My Life With Lymphedema

The Puzzle - An Inside Glimpse of Lymphedema - New Book

2011-09-01T08:49:00.001-07:00

Here's our new book on lymphedema. I also have a chapter with several articles.....

(including my own story). Pat

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The book is compiled so that people who have been touched by lymphedema can
share their stories; their trials and tribulations, their sadness and
disappointments, their strength and hopes. It is intended to encourage, educate
and inspire patients and loved ones, who can often feel isolated and uninformed.
We hope to increase awareness and general knowledge of a condition that is often
overlooked and misdiagnosed, yet which can have monumental physical and
emotional impact on the lives that it affects.

Not every story has a happy ending, yet there is hope. By sharing these stories
with one another, we can learn from the struggles and successes that others have
experienced, and can help each other to live well with lymphedema.

How do I get this book ???

This book will be available at:

14th State of Georgia Lymphedema Education & Awareness Program14th Program

OR FROM:

Beverly Thompson 770-476-2671
HILTON GARDEN INN — ATLANTA PERIMETER CENTER
1501 Lake Hearn Drive, Atlanta, GA 30319
Saturday, October 15, 2011
7:30 am - 5:00 pm

The book will be available at any sponsored Lighthouse Lymphedema Network
program or conference for a donation of $15.00
Lighthouse

Please mail your completed order form and donation to:

Lighthouse Lymphedema Network Book
10240 Crescent Ridge Drive
Roswell, GA 30076

Please send a donation of :
$19.95 per copy
Plus $5.00 per copy for Shipping Costs

Order Form

Name: Last First___________________________________________________

Mailing Address____________________________________________________

City State ZIP Code_________________________________________________

Home Telephone Number Cell Telephone Number________________________

Email Address_____________________________________________________

Number of Copies you would like to order______________________________

$_______________________________________________________________

Amount Enclosed__________________________________________________

I really am here friends

2011-02-11T17:39:00.001-08:00

Hi to Everyone

It has been probably a year since I've posted anything in my blogs. I so apologize to everyone, but my health has simply prevented me from much activity, even on the computer. But, it is high time I try again to see how much I can push things.

I'll put in an update on my own lymphedema shortly.

My very very best to all my visitors and readers

Pat O Connor - Blog author and co founder/director of:

Lymphedema People

2010 Georgia Lymphedema Education and Awareness Program

2010-06-05T03:36:00.000-07:00

2010 Georgia Lymphedema Education and Awareness Program

13th State of Georgia Lymphedema Education and Awareness Program, October 16,
2010, Decatur, GA.

View and Print out Brochure to Register (vertical menu item)

The LLN Brochure also includes much information about our not-for-profit
organization in Georgia and can be printed out (vertical menu item)

The program is entitled:

SHEDDING LIGHT ON LYMPHEDEMA

Sponsored by the Lighthouse Lymphedema Network

Courtney Day

2009-11-04T08:35:00.000-08:00

Courtney Day

One of the special treats of these Lymphedema groups is that you get the opportunity to meet new people.

This past week, I had the most delightful time meeting a lovely young lady with Lymphedema. Her name is Courtney day, a fourteen year old high school student and co-author of a new book where she shares her journey so far with LE.

I bought a copy and read it when I got back to the hotel and it was delightful. I think you’ll find it refreshing to read as she is so open and honest about her struggles in ways that we as adults are too timid to do. It is very encouraging as well as she is unashamed of her faith and shares that as well and how she is determined not to let lmphedema ruin or control her life – or to let it rob her of her dreams and hopes for the future.

In addition to her school activities, Courtney is active in her church, the National Charity League (helps organizations such as the Rnald McDonald House and the Drake house. She is also involved with a local food help group Norcross Food Co-0p..

She and her co-author, LE therapist Emily Smith also have a Facaebook group:

Emily is a Vodder trained and certified therapist and has also written a couple books on Stretch Therapy.

A Leg Up on Lymphedema - Facebook group

The book is:

A Leg up on Lymphedema

And can be ordered through this link: A Leg up on Lymphedema

Enjoy!

Pat

Baby Kayden in Oklahoma

2009-11-04T01:04:00.000-08:00

Baby Kayden in Oklahoma

Good Morning Everyone

I wanted to bring this to everyone’s attention and encourage anyone who can to help this little baby. Kayden has vascular Lymphedema and was just born on August 18, 2009…he’s got a long road ahead of him so let’s do anything we can for him and his family:

Baby Kayden

He’s a real little doll too!

Thanks Everyone!!!!!!!!!!!!!!!!!!!!

Pat

12th State of Georgia Lymphedema Awareness Day

2009-10-17T03:34:00.000-07:00

12th State of Georgia Lymphedema Awareness Program

Lighthouse Lymphedema Network

THERE IS STILL TIME TO GET THOSE REGISTRATIONS IN

An educational and awareness conference for patients, caregivers and professionals!

Where?

Saint Joseph Hospital Auditorium 5665 Peachtree Dunwoody Road, NE Atlanta, GA 30342

When?

Saturday, October 24, 2009 7:30 am - 5:00 pm

Click here for Registration Form

Schedule

7:30-8:15am Registration – Continental Breakfast – Exhibits 8:15-8:30am Welcome .

Plenary Session:

8:30-10:00am Moderator: Elaine Gunter, MT (ASCP)

Nicole Stout, PT, MPT, CLT-LANA Will discuss her studies on early intervention for breast cancer including the anatomy, reconstruction, breast cancer surgeries, truncal and other upper extremity lymphedema

10:00-10:30am Break Exhibits

10:30-12:00 Charles McGarvey, PT, DPT, MS, FAPTA

Lymphedema Secondary to Pelvic Cancer Treatment: A Review of Literature and Clinical Practice

12:00 – 1:30pm Lunch Exhibits

1:00-2:15pm Teen (only) Networking -Parent Networking (parents of children with lymphedema)

Separate sessions

Plenary Session:

1:30-2:15pm Daniel Beless, MD, Director of Wound Care at Saint Joseph Hospital Wound Care and the lymphedema patient

2:15-3:00pm DeCourcy Squire, PT, CLT-LANA

Research updates from the International Society of Lymphology of Lymphedema Diagnosis and Treatment

3:00-3:30pm Break Exhibits

3:30-4:30pm Panel Discussion

All speakers will participate in this question and answer discussion

4:30-5:00pm Closing Remarks

New Lymphedema Treatment Clinic - Myrtle beach, South Carolina

2009-10-14T08:11:00.000-07:00

It gives me great pleasure to announce a new lymphedema treatment clinic in the Myrtle Beach, South Carolina area:

Tom Kincheloe, OTR/L, CLT
Founder/Clinical Director
RIVERTOWN LYMPHEDEMA CLINIC AND REHAB, LLC.
100 Prather Park Drive, Suite A
Myrtle Beach, SC 29588-7910
Bus. Phone: (843) 742-5701
Bus. Fax: (843) 742-5704
Cell: (843) 957-2422
Email: erivertownlymph@sc.rr.com

I know Tom personally and two things strike me about him.

First, is his real concern/compassion for his patients.

Secondly is his knowledge of lymphedema.

A winning combination! So if you live in his area and are looking for lymphedema help, give him a call.

Pat

Angiosarcoma consecutive to chronic lymphoedema: a Stewart-Treves syndrome

2009-10-11T03:21:00.000-07:00

Lymphangiosarcoma referred to as angiosarcoma or Stewart Treves Syndrome is a possible complication

of long term (chronic) lymphedema. It has always been reported as rare, but ironically in the groups I participate in there

have been several members over the last couple years that have come down with it.

Historically, it was though that this mostly effected breast cancer survivors, but now is being recognized as something

that is possible for all chronic LE patients. Indeed, every one of the members who got it were not breast cancer patients.

A couple had other types of cancer and another two were primary lymphedema.

Also, it needs to be mentioned that in every case our members had bruises that didn't heal. When they were biopsied, it

turned out to be lymphangiosarcoma. it is critical that we keep check on our limbs that are effected and don't assume

any change is simply a discoloration cause by the LE.

In my own case, I had a small perfectly round spot on the calf of my left leg. It continued to grow until it reached

the size of a quarter. For me, it turned out to be mixed b-cell lymphoma.

So pay attention and report to your doctor when these spots arise.

Pat

Angiosarcoma consecutive to chronic lymphoedema: a Stewart-Treves syndrome

Rev Med Liege. 2009 Jul-Aug

Gonne E, Collignon J, Kurth W, Thiry A, Henry F, Jerusalem G, Gennigens C.
Université de Liège, Belgique.
The Stewart-Treves Syndrome is defined as an angiosarcoma (very aggressive malignant tumor originating from endothelial cells) appearing in a specific clinical setting. This tumor develops in patients suffering from chronic lymphedema of the upper limb following mastectomy and axillary lymph node dissection for breast cancer. The diagnosis relies on medical history, clinical examination and a histological assesment (biopsy or resection). This syndrome represents a rare clinical entity. Unfortunately, the prognosis is poor. A large surgical resection is the treatment of choice if the patient is a candidate for a surgical resection with a curative intent Radiotherapy is sometimes used as a palliative local treatment. Chemotherapy is only used in more advanced cases, not curable by surgery alone.
Pub Med
For further information, please refer to our pages:
LYMPHANGIOSARCOMA
and
Stewart Treves Syndrome

Lighthouse Lymphedema Network

2009-09-29T02:21:00.000-07:00

I wanted to make a special announcement that the Lighthouse Lymphedema.Network is now on Facebook.

