only amount of time spent on data management, but also the number of data entry errors. Readers interested in acquiring an electronic copy of the startle workbook example, which contains the complete VBA code, should send the request to the authors at reseco@erols.com or maurice.sipos@us.army.mil. PMID:12948548

  13. Basic diagnosis of solid waste generated at Agua Blanca State Park to propose waste management strategies.

    Science.gov (United States)

    Laines Canepa, José Ramón; Zequeira Larios, Carolina; Valadez Treviño, Maria Elena Macías; Garduza Sánchez, Diana Ivett

    2012-03-01

    State parks are highly sensitive areas of great natural importance and tourism value. Herein a case study involving a basic survey of solid waste which was carried out in 2006 in Agua Blanca State Park, Macuspana, Tabasco, Mexico with two sampling periods representing the high and low tourist season is presented. The survey had five objectives: to find out the number of visitors in the different seasons, to consider the daily generation of solid waste from tourist activities, to determine bulk density, to select and quantify sub-products; and to suggest a possible treatment. A daily average of 368 people visited the park: 18,862 people in 14 days during the high season holiday (in just one day, Easter Sunday, up to 4425 visitors) and 2092 visitors in 43 days during the low season. The average weight of the generated solid waste was 61.267 kg day(-1) and the generated solid waste average per person was 0.155 kg person(-1 ) day(-1). During the high season, the average increased to 0.188 kg person(-1 ) day(-1) and during the low season, the average decreased to 0.144 kg person(-1 ) day(-1). The bulk density average was 75.014 kg m(-3), the maximum value was 92.472 kg m(-3) and the minimum was 68.274 kg m(-3). The sub-products comprised 54.52% inorganic matter; 32.03% organic matter, 10.60% non-recyclable and 2.85% others. Based on these results, waste management strategies such as reuse/recycling, aerobic and anaerobic digestion, the construction of a manual landfill and the employment of a specialist firm were suggested.

  14. Fostering assumption-based stress-test thinking in managing groundwater systems: learning to avoid failures due to basic dynamics

    Science.gov (United States)

    Guillaume, Joseph H. A.; El Sawah, Sondoss

    2014-06-01

    Sustainable groundwater resource management can only be achieved if planning processes address the basic dynamics of the groundwater system. Conceptual and distributed groundwater models do not necessarily translate into an understanding of how a plan might operate in reality. Prompted by Australian experiences, `iterative closed-question modelling' has been used to develop a process of iterative dialogue about management options, objectives and knowledge. Simple hypothetical models of basic system dynamics that satisfy agreed assumptions are used to stress-test the ability of a proposed management plan to achieve desired future conditions. Participants learn from models in which a plan succeeds and fails, updating their assumptions, expectations or plan. Their new understanding is tested against further hypothetical models. The models act as intellectual devices that confront users with new scenarios to discuss. This theoretical approach is illustrated using simple one and two-cell groundwater models that convey basic notions of capture and spatial impacts of pumping. Simple extensions can address uncertain climate, managed-aquifer recharge and alternate water sources. Having learnt to address the dynamics captured by these models, participants may be better placed to address local conditions and develop more effective arrangements to achieve management outcomes.

  15. Project Basic and School Library Media Programs. Issues in Media Management: 1980 Series.

    Science.gov (United States)

    Maryland State Dept. of Education, Baltimore. Div. of Library Development and Services.

    The seven papers in this collection, which were presented at a workshop for library media supervisors, focus on competency-based education and the role of media centers in implementing Maryland's Project Basic. Papers included are: "Project Basic Instructional Guides: A Resource for Teachers," by Margaret Trader; "Scope and Sequence Charts for the…

  16. EFFECTS OF COMPRESSION ON LYMPHEDEMA DURING RESISTANCE EXERCISE IN WOMEN WITH BREAST CANCER-RELATED LYMPHEDEMA: A RANDOMIZED, CROSS-OVER TRIAL.

    Science.gov (United States)

    Singh, B; Newton, R U; Cormie, P; Galvao, D A; Cornish, B; Reul-Hirche, H; Smith, C; Nosaka, K; Hayes, S C

    2015-06-01

    The use of compression garments during exercise is recommended for women with breast cancer-related lymphedema, but the evidence behind this clinical recommendation is unclear. The aim of this randomized, cross-over trial was to compare the acute effects of wearing versus not wearing compression during a single bout of moderate-load resistance exercise on lymphedema status and its associated symptoms in women with breast cancer-related lymphedema (BCRL). Twenty-five women with clinically diagnosed, stable unilateral breast cancer-related lymphedema completed two resistance exercise sessions, one with compression and one without, in a randomized order separated by a minimum 6 day wash-out period. The resistance exercise session consisted of six upper-body exercises, with each exercise performed for three sets at a moderate-load (10-12 repetition maximum). Primary outcome was lymphedema, assessed using bioimpedance spectroscopy (L-Dex score). Secondary outcomes were lymphedema as assessed by arm circumferences (percent inter-limb difference and sum-of-circumferences), and symptom severity for pain, heaviness and tightness, measured using visual analogue scales. Measurements were taken pre-, immediately post- and 24 hours post-exercise. There was no difference in lymphedema status (i.e., L-Dex scores) pre- and post-exercise sessions or between the compression and non-compression condition [Mean (SD) for compression pre-, immediately post- and 24 hours post-exercise: 17.7 (21.5), 12.7 (16.2) and 14.1 (16.7), respectively; no compression: 15.3 (18.3), 15.3 (17.8), and 13.4 (16.1), respectively]. Circumference values and symptom severity were stable across time and treatment condition. An acute bout of moderate-load, upper-body resistance exercise performed in the absence of compression does not exacerbate lymphedema in women with BCRL. PMID:26714372

  17. Acute Inflammatory Response to Low-, Moderate-, and High-Load Resistance Exercise in Women With Breast Cancer-Related Lymphedema.

    Science.gov (United States)

    Cormie, Prue; Singh, Benjamin; Hayes, Sandi; Peake, Jonathan M; Galvão, Daniel A; Taaffe, Dennis R; Spry, Nigel; Nosaka, Kazunori; Cornish, Bruce; Schmitz, Kathryn H; Newton, Robert U

    2016-09-01

    Background Resistance exercise is emerging as a potential adjunct therapy to aid in the management of breast cancer-related lymphedema (BCRL). However, the mechanisms underlying the relationships between the acute and long-term benefits of resistance exercise on BCRL are not well understood. Purpose To examine the acute inflammatory response to upper-body resistance exercise in women with BCRL and to compare these effects between resistance exercises involving low, moderate, and high loads. The impact on lymphedema status and associated symptoms was also compared. Methods A total of 21 women, 62 ± 10 years old, with BCRL participated in the study. Participants completed low-load (15-20 repetition maximum [RM]), moderate-load (10-12 RM), and high-load (6-8 RM) exercise sessions consisting of 3 sets of 6 upper-body resistance exercises. Sessions were completed in a randomized order separated by a 7- to 10-day wash-out period. Venous blood samples were obtained to assess markers of exercise-induced muscle damage and inflammation. Lymphedema status was assessed using bioimpedance spectroscopy and arm circumferences, and associated symptoms were assessed using Visual Analogue Scales for pain, heaviness, and tightness. Measurements were conducted before and 24 hours after the exercise sessions. Results No significant changes in creatine kinase, C-reactive protein, interleukin-6, and tumor necrosis factor-α were observed following the 3 resistance exercise sessions. There were no significant changes in arm swelling or symptom severity scores across the 3 resistance exercise conditions. Conclusions The magnitude of acute exercise-induced inflammation following upper-body resistance exercise in women with BCRL does not vary between resistance exercise loads. PMID:26582633

  18. Virtual patients: an effective educational intervention to improve paediatric basic specialist trainee education in the management of suspected child abuse?

    LENUS (Irish Health Repository)

    McEvoy, M M

    2011-09-01

    Child abuse is a particularly difficult subject to teach at both undergraduate and postgraduate level. Most doctors are dissatisfied with their training in child abuse recognition and management. We developed an interactive video based Virtual Patient to provide formal training for paediatric Basic Specialist Trainees in the recognition of suspected child abuse. The Virtual Patient case revolves around the management of suspected physical abuse in a seven month old child, who initially presents to the Emergency Department with viral upper respiratory tract symptoms. This Virtual Patient was used to facilitate a case discussion with Basic Specialist Trainees. A questionnaire was developed to determine their perception of the value of the Virtual Patient as an educational tool. Twenty five Basic Specialist Trainees completed the questionnaire. Upon completion of the case, 23\\/25 (92%) participants reported greater self confidence in their ability to recognize cases of suspected child abuse and 24\\/25 (96%) of participants reported greater self confidence in their ability to report cases of suspected child abuse. Basic Specialist Trainees perceived the Virtual Patient to be a useful educational tool. Virtual Patients may have a role to play in enhancing postgraduate training in the recognition of suspected child abuse.

  19. Excess Lymphangiogenesis Cooperatively Induced by Macrophages and CD4(+) T Cells Drives the Pathogenesis of Lymphedema.

    Science.gov (United States)

    Ogata, Fusa; Fujiu, Katsuhito; Matsumoto, Sahohime; Nakayama, Yukiteru; Shibata, Munehiko; Oike, Yuichi; Koshima, Isao; Watabe, Tetsuro; Nagai, Ryozo; Manabe, Ichiro

    2016-03-01

    Lymphedema is a debilitating progressive condition that severely restricts quality of life and is frequently observed after cancer surgery. The mechanism underlying lymphedema development remains poorly understood, and no effective pharmacological means to prevent or alleviate the ailment is currently available. Using a mouse model of lymphedema, we show here that excessive generation of immature lymphatic vessels is essential for initial edema development and that this early process is also important for later development of lymphedema pathology. We found that CD4(+) T cells interact with macrophages to promote lymphangiogenesis, and that both lymphangiogenesis and edema were greatly reduced in macrophage-depleted mice, lymphocyte-deficient Rag2(?/?) mice or CD4(+) T-cell-deficient mice. Mechanistically, T helper type 1 and T helper type 17 cells activate lesional macrophages to produce vascular endothelial growth factor-C, which promotes lymphangiogenesis, and inhibition of this mechanism suppressed not only early lymphangiogenesis, but also later development of lymphedema. Finally, we show that atorvastatin suppresses excessive lymphangiogenesis and lymphedema by inhibiting T helper type 1 and T helper type 17 cell activation. These results demonstrate that the interaction between CD4(+) T cells and macrophages is a potential therapeutic target for prevention of lymphedema after surgery.

  20. The frequency and risk factors of developing lymphedema of the upper extremity after breast conserving therapy

    International Nuclear Information System (INIS)

    The aim of the study was to evaluate the frequency of lymphedema of the upper extremity in breast cancer patients after breast conserving therapy (BCT) and to assess the risk factors influencing this complication. We evaluated 174 patients with breast cancer, mean age 53 yrs, stage 0, I and II undergoing BCT at the Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology in Warsaw between the years 1995 and 1999. Mean follow-up time was 50 months. Adjuvant chemotherapy or hormonotherapy had been administered to 83 pts. The circumference of both arms was measured by tape 10 cm above the lateral picondyle, 10 cm below it and at the metacarpal level. A difference of 2-4 cm was recognized as mild; of 4-6 cm as moderate and over 6 cm as severe lymphedema. In order to assess the risk factors of lymphedema we performed a statistical analysis of the following elements: age, tumour location, number of excised nodes, number of metastatic lymph nodes, radiotherapy to lymph node areas and adjuvant systemic therapy. We observed 17/174 (10%) cases of lymphedema - 15/17 mild; 1/17 moderate and 1/17 severe. On statistical analysis we found, that the only factor affecting lymphedema was irradiation to the lymph node areas. The incidence of lymphedema of the upper extremity after breast conserving therapy is low (10%), similar to published data. Radiotherapy of the lymph node areas is the only factor increasing the risk of lymphedema. (author)

  1. Lymphedema following breast cancer treatment and impact on quality of life: a review.

    Science.gov (United States)

    Taghian, Nadine R; Miller, Cynthia L; Jammallo, Lauren S; O'Toole, Jean; Skolny, Melissa N

    2014-12-01

    Lymphedema resulting from breast cancer treatment is a chronic condition which can significantly compromise quality of life. We sought to review various aspects of breast-cancer related lymphedema including measurement techniques, definitions, risk factors, and specifically, impact on physical, psychological, and emotional well-being of women treated for breast cancer. For the purpose of this review, we performed a literature search using PubMed for articles on lymphedema secondary to breast cancer treatment published since 1997. While improvements in breast cancer therapy have contributed to a decrease in the incidence of lymphedema, the overall negative impact the condition has on patients and survivors has remained unchanged. The development of lymphedema results in physical impairments including compromised function, diminished strength, fatigue, and pain in the affected arm. Affected women may have decreased self-confidence resulting from a distorted body image. Negative emotions reported by women with lymphedema include anxiety, frustration, sadness, anger, fear, and increased self-consciousness. Lymphedema secondary to breast cancer treatment remains a significant quality of life issue, with known consequences related to a woman's physical, psychological, and emotional well-being.

  2. Ultrasonografic changes in the axillary vein of patients with lymphedema after mastectomy

    Directory of Open Access Journals (Sweden)

    Gilberto Ferreira de Abreu Junior

    2015-04-01

    Full Text Available OBJECTIVE: To determine the prevalence of sonographic abnormalities (SA in the axillary vein of patients with and without post-mastectomy lymphedema. METHODS: We studied a sample of 80 women, divided into two equal groups, with and without lymphedema, with B mode ultrasound, color and pulsed Doppler. The primary variable, SA, is defined as change in the venous diameter, parietal thickening, intraluminal images, compressibility, parietal collapse at inspiration and feature of the axillary venous flow on the operated side. Secondary variables were: stage of lymphedema, surgical technique, number of radio and chemotherapy sessions, limb volume, weight and age. The differences between the proportions in the groups were determined using the Chi-square test and / or Fisher's test. For continuous variables, we used the Mann-Whitney Test. To estimate the magnitude of the associations, we used the prevalence rate of SA in both groups as a measure of frequency, and as a measure of association, the prevalence ratio (PR obtained as a function of relative risk (RR and estimated by the test Mantel-Haenszel homogeneity test. We adopted the statistical significance level of 5% (p < 0.05. RESULTS: only the criterion "parietal thickening" was strongly associated with the lymphedema group (p = 0.001. The prevalence of SA was 55% in patients with lymphedema and 17.5% in the group without it, with difference in prevalence of 37.5%. CONCLUSION: the prevalence of SA was higher in patients undergoing mastectomy with lymphedema than in those without lymphedema.

  3. Clinical Significance of Lymphoscintigraphy Findings in the Evaluation of Lower Extremity Lymphedema

    Directory of Open Access Journals (Sweden)

    Seyhan Karaçavuş

    2015-06-01

    Full Text Available Objective: The purpose of this study was to investigate the clinical significance of lymphoscintigraphy imaging in the evaluation of lower extremity lymphedema. Methods: Technetium-99m-labeled nanocolloid was injected subcutaneously in the first web spaces of both feet of 123 patients (M/F: 43/80, mean age 57.5±13.1 years, range 16-78 years who had clinical evidence of lower extremity swelling with suspicion of lymphedema, and were referred for routine lymphoscintigraphy. Lymphoscintigraphy scan was started as dynamic viewing followed by static whole body imaging at 10 minute, 1 hour and 4 hours after injection. Results: Eighty-seven patients had lymphedema. Patients who had lymphedema were divided into two groups according to their scintigraphy findings: Group I included 58 patients without uptake in the popliteal nodes, and group II included 29 patients with positive popliteal nodes. The rate of popliteal node visualization was higher in patients with dermal backflow as compared to those without dermal backflow (p<0.001. The duration of lymphedema was also longer in patients with dermal backflow and popliteal nodes (p<0.004. Conclusion: Lymphoscintigraphy is a reliable, easily applied and well-tolerated objective method to diagnose lower extremity lymphedema. Uptake by popliteal lymph nodes and the presence of dermal backflow on lymphoscintigraphy, which is performed for evaluation of the lower limb lymphedema, were important signs indicating longer disease duration and higher severity of lymphatic dysfunction.

  4. Symptom report in detecting breast cancer-related lymphedema

    OpenAIRE

    Fu; Axelrod D; Clel; CM; Qiu Z; Guth AA; Kleinman R; Scagliola J; Haber J

    2015-01-01

    Mei R Fu,1 Deborah Axelrod,2,3 Charles M Cleland,1 Zeyuan Qiu,4 Amber A Guth,2,3 Robin Kleinman,2 Joan Scagliola,2 Judith Haber1 1College of Nursing, New York University, 2Department of Surgery, NYU School of Medicine, 3NYU Clinical Cancer Center, New York, NY, 4Department of Chemistry and Environmental Science, New Jersey Institute of Technology, Newark, NJ, USA Abstract: Breast cancer-related lymphedema is a syndrome of abnormal swelling coupled with multiple symptoms resulting from obstru...

  5. Treatment of lymphedema praecox through low level laser therapy (LLLT)

    OpenAIRE

    Manoochehr Mahram; Majid Rajabi

    2011-01-01

    A 15-year-old girl with right lower extremity lymphedema praecox was treated through Low Level Laser Therapy (LLLT), by means of a GaAs and GaAlAs diodes laser-therapy device. Treatment sessions were totally 24, each cycle containing 12 every other day 15-minute sessions, and one month free between the cycles. The treatment was achieved to decrease the edema and no significant increase in circumference of involved leg was found following three months after the course of treatment. Although LL...

  6. Massive localized lymphedema: A case series and literature review.

    Science.gov (United States)

    Evans, Robin James; Scilley, Chris

    2011-01-01

    A large, deep, soft tissue mass is often malignant in nature; however, a recent study described a large soft tissue mass present in morbidly obese patients that was found to be benign. Massive localized lymphedema (MLL) is a large pedunculated lymphadematous mass found in the lower extremity of morbidly obese patients. MLL often enlarges over many years and may interfere with mobility. Although histologically similar to well-differentiated liposarcoma, MLL has recently emerged as a separate, benign clinical entity. The pathophysiology of MLL is yet to be understood. A literature review, and the authors' experiences are discussed to assist in clinical decision making. PMID:22942667

  7. Penoscrotal lymphedema associated with metastatic renal cell carcinoma.

    Science.gov (United States)

    Crawley, David; Haddock, Peter; Jackson, Max; Kamradt, Jeffrey; Kesler, Stuart

    2015-08-01

    A 64-year-old male presented with lower back pain, radiating in a sciatic-type distribution, swelling in his lower abdomen and right leg, and edema of the scrotum and penile shaft. A sonogram and CT imaging indicated an enhancing mass in the right kidney and a spinal metastasis. The right lower extremity and penoscrotal lymphedema was caused by lymphatic obstruction due to a sacral metastasis of renal cell carcinoma. He was treated with cytoreductive nephrectomy, radiation and a systemic tyrosine kinase inhibitor. Pelvic imaging is suggested to determine whether malignant lymphatic obstruction is present when presented with idiopathic penoscrotal edema. PMID:26267035

  8. Yellow Nail Syndrome: Dystrophic Nails, Peripheral Lymphedema and Chronic Cough

    Directory of Open Access Journals (Sweden)

    Christian Dornia

    2011-01-01

    Full Text Available A case involving a 41-year-old man with yellow nail syndrome (YNS is reported. YNS is a rare disorder characterized by yellow, dystrophic nails, peripheral lymphedema and bronchiectasis with recurrent lower respiratory tract infections. YNS is often misdiagnosed because the syndrome is not well known. An interdisciplinary approach is required to recognize and collate the components of the syndrome accurately. Correct diagnosis is of utmost clinical importance because YNS can occur secondary to malignancies and autoimmune disorders. Hence, the diagnosis of YNS must prompt further investigation.

  9. Stewart-Treves syndrome: MR imaging of a postmastectomy upper-limb chronic lymphedema with angiosarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Schindera, S.T.; Anderson, S.E. [University Hospital of Bern, Department of Diagnostic Radiology, Inselspital, Bern (Switzerland); Streit, M.; Kaelin, U. [University Hospital of Bern, Department of Dermatology, Inselspital, Bern (Switzerland); Stauffer, E. [University Hospital of Bern, Department of Pathology, Inselspital, Bern (Switzerland); Steinbach, L. [University of California San Francisco, Department of Radiology, San Francisco, CA (United States)

    2005-03-01

    The rare occurrence of angiosarcoma in postmastectomy upper-limb lymphedema with magnetic resonance (MR) imaging is discussed. Unfamiliarity with this aggressive vascular tumor and its harmless appearance often leads to delayed diagnosis. Angiosarcoma complicating chronic lymphedema may be low in signal intensity on T2-weighting and short tau inversion recovery (STIR) imaging reflecting the densely cellular, fibrous stroma, and sparsely vascularized tumor histology. Additional administration of intravenous contrast medium revealed significant enhancement of the tumorous lesions. Awareness of angiosarcoma and its MR imaging appearance in patients with chronic lymphedema may be a key to early diagnosis or allow at least inclusion in the differential diagnosis. (orig.)

  10. Study of lymphoscintigraphy with sup(99m)Tc rhenium colloid for diagnosis of lymphedema

    International Nuclear Information System (INIS)

    Clinical evaluation of the lymphoscintigraphy with sup(99m)Tc rhenium colloid for the diagnosis of lymphedema was investigated. 2 normal subjects, 10 various diseases with lower extremity edema and 18 malignancies without lower extremity edema were selected as the materials. Findings noted in the lymphoscintigram were diffuse radioactivity of subcutaneous tissue, activity in lymphatic vessel and image of inguinal lymphnodes. Diffuse radioactivity throughout subcutaneous tissue or persistence of radioactivity in the lymphatic vessel of the involved lower extremity were considered to be the characteristic findings of lymphedema. In conclusion, lymphoscintigraphy with sup(99m)Tc rhenium colloid was proved to be useful for detection of lymphedema of lower extremity. (author)

  11. Primary amyloidosis of the mesentery and the retroperitoneum presenting with lymphedema.

    Science.gov (United States)

    Halm, U; Berr, F; Tannapfel, A; Klöppel, R; Secknus, R; Mössner, J

    1998-11-01

    We report the case of a 57-yr-old woman presenting with moderate weight loss, abdominal distension, and lymphedema of the legs and vulva. Computed tomography of the abdomen revealed massive thickening of the rectal wall, mesentery, and retroperitoneum. Primary amyloidosis was diagnosed by immunohistochemistry from the rectum and duodenum. To our knowledge, lymphedema due to primary amyloidosis has not yet been reported. The diagnosis should be presumed in the case of retroperitoneal thickening and lymphedema and can be established by immunohistochemistry. PMID:9820426

  12. Streptococcal toxic shock syndrome occurred during postoperative radiotherapy in a cancer patient with preexisting lymphedema and chronic illness -case report-

    International Nuclear Information System (INIS)

    A case is reported of a man with malignant fibrous histiocytoma (MFH) in right thigh who developed streptococcal toxic shock syndrome (STSS) during postoperative radiotherapy. Before radiotherapy, a patient complained wax and wane lymphedema following wide excision of tumor mass which was confirmed as MFH. He took some nonsteroidal antiinflammatory drug (NSAID) for about one month. He suffered preexisting hepatitis C virus (HCV) infection, diabetes and well-controlled hypertension. The patient received conventional radiotherapy to right thigh with a total dose of 32.4 Gy at 1.8 Gy per day. At last radiotherapy fraction, cutaneous erythematous inflammation was suddenly developed at his affected thigh. At that time, he also complained of oliguria, fever and chills. The patient was consulted to internal medicine for adequate evaluation and management. The patient was diagnosed as suggested septic shock and admitted without delay. At admission, he showed hypotension, oliguria, constipation, abnormal renal and liver function. As a result of blood culture, Streptococcus pyogenes was detected. The patient was diagnosed to STSS. He was treated with adequate intravenous antibiotics and fluid support. STSS is one of oncologic emergencies and requires immediate medical intervention to prevent loss of life. In this patient, underlying HCV infection, postoperative lymphedema, prolonged NSAID medication, and radiotherapy may have been multiple precipitating factors of STSS

  13. Streptococcal toxic shock syndrome occurred during postoperative radiotherapy in a cancer patient with preexisting lymphedema and chronic illness -case report-

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Ji Young; Oh, Yoon Kyeong; Kim, Dong Min [Chosun University College of Medicine, Gwangju (Korea, Republic of)

    2006-12-15

    A case is reported of a man with malignant fibrous histiocytoma (MFH) in right thigh who developed streptococcal toxic shock syndrome (STSS) during postoperative radiotherapy. Before radiotherapy, a patient complained wax and wane lymphedema following wide excision of tumor mass which was confirmed as MFH. He took some nonsteroidal antiinflammatory drug (NSAID) for about one month. He suffered preexisting hepatitis C virus (HCV) infection, diabetes and well-controlled hypertension. The patient received conventional radiotherapy to right thigh with a total dose of 32.4 Gy at 1.8 Gy per day. At last radiotherapy fraction, cutaneous erythematous inflammation was suddenly developed at his affected thigh. At that time, he also complained of oliguria, fever and chills. The patient was consulted to internal medicine for adequate evaluation and management. The patient was diagnosed as suggested septic shock and admitted without delay. At admission, he showed hypotension, oliguria, constipation, abnormal renal and liver function. As a result of blood culture, Streptococcus pyogenes was detected. The patient was diagnosed to STSS. He was treated with adequate intravenous antibiotics and fluid support. STSS is one of oncologic emergencies and requires immediate medical intervention to prevent loss of life. In this patient, underlying HCV infection, postoperative lymphedema, prolonged NSAID medication, and radiotherapy may have been multiple precipitating factors of STSS.

  14. Development of consensus International Classification of Functioning, Disability and Health (ICF) core sets for lymphedema

    NARCIS (Netherlands)

    Viehoff, P.B.; Heerkens, Y.F.; Ravensberg, C.D. van; Hidding, J.; Damstra, R.J.; Napel, H. ten; Neumann, H.A.

    2015-01-01

    To understand the challenges of patients with lymphedema it is important to describe functioning and to measure the effectiveness of treatment in changing functioning. The International Classification of Functioning, Disability and Health (ICF) offers an international framework to classify functioni

  15. Indocyanine Green Lymphographic Signs of Lymphatic Collateral Formation in Lower Extremity Lymphedema After Cancer Resection.

    Science.gov (United States)

    Tashiro, Kensuke; Shibata, Takashi; Mito, Daisuke; Ishiura, Ryohei; Kato, Motoi; Yamashita, Shuji; Narushima, Mitsunaga; Iida, Takuya; Koshima, Isao

    2016-08-01

    Indocyanine green lymphography has recently been used to assess lymphatic vessel function in lymphedema patients. Postoperative collateral lymphatic vessels toward ipsilateral axillary lymph nodes are rarely seen above the umbilical level in lower lymphedema patients. Between January 2012 and December 2014, we performed indocyanine green lymphography of 192 limbs in 96 lower extremity lymphedema cases. As a result, dermal back flow appeared in 95 cases, with 38 in the lower abdominal area and 31 in the genital area. We confirmed 3 cases of superficial lymphatic collateral ways extending above the umbilical level to the axillary lymph nodes. All 3 cases had similarity in lower abdominal edema, so excessive lymphatic fluid in the lower abdomen was assumed to be the cause. Lymphatic collateral ways from abdomen to axillary lymph nodes in this study was likely to be designed to prevent the progress of lymphedema. PMID:26418772

  16. Coding of meaningful concepts in lymphedema-specific questionnaires with the ICF

    NARCIS (Netherlands)

    Viehoff, P.B.; Hidding, J.T.; Heerkens, Y.F.; Ravensberg, C.D. van; Neumann, H.A.

    2013-01-01

    Abstract Purpose: To identify and quantify the meaningful concepts within questionnaires focusing on lymphedema using the International Classification of Functioning, Disability and Health (ICF). Methods: Electronic searches of Medline, EMBASE, CINAHL, CENtral and Pedro (2005-2010) were conducted. T

  17. Chronic Lymphedema of the Lower Limb: A Rare Cause of Dislocation of Total Hip Arthroplasty.

    Science.gov (United States)

    Vaishya, Raju; Agarwal, Amit Kumar; Gupta, Nishint; Vijay, Vipul

    2016-01-01

    Total hip arthroplasty (THA) in a patient with chronic lymphedema of both lower limbs is rarely reported in the literature. Chronic lymphedema is a challenging condition associated with various complications especially in a patient with THA. However, dislocation of the total hip prosthesis due to acute exacerbation of lower limb swelling in the postoperative period is an extremely rare complication. The cause that led to the dislocation of the prosthesis is intricate and difficult to assess, as this has not been discussed in the literature yet. We believe that the excessive weight of the limb due to chronic lymphedema had a deleterious effect on the biomechanics of total hip prosthesis, thereby increasing the tendency for dislocation. This case illustrates that chronic lymphedema of the lower limb should be dealt with aggressively using various modalities like intermittent pneumatic compression pumps and compression stockings after THA in such patients. PMID:27226940

  18. Screening for Breast Cancer-Related Lymphedema: The Need for Standardization

    OpenAIRE

    O'Toole, Jean; Jammallo, Lauren S.; Miller, Cynthia L.; Skolny, Melissa N.; Specht, Michelle C.; Taghian, Alphonse G.

    2013-01-01

    This commentary explores the challenges surrounding the development of a standard definition of lymphedema and method of quantification, proposes solutions, and calls for a collaborative effort among providers who care for patients with breast cancer.

  19. Adaptations in the Treatment of Congenital Lymphedema Centered on the Quality of Life

    OpenAIRE

    Jose Maria Pereira de Godoy; Ana Paula Sanchez; Daniel Zucchi Libanore; Maria de Fatima Guerreiro Godoy

    2014-01-01

    Case Description. This report describes the evolution, necessary adaptations, and complications in the treatment of a 9-year-old child with primary congenital lymphedema. Description of Intervention. The clinical treatment of lymphedema was started in the first year of the patient’s life and for five years she was only treated using the Godoy & Godoy technique of cervical stimulation. Three years ago the patient was prescribed a compression stocki...

  20. Prevalence and Epidemiological Factors Involved in Cellulitis in Korean Patients With Lymphedema

    OpenAIRE

    Park, Sae In; Yang, Eun Joo; Kim, Dong Kyu; Jeong, Ho Joong; Kim, Ghi Chan; Sim, Young-Joo

    2016-01-01

    Objective To evaluate the prevalence and associated factors involved in cellulitis with lymphangitis among a group of Korean patients who were being treated for lymphedema. We present our epidemiologic research and we also report a systematic review of these types of cases. Methods This was a retrospective medical record study among 1,246 patients diagnosed with lymphedema. The study was carried out between January 2006 and December 2012 at the Kosin University Gospel Hospital and Seoul Natio...