You can join by going to:

Lighthouse Facebook

There is also an area where you can post and participate. AND - don't forget our upcoming program in October.

We will be having both a parenting network and a teen network this year....be there or be square!

see the details for that at:

Lighthouse Lymphedema Network

**yes, I'm on it too :-)

Pat

The CEAP-L classification for lymphedemas of the limbs: the Italian experience.

2009-09-21T21:30:00.000-07:00

The CEAP-L classification for lymphedemas of the limbs: the Italian experience.
Int Angiol. 2009 Aug

Gasbarro V, Michelini S, Antignani PL, Tsolaki E, Ricci M, Allegra C.
Unit of Vascular and Endovascular Surgery, Department of Surgical, Anesthesiological and Radiological Sciences, Sant'Anna University Hospital, University of Ferrara, Ferrara, Italy allegra@mclink.it.

AIM: A method to classificate lymphedema has been needed to gather all the important information on the clinical evolution of the disease using a common language and an easy clinical applicability.

METHODS: The proposal for a new classification of the limb lymphedema was inspired by the C.E.A.P. classification for chronic venous insufficiency of the lower limb. The classification adopts the acronym C.E.A.P. by adding the letter L to underline the aspect ''lymphedema'' and is based on clinical data such as extension of lymphedema, presence of lymphangitis, leg ulcers and loss of functionality of the limb and instrumental criteria that permit to confirm and precise diagnosis. The Clinical classification is based on the most objective sign in these patients, the edema which is subdivided into 5 classes depending on the clinical manifestations. The etiological aspect considers 2 types of alterations of the lymphatic system: congenital and acquired. The anatomic is aimed to locate the anatomical structures involved. Pathophysiological conditions are gathered into 5 groups: agenesia or hypoplasia, hyperplasia, reflux, overload, obstruction.

RESULTS: The classification has already been appraised after 4 years of activity at the unit of Vascular and Endovascular Surgery of Ferrara, at the S. Giovanni Battista Hospital in Rome, at the Umberto I Ancona Hospital and at the S. Giovanni- Addolorata Hospital in Rome.

CONCLUSIONS: The proposal for a new classification of lymphedema C.E.A.P. L was developed in order to categorize patients with definite and objective marks, creating clinical reports with a common vocabulary, clear to all clinicians, permitting to stage the disease, evaluate treatment and finally obtain epidemiological and statistical data.

PubMed

Adverse effects of compression in treatment of limb lymphedema.]

2009-09-20T11:50:00.000-07:00

Adverse effects of compression in treatment of limb lymphedema.

J Mal Vasc. 2009 Aug 18

Vignes S, Arrault M.

Unité de lymphologie, centre national de référence des maladies vasculaires rares, hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France.

INTRODUCTION: Limb lymphedema, whether primary or secondary, is a chronic disease. Compression is the cornerstone of therapy and includes multilayer low-stretch bandages and elastic garments. Compression is usually well-tolerated. The aim of our study was to identify all the different types of adverse effects of compression.

MATERIALS AND METHODS: Since January 2005, we have recorded all adverse events occurring in outpatients and inpatients consulting in a single lymphology department, spontaneously reported by patient during consultations or physical examinations, and noted the type of compression material used.

RESULTS: Adverse effects were secondary to poor choice of therapeutic material, excessive pressure or contact dermatitis. For the arms, an elastic garment stopping at the wrist can be responsible for lymphedema of the hand and fingers. Rubbing of sleeve seams may cause pain and even ulcers between the thumb and forefinger. Open-toed elastic stockings may exacerbate digital lymphedema, leading to the formation of oozing lymph vesicles. Hyperpressure may cause severe pain localized to the first and fifth toes, overlapping toes, interdigital corns and/or ingrown toenails. Silicone-banded soft-fit elastic garments may cause painful phlyctena, urticaria or eczematiform lesions. Elastic bandages may induce pain or purpuric lesions.

CONCLUSION: Compression can be responsible for adverse effects, sometimes severe, requiring treatment change or withdrawal. Further studies are needed to precisely determine their frequency to improve prescriptions and currently available products.

EMConsulte

Massive Localized Lymphedema - A Review

2009-09-17T04:05:00.000-07:00

Massive localised lymphoedema: a clinicopathological study of 22 cases and review of the literature.

J Clin Pathol. 2009 Sep;

Manduch M, Oliveira AM, Nascimento AG, Folpe AL.
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA.

BACKGROUND: Massive localised lymphedema (MLL) is a rare, relatively recently described pseudosarcoma most often occurring in morbidly obese patients.

AIM: To perform a retrospective review of all cases diagnosed as MLL.

METHODS AND RESULTS: Clinical information was obtained. 22 morbidly obese adults (mean patient weight 186 kg) presented with unilateral, large soft tissue lesions of longstanding duration. Most lesions involved the thigh, but also occurred in the posterior calf and lower leg. Clinically, most lesions were regarded as representing benign processes, including pedunculated lipoma, lymphocoele or recurrent cellulitis, although soft tissue sarcoma was also suspected in two cases. Grossly, all masses showed markedly thickened skin with a "cobblestone" appearance, and were ill-defined, unencapsulated, lobulate, and very large (mean size 31 cm, range 15-61.5 cm, mean weight 3386 g, range 1133-10,800 g). Histologically, all 22 cases showed striking dermal fibrosis, expansion of the fibrous septa between fat lobules with increased numbers of stromal fibroblasts, lymphatic proliferation and lymphangiectasia. Multinucleated fibroblastic cells, marked vascular proliferation, moderate stromal cellularity and fascicular growth raised concern among referring pathologists for atypical lipomatous tumour/well differentiated liposarcoma, angiosarcoma, and a fibroblastic neoplasm such as fibromatosis in 10, 2 and 1 case, respectively.

CONCLUSION: The diagnosis of MLL continues to be challenging, in particular for pathologists. Awareness of this entity, clinical correlation and gross pathological correlation are essential in the separation of this distinctive pseudosarcoma from its various morphological mimics.

British Medical Journal

For further information on Massive Localized Lymphedema and Tretments available click here: Massive Localized Lymphedema

Georgia Lymphedema Education and Awareness Program

2009-09-11T04:24:00.000-07:00

11th Annual Lymphedema Education & Awareness Program

An educational and awareness conference for patients, caregivers and professionals!

Where?

Piedmont Hospital

Richard H. Rich Auditorium

1968 Peachtree Road, NW, Building 77

Atlanta, Georgia

When?

Saturday, October 18, 20087:30 am - 5:30 pm

Program includes

What to expect of tissue after radiation?

What is the physiology response of radiation?

What does radiation do to the lymph nodes? - Peter Rossi, MD

How does vascular flow affect the lymphatics? - Ken Harper, MD

Expectations of surgery. - Christopher Hart, MD, FACSThe Lymphatic System, Wound Care,

Infections and Treatment - Paula Stewart, MDParent Networking

Aquatic Exercises

The Connection of obesity and increased swelling in people with lymphedema and lipedema.and more.

Additional information and registration form - Home website - Lighthouse Lymphedema Network

See you there - Pat

Podoconiosis - non-filarial geochemical elephantiasis - a neglected tropical disease?

2009-06-08T08:37:00.000-07:00

Podoconiosis - non-filarial geochemical elephantiasis - a neglected tropical disease?

J Dtsch Dermatol Ges. 2009 May

Nenoff P, Simon JC, Muylowa GK, Davey G.
Laboratory for Medical Microbiology, Mölbis, Germany.

Summary

Podoconiosis or mossy foot is a form of non-filarial lymphedema. This geo-chemical elephantiasis is a disabling condition caused by the passage of microparticles of silica and aluminum silicates through the skin of people walking barefoot in areas with a high content of soil of volcanic origin. Podoconiosis is widespread in tropical Africa, Central America and North India, yet it remains a neglected and under-researched condition. The disabling effects of podoco-niosis cause great hardship to patients. It adversely affects the economic (reduced productivity and absenteeism), social (marriage, education, etc.) and psychological (social stigma) well-being of those affected. Podoconiosis can be prevented; the main primary preventive measure is protective footwear. Secondary measures include a strict hygiene regimen and compression therapy, which can reverse initial lesions. Tertiary approaches include surgical management, such as shaving operations to reduce hyperplastic and verru-cous elephantiasis.