  1. Godoy & Godoy technique in the treatment of lymphedema for under-privileged populations

    OpenAIRE

    José Maria Pereira de Godoy, Maria de Fátima Guerreiro de Godoy

    2010-01-01

    The aim of this paper is to report new options in the treatment of lymphedema for under-privileged populations. Several articles and books have been published reporting recent advances and contributions. A new technique of manual lymph drainage, mechanisms of compression, development of active and passive exercising apparatuses and the adaptation of myolymphokinetic activities have been developed for the treatment of lymphedema. This novel approach can be adapted for the treatment of lymphede...

  2. VEGF-C gene therapy augments postnatal lymphangiogenesis and ameliorates secondary lymphedema

    OpenAIRE

    Yoon, Young-sup; Murayama, Toshinori; Gravereaux, Edwin; Tkebuchava, Tengiz; Silver, Marcy; Curry, Cynthia; Wecker, Andrea; Kirchmair, Rudolf; Hu, Chun Song; Kearney, Marianne; Ashare, Alan; Jackson, David G.; Kubo, Hajime; Isner, Jeffrey M.; Losordo, Douglas W.

    2003-01-01

    Although lymphedema is a common clinical condition, treatment for this disabling condition remains limited and largely ineffective. Recently, it has been reported that overexpression of VEGF-C correlates with increased lymphatic vessel growth (lymphangiogenesis). However, the effect of VEGF-C–induced lymphangiogenesis on lymphedema has yet to be demonstrated. Here we investigated the impact of local transfer of naked plasmid DNA encoding human VEGF-C (phVEGF-C) on two animal models of lymphed...

  3. Clinical Outcomes of Extracorporeal Shock Wave Therapy in Patients With Secondary Lymphedema: A Pilot Study

    OpenAIRE

    Bae, Hasuk; Kim, Ho Jeong

    2013-01-01

    Objective To investigate the clinical effect of extracorporeal shock wave therapy (ESWT) in patients with secondary lymphedema after breast cancer treatment. Methods In a prospective clinical trial, ESWT was performed consecutively 4 times over two weeks in 7 patients who were diagnosed with stage 3 secondary lymphedema after breast cancer treatment. Each patient was treated with four sessions of ESWT (0.056-0.068 mJ/mm2, 2,000 impulses). The parameters were the circumference of the arm, thic...

  4. Current Status of Lymphatic Reconstructive Surgery for Chronic Lymphedema: It Is Still an Uphill Battle!

    OpenAIRE

    Lee, B.B.; Laredo, J.; Neville, R.

    2011-01-01

    The goal of reconstructive lymphatic surgery is to restore normal lymphatic function to “cure” permanently the lymphedematous limb in patients with lymphedema. In reality, reconstructive surgery remains an adjunctive treatment at best, with its current indication being refractory lymphedema in patients treated with complex decongestive therapy (CDT) alone. The role of reconstructive lymphatic surgery remains controversial and is far from being accepted as standard independent therapy because ...

  5. Results of surgical treatment of massive localized lymphedema in severely obese patients

    OpenAIRE

    Wilson Cintra Júnior; Miguel Luiz Antonio Modolin; Rodrigo Itocazo Rocha; Thadeu Rangel Fernandes; Ariel Barreto Nogueira; Rolf Gemperli

    2014-01-01

    OBJECTIVE: to evaluate the importance of treatment of deformities caused by massive localized lymphedema (MLL) in the severely obese. METHODS: in a period of seven years, nine patients with morbid obesity and a mean age of 33 years underwent surgical resection of massive localized lymphedema with primary synthesis. This is a retrospective study on the surgical technique, complication rates and improved quality of life. RESULTS: all patients reported significant improvement after surgery, ...

  6. Predictors of Practice Patterns for Lymphedema Care Among Oncology Advanced Practice Nurses

    OpenAIRE

    Ryan, Joanne C.; Cleland, Charles M.; Mei R. Fu

    2012-01-01

    Lymphedema, a debilitating and chronic condition, is considered to be one of the most distressing adverse effects of cancer treatment. The purpose of this study was to understand the practice patterns in lymphedema care and identify predictors influencing those patterns among oncology nurses, with a focus on advanced practice nurses. Random and purposive sampling was utilized to recruit 238 oncology nurses who completed the Web-based study. Participants included advanced practice nurses (nurs...

  7. New Refinements in Greater Omentum Free Flap Transfer for Severe Secondary Lymphedema Surgical Treatment

    OpenAIRE

    Lasso, Jose M.; Pinilla, Carmen; Castellano, Michele

    2015-01-01

    Summary: Lymphedema is a chronic debilitating disease, affecting a considerable part of the population; it results from impairment of the lymphatic system. It is highly prevalent among patients subjected to axillary and groin nodal dissection after surgery for breast cancer, abdominopelvic surgery, and lymphadenectomy after melanoma surgery. Interestingly, among the surgical treatment options for lymphedema, groin lymph node transfer is gaining popularity; however, in some cases, dissection a...

  8. Lymphedema Following Treatment for Breast Cancer: A New Approach to an Old Problem

    OpenAIRE

    O’Toole, Jean; Jammallo, Lauren; Skolny, Melissa; Miller, Cynthia; Elliott, Krista; Specht, Michelle; Taghian, Alphonse G.

    2013-01-01

    Lymphedema following treatment for breast cancer can be an irreversible condition with a profound negative impact on quality of life. The lack of consensus regarding standard definitions of clinically significant lymphedema and optimal methods of measurement and quantification are unresolved problems. Inconsistencies persist regarding the appropriate timing of intervention and what forms of treatment should be the standard of care. There are reports that early detection and intervention can p...

  9. The effect of mechanical lymph drainage accompanied with heat on lymphedema

    OpenAIRE

    Valente Flávia Mariana; Guerreiro Godoy Maria de Fátima; Pereira de Godoy José Maria

    2011-01-01

    Background: Thermotherapy has been indicated by some researchers as a treatment for lymphedema. A study comparing temperatures demonstrated that a temperature of 40°C significantly increased the transportation of lymph compared to other temperatures assessed. The aim of this study was to evaluate the possible benefits of mechanical lymph drainage accompanied with heat in the treatment of lymphedema of the lower limbs. Methods: In a cross-over randomized study, the effect of heat on lymph ...

  10. New compression mechanism in penile-scrotal lymphedema and sexual rehabilitation

    OpenAIRE

    Jose Maria Pereira de Godoy; Fernando Nestor Facio; Eleni Cássia Matias de Carvalho; Maria de Fatima Guerreiro Godoy

    2014-01-01

    The objective of this study is to describe a new compression mechanism in the treatment of lymphedema of the penis and scrotum and the ensuing sexual rehabilitation. The patient, a 58-year-old man, had edema of the penile and scrotal region as a result of surgery of the pancreas and spleen and chemotherapy. The patient complained of pain, discomfort, and difficulties to walk and urinate. A clinical diagnosis of lymphedema of the penis and scrotum was reached. Treatment involved the continuous...

  11. The risk of lymphedema after postoperative radiation therapy in endometrial cancer

    OpenAIRE

    Mitra, Devarati; Catalano, Paul J.; Cimbak, Nicole; Damato, Antonio L; Muto, Michael G.; Viswanathan, Akila N.

    2016-01-01

    Objective: Lower extremity lymphedema adversely affects quality of life by causing discomfort, impaired mobility and increased risk of infection. The goal of this study is to investigate factors that influence the likelihood of lymphedema in patients with endometrial cancer who undergo adjuvant radiation with or without chemotherapy. Methods: A retrospective chart review identified all stage I–III endometrial cancer patients who had a hysterectomy with or without complete staging lymphadenect...

  12. Upper extremity impairments in women with or without lymphedema following breast cancer treatment

    OpenAIRE

    Smoot, Betty; Wong, Josephine; Cooper, Bruce; Wanek, Linda; Topp, Kimberly; Byl, Nancy; Dodd, Marylin

    2010-01-01

    Introduction Breast-cancer-related lymphedema affects ∼25% of breast cancer (BC) survivors and may impact use of the upper limb during activity. The purpose of this study is to compare upper extremity (UE) impairment and activity between women with and without lymphedema after BC treatment. Methods 144 women post BC treatment completed demographic, symptom, and Disability of Arm-Shoulder-Hand (DASH) questionnaires. Objective measures included Purdue pegboard, finger-tapper, Semmes-Weinstein m...

  13. The risk of lymphedema after postoperative radiation therapy in endometrial cancer

    OpenAIRE

    Mitra, Devarati; Catalano, Paul J.; Cimbak, Nicole; Damato, Antonio L; Muto, Michael G.; Viswanathan, Akila N.

    2015-01-01

    Objective Lower extremity lymphedema adversely affects quality of life by causing discomfort, impaired mobility and increased risk of infection. The goal of this study is to investigate factors that influence the likelihood of lymphedema in patients with endometrial cancer who undergo adjuvant radiation with or without chemotherapy. Methods A retrospective chart review identified all stage I–III endometrial cancer patients who had a hysterectomy with or without complete staging lymphadenectom...

  14. Improvement of Upper Extremity Lymphedema after Delayed Breast Reconstruction with an Extended Latissimus Dorsi Myocutaneous Flap

    OpenAIRE

    Kyeong Tae Lee; So-Young Lim; Jai-Kyung Pyun; Goo-Hyun Mun; Kap-Sung Oh; Sa-Ik Bang

    2012-01-01

    Lymphedema is a common complication after mastectomy in breast cancer patients. Many treatment options are available, but no treatment results in a complete cure. We report a case of lymphedema that occurred after modified radical mastectomy in a breast cancer patient who showed objective improvement after delayed breast reconstruction with an latissimus dorsi myocutaneous flap. A 41-year-old female patient with left breast cancer had undergone modified radical mastectomy with axillary lymph ...

  15. Clinical Significance of Lymphoscintigraphy Findings in the Evaluation of Lower Extremity Lymphedema

    OpenAIRE

    Seyhan Karaçavuş; Yunus Keser Yılmaz; Hasan Ekim

    2015-01-01

    Objective: The purpose of this study was to investigate the clinical significance of lymphoscintigraphy imaging in the evaluation of lower extremity lymphedema. Methods: Technetium-99m-labeled nanocolloid was injected subcutaneously in the first web spaces of both feet of 123 patients (M/F: 43/80, mean age 57.5±13.1 years, range 16-78 years) who had clinical evidence of lower extremity swelling with suspicion of lymphedema, and were referred for routine lymphoscintigraphy. Lymphos...

  16. Primary Congenital Lymphedema Complicated by Hydrops Fetalis: A Case Report and Review of the Literature

    OpenAIRE

    Paul Singh; Matthew Connell

    2013-01-01

    Introduction. Primary congenital lymphedema is a rare disorder associated with insufficient development of lymphatic vessels. Usually most patients present with lower extremity edema seen sonographically. Rarely primary congenital lymphedema may be associated with severe lymphatic dysfunction resulting in hydrops fetalis. Case. A 27-year-old primigravida with a family history of leg swelling throughout multiple generations was diagnosed early in the third trimester with hydrops fetalis. Deliv...

  17. Rhesus monkey is a new model of secondary lymphedema in the upper limb

    OpenAIRE

    Wu, Guojun; Xu, Hao; Zhou, Wenhong; Yuan, Xianshun; Yang, Zhe; Yang, Qing; Ding, Feng; Meng, Zhigang; Liang, Weili; Geng, Chong; Gao, Ling; Tian, Xingsong

    2014-01-01

    Objective: This study is to establish the rhesus monkey model of lymphedema in the upper limbs, and assess the suitability of this model. Methods: An animal model of lymphedema was established by the combined irradiation and surgical techniques in the upper limbs of these rhesus monkeys. Physical examination, high-resolution MR lymphangiography, bioelectrical impedance analysis (BIA), and immunohistochemical staining were performed to determine the severity of the edema in the upper limbs of ...

  18. Cutaneous Epithelioid Clear Cells Angiosarcoma in a Young Woman with Congenital Lymphedema

    OpenAIRE

    Flore Tabareau-Delalande; Anne De Muret; Elodie Miquelestorena-Standley; Anne-Valérie Decouvelaere; Gonzague De Pinieux

    2013-01-01

    Angiosarcomas are rare aggressive neoplasms that can occur secondary to chronic lymphedema (Stewart-Treves syndrome). Although secondary angiosarcomas are commonly described after-mastectomy and/or after-radiotherapy, few cases have been reported in association with chronic lymphedema of congenital origin. We report the clinical, pathological, and cytogenetic findings in a case of cutaneous epithelioid clear cells angiosarcoma that occurred in a 21-year-old woman with hemibody congenital lymp...

  19. The Influence of Arm Swelling Duration on Shoulder Pathology in Breast Cancer Patients with Lymphedema

    OpenAIRE

    Dae-Hyun Jang; Min-Wook Kim; Se-Jeong Oh; Jae Min Kim

    2015-01-01

    Purpose To evaluate the pathological effect of the duration of arm swelling on the shoulder pathology in patients with breast cancer-related lymphedema. Methods Forty seven breast cancer patients with unilateral arm lymphedema were assessed. The duration of the arm swelling and shoulder pain were recorded. Ultrasound examination of the shoulder joint was performed in all patients to detect any lesions. Results Abnormalities were detected by ultrasound in 41/47 (87.2%) study participants. Suba...

  20. Clinical Effectiveness of Complex Decongestive Physiotherapy for Malignant Lymphedema: A Pilot Study

    OpenAIRE

    Hwang, Ki Hun; Jeong, Ho Joong; Kim, Ghi Chan; Sim, Young-Joo

    2013-01-01

    Objective To evaluate the effect of complex decongestive physiotherapy (CDPT) on malignant lymphedema patients. Methods Patients (n=22) with malignant lymphedema of the upper or the lower limb were assigned to this study. CDPT without manual lymphatic drainage (MLD) was used five times per week for two weeks. The main outcome measurements included measurement of the circumference of the limb (proximal, distal, and total) to assess volume changes. We also employed the visual analog scale (VAS)...

  1. Liposuction for Advanced Lymphedema: A Multidisciplinary Approach for Complete Reduction of Arm and Leg Swelling

    OpenAIRE

    Boyages, John; Kastanias, Katrina; Koelmeyer, Louise A.; Winch, Caleb J.; Lam, Thomas C.; Sherman, Kerry A.; Munnoch, David Alex; Brorson, Håkan; Ngo, Quan D.; Heydon-White, Asha; Magnussen, John S.; Mackie, Helen

    2015-01-01

    Purpose This research describes and evaluates a liposuction surgery and multidisciplinary rehabilitation approach for advanced lymphedema of the upper and lower extremities. Methods A prospective clinical study was conducted at an Advanced Lymphedema Assessment Clinic (ALAC) comprised of specialists in plastic surgery, rehabilitation, imaging, oncology, and allied health, at Macquarie University, Australia. Between May 2012 and 31 May 2014, a total of 104 patients attended the ALAC. Eligibili...

  2. Impairment of Lymph Drainage in Subfascial Compartment of Forearm in Breast Cancer-Related Lymphedema

    OpenAIRE

    Stanton, A.W.B.; MELLOR, R.H.; Cook, G.J.; Svensson, W E; Peters, A M; Levick, J. R.; Mortimer, P S

    2003-01-01

    Background: In arm lymphedema secondary to axillary surgery and radiotherapy (breast cancer-related lymphedema), the swelling is largely epifascial and lymph flow per unit epifascial volume is impaired. The subfascial muscle compartment is not measurably swollen despite the iatrogenic damage to its axillary drainage pathway, but this could be due to its low compliance. Our aim was to test the hypothesis that subfascial lymph drainage too is impaired.

  3. A comprehensive review of the natural lymphaticovenous communications and their role in lymphedema surgery.

    Science.gov (United States)

    Miranda Garcés, María; Mirapeix, Rosa; Pons, Gemma; Sadri, Amir; Masià, Jaume

    2016-03-01

    Cancer-related lymphedema is a progressive, chronic condition that impairs quality of life. Its pathophysiology and the mechanisms of action of current reconstructive surgical treatments are not fully understood but lymphaticovenous communications may play a key role. We review the available literature on lymphaticovenous communications and their implications in lymphedema surgery, and propose a subclassification of lymphaticovenous communications. J. Surg. Oncol. 2016;113:374-380. © 2016 Wiley Periodicals, Inc. PMID:26780968

  4. Evaluation of kinesthetic sense and hand function in women with breast cancer-related lymphedema

    OpenAIRE

    Karadibak, Didem; Yavuzsen, Tugba

    2015-01-01

    [Purpose] This study evaluated the functional ability and kinesthetic sense of the hands of women with breast cancer-related lymphedema. [Subjects and Methods] Fifty-seven women experiencing lymphedema after breast surgery and adjuvant radiotherapy were included. The patients were divided into two groups: women with hand edema (HE+, n = 29) and without hand edema (HE−, n = 28) after breast cancer treatment. Arm edema severity, hand size, functional mobility and kinesthetic sense of the hand, ...

  5. Intermittent pneumatic compression pump in upper extremity impairments of breast cancer-related lymphedema

    OpenAIRE

    UZKESER, Hülya; Karatay, Saliha

    2013-01-01

    To investigate the effect of intermittent pneumatic compression (IPC) pumps on upper extremity impairments in breast cancer-related lymphedema. Materials and methods: Twenty-five patients with lymphedema were randomized into 2 groups. For 3 weeks, the pneumatic compression group (n = 12) underwent a treatment program including skin care, compression bandage, exercise therapy, manual lymph drainage (MLD), and IPC. The control group (n = 13) participated in the same program, but without IPC. ...

  6. Recurrent furunculosis as a cause of isolated penile lymphedema: a case report

    OpenAIRE

    Sood Suneet; Al-shaham Ali A

    2010-01-01

    Abstract Introduction Isolated lymphedema of the penis is extremely rare: combined involvement of the scrotum and penis is the norm. Furunculosis as a cause is not, to our knowledge, previously reported. We present a case of isolated penile lymphedema that responded to excision of lymphedematous tissue and reconstruction with flaps. Case presentation A 32-year-old Arab man presented with a three-year history of a gradually increasing, painless penile swelling. Our patient's main complaint was...

  7. Basic safety principles of INSAG and their application in radioactive waste management

    International Nuclear Information System (INIS)

    The International Nuclear Safety Advisory Group (INSAG) has, in INSAG-11, attempted to show what safety principles are common to all applications of all sources of radiation. It has been considered that these general principles should apply to all industrial activities. A comparison of INSAG-11 with Article 11 of the Joint Convention on the Safety of Spent Fuel Management and on the Safety of Radioactive Waste Management (Joint Convention) shows that the management of radioactive waste is but a special case of industrial activity and follows the same safety rules. The importance of the Joint Convention comes, however, from the fact that it is a politically important document, requiring ratification by the parliaments of the contracting parties. The safe management of radioactive waste implies that five types of issue must be taken into consideration, not only technical and ethical ones, but also socio-political, economic and ecological ones. By comparison, sustainable development in its three dimensions (temporal, spatial and sectorial) has five components (ecology, economics, ethics, socio-politics and technology), just like the safe management of radioactive waste. The consequence of this is that if management is treated as a particular case of sustainable development, it will not be accepted by society. The conclusions are that technology alone can not ensure the safety of radioactive waste management and that society will always give priority to socio-political issues over technological ones. Furthermore, it is crucial that people involved in the management of radioactive waste learn to communicate better and to listen more attentively. Their efforts will only succeed when they incorporate all the components that determine the fabric of our society. (author)

  8. A Survey of the Status of Awareness of Lymphedema in Breast Cancer Patients in Busan-Gyeongnam, Korea

    OpenAIRE

    Choi, Jong Kyoung; Kim, Hui Dong; Sim, Young Joo; Kim, Ghi Chan; Kim, Dong Kyu; Yu, Byeng Chul; Park, Si-Sung; Jeong, Ho Joong

    2015-01-01

    Objective To support the establishment of lymphedema education plans and the actual practice of education by investigating the current lymphedema awareness status of Korean breast cancer patients. Methods cross-sectional population survey was conducted in 116 breast cancer patients in the Busan-Gyeongnam area. The survey included questions regarding demographic characteristics, breast cancer-related lymphedema (BCRL) risk factors, and characteristics and treatments of the disease. Some of the...

  9. Study Regarding the Effectiveness of Manual Lymphatic Drainage in the Case of Patients with Breast Cancer that Present Lymphedema

    OpenAIRE

    Alexandru MIOC; Corina PANTEA

    2013-01-01

    Lymphedema is defined as a persistent increase of tissue volume caused by the blocked or absent lymphatic drainage. The purpose of this study is to analyse the effectiveness of lymphatic drainage in the treatment of lymphedema after a mastectomy, with the aim of reducing the volume of the lymphedema and improving overall symptomatology, as well as providing information regarding the impact of this treatment on quality-of-life and the physical limitations of these patients. With these objectiv...

  10. A Pilot Randomized Trial Evaluating Lymphedema Self-Measurement with Bioelectrical Impedance, Self-Care Adherence, and Health Outcomes

    OpenAIRE

    Ridner, Sheila H.; Shih, Ya-Chen Tina; Doersam, Jennifer K.; Rhoten, Bethany Andrews; Schultze, Benjamin S.; Dietrich, Mary S.

    2014-01-01

    Background: Less than half of breast cancer survivors with lymphedema perform self-care as directed. Effective lymphedema self-care is required to obtain acceptable health outcomes. Self-Regulation Theory suggests that objective self-measurement of physiological conditions is necessary to promote self-regulation/self-care. Bioelectric Impedance Spectroscopy (BIS) represents a potential self-measurement method for arm lymphedema. The purpose of this pilot study was to examine the impact of arm...

  11. Diabetic Foot Ulcers Combination with Lower Limb Lymphedema Treated by Staged Charles Procedure: Case Report and Literature Review

    OpenAIRE

    Lin, Chin-Ta; Ou, Kuang-Wen; Chang, Shun-Cheng

    2013-01-01

    Primary or secondary, lymphedema is lymphatic dysfunction which results in protein-rich interstitial fluid accumulated in the skin and subcutaneous tissue. In developed countries, surgical resection of regional lymph nodes or chronic inflammation process is the most common etiology of lymphedema instead of parasite infection seen in developing countries. Patients with lymphedema sustain either cosmetic or functional problems, and several studies have indicated the potential risk, though not h...

  12. Effect of complete decongestive therapy and home program on health- related quality of life in post mastectomy lymphedema patients

    OpenAIRE

    Melam, Ganeswara Rao; Buragadda, Syamala; Alhusaini, Adel A.; Arora, Nisha

    2016-01-01

    Background Secondary lymphedema is common in women treated for breast cancer. It may be a result of surgery or radiotherapy. Edema commonly affects the arm, leading to discomfort, reduced arm movements, pain and diminished quality of life. Therefore, the relationship between post mastectomy lymphedema and quality of life has evolved as an important criteria in treatment of breast cancer survivors. Methods Sixty breast cancer survivors who developed post mastectomy lymphedema were recruited. P...

  13. Prevalence of lymphedema in women undergoing treatment for breast cancer in a referral center in southeastern Brazil

    OpenAIRE

    Paiva Daniella MF; Rodrigues Vivian O; Cesca Marcelle G; Palma Pamella V; Leite Isabel CG

    2013-01-01

    Abstract Background Lymphedema is a highly prevalent condition in women who have undergone treatment for breast cancer. Lymphedema negatively affects the quality of life. The objective of this study was to estimate the prevalence of lymphedema and associated factors in women treated for breast cancer in the municipality of Juiz de Fora. Methods We performed a cross-sectional study that evaluated 250 women who were being treated for breast cancer. Pre-screening of the sample by analysis of med...

  14. Basic criteria for a sustainable water management at the U.S.-México border: the case of ambos Nogales

    Directory of Open Access Journals (Sweden)

    Luis Ernesto Cervera Gómez

    2003-01-01

    Full Text Available This article aims to analyze some basic criteria for a sustainable use of water in an international watershed shared by Mexico and the United States. The study area comprises the region of Ambos Nogales, which is located inside the Upper Santa Cruz River Basin. This portion of the watershed represents the main ecosystem and the main source of water for urban and rural populations located in this region. Following criteria of sustainability the authors revise and adapt to the case of Ambos Nogales, a set of guidelines proposed by the Pacific Institute for Studies in Development, Environment, and Security. These guidelines include the following elements: basic water requirements needed to maintain quality of life in the population and the health of ecosystems; water quality that meets certain minimum standards; human actions and their impact on long-term renewability of freshwater stocks and flows; collection of data concerning water resources, use and quality of water; institutional mechanisms to prevent and resolve conflicts; and a democratic process of water-planning and decision-making. These twin cities have a long history of cooperation and conflict linked to water resources, which makes available enough information to create a diagnostic about the water management inside a binational arena, and allowing to explore possibilities for a better water resources management under a sustainable regime and from an international perspective. Keywords: Sustainability, binational water management, ambos Nogales region.

  15. Improvement of Upper Extremity Lymphedema after Delayed Breast Reconstruction with an Extended Latissimus Dorsi Myocutaneous Flap

    Directory of Open Access Journals (Sweden)

    Kyeong Tae Lee

    2012-03-01

    Full Text Available Lymphedema is a common complication after mastectomy in breast cancer patients. Manytreatment options are available, but no treatment results in a complete cure. We report acase of lymphedema that occurred after modified radical mastectomy in a breast cancerpatient who showed objective improvement after delayed breast reconstruction with anlatissimus dorsi myocutaneous flap. A 41-year-old female patient with left breast cancer hadundergone modified radical mastectomy with axillary lymph node dissection and postoperativeradiotherapy 12 years previously. Four years after surgery, lymphedema developed andincreased in aggravation despite conservative treatment. Eight years after the first operation,the patient underwent delayed breast reconstruction using the extended latissimus dorsimyocutaneous flap method. After reconstruction, the patient’s lymphedema symptomsshowed dramatic improvement by subjective measures including tissue softness and feeling oflightness, and by objective measures of about 7 mL per a week, resulting in near normal rangesof volume. At a postoperative follow-up after 3 years, no recurrence was observed. Delayedbreast reconstruction with extended latissimus dorsi myocutaneous flaps may be helpful topatients with lymphedema after mastectomy. This may be a good option for patients who areworried about the possibility of the occurrence or aggravation of secondary lymphedema.

  16. Profilometry and subsurface imaging in point of care diagnosis in ocular disease and lymphedema after breast cancer treatment

    Science.gov (United States)

    Sayegh, Samir I.; Taghian, Alphonse

    2013-02-01

    Breast cancer-related lymphedema (BCRL) can be irreversible with profound negative impact on patients' quality of life. Programs that provide screening and active surveillance for BCRL are essential to determine whether early detection and intervention influences the course of lymphedema development. Established methods of quantitatively assessing lymphedema at early stages include "volume" methods such as perometry and bioimpedance spectroscopy. Here we demonstrate 1) Use of topographical techniques analogous to those used in corneal topography 2) Development of point-of-care lymphedema detection and characterization based on off-the-shelf hardward 3) The role of subsurface imaging 4) Multimodal diagnostics and integration yielding higher sensitivity/ specificity.

  17. Indirect magnetic resonance lymphangiography in patients with lymphedema

    Energy Technology Data Exchange (ETDEWEB)

    Lohrmann, Christian [Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, D-79106 Freiburg (Germany)]. E-mail: lohrmann@mrs1.ukl.uni-freiburg.de; Foeldi, Etelka [Foeldi Clinic for Lymphology, Hinterzarten, Roesslehofweg 2-6, D-79856 Hinterzarten (Germany); Langer, Mathias [Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, D-79106 Freiburg (Germany)

    2006-09-15

    Purpose: To assess the feasibility of indirect magnetic resonance (MR) lymphangiography with intracutaneous injection of gadodiamide, a commercially available, non-ionic, extracellular paramagnetic contrast agent for the detection of lymphatic vessels in patients with lymphedema. Materials and methods: In 2005, three patients with lymphedema of the lower extremities (1 primary, 2 secondary) were referred by the Foeldi Clinic for Lymphology for indirect magnetic resonance lymphangiography. 4.5 mL of gadodiamide and 0.5 mL of mepivacainhydrochloride 1% were injected intracutaneously into the dorsal aspect of each foot. MR imaging was performed with a 1.5-T system equipped with high-performance gradients. For indirect magnetic resonance lymphangiography, a 3D Fast Low Angle Shot (FLASH) sequence (TR/TE: 5.1/1.23; flip angle: 25; matrix: 448 x 448; bandwidth: 330 Hz/pixel; 6/8 rectangular field of view with a maximum dimension of 500 mm; slices: 88; voxel size: 2.0 mm x 1.0 mm x 1.0 mm; acquisition time: 0 min 31 s) was used. Results: Indirect magnetic resonance lymphangiography depicted lymphatic vessels of the lower and upper leg, and inguinal lymph nodes in all three patients. After 5 min of contrast material application, concomitant venous enhancement was detected. Collateral vessels with dermal back-flow were seen in two patients. A lymphocele in the inguinal region with the afferent lymphatic vessel was depicted in one patient. Conclusion: In the presented small study group, indirect magnetic resonance lymphangiography was technically feasible, and no complications were observed after intracutaneous injection of gadodiamide. Visualizing the lymphatic vessels and accompanying complications non-invasively and without the use of radiation, the presented method has the capability to become a routine diagnostic imaging tool in patients with primary and secondary lymphedema. The method is not able to characterize lymph node morphology, but could provide additional

  18. Back to basics--just how much should a risk manager know about risk financing?

    Science.gov (United States)

    Miller, Vivian B

    2011-01-01

    Whether directly involved in development and implementation of the organization's risk financing program or not, risk management professionals, at the very least, need to be familiar with and understand the various risk financing strategies available to address all areas of exposure. This article addresses the types of coverages and risk financing options that should be considered when developing a comprehensive risk-financing program, and why it is important for risk management professionals to have some knowledge about these products, in order for their true value to be fully appreciated.

  19. Energy management and effective energy use in Ukraine: basic problems and ways to solve them

    International Nuclear Information System (INIS)

    In this paper, barriers in the way of energy efficiency are considered and classified. The classification is made in six blocks: financial, sociological, manufacturing, management-organisational, legal and market. A strategy to overcome these barriers and the achievement of more effective energetics in Ukraine are proposed. On the basis of the strategy, five indissoluble tasks are considered: energy supply reliability, pricing and tariff policy, the legislative and normative base, energy use efficiency, environmental protection and decrease in influence on climate change. Solving these problems will allow the construction of an effective system of energy management in Ukraine. (author)

  20. Application of an Online Reference for Reviewing Basic Statistical Principles of Operating Room Management

    Science.gov (United States)

    Dexter, Franklin; Masursky, Danielle; Wachtel, Ruth E.; Nussmeier, Nancy A.