WileyInterScience

Pole walking for patients with breast cancer-related arm lymphedema

2009-05-19T07:37:00.000-07:00

Pole walking for patients with breast cancer-related arm lymphedema
Physiother Theory Pract. 2009 Apr

Jönsson C, Johansson K.
Lymphedema Unit, Lund University Hospital, Lund, Sweden. charlotta.jonsson@skane.se

Arm lymphedema is a well-known side effect of breast cancer treatment. Studies of the effect of physical exercise on arm lymphedema are very rare. The purpose of this study was to investigate the influence of pole walking on breast cancer-related arm lymphedema when using a compression sleeve. Twenty-six women with unilateral arm lymphedema took part in a clinical study of pole walking on one occasion, 4 kilometers for 1 hour. Measurements were made before, immediately after, and 24 hours later. Results revealed no changes in total arm volume of the swollen arm, measured with water displacement method, or in subjective assessments of heaviness and tightness in the affected arm using visual analogue scale. Immediately after pole walking, a temporary increase in total arm volume of the healthy arm (P=0.037) was found. Twenty-four hours later, no differences were found compared to the measurements before walking. The median for perceived exertion immediately after pole walking, measured with Borg scale, was 11 ("fairly light"). The results suggest that a controlled, short-duration pole-walking program can be performed by patients with arm lymphedema, using a compression sleeve, without deterioration of the arm lymphedema.

InformaWorld

Antibiotic Preventative Therapy for LE Related Cellulitis

2009-05-19T07:30:00.000-07:00

Antibiotic Preventative Therapy for LE Related Cellulitis

May 11, 2009

The protocol I use and recommend comes directly from all my doctors over thelast forty years including infectious disease doctors, so it isn't just alayman's suggestion. It is also supported by several of our well known LE doctors that I have discussed it with.

You can not treat cellulitis in an individual as if it was just a simple infection.

One must remember

(1) A lymphedema limb is a immuno-compromised limb.

(2) As such any infection must be treat immediately to prevent spread anddditional lymphatic damage and complications such as gangrene and/or sepsis. Because of the limb being immuno-compromised the infection WILL spread rapidly without immediate care.

(3.) When you do go to the doc, they will look at the leg and prescribe sometype of antiibiotic. And...guess what????? When they do so, they don't have aclue as to the specific bacteria that is causing the infection.

There are only two ways you can tell the specifics. First, if you took anactual biopsy/culture of the infected area. This is almost never done anymore and is absolutely not what a LE patient needs to have - an open wound in the midst of infected tissue.

The second way is to do a blood culture. But, the only way you can identify thebacterium in a blood culture is if you are already septic or rather if the infection has become systemic. You must in no uncertain terms wait for this to happen.

Finally, time is absolutely essential here. Here's the scenario about waitingthat so many have expressed.

You call your doctor. Generally, they will/might say that can't see you today -perhaps tomorrow - perhaps whenever. To wait is not acceptable.

Or - they do tell you to come in and they prescribe an antibiotic as I said previously without identifying the bacteria. Or - they will say go to the ER. Here's the problem with that. In a leadingCanadian hospital, they found that cellulitis was incorrectly diagnosed andimproperly treated in 30% of the ER cases in their distinguished hospital. Thisis just my opinion - but that isn't a record I frankly would want to put my life on the line for.

Then you wait, possible again for hours. Then, more and more they give you abag of cancomycin and send you home.

This is bad for two reasons:

(1) Vanco should be used as a last line antibacterial defense. Use of it as an immediate frontline med is what is truely helping create the super duper bugs. Bacterial infections fall into two broad groups. What is called gram-positive or what isreferred to as gram-negative. What most doctors would do is presribe a longer term broad spectrum antibiotic that is capable of hitting both types of bacteria.

(2) Giving you one bag of Vanco and sending you home very well could be aprescription for disaster. Most cellulitis is simply not going to be eliminatedby one bag of super antibiotic.

Why?

Well, first if you have fibrosis, this is going to make it very very hardfor the antibiotic to penetrate to areas where the bacterial may be hiding. One"hit" may not do the job.

Secondly, we are talking about limbs that are greatly enlarged with a lot ofextra fluid - greatly diluting the antibiotic.

Quantitative bioimpedance spectroscopy for the assessment of lymphedema

2008-12-30T08:00:00.000-08:00

Quantitative bioimpedance spectroscopy for the assessment of lymphoedema

Breast Cancer Res Treat. 2008 Dec

Ward LC, Czerniec S, Kilbreath SL.
School of Molecular and Microbial Sciences, University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia, l.ward@uq.edu.au.

The aim was to make bioimpedance spectroscopy (BIS) quantitative for assessment of lymphoedema. Apparent resistivity coefficients were determined for the intra- and extracellular water of arms in a control cohort of women (n = 66). These coefficients were used to predict water volumes in the arms of women with lymphoedema (n = 23) and a separate control group without lymphoedema (n = 13) and to compare these with total arm size measured by perometry. Total arm volume was highly correlated (r = 0.80-0.90) with arm fluid volumes predicted by BIS and the proportional increase in arm size predicted by BIS was not significantly different to that measured by perometry. BIS predicted that the increased volume in the women with lymphoedema was predominantly (60%) due to increase in extracellular fluid. BIS is capable of quantifying the volume increase in limb size seen in lymphoedema.

SpringerLink

Lymphedema in systemic juvenile arthritis: a rare extraarticular feature

2008-12-30T07:56:00.000-08:00

Lymphedema in systemic juvenile arthritis: a rare extraarticular feature
Acta Reumatol Port. 2008 Oct-Dec

Ambrósio C, Abreu P, Alexandre M, Malcata A.
Serviço de Reumatologia dos Hospitais da Universidade de Coimbra.

Extraarticular features are usually found in rheumatological diseases sometimes with no correlation with the disease's activity in that moment. Lymphoedema is one of these manifestations and it's defined as a tissue fluid accumulation with gradual onset of swelling of a limb. Because it is an unusual finding, the physiopatological explanation of this feature is still difficult to understand. We describe a case report of lymphoedema on left upper arm, in a patient with systemic juvenile arthritis, with no identified cause and with no associated systemic signs or symptoms.

PMID: 19107091 [PubMed - in process]

Supplemental surgical treatment to end stage (stage IV-V) of chronic lymphedema.

2008-11-23T08:32:00.000-08:00

Supplemental surgical treatment to end stage (stage IV-V) of chronic lymphedema.

*Note - I am posting this for information and it shuld not be taken as an endorsement for the surgical treatment of lymphedema. It is critical that ALL efforts be made to treat and manage lymphedema through manual decongestive therapymanual lymphatic drainage (MLD, CDT) before any attempt at any surgery.

The results from MLD can be remarkable, even with limbs that would otherwise look hopeless.

Pat

Supplemental surgical treatment to end stage (stage IV-V) of chronic lymphedema.

Int Angiol. 2008 Oct

Lee BB, Kim YW, Kim DI, Hwang JH, Laredo J, Neville R.
Department of Surgery, Georgetown University, Washington DC, USA.

AIM: When the lymphedema reaches to its end stages, the complex decongestive therapy (CDT) and/or compression therapy become less effective and increased risk of systemic/general sepsis to become potentially life threatening condition.

METHODS: To improve its clinical management, excisional surgery was performed on 22 patients for their 33 limbs in the end stage of lymphedema as a supplemental therapy, and its efficacy was retrospectively analyzed. Diagnosis was made by radionuclide lymphoscintigraphy and basic laboratory studies (e.g. ultrasonography, magnetic resonance imaging). Twenty-two patients (mean age: 46 years; 3 male and 19 female; 5 primary and 17 secondary) submitted to the excisional surgery on 33 limbs (unilateral: 11; bilateral: 22). Surgery was indicated by further progression of the disease with recurrent sepsis despite adequate antibiotics therapy. A modified Auchincloss-Homan's operation was used to excise grotesquely disfigured soft tissue with advanced dermato-lipo-fibrosclerotic change. The normal limb contour was re-established to allow proper postoperative therapy. Postoperative CDT and compression therapy were mandatorily implemented in all cases.

RESULTS: A postoperative assessment of the treatment results, at 12 months showed an overall improvement in 28 of the 33 limbs: substantial improvement on the condition of limb function and quality of life (QOL), and local and/or systemic sepsis. Eighteen patients with good compliance to maintain the postoperative CDT showed much improved clinical results and QOL through the first interim assessment (24 months).

CONCLUSION: Excisional surgery at the end stage of lymphedema seems to provide substantial improvement of clinical condition and QOL only when mandated postoperative CDT/compression therapy is well kept.

PMID: 18974701 [PubMed - in process]

Do Bone Fractures Cause Lymphedema?

2008-11-12T03:46:00.000-08:00

Do Bone Fractures Cause Lymphedema?
Over the past few years, there have been several members of my various groups who have reported lymphedema triggered by bone breaks. These cases involve both arm lymphedema and leg lymphedema.

This is highly unusual and even many lymphedema experts are unaware this can occur.

If we start with the premise that some people are born with an already “at risk” lymph system and then understand the exact mechanisms of the lymphatic system response to trauma and the changes within the lymph nodes, then it becomes clear that this is in fact a possibility.

I need to remind readers that I am not a medical professional nor have I ever had formal medical training and/or education. What is presented is a combination of my fifty-five years of living with lymphedema and from the research that I have undertaken.

Pat

Effect of lymphedema on the recovery of fractures

J Orthop Sci. 2007 Nov;
Arslan H, Uludağ A, Kapukaya A, Gezici A, Bekler HI, Ketani A. Department of Orthopedic and Trauma Surgery, University of Dicle, School of Medicine, Diyarbakir, Turkey.

BACKGROUND: Lymphedema delays the healing of any wound by negatively affecting its inflammatory period. Whether it affects bone healing in a similar negative manner is unknown. Therefore, we experimentally investigated the effect of lymphedema on fracture recovery.