    2010-01-01

    Operating room (OR) management differs from clinical anesthesia in that statistical literacy is needed daily to make good decisions. Two of the authors teach a course in operations research for surgical services to anesthesiologists, anesthesia residents, OR nursing directors, hospital administration students, and analysts to provide them with the…

  1. MRI of lymphedema using short-TI-IR (STIR)

    Energy Technology Data Exchange (ETDEWEB)

    Fujii, Koichi; Ishida, Osamu; Mabuchi, Norihisa; Shindou, Hiroshi; Yoshioka, Hiroyasu; Kumano, Machiko; Hamada, Tatsumi; Ohkuma, Moriya (Kinki Univ., Osaka (Japan). School of Medicine)

    1990-01-01

    Thirty four cases with lymphedema of the extremities were examined with MRI at 0.5 tesla. On T1-weighted image, the enlarged subcutaneous tissue and the subcutaneous trabecular structures were seen in all cases. Moreover, the trabecular structures in the enlarged subcutaneous tissue showed low signal intensity on T1-weighted image and high signal intensity on T2-weighted image in all cases. Additionally, in 12 of 15 cases examined by Short-TI-IR (STIR) image, the trabecular structures and fluid collections in the subcutaneous tissue were shown more definitely in high signal intensity than by T2-weighted image. We consider MRI using STIR is to be useful in the evaluation of edematous disease. (author).

  2. Impact of adjuvant taxane-based chemotherapy on development of breast cancer-related lymphedema: results from a large prospective cohort

    OpenAIRE

    Swaroop, Meyha N.; Ferguson, Chantal M.; Horick, Nora K.; Skolny, Melissa N; Miller, Cynthia L.; Jammallo, Lauren S; Brunelle, Cheryl L.; O’Toole, Jean A; Isakoff, Steven J.; Specht, Michelle C.; Taghian, Alphonse G.

    2015-01-01

    Taxane-based chemotherapy for the treatment of breast cancer is associated with fluid retention in the extremities; however, its association with development of breast cancer-related lymphedema is unclear. We sought to determine if adjuvant taxane-based chemotherapy increased risk of lymphedema or mild swelling of the upper extremity. 1121 patients with unilateral breast cancer were prospectively screened for lymphedema with perometer measurements. Lymphedema was defined as a relative volume ...

  3. Comparison of Breast Cancer-Related Lymphedema (Upper Limb Swelling) Prevalence Estimated Using Objective and Subjective Criteria and Relationship with Quality of Life

    OpenAIRE

    Catherine Bulley; Susanne Gaal; Fiona Coutts; Christine Blyth; Wilma Jack; Udi Chetty; Matthew Barber; Chee-Wee Tan

    2013-01-01

    This study aimed to investigate lymphedema prevalence using three different measurement/diagnostic criterion combinations and explore the relationship between lymphedema and quality of life for each, to provide evaluation of rehabilitation. Cross-sectional data from 617 women attending review appointments after completing surgery, chemotherapy, and radiotherapy included the Morbidity Screening Tool (MST; criterion: yes to lymphedema); Lymphedema and Breast Cancer Questionnaire (LBCQ; criterio...

  4. PROBLEMS AND PROSPECTS OF MANAGEMENT OF INFORMATION BASE OF INNOVATION ENVIRONMENT: BASIC APPROACHES TO THE CONTENT OF THE INNOVATION STATISTICS

    Directory of Open Access Journals (Sweden)

    Oxana Vasilevna Buz

    2014-09-01

    Full Text Available Subject of the research are basic approaches to the content of innovation statistics. The purpose of the study is an analysis of the current situation and making proposals for improvement of the management information base of innovative environment and the content of innovation statistics.The analysis of the regulations and guides that regulate the existing methods of data collection, generalization and analysis of information on innovation at the level of the regions of the Russian Federation is made. Existing deficiencies of the management of information base innovation environment were defined, including the lack of regulations of interaction of executive authorities at various levels, the discrepancy of the method of calculation of indicators of innovation statistics to the specifics of particular regions, big time of data acquisition and processing that does not allow the operational management of innovation activity.As a result of the study a set of measures to improve the quality of statistics of innovation and improvement of the management of innovation activity were developed.

  5. The Nephrologist's Tumor: Basic Biology and Management of Renal Cell Carcinoma.

    Science.gov (United States)

    Hu, Susie L; Chang, Anthony; Perazella, Mark A; Okusa, Mark D; Jaimes, Edgar A; Weiss, Robert H

    2016-08-01

    Kidney cancer, or renal cell carcinoma (RCC), is a disease of increasing incidence that is commonly seen in the general practice of nephrology. However, RCC is under-recognized by the nephrology community, such that its presence in curricula and research by this group is lacking. In the most common form of RCC, clear cell renal cell carcinoma (ccRCC), inactivation of the von Hippel-Lindau tumor suppressor is nearly universal; thus, the biology of ccRCC is characterized by activation of hypoxia-relevant pathways that lead to the associated paraneoplastic syndromes. Therefore, RCC is labeled the internist's tumor. In light of this characterization and multiple other metabolic abnormalities recently associated with ccRCC, it can now be viewed as a metabolic disease. In this review, we discuss the basic biology, pathology, and approaches for treatment of RCC. It is important to distinguish between kidney confinement and distant spread of RCC, because this difference affects diagnostic and therapeutic approaches and patient survival, and it is important to recognize the key interplay between RCC, RCC therapy, and CKD. Better understanding of all aspects of this disease will lead to optimal patient care and more recognition of an increasingly prevalent nephrologic disease, which we now appropriately label the nephrologist's tumor.

  6. Lymphedema of the lower limbs - a lymphoscintigraphic approach; Linfedemas dos membros inferiores: estudo linfocintilografico

    Energy Technology Data Exchange (ETDEWEB)

    Cestari, S.C.P.; Petri, V.; Castiglioni, M.L.V.; Lederman, H. [Escola Paulista de Medicina, Sao Paulo, SP (Brazil)

    1994-12-31

    Patients with lymphedema of the lower limbs (LLL) are usually affected by recurrent erysipelas. This bacterial infection is usually admitted as an aetiological factor, but it can be a consequence of some previous lymphatic abnormality. Classically, the commonest causative factors of LLL are bacterial infection, venous ulcers, trauma (leading to secondary lymphedema) and congenital disorders of the lymphatic system primary lymphedema praecox or tarda. To identify previous lymphatics abnormalities in patients with LLL, admitted as having secondary lymphatic lymphedema - as consequences of infection, trauma or other factors -, by using lymphoscintigraphic method. To observe advantages of this approach in practical assistance and evaluation of LLL cases. Twelve patients with LLL, supposed to have primary (congenital) or secondary disorder affecting one or both lower extremities were submitted to lymphoscintigraphy at the Escola Paulista de Medicina of Sao Paulo, Brazil. Each patient received an intra dermal injection of labelled Dextran (Dx{sup 99m} Tc) at the first interdigital space of each foot and , after one to three hours, images of lower extremities, pelvic and abdominal areas were obtained with Gammatome CGR. Examination of all 24 lower extremities disclosed clinical diagnosis of lymphedema in 17 (70.8%), being five (41.6%) with clinical signs of lymphedema of both lower limbs and seven (58.3%) of a single one. The lymphoscintigraphic images revealed lymphatic disordersin 22 of the 24 extremities (91.7%). Lymphoscintigraphic abnormalities in clinically normal lower extremities were observed in five cases (41.3%). Lymphoscintigraphy is a non-invasive useful method to study LLL, with involvement of one or both limbs. It does not differentiate between primary and secondary lymphedema, but makes possible to detect cases of normal appearance of the limbs with previous lymphatic defect(s), changing aetiological diagnosis. (Abstract Truncated)

  7. The implementation of quality assurance programs: basic aspect in nuclear plants management

    International Nuclear Information System (INIS)

    Experience in implementing and developing the Quality Assurance programme for the Almaraz nuclear power plant is briefly described. Almaraz was the first Spanish nuclear plant that had to apply specific Quality Assurance standards to its project and construction. The complexity of the project which was developed using standards in a continuous state of evolution, the large number of participating organizations and the numerous interrelationships between them, made the working methods required by the Quality Assurance standards a fundamental tool for establishing order within the framework of the projects, an essential requirement to achieve the objectives regarding costs, schedules and quality. The experience has shown that implementation of Quality Assurance programmes must be accomplished from the highest levels of management and must be thought of as being an essential management tool for achievement of the objectives established, and subjected to periodic revisions in order to check their effectiveness. This logically means that the scope of Quality Assurance must be extended to cover not only those aspects relating to safety but also all activities directly or indirectly affecting adequate operation of the plant, grading the requirements depending on several factors as impact on plant availability, costs of items, complexity of activities, etc. (author)

  8. Microzonation in Urban Areas, Basic Element for Land-Use Planning, Risk Management and Sustainable Development

    Science.gov (United States)

    Torres Morales, G. F.; Dávalos Sotelo, R.; Castillo Aguilar, S.; Mora González, I.; Lermo Samaniego, J. F.; Rodriguez, M.; García Martínez, J.; Suárez, M. Leonardo; Hernández Juan, F.

    2013-05-01

    This paper presents the results of microzonification of the natural hazards for different metropolitan areas and highlights the importance of integrating these results in urban planning. The cities that have been covered for the definition of danger in the state of Veracruz are: Orizaba, Veracruz and Xalapa, as part of the production of a Geological and Hydrometeorology Hazards Atlas for the state of Veracruz, financed by the Funds for the Prevention of Natural Disasters FOPREDEN and CONACYT. The general data of each metropolitan area was integrated in a geographic information system (GIS), obtaining different theme maps, and maps of dynamic characteristics of soils in each metropolitan area. For the planning of an urban area to aspire to promote sustainable development, it is essential to have a great deal of the details on the pertinent information and the most important is that that has to do with the degree of exposure to natural phenomena. In general, microzonation investigations consider all natural phenomena that could potentially affect an area of interest and hazard maps for each of potential hazards are prepared. With all the data collected and generated and fed into a SIG, models were generated which define the areas most threatened by earthquake, flood and landslide slopes. These results were compared with maps of the main features in the urban zones and a qualitative classification of areas of high to low hazard was established. It will have the basic elements of information for urban planning and land use. This information will be made available to the authorities and the general public through an Internet portal where people can download and view maps using free software available online.;

  9. Identification of relevant ICF (International Classification of Functioning, Disability and Health) categories in lymphedema patients: A cross-sectional study

    NARCIS (Netherlands)

    Viehoff, P.B.; Potijk, F.; Damstra, R.J.; Heerkens, Y.F.; Ravensberg, C.D. van; Berkel, D.M. van; Neumann, H.A.

    2015-01-01

    BACKGROUND: To describe functioning and health of lymphedema patients and to identify their most common problems using the International Classification of Functioning, Disability and Health (ICF) as part of the preparatory studies for the development of ICF Core Sets for lymphedema. METHODS: Cross-s

  10. Identification of relevant ICF (International Classification of Functioning, Disability and Health) categories in lymphedema patients: A cross-sectional study

    NARCIS (Netherlands)

    P.B. Viehoff (Peter); F. Potijk; R.J. Damstra; Y.F. Heerkens (Yvonne); C.D. van Ravensberg (Dorine); D.M. Van Berkel; H.A.M. Neumann (Martino)

    2015-01-01

    textabstractBackground. To describe functioning and health of lymphedema patients and to identify their most common problems using the International Classification of Functioning, Disability and Health (ICF) as part of the preparatory studies for the development of ICF Core Sets for lymphedema.Metho

  11. WATER EXERCISE COMPARED TO LAND EXERCISE OR STANDARD CARE IN FEMALE CANCER SURVIVORS WITH SECONDARY LYMPHEDEMA.

    Science.gov (United States)

    Lindquist, H; Enblom, A; Dunberger, G; Nyberg, T; Bergmark, K

    2015-06-01

    There are few studies showing that physical exercise can improve secondary lymphedema. We hypothesized that water exercise would be more effective than land exercise in reducing limb volume. Secondary objectives were joint movement, BMI, daily function, well-being, and body image. Limb volume was measured with circumference or was volumetric. Well-being and body image were measured with a study-specific questionnaire and daily function with DASH and HOOS questionnaires. Eighty-eight eligible patients with secondary lymphedema after breast or gynecological cancer participated in this controlled clinical intervention study. There was a higher proportion of women who participated in water exercises who reduced their secondary arm limb volume (p = 0.029), and there were also significant differences for BMI (p = 0.047) and self-reported frequency of swelling (p = 0.031) in the water exercise group after intervention. Women with arm lymphedema in the land exercise group improved DASH scores (p = 0.047) and outer rotation in the shoulder (p = 0.001). Our results suggest that to reduce objective and self-reported swelling, lymphedema patients may be offered water exercise training while to improve daily shoulder function, land exercises are preferred. To guide female cancer survivors with lymphedema to effective exercise resulting in reduced limb volume and improved function, adequate evidenced-based programs are needed. PMID:26714371

  12. Prominent Lymphatic Vessel Hyperplasia with Progressive Dysfunction and Distinct Immune Cell Infiltration in Lymphedema.

    Science.gov (United States)

    Gousopoulos, Epameinondas; Proulx, Steven T; Scholl, Jeannette; Uecker, Maja; Detmar, Michael

    2016-08-01

    Lymphedema is a common complication that occurs after breast cancer treatment in up to 30% of the patients undergoing surgical lymph node excision. It is associated with tissue swelling, fibrosis, increased risk of infection, and impaired wound healing. Despite the pronounced clinical manifestations of the disease, little is known about the morphological and functional characteristics of the lymphatic vasculature during the course of lymphedema progression. We used an experimental murine tail lymphedema model where sustained fluid stasis was generated on disruption of lymphatic flow, resulting in chronic edema formation with fibrosis and adipose tissue deposition. Morphological analysis of the lymphatic vessels revealed a dramatic expansion during the course of the disease, with active proliferation of lymphatic endothelial cells at the early stages of lymphedema. The lymphatic capillaries exhibited progressively impaired tracer filling and retrograde flow near the surgery site, whereas the collecting lymphatic vessels showed a gradually decreasing contraction amplitude with unchanged contraction frequency, leading to lymphatic contraction arrest at the later stages of the disease. Lymphedema onset was associated with pronounced infiltration by immune cells, predominantly Ly6G(+) and CD4(+) cells, which have been linked to impaired lymphatic vessel function. PMID:27315777

  13. Refractory lymphedema of the hand: an unusual presentation of recurrent herpes simplex virus infection

    Directory of Open Access Journals (Sweden)

    Ali Majdzadeh

    2016-07-01

    Full Text Available Introduction: Herpes Simplex Virus (HSV infection of the hand resulting in lymphatic complications such as lymphangitis and lymphedema is exceedingly uncommon. Although these complications typically resolve in 21 days, they can be persistent and may not resolve even with antiviral use, thereby mimicking dyshidrotic eczema or a bacterial event and often being misdiagnosed and inappropriately treated as such. We report a case of frequently recurring HSV infection of the hand over a long period of time resulting in refractory lymphedema which did not resolve with antiviral treatment. We further endeavor to raise awareness about this highly unusual presentation of HSV infection. A comprehensive review of the literature was conducted for similar cases using PubMed and Medline. Case Report: This is the first reported case with nearly a decade-long interval between the onset of primary HSV infection and the development of chronic lymphedema. Although valacyclovir significantly reduced the episodic aggravation of the lymphedema, it did not entirely resolve it. Similar cases of persistent lymphedema also included a long history of untreated and recurrent HSV infection of the hand, suggesting that this lymphatic outcome may be circumvented by prompt treatment with antivirals. Conclusion: This case report not only presents a highly uncommon lymphatic manifestation and unusual timeline of exacerbation of the very common HSV infection, but also highlights the importance and benefits of early initiation of antiviral therapy and the prevention of reactivation.

  14. Basic Education Management Informatization Standard Ideas%关于基础教育管理信息化功能标准思路

    Institute of Scientific and Technical Information of China (English)

    张为民

    2011-01-01

    Higher education in the social structure of the transition,facing new opportunities and challenges,basic educational information in the education management information can become an important strategy for the reform of education and management trends.Basic teaching of management information to further improve the quality of basic education management and the absolute need.%高等教育在社会结构的转型期面临新的机遇和挑战,基础教育信息化在教育管理信息化中能够成为教育管理改革的重要战略发展趋势。基础教学管理信息化能进一步提高基础教学管理水平和质量的绝对需要

  15. Measuring and managing progress in the establishment of basic health services: the Afghanistan health sector balanced scorecard.

    Science.gov (United States)

    Hansen, Peter M; Peters, David H; Niayesh, Haseebullah; Singh, Lakhwinder P; Dwivedi, Vikas; Burnham, Gilbert

    2008-01-01

    The Ministry of Public Health (MOPH) of Afghanistan has adopted the Balanced Scorecard (BSC) as a tool to measure and manage performance in delivery of a Basic Package of Health Services. Based on results from the 2004 baseline round, the MOPH identified eight of the 29 indicators on the BSC as priority areas for improvement. Like the 2004 round, the 2005 and 2006 BSCs involved a random selection of more than 600 health facilities, 1700 health workers and 5800 patient-provider interactions. The 2005 and 2006 BSCs demonstrated substantial improvements in all eight of the priority areas compared to 2004 baseline levels, with increases in median provincial scores for presence of active village health councils, availability of essential drugs, functional laboratories, provider knowledge, health worker training, use of clinical guidelines, monitoring of tuberculosis treatment, and provision of delivery care. For three of the priority indicators-drug availability, health worker training and provider knowledge-scores remained unchanged or decreased between 2005 and 2006. This highlights the need to ensure that early gains achieved in establishment of health services in Afghanistan are maintained over time. The use of a coherent and balanced monitoring framework to identify priority areas for improvement and measure performance over time reflects an objectives-based approach to management of health services that is proving to be effective in a difficult environment.

  16. Acupotomy and venesection in Upper Limb Lymphedema and Peripheral neuropathy following Breast Cancer Surgery

    Directory of Open Access Journals (Sweden)

    Jang Eun-ha

    2009-12-01

    Full Text Available Purpose: In order to estimate clinical effects of acupotomy and venesection in a patient with peripheral neuropathy and upper limb lymphedema following breast cancer surgery. Methods: From 17th August, 2009 to 29th August 2009, 1 female patient with peripheral neuropathy and upper limb lymphedema following breast cancer surgery was treated with general oriental medicine therapy(acupuncture, moxibustion, cupping, physical therapy, herbal medication and acupotomy with venesection. Results: The patient's chief complaints- Lt hand numbness, Lt arm edema, Lt. wrist flexion limitation - were notably improved. Conclusions : This study demonstrates that oriental medical treatment with acupotomy and venesection therapy has significant effect in improving symptoms of peripheral neuropathy and upper limb lymphedema following breast cancer surgery, as though we had not wide experience in this treatment, more research is needed.

  17. Phototherapeutic treatment of lymphedema and other complications after mastectomy

    Science.gov (United States)

    Zharov, Vladimir P.; Kalinin, Konstantin L.; Borisov, Andrei A.; Velsher, Leonid Z.; Stakhanov, Mikhail L.; Eskin, Vadim G.; Savin, Alexei A.; Shihkerimov, Raphiz K.

    2000-05-01

    One of the possible consequences of mastectomy is lymphedema of soft tissues of upper extremities on the side of ablated breast as result of cutting and trauma of multiple nerves, lymphatic and blood vessels. This phenomenon is often accompanied by deterioration of blood and lymphatic microcirculation, increasing of stagnation and aggregation ability of thrombocities, limitation of humeral and ulnar joint activity, severe pain and decreasing of myotonus. The developing of new phototherapeutic method based on using of light-emitting diodes (LED) arrays is attempted. This method is just directed on improvement of patient's condition in combination with other traditional methods such as drug therapy, pressure bandaging etc. The main parameters of LED arrays fixed inside cylindrical tube covering pathology region are: wavelength -- 660 nm, intensity range -- 0.5 mW/sm2. To control and study efficiency of phototreatment ultrasonic dopplerography, thermography, electromyography and viscosimetry have been used. During clinical trials in oncology department of Moscow State University of Medicine and Dentistry 128 patients have been treated with following results: patients felt complete disappearance of pain and weightiness sensation in arm, restoration of skin sensitivity and muscle strength. There were statistically proved amelioration of excitation spreading velocity on radial nerve, decreasing of blood viscosity, increasing of blood velocity in main arteries of shoulder and symmetry of temperature distribution.

  18. Vascularized lymph node transfer and lymphovenous bypass: Novel treatment strategies for symptomatic lymphedema.

    Science.gov (United States)

    Silva, Amanda K; Chang, David W

    2016-06-01

    Lymphedema is a debilitating disease that is commonly caused by cancer and it is treatments in the developed world. Surgery is an option for refractory disease. Lymphovenous bypass and vascularized lymph node transfer are newer modalities that show great promise. Further work is necessary to determine proper patient selection and ensure minimum donor site morbidity. Liposuction and direct excision still have a role, especially in advanced cases. Further investigations into prevention of iatrogenic lymphedema are underway. J. Surg. Oncol. 2016;113:932-939. © 2016 Wiley Periodicals, Inc. PMID:26846735

  19. The Godoy & Godoy cervical stimulation technique in the treatment of primary congenital lymphedema

    OpenAIRE

    Jose Maria Pereira de Godoy; Ana Carolina Pereira de Godoy; Tania Dias Guimarães; Maria de Fatima Guerreiro Godoy

    2012-01-01

    The aim of the current study is to report on the treatment of primary lymphedema using a new form of therapy: cervical stimulation. In a prospective cohort study, 9 boys and 5 girls with primary congenital lymphedema were evaluated over two years. Age ranged from two months to 8.5 years. After diagnosis, all mothers were trained in the new technique. The Godoy & Godoy cervical stimulation technique consists of between 20 to 30 stimuli per minute using light movements in the cervical regio...

  20. Microcephaly/lymphedema and terminal deletion of the long arm of chromosome 13

    Energy Technology Data Exchange (ETDEWEB)

    Fryns, J.P. [Univ. of Leuven (Belgium)

    1995-07-03

    Recently, we examined a 2-year-old boy with the association of microcephaly and significant pedal edema that extended to the distal parts of the legs. Prometaphase chromosome studies showed a small terminal deletion in the long arm of chromosome 13 of band 13q34, karyotype 46,XY,del(13)(q34{yields}qter). The present finding of a small terminal 13q34 deletion in this young boy with microcephaly/lymphedema is a first indication that the lymphedema/microcephaly association can be due to a small terminal 13q deletion. 2 refs.

  1. The Impact of Radiation Therapy on the Risk of Lymphedema After Treatment for Breast Cancer: A Prospective Cohort Study

    International Nuclear Information System (INIS)

    Purpose/Objective: Lymphedema after breast cancer treatment can be an irreversible condition with a negative impact on quality of life. The goal of this study was to identify radiation therapy-related risk factors for lymphedema. Methods and Materials: From 2005 to 2012, we prospectively performed arm volume measurements on 1476 breast cancer patients at our institution using a Perometer. Treating each breast individually, 1099 of 1501 patients (73%) received radiation therapy. Arm measurements were performed preoperatively and postoperatively. Lymphedema was defined as ≥10% arm volume increase occurring >3 months postoperatively. Univariate and multivariate Cox proportional hazard models were used to evaluate risk factors for lymphedema. Results: At a median follow-up time of 25.4 months (range, 3.4-82.6 months), the 2-year cumulative incidence of lymphedema was 6.8%. Cumulative incidence by radiation therapy type was as follows: 3.0% no radiation therapy, 3.1% breast or chest wall alone, 21.9% supraclavicular (SC), and 21.1% SC and posterior axillary boost (PAB). On multivariate analysis, the hazard ratio for regional lymph node radiation (RLNR) (SC ± PAB) was 1.7 (P=.025) compared with breast/chest wall radiation alone. There was no difference in lymphedema risk between SC and SC + PAB (P=.96). Other independent risk factors included early postoperative swelling (P<.0001), higher body mass index (P<.0001), greater number of lymph nodes dissected (P=.018), and axillary lymph node dissection (P=.0001). Conclusions: In a large cohort of breast cancer patients prospectively screened for lymphedema, RLNR significantly increased the risk of lymphedema compared with breast/chest wall radiation alone. When considering use of RLNR, clinicians should weigh the potential benefit of RLNR for control of disease against the increased risk of lymphedema

  2. The Impact of Radiation Therapy on the Risk of Lymphedema After Treatment for Breast Cancer: A Prospective Cohort Study

    Energy Technology Data Exchange (ETDEWEB)

    Warren, Laura E.G.; Miller, Cynthia L. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Horick, Nora [Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts (United States); Skolny, Melissa N.; Jammallo, Lauren S.; Sadek, Betro T.; Shenouda, Mina N. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); O' Toole, Jean A. [Department of Physical and Occupational Therapy, Massachusetts General Hospital, Boston, Massachusetts (United States); MacDonald, Shannon M. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Specht, Michelle C. [Division of Surgical Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Taghian, Alphonse G., E-mail: ataghian@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States)

    2014-03-01

    Purpose/Objective: Lymphedema after breast cancer treatment can be an irreversible condition with a negative impact on quality of life. The goal of this study was to identify radiation therapy-related risk factors for lymphedema. Methods and Materials: From 2005 to 2012, we prospectively performed arm volume measurements on 1476 breast cancer patients at our institution using a Perometer. Treating each breast individually, 1099 of 1501 patients (73%) received radiation therapy. Arm measurements were performed preoperatively and postoperatively. Lymphedema was defined as ≥10% arm volume increase occurring >3 months postoperatively. Univariate and multivariate Cox proportional hazard models were used to evaluate risk factors for lymphedema. Results: At a median follow-up time of 25.4 months (range, 3.4-82.6 months), the 2-year cumulative incidence of lymphedema was 6.8%. Cumulative incidence by radiation therapy type was as follows: 3.0% no radiation therapy, 3.1% breast or chest wall alone, 21.9% supraclavicular (SC), and 21.1% SC and posterior axillary boost (PAB). On multivariate analysis, the hazard ratio for regional lymph node radiation (RLNR) (SC ± PAB) was 1.7 (P=.025) compared with breast/chest wall radiation alone. There was no difference in lymphedema risk between SC and SC + PAB (P=.96). Other independent risk factors included early postoperative swelling (P<.0001), higher body mass index (P<.0001), greater number of lymph nodes dissected (P=.018), and axillary lymph node dissection (P=.0001). Conclusions: In a large cohort of breast cancer patients prospectively screened for lymphedema, RLNR significantly increased the risk of lymphedema compared with breast/chest wall radiation alone. When considering use of RLNR, clinicians should weigh the potential benefit of RLNR for control of disease against the increased risk of lymphedema.

  3. Development in self-reported arm-lymphedema in Danish women treated for early-stage breast cancer in 2005 and 2006 – A nationwide follow-up study

    DEFF Research Database (Denmark)

    Gärtner, Rune; Mejdahl, Mathias Kvist; Andersen, Kenneth Geving;

    2014-01-01

    contrast to 30% treated with ALND. However, 19% of women treated with ALND and not reporting lymphedema in 2008 had developed lymphedema by 2012. In conclusion lymphedema remains a frequent problem, years after treatment for breast cancer, though, number of women reporting lymphedema and overall severity......The main purpose of this nationwide follow-up study was to examine the development of self-reported lymphedema in the population of women with early-stage breast cancer in Denmark. In 2008 and 2012 two identical questionnaires were sent to the women aged 18-70 years treated for unilateral primary...... breast cancer in 2005 and 2006. 2293 women (87%) reported on lymphedema in 2008 and 2012. Overall 37% reported lymphedema in 2008 while 31% reported lymphedema in 2012 and severity of symptoms decreased. 50% of women treated with SLNB and reporting lymphedema in 2008 did not report symptoms by 2012 in...

  4. [In search of the ideal surgical treatment for lymphedema. Report of 2nd European Conference on supermicrosurgery (Barcelona - March 2012)].

    Science.gov (United States)

    Rausky, J; Robert, N; Binder, J-P; Revol, M

    2012-12-01

    Since more than 50 years, many surgeons all around the world try to find the perfect surgical technique to treat limb lymphedemas. Decongestive physiotherapy associated with the use of a compressive garment has been the primary choice for lymphedema treatment. Many different surgical techniques have been developed, however, to date, there is no consensus on surgical procedure. Most surgical experts of lymphedema met in the second European Conference on supermicrosurgery, organized on March 1st and 2nd 2012, in San Pau Hospital, Barcelona. Together they tried to clarify these different options and ideally a strategy for using these techniques.

  5. Bioelectrical impedance for detecting and monitoring lymphedema in patients with breast cancer. Preliminary results of the florence nightingale breast study group.

    Science.gov (United States)

    Erdogan Iyigun, Zeynep; Selamoglu, Derya; Alco, Gul; Pilancı, Kezban Nur; Ordu, Cetin; Agacayak, Filiz; Elbüken, Filiz; Bozdogan, Atilla; Ilgun, Serkan; Guler Uysal, Fusun; Ozmen, Vahit

    2015-03-01

    The aim of this study was to evaluate the efficacy of bioimpedance spectroscopy for the follow-up of patients with lymphedema in Turkey and its benefits in the diagnosis of stage 0, 1, and 2 lymphedema in patients who are under treatment for breast cancer. Thirty-seven female patients with breast cancer who underwent surgical procedures in our Breast Health Centre were followed up for lymphedema using bioimpedance, and clinical measurements were taken for a minimum period of 1 year at 3-month intervals. Patients who had been monitored regularly between November, 2011, and September, 2013, were enrolled to the study. In total, 8 patients developed lymphedema with an overall rate of 21.6%. Among the 8 patients who developed lymphedema, 4 had Stage 2, 1 had Stage 1, and 3 had Stage 0 lymphedema. Stage 0 lymphedema could not be detected with clinical measurements. During the patients' 1-year follow-up period using measurements of bioimpedance, a statistically significant relationship was observed between the occurrence of lymphedema and the disease characteristics. including the number of the extracted and remaining lymph nodes and the region of radiotherapy (p=0.042, p=0.024, p=0.040). Bioimpedance analysis seems to be a practical and reliable method for the early diagnosis of lymphedema. It is believed that regular monitoring of patients in the high-risk group using bioimpedance analyses increases the ability to treat lymphedema.

  6. Cancer-related lymphedema risk factors, diagnosis, treatment, and impact: a review.

    Science.gov (United States)

    Paskett, Electra D; Dean, Julie A; Oliveri, Jill M; Harrop, J Phil

    2012-10-20

    PURPOSE Cancer-related lymphedema (LE) is an incurable condition associated with lymph-involved cancer treatments and is an increasing health, quality of life (QOL), and cost burden on a growing cancer survivor population. This review examines the evidence for causes, risk, prevention, diagnosis, treatment, and impact of this largely unexamined survivorship concern. METHODS PubMed and Medline were searched for cancer-related LE literature published since 1990 in English. The resulting references (N = 726) were evaluated for strength of design, methods, sample size, and recent publication and sorted into categories (ie, causes/prevention, diagnosis, treatment, and QOL). Sixty studies were included. Results Exercise and physical activity and sentinel lymph node biopsy reduce risk, and overweight and obesity increase risk. Evidence that physiotherapy reduces risk and that lymph node status and number of malignant nodes increase risk is less strong. Perometry and bioimpedence emerged as attractive diagnostic technologies, replacing the use of water displacement in clinical practice. Swelling can also be assessed by measuring arm circumference and relying on self-report. Symptoms can be managed, not cured, with complex physical therapy, low-level laser therapy, pharmacotherapy, and surgery. Sequelae of LE negatively affect physical and mental QOL and range in severity. However, the majority of reviewed studies involved patients with breast cancer; therefore, results may not be applicable to all cancers. CONCLUSION Research into causes, prevention, and effect on QOL of LE and information on LE in cancers other than breast is needed. Consensus on definitions and measurement, increased patient and provider awareness of signs and symptoms, and proper and prompt treatment/access, including psychosocial support, are needed to better understand, prevent, and treat LE. PMID:23008299

  7. Measurement Issues in Anthropometric Measures of Limb Volume Change in Persons at Risk for and Living with Lymphedema: A Reliability Study

    Directory of Open Access Journals (Sweden)

    Dorit Tidhar

    2015-09-01

    Full Text Available Understanding whether a true change has occurred during the process of care is of utmost importance in lymphedema management secondary to cancer treatments. Decisions about when to order a garment, start an exercise program, and begin or end therapy are based primarily on measurements of limb volume, based on circumferences taken by physiotherapists using a flexible tape. This study aimed to assess intra-rater and inter-rater reliability of measurements taken by physiotherapists of legs and arms with and without lymphedema and to evaluate whether there is a difference in reliability when measuring a healthy versus a lymphedematous limb. The intra-rater reliability of arm and leg measurements by trained physiotherapist is very high (scaled standard error of measurements (SEMs for an arm and a leg volume were 0.82% and 0.64%, respectively and a cut-point of 1% scaled SEM may be recommended as a threshold for acceptable reliability. Physiotherapists can rely on the same error when assessing lymphedematous or healthy limbs. For those who work in teams and share patients, practice is needed in synchronizing the measurements and regularly monitoring their inter-rater reliability.

  8. Low-level laser therapy in secondary lymphedema after breast cancer: systematic review.

    Science.gov (United States)

    E Lima, Mariana Toledo Biscaia Raposo Mourão; E Lima, Januário Gomes Mourão; de Andrade, Mauro Figueiredo Carvalho; Bergmann, Anke

    2014-05-01

    Complex physical therapy is the main treatment for the secondary lymphedema after breast cancer. The low-level laser therapy (LLLT) has been used in order to stimulate lymphangiogenesis, encourage lymphatic motility, and reduce lymphostatic fibrosis. However, these factors could also favor the development of recurrence and metastasis. The objective of this study is to discuss the use of LLLT in the treatment of lymphedema after breast cancer. This study utilized a systematic review on the use of LLLT in the treatment of lymphedema after breast cancer. Evaluating quality of articles was conducted through the PEDro scale. Of the 41 articles identified, four were considered to be of high methodological quality (score ≥ 5). The low-level laser in the axillary region was performed in all studies. The control group was not similar across studies. The results presented showed that there was a reduction in limb volume in the group subjected to low-power laser when compared with other treatments. No studies have evaluated the risk of metastasis or relapse in the irradiated areas. Because no studies have included the complex physical therapy as the comparison group, we cannot claim that laser treatment is the best efficacy or effectiveness in lymphedema treatment after breast cancer. No studies have evaluated the hypothesis that the LLLT can increase the risk of recurrence or metastasis. Therefore, the questions about the safety of this procedure in cancer patients remain.

  9. Pathological steps of cancer-related lymphedema: histological changes in the collecting lymphatic vessels after lymphadenectomy.

    Directory of Open Access Journals (Sweden)

    Makoto Mihara

    Full Text Available INTRODUCTION: To date, an electron microscopy study of the collecting lymphatic vessels has not been conducted to examine the early stages of lymphedema. However, such histological studies could be useful for elucidating the mechanism of lymphedema onset. The aim of this study was to clarify the changes occurring in collecting lymphatic vessels after lymphadenectomy. METHODS: The study was conducted on 114 specimens from 37 patients who developed lymphedema of the lower limbs after receiving surgical treatment for gynecologic cancers and who consulted the University of Tokyo Hospital and affiliated hospitals from April 2009 to March 2011. Lymphatic vessels that were not needed for lymphatico venous anastomosis surgery were trimmed and subsequently examined using electron microscopy and light microscopy. RESULTS: Based on macroscopic findings, the histochemical changes in the collecting lymphatic vessels were defined as follows: normal, ectasis, contraction, and sclerosis type (NECST. In the ectasis type, an increase in endolymphatic pressure was accompanied by a flattening of the lymphatic vessel endothelial cells. In the contraction type, smooth muscle cells were transformed into synthetic cells and promoted the growth of collagen fibers. In the sclerosis type, fibrous elements accounted for the majority of the components, the lymphatic vessels lost their transport and concentrating abilities, and the lumen was either narrowed or completely obstructed. CONCLUSIONS: The increase in pressure inside the collecting lymphatic vessels after lymphadenectomy was accompanied by histological changes that began before the onset of lymphedema.

  10. Modification of a Rodent Hindlimb Model of Secondary Lymphedema: Surgical Radicality versus Radiotherapeutic Ablation

    Directory of Open Access Journals (Sweden)

    Hyung Sub Park

    2013-01-01

    Full Text Available Secondary lymphedema is an intractable disease mainly caused by damage of the lymphatic system during surgery, yet studies are limited by the lack of suitable animal models. The purpose of this study was to create an improved model of secondary lymphedema in the hindlimbs of rodents with sustained effects and able to mimic human lymphedema. This was achieved by combining previously reported surgical methods and radiation to induce chronic lymphedema. Despite more radical surgical destruction of superficial and deep lymphatic vessels, surgery alone was not enough to sustain increased hindlimb volume. Radiotherapy was necessary to prolong these effects, with decreased lymphatic flow on lymphoscintigraphy, but hindlimb necrosis occurred after 4 weeks due to radiation toxicity. The applicability of this model for studies of therapeutic lymphangiogenesis was subsequently tested by injecting muscle-derived stem cells previously cocultured with the supernatant of human lymphatic endothelial cells in vitro. There was a tendency for increased lymphatic flow which significantly increased lymphatic vessel formation after cell injection, but attenuation of hindlimb volume was not observed. These results suggest that further refinement of the rodent hindlimb model is needed by titration of adequate radiation dosage, while stem cell lymphangiogenesis seems to be a promising approach.

  11. Breast Cancer Survivors Coping with Lymphedema: What All Counselors Need to Know

    Science.gov (United States)

    Heppner, P. Paul; Tierney, Candece Glauser; Wang, Yu-Wei; Armer, Jane M.; Whitlow, Natalie M.; Reynolds, Alysia

    2009-01-01

    The purpose of this study was to promote greater understanding among counselors and other helping professionals regarding the stressors associated with lymphedema, how women cope with the stressors, and the role of social support. An intensive qualitative study was conducted; data were analyzed using a consensual qualitative research approach. The…

  12. Lymphedema After Surgery in Patients With Endometrial Cancer, Cervical Cancer, or Vulvar Cancer

    Science.gov (United States)

    2014-12-23

    Lymphedema; Stage IA Cervical Cancer; Stage IA Uterine Corpus Cancer; Stage IA Vulvar Cancer; Stage IB Cervical Cancer; Stage IB Uterine Corpus Cancer; Stage IB Vulvar Cancer; Stage II Uterine Corpus Cancer; Stage II Vulvar Cancer; Stage IIA Cervical Cancer; Stage IIIA Vulvar Cancer; Stage IIIB Vulvar Cancer; Stage IIIC Vulvar Cancer; Stage IVB Vulvar Cancer

  13. Risk assessment of dermatolymphangioadenitis by lymphoscintigraphy in patients with lower extremity lymphedema

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Joon Young; Hwang, Ji Hye; Park, Jung Mi; Lee, Kyung Han; Kim, Sang Eun; Kim, Dong Ik; Lee, Byung Boong; Kim, Byung Tae [College of Medicine, Sungkyunkwan Univ., Seoul (Korea, Republic of)

    1999-02-01

    Dermatolymphangioadenitis (DLA) is a common and serious complication of lymphedema which deteriorates lymphatic function. The purpose of this study was to assess the risk of DLA by lymphoscintigraphy in patients with lower extremity lymphedema. The subjects were 59 edematous lower extremities of 50 patients without previous episode of DLA and 12 lower extremities of 6 controls. Whole body images were acquired 1 min and 2 hr after subcutaneous injection of 37 MBq of Tc-99m-antimony sulfide colloid into interdigital spaces of both feet before therapy for lymphedema. The lymphoscintigrapic and clinical variables were compared between groups with or without occurrence of DLA during clinical follow up. There were 20 episodes of DLA in 12 extremities during clinical follow-up (19{+-}6 months). On univariate analysis, there were significant differences in ilioinguinal lymph node uptake, uptake pattern of main lymphatic vessel, clinical stage and therapy compliance between the two groups. After multivariate analysis, only the uptake pattern of main lymphatic vessel and therapy compliance were confirmed to be independent variables. In other words, non-visualized main lymphatic vessel and poor compliance to therapy were more frequent in extremities with subsequent occurrence of DLA. Lymphoscintigraphy can be used to predict the risk of DLA and may thus be helpful for determining the initial therapeutic plan in patients with lower extremity lymphedema.

  14. Severe cheek and lower eyelid lymphedema after resection of oropharyngeal tumor and radiation.

    Science.gov (United States)

    Silverman, Adam T; Hoffman, Ryan; Cohen, Mimis; Garza, Rebecca

    2010-03-01

    Facial lymphedema, a rare condition with poorly understood pathogenesis, is commonly associated with previous infection, radiation therapy, local tumor growth, or previous surgery in the head and neck region. Few cases of isolated facial lymphedema have been reported in the literature. Surgical excision has emerged as the mainstay of therapy in such cases, although the long-term efficacy and recurrence rate after excision remain unknown. We present a unique case of a patient with severe unilateral facial lymphedema, which manifested many years after extirpation of a floor-of-the-mouth squamous cell carcinoma, bilateral supraomohyoid neck dissections, and radiation therapy. The massive cheek and eyelid lymphedema, which extended from the patient's left lower eyelid to patient's oral commissure measured 11 x 15 cm with a thickened, brawny, lobulated, and bosselated skin surface. This mass interfered with activities of daily life, caused poor oral intake, and contributed to the patient's severe kyphosis. Because the mass did not clinically or radiologically appear to be malignant, we decided to perform a salvage procedure consisting of wide excision of the massive lymphedematous mass and immediate coverage with a split-thickness skin grafting. Temporary tarsorraphy sutures were also used to provide support to the lower eyelid. The patient tolerated the procedure well, with no complications and with full take of the skin graft. Postoperatively, he was very grateful to be relieved of his debilitating symptoms. PMID:20489462

  15. Lymphoscintigraphic evaluation in the patients with secondary lymphedema of lower extremities

    Energy Technology Data Exchange (ETDEWEB)

    Asakura, Koichi; Ono, Yoshimi; Watari, Kiichi; Yuzuta, Katsuteru; Kawashima, Hiroyuki (Yokohama City Univ. (Japan). Faculty of Medicine)

    1983-02-01

    The results of lymphoscintigraphy in 41 patients with secondary lymphedema of lower extremities using Tc-99m sulfur or rhenium colloid were reviewed. These patients include 23 uterine cervix cancers, 12 other pelvic tumors, 4 malignant lymphomas and others. The patterns of scintigrams were classified as follows; (A) normal radiocolloid distributuion in the ilioinguinal chain of the nodes; (B) decreased uptake or defect in the ipsilateral iliac and/or inguinal nodes; (C) diffuse soft tissue activity throughout lower extremity due to radiocolloid back flow; (D) persistent radioactivity in the lymph vessels in the entire lower extremity; and (E) markedly decreased uptake in the ilioinguinal nodes without dermal back flow. These scintigraphic patterns were well correlated with clinical grades of lymphedemas. The correlation between these findings and clinical grades of lymphedema were observed more severely if the pattern classification goes (A) to (E). This scintigraphic study to evaluate the patients with secondary lymphedema is valuable to determine the cause and the grade of edema without any significant risk.

  16. Lymphoscintigraphic evaluation in the patients with secondary lymphedema of lower extremities

    International Nuclear Information System (INIS)

    The results of lymphoscintigraphy in 41 patients with secondary lymphedema of lower extremities using Tc-99m sulfur or rhenium colloid were reviewed. These patients include 23 uterine cervix cancers, 12 other pelvic tumors, 4 malignant lymphomas and others. The patterns of scintigrams were classified as follows; (A) normal radioFcolloid distributuion in the ilioinguinal chain of the nodes; (B) decreased uptake or defect in the ipsilateral iliac and/or inguinal nodes; (C) diffuse soft tissue activity throughout lower extremity due to radiocolloid back flow; (D) persistent radioFactivity in the lymph vessels in the entire lower extremity; and (E) markedly decreased uptake in the ilioinguinal nodes without dermal back flow. These scintigraphic patterns were well correlated with clinical grades of lymphedemas. The correlation between these findings and clinical grades of lymphedema were observed more severely if the pattern classification goes (A) to (E). This scintigraphic study to evaluate the patients with secondary lymphedema is valuable to determine the cause and the grade of edema without any significant risk. (author)

  17. Recurrent furunculosis as a cause of isolated penile lymphedema: a case report

    Directory of Open Access Journals (Sweden)

    Sood Suneet

    2010-06-01

    Full Text Available Abstract Introduction Isolated lymphedema of the penis is extremely rare: combined involvement of the scrotum and penis is the norm. Furunculosis as a cause is not, to our knowledge, previously reported. We present a case of isolated penile lymphedema that responded to excision of lymphedematous tissue and reconstruction with flaps. Case presentation A 32-year-old Arab man presented with a three-year history of a gradually increasing, painless penile swelling. Our patient's main complaint was non-erectile sexual dysfunction. The swelling was preceded by at least three prior episodes of severe furunculosis at the penile root. He had no other contributory past medical or family history. On examination there was gross penile enlargement, maximally at the mid shaft, associated with thickened skin at the sites of prior furunculosis. The glans and scrotum were normal. Both testes were palpable. Serology for filariasis, and urinary tract ultrasound and computed tomography scan were normal. The clinical diagnosis was lymphedema following recurrent penile furunculosis. At operation the lymphedematous tissues were removed. Closure of the penile shaft was accomplished by bilateral advancement of flaps from both ends of the penis. He resumed normal sexual activity one month after surgery. At 12 months, he had a good cosmetic result, with no signs of recurrence. Conclusions Furunculosis at the penile root may result in lymphedema confined to the penile shaft, sparing the scrotum. Excision of abnormal tissue and cover with a skin flap gave excellent cosmetic results, and allowed satisfactory sexual activity.

  18. Effect of lymphedema treatment. The interim report of prospective study at multiple facilities

    International Nuclear Information System (INIS)

    We are in the process of analyzing the effect of complex physical therapy (CPT) for the patients of secondary lymphedema associated with cancer treatment. At this time, we present an interim report of the past 3 months started in March 2009. We classified the lymphedema stage into four stages based on the International Society of Lymphology criterion using the imaging diagnosis (ultrasonography (US), CT, etc.) in addition to a conventional observation. We also classified the CPT treatment period into two in accordance with water retention in the subcutaneous adipose tissue of the limbs. CPT was performed by the specialist of lymphedema treatment. We used the change in volume of limbs and quality of life (QOL) evaluation by SF-36 and Skindex29 for analysis. On this report, the volume of limbs, which has lymphedema and an improvement on SF-36, did not change significantly. This may have been resulted from not having enough follow-up period and lack of few cases at each stage in the analysis. However, we confirmed that the general and emotion evaluation on Skindex29 showed a meaningful change. We are still planning to accumulate more cases and study them for further detailed analysis. (author)

  19. Yellow Nails, Lymphedema and Chronic Cough: Yellow Nail Syndrome in an Eight-Year-Old Girl

    OpenAIRE

    Ishita Siddiq; Daniel Hughes

    2012-01-01

    Yellow nail syndrome is a rare disease and reported mainly in adults. A case of yellow nail syndrome involving an eight-year-old girl with associated discoloured yellowish nails on the fingers and toes, lymphedema and chronic cough, and sputum production is reported.

  20. Biomarker and Phenotypic Risk Factors for Breast Cancer Lymphedema | Division of Cancer Prevention

    Science.gov (United States)

     DESCRIPTION (provided by applicant): Lymphedema (LE) following treatment for breast cancer is the most common form of secondary LE in the industrialized world. It occurs in 20% to 87% of patients following treatment for breast cancer and results in significant disability. At the |

  1. Mutations in the VEGFR3 signaling pathway explain 36% of familial lymphedema

    DEFF Research Database (Denmark)

    Mendola, A; Schlögel, M J; Ghalamkarpour, A;

    2013-01-01

    , stratification of treatments and generation of disease models. Interestingly, most of the proteins that are encoded by the genes mutated in primary lymphedema seem to act in a single functional pathway involving VEGFR3 signaling. This underscores the important role this pathway plays in lymphatic development...

  2. Combined physical therapy for lymphedema evaluated by fluorescence microlymphography and lymph capillary pressure measurements.

    Science.gov (United States)

    Franzeck, U K; Spiegel, I; Fischer, M; Börtzler, C; Stahel, H U; Bollinger, A

    1997-01-01

    The treatment of patients with lymphedema is still controversial. Combined physical therapy with manual lymph drainage and compression therapy is most frequently used to reduce lymphatic leg swelling. However, objective evidence is rare that this empirical form of treatment has a scientific basis. In a prospective study fluorescence microlymphography and pressure measurements in cutaneous lymph capillaries were used to assess objectively the effect of combined decongestive physical therapy on abnormal microlymphatic dynamics in lymphedema. 12 patients with primary and secondary lymphedema were studied before treatment, after 2 weeks of intensive physical therapy and 3 months of continuing compression and ergotherapy. After 2 weeks of intensive manual lymph drainage and compression bandaging (phase 1) microlymphatic hypertension (12.8 +/- 5.7 mm Hg) was significantly (p = 0.01) reduced to a mean lymph capillary pressure of 5.9 +/- 4.5 mm Hg. More than 3 months later after continuing compression lymph capillary pressure (3.2 +/- 5.2 mm Hg) was still significantly (p = 0.03) reduced. Simultaneously the maximum spread of the fluorescent contrast medium in the superficial lymph capillary network decreased significantly (p = 0.01) from 21.3 +/- 14.3 to 11.3 +/- 4.8 mm. Accordingly the clinical condition improved, and the mean circumferences of the forefoot and ankle were significantly (p < 0.05) reduced. Combined decongestive physical therapy is an effective treatment for lymphedema which results in a normalization of microlymphatic hypertension and an improvement of the clinical appearance. PMID:9256091

  3. Yellow Nails, Lymphedema and Chronic Cough: Yellow Nail Syndrome in an Eight-Year-Old Girl

    Directory of Open Access Journals (Sweden)

    Ishita Siddiq

    2012-01-01

    Full Text Available Yellow nail syndrome is a rare disease and reported mainly in adults. A case of yellow nail syndrome involving an eight-year-old girl with associated discoloured yellowish nails on the fingers and toes, lymphedema and chronic cough, and sputum production is reported.

  4. Microsurgical techniques for the treatment of breast cancer-related lymphedema: a systematic review

    NARCIS (Netherlands)

    Penha, T.R.; Ijsbrandy, C.; Hendrix, N.A.; Heuts, E.M.; Voogd, A.C.; Meyenfeldt, M.F. von; Hulst, R.R. van der

    2013-01-01

    BACKGROUND: Upper limb lymphedema is one of the most underestimated and debilitating complications of breast cancer treatment. The aim of this review is to summarize the recent literature for evidence of the effectiveness of lymphatic microsurgery for the treatment of breast cancer-related lymphedem

  5. Risk factors for breast cancer-related upper extremity lymphedema: a meta-analysis

    International Nuclear Information System (INIS)

    Objective: To systematically evaluate the risk factors for upper extremity lymphedema after breast cancer treatment and the strength of their associations. Methods: PubMed, Ovid, EMbase, and the Cochrane Library were searched to identify clinical trials published up to December 2012. The quality of included studies was assessed by the Newcastle-Ottawa Scale;data analysis was performed by Stata 10.0 and RevMan 5.2; the strength of associations between risk factors and breast cancer-related upper extremity lymphedema was described as odds ratio (OR) and 95% confidence intervals (CI). Results: Twenty-two studies involving 10106 patients were included in the meta-analysis. The risk factors for upper extremity lymphedema after breast cancer treatment mainly included axillary lymph node dissection (OR=2.72, 95% CI=1.06-6.99, P=0.038), hypertension (OR=1.84, 95% CI=1.38-2.44, P=0.000), body mass index (OR=1.68, 95% CI=1.22-2.32, P=0.001), and radiotherapy (OR=1.65, 95% CI=1.20-2.25, P=0.002), while no significant associations were found for such factors as chemotherapy, age, number of positive lymph nodes, and number of dissected lymph nodes. Conclusions: The incidence of upper extremity lymphedema is high among patients with breast cancer after treatment, and axillary lymph node dissection, hypertension,body mass index, and radiotherapy are the main risk factors for lymphedema after breast cancer treatment. (authors)

  6. Interleukin-8 reduces post-surgical lymphedema formation by promoting lymphatic vessel regeneration.

    Science.gov (United States)

    Choi, Inho; Lee, Yong Suk; Chung, Hee Kyoung; Choi, Dongwon; Ecoiffier, Tatiana; Lee, Ha Neul; Kim, Kyu Eui; Lee, Sunju; Park, Eun Kyung; Maeng, Yong Sun; Kim, Nam Yun; Ladner, Robert D; Petasis, Nicos A; Koh, Chester J; Chen, Lu; Lenz, Heinz-Josef; Hong, Young-Kwon

    2013-01-01

    Lymphedema is mainly caused by lymphatic obstruction and manifested as tissue swelling, often in the arms and legs. Lymphedema is one of the most common post-surgical complications in breast cancer patients and presents a painful and disfiguring chronic illness that has few treatment options. Here, we evaluated the therapeutic potential of interleukin (IL)-8 in lymphatic regeneration independent of its pro-inflammatory activity. We found that IL-8 promoted proliferation, tube formation, and migration of lymphatic endothelial cells (LECs) without activating the VEGF signaling. Additionally, IL-8 suppressed the major cell cycle inhibitor CDKN1C/p57(KIP2) by downregulating its positive regulator PROX1, which is known as the master regulator of LEC-differentiation. Animal-based studies such as matrigel plug and cornea micropocket assays demonstrated potent efficacy of IL-8 in activating lymphangiogenesis in vivo. Moreover, we have generated a novel transgenic mouse model (K14-hIL8) that expresses human IL-8 in the skin and then crossed with lymphatic-specific fluorescent (Prox1-GFP) mouse. The resulting double transgenic mice showed that a stable expression of IL-8 could promote embryonic lymphangiogenesis. Moreover, an immunodeficient IL-8-expressing mouse line that was established by crossing K14-hIL8 mice with athymic nude mice displayed an enhanced tumor-associated lymphangiogenesis. Finally, when experimental lymphedema was introduced, K14-hIL8 mice showed an improved amelioration of lymphedema with an increased lymphatic regeneration. Together, we report that IL-8 can activate lymphangiogenesis in vitro and in vivo with a therapeutic efficacy in post-surgical lymphedema.

  7. Poor Design and Management Hamper Army's Basic Skills Education Program. Report to the Secretary of the Army.

    Science.gov (United States)

    General Accounting Office, Washington, DC.

    The Army's Basic Skills Education Program (BSEP) was studied to consider whether it was properly designed to determine the basic skills needed in Army jobs and to be effectively implemented. Information and reports on BSEP were reviewed, and three major commands were selected for evaluation. In designing the program, the Army did not identify the…

  8. Functioning in lymphedema from the patients' perspective using the International Classification of Functioning, Disability and health (ICF) as a reference

    NARCIS (Netherlands)

    Viehoff, P.B.; Gielink, P.D.; Damstra, R.J.; Heerkens, Y.F.; Ravensberg, C.D. van; Neumann, M.H.

    2015-01-01

    Abstract Purpose. To identify and quantify meaningful concepts in lymphedema from the patients' perspectives using the International Classification of Functioning, Disability and Health (ICF). Methods. Six focus group interviews in five different centers were organized, audiotaped, transcribed verba

  9. Functioning in lymphedema from the patients' perspective using the International Classification of Functioning, Disability and health (ICF) as a reference

    NARCIS (Netherlands)

    P.B. Viehoff (Peter); P.D.C. Gielink (Petra D. C.); R.J. Damstra; Y.F. Heerkens (Yvonne); D.C. Van Ravensberg (Dorine C.); H.A.M. Neumann (Martino)

    2015-01-01

    textabstractPurpose. To identify and quantify meaningful concepts in lymphedema from the patients' perspectives using the International Classification of Functioning, Disability and Health (ICF). Methods. Six focus group interviews in five different centers were organized, audiotaped, transcribed ve

  10. Congenital segmental lymphedema in tuberous sclerosis complex with associated subependymal giant cell astrocytomas treated with Mammalian target of rapamycin inhibitors.

    Science.gov (United States)

    Prato, Giulia; Mancardi, Maria Margherita; Baglietto, Maria Giuseppina; Janis, Sara; Vercellino, Nadia; Rossi, Andrea; Consales, Alessandro; Raso, Alessandro; Garrè, Maria Luisa

    2014-09-01

    Tuberous sclerosis complex is a genetic, multisystemic disorder characterized by circumscribed benign lesions (hamartomas) in several organs, including brain. This is the result of defects in the TSC1 and/or TSC2 tumor suppressor genes, encoding the hamartin-tuberin complex that inhibits the mammalian target of rapamycin pathway. Specific inhibitors of this pathway have been shown to reduce the volume of subependymal giant cell astrocytomas associated with tuberous sclerosis. Congenital lymphedema is rarely seen in association with tuberous sclerosis, with only a few reported cases. Although this association can be coincidental, the dysgenetic lymphatic system can represent a hamartia as a consequence of gene mutation. We describe a child with congenital lymphedema in tuberous sclerosis and associated subependymal giant cell astrocytoma who experienced lymphangitis under treatment with mammalian target of rapamycin inhibitors. Because our patient did not show worsening of lymphedema, congenital lymphedema does not seem to be a contraindication for this therapy. PMID:24056156

  11. 社会管理体制创新中的几个基本问题%Some Basic Questions in Social Management System Innovation

    Institute of Scientific and Technical Information of China (English)

    王印红

    2012-01-01

    面对复杂的国内外形势,推进社会管理体制创新成为执政党的重要抉择。在推进社会管理体制创新之前,几个基本问题有必要取得共识。第一,明确社会管理的内涵和外延是社会管理体制创新的基础和前提。第二,任何的体制、制度、政策都是基本理念的具体体现,这凸显了基本理念的重要作用,它们是社会管理体制创新的指导思想和价值观。第三,平衡机制的探索是社会管理体制创新的基本方向,就目前实践而言,在于寻求公共利益与私人利益、各利益集团之间、城乡之间、行业之间、区域之间等的平衡机制。第四,契约式社会管理的良好效果表明它或许是社会管理体制创新的基本方式和途径。%Facing the complicated situation at home and aboard, promoting institutional innovation of social management is becoming an important choice to the ruling party. It is necessary to reach consensus of some basic problem before promoting institutional innovation of social management. First of all, making clear the connotation and extension is the basics and precondition of institutional innovation of social management. Secondly, every system, institution and policy is the specific expression of basic idea that highlight the important role of basic idea. And they are the guiding ideology and values to the social manage- ment system' s innovation. Thirdly, the exploring of balancing mechanism is the basic direction to the institutional innovation of social management, In terms of current practice, which is seeking the balancing mechanism among public and private ben- efit, interest groups, urban and rural areas, industries, areas and so on. Finally, the good effect of contractual social management shows that maybe it is the basic way of institutional innovation of social management.

  12. Risk factors for lower limb lymphedema after lymph node dissection in patients with ovarian and uterine carcinoma

    OpenAIRE

    Tada, Harue; Teramukai, Satoshi; Fukushima, Masanori; Sasaki, Hiroshi

    2009-01-01

    Background Lymph node dissection has proven prognostic benefits for patients with ovarian or uterine carcinoma; however, one of the complications associated with this procedure is lymphedema. We aimed to identify the factors that are associated with the occurrence of lymphedema after lymph node dissection for the treatment of ovarian or uterine carcinoma. Methods A total of 694 patients with histologically confirmed ovarian (135 patients) or uterine cancer (258 with cervical cancer, 301 with ...

  13. Risk factors for lower limb lymphedema after lymph node dissection in patients with ovarian and uterine carcinoma.

    OpenAIRE

    Tada, Harue; Teramukai, Satoshi; Fukushima, Masanori; Sasaki, Hiroshi

    2009-01-01

    [Background]Lymph node dissection has proven prognostic benefits for patients with ovarian or uterine carcinoma; however, one of the complications associated with this procedure is lymphedema. We aimed to identify the factors that are associated with the occurrence of lymphedema after lymph node dissection for the treatment of ovarian or uterine carcinoma. [Methods]A total of 694 patients with histologically confirmed ovarian (135 patients) or uterine cancer (258 with cervical cancer, 301 wit...

  14. Risk factors for lower limb lymphedema after lymph node dissection in patients with ovarian and uterine carcinoma

    OpenAIRE

    Fukushima Masanori; Teramukai Satoshi; Tada Harue; Sasaki Hiroshi

    2009-01-01

    Abstract Background Lymph node dissection has proven prognostic benefits for patients with ovarian or uterine carcinoma; however, one of the complications associated with this procedure is lymphedema. We aimed to identify the factors that are associated with the occurrence of lymphedema after lymph node dissection for the treatment of ovarian or uterine carcinoma. Methods A total of 694 patients with histologically confirmed ovarian (135 patients) or uterine cancer (258 with cervical cancer, ...

  15. Lymphedema Prevalence and Treatment Benefits in Cancer: Impact of a Therapeutic Intervention on Health Outcomes and Costs

    OpenAIRE

    Brayton, Kimberly M.; Hirsch, Alan T; Patricia J O Brien; Andrea Cheville; Pinar Karaca-Mandic; Stanley G Rockson

    2014-01-01

    Background Lymphedema is a common complication of cancer therapeutics; its prevalence, treatment outcomes, and costs have been poorly defined. The objective of this study was to examine lymphedema prevalence among cancer survivors and to characterize changes in clinical outcomes and costs associated with a defined therapeutic intervention (use of a pneumatic compression devices [PCD]) in a representative, privately insured population. Methods and Findings Retrospective analysis of de-identifi...