METHODS: We used thirty 200- to 250-g Sprague-Dawley rats for the experiment. The rats were randomly divided into two groups of 15 rats each for the experimental lymphedema and control groups. Lymphedema development was confirmed by measuring the circumference and diameter of the extremities together with lymphoscintigraphy. Twenty days after the development of lymphedema, a fracture model was created in both groups in the right tibia with mid-diaphyseal osteotomy and fixing with an intramedullary Kirschner wire. After 6 weeks, all rats were sacrificed and the callus tissue that formed along the osteotomy was compared between groups with respect to radiographic, histological, and biomechanical characteristics.

RESULTS: The three-point bending test yielded an average stiffness value of 1227 N/mm (n = 6) in the control group and 284 N/mm (n = 7) in the experimental lymphedema group (P <>

CONCLUSIONS: Lymphedema negatively affected bone healing in rats. However, the mechanism of this negative effect and its occurrence in humans are still unknown. Further experimental and clinical studies are needed to support and extend our findings.

Springerlink

The healing of tibial fracture and response of the local lymphatic system

Szczesny G, Olszewski WL, Gewartowska M, Zaleska M, Górecki A. Department of Surgical Research and Transplantology, Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland. g.szczesny@cmdik.pan.pl

BACKGROUND: Damage of tissues by mechanical injury and inflammation is followed by reaction of the regional lymphoid tissue, lymphatics, and lymph nodes. In our previous lymphoscintigraphic studies, we showed that closed fractures of a lower limb cause reaction of the local lymphoid tissue. There was dilation of lymphatics draining the site of the fracture and enlargement of inguinal lymph nodes. These changes persisted even after clinical healing of the fracture. In the long-lasting nonhealing fractures, the lymphoscintigraphic pictures were different. The draining lymphatics became obliterated, and the lymph nodes disappeared.

METHODS: In this study, we tried to correlate the lymphoscintigraphic images, reflecting the immune events at the fracture site, with the immunohistochemical observations of the biopsy specimens obtained during corrective operations from the healing and nonhealing fracture gaps. Thirty-eight patients with closed fracture of the tibia without traumatic skin changes were studied.

RESULTS: We confirmed that closed tibial fracture evokes response of the regional lymphatic system. Normal fracture healing with immune cell infiltrates and foci of ossification was accompanied by dilated lymphatics and enlarged lymph nodes. Prolonged nonhealing fracture with lack of cellular reaction in the gap proceeded with decreased mass of lymph nodes.

CONCLUSION: This study provides evidence for existence of a functional axis between wound of bone and surrounding soft tissue and the local lymphatic (immune) system. We hypothesize that the fast healing is regulated by influx into the wound of lymph node regulatory cells, whereas prolonged healing causes gradual exhaustion of the regional lymph node functional elements, and reciprocally impairment in sending regulatory cells to the fracture gap.

Journal of Trauma

Limb lymph node response to bone fracture.

Lymphat Res Biol. 2004;
Szczesny G, Olszewski WL, Zaleska M. Department of Surgical Research and Transplantology, Medical Research Centre, Polish Academy of Sciences, 02-106 Warsaw, Poland. g.szczesny@cmdik.pan.pl

In previous clinical studies, dilation of afferent lymphatics and enlargement of inguinal lymph nodes (LN) were observed in lymphoscintigrams from patients with persistent posttraumatic edema of lower extremities after fractures and trauma of soft tissues. In this study, changes in rat popliteal and iliac lymph nodes draining lymph from the site of tibial fracture and adjacent soft tissue injury were investigated. The observed parameters were lymph node weight, cell number, phenotype frequency, cell cytokine expression, and reactivity to mitogens. The key observations included: a) increase in the weight and total cell number of the lymph nodes; b) increased autotransformation rate and responsiveness of lymph node cells to mitogen; c) decreased frequency of ED1 macrophages and activated OX8 cytotoxic cells in flow cytometry analysis; d) high expression of OX6 class II-positive, OX7 (stem cells), OX62 (migrating dendritic cells), ED1 (macrophages), and OX12 (B cells) on immunohistochemical sections of LNs with some few HIS48 (granulocytes); e) high expression of NOS3 and TGF beta by lymph node lymphocytes and endothelial cells.

In summary, local lymph nodes reacted to internal wounds, such as bone fracture and injury to adjacent tissues, through mobilization of cells from the blood circulation, along with activation of cellular subsets. The molecular mechanism that provides the signal for this reaction remains unknown. The absence of major changes in the frequency of lymph node cell subpopulations indicates that lymph nodes are constitutively prepared for influx of antigens from damaged tissues and react only with increase in cell number and cell activation. The nature of the reaction, including lack of immunization against autoantigens, remains unclear. Further elucidation will require studies on the mechanism of cross-tolerance to self-antigens during wound healing.

Liebertonline

Lymphedema of the Hand and Forearm Following Fracture of the Distal Radius

By David A. Kasper, DO, MBA; Menachem M. Meller, MD, PhD ORTHOPEDICS 2008; 31:172

February 2008

Lymphedema of the hand following a fracture of the distal radius is a rare complication resulting from abnormal protein-rich fluid accumulation in the affected area. Although lymphedema affects approximately 2.5 million Americans and frequently is associated with breast cancer treatment, its occurrence in the context of a commonplace injury to the wrist is virtually nonexistent.1

The etiology of lymphedema development following fracture care is poorly understood and has been attributed to psychogenic causes. Only one case of lymphedema following a Colles fracture has been reported in the literature.2 In that report, the patient was a 42-year old man who presented with lymphedema after a fall while accidentally being pulled by a chain. After closed reduction of the fracture and immobilization, the patient reported intense pain without swelling. Immediately after removal of the patient’s final cast, his hand began to swell, and he underwent intense physiotherapy, numerous sympathetic nerve blocks, and hospitalization with no improvement. The authors suggested the pathogenesis of the patient’s lymphedema after his fracture was self-induced and psychogenic in nature.

This article presents a case of Colles fracture complicated by nonpitting edema in a 62-year-old woman in whom psychogenic causes were not identified.

Case Report

A 62-year-old right hand-dominant woman fell down a few steps at work onto her outstretched right hand. Evaluation in the emergency room indicated a fracture of the distal radius, and the patient underwent closed reduction (Figure 1) under general anesthesia without a tourniquet.
This resulted in excellent restoration of the skeletal alignment. She was placed in a well-padded short arm cast.

At a routine follow-up visit 10 days later, the patient had complete loss of position, with the fracture reverting to the presurgical misalignment sustained immediately following the injury. She subsequently underwent open reduction and internal fixation using a dorsal plate. Both the surgery and postoperative course were uneventful.

The patient’s history included controlled hypertension, mitral valve prolapse, gastroesophageal reflux disease, rheumatic fever, scarlet fever, and a prior arthroscopic knee procedure. She reported no prior malignancies, and she was compliant with routine general medical care.
Psychological profiling was normal.

Following cast removal, the patient began occupational and physical therapy. Two months postoperatively, the swelling persisted, and she developed increasing asymmetry. She also had progressive nonpitting edema. The patient reported having no pain, hypersensitivity, or other symptoms. She also reported she did not develop any other illnesses or malignancies during this time.

The patient underwent an extensive workup that included electrodiagnostic studies and radiographs of the cervical spine, right shoulder, and right wrist (Figure 2). Computed tomography and magnetic resonance imaging revealed prominent edema adjacent to the capsule (Figure 3). An intravenous Doppler study ruled out deep vein thrombosis of the right upper extremity. A Duplex arterial scan and technetium bone scan revealed no pathological findings other than the fractured wrist.

Her fracture healed satisfactorily without additional loss of position. However, the function of her right hand was limited by the edema (Figure 4). Traditional treatments, such as a Jobst gauntlet (BSN-Jobst, Inc, Charlotte, North Carolina), Kinesio taping (Kinesio, Albuquerque, New Mexico), massage, elevation, and Isotoner gloves (Totes Isotoner Corp, Cincinnati, Ohio) supplemented by home exercises failed to relieve her symptoms.

Treatment subsequently was prescribed with the NormaTec PCD (pneumatic compression device; NormaTec, Newton Center, Massachusetts), and the patient initially used it at home for 4 hours daily. Within 2 weeks, her massive forearm edema dramatically diminished, and her wrist and hand motion normalized. She was able to bring her fingertips down to the proximal palmar crease with good grip, pinch, and opposition.

To inhibit the recurrence of the edema and hand stiffness, the patient has continued to use the device at home approximately 1 hour per week. She requires no compression garments and has not had any episodes of cellulitis (Figure 5).

Discussion

Although lymphedema is a common and severely disabling medical condition, it has not been described following orthopedic injuries such as a Colles fracture. The only previously published case report describing this injury combination attributed the lymphedema to psychogenic causes.2 In our patient, psychogenic causes were not identified.

Lymphedema results when the lymphatic volume in tissue exceeds the lymphatic transport system’s capabilities to clear the fluid. Increased hydrostatic pressure or decreased plasma oncotic pressure creates gradients across the capillary membranes, which causes the excess fluid to spill and accumulate in the interstitial space. Possible causes of this excess fluid production include local inflammation, surgery, infection, cancer, lymphatic obstruction (ie, due to scarring), and trauma.3 Although all body tissues are bathed in interstitial fluid, the lymph circulation still remains a complex, dynamic, and incompletely understood process.4

Lymphedema can be classified into two types: primary and secondary. Primary lymphedema is associated with hypoplastic, hyperplastic, missing, or impaired lymph vessels. Other presentations are classified further by age of onset. However, causes of primary lymphedema are generally unknown and cannot be linked to any specific traumatic event. The most common cause of primary lymphedema is lymphangiodysplasia.

Secondary lymphedema can be attributed to trauma to the lymph nodes or the lymphatic vessels themselves. Secondary lymphedema frequently is seen in surgical patients and is attributed to lymphatic obstruction.3 Speculations suggest secondary lymphedema associated with trauma is a consequence of an infectious or inflammatory process.3

Mechanical injury of the soft tissues and bones of the extremities usually is followed by edema distal to the site and at the site itself but not proximal to it. Patients usually present with a sensation of fullness and pain in the affected area, induration, edema, hyperkeratosis, and xerosis. Functional limitations include decreased range of motion, joint inflexibility, decreased mobility (if the lower limb is affected), and decreased activities of daily living (eg, grooming and dressing).3

For several decades, treatments to relieve lymphedema and traumatic or postoperative edema included manual massage, gradient compression stockings and sleeves, bandaging, taping, and pneumatic compression devices previously referred to as lymphedema pumps. All of these treatments used external compression, but none produced consistently good clinical outcomes.

Additionally, these treatments used static compression strategies, with compression applied and held constant for varying lengths of time. Most of the lymphedema pumps were poorly bioengineered, and their designs lacked understanding of the optimum parameters for noninvasive compression.

Recently, the concept of pneumatic medicine was developed to more clearly characterize and advance the science of external compression strategies. As defined by Avery et al,5 pneumatic medicine is the use of noninvasive, dynamic compression to treat the array of peripheral vascular disorders, including arterial insufficiency, chronic wounds, venous insufficiency, and lymphedema.

The NormaTec PCD uses a multi-cell sleeve or boot that is placed on the affected limb and pneumatically inflated and deflated via a unique Peristalic Pulse dynamic compression strategy. The patented Peristalic Pulse pneumatic waveform consists of a “pulse, gradient hold, release” compression cycle, simulating normal physiology. It incorporates three major physiological concepts: dynamic pulsing compression as seen in the muscle pump of a normal limb, directionality of flow similar to the venous and lymphatic one-way valves, and the effective movement of fluids created by peristalsis. The parameters of the NormaTec PCD are programmed by the physician, and the patient then uses the device independently at home.
A full functional outcome for our patient, who had chronic, clinically significant symptoms, was achieved in a brief period of time after numerous other treatments failed. The Peristalic Pulse compression strategy dynamically decongested the edematous tissues, and her hand and wrist range of motion improved markedly. Our patient has continued to use the device approximately 1 hour per week as maintenance therapy to prevent the return of edema and upper extremity stiffness. No compression garment is required, and compliance with the treatment program has been excellent.

A pathological anomaly that may have been a causative agent in our patient’s proximal edema following reduction of her Colles fracture is complex regional pain syndrome. According to the literature, the incidence of patients with Colles fractures who develop complex regional pain syndrome, albeit controversial, ranges between 2% and 37%.6 Although the pathogenesis is poorly understood, complex regional pain syndrome commonly is triggered by minor injuries such as fractures, crush injuries, peripheral nerve injuries, and other precipitating events that involve abnormal sympathetic nervous system activity.

Complex regional pain syndrome is characterized by pain and tenderness that is described as burning or aching in nature and usually occurring at a distal extremity. Patients with complex regional pain syndrome may develop rapid bony demineralization, trophic skin changes, and vasomotor instability that also are disproportionate to the underlying injury.

Complex regional pain syndrome progresses through three clinical phases. The first phase is characterized by an intense burning pain, edema, warmth, and tenderness of a distal extremity, especially noted around the joints. The joints become stiff, and pain is reproduced on passive and active motion of the joint. During the second phase (3 to 6 months), the patient’s skin becomes thin, cool, and shiny. In the third phase (another 3 to 6 months), the skin becomes atrophic and dry, with progression to flexion contractures and palmar fibromatosis.3

To aid in the diagnosis of complex regional pain syndrome, plain radiographs of patients with fractures may exhibit spotty rarefaction (Sudeck atrophy). Other tests used to substantiate this diagnosis include thermography, bone scan, and sympathetic blockade.

The key component to successful conservative treatment is early diagnosis within 6 to 8 weeks. Conservative treatment modalities include heat, elevation, and desensitization. Chronic disability occurs when the diagnosis and subsequent treatment is delayed. However, some authors have suggested there is no correlation among age, adequacy or number of reductions, or severity of fracture in patients who present with complex regional pain syndrome.3 In our patient, we ruled out complex regional pain syndrome because electromyography, nerve conduction study, radiographs, intravenous Doppler study, duplex arterial scan, and technetium bone scan revealed no pathologic findings other than the fractured wrist.

Some patients present with this syndrome after age 40 years, with the highest incidence in the sixth decade of life. Some patients also present with this anomaly after requiring repeated fracture reductions. Itzchaki et al2 suggested there may be a psychogenic component to this syndrome. Emotional instability was identified in one third of patients with this syndrome.2
Other causes of lymphedema were evaluated extensively in our patient. Local, regional, and metastatic causes such as breast cancer and Pancoast tumor were ruled out as were mechanical dysfunctions such as thoracic outlet syndrome and Milroy disease. Neurological involvement also was ruled out based on normal electroencephalographic readings and nonpathological clinical and physical findings.

The surgical procedure in our patient was uncomplicated and thus lymphedema secondary to any vascular injury was ruled out. Questions that need to be addressed are whether the lymphedema was locally or systemically mediated, or whether the onset of the fracture induced an avascular anastomosis that led to the lymphedema. Our conclusions led us to believe the development of lymphedema of the distal radius following Colles fracture was idiopathic in our patient.

References

Norton S. Managing lymphedema. Advance. 2000; 11(10):1-6. Itzchaki M, Ben-Hur N, Ashur H. Lymphedema of the hand following a fracture of the distal radius. Int Surg. 1978; 63(1):29-30. Patel AT. Lymphedema. In: Frontera WR, Silver JK, eds. Essentials of Physical Medicine and Rehabilitation. 1st ed. Philadelphia, PA: Hanley and Belfus; 2002:575-577. St Louis JD, McCann RL. Lymphatic System. In: Townsend CM, ed. Sabiston Textbook of Surgery. 16th ed. Philadelphia, PA: WB Saunders Co; 2001:1446-1450. Avery KB, Solomon AD, Weber RB, Jacobs LF. Treatment of congenital lymphoedema with sequential intermittent pneumatic compression therapy. The Foot. 2000; 10(4):210-215. Stern PJ, Derr RG. Non-osseous complications following distal radius fractures. Iowa Orthop J. 1993; 13:63-69. Authors Drs Kasper and Meller are from the Department of Orthopedic Surgery, Veterans Hospital, University of Pennsylvania, Philadelphia, Pennsylvania.

Drs Kasper and Meller have no relevant financial relationships to disclose.

Correspondence should be addressed to: Menachem M. Meller, MD, PhD, Department of Orthopedic Surgery, Veterans Hospital, University of Pennsylvania, 424 Stemmler Hall, Philadelphia, PA 19104-6081.

OrthoSuperSite

Supplemental surgical treatment to end stage (stage IV-V) of chronic lymphedema.

2008-11-04T04:24:00.000-08:00

Normally, I don't post articles suggesting surgeries on lymphedema. Due to the complications that have been experienced by lymphedema patients, I am strongly opposed to what we call a debulking surgery.

However, this study is interesting for a couple reason. The surgery appears to be one I have never heard of - Auchincloss-Homan's procedure and references to stages IV-V which they call "end-Stage" lymphedema.

I research those items to see what I can find and of course will post the info.

In the meantime, here is the abstract.

Supplemental surgical treatment to end stage (stage IV-V) of chronic lymphedema.

Int Angiol. 2008 Oct

Lee BB, Kim YW, Kim DI, Hwang JH, Laredo J, Neville R.
Department of Surgery, Georgetown University, Washington DC, USA.

PMID: 18974701 [PubMed - in process]

Irradiation of lymph nodes areas in breast cancer

2008-10-28T06:12:00.000-07:00

Irradiation of lymph nodes areas in breast cancer

Cancer Radiother. 2008 Oct 16

Hennequin C, Romestaing P, Maylin C.
Service de cancérologie-radiothérapie, hôpital Saint-Louis, 1, avenue Claude-Vellefeaux, 75010 Paris, France.

Postoperative radiotherapy after breast surgery increases overall survival by decreasing the local relapse rate. The main site of relapse is the breast or the chest wall. The value of irradiation of the nodal basins is still discussed. It must be emphasized that nodal areas were systematically irradiated in the postmastectomy randomized trials demonstrating a benefit in survival for adjuvant radiotherapy. Axillary relapses are infrequent in case of complete axillary dissection; complementary irradiation could be proposed if the axillary dissection is incomplete or if there is a massive pathologic involvement of the axilla.