  16. Exercise barriers self-efficacy: development and validation of a subcale for individuals with cancer-related lymphedema

    OpenAIRE

    Buchan, Jena; Janda, Monika; Box, Robyn; Rogers, Laura; Hayes, Sandi

    2015-01-01

    Background No tool exists to measure self-efficacy for overcoming lymphedema-related exercise barriers in individuals with cancer-related lymphedema. However, an existing scale measures confidence to overcome general exercise barriers in cancer survivors. Therefore, the purpose of this study was to develop, validate and assess the reliability of a subscale, to be used in conjunction with the general barriers scale, for determining exercise barriers self-efficacy in individuals facing lymphede...

  17. Comparison of effectiveness in application of manual lymphatic drainage and kinesiology taping with patients suffering post mastectomy Lymphedema

    OpenAIRE

    Ciesielska, Natalia; Sokołowski, Remigiusz; Klimkiewicz, Karolina; Kuriga, Mateusz; Hagner, Wojciech

    2012-01-01

    Introduction. According to the GUS study conducted in year 2008 in Poland is high morbidity in women because of malignant breast tumor (22,2% of all female cancer). After a mastectomy procedure about 30-50% of patients suffer from lymphedema as a consequence of axillary lymph nodes removal, what impedes returning to normal activity. Aim. Comparison of effectiveness of two methods suitable for elimination of mastectomy side upper limb lymphedema: Manual Lymphatic Drainage (MLD) (method A) and ...

  18. Surgical treatment of lymphedema of the penis and scrotum Tratamento cirúrgico do linfedema peno-escrotal

    OpenAIRE

    Miguel Modolin; Anuar Ibrahim Mitre; José Carlos Faes da Silva; Wilson Cintra; Ana Paula Quagliano; Sami Arap; Marcus Castro Ferreira

    2006-01-01

    PURPOSE: Lymphedema of the penis and scrotum, regardless of its etiology, is determined by reduced lymphatic flow with subsequent enlargement of the penis and scrotum. The clinical course of this condition is characterized by extreme discomfort for patients, with limitation of local hygiene, ambulation, sexual intercourse, and voiding in the standing position. The purpose of the present study is to present the experience and results of the treatment of lymphedema of the penis and scrotum by r...

  19. A randomized controlled trial comparing two types of pneumatic compression for breast cancer-related lymphedema treatment in the home

    OpenAIRE

    Fife, Caroline E.; Davey, Suzanne; Maus, Erik A.; Guilliod, Renie; Mayrovitz, Harvey N.

    2012-01-01

    Purpose Pneumatic compression devices (PCDs) are used in the home setting as adjunctive treatment for lymphedema after acute treatment in a clinical setting. PCDs range in complexity from simple to technologically advanced. The objective of this prospective, randomized study was to determine whether an advanced PCD (APCD) provides better outcomes as measured by arm edema and tissue water reductions compared to a standard PCD (SPCD) in patients with arm lymphedema after breast cancer treatment...

  20. Health-Related Quality of Life in Breast Cancer Patients with Lymphedema Who Survived More than One Year after Surgery

    OpenAIRE

    Lee, So Hyun; Min, Yu-Sun; Park, Ho Yong; Jung, Tae-Du

    2012-01-01

    Purpose To identify the influence of lymphedema on health-related quality of life (HRQOL) more than 1 year after breast cancer surgery. Methods Ninety-six breast cancer patients who survived more than 1 year after surgery and 104 members of the general population were recruited. Patients were divided into 2 groups according to the presence of lymphedema. HRQOL was evaluated with the Short-Form 36-Item Health Survey. Results There were no statistically significant differences in any scales bet...

  1. Breast Cancer–Related Lymphedema: Comparing Direct Costs of a Prospective Surveillance Model and a Traditional Model of Care

    OpenAIRE

    Stout, Nicole L.; Pfalzer, Lucinda A.; Springer, Barbara; Levy, Ellen; McGarvey, Charles L.; Danoff, Jerome V.; Gerber, Lynn H.; Soballe, Peter W

    2011-01-01

    Secondary prevention involves monitoring and screening to prevent negative sequelae from chronic diseases such as cancer. Breast cancer treatment sequelae, such as lymphedema, may occur early or late and often negatively affect function. Secondary prevention through prospective physical therapy surveillance aids in early identification and treatment of breast cancer–related lymphedema (BCRL). Early intervention may reduce the need for intensive rehabilitation and may be cost saving. This pers...

  2. Laser CO2 treatment for vulvar lymphedema secondary to gynecological cancer therapy: A report of two cases and review of the literature

    OpenAIRE

    Sopracordevole, Francesco; Mancioli, Francesca; Canzonieri, Vincenzo; Buttignol, Monica; Giorda, Giorgio; Ciavattini, Andrea

    2015-01-01

    Vulvar lymphedema is an uncommon and disabling side-effect of pelvic lymphadenectomy and pelvic radiotherapeutic treatment for invasive genital cancer. Lymphorrhea, a complication of lymphedema, may be extremely distressing for patients due to the requirement to wear sanitary towels and as the pain and loss of elasticity of the vulvar skin and mucosa can cause discomfort during coitus. Surgical treatments of lymphorrhea and vulvar lymphedema secondary to gynecological cancer treatments remain...

  3. Therapeutic Effects of Saireito (Chai-Ling-Tang), a Traditional Japanese Herbal Medicine, on Lymphedema Caused by Radiotherapy: A Case Series Study

    OpenAIRE

    Aiko Nagai; Yuta Shibamoto; Keiko Ogawa

    2013-01-01

    Despite the development of radiotherapy machines and technologies, a proportion of patients suffer from radiation-induced lymphedema. Saireito (SRT) is a traditional Japanese herbal medicine that has been used for treating edema and inflammation in conditions such as nephritic disease. This study investigated the effect of SRT on lymphedema caused by radiotherapy. Four patients were treated with SRT at a dose of 9 g/day. The severity of lymphedema was evaluated using the Common Terminology Cr...

  4. Study Regarding the Effectiveness of Manual Lymphatic Drainage in the Case of Patients with Breast Cancer that Present Lymphedema

    Directory of Open Access Journals (Sweden)

    Alexandru MIOC

    2013-06-01

    Full Text Available Lymphedema is defined as a persistent increase of tissue volume caused by the blocked or absent lymphatic drainage. The purpose of this study is to analyse the effectiveness of lymphatic drainage in the treatment of lymphedema after a mastectomy, with the aim of reducing the volume of the lymphedema and improving overall symptomatology, as well as providing information regarding the impact of this treatment on quality-of-life and the physical limitations of these patients. With these objectives in mind, a series of articles evaluating the effectiveness of manual lymphatic drainage in the case of patients with breast cancer and lymphedema have been studied. The parameters under observation were: duration of lymphedema reduction and improved symptomatology (pain, a feeling of swelling of the upper limb, functional limitation, and patient dissatisfaction towards their body image. Following this analysis, one can conclude that the association of manual lymphatic drainage to physical exercise and physiotherapy has produced changes in the volume of the limb affected by the lymphedema; however, its isolated use has not resulted in significant changes.

  5. EFFECTS OF RESISTANCE EXERCISES AND COMPLEX DECONGESTIVE THERAPY ON ARM FUNCTION AND MUSCULAR STRENGTH IN BREAST CANCER RELATED LYMPHEDEMA.

    Science.gov (United States)

    Do, J H; Kim, W; Cho, Y K; Lee, J; Song, E J; Chun, Y M; Jeon, J Y

    2015-12-01

    The incorporation of resistance exercises into the lifestyle of patients with lymphedema is understudied and an emerging interest. We investigated the effectiveness and results of adding a moderate intensity resistance exercise program for 8 weeks in conjunction with intensive CDT for 1 or 2 weeks (depending on severity) on arm volume, arm function, QOL, and muscular strength in patients with breast cancer-related lymphedema. This prospective, pilot trial included forty-four patients with a history of breast cancer who were beginning complex decongestive therapy for lymphedema. They were assigned to either the intervention (n = 22) or control (n = 22). groups. The intervention comprised of resis- tance band exercises 5 times a week for 8 weeks. These were initially supervised during the intensive lymphedema treatment, but performed independently during the study period. Limb volume, muscular strength, and the European Organization for Research and Treatment of Cancer QOL Questionnaire C30 (EORTC QLQ-C30), EORTC-Breast Cancer-Specific QOL Questionnaire (EORTC QLQ-BR23), and Disabilities of Arm, Shoulder, and Hand (DASH) questionnaires were assessed at baseline and at 8 weeks. After 8 weeks, the intervention group demonstrated statistically significant differences (p cancer related lymphedema during and shortly post intensive CDT lymphedema treatment. PMID:27164764

  6. Brain Basics

    Medline Plus

    Full Text Available ... as depression. The Growing Brain Inside the Brain: Neurons & Neural Circuits Neurons are the basic working unit of the brain ... specialized for the function of conducting messages. A neuron has three basic parts: Cell body which includes ...

  7. Asthma Basics

    Science.gov (United States)

    ... Tropical Delight: Melon Smoothie Pregnant? Your Baby's Growth Asthma Basics KidsHealth > For Parents > Asthma Basics Print A ... Asthma Categories en español Asma: aspectos fundamentales About Asthma Asthma is a common lung condition in kids ...

  8. Brain Basics

    Medline Plus

    Full Text Available ... Basics will introduce you to some of this science, such as: How the brain develops How genes and the environment affect the brain The basic structure of the brain How different parts of ...

  9. Backpack Basics

    Science.gov (United States)

    ... How Can I Help a Friend Who Cuts? Backpack Basics KidsHealth > For Teens > Backpack Basics Print A ... it can cause back problems or even injury. Backpacks Are Best Backpacks can't be beat for ...

  10. Basic Science Training Program.

    Science.gov (United States)

    Brummel, Clete

    These six learning modules were developed for Lake Michigan College's Basic Science Training Program, a workshop to develop good study skills while reviewing basic science. The first module, which was designed to provide students with the necessary skills to study efficiently, covers the following topics: time management; an overview of a study…

  11. related Factors of complete basic Immunization on children and Vaccine Management at Primary Health care and Health Post in X Subdistrict Depok city

    Directory of Open Access Journals (Sweden)

    Tri Afriani

    2015-01-01

    Full Text Available background:Immunization is an effective primary prevention against infectious diseases on children. The purpose of this study was to determine the related factors to the completeness of basic immunization on children and vaccine management at primary health care and posyandu in X Subdistric, Depok City. Methods:The study used a cross-sectional design with a sample of 140 mothers of children aged at least 11 months, and qualitatif study about vaccines management. Mother and child data collection using questionnaires and child health card (Kartu Menuju Sehat in December 2012–May 2013. Vaccine management data was collected at 2 primary health care and 2 posyandu with interview and observation. Data analysis was performed with Chi-square test. result:The largest percentage of mothers who have children under the age of at least 11 months of age <30 years, at least graduated from junior high school education, no work, have a low knowledge about immunization. Vaccine management in clinics and neighborhood health center for storage after use of vaccines in posyandu not be returned to the community health center, recording and reporting is not done on the book of the records so that the possibility of scattered or lost, and the person in charge of managing the vaccine instead of pharmacy personnel. Residual use of the vaccine in posyandu not directly returned to the health center. Recording the use of vaccines in posyandu not carried on the books, so it is probable scattered or lost. Manager vaccine at primary health care should a technical pharmacy in accordance with Government Regulation No. 51 of 2009 conclusion: Completeness of basic immunization of children under one years old (82,9%, incomplete biggest measles immunization (15,0%. Factors parental characteristics (age, education, occupation, knowledge and the availability of the vaccine were not significantly associated with children complete basic immunization. recommendation: Improving health

  12. Proceedings of the Scientific Meeting and Presentation on Basic Researchin Nuclear Science and Technology part II: Nuclear Chemistry, Process Technology, Radioactive Waste Management and Environment

    International Nuclear Information System (INIS)

    Scientific Meeting and Presentation on Basic Research in Nuclear Scienceand Technology is an annual activity held by Centre for Research and Development of Advanced Technology, National Nuclear Energy Agency, for monitoring research activities achieved by the Agency. The papers presented in the meeting were collected into proceedings. These are the second part of the proceedings that contain 71 articles in the fields of nuclear chemistry, process technology, radioactive waste management, and environment (PPIN).

  13. On the Basic Problems of the University Sports Management%高校体育管理工作中的基本问题初探

    Institute of Scientific and Technical Information of China (English)

    贾菁

    2012-01-01

    在简要论述高校体育管理工作的现状与特点的基础上,分析高校体育管理工作应遵循的基本原则,并据此进一步提出了开展高校体育管理工作几点建议,以期对提高我国高校体育管理工作的水平有所助益。%In briefly discussion of the status of college sports management and characteristics as the basis of analysis,college sports management should follow the basic principles,and the paper also puts forward several suggestions to carry out the college sports management,in hope to improve our colleges and universities sports management level.

  14. [Lymphedema secondary to breast cancer treatment: possibility of diagnostic and therapeutic prevention].

    Science.gov (United States)

    Campisi, C; Boccardo, F; Zilli, A; Maccio, A; Napoli, F; Ferreira Azevedo, W; Fulcheri, E; Taddei, G

    2002-01-01

    We performed a prospective randomized study upon 50 patients who had undergone a breast cancer treatment, considering particularly the possibility of appearance of arm secondary lymphedema. The patients were divided in two groups of 25 patients each. In the 1st group, we performed only a clinical follow-up, whilst in the 2nd one, we used also lymphoscintigraphy. The aim of the study was to compare the incidence of arm secondary lymphedema in the two groups, and relate the data with those of the international literature, in order to identify diagnostic procedures indicative of the risk of development of lymphedema and find proper therapeutic preventive measures. It is certainty complex to foresee the appearance of arm lymphedema due to breast cancer treatment. No specific preventive therapeutic methods based upon particular diagnostic investigations were ever reported. Patients had undergone surgery and radiation for breast cancer in the period between April 1992 and June 1994, and controlled at over 5 years after operation. Upper limb lymphoscintigraphy was performed only in one of the two groups of 25 patients, before operation and, furthermore, after 1-3-6 months and 1-3 years from the treatment. Patients who presented lymphoscintigraphic alterations (dermal back flow, diffused or delayed transit of the tracer, etc.), before edema appeared clinically, underwent physical and rehabilitative therapy (bandages, manual lymphatic drainage, mechanical lymph drainage, elastic garments, etc.) and microsurgery (lymphatic-venous anastomoses at the arm), performed early (stages Ib and II) in patients not responsive to physical therapy. In the first group followed only clinically, secondary arm lymphedema occurred in 9 cases (36%), and appeared after a period variable from 1 week to 2 years (3-6 months averagely). In the second group, lymphoscintigraphy, performed preoperatively, permitted to find lymphatic impairment (absence of deltoid way, reduced axillary lymph nodal

  15. THE EFFECT OF MICROWAVE AND BANDAGING TREATMENT ON SKIN IMMUNOLOGICAL CELLS IN CHRONIC LIMB LYMPHEDEMA

    Institute of Scientific and Technical Information of China (English)

    曹卫刚; 张涤生; 干季良

    2000-01-01

    Objective To clarify the characteristics of immunological reactions in skin tissues of non - filarial lymphedema patients with or without skin bacterial infection. Methods Avidin-biotin peroxidase (ABC)immunohistochemical method was used to examine the local skin tissue infiltrating inflammatory cells in 16chronic limb lymphedema patients before and after two courses of microwave and bandaging treatment. Results There was a significant increase of T lymphocyte infiltration in lymphedematous skin tissues; after two courses of microwave treatment, T lymphocyte infiltration was greatly resolved whereas the number of macrophages, which can lyse the stagnant proteins in lymphedematous tissues through proteolysis increased. Conclusion Microwave and bandaging treatment can promote regression of extremity edema by reducing chronic inflammation and enhancing the stagnant protein lysis capability in lymphedematous skin tissues.

  16. [Current wound care in patients with elephantiasis--third-stage lymphedema].

    Science.gov (United States)

    Rucigaj, Tanja Planinsek; Slana, Ana; Leskovec, Nada Kecelj

    2012-10-01

    Lymphedema resulting from fluid accumulation due to impairment in the lymphatic system drainage leads to enlargement of the body part involved. If left untreated, in its third stage it results in elephantiasis. Elephantiasis is frequently accompanied by papillomatosis and lymphocutaneous fistulas with lymphorrhoea, erosions and ulcers, frequently with the loss of function in the respective part of the body. Unlike other chronic wounds, wound healing in lymphedema is highly dependent on the use of combined therapies because local treatment with modern supportive dressings and compression therapy with adhesive and non-adhesive short-stretch systems is only part of the complete treatment. This treatment also includes sub-bandage foamy materials, kinesitherapy with tapes (kinesiotaping), intermittent local application of high-pressure oxygen, breathing exercise, and manual lymph drainage and exercises. PMID:23193819

  17. mHealth self-care interventions: managing symptoms following breast cancer treatment

    Science.gov (United States)

    Fu, Mei R.; Axelrod, Deborah; Guth, Amber A.; Rampertaap, Kavita; El-Shammaa, Nardin; Hiotis, Karen; Scagliola, Joan; Yu, Gary; Wang, Yao

    2016-01-01

    Background Many women suffer from daily distressing symptoms related to lymphedema following breast cancer treatment. Lymphedema, an abnormal accumulation of lymph fluid in the ipsilateral body area or upper limb, remains an ongoing major health problem affecting more than 40% of 3.1 million breast cancer survivors in the United States. Patient-centered care related to lymphedema symptom management is often inadequately addressed in clinical research and practice. mHealth plays a significant role in improving self-care, patient-clinician communication, and access to health information. The-Optimal-Lymph-Flow health IT system (TOLF) is a patient-centered, web-and-mobile-based educational and behavioral mHealth interventions focusing on safe, innovative, and pragmatic electronic assessment and self-care strategies for lymphedema symptom management. The purpose of this paper is to describe the development and test of TOLF system. Methods The development of TOLF was guided by the Model of Self-Care for Lymphedema Symptom Management and designed based on principles fostering accessibility, convenience, and efficiency of mHealth system to enhance training and motivating assessment of and self-care for lymphedema symptoms. Test of TOLF was accomplished by conducting a psychometric study to evaluate reliability, validity, and efficiency of the electronic version of Breast Cancer and Lymphedema Symptom Experience Index (BCLE-SEI), a usability testing and a pilot feasibility testing of mHealth self-care interventions. Results Findings from the psychometric study with 355 breast cancer survivors demonstrated high internal consistency of the electronic version of the instrument: a Cronbach’s alpha coefficient of 0.959 for the total scale, 0.919 for symptom occurrence, and 0.946 for symptom distress. Discriminant validity of the instrument was supported by a significant difference in symptom occurrence (z=−6.938, Psignificantly positive effects on less pain (P=0.031), less

  18. Lymphedema prevalence and treatment benefits in cancer: impact of a therapeutic intervention on health outcomes and costs.

    Directory of Open Access Journals (Sweden)

    Kimberly M Brayton

    Full Text Available Lymphedema is a common complication of cancer therapeutics; its prevalence, treatment outcomes, and costs have been poorly defined. The objective of this study was to examine lymphedema prevalence among cancer survivors and to characterize changes in clinical outcomes and costs associated with a defined therapeutic intervention (use of a pneumatic compression devices [PCD] in a representative, privately insured population.Retrospective analysis of de-identified health claims data from a large national insurer for calendar years 2007 through 2013. Patients were required to have 12 months of continuous insurance coverage prior to PCD receipt (baseline, as well as a 12-month follow-up period. Analyses were performed for individuals with cancer-related lymphedema (n = 1,065. Lymphedema prevalence was calculated: number of patients with a lymphedema claim in a calendar year divided by total number of enrollees. The impact of PCD use was evaluated by comparing rates of a pre-specified set of health outcomes and costs for the 12 months before and after, respectively, PCD receipt. Lymphedema prevalence among cancer survivors increased from 0.95% in 2007 to 1.24% in 2013. PCD use was associated with decreases in rates of hospitalizations (45% to 32%, p<0.0001, outpatient hospital visits (95% to 90%, p<0.0001, cellulitis diagnoses (28% to 22%, p = 0.003, and physical therapy use (50% to 41%, p<0.0001. The average baseline health care costs were high ($53,422 but decreased in the year after PCD acquisition (-$11,833, p<0.0001.Lymphedema is a prevalent medical condition that is often a defining attribute of cancer survivorship. The problem is associated with high health care costs; Treatment (in this instance, use of PCD is associated with significant decreases in adverse clinical outcomes and costs.

  19. Computed Tomography as an Objective Measurement Tool for Secondary Lymphedema Treated With Extracorporeal Shock Wave Therapy

    OpenAIRE

    Kim, So-Yeon; Bae, Hasuk; Ji, Hye Min

    2015-01-01

    Two patients with stage three secondary lymphedema of the upper extremities underwent treatment for breast cancer, including surgery, chemotherapy, and radiotherapy. They were examined with computed tomography (CT) before and after extracorporeal shock wave therapy (ESWT). We used a manual tracing method using PiViewSTAR software to calculate the volume of the upper extremities. There was a decrease in the volume of the subcutaneous compartment measured by CT before and after ESWT. CT may be ...

  20. The need for preoperative baseline arm measurement to accurately quantify breast cancer-related lymphedema.

    Science.gov (United States)

    Sun, Fangdi; Skolny, Melissa N; Swaroop, Meyha N; Rawal, Bhupendra; Catalano, Paul J; Brunelle, Cheryl L; Miller, Cynthia L; Taghian, Alphonse G

    2016-06-01

    Breast cancer-related lymphedema (BCRL) is a feared outcome of breast cancer treatment, yet the push for early screening is hampered by a lack of standardized quantification. We sought to determine the necessity of preoperative baseline in accounting for temporal changes of upper extremity volume. 1028 women with unilateral breast cancer were prospectively screened for lymphedema by perometry. Thresholds were defined: relative volume change (RVC) ≥10 % for clinically significant lymphedema and ≥5 % including subclinical lymphedema. The first postoperative measurement (pseudo-baseline) simulated the case of no baseline. McNemar's test and binomial logistic regression models were used to analyze BCRL misdiagnoses. Preoperatively, 28.3 and 2.9 % of patients had arm asymmetry of ≥5 and 10 %, respectively. Without baseline, 41.6 % of patients were underdiagnosed and 40.1 % overdiagnosed at RVC ≥ 5 %, increasing to 50.0 and 54.8 % at RVC ≥ 10 %. Increased pseudo-baseline asymmetry, increased weight change between baselines, hormonal therapy, dominant use of contralateral arm, and not receiving axillary lymph node dissection (ALND) were associated with increased risk of underdiagnosis at RVC ≥ 5 %; not receiving regional lymph node radiation was significant at RVC ≥ 10 %. Increased pseudo-baseline asymmetry, not receiving ALND, and dominant use of ipsilateral arm were associated with overdiagnosis at RVC ≥ 5 %; increased pseudo-baseline asymmetry and not receiving ALND were significant at RVC ≥ 10 %. The use of a postoperative proxy even early after treatment results in poor sensitivity for identifying BCRL. Providers with access to patients before surgery should consider the consequent need for proper baseline, with specific strategy tailored by institution. PMID:27154787

  1. Axillary evaluation and lymphedema in women with ductal carcinoma in situ.

    Science.gov (United States)

    Coromilas, Ellie J; Wright, Jason D; Huang, Yongmei; Feldman, Sheldon; Neugut, Alfred I; Hillyer, Grace Clarke; Chen, Ling; Hershman, Dawn L

    2016-07-01

    Axillary evaluation in women with ductal carcinoma in situ (DCIS) is increasing; however, this may introduce additional morbidity with unclear benefit. Our objective was to examine the morbidity and mortality associated with axillary evaluation in DCIS. We conducted a retrospective cohort study of 10,504 women aged 65-90 years with DCIS who underwent breast conserving surgery between 2002 and 2012 using SEER-Medicare database. Patients were categorized by receipt of axillary evaluation with either sentinel lymph node biopsy (SLNB) or axillary node dissection (ALND). We determined the incidence of lymphedema treatment as defined by diagnostic and procedural codes, as well as 10-year breast cancer-specific and all-cause mortality. 18.3 % of those treated with BCS and 69.4 % of those treated with mastectomy had an axillary evaluation. One year after treatment, 8.2 % of women who had an axillary evaluation developed lymphedema, compared to 5.9 % of those who did not. In a multivariable Cox proportional hazard model, the incidence of lymphedema was higher among those who underwent axillary evaluation (HR 1.22, 95 % CI 1.04-1.45). Overall 10-year breast cancer-specific survival was similar between both groups (HR 0.83, 95 % CI 0.40-1.74). Only 44 (0.40 %) women died of breast cancer; receipt of axillary evaluation did not alter overall survival. Axillary evaluation is commonly performed in women with DCIS, especially those undergoing mastectomy. However, women who receive an axillary evaluation have higher rates of lymphedema, without breast cancer-specific or overall survival benefit. Efforts should be made to determine the population of women with DCIS who benefit from this procedure. PMID:27365080

  2. A Woman with Unilateral Rash and Fever: Cellulitis in the Setting of Lymphedema

    Directory of Open Access Journals (Sweden)

    Melissa Joseph

    2015-01-01

    Full Text Available Cellulitis in the setting of lymphedema is an uncommon but clinically important presentation to the emergency department. Stagnant lymph is an ideal medium for bacterial growth and progression can be rapid due to decreased ability to fight infection in the affected area. Infections are commonly caused by gram-positive cocci, though blood cultures are often negative. Treatment should be aimed at rapid initiation of antibiotics targeting these species. There may be a role for antibiotic prophylaxis in recurrent cases.

  3. Multiple metastatic basal cell carcinoma with concurrent metastatic pleomorphic sarcoma in chronic lymphedema area - Case report *

    OpenAIRE

    Giuliano da Paz Oliveira; Régio José Santiago Girão; Cléverson Teixeira Soares; Edgard Jose Franco Mello Junior

    2012-01-01

    Chronic lymphedema presents as interstitial fluid retention due to a failure in the lymphatic system drainage. The affected region becomes more vulnerable immunologically and predisposed to the onset of neoplasms. Basal Cell Carcinoma is the most common sort of neoplasm, nevertheless it rarely metastisizes. Sarcomas are malignant mesenchymal neoplasms, locally aggressive, which can spread. Here is reported an infrequent case of multiple basal cell carcinoma, synchronous to a poorly differenti...

  4. Massive Localized Lymphedema Arising from Abdominal Wall: A Case Report and Review of the Literature

    OpenAIRE

    Teodóra Tóth; Yi-Che Chang Chien; Sándor Kollár; Ilona Kovács

    2015-01-01

    Massive localized lymphedema (MLL) is a rare pseudosarcomatous lesion due to localized lymphatic obstruction from variable causes. It is most common on medial aspect of thigh and inguinal region. Abdominal localization is rare and may cause clinical diagnostic confusion with other malignant tumors due to its large size. We report a case of abdominal wall MLL of a 56-year-old male patient under clinical suspicion of well differentiated liposarcoma. The literature search and differential diagno...

  5. Lipidomic Profiling of Adipose Tissue Reveals an Inflammatory Signature in Cancer-Related and Primary Lymphedema

    OpenAIRE

    Sedger, Lisa M.; Tull, Dedreia L.; Malcolm J McConville; De Souza, David P.; Rupasinghe, Thusitha W. T.; Williams, Spencer J; Saravanan Dayalan; Daniel Lanzer; Helen Mackie; Lam, Thomas C.; John Boyages

    2016-01-01

    Cancer-related and primary lymphedema (LE) are associated with the production of adipose tissue (AT). Nothing is known, however, about the lipid-based molecules that comprise LE AT. We therefore analyzed lipid molecules in lipoaspirates and serum obtained from LE patients, and compared them to lipoaspirates from cosmetic surgery patients and healthy control cohort serum. LE patient serum analysis demonstrated that triglycerides, HDL- and LDL-cholesterol and lipid transport molecules remained ...

  6. Prediction of Treatment Outcome with Bioimpedance Measurements in Breast Cancer Related Lymphedema Patients

    OpenAIRE

    Kim, Leesuk; Jeon, Jae Yong; Sung, In Young; Jeong, Soon Yong; Do, Jung Hwa; Kim, Hwa Jung

    2011-01-01

    Objective To investigate the usefulness of bioimpedance measurement for predicting the treatment outcome in breast cancer related lymphedema (BCRL) patients. Method Unilateral BCRL patients who received complex decongestive therapy (CDT) for 2 weeks (5 days per week) were enrolled in this study. We measured the ratio of extracellular fluid (ECF) volume by using bioelectrical impedance spectroscopy (BIS), and single frequency bioimpedance analysis (SFBIA) at a 5 kHz frequency before treatment....

  7. EXPERIMENTAL TREATMENT FOR OBSTRUCTIVE LYMPHEDEMA BY TRANSPLANTATION OF FASCIAL FLAP RICHED IN LYMPH VESSELS

    Institute of Scientific and Technical Information of China (English)

    SUN Feng; CAO Wei-gang; LI Sheng-li; WANG Shan-liang; ZHANG Di-sheng

    2008-01-01

    Objective To provide a more effective microsurgical treatment for obstructive lymphedema.Methods Sixty models of rabbits with lymphedema in right hindlimb were devided into three groups: 20 for fascial flap transplantation (group A), 20 for no treatment (group B) and 20 for anastomosis of lymph vessels and vein (group C) as control. For group A, the posterior branch of medial vein in the normal hindlimb was cut down together with the fascial strip (about 3 cm wide) around it and concomitant lymph vessels, then transferred through the block region of the affected limb. The two broken tips of the vein were anastomosed respectively to normal veins beside the block region. Subcutaneous tissue and skin were sutured at last. For group B, no treatment was carried out. But traditional anastomosis of lymph vessels and vein was used for group C. Postoperative variation of volume was observed and lymphoscintigraphy was made.Results The volume curve of the affected limb in group A kept declining after 2 weeks and nearing to that of the normal hindlimb in group B but away from that of the affected limb in group B. The curve of donor limb in group A was similar to that of the normal limb of group B, which meant no secondary lymphedema occurred in donor limb. The volume of the affected limb of group A had significant difference to that of group C at postoperative 24 weeks, which meant the effect of group A was better than C. The lymphatic drainage of the affected limb of group A was obviously better than B and C in lymphoscintigraphic image. Deposit of nuclein was lessened.Conclusion It was verified that the transplantation of vein-lymph vessels-fatty fascial flap had following advantages: decreased technical difficulty, better long-term effect, aost no chronic lymphedema occurred in donor site, extensive adaptation.