Its main complication is lymphoedema, which remains the most frequent sequellae of the treatment of breast cancer. Supraclavicular irradiation is logical in case of axillary involvement. Internal mammary nodes are involved in 20 to 40% of the patients, depending of the axillary involvement and location of the tumor inside the breast. Irradiation of the internal mammary basin is difficult: optimal dosimetry required a CT-based simulation. Its benefit remains to be proved. Internal mammary nodes irradiation probably increased cardiovascular mortality. Sophisticated techniques are needed to spare the heart from irradiation. Two large randomized trials (French group, European Organization for Research and Treatment of Cancer [EORTC]) are currently evaluating the possible benefit of internal mammary irradiation.

PMID: 18951822 [PubMed - as supplied by publisher]

Treatment of upper limb lymphedema with combination of liposuction, myocutaneous flap transfer, and lymph-fascia grafting

2008-10-26T10:32:00.000-07:00

Treatment of upper limb lymphedema with combination of liposuction, myocutaneous flap transfer, and lymph-fascia grafting
Microsurgery. 2008 Oct 22

Qi F, Gu J, Shi Y, Yang Y.
Department of Plastic and Reconstructive Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.

Treatment of obstructive extremity lymphedema remains a challenge in reconstructive surgery, since none of the varieties of procedures have been demonstrated a reliable resolution for the lymphedema. In this report, we present the preliminary results of treatment of severe upper extremity lymphedema with combined liposuction, latissimus myocutaneous flap transfer, and lymph-fascia grafting in 11 patients. All patients had histories of radical mastectomy, irradiation therapy for breast cancer, and frequent onsets of erysipelas. Postoperative measurements in an average of 26 months follow up showed that significant decrease of circumferences of the arms on all levels at surgery side were achieved. The onsets of erysipelas were also reduced. There was no chronic lymphedema found in the donor leg after harvest of the lymph-fascia graft. The results suggest the strategy of liposuction, latissimus myocutaneous flap transfer, and lymph-fascia grafting may provide a useful method for treatment of the chronic upper extremity lymphedema with severe axillary scar contracture.

Wiley InterScience

Lymphedema and Pregnancy

2008-08-12T05:32:00.000-07:00

Lymphedema and Pregnancy
Introduction

For young women with lymphedema, especially primary lymphedema, the thought of having babies and what might happen is a scary topic with many many questions.

They want to know if their lymphedema will worsen as a result of pregnancy; if they have hereditary lymphedema, can they have a baby and can they pass it on to their children.

While lymphedema can increase your risk of some complications and while you may have to take extra steps to stay healthy, the good news is that you can have a baby, that most women who have lymphedema do not experience a worsening of their lymhpedema.

Will you pass primary lymphedema to your baby?

As you read the following posts, you will find that most have not passed it on. My own grandmother who had primary lymphedema had in children and only one of them had lymphedema. In fact, remember, I am just a layperson, but from my own observations and from the experience of so many many mothers who have lymphedema I absolutely challenge the statistic that if you have primary lymphedema you have a 50% chance of pasing it on. There is no evidence or clinical studies that I know of to substantiate that claim.

See also: Arm and Leg Swelling In a Baby

Here are some tips that I believe will greatly help during your pregnancy.

Tips for Pregnancy and Lymphedema

Diet

A good balance and nutritionl diet is an absolute must, whether or not you have lymphedema. It may be even more important for those with LE.

Internal Links

The Lymphedema Diet
Vitamins
Vitamin Glossary
Minerals, Amino Acids
Healthcastle
Nutritional Tips during Pregnancy

Exercise

It is a well established fact that exercise is necessary to be healthy. The same holds true for keeping in shape during pregnancy.

The idea is not to simply stop exercising because you are pregnant and have lymphedema, but rather to adjust the type of exercises you do. Take a look at our page on exercises for some good ideas and programs on low impact, less strenuous types of exercises.

Exercises for Lymphedema
Exercise in Pregnancy

Weight control

Because excess weight complicate lymphedema, you’ll want to do all you can to avoid gaining weight that would be out of the normal range for your pregnancy. With lymphedema, you can suddently gain weight simply from the fluid accumulation. Should you experience a sudden weight gain, be sure to let your doctor know.

Skin Care

While skin care is critical all the time for lymphedema, it becomes even more important during pregnancy to help avoid possible infections and to help your skin avoid any possible complications.

You’ll want to also continue your program of healthy skin care for lymphedema patients in general.

Lymphedema Skin Care
Safe skin care during pregnancy

Bandaging

Continue your daily bandaging routine. This also can be a great help in control any possible increased swelling.

Compression bandages for lymphedema
Short stretch bandages for lymphedema

Pneumatic Compression Pumps

Because of the documented possibilities of genital lymphedema,I oppose the use of these devices for leg lymphedema and feel even stronger about it during pregnancy.

Why Compression Pumps cause Complications with Lymphedema

Compression garments

There is no documented reason why you should not be able to continue wearing your compression garments, especially during the early phase of your pregnancy.
However, be sure to check with you doctor and your lymphedema therapist.

Obviously, this is going to be difficult, if not impossible during the later stages of your pregnancy,, so you may have to make adaptations.

An alternative to the full waist high garment would be a thigh high. This will help the legs.

Compression garments stockings for lymphedema

Self Massage

Self lymphatic massage can be a great help in continuing to manage your lymphedema and in helping keep the swelling down.

Manual Lymph Drainage

I urge you to continue this if you are already doing so and if you are not to seriously think about seeing a certified lymphedema therapist to designa treatment program in conjuntion with your pregnancy.

Interal Link

Manual Lymphatic Drainage

Rest

As your pregnancy progresses you will find that you tire more quickly Be kind to yourself and allow time for extra rest. This may also be necessary should you have a significant amount of increased swelling.

Possible Complications

To remain as healthy as possible you'll need to have an understanding of the possible complications of pregnancy and of lymphedema. Here are a couple pages of information that should help.

Complications of Lymphedema
Pregnancy Complications

Preeclampsia

Preclampsia, previously known as toxemia seems to be the biggest risk during pregnancy. Infact, it is estimate that as many as 14% of pregnancies involve preeclampsia. It can happen during the second half of pregnancy (20th week) or in the third trimester.

This condition is characterized by a sudden and/or rapid increase in swelling, blood pressure, increased protein in your urine. Other symptoms include upper abdominal pain, usually under the ribs on the right side, dizziness, changes in vision, including temporary loss of vision, blurred vision or light sensitivity, severe headaches, decreased urine output.

This also seems to be the number one problem experienced by those with lymphedema.

Preeclampsia Foundation
Pregnancy, Preeclampsia

Hypertension

Hypertension is one of the most common complications of pregnancy so you will want to familiarize yourself with this possible complication. It is estimate that hypertension complicates aproximately 3 - 5% of pregnancies.

Related high blood pressure disorders during pregnancy include:

Gestational hypertension.

Women with gestational hypertension have high blood pressure, but no excess protein in their urine. Some women with gestational hypertension eventually develop preeclampsia.

Chronic hypertension.

Chronic hypertension is high blood pressure that appears before 20 weeks of pregnancy or lasts more than 12 weeks after delivery. Often, chronic hypertension was present — but not detected — before pregnancy.

Preeclampsia superimposed on chronic hypertension. This term describes women who have chronic high blood pressure before pregnancy and then develop worsening high blood pressure and protein in the urine during pregnancy.

Having lymphedema, whether primary or secondary, does not automatically mean you are more susceptible to this condition.

American Pregnancy Association
Hypertension and Pregnancy

Gestational Diabetes

This is a type of diabetes that some women develop during pregnancy. Between 2 and 7 percent of expectant mothers develop this condition, making it one of the most common health problems of pregnancy.

Gestational Diabetes

Infections

Lymphedema patients are already at a greater risk of infectons due to the immunocompromised condition of the lymphedema leg, with pregnancy and the effects on the immune system you will want to keep an eye on this and familiarize yourself with possible infections, what to look for, how to prevent them and how to treat them.

See also:

Infections Associated with Lymphedema
Immune System and Pregnancy

Experience of Lymphedema People Members

Lazylefty
July 9, 2007

Hi ann. I'm 29 with a 2 yr old and have had secondary LE for 4 yrs now. My drs were concerned with clotting during pregnancy in my affected leg. I'm happy to say that my pregnancy went great with very little issues. I made sure to rest off of my feet as much as possible. I put a stool under my desk at work to keep my feet up. I also did my low impact exercises to help my leg circulation. the hardest part for me was once I was in the hospital I took my stocking off because of the over night stay and with all the fluid they were pumping in me it made the swelling worse in my leg. I couldn't get my stocking on the next day so lucky for me I was in bed all day and not on my feet anyway. I would suggest you wear your stockings, do your massage as often as you can and you'll most likely be fine! good luck!!
Stacy

Ann
July 10, 2007
I have two daughters and did not have any problems with my LE while pregnant. (I have primary in both legs). If you have primary LE you might want to have genetic counseling. My youngest daughter has developed LE i her legs (she's 17) and I had no idea when I was having children that my LE could be inherited. I can't imagine doing anything differently, though I wish that I could have spared her.
Stacy

Silkie
August 1, 2005
Hi ya Nikkid
I am sure if i had known i had lymph when i had my children i would have asked the same question.