  8. Cardiorespiratory Fitness in Women with and without Lymphedema following Breast Cancer Treatment

    OpenAIRE

    2012-01-01

    Following breast cancer (BC) treatment, many women develop impairments that may impact cardiorespiratory (CR) fitness. The aims of this study were to 1) evaluate CR fitness in women following BC treatment, 2) evaluate differences in CR fitness in those with and without breast cancer-related lymphedema (BCRL) and compare these to age-matched norms, and 3) evaluate the contribution of predictor variables to CR fitness. 136 women post-BC treatment completed testing: 67 with BCRL, and 69 without....

  9. Effect of complete decongestive therapy and a home program for patients with post mastectomy lymphedema

    OpenAIRE

    Buragadda, Syamala; Alhusaini, Adel A.; Melam, Ganeswara Rao; Arora, Nisha

    2015-01-01

    [Purpose] Post mastectomy lymphedema is common among breast cancer survivors. It leads to physical discomfort and functional impairment. Rehabilitation forms the mainstay of treatment and is multidisciplinary. [Subjects and Methods] Sixty post mastectomy patients were allocated randomly and assigned to either a conventional treatment group (n=30) or a complete decongestive therapy (CDT) group (n=30). The conventional treatment group received manual lymphatic drainage, wore a low elastic compr...

  10. Enhancing Supportive-Educative Nursing Systems to Reduce Risk of Post-Breast Cancer Lymphedema

    OpenAIRE

    Jane M Armer; Shook, Robin P.; Schneider, Melanie K; Brooks, Constance W.; Peterson, Julie; Stewart, Bob R.

    2009-01-01

    This study describes the use of data regarding self-care agency to enhance a supportive-educative nursing system for breast cancer survivors to reduce the risk of developing lymphedema post surgery. Impetus for this study came from the analysis of participant feedback from a parent study (Lance Armstrong Foundation pilot study) that sought to plan an educational program for nurses that will improve their supportive-educative nursing system when working with breast cancer survivors. The goal i...

  11. Basic electrotechnology

    CERN Document Server

    Ashen, R A

    2013-01-01

    BASIC Electrotechnology discusses the applications of Beginner's All-purpose Symbolic Instruction Code (BASIC) in engineering, particularly in solving electrotechnology-related problems. The book is comprised of six chapters that cover several topics relevant to BASIC and electrotechnology. Chapter 1 provides an introduction to BASIC, and Chapter 2 talks about the use of complex numbers in a.c. circuit analysis. Chapter 3 covers linear circuit analysis with d.c. and sinusoidal a.c. supplies. The book also discusses the elementary magnetic circuit theory. The theory and performance of two windi

  12. Aligned nanofibrillar collagen scaffolds - Guiding lymphangiogenesis for treatment of acquired lymphedema.

    Science.gov (United States)

    Hadamitzky, Catarina; Zaitseva, Tatiana S; Bazalova-Carter, Magdalena; Paukshto, Michael V; Hou, Luqia; Strassberg, Zachary; Ferguson, James; Matsuura, Yuka; Dash, Rajesh; Yang, Phillip C; Kretchetov, Shura; Vogt, Peter M; Rockson, Stanley G; Cooke, John P; Huang, Ngan F

    2016-09-01

    Secondary lymphedema is a common disorder associated with acquired functional impairment of the lymphatic system. The goal of this study was to evaluate the therapeutic efficacy of aligned nanofibrillar collagen scaffolds (BioBridge) positioned across the area of lymphatic obstruction in guiding lymphatic regeneration. In a porcine model of acquired lymphedema, animals were treated with BioBridge scaffolds, alone or in conjunction with autologous lymph node transfer as a source of endogenous lymphatic growth factor. They were compared with a surgical control group and a second control group in which the implanted BioBridge was supplemented with exogenous vascular endothelial growth factor-C (VEGF-C). Three months after implantation, immunofluorescence staining of lymphatic vessels demonstrated a significant increase in lymphatic collectors within close proximity to the scaffolds. To quantify the functional impact of scaffold implantation, bioimpedance was used as an early indicator of extracellular fluid accumulation. In comparison to the levels prior to implantation, the bioimpedance ratio was significantly improved only in the experimental BioBridge recipients with or without lymph node transfer, suggesting restoration of functional lymphatic drainage. These results further correlated with quantifiable lymphatic collectors, as visualized by contrast-enhanced computed tomography. They demonstrate the therapeutic potential of BioBridge scaffolds in secondary lymphedema. PMID:27348849

  13. Lymphedema in Klippel-Trenaunay Syndrome: Is It Possible to Normalize?

    Science.gov (United States)

    Río, Angela; Domingo Garcia, Paloma; de Fatima Guerreiro Godoy, Maria

    2016-01-01

    The aim of this study is to report the results of intensive therapy of lymphedema associated with Klippel-Trenaunay syndrome. A 24-year-old female patient reported that her family had observed edema in her right leg and port wine stains from birth. For ten years, they consulted with different specialists in the region but the prognosis did not change and no specific treatment was found. In 2014, at the age of 24, with massive lymphedema, a leg ulcer, and recurrent infections, she started treatment at the Clínica Godoy in São José do Rio Preto. She was evaluated by clinical history, physical examination, water displacement volumetry, and bioimpedance. Intensive therapy (8 hours daily) was proposed using Manual Lymphatic Therapy (Godoy & Godoy), Cervical Stimulation Therapy, Mechanical Lymphatic Therapy, a grosgrain stocking adjusted several times a day, and the use of Unna boot in the region of the ulcer. The volume of edema was reduced by about 44% within the first week with further reductions in the following weeks and healing of the ulcer. Subsequently, it was possible to control and maintain the reduction in swelling with less intense treatment. It is possible to reduce and maintain the treatment results of lymphedema associated with Klippel-Trenaunay syndrome. PMID:27529050

  14. Risk factors for lower-limb lymphedema after surgery for cervical cancer

    International Nuclear Information System (INIS)

    Lower-limb lymphedema (LLL) is a prevalent complication that is encountered after treatment for gynecological malignancies. The aim of this study was to evaluate the risk factors for postoperative LLL in patients with cervical cancer. We conducted a retrospective chart review for patients who had undergone surgery, including systematic lymphadenectomy, for cervical cancer. Patients who died of cancer, were evaluated for short periods of time (<2 years), had missing medical records, or were suffering from deep venous thrombosis were excluded. We utilized the International Society of Lymphology staging of lymphedema severity as the diagnostic criteria for LLL, and patients with stage II or III lymphedema, as objectively determined by physicians, were included in the group of patients with LLL. Multivariate analysis was performed to confirm independent risk factors. A total of 155 patients with cervical cancer were evaluated. Thirty-one patients (20.0%) contracted LLL with a median follow-up of 6.1 years. Suprafemoral node dissection (odds ratio, 9.5; 95% confidence interval, 1.2-73.3; P=0.031) and adjuvant radiotherapy (3.7; 1.2-10.9; P=0.019) were identified as independent risk factors. Given that the effectiveness of the above two therapeutic options for cervical cancer is currently controversial, the clinical benefits of these therapies should be reevaluated specifically to conserve the quality of life for patients with this disease. (author)

  15. Lymphedema in Klippel-Trenaunay Syndrome: Is It Possible to Normalize?

    Directory of Open Access Journals (Sweden)

    Jose Maria Pereira de Godoy

    2016-01-01

    Full Text Available The aim of this study is to report the results of intensive therapy of lymphedema associated with Klippel-Trenaunay syndrome. A 24-year-old female patient reported that her family had observed edema in her right leg and port wine stains from birth. For ten years, they consulted with different specialists in the region but the prognosis did not change and no specific treatment was found. In 2014, at the age of 24, with massive lymphedema, a leg ulcer, and recurrent infections, she started treatment at the Clínica Godoy in São José do Rio Preto. She was evaluated by clinical history, physical examination, water displacement volumetry, and bioimpedance. Intensive therapy (8 hours daily was proposed using Manual Lymphatic Therapy (Godoy & Godoy, Cervical Stimulation Therapy, Mechanical Lymphatic Therapy, a grosgrain stocking adjusted several times a day, and the use of Unna boot in the region of the ulcer. The volume of edema was reduced by about 44% within the first week with further reductions in the following weeks and healing of the ulcer. Subsequently, it was possible to control and maintain the reduction in swelling with less intense treatment. It is possible to reduce and maintain the treatment results of lymphedema associated with Klippel-Trenaunay syndrome.

  16. Effect of complete decongestive therapy and a home program for patients with post mastectomy lymphedema.

    Science.gov (United States)

    Buragadda, Syamala; Alhusaini, Adel A; Melam, Ganeswara Rao; Arora, Nisha

    2015-09-01

    [Purpose] Post mastectomy lymphedema is common among breast cancer survivors. It leads to physical discomfort and functional impairment. Rehabilitation forms the mainstay of treatment and is multidisciplinary. [Subjects and Methods] Sixty post mastectomy patients were allocated randomly and assigned to either a conventional treatment group (n=30) or a complete decongestive therapy (CDT) group (n=30). The conventional treatment group received manual lymphatic drainage, wore a low elastic compression garment, received glenohumeral mobilization, and performed deep breathing exercises, and the complete decongestive therapy group received CDT from a trained physiotherapist and a daily home program along with the conventional treatment, 5 days a week for 6 weeks. [Results] Arm circumference measurements were taken at five levels: the wrist, mid forearm, elbow, mid-upper arm, and axilla. The upper extremity function was evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and pain was assessed using the visual analogue scale. Measurements were taken at baseline, and at 4th and 6th weeks after the start of intervention. Within and between group comparisons showed significant improvements in the CDT group. [Conclusion] Complete decongestive therapy and a home program assists breast cancer related lymphedema survivors in regaining their lost functions. It also helps to improve their independence in daily activities, reduce their need for caregivers, and thereby improving their quality of life. Therefore, the results of this study showed that the CDT with a home program is an effective treatment for reducing post mastectomy lymphedema. PMID:26504284

  17. Brain Basics

    Medline Plus

    Full Text Available ... pituitary-adrenal (HPA) axis. Brain Basics in Real Life Brain Basics in Real Life—How Depression affects the Brain Meet Sarah Sarah ... having trouble coping with the stresses in her life. She began to think of suicide because she ...

  18. Brain Basics

    Medline Plus

    Full Text Available ... Basics in Real Life Brain Basics in Real Life—How Depression affects the Brain Meet Sarah Sarah is a middle-aged woman who seemed to have it all. She was happily married and successful in business. Then, after a serious setback at work, she lost interest ...

  19. "You're naked, you're vulnerable": Sexual well-being and body image of women with lower limb lymphedema.

    Science.gov (United States)

    Winch, Caleb J; Sherman, Kerry A; Smith, Katriona M; Koelmeyer, Louise A; Mackie, Helen; Boyages, John

    2016-09-01

    Lower-limb lymphedema is an incurable illness manifesting as visible swelling enlarging the leg(s) and/or feet, buttocks, and genitals. This study used semi-structured interviews and thematic analysis to explore sexual well-being among women with primary (congenital) lymphedema (n=11) or secondary lymphedema associated with gynecological cancer (n=8). Five themes (subthemes) summarized women's responses, with Attractiveness and Confidence (Publicly Unattractive, Privately Unconfident, Lymphedema or Aging?) describing women's central concern. These body image-related concerns accounted for sexual well-being in association with Partner Support (Availability of Support, Languages of Support, Fears About Support) and the degree of Functional Interruptions (Lymphedema in Context, Enduring Impacts, Overcoming Interruptions). Successful Lymphedema Coping (Control, Acceptance) and self-perceived ability to fulfill a valued Sexual Role also affected sexual well-being. Few differences between women with primary versus secondary lymphedema were evident. Lymphedema clinicians should screen for sexual concerns and have referral options available. PMID:27434105

  20. Quantitative and Morphologic Change Associated with Breast Cancer-Related Lymphedema. Comparison of 3.0T MRI to External Measures

    OpenAIRE

    Gardner, Gregory C.; Nickerson, Joshua P.; Watts, Richard; Nelson, Lee; Dittus, Kim L.; O'Brien, Patricia J.

    2014-01-01

    Introduction: Lymphedema is a chronic disease of increasing importance to cancer survivors. A tape measurement tool used for lymphedema relies on indirect volume calculations based on external circumference, which may not reflect the true extent of abnormal fluid accumulation accurately. Fluid-sensitive MRI sequences may be able to delineate the severity of this condition more precisely and thus also monitor response to therapy.

  1. Prevalence of lymphedema in women undergoing treatment for breast cancer in a referral center in southeastern Brazil

    Directory of Open Access Journals (Sweden)

    Paiva Daniella MF

    2013-02-01

    Full Text Available Abstract Background Lymphedema is a highly prevalent condition in women who have undergone treatment for breast cancer. Lymphedema negatively affects the quality of life. The objective of this study was to estimate the prevalence of lymphedema and associated factors in women treated for breast cancer in the municipality of Juiz de Fora. Methods We performed a cross-sectional study that evaluated 250 women who were being treated for breast cancer. Pre-screening of the sample by analysis of medical records was performed to select women who met the inclusion criteria as follows: women who had an operation more than 6 months ago; absence of active disease, locoregional or distant; the absence of functional change in the affected limb before surgery, which could lead to swelling of the limb; and simulating or masking symptoms of lymphedema, such as bursitis, tendonitis, and work-related musculoskeletal disorders. Women with bilateral breast cancer, absence of axillary intervention (partial or complete axillary dissection and/or SLN biopsy, active disease in the region, or lympho-venous alteration of the limb before surgery were excluded. Data were collected from the medical records of the selected cases, and they subsequently underwent an interview and a physical assessment. Results The prevalence of lymphedema was 44.8%. There were medical records on the presence of this condition in 5.4% of cases. With regard to shoulder joint mobility, restrictions on abduction movements, internal and external rotation, and anterior shoulder adduction were significantly associated with lymphedema. Variables, including the presence of seroma, vascular changes, time elapsed after surgery, episodes of redness in the extremities, and cuticle removal from the hand with pliers were considered as major associated factors for lymphedema (p Conclusions The prevalence of 44.8% for lymphedema found in this study is considered to be relevant because it is a morbidity that

  2. MANAGERS AND BASIC EDUCATION TEACHERS : THE IMPLICATIONS OF ITS ROLE WITH THE EFFECTIVENESS OF TECHNICAL SCHOOL BOARDS

    Directory of Open Access Journals (Sweden)

    Manuel Ortega Muñoz

    2015-06-01

    Full Text Available This letter is part of a broader investigation that deals with the functioning of the School Technical Councils in the elementary schools in the state of Durango, Mexico. In this part, they were raised the following objectives: a Identify what level of implications of the role of principals and teachers in the effective functioning of the School Technical Councils, b Identify the implications of the role of principals and teachers are regarding compliance with the objectives of the School Technical Councils in schools of basic education in the state of Durango and c Identify the implications of the role of principals and teachers regarding the exercise of the powers of the Technical School Councils in schools are Basic education in the state of Durango, Mexico. To achieve the objectives was carried out an exploratory, descriptive, correlational, cross-sectional non-experimental study. Information gathering was conducted by survey method using a questionnaire applied to 1243 principals, group teachers, support teachers and of basic education in the State of Durango, México. Its main results support the conclusion that the gender implications regarding the effective functioning of the School Technical Councils in the elementary schools in the state of Durango have a low level, analyzing its dimensions: achievement of objectives and exercise of powers.

  3. Correlates of Lymphedema in Women with Breast Cancer: a Case Control Study in Shiraz, Southern Iran.

    Science.gov (United States)

    Honarvar, Behnam; Sayar, Negin; Tahmasebi, Sedigheh; Zakeri, Zeinab; Talei, Asra; Rostami, Sara; Khademi, Sahar; Sabzi Sarvestani, Amene; Sekhavati, Eghbal

    2016-01-01

    Globally, the burden of breast cancer (BC) continues to increase. BC related lymphedema (BCRL) is currently non curable and as a life time risk it affects at least 25% of BC patients. Knowing more about BCRL and appropriate control of its modifiable risk factors can improve quality of life (QOL) of the affected patients. In this case control study to detect factors, 400 women with BCRL (as the case group) and 283 patients with BC without lymphedema (as the control group) that were referred to Shiraz University of Medical Sciences affiliated BC clinic center were assessed. The data were analyzed in SPSS. The mean age of the case group was 52.3±11.0 years and of the control group was 50.1±10.9 years. In patients with BCRL, 203(50.7%) had left (Lt) side BC and in non- lymphedema group 151 (53.3%) had Lt side BC. Out of all BCRL patients, 204 (51%) had lymphedema in all parts of their affected upper extremities, 100 (25%) had swelling in the arm and forearm and 23 (5.7%) had edema in both the upper extremity and trunk. Edema, heaviness, concern about changing body image, pain and paresthesia were the most common signs/symptoms among patients with BCRL. In BCRL patients, the difference of circumference between the affected upper limb and non-affected limb was 4.4±2.5 cm and the difference in volume displacement was 528.7±374.4 milliliters. Multiple variable analysis showed that moderate to severe activity (OR; odds ratio =14, 95% CI: 2.6-73.3 ), invasiveness of BC (OR =13.7, 95% CI: 7.3-25.6), modified radical mastectomy (OR=4.3, 95% CI: 2.3-7.9), BMI =>25 (OR=4.2, 95% CI: 2-8.7), radiotherapy (OR=3.9, 95% CI: 1.8-8.2 ), past history of limb damage (OR=1.7, 95% CI: 0.9-3.1) and the number of excised lymph nodes (OR=1.06, 95% CI: 1.02-1.09) were the significant predictors of lymphedema in women with BC. Modifiable risk factors of BCRL such as non-guided moderate to severe physical activity, high BMI and trauma to the limb should be controlled as early as possible in

  4. Decision support basics

    CERN Document Server

    Power, Daniel J

    2009-01-01

    This book is targeted to busy managers and MBA students who need to grasp the basics of computerized decision support. Some of the topics covered include: What is a DSS? What do managers need to know about computerized decision support? And how can managers identify opportunities to create innovative DSS? Overall the book addresses 35 fundamental questions that are relevant to understanding computerized decision support.

  5. Clinical feasibility of Axillary Reverse Mapping and its influence on breast cancer related lymphedema: a systematic review.

    Science.gov (United States)

    Gebruers, Nick; Tjalma, Wiebren A A

    2016-05-01

    Breast cancer is the most common malignancy in women worldwide. Fortunately, the overall survival is good. Therefore it is important to focus on the morbidities related to breast cancer treatment. One of the most dreaded morbidities is lymphedema. In 2007 the Axillary Reverse Mapping (ARM) was introduced to limit the invasiveness in the axilla during breast cancer surgery. It is hypothesized that ARM is able to limit the incidence of breast cancer related lymphedema (BCRL) considerably. This systematic review aims to answer the following research questions: (1) which approaches for ARM are described? (2) Is ARM surgical feasible and oncological safe? (3) Does ARM decrease the incidence of lymphedema after sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND)? In total 27 papers were retrieved using four electronic databases (PubMed, Web of Science, Medline and Cochrane clinical trials; assessed until May 13, 2015. The level of evidence of these studies was low (mostly level 3). Therefore the conclusions are that the ARM procedure is feasible although ARM-node rates have a broad range. Additionally, from a theoretical point there is a clear benefit from ARM in terms of lymphedema prevention. From a practical point there is little scientific data to support this due to the lack of studies; and especially because of the different methods and definitions for lymphedema used in the different studies. PMID:27019287

  6. Basic hydraulics

    CERN Document Server

    Smith, P D

    1982-01-01

    BASIC Hydraulics aims to help students both to become proficient in the BASIC programming language by actually using the language in an important field of engineering and to use computing as a means of mastering the subject of hydraulics. The book begins with a summary of the technique of computing in BASIC together with comments and listing of the main commands and statements. Subsequent chapters introduce the fundamental concepts and appropriate governing equations. Topics covered include principles of fluid mechanics; flow in pipes, pipe networks and open channels; hydraulic machinery;

  7. BASIC ACTIVITIES OF THE HUMAN RESOURCE MANAGEMENT IN ENSURING STAFF FOR S.C. ROMLUX S.A.

    OpenAIRE

    SECARĂ CARMEN-GABRIELA

    2014-01-01

    Within the analysis conducted, the main activities in the field of human resource management has been assessed, such as: human resource planning; recruitment and selection of staff; assessment of individual professional performances; initial and continuing training; evaluation of human resources management costs; motivation. However, there have also been reviewed with a lower degree of detailing, other issues of interest, such as: human resources assessment; promotion of staff...

  8. Brain Basics

    Medline Plus

    Full Text Available ... the anatomy, physiology, and chemistry of the nervous system. When the brain cannot effectively coordinate the billions ... basic working unit of the brain and nervous system. These cells are highly specialized for the function ...

  9. Brain Basics

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    Full Text Available ... News About Us Home > Health & Education > Educational Resources Brain Basics Introduction The Growing Brain The Working Brain ... to mental disorders, such as depression. The Growing Brain Inside the Brain: Neurons & Neural Circuits Neurons are ...

  10. Brain Basics

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    Full Text Available ... Trials — Participants Statistics Help for Mental Illnesses Outreach Research Priorities Funding Labs at NIMH News About Us Home > Health & Education > Educational Resources Brain Basics Introduction The Growing Brain The ...

  11. Brain Basics

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    Full Text Available ... Brain Basics will introduce you to some of this science, such as: How the brain develops How ... cell, and responds to signals from the environment; this all helps the cell maintain its balance with ...

  12. Brain Basics

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    Full Text Available ... How the brain develops How genes and the environment affect the brain The basic structure of the ... inside contents of the cell from its surrounding environment and controls what enters and leaves the cell, ...

  13. Brain Basics

    Science.gov (United States)

    ... News About Us Home > Health & Education > Educational Resources Brain Basics Introduction The Growing Brain The Working Brain ... to mental disorders, such as depression. The Growing Brain Inside the Brain: Neurons & Neural Circuits Neurons are ...

  14. Cancer Basics

    Science.gov (United States)

    ... Cancer? Breast Cancer Colon/Rectum Cancer Lung Cancer Prostate Cancer Skin Cancer Show All Cancer Types News and Features Cancer Glossary ACS Bookstore Cancer Information Cancer Basics Cancer Prevention & Detection Signs & Symptoms of Cancer Treatments & Side Effects ...

  15. Brain Basics

    Medline Plus

    Full Text Available ... Brain Basics provides information on how the brain works, how mental illnesses are disorders of the brain, ... learning more about how the brain grows and works in healthy people, and how normal brain development ...

  16. Basic Finance

    Science.gov (United States)

    Vittek, J. F.

    1972-01-01

    A discussion of the basic measures of corporate financial strength, and the sources of the information is reported. Considered are: balance sheet, income statement, funds and cash flow, and financial ratios.

  17. Brain Basics

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    Full Text Available ... Brain Basics provides information on how the brain works, how mental illnesses are disorders of the brain, ... others live with symptoms of mental illness every day. They can be moderate, or serious and cause ...

  18. Brain Basics

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    Full Text Available ... the function of conducting messages. A neuron has three basic parts: Cell body which includes the nucleus, ... Plan in 2016 August 31, 2016, 2:00-3:00 PM ET Recovery Month September 2016 National ...

  19. Blood Basics

    Science.gov (United States)

    ... Patient Group Links Advocacy Toolkit Home For Patients Blood Basics Blood is a specialized body fluid. It ... about 9 pints. Jump To: The Components of Blood and Their Importance Many people have undergone blood ...

  20. Brain Basics

    Medline Plus

    Full Text Available ... for the function of conducting messages. A neuron has three basic parts: Cell body which includes the ... disorder (ADHD) . Glutamate —the most common neurotransmitter, glutamate has many roles throughout the brain and nervous system. ...

  1. Brain Basics

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    Full Text Available ... interconnections. neuron —A nerve cell that is the basic, working unit of the brain and nervous system, which processes and transmits information. neurotransmitter —A chemical produced by ...

  2. Brain Basics

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    Full Text Available ... The Growing Brain Inside the Brain: Neurons & Neural Circuits Neurons are the basic working unit of the ... distant nerve cells (via axons) to form brain circuits. These circuits control specific body functions such as ...

  3. Brain Basics

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    Full Text Available ... science, such as: How the brain develops How genes and the environment affect the brain The basic ... that with brain development in people mental disorders. Genes and environmental cues both help to direct this ...

  4. Body Basics

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    ... about how the body works, what basic human anatomy is, and what happens when parts of the body don't function properly. Blood Bones, Muscles, and Joints Brain and Nervous System Digestive System Endocrine System Eyes Female Reproductive System ...

  5. Brain Basics

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    Full Text Available ... Real Life Brain Basics in Real Life—How Depression affects the Brain Meet Sarah Sarah is a ... blues" from time to time. In contrast, major depression is a serious disorder that lasts for weeks. ...

  6. Discussion on the Basic Principle of Food Safety Risk Management%食品安全风险管理基本理论探析

    Institute of Scientific and Technical Information of China (English)

    刘为军; 魏益民; 郭波莉; 魏帅

    2011-01-01

    本文就食品安全风险管理的概念、原则和实施框架等基本理论问题进行了探讨.食品安全风险管理是风险分析体系的重要组成部分,是在风险评估结果基础上的政策选择过程,包括选择实施适当的控制理念以及法规管理措施.食品安全风险管理包括风险评价、选择评估、执行评估、监控和回顾4个要素.%This paper discussed the basic principle of food safety risk management, which includes the concept, principles and implement framework. Risk management is one of the important components of risk analysis. Risk management is defined as the process of weighing policy alternatives in the light of the results of risk assessment and selecting and implementing appropriate control options, including regulatory measures. The framework includes 4 elements: risk evaluation, risk management option assessment, implementation of management decision, and monitoring and review.

  7. BASIC ACTIVITIES OF THE HUMAN RESOURCE MANAGEMENT IN ENSURING STAFF FOR S.C. ROMLUX S.A.

    Directory of Open Access Journals (Sweden)

    SECARĂ CARMEN-GABRIELA

    2014-08-01

    Full Text Available Within the analysis conducted, the main activities in the field of human resource management has been assessed, such as: human resource planning; recruitment and selection of staff; assessment of individual professional performances; initial and continuing training; evaluation of human resources management costs; motivation. However, there have also been reviewed with a lower degree of detailing, other issues of interest, such as: human resources assessment; promotion of staff. Following the integration of conclusions of analysis conducted for the business areas listed, it resulted the picture of the most important elements with generalizing value.

  8. Evaluation of inter-rater reliability of subjective and objective criteria for diagnosis of lymphedema in upper and lower limbs

    Directory of Open Access Journals (Sweden)

    Larissa Louise Campanholi

    2015-03-01

    Full Text Available BACKGROUND: The diagnosis of lymphedema can be obtained objectively by measurement methods, and also by subjective methods, based on the patient's complaint. OBJECTIVE: To evaluate inter-rater reliability of objective and subjective criteria used for diagnosis of lymphedema and to propose a lymphedema cut-off for differences in volume between affected and control limbs. METHODS: We studied 84 patients who had undergone lymphadenectomy for treatment of cutaneous melanoma. Physical measures were obtained by manual perimetry (MP. The subjective criteria analyzed were clinical diagnosis of lymphedema in patients' medical records and self-report of feelings of heaviness and/or increase in volume in the affected limb. RESULTS: For upper limbs, the subjective criteria clinical observation (k 0.754, P<0.001 and heaviness and swelling (k 0.689, P<0.001 both exhibited strong agreement with MP results and there was moderate agreement between MP results and swelling (k 0.483 P<0.001, heaviness (k 0.576, P<0.001 and heaviness or swelling (k 0.412, P=0.001. For lower limbs there was moderate agreement between MP results and clinical observation (k 0.423, P=0.003 and regular agreement between MP and self-report of swelling (k 0.383, P=0.003. Cut-off values for diagnosing lymphedema were defined as a 9.7% difference between an affected upper limb and control upper limb and a 5.7% difference between lower limbs. CONCLUSION: Manual perimetry, medical criteria, and self-report of heaviness and/or swelling exhibited better agreement for upper limbs than for lower limbs for diagnosis of lymphedema.

  9. 基层血库工作管理研究%Study on the Basic Blood Bank Management

    Institute of Scientific and Technical Information of China (English)

    李建屏

    2015-01-01

    Blood banks are very important parts of the hospital, and hospital treatment has a very close relationship, to normalize their management are very necessary. The special nature of the blood bank, its management and other departments of the essential difference. Management in grass-roots hospital blood bank will be carried out in this paper simple Exposition, designed to provide reference for primary blood bank management.%血库是医院中非常重要的部门,与医院的救治工作有着非常密切的联系,对其进行规范化管理也是非常必要的。血库的性质较为特殊,其管理工作也与其他部门有着本质性的区别。该研究将对基层医院血库的管理工作进行简单的阐述,旨在为基层血库管理工作提供可参考依据。

  10. Brain Basics

    Medline Plus

    Full Text Available ... Funding Strategy for Grants Clinical Research Application Process Managing Grants Training Labs at NIMH Labs at NIMH ... motivated and stay focused on a task, and managing proper emotional reactions. Reduced ACC activity or damage ...

  11. Effect of Kinesiology Taping on Breast Cancer-Related Lymphedema: A Randomized Single-Blind Controlled Pilot Study

    OpenAIRE

    Smykla, A.; Walewicz, K.; Trybulski, R.; Halski, T.; Kucharzewski, M.; Kucio, C.; W. Mikusek; Klakla, K.; J. Taradaj

    2013-01-01

    The aim of the study was to assess the efficacy of Kinesiology Taping (KT) for treating breast cancer-related lymphedema. Sixty-five women with unilateral stage II and III lymphedema were randomly grouped into the KT group (K-tapes, n = 20), the Quasi KT group (quasi K-tapes, n = 22), or the MCT group (multilayered compression therapy group, n = 23). Skin care, 45 min pneumatic compression therapy, 1 h manual lymphatic drainage, and application of K-tape/Quasi K-tapes/multilayered short-stret...

  12. Multiple metastatic basal cell carcinoma with concurrent metastatic pleomorphic sarcoma in chronic lymphedema area--case report.