I can tell you I did have lymph not diagnosed I gained weight hun my ankles swelled and feet got bigger, had a lot of what they said was fluid retention.

They were worried i had toximia because of my ankles (it was the lymph I didn’t know there was lymph at the time). I had good births and I worked hard with the “fluid as they called it and did reduce took a while couple of years never got back to my original size. I got pregnant again more or less the same type of pregnancy and I had my daughter third and last not a problem except for the weight and swelling, thank God non show signs of lymph but I was terrible conscious of their weight.

If i had known about the lymph I would still have had my children life is about living and loving the lymph and the difficulties we all face are secondary to living our lives

huggggggggg silks xxxxxxxxxxxxxxxxxxxxxx

Tamie
February 20, 2004

During my first pregnancy at 19 years old my hands started to swell. I saw a doctor who said the swelling wasn't that serious, but be sure to take a sit down job. I was working in retail at the time and often as a cashier which standing in one spot all day makes the condition worse!

When I had my 1st child at the age of 20 and was recovering from a c-section the doctors were concerned with my swollen leg that I might get a blood clot in it so I had to wear compression hose during my 2 week ordeal/recovery.
Tamie

Pregnancy and Lymphedema

Several months ago one of our readers asked whether pregnancy caused lymphedema to get worse. I reviewed the published literature and, as is too often the case, found very little published information. In addition, what information was available was based on very limited numbers of patients. To gain additional understanding about pregnancy and lymphedema, I created a pregnancy survey for our readers. 13 women have responded to that survey and I am including a summary of their responses and insights.

12 of the 13 women had primary lymphedema. The average age of onset was 10 years of age and the range was from 1 to 16 years of age. 1 patient had breast cancer and a mastectomy and developed lymphedema during her first pregnancy 9 years later.

Of the 12 patients with primary lymphedema, 9 of 12 (75%) had the onset of lymphedema or developed worse lymphedema during their pregnancy. Most of these women found that the lymphedema got worse in the final months of their pregnancy. 2 women reported having persistent lymphedema after delivery.

8 women reported second pregnancies and 5 of the 8 (63%) had worsening of their lymphedema and all reported that the lymphedema was worse with the second pregnancy. All 3 women who did not report worsening of their lymphedema had miscarriages that occurred between 3 and 5 months of gestation.

4 women reported having third pregnancies and 3 of the 4 had worsening lymphedema with the pregnancy and all reported that the lymphedema became progressively worse with each pregnancy. The remaining woman had a miscarriage.

One woman reported a 4th pregnancy and had worsening lymphedema with the 4th pregnancy but that the lymphedema got better after the delivery of her child.

The one respondent with secondary lymphedema commented that she had been free of lymphedema for 9 years after her mastectomy but developed lymphedema in her hand and forearm during her first pregnancy.

The only women not reporting worsening of their lymphedema during their second and subsequent pregnancies had miscarriages. Miscarriages occur in about 10% of pregnancies so it is notable that so many of the women responding to this survey reported miscarriages. Please keep in mind that a small number of women responded to this survey and any results represent the bias of any small sample. However, it is also possible that the incidence of miscarriages is higher than the expected in women with lymphedema. I will continue to report on additional findings of this survey as we get more information.

Many of the comments made by the women provided interesting insight into the problem of lymphedema during pregnancy so I have included a sample of these comments below.

Comments:

“I am currently in my eighth month of pregnancy and have doubled the size of my left leg. Prior to the pregnancy, I had not swelling in my right leg. Now in my eighth month of pregnancy, my right leg is swelling. I am hoping the swelling in my right leg will go away after the baby is born.”

“By 11-12 weeks of pregnancy, my leg was fuller and growing uncomfortable. I was able to continue working full time as a nurse until the 20th week of pregnancy. At that point my leg was heavy and uncomfortable. I was comfortable, however, if I was lying down. During the pregnancy, I gained over 60 lbs., I was very congested in my entire body. I remember having to put my left leg and foot under cold water to reduce the discomfort. I was unable to wear any shoes other than ballet slippers, and could only do minimal walking around the house. After my daughter was born, one to two weeks after her deliver, my leg returned to essentially a pre-pregnancy baseline. My leg improved as I took off the weight gain of fat that naturally occurs with pregnancy. ”

“I am currently at the last stage of my third pregnancy, and the swelling is once again more pronounced than in previous months. I tend to be lazier about the stockings this time, so my swelling could probably be better.”

“Thank you for posting this survey, I would have enjoyed having some preview of the effects of childbirth on lymphedema. Overall, pregnancy was a temporary setback, which is an important consideration. However, I was still uncertain enough not to attempt my good luck with a second pregnancy. Who knows what the outcome would be, especially after age 35. My personal experience with this condition has led me to believe that insect bites are far worse for my leg. If I get bites on my left leg, my leg gets worse, and doesn't want to return to baseline. It's as if I “loose ground” whenever this happens. The increase with pregnancy, although very substantial, was reversible. It seemed to me to be in indication of lymphatic system overload, rather than tissue scaring or damage. I did notice that as my weight returned to normal, my leg kept improving.”

Tony Reid MD Ph.D.

Acknowledgment
Peninsula Medical, Dr. Reid's Corner

Pregnancy and Lymphedema: Follow up

Last year I presented data on the relationship between pregnancy and lymphedema. Since that time more women have responded to the survey and I presented the update of that survey at the Lymphedema conference held in Dallas, Texas sponsored by Healthtronix.

This survey was prompted by several questions that were sent to me asking whether pregnancy worsens lymphedema. For example, a woman had primary lymphedema and was considering an abortion because she was very fearful of her lymphedema getting worse. She already had a bad case of lymphedema and felt that if it got much worse she would no be able to function. There was no published data to help answer these questions and so I posted a survey on our web site to help find some answers to this question.

First, I want to say that the results of the survey are limited by a number of factors. The number of women answering this survey, while growing, is still relatively small. In addition, this is not a random sample of all women with primary lymphedema who have had a pregnancy and effective treatment may change the outcome. This survey only documents the experience of the women who have responded. However, I appreciate the fact that these women have taken the time and effort to answer these questions and I hope that this project will continue to develop and provide additional information that is helpful to women facing this problem.

33 women responded to the survey. Of these, 26 had primary lymphedema and this survey will focus on those 26 responses. Most women with secondary lymphedema have it as a result of treatment for breast cancerbreast cancer. As a result, the majority of these women are past their child bearing years. In addition, the treatment, especially chemotherapy, generally causes infertility. So, most of the women who have lymphedema during their child bearing years have primary lymphedema. I will analyze the results of the women with secondary lymphedema separately. Since there are only a few responses, the data is still limited.

The average age of onset of lymphedema in this group of women with primary lymphedema was 10.7 years but the range of responses was very wide. Some women developed lymphedema at birth while others developed lymphedema in their late teens or twenties.

Of the 26 women with primary lymphedema who responded to this survey, 12 of 26 (46%) reported worsening of lymphedema with the first pregnancy. Of the 12 who had worsening of lymphedema during pregnancy, 7 reported that the lymphedema returned to baseline after delivery so that 5 of 26 (19%) reported persistent lymphedema after pregnancy. However, among the women who improved after delivery, 2 of these women subsequently had worsening of lymphedema within a year. As a result, 7 of 26 (27%) reported lymphedema that was worse following their first pregnancy. Here are several comments from these women.

“After delivery my leg went back to it's prior size before becoming pregnant. However, after 7 months my leg again became swollen and progressively got worse.”

“In my second trimester my ankles began to swell and the doctor assumed it was all normal. After the delivery of my child the swelling in my right leg / ankle went away but the swelling in my left leg continued.”

These results suggest that about half of the women with primary lymphedema experienced worsening of lymphedema during their pregnancy. Among the women who reported that their lymphedema worsened with pregnancy, about half of these women reported improvement after delivery of the baby. As a result about 27% (7/26), of the women with primary lymphedema experienced persistent worsening of the lymphedema with pregnancy.

Some of these women had additional pregnancies and I will present the analysis of the results in the subsequent edition of eNews.

Sincerely,
Tony Reid MD, Ph.D

Acknowledgment
Peninsula Medical, Dr. Reid's Corner

Questions on Pregnancy and Lymphedema
National Lymphedema Network

Should I wear a sleeve or bandage while pregnant?

Q. I had a lumpectomy and node dissection 8-1/2 years ago and developed LE within a year of my surgery. I am very diligent in my self-care, i.e., self-MLD, compression sleeve every day, bandaging every night, professional MLD once a year. One question that no one has been able to answer for me is how pregnancy affects LE. One doctor told me that I shouldn't wear a sleeve OR bandage during pregnancy, while MLD therapists tell me I shouldn't alter my routine at all. (FYI: I m not pregnant right now.) I d really like to understand what will happen: can the LE become worse, and how best to continue treatment during pregnancy? Thanks!

A. There is no documented scientific evidence anywhere stating that compression garments should not be worn during pregnancy, or that MLD is contraindicated during pregnancy. Of course, modifications in the abdominal breathing/abdominal clearance would be made during pregnancy. In fact, for lymphedema of the legs, it is essential to maintain compression during pregnancy, to avoid worsening of the swelling from abdominal pressure on the great veins.

There is an increase in total blood volume during pregnancy to support the fetus. This should not have a direct effect on the lymphedema in your upper extremity. My suggestion would be to continue to follow your usual lymphedema management program, including wearing your compression garments and bandaging at night if that has been your routine. I know that you are not pregnant now, but I hope that this information will allay your fears about your lymphedema worsening during pregnancy. You can safely continue to do your self-care program, perhaps with some modifications, if you do become pregnant.

Acknowledgment
National Lymphedema Network

Q: What is the percentage of children born with or who develop lymphedema when the mother has primary lymphedema?

A: Due to the inattention given lymphedema in the U.S., we do not have any concrete data identifying the number of people born with primary lymphedema. Here at the NLN, the number of calls we receive from young parents, concerned that their child will inherit the condition, is increasing. We do see, and talk to, a growing number of people who have multiple generations in their family affected by primary lymphedema, and some who have none at all. However, a number of my patients with primary lymphedema from both backgrounds have had very healthy, lymphedema-free babies who, so far, have not developed the condition. So, at this point, it's very difficult to say what the odds are. Marlys and Charles Witte, M.D.'s at the University of Arizona (Tel: 520-626-6118), are actively working with a number of families, trying to identify some genetic link and/or other correlations. Possible genetic links are also being studied in the Department of Human Genetics at the University of Pittsburgh, PA. For more info about the study, contact Kara Levinson, MS, at: 412-624-4657. Or visit their website at University of Pittsburg - lymphedema. This research data will greatly enhance our ability to forecast a child's susceptibility. If you do have a child with lymphedema: there is a new organization called “PLAN” (Primary Lymphedema Action Network), which focuses on families with young infants born with primary lymphedema.

Q: Are there concerns of permanent deterioration or worsening of a mother's condition if she has primary lymphedema and becomes pregnant (such as spreading to the other leg, additional risk of infection, etc.)?

A: It really depends on the overall condition of the mom. If she is healthy without any other medical problems, there should not be a problem. But it is very important that couples prepare themselves and realize the tremendous re-sponsibility. You'll need to increase your daily care, such as manual lymphatic drainage twice a day, wearing well fitted maternity panty hose (45-55 mm/hg) or, as some women do, wear an additional stocking to add compression. Avoid sodium and drink lots of fluids (water, tea, natural juices, etc). In regard to spreading to another limb - and if you are concerned, I would suggest doing a lymphoscintigraphy (contact the Witte's; see answer to question above) - a very sophisticated diagnostic tool used to visualize the lymphatics - prior to your pregnancy. Also, if you have a history of recurrent onset of lymphangitis in your leg, you will be at greater risk of recurrent infection during pregnancy as a result of increased weight/swelling and protein in the tissue. If severe enough, an infection could cause a miscarriage, so you will want to watch closely for signs and symptoms. The best advice: use common sense and practice meticulous self-care. If you are well, there is no reason that you cannot have a healthy, happy baby.

Q: What are the possible complications from a C-section vs. vaginal delivery and its relation to lymphedema?

A: Both procedures have their concerns. Any time an invasive procedure is performed on a patient with lymphedema, you want to be careful. Especially the woman who has swelling in the pelvic area and lower abdomen needs to make sure to take antibiotics just before, during and after the C-section. Vaginal delivery always has risk factors as well, especially for a woman who is in labor for many hours: usually there is more swelling in the pelvic region and leg(s) from pushing. But once the baby is born, swelling usually subsides in a matter of days.

Q: Is it safe to undergo Manual Lymphatic Drainage during pregnancy?

A: Not only is it safe, but it's extremely important to continue therapy. Your goal is to keep the leg(s) in its optimum condition. Do not forget to use lotion to keep the skin soft and supple. See a podiatrist educated in lymphedema just to make sure that you do not have any possible risk factors such as fungi, Athletes foot, callouses, etc., which could lead into infection. VERY IMPORTANT: Be sure to wear well-fitted high compression maternity stockings.

Additional tips for pregnancy: Educate your GYN and other involved doctors about lymphedema. Get plenty of rest, avoid stress when you can, follow the 18 STEPS TO PREVENTION, and if possible, shoot for winter time for your last trimester, when it's cool. Happy Pregnancy!

National Lymphedema Network

Primary lymphedema and pregnancy

Brunner U, Lachat M.
Departement Chirurgie, Hopital Universitaire, Zurich.

From a retrospective analysis of 15 female patients, it appears that primary lymphedema, reversible at first, tends to become irreversible during successive pregnancies. A remission takes place following the first and second pregnancy, and during a third pregnancy, an irreversible stage is reached.

PMID: 2626470 [PubMed - indexed for MEDLINE]

Suggestions for lymphedema and pregnancy

I was always taught that pregnancy was an indication FOR Manual Lymphatic Drainage and that is was great to have it during pregnancy, provided there were no other contra-indications present (or complications to be considered). As you are having it regularly anyway, it should not be a 'shock to the system'.

Some practitioners might choose to avoid the first tri-mester (but this is more to do with avoiding being associated should anything go amiss in the most vulnerable first three months, I think - although, of course, some people don't actually know they are pregnant until well into the three months anyway).

Hosiery - no reason not to wear it

In fact, anything that you can do (safely) - eg., wearing hosiery and having MLD during pregnancy that will help to keep oedema down has to be a good thing. The body naturally tends to retain fluid during pregnancy - many women experience swollen ankles, carpal tunnel syndrome etc as a natural complication of the extra fluid carried. It will likely make any lymphoedema a little more troublesome, so keeping hosiery on and staying with MLD could help to keep the balance.

If you are able, walking in water would be excellent as it is good for lymphoedema anyway and exercising in water while pregnant is fantastic. The water needs to be about the height of your boobs - don't overdo it, stop before your muscles get fatigued and wear some old, worn out compression hosiery while in the pool for an even greater effect.

The action of walking activates the calf muscles and the lymphatic system of the legs, the induced deeper breathing encourages lymphatic return and the water acts like an all over MLD massage, supporting the skin. You may find that you need to leave the pool to wee quite often!

It is important though, to stop before your muscles get tired. This avoids bringing too much extra circulation to the legs as that could lead to more oedema.

Your regular MLD practitioner would be the person to talk to - would they be happy?

From ULKymph Discussion Board - Author is Anne - who not only has lymphedema but is a Vodder Therapist as well ……..

Another members experience: I have had the L/O symptoms in both my lower legs since I was 12 years old although I think I was born with it.

Five years ago I had my beautiful daughter Ellie and although it was uncomfortable during the last few months as I was carrying extra weight my legs did not really suffer.

I am lucky in that my L/O is pretty mild compared to some sufferers, but I just made sure that at the end of the day (I was commuting to London for work) and whenever they started to ache, I would put my feet up and rest. I also made sure I wore my support stockings (Jobst I find are the best) all the time even during the summer when it was warm.

I dont know whether I have passed the gene onto her and I hope to God that I havent. I just try not to think about it but I would not be without her for the world.

I do notice that my legs do swell up more quickly than say they did 10 years ago but I dont believe that has anything to do with me being a mum and so long as you look after yourself and let your husband/partner spoil you rotten during those 9 months I am sure you will be fine.

Its worth talking to your doctor/specialist though to get a qualified opinion.

Lymphoedema and Pregnancy

By Professor Peter Mortimer, LSN Chief Medical Advisor and Dr Sahar Mansour, Consultant Clinical Geneticist, St. George's Hospital, London

Changes in a Normal Pregnancy

The cardiovascular system undergoes considerable changes during pregnancy with an increase in blood output from the heart by at least 50%. Blood vessels generally enlarge creating a relatively 'under filled' circulation and so to compensate, the kidneys try and conserve salt and water. This leads to fluid retention amounting to some 6-8 litres in the body. The dilution of the plasma proteins encourages fluid to leak from the blood vessels into the tissues. A fall in the threshold of the hormone that encourages a fluid diuresis maintains a fluid retention state. By the end of the pregnancy, 80% of healthy women will have some degree of oedema.
Very little is known about what happens to the lymphatic system during pregnancy. If blood vessels enlarge, i.e. relax, then by implication, lymphatic vessels are likely to do the same, in which case they will not be as efficient at draining fluid. Normally there is sufficient reserve in lymphatic transport so that any increases in tissue fluid will be compensated for by increases in lymph drainage. If the lymph drainage is already working close to capacity because of a genetic or constitutional weakness in the lymphatic system (but not so severe as to have produced lymphoedema before), then the extra demands of pregnancy may be all that is needed to manifest swelling for the first time.

Other factors that potentially increase the risk of oedema during pregnancy are weight gain and a reduction in exercise levels.While fluid retention will increase weight, so will obesity. Lean women who eat to appetite gain as much as 1kg in the first 10 weeks and women with a tendency to obesity will gain much more. Such weight gain will probably have an adverse effect on lymph drainage, particularly in the legs. It is difficult to maintain exercise levels during pregnancy because of tiredness and the awkwardness the pregnancy brings to walking. Exercise is, of course, crucial for good lymph