    Science.gov (United States)

    Oliveira, Giuliano da Paz; Girão, Régio José Santiago; Soares, Cléverson Teixeira; Mello Junior, Edgard Jose Franco

    2012-01-01

    Chronic lymphedema presents as interstitial fluid retention due to a failure in the lymphatic system drainage. The affected region becomes more vulnerable immunologically and predisposed to the onset of neoplasms. Basal Cell Carcinoma is the most common sort of neoplasm, nevertheless it rarely metastisizes. Sarcomas are malignant mesenchymal neoplasms, locally aggressive, which can spread. Here is reported an infrequent case of multiple basal cell carcinoma, synchronous to a poorly differentiated pleomorphic sarcoma, both spreading to lymph nodes and arising from tissue compromised by chronic lymphedema. PMID:23197211

  13. Taking the lymphatic system into consideration in nursing : How lymphedema impacts the breast cancer patients’ quality of life

    OpenAIRE

    Haapiainen, Tiina

    2015-01-01

    The lymphatic system has several vital functions to maintain a healthy immune system. Breast cancer-related lymphedema is a non-curable condition that refers to post-surgical chronic and painful swelling of the upper limb. The aim of this study was to review existing literature to see what information is available for nurses about the importance of the lymphatic system. The study focused on breast cancer related lymphedema patients and two research questions were asked 1) What are some of the...

  14. Basic electronics

    CERN Document Server

    Holbrook, Harold D

    1971-01-01

    Basic Electronics is an elementary text designed for basic instruction in electricity and electronics. It gives emphasis on electronic emission and the vacuum tube and shows transistor circuits in parallel with electron tube circuits. This book also demonstrates how the transistor merely replaces the tube, with proper change of circuit constants as required. Many problems are presented at the end of each chapter. This book is comprised of 17 chapters and opens with an overview of electron theory, followed by a discussion on resistance, inductance, and capacitance, along with their effects on t

  15. Comparison of Breast Cancer-Related Lymphedema (Upper Limb Swelling Prevalence Estimated Using Objective and Subjective Criteria and Relationship with Quality of Life

    Directory of Open Access Journals (Sweden)

    Catherine Bulley

    2013-01-01

    Full Text Available This study aimed to investigate lymphedema prevalence using three different measurement/diagnostic criterion combinations and explore the relationship between lymphedema and quality of life for each, to provide evaluation of rehabilitation. Cross-sectional data from 617 women attending review appointments after completing surgery, chemotherapy, and radiotherapy included the Morbidity Screening Tool (MST; criterion: yes to lymphedema; Lymphedema and Breast Cancer Questionnaire (LBCQ; criterion: yes to heaviness and/or swelling; percentage limb volume difference (perometer: %LVD; criterion: 10%+ difference; and the Functional Assessment of Cancer Therapy breast cancer-specific quality of life tool (FACT B+4. Perometry measurements were conducted in a clinic room. Between 341 and 577 participants provided sufficient data for each analysis, with mean age varying from 60 to 62 (SD 9.95–10.03 and median months after treatment from 49 to 51. Lymphedema prevalence varied from 26.2% for perometry %LVD to 20.5% for the MST and 23.9% for the LBCQ; differences were not significant. Limits of agreement analysis between %LVD and the subjective measures showed little consistency, while moderate consistency resulted between the subjective measures. Quality of life differed significantly for women with and without lymphedema only when subjective measurements were used. Results suggest that subjective and objective tools investigate different aspects of lymphedema.

  16. Standardized Method for Quantification of Developing Lymphedema in Patients Treated for Breast Cancer

    International Nuclear Information System (INIS)

    Purpose: To develop a simple and practical formula for quantifying breast cancer-related lymphedema, accounting for both the asymmetry of upper extremities' volumes and their temporal changes. Methods and Materials: We analyzed bilateral perometer measurements of the upper extremity in a series of 677 women who prospectively underwent lymphedema screening during treatment for unilateral breast cancer at Massachusetts General Hospital between August 2005 and November 2008. Four sources of variation were analyzed: between repeated measurements on the same arm at the same session; between both arms at baseline (preoperative) visit; in follow-up measurements; and between patients. Effects of hand dominance, time since diagnosis and surgery, age, weight, and body mass index were also analyzed. Results: The statistical distribution of variation of measurements suggests that the ratio of volume ratios is most appropriate for quantification of both asymmetry and temporal changes. Therefore, we present the formula for relative volume change (RVC): RVC = (A2U1)/(U2A1) - 1, where A1, A2 are arm volumes on the side of the treated breast at two different time points, and U1, U2 are volumes on the contralateral side. Relative volume change is not significantly associated with hand dominance, age, or time since diagnosis. Baseline weight correlates (p = 0.0074) with higher RVC; however, baseline body mass index or weight changes over time do not. Conclusions: We propose the use of the RVC formula to assess the presence and course of breast cancer-related lymphedema in clinical practice and research.

  17. Basic Backwardness.

    Science.gov (United States)

    Weingartner, Charles

    This paper argues that the "back to basics" movement is regressive and that regression is the characteristic mode of fear-ridden personalities. It is argued that many people in American society today have lost their ability to laugh and do not have the sense of humor which is crucial to a healthy mental state. Such topics as necrophilia, mental…

  18. Brain Basics

    Medline Plus

    Full Text Available ... Life Brain Basics in Real Life—How Depression affects the Brain Meet Sarah Sarah is a middle-aged woman ... new memories. hypothalmic-pituitary-adrenal (HPA) axis —A brain-body ... stress. impulse —An electrical communication signal sent between neurons ...

  19. Brain Basics

    Medline Plus

    Full Text Available ... Welcome. Brain Basics provides information on how the brain works, how mental illnesses are disorders of the brain, ... highly developed area at the front of the brain that, in humans, plays a role in executive functions such as ...

  20. Ethanol Basics

    Energy Technology Data Exchange (ETDEWEB)

    None

    2015-01-30

    Ethanol is a widely-used, domestically-produced renewable fuel made from corn and other plant materials. More than 96% of gasoline sold in the United States contains ethanol. Learn more about this alternative fuel in the Ethanol Basics Fact Sheet, produced by the U.S. Department of Energy's Clean Cities program.

  1. Basic Skills.

    Science.gov (United States)

    Luparelli, Augustus N.; And Others

    1981-01-01

    These four articles focus on developing basic reading, science, and job search skills: "Reading Program for Vocational Classes" by Augustus Luparelli; "Why Teach Employability Skills?" by Larry Siefferman; "Improving Vocabulary and Reading Skills" by Edythe Conway; and "Science in Everyday Life" by Virginia Eleazer and George Carney. (SK)

  2. Localized bullous pemphigoid on sites of radiotherapy and lymphedema in the same patient

    Directory of Open Access Journals (Sweden)

    Manikoth P Binitha

    2014-01-01

    Full Text Available Bullous pemphigoid (BP is a blistering disorder due to autoantibodies to the epidermal basement membrane zone. The triggering factor could be localized damage to the skin by physical or chemical agents. We report a case of a 68-year-old woman with a three year history of oral lesions of BP following radiotherapy for carcinoma of the hypopharynx, and a three month history of BP over lymphedematous sites on the right hand and right lower limb. Localized BP induced by radiotherapy or lymphedema is rare; both factors working simultaneously in the same patient is even rarer.

  3. Massive Localized Lymphedema Arising from Abdominal Wall: A Case Report and Review of the Literature.

    Science.gov (United States)

    Tóth, Teodóra; Chang Chien, Yi-Che; Kollár, Sándor; Kovács, Ilona

    2015-01-01

    Massive localized lymphedema (MLL) is a rare pseudosarcomatous lesion due to localized lymphatic obstruction from variable causes. It is most common on medial aspect of thigh and inguinal region. Abdominal localization is rare and may cause clinical diagnostic confusion with other malignant tumors due to its large size. We report a case of abdominal wall MLL of a 56-year-old male patient under clinical suspicion of well differentiated liposarcoma. The literature search and differential diagnosis will be addressed. In doubt cases, immunohistochemical stain or fluorescent in situ hybridization can help to separate this entity from the other mimickers. PMID:26417468

  4. Massive Localized Lymphedema Arising from Abdominal Wall: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Teodóra Tóth

    2015-01-01

    Full Text Available Massive localized lymphedema (MLL is a rare pseudosarcomatous lesion due to localized lymphatic obstruction from variable causes. It is most common on medial aspect of thigh and inguinal region. Abdominal localization is rare and may cause clinical diagnostic confusion with other malignant tumors due to its large size. We report a case of abdominal wall MLL of a 56-year-old male patient under clinical suspicion of well differentiated liposarcoma. The literature search and differential diagnosis will be addressed. In doubt cases, immunohistochemical stain or fluorescent in situ hybridization can help to separate this entity from the other mimickers.

  5. Composing hope through collage: A community-based intervention for cancer survivors living with lymphedema

    Directory of Open Access Journals (Sweden)

    Roanne Thomas

    2016-07-01

    Full Text Available Secondary lymphedema after cancer may result in distress, yet few interventions exist to support coping skills in this population. As part of a community-based intervention, we piloted the use of creative practices to promote active orientations to hope. A total of 19 participants completed the workshops; 11 collaged. The main themes address the collage processes as well as their content. The former addresses sub-themes such as selecting/composing. The latter includes sub-themes related to movement depicted in the collages. Collages and their associated discussions concretized hoping as an active and accessible process for participants living with two chronic illnesses.

  6. Quality of life of women with lymphedema after surgery for breast cancer

    OpenAIRE

    Marislei Sanches Panobianco; Natalia Campacci; Letícia Meda Vendrusculo Fangel; Maria Antonieta Spinoso Prado; Ana Maria de Almeida; Thais de Oliveira Gozzo

    2014-01-01

    This study evaluated the quality of life of 20 women with post-mastectomy lymphedema due to breast cancer, using the Flanagan’s Adapted Quality of Life Scale (1) and the Visual Analogue Scale (2), with data collection from July to December 2009 in the countryside of the state of São Paulo. It was observed a lower quality of life concerning participation in recreational and work activities, and better quality of life was related to relationship with friends; listening to music, reading, watchi...

  7. Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature

    NARCIS (Netherlands)

    Damstra, R. J.; Voesten, H. G. J.; van Schelven, W. D.; van der Lei, B.

    2009-01-01

    Objective The incidence of breast cancer related lymphedema (BCRL) varies between 7-35% depending on the combination of treatment modalities. Early detection of BCRL is crucial in order to start an effective non-operative treatment program. Because of the lack of prospective research on this topic,

  8. A plant resource and experiment management system based on the Golm Plant Database as a basic tool for omics research

    Directory of Open Access Journals (Sweden)

    Selbig Joachim

    2008-05-01

    Full Text Available Abstract Background For omics experiments, detailed characterisation of experimental material with respect to its genetic features, its cultivation history and its treatment history is a requirement for analyses by bioinformatics tools and for publication needs. Furthermore, meta-analysis of several experiments in systems biology based approaches make it necessary to store this information in a standardised manner, preferentially in relational databases. In the Golm Plant Database System, we devised a data management system based on a classical Laboratory Information Management System combined with web-based user interfaces for data entry and retrieval to collect this information in an academic environment. Results The database system contains modules representing the genetic features of the germplasm, the experimental conditions and the sampling details. In the germplasm module, genetically identical lines of biological material are generated by defined workflows, starting with the import workflow, followed by further workflows like genetic modification (transformation, vegetative or sexual reproduction. The latter workflows link lines and thus create pedigrees. For experiments, plant objects are generated from plant lines and united in so-called cultures, to which the cultivation conditions are linked. Materials and methods for each cultivation step are stored in a separate ACCESS database of the plant cultivation unit. For all cultures and thus every plant object, each cultivation site and the culture's arrival time at a site are logged by a barcode-scanner based system. Thus, for each plant object, all site-related parameters, e.g. automatically logged climate data, are available. These life history data and genetic information for the plant objects are linked to analytical results by the sampling module, which links sample components to plant object identifiers. This workflow uses controlled vocabulary for organs and treatments. Unique

  9. Wavelet basics

    CERN Document Server

    Chan, Y T

    1995-01-01

    Since the study of wavelets is a relatively new area, much of the research coming from mathematicians, most of the literature uses terminology, concepts and proofs that may, at times, be difficult and intimidating for the engineer. Wavelet Basics has therefore been written as an introductory book for scientists and engineers. The mathematical presentation has been kept simple, the concepts being presented in elaborate detail in a terminology that engineers will find familiar. Difficult ideas are illustrated with examples which will also aid in the development of an intuitive insight. Chapter 1 reviews the basics of signal transformation and discusses the concepts of duals and frames. Chapter 2 introduces the wavelet transform, contrasts it with the short-time Fourier transform and clarifies the names of the different types of wavelet transforms. Chapter 3 links multiresolution analysis, orthonormal wavelets and the design of digital filters. Chapter 4 gives a tour d'horizon of topics of current interest: wave...

  10. Four Basic Problems of the Kindergarten Archive Management Research%论幼儿园档案管理的四个基本问题

    Institute of Scientific and Technical Information of China (English)

    时松

    2014-01-01

    Kindergarten archives management is an important part of kindergarten standardized man-agement.This research expounds four basic questions:where the archives of the kindergarten come from;what is the value of archives management in kindergarten;how to classify kindergarten archives;how to manage the kindergarten archives.%幼儿园档案管理工作是幼儿园规范化管理的重要组成部分。其档案管理必须厘清四个基本问题:幼儿园档案从哪里来、幼儿园档案管理有何价值、幼儿园档案怎么分类、幼儿园档案如何管理。明确了这四个问题的答案,幼儿园档案管理工作必然井井有条,服务到位。

  11. Indocyanine green (ICG lymphography is superior to lymphoscintigraphy for diagnostic imaging of early lymphedema of the upper limbs.

    Directory of Open Access Journals (Sweden)

    Makoto Mihara

    Full Text Available BACKGROUND: Secondary lymphedema causes swelling in limbs due to lymph retention following lymph node dissection in cancer therapy. Initiation of treatment soon after appearance of edema is very important, but there is no method for early diagnosis of lymphedema. In this study, we compared the utility of four diagnostic imaging methods: magnetic resonance imaging (MRI, computed tomography (CT, lymphoscintigraphy, and Indocyanine Green (ICG lymphography. PATIENTS AND METHODS: Between April 2010 and November 2011, we examined 21 female patients (42 arms with unilateral mild upper limb lymphedema using the four methods. The mean age of the patients was 60.4 years old (35-81 years old. Biopsies of skin and collecting lymphatic vessels were performed in 7 patients who underwent lymphaticovenous anastomosis. RESULTS: The specificity was 1 for all four methods. The sensitivity was 1 in ICG lymphography and MRI, 0.62 in lymphoscintigraphy, and 0.33 in CT. These results show that MRI and ICG lymphography are superior to lymphoscintigraphy or CT for diagnosis of lymphedema. In some cases, biopsy findings suggested abnormalities in skin and lymphatic vessels for which lymphoscintigraphy showed no abnormal findings. ICG lymphography showed a dermal backflow pattern in these cases. CONCLUSIONS: Our findings suggest the importance of dual diagnosis by examination of the lymphatic system using ICG lymphography and evaluation of edema in subcutaneous fat tissue using MRI.

  12. Quantitative evaluation of leg lymphedema by MR imaging. Estimation of therapeutic effect by intra-arterial injection of lymphocytes

    Energy Technology Data Exchange (ETDEWEB)

    Makimoto, Yumi; Harada, Masafumi; Matsuzaki, Kenji; Hayashi, Yoshinori; Nishitani, Hiromu; Yoshizumi, Masanori; Yoshida, Osamu; Katoh, Itsuo [Tokushima Univ. (Japan). School of Medicine

    1994-12-01

    The purpose of this study was to obtain characteristic findings of lymphedema and reactions after intra-arterial lymphocytes injection therapy by MRI and to evaluate quantitatively effect of intra-arterial lymphocytes injection. Five patients were treated by several intra-arterial lymphocytes injections. We measured T{sub 2} value on edematous tissue using triple echo sequence and shot TI IR (STIR) images to assess the extent of lymphedema. MRI was measured before and after each intra-arterial lymphocytes injection. Mean T{sub 2} and standard deviation (SD) of T{sub 2} distribution were obtained from T{sub 2}-calculated images. Characteristic findings of lymphedema were the thickening of subcutaneous, meshed pattern of fluid, thickening of skin, and fluid on the fascia. After therapy, thickness of subcutaneous tissue and meshed pattern were greatly decreased, but thickening of skin and fluid on the fascia still remained. Mean T{sub 2} and SD of T{sub 2} in edematous tissue were much higher than those of normal tissue. Both of them decreased extremely after therapy on improved cases but did not change on less effective cases. STIR could differentiate water from adipose tissue and clearly indicated the distribution of water. Mean T{sub 2} and SD of T{sub 2} distribution were useful to indicate evaluation of lymphedema and assessment of therapy. (author).

  13. Validity and intra- and interobserver reliability of an indirect volume measurements in patients with upper extremity lymphedema

    NARCIS (Netherlands)

    Meijer, R.S.; Rietman, J.S.; Geertzen, J.H.B.; Bosmans, J.C.; Dijkstra, P.U.

    2004-01-01

    We investigated a method of indirect volume measurement that utilized surface measurements and a simplified formula derived from the formula for a frustum (Sitzia's method) to determine limb volumes in patients with breast cancer-related lymphedema of the upper extremity. Repeated measurements of up

  14. PENILE AND SCROTAL LYMPHEDEMA AS AN UNUSUAL PRESENTATION OF CROHN'S DISEASE : CASE REPORT AND REVIEW OF THE LITERATURE

    NARCIS (Netherlands)

    Reitsma, W.; Wiegman, M. J.; Damstra, R. J.

    2012-01-01

    Crohn's disease is an inflammatory intestinal disease that primarily causes abdominal pain and diarrhea. We report a male patient who presented with penile and scrotal lymphedema and inguinal fistulas as the first manifestations of Crohn's disease. Extraintestinal or metastatic Crohn's disease initi

  15. Effect of Kinesiology Taping on Breast Cancer-Related Lymphedema: A Randomized Single-Blind Controlled Pilot Study

    Directory of Open Access Journals (Sweden)

    A. Smykla

    2013-01-01

    Full Text Available The aim of the study was to assess the efficacy of Kinesiology Taping (KT for treating breast cancer-related lymphedema. Sixty-five women with unilateral stage II and III lymphedema were randomly grouped into the KT group (K-tapes, n=20, the Quasi KT group (quasi K-tapes, n=22, or the MCT group (multilayered compression therapy group, n=23. Skin care, 45 min pneumatic compression therapy, 1 h manual lymphatic drainage, and application of K-tape/Quasi K-tapes/multilayered short-stretch bandages were given every treatment session, 3 times per week for 1 month. Patient evaluation items included limb size and percentage edema. Comparing the changes in K-tapes with quasi K-tapes changes, there were no significant differences (P>0.05. The edema reduction of multilayered bandages was much better than in results observed in taping groups. The KT appeared to be ineffective at secondary lymphedema after breast cancer treatment. The single-blind, controlled pilot study results suggest that K-tape could not replace the bandage, and at this moment it must not be an alternative choice for the breast cancer-related lymphedema patient. The trial is registered with ACTRN12613001173785.

  16. EPOC: Propuesta de manejo simple del paciente estable COPD: A PROPOSAL OF BASIC MANAGEMENT OF THE STABLE PATIENT

    Directory of Open Access Journals (Sweden)

    MÓNICA GUTIÉRREZ C.

    2002-07-01

    Full Text Available Considerando la frecuencia con que la EPOC estable debe ser enfrentada en el nivel primario, en esta exposición se propone en forma esquemática a través de texto y diagramas de flujo una secuencia simplificada para el diagnóstico, etapificación, evaluación funcional y tratamiento de esta condición en sus diversas etapas. Las recomendaciones se circunscriben a los métodos y procedimientos cuya eficacia tiene un respaldo adecuado en la experiencia clínica y en las publicaciones y que, además, son factibles de aplicar en nuestro medioConsidering that COPD usually seen and frequently managed at the primary level this proposal schematically summarizes through text and diagrams a simplified sequence for the diagnosis, staging, functional evaluation and treatment of this condition in its different stages. Recommendations are cicumscribed to the methods and procedures whose efficiency is adequately backed by clinical experience and publications and which can be feasibly applied in our medium

  17. Brain Basics

    Medline Plus

    Full Text Available ... in controlling movement, managing the release of various hormones, and aiding the flow of information to the ... at the front of the brain that, in humans, plays a role in executive functions such as ...

  18. Brain Basics

    Medline Plus

    Full Text Available ... Announcements Funding Strategy for Grants Clinical Research Application Process Managing Grants Training Labs at NIMH Labs at ... our original set of DNA. Sometimes this copying process is imperfect, leading to a gene mutation that ...

  19. Brain Basics

    Medline Plus

    Full Text Available ... the brain, which is linked to thought and emotion. It is also linked to reward systems in ... stay focused on a task, and managing proper emotional reactions. Reduced ACC activity or damage to this ...

  20. Brain Basics

    Medline Plus

    Full Text Available ... Domain Criteria (RDoC) Scientific Meetings Funding Funding Home Opportunities & Announcements Funding Strategy for Grants Clinical Research Application Process Managing Grants Training Labs at NIMH Labs at NIMH ...

  1. The West End Revitalization Association (WERA)'s right to basic amenities movement: voice and language of ownership and management of public health solutions in Mebane, North Carolina.

    Science.gov (United States)

    Wilson, Omega R; Bumpass, Natasha G; Wilson, Omari M; Snipes, Marilyn H

    2008-01-01

    The West End Revitalization Association (WERA) cultivated strategies for assessing environmental hazards, managing stakeholder participation, and implementing corrective actions in three low-income African American communities in Mebane, North Carolina. The community voices evolved into language to drive WERA's "Right to Basic Amenities Movement" as a way to address health, legal, and quality-of-life disparities. The sustainability of this movement depends on communicating a solutions process with funding equity. Disparities are a way of life for impacted residents: dusty dead-end streets, contaminated drinking water, failed backyard septic tanks, and putrid odors. WERA organized on "common knowledge" for effective use of public health statutes and Title VI of the Civil Rights Act of 1964. WERA's board, staff, and volunteers exercised their voices in the language of government, public health, university research, and legal agencies. WERA's best practices and lessons learned may influence public policy in comparable communities in North Carolina and throughout the nation. PMID:20208201

  2. Active exercises utilizing a facilitating device in the treatment of lymphedema resulting from breast cancer therapy

    Directory of Open Access Journals (Sweden)

    de Fátima Guerreiro Godoy, Maria

    2010-01-01

    Full Text Available The aim of this study was to evaluate the reduction in volume of arm lymphedema secondary to breast cancer therapy utilizing an exercise facilitating device. Twenty-one women with arm lymphedema resulting from the surgical and radiotherapeutic treatment of breast cancer were randomly selected. Evaluation was made by water-displacement volumetry before and after each session. The patients were submitted to a series of active exercises using a facilitating device for four 12-minute sessions with intervals of 3 minutes between sessions in the sitting position with alignment of the spinal column. The lymphedematous arm was maintained under compression using a cotton-polyester sleeve. The active exercising device used was a mobile flexion bar fixed on a metal base at a height of 30 cm from the tabletop and at a distance of 10 cm from the patient’s body. The paired t-test was utilized for statistical analysis with an alpha error of 5% (p-value ≤0.05 being considered significant. The initial mean volume of the arms was 2,089.9 and the final volume was 2,023.0 mL with a mean loss of 66.9 mL (p-value <0.001. In conclusion, active exercises utilizing facilitating devices can contribute to a reduction in size of lymphedematous limbs.

  3. Quality of life of women with lymphedema after surgery for breast cancer

    Directory of Open Access Journals (Sweden)

    Marislei Sanches Panobianco

    2014-06-01

    Full Text Available This study evaluated the quality of life of 20 women with post-mastectomy lymphedema due to breast cancer, using the Flanagan’s Adapted Quality of Life Scale (1 and the Visual Analogue Scale (2, with data collection from July to December 2009 in the countryside of the state of São Paulo. It was observed a lower quality of life concerning participation in recreational and work activities, and better quality of life was related to relationship with friends; listening to music, reading, watching TV and going to the movies. Cronbach's alpha of Scale 1 was 0.86 and the average of Scale 2 was 6.26. Overall, the scales showed satisfactory results of quality of life, but low values showed factors that must be worked out, such as participation in sports, work and learning activities. Thus, lymphedema interferes with the quality of life, indicating a need for early intervention in order to help women achieve better quality of life.

  4. Results of surgical treatment of massive localized lymphedema in severely obese patients

    Directory of Open Access Journals (Sweden)

    Wilson Cintra Júnior

    2014-01-01

    Full Text Available OBJECTIVE: to evaluate the importance of treatment of deformities caused by massive localized lymphedema (MLL in the severely obese. METHODS: in a period of seven years, nine patients with morbid obesity and a mean age of 33 years underwent surgical resection of massive localized lymphedema with primary synthesis. This is a retrospective study on the surgical technique, complication rates and improved quality of life. RESULTS: all patients reported significant improvement after surgery, with greater range of motion, ambulation with ease and more effective hygiene. Histological analysis demonstrated the existence of a chronic inflammatory process marked by lymphomonocitary infiltrate and severe tissue edema. We observed foci of necrosis, formation of microabscesses, points of suppuration and local fibrosis organization, and pachydermia. The lymphatic vessels and some blood capillaries were increased, depicting a framework of linfangiectasias. CONCLUSION: surgical treatment of MLL proved to be important for improving patients' quality of life, functionally rehabilitating them and optimizing multidisciplinary follow-up of morbid obesity, with satisfactory surgical results and acceptable complication rates, demonstrating the importance of treatment and awareness about the disease.

  5. AWARENESS OF PHYSICAL THERAPY REHABILITATION FOR BREAST CANCER RELATED LYMPHEDEMA AMONG MEDICAL ONCOLOGY TEAM - A SURVEY

    Directory of Open Access Journals (Sweden)

    Mullai

    2013-10-01

    Full Text Available Objective:To analyses the awareness of physical therapy rehabilitation for breast cancer related lymphedemaamong medical oncology team member.Method and materials:The data was contents of 12 custom made questionnaires which distributed and collectedfrom 34 medical oncology team members who are working in CMC & H, DMC & H, Chandigarh PGI,Results:Nearly 100 % of clinical oncologist and Radiation oncologist were aware about physical therapyrehabilitation and nearly 80% of Surgeon and Physician were aware about it (p<0.05. Relatively fewteam members(53% sent their patients to out patient department of physiotherapy and mostly (47% not sent (p< 0.03.Conclusion:Medical oncology team was aware of role of physiotherapist for breast cancer related lymphedema.But they were concentrating only shoulder activity not in decongestive exercises So, it is importantthat awarenessabout physical therapy techniques and its effects to the medical professionals is necessary and alsoinclusion ofphysical therapist in the rehabilitation team make lot of difference in the quality of life of Lymphedema patients

  6. Basic principles of knowledge management and its application to the industrial company in tactical operations of maintenance and operational exploitation: A qualitative study

    Directory of Open Access Journals (Sweden)

    Francisco Javier Cárcel Carrasco

    2013-01-01

    Full Text Available Purpose: Although knowledge and its management is, and has been, studied in depth, particularly since the 90’s decade of the past century, especially for the strategic management, innovation, trade, or business administration, there are still many questions on how it articulates or transfers and the barriers to its management, especially when we talk about internal tactical activities that affect staff that we could call "offices", such as maintenance and industrial assembly or exploitation and conduction of the facilities. Because of the peculiarities normally seen in this kind of activity in the industrial companies, the knowledge of these people is strongly based on their experience (strong tacit component, difficult to measure and articulate, and on many occasions, however, this rupture of information-knowledge, can represent a high cost for the company (often assumed to be something inevitable due to the increase in production and service downtime, loss of efficiency, or tuning time of new staff to these areas.Design/methodology/approach: After a description of the State of the art and the basic principles of knowledge management, a qualitative study in an industrial company has been carried out, within the areas of operation and maintenance, in order to know the barriers and facilitators that such involved personnel finds in order to achieve an adequate transmission and use of that knowledge.Findings and Originality/value: Learn about barriers, facilitators and impact that offers the knowledge management in the areas of industrial maintenance, especially among professionals in offices which operate with a high degree of tacit knowledge and with a heavy dependence on the company on these professionals.Research limitations/implications: Those characteristics of a qualitative study in a particular area and within a geographical area, although it can be extrapolated to other types of companies and regional areas.Practical implications: Learn

  7. Yoga protocol for treatment of breast cancer-related lymphedema

    Directory of Open Access Journals (Sweden)

    S R Narahari

    2016-01-01

    Discussion: Yoga exercises were selected on the basis of their role in chest expansion, maximizing range of movements: flexion of large muscles, maximum stretch of skin, and thus part-by-part lymph drainage from center and periphery. This protocol addressed functional, volume, and movement issues of BCRL and was found to be superior to other BCRL yoga protocols. However, this protocol needs to be tested in centers routinely managing BCRL.

  8. Clinical significance of a proposed lymphoscintigrpahic functional grade system in patients with extremity lymphedema of stage i

    International Nuclear Information System (INIS)

    We proposed a new lymphoscintigrpahic functional grade (LGr) system in extremity lymphedema, and investigated the association between the LGr and a long-term response to physical therapy in patients with extremity lymphedema of stage I. The subjects were 20 patients with unilateral extremity lymphedema of stage I, who underwent pre-treatment extremity lymphoscintigraphy using Tc-99m antimony sulfur colloid, and were treated by complex decongestive physical therapy (CDPT). A proposed lymphoscintigrpahic functional grade system consisted of LGr 0 to LGr 4 according to the ilioinguinal nodal uptake, amount of dermal backflow, and uptake pattern of main and collateral lymphatics : LGr 0 = normal, LGr 1 = decreased lymphatic function without dermal backflow, LGr 2 = decreased lymphatic function with dermal backflow, LGr 3 = non - visualization of main lymphatics with dermal backflow, and LGr 4 = no significant lymphatic transport from injection site. LGr 2 was divided into 2A and 2B based on the amount of dermal backflow. A physician who is a lymphedema specialist determined the long-term outcome to CDPT with normalized response (NR), good response (GR) and poor response (PR) based on the change of edema volume reduction, skin status and occurrence of dermatolymphangioadenitis after the clinical follow-up for more than 1 year. Therapeutic responses were NR in 2 patients. GR in 9 patients and PR in 9 patients. Baseline LGrs were 1 in 7 patients, 2A in 4 patients, 2B in 5 patients, 3 in 2 patients, and 4 in 2 patients. There was a significant relationship between therapeutic response and LGr (p=0.003). In other words, 10 of 11 patients (91%) with LGr 1 or 2A showed NR. or GR. On the contrary, 8 of 9 patients (89%) with LGr 2B, 3 or 4 showed PR. Patients with unilateral extremity lymphedema of stage I had different lymphoscintigrpahic functional grades. This grade system may be useful to predict the response to physical therapy in such patients

  9. Clinical significance of a proposed lymphoscintigrpahic functional grade system in patients with extremity lymphedema of stage i

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Joan Young; Hwang, Ji Hye; Kim, Dong Ik; Cho, Young Seok; Lee, Su Jin; Choi, Yong; Choe, Yeam Seong; Lee, Kyung Han; Kim, Byung Tae [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2005-07-01

    We proposed a new lymphoscintigrpahic functional grade (LGr) system in extremity lymphedema, and investigated the association between the LGr and a long-term response to physical therapy in patients with extremity lymphedema of stage I. The subjects were 20 patients with unilateral extremity lymphedema of stage I, who underwent pre-treatment extremity lymphoscintigraphy using Tc-99m antimony sulfur colloid, and were treated by complex decongestive physical therapy (CDPT). A proposed lymphoscintigrpahic functional grade system consisted of LGr 0 to LGr 4 according to the ilioinguinal nodal uptake, amount of dermal backflow, and uptake pattern of main and collateral lymphatics : LGr 0 = normal, LGr 1 = decreased lymphatic function without dermal backflow, LGr 2 = decreased lymphatic function with dermal backflow, LGr 3 = non - visualization of main lymphatics with dermal backflow, and LGr 4 = no significant lymphatic transport from injection site. LGr 2 was divided into 2A and 2B based on the amount of dermal backflow. A physician who is a lymphedema specialist determined the long-term outcome to CDPT with normalized response (NR), good response (GR) and poor response (PR) based on the change of edema volume reduction, skin status and occurrence of dermatolymphangioadenitis after the clinical follow-up for more than 1 year. Therapeutic responses were NR in 2 patients. GR in 9 patients and PR in 9 patients. Baseline LGrs were 1 in 7 patients, 2A in 4 patients, 2B in 5 patients, 3 in 2 patients, and 4 in 2 patients. There was a significant relationship between therapeutic response and LGr (p=0.003). In other words, 10 of 11 patients (91%) with LGr 1 or 2A showed NR. or GR. On the contrary, 8 of 9 patients (89%) with LGr 2B, 3 or 4 showed PR. Patients with unilateral extremity lymphedema of stage I had different lymphoscintigrpahic functional grades. This grade system may be useful to predict the response to physical therapy in such patients.

  10. Regression Basics

    CERN Document Server

    Kahane, Leo H

    2007-01-01

    Using a friendly, nontechnical approach, the Second Edition of Regression Basics introduces readers to the fundamentals of regression. Accessible to anyone with an introductory statistics background, this book builds from a simple two-variable model to a model of greater complexity. Author Leo H. Kahane weaves four engaging examples throughout the text to illustrate not only the techniques of regression but also how this empirical tool can be applied in creative ways to consider a broad array of topics. New to the Second Edition Offers greater coverage of simple panel-data estimation:

  11. Basic electronics

    CERN Document Server

    Tayal, DC

    2010-01-01

    The second edition of this book incorporates the comments and suggestions of my friends and students who have critically studied the first edition. In this edition the changes and additions have been made and subject matter has been rearranged at some places. The purpose of this text is to provide a comprehensive and up-to-date study of the principles of operation of solid state devices, their basic circuits and application of these circuits to various electronic systems, so that it can serve as a standard text not only for universities and colleges but also for technical institutes. This book

  12. Bioimpedance Spectroscopy in Detecting Lower-Extremity Lymphedema in Patients With Stage I, Stage II, Stage III, or Stage IV Vulvar Cancer Undergoing Surgery and Lymphadenectomy

    Science.gov (United States)

    2016-02-09

    Lymphedema; Perioperative/Postoperative Complications; Stage IA Vulvar Cancer; Stage IB Vulvar Cancer; Stage II Vulvar Cancer; Stage IIIA Vulvar Cancer; Stage IIIB Vulvar Cancer; Stage IIIC Vulvar Cancer; Stage IVA Vulvar Cancer; Stage IVB Vulvar Cancer

  13. Safety of Weightlifting Among Women with or at Risk for Breast Cancer–Related Lymphedema: Musculoskeletal Injuries and Health Care Use in a Weightlifting Rehabilitation Trial

    OpenAIRE

    Brown, Justin C.; Troxel, Andrea B; Schmitz, Kathryn H.

    2012-01-01

    Breast cancer survivors with and at risk for lymphedema were randomized to twice-weekly weightlifting or standard care for 1 year. Despite the demonstrated efficacy of weightlifting, musculoskeletal injuries and other health problems did occur.

  14. Emergency medicine: beyond the basics.

    Science.gov (United States)

    Malamed, S F

    1997-07-01

    Medical emergencies can arise in the dental office. Preparedness for these emergencies is predicated on an ability to rapidly recognize a problem and to effectively institute prompt and proper management. In all emergency situations, management is based on implementation of basic life support, as needed. The author describes the appropriate management of two common emergency situations: allergy and chest pain.

  15. The basic concept of library crisis management and content analysis%图书馆危机管理的基本概念及内容分析

    Institute of Scientific and Technical Information of China (English)

    李荣

    2014-01-01

    the library crisis means of library system security threat and destruction, so that the library into a state of high volatility. The emergence of library crisis management is to prevent the crisis after crisis has the correct effectively solve the corresponding strategy and so on the basic concept and content of library crisis management is necessary to in-depth study.%图书馆危机指的是对图书馆系统安全造成威胁和破坏从而使图书馆进入高度震荡的状态。图书馆危机管理就是为了防范危机的出现概率,出现危机后能有正确有效的对应解决策略,所以对图书馆危机管理的基本概念以及内容进行深入研究是非常有必要的。

  16. Does the effect of weight lifting on lymphedema following breast cancer differ by diagnostic method: results from a randomized controlled trial.

    Science.gov (United States)

    Hayes, Sandra C; Speck, Rebecca M; Reimet, Elizabeth; Stark, Azadeh; Schmitz, Kathryn H

    2011-11-01

    The lymphedema diagnostic method used in descriptive or intervention studies may influence results found. The purposes of this work were to compare baseline lymphedema prevalence in the physical activity and lymphedema (PAL) trial cohort and to subsequently compare the effect of the weight-lifting intervention on lymphedema, according to four standard diagnostic methods. The PAL trial was a randomized controlled intervention study, involving 295 women who had previously been treated for breast cancer, and evaluated the effect of 12 months of weight lifting on lymphedema status. Four diagnostic methods were used to evaluate lymphedema outcomes: (i) interlimb volume difference through water displacement, (ii) interlimb size difference through sum of arm circumferences, (iii) interlimb impedance ratio using bioimpedance spectroscopy, and (iv) a validated self-report survey. Of the 295 women who participated in the PAL trial, between 22 and 52% were considered to have lymphedema at baseline according to the four diagnostic criteria used. No between-group differences were noted in the proportion of women who had a change in interlimb volume, interlimb size, interlimb ratio, or survey score of ≥5, ≥5, ≥10%, and 1 unit, respectively (cumulative incidence ratio at study end for each measure ranged between 0.6 and 0.8, with confidence intervals spanning 1.0). The variation in proportions of women within the PAL trial considered to have lymphoedema at baseline highlights the potential impact of the diagnostic criteria on population surveillance regarding prevalence of this common morbidity of treatment. Importantly though, progressive weight lifting was shown to be safe for women following breast cancer, even for those at risk or with lymphedema, irrespective of the diagnostic criteria used. PMID:21562712

  17. Lymphatic abnormalities in the normal contralateral arms of subjects with breast cancer-related lymphedema as assessed by near-infrared fluorescent imaging

    OpenAIRE

    Aldrich, Melissa B.; Guilliod, Renie; Fife, Caroline E.; Maus, Erik A.; Smith, Latisha; Rasmussen, John C.; Sevick-Muraca, Eva M.

    2012-01-01

    Current treatment of unilateral breast cancer-related lymphedema (BCRL) is only directed to the afflicted arm. Near-infrared fluorescent imaging (NIRF) of arm lymphatic vessel architecture and function in BCRL and control subjects revealed a trend of increased lymphatic abnormalities in both the afflicted and unafflicted arms with increasing time after lymphedema onset. These pilot results show that BCRL may progress to affect the clinically “normal” arm, and suggest that cancer-related lymph...

  18. 肢体淋巴水肿微波烘疗对淋巴回流的影响%Effects of Microwave Heating on Lymph Flow in the Lymphedema of Extremities

    Institute of Scientific and Technical Information of China (English)

    李圣利; 张涤生

    2000-01-01

    Objective To investigate the changes of lymph flow by microwave heating whichhad achieved an excellent result in the management of lymphedema of extremities. Methods 26 caseswith lymphedema of the extremities had been evaluated by means of lymphoscintigraphy using 99mTc -Dextran and SPECT to examine the lymph flow speed and half- time(T1/2)clearance of the injection siteas well as lymphatic images of the affected limbs before and after treatment. Results The averagelymph flow speed in the affected limbs was significantly lower than that of the contralateral normal limbswith 7.82cm/min and 10.41cm/min respectively before treatment, and they increased significantly from7.82 to 9.36cm/min after two courses of treatment; in contrary, T1/2 was higher in the lymphedema-tous limbs with an average value of 154.21 min in comparison with 91.55 min contralaterally, and de-creased significantly to 115.38 min after treatment. In addition, lymphatic image disturbances improvedmarkedly in 22/26 cases(84.6% ) after treatment, especially in the patients with infectious lymphede-ma, and showed no changes in two cases. Conclusion The results demonstrated that there was evi-dent lymph flow stasis in lymphedematous limbs, based on the preliminary calculation of lymph flow in-dexes; microwave heating could promote the lymph flow in lymphedema of extremities.%目的 探讨烘疗对肢体淋巴回流的影响。方法 采用99mTc-Dextran和SPECT对26例肢体淋巴水肿患者进行治疗前后淋巴显像的研究,测量比较淋巴回流速度(LFS)、注射部位的半排时间(T1/2)及淋巴管图像的变化。结果 微波烘疗前,患肢的平均LFS明显低于对侧健肢,分别为7.82cm/min和10.41cm/min;2个疗程治疗后,患肢平均LFS增加到9.36cm/min。而T1/2烘疗前淋巴水肿肢体为154.21min,高于健肢的91.55min,烘疗后显著下降为115.38min。淋巴淤滞图像26例中22例治疗后得到改善,尤以感染性肢体

  19. Inflation Basics

    Energy Technology Data Exchange (ETDEWEB)

    Green, Dan [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States)

    2014-03-01

    inflation since metrical fluctuations, both scalar and tensor, are also produced in inflationary models. Thus, the time appears to be appropriate for a very basic and simple exposition of the inflationary model written from a particle physics perspective. Only the simplest scalar model will be explored because it is easy to understand and contains all the basic elements of the inflationary model.

  20. Fuel management inside the reactor. Impact of the substitution of the basic libraries of the Eclipse and Record codes of the FMS system of fuel management

    International Nuclear Information System (INIS)

    The present work is given to know the repercussions in the obtained results by the ECLIPSE-RECORD system of the package of fuel management FMS of SCANDPOWER, with the use of the libraries of effective sections of neutrons, for both codes, generated starting from the ENDF-B/IV database. Inside of the Institute it doesn't have any version of the ECLIPSE code it which drove us to make use of the versions of the THERMOS and GADPOL codes. The obtained results with the libraries generated were compared against those that are obtained making use of the libraries that it possesses the code, generated starting from the ENDF-B/III database, and the data that General Electric Co. reports for the cells that were used for this work. The calculations with the THERMOS-GADPOL-RECORD system, installed in 830 CDC machine of the Institute, its were carried out following the calculation sequence that it is continued during the generation of nuclear databases proposed by CFE only for the series 1 and 2. The obtained results are reported in the Appendixes B and C as well as some of the enter files for the codes used in the Appendix D, which are specified for those installed versions. (Author)

  1. Development of Payroll Data Management System for External Teachers Based on Visual Basic%基于VB的外聘教师工资数据管理系统开发

    Institute of Scientific and Technical Information of China (English)

    刘春东; 张东辉; 戴美魁; 霍珍珍; 刘洋

    2015-01-01

    利用VB6.0与Access数据库相关联开发外聘教师工资数据管理系统,实现外聘教师基本信息和工资数据管理系统化、规范化、自动化.%Payroll data management system for external teachers is developed with the combination of Visual Basic 6 .0 and Microsoft Access,providing access to the systematization,standardization, and automation of the management with the basic information and payroll data of external teach-ers.

  2. Lymphoscintigraphic evaluation of intra-arterial lymphocyte injection in patients with leg lymphedema

    Energy Technology Data Exchange (ETDEWEB)

    Suga, Kazuyoshi; Uchisako, Hiroji; Yoneshiro, Shu; Fujita, Takefumi; Nakanishi, Takashi; Wakamatsu, Takafumi; Esato, Kensuke (Yamaguchi Univ., Ube (Japan). School of Medicine)

    1992-05-01

    Three patients with chronic leg lymphedema were treated by intra-arterial lymphocyte injection and the effect was evaluated by lymphoscintigraphy using intradermal injection of {sup 99m}Tc-HSA. In all of the patients, the followed-up lymphoscintigraphy showed disappearance of the abnormalities of dermal back flow and/or collateral pathways observed before treatment and these findings were thought to indicate reduced load of dermal lymphatics induced by the treatment. These results indicated the usefulness of imaging with intradermal injection of {sup 99m}Tc-HSA for assessing the effect of treatment with intra-arterial lymphocyte injection. In addition, in two patients of them, analysis of lymph flow after treatment was underwent by time-activity curves obtained by lymphoscintigraphy using a load produced by standing. We also described the significance of the load test with standing. (author).

  3. Qualitative and quantitative lymphoscintigraphy in the evaluation of lower limbs lymphedema

    Energy Technology Data Exchange (ETDEWEB)

    Dalia, Roberta Maria; Martins, Glaucia Ribeiro P.; Barbosa, Rodolfo [Uniao Educacional do Vale do Aco, Belo Horizonte, MG (Brazil); Lima, Carla Flavia de; Siqueira, Cristiano Ferrari [Ecograf Medicina Nuclear, Belo Horizonte, MG (Brazil)

    2005-10-15

    The purpose of this study was to prove the efficiency of qualitative and quantitative lymphoscintigraphy in the diagnosis of the lower extremity lymphedema. Seventy-seven patients had been studied, most of then (85.7%) were female. Patients' ages ranged from 18 to 82 years. All patients underwent a bilateral lymphoscintigraphy. Images were recorded with a dual-detector instrument in the whole-body scanning mode. Feet and inguinal static views were acquired within 15 minutes and three hours after radiopharmaceutical injection. Two nuclear doctors evaluated the lymphoscintigrams qualitatively. Quantitative studies of the radiopharmaceutical absorption and the lymph node chain uptake were also obtained. Of the 154 evaluated members, 21.44% (n = 33) were classified as normal, 61.68% (n = 95) as mildly altered and 16.88% (n = 26) much altered. Quantitation of lymphatic chain uptake may be a more sensitive approach to the diagnosis of lymphatic impairment than the qualitative analysis. (author)

  4. Immune proteins and other biochemical constituents of peripheral lymph in patients with malignancy and postirradiation lymphedema

    International Nuclear Information System (INIS)

    Concentrations of immunoglobulins and complement proteins were studied in a group of 33 patients with localized tumors and lymphoproliferative disorders. Generally, low levels have been found, in many cases below the lowest limit of the control group. The reductions in concentration were more pronounced in patients with lympho-proliferative disorders than with solid tumors. The most reduced were lgM, Clg and total complement hemolytic activity. In a group of 8 patients with lymphedema of lower extremity complicating therapy for uterine cancer an increase of IgM and IgA and decrease in hemolytic activity were found. This indicates the existence of a chronic inflammatory process typical for tissues deprived in lymphatic outflow. (orig.)

  5. Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature

    OpenAIRE

    Damstra, R. J.; Voesten, H. G. J.; Schelven, W. D.; Lei, B.

    2008-01-01

    Abstract Objective The incidence of breast cancer related lymphedema (BCRL) varies between 7-35% depending on the combination of treatment modalities. Early detection of BCRL is crucial in order to start an effective non-operative treatment program. Because of the lack of prospective research on this topic, this study was undertaken to prospectively determine the effect of Lympho Venous Anastomosis (LVA) on BCRL and to review the current lit...

  6. 仓储管理基础课程教学改革研究%Reform about basic course of Warehouse Management

    Institute of Scientific and Technical Information of China (English)

    韩庆田

    2014-01-01

    Choice of teaching methods of teaching effectiveness had played a crucial role, the article analyzes the basic situation,"Base Of Warehouse Management"course teaching, application of modern educational concepts, combined with the characteristics of the course, teaching guide gives a willingness to stimulate active learning, simulation teaching method exercises to improve the ability to post office, individualized learning to explore business potential, develop self study method and other aspects of learning.%教学方法的选择对课程教学效果过起到至关重要的作用,文章分析了《仓储管理基础》课程教学基本情况,应用现代教育理念,结合课程特点,给出了教学引导激发主动学习意愿、模拟演练提高岗位任职能力、因材施教发掘业务学习潜能、学法指导培养自我学习能力等方面的教学改革方法。

  7. Effect of physical therapy on breast cancer related lymphedema: protocol for a multicenter, randomized, single-blind, equivalence trial

    OpenAIRE

    Tambour, Mette; Tange, Berit; Christensen, Robin; Gram, Bibi

    2014-01-01

    Background Physical therapy treatment of patients with lymphedema includes treatment based on the principles of ‘Complete Decongestive Therapy’ (CDT). CDT consists of the following components; skin care, manual lymphatic drainage, bandaging and exercises. The scientific evidence regarding what type of treatment is most effective is sparse. The objective of this study is to investigate whether CDT is equally effective if it includes manual lymphatic drainage or not in the treatment of arm lymp...

  8. The Health Deviation of Post-Breast Cancer Lymphedema: Symptom Assessment and Impact on Self-Care Agency

    OpenAIRE

    Armer, Jane M.; Henggeler, Mary H; Brooks, Constance W.; Zagar, Eris A.; Homan, Sherri; Bob R. Stewart

    2008-01-01

    Breast cancer is the leading cancer among women world-wide, affecting 1 of 8 women during their lifetimes. In the US alone, some 2 million breast cancer survivors comprise 20% of all cancer survivors. Conservatively, it is estimated that some 20-40% of all breast cancer survivors will develop the health deviation of lymphedema or treatment-related limb swelling over their lifetimes. This chronic accumulation of protein-rich fluid predisposes to infection, leads to difficulties in fitting clot...

  9. Long-Term Effects of Complex Decongestive Therapy in Breast Cancer Patients With Arm Lymphedema After Axillary Dissection

    OpenAIRE

    Hwang, Jung Min; Hwang, Ji Hye; Kim, Tae Won; Lee, Seung Yeol; Chang, Hyun Ju; Chu, In Ho

    2013-01-01

    Objective To investigate the long-term effects of complex decongestive therapy (CDT) on edema reduction in breast cancer-related lymphedema patients after axillary dissection, according to the initial volume of edema. Methods A retrospective review of 57 patients with unilateral arm after an axillary dissection for breast cancer was performed. The patients, treated with two weeks of CDT and self-administered home therapy, were followed for 24 months. Arm volume was serially measured by using ...

  10. Regional Distribution of Epifascial Swelling and Epifascial Lymph Drainage Rate Constants in Breast Cancer-Related Lymphedema

    OpenAIRE

    Modi, Stephanie; Stanton, Anthony W. B.; MELLOR, RUSSELL H.; MICHAEL PETERS, A.; RODNEY LEVICK, J.; Mortimer, Peter S.

    2005-01-01

    Background: The view that breast cancer-related lymphedema (BCRL) is a simple, direct mechanical result of axillary lymphatic obstruction (‘stopcock’ mechanism) appears incomplete, because parts of the swollen limb (e.g., hand) can remain nonswollen. The lymph drainage rate constant (k) falls in the swollen forearm but not in the spared hand, indicating regional differences in lymphatic function. Here the generality of the hypothesis that regional epifascial lymphatic failure underlies region...

  11. Establishing and Sustaining a Prospective Screening Program for Breast Cancer-Related Lymphedema at the Massachusetts General Hospital: Lessons Learned

    OpenAIRE

    Brunelle, Cheryl; Skolny, Melissa; Ferguson, Chantal; Swaroop, Meyha; O’Toole, Jean; Taghian, Alphonse G.

    2015-01-01

    There has been an increasing call to prospectively screen patients with breast cancer for the development of breast cancer-related lymphedema (BCRL) following their breast cancer treatment. While the components of a prospective screening program have been published, some centers struggle with how to initiate, establish, and sustain a screening program of their own. The intent of this manuscript is to share our experience and struggles in establishing a prospective surveillance program within ...

  12. Illustrating the (in)visible: Understanding the impact of loss in adults living with secondary lymphedema after cancer

    OpenAIRE

    Thomas, Roanne; Hamilton, Ryan

    2014-01-01

    Life with a disability is often riddled with paradoxes, one of which is being visibly marked, while personal experiences, losses, and challenges remain hidden. Our article draws attention to this paradox among people who live with secondary lymphedema after cancer (SLC). SLC is a relatively unfamiliar chronic condition within medical and lay discourses of cancer, which proves challenging for the many cancer survivors who are in search of information and understanding. Thirteen men and women w...

  13. Lymphedema (PDQ)

    Science.gov (United States)

    ... Bacteria can enter the body through a cut, scratch, insect bite, or other skin injury. Fluid that ... blood tests. Use a thimble for sewing. Avoid testing bath or cooking water using the limb with ...

  14. THEORETICAL ASPECTS OF BASIC PROVISIONS OF THE ENERGY SAVING MANAGEMENT SYSTEM IN THE FIELD OF HOUSING AND PUBLIC UTILITIES THROUGH INTRODUCTION OF SMALL INNOVATIVE ENTERPRISES

    Directory of Open Access Journals (Sweden)

    Kiseleva Ekaterina Alexandrovna

    2012-10-01

    Full Text Available The author addresses solutions to problems of the housing and utilities sector (including a substantial depreciation of fixed assets of the municipal infrastructure, a gap between domestic utilities management technologies and those employed worldwide, and the fund raising problem through power saving actions to be facilitated by small innovative enterprises. The proposed solutions contribute to formation of new jobs in the regions, reduction of power consumption and higher efficiency of regional economies due to reduced costs and rates (prices set for utilities-related services, and improvement of the standard and quality of living. The principal objective is to develop a set of procedures and criteria to serve as the basis for the selection of tools of power saving innovations in the housing and utilities sector of regions and municipalities. The above actions are to be implemented through the involvement of small innovative enterprises. The basic tools (instruments of the state social and economic (including innovation-related policy, that are to stimulate subjects of innovative activities to implement innovative projects in this sector stimulate energy efficiency innovations in the housing and utilities sector. The proposed set of tools includes tax holidays, subsidies, grants, soft loans, concessional loans, state and municipal orders, etc. The procedure of selection of instruments of state-initiated innovations designated for the improvement of the power efficiency of the housing and public utilities sector to be implemented by regional and municipal authorities is proposed by the author. The author identifies several types of energy saving innovations in the housing and utilities sector, based on their systemic effects. Upon identification of the top-priority recipients of state support, financial resources are to be distributed. Advantages of innovative energy saving projects in the housing and utilities sector, developed and implemented

  15. The articulated action plan (par in municipalities in Mato Grosso do Sul State and its implications for the democratic management of basic education - doi: 10.4025/actascieduc.v34i2.17546

    Directory of Open Access Journals (Sweden)

    Regina Tereza Cestari de Oliveira

    2012-11-01

    Full Text Available The paper analyzes the implications of the Articulated Action Plan (PAR, a component of the Education Development Plan (PDE, to the democratic management of basic education, within the context of the educational policy, during President Luiz Inácio Lula da Silva’s second government term (2007-2010. It presents research findings through the examination of documentary sources, focusing on the actions defined by the municipalities in the state of Mato Grosso do Sul, within PAR’s Educational Management Dimension. These actions, in alignment with the guidelines of the plan called All for Education, indicate the limits and possibilities of building a democratic management of basic education, depending on the implementation by the municipalities, as they exercise their autonomy.  

  16. The RSZ BASIC programming language manual

    Science.gov (United States)

    Stattel, R. J.; Niswander, J. K.; Kochhar, A. K.

    1980-01-01

    The RSZ BASIC interactive language is described. The RSZ BASIC interpreter is resident in the Telemetry Data Processor, a system dedicated to the processing and displaying of PCM telemetry data. A series of working examples teaches the fundamentals of RSZ BASIC and shows how to construct, edit, and manage storage of programs.

  17. Quality of Life in Patients with Breast Cancer-Related Lymphedema and Reconstructive Breast Surgery.

    Science.gov (United States)

    Penha, Tiara R Lopez; Botter, Bente; Heuts, Esther M; Voogd, Adri C; von Meyenfeldt, Maarten F; van der Hulst, René R

    2016-07-01

    Background To evaluate the quality of life (QOL) of breast cancer survivors who have undergone breast reconstruction and have breast cancer-related lymphedema (BCRL). Methods Patients with a unilateral mastectomy with or without breast reconstruction were evaluated for BCRL and their QOL. Patients were divided into a non-BCRL and a BCRL group. Patients with subjective complaints of arm swelling and/or an interlimb volume difference of >200 mL, or undergoing treatment for arm lymphedema were defined as having BCRL. QOL was assessed using cancer-specific (EORTC QLQ-C30 and EORTC QLQ-B23) and disease specific (Lymph-ICF) questionnaires. Results In total, 253 patients with a mean follow-up time of 51.7 (standard deviation = 18.5) months since mastectomy completed the QOL questionnaires. Of these patients, 116 (46%) underwent mastectomy alone and 137 (54%) had additional breast reconstruction. A comparison of the QOL scores of 180 patients in the non-BCRL group showed a significantly better physical function (p = 0.004) for patients with reconstructive surgery compared with mastectomy patients. In the 73 patients with BCRL, a comparison of the QOL scores showed no significant differences between patients with mastectomy and reconstructive surgery. After adjusting for potential confounders, multivariate analysis showed a significant impact of BCRL on physical function (β =  - 7.46; p = 0.009), role function (β =  - 15.75; p = 0.003), cognitive function (β =  - 11.56; p = 0.005), body vision (β =  - 11.62; p = 0.007), arm symptoms (β = 20.78; p = 0.000), and all domains of the Lymph-ICF questionnaire. Conclusions This study implies that BCRL has a negative effect on the QOL of breast cancer survivors, potentially negating the positive effects on QOL reconstructive breast surgery has. PMID:26919383

  18. Implementation status and improvement recommendations of HSE system management in basic units of petrochemical enterprise%HSE体系管理在炼化企业基层单位实施现状及改进建议

    Institute of Scientific and Technical Information of China (English)

    陶卫君; 秦丽娟; 朱焱松; 邢新华

    2012-01-01

    对当前炼化企业基层单位HSE管理体系现状进行了分析.指出了基层单位HSE管理理念没有真正转变、HSE管理制度执行力差、HSE管理职责落实不到位、HSE培训缺乏针对性、HSE绩效考核重结果轻过程、企业安全文化建设重形式轻根基等问题.提出基层单位HSE体系管理改进建议,真正落实“以人为本”的HSE管理理念、强化HSE管理制度的执行力、真正将HSE管理职责落实到位、强化HSE培训需求分析,增强培训的针对性、加强HSE绩效考核过程管理、推进安全文化建设.%The implementation status of HSE management system in basic units of petrochemical enterprise was analyzed. The problems in HSE management system were pointed out, such as HSE management idea was not really changed, HSE management system implementation power was weak, HSE management responsibilities were not implemented, HSE training was not targeted, HSE performance appraisal emphasis on results than process. Improvement recommendations of HSE system management in basic units were proposed. We should real implementation the ideas of "people-oriented" in HSE management, and strengthen the HSE management system execution power, strengthen HSE management responsibilities, intensify training needs analysis, enhance training target, enhance HSE performance evaluate process management, and promote HSE safety culture Construction.

  19. Role of lymphoscintigraphy in diagnosis and management of patients with leg swelling of unclear etiology

    International Nuclear Information System (INIS)

    To study the utility of lymphoscintigraphy in detection of lymphatic obstruction in patients with leg swelling of unclear etiology, selection of site for nodo venous shunt procedure, and follow-up lymphoscintigraphic documentation of improved lymph flow in surgically treated limb. Twenty four consecutive patients with leg swelling, 10 male, 14 female with mean age 47 years, range from 13 years to 74 years underwent lymphoscintigraphy. All patients were referred from Department of Plastic Surgery, after initial work-up, and routine investigations to rule out the other causes of leg swelling. Both clinical and scintigraphic staging performed for all patients. All clinically and scintigraphically positive patients treated with decongestive lymphatic therapy (DLT). In addition to the DLT, those patients positive for unilateral or bilateral lymphedema, consented for surgical intervention, nodo venous shunt (NVS) in their only affected or one of the two affected lower limbs. Follow-up lymphoscintigraphy performed in operated cases after 3 months to 6 months of surgery, lymphoscintigraphy images of each patient in pre and post-surgery compared. In 20/24 cases (83%) of clinically positive leg swelling were found to be positive for lymphedema on lymphoscintigraphy and remaining, 4/24 were scintigraphically normal. Based on the clinical and lymphoscintigraphy staging, 03/20 cases (15%) had Grade I lymphedema, 01/20 (5%) Grade II lymphedema, 06/20 (30%) Grade III and remaining 10/20 (50%) had Grade IV lymphedema. 11/20 cases of Lymphedema (55%) were managed conservatively by only DLT and in remaining 09/20 cases (45%), who were case of Grade IV, lymphedema (five patients with unilateral and four patients with bilateral disease) initially treated with DLT, and on completion of DLT, undergone for NVS procedure, in their unilaterally affected lower limb or one of the two diseased lower limbs. All nine patients showed remarkable clinical improvement in leg swelling and their

  20. Lymphoscintigraphic evaluation of leg lymphedema using intradermal injection of technetium 99m-labeled human serum albumin; Assessment of the effect of standing

    Energy Technology Data Exchange (ETDEWEB)

    Uchisako, Hiromichi; Suga, Kazuyoshi; Ito, Katsuyoshi; Kuramitsu, Tatsuya; Tanaka, Nobuyuki; Nakaki, Hiroji; Nakanishi, Takashi; Esato, Kensuke (Yamaguchi Univ., Ube (Japan). School of Medicine)

    1993-11-01

    Twenty-four patients with lymphedema of the lower limbs and seven normal subjects were examined by lymphoscintigraphy following an intradermal injection of [sup 99m]Tc-HSA. The effect of changing to a standing position was determined. In normal subjects, a large spiking wave and a rapid stepwise increase in tracer activity frequently occurred on standing, although a decreased phase appeared less often on time-activity curves. These findings indicated that lymphatic flow was increased after the load produced by standing. The frequency of these changes was decreased in the patients with lymphedema, indicating that lymphatic disruption was responsible for their edema. Thus, lymphoscintigraphy using a load produced by standing can provide useful information in patients with lymphedema of the legs. (author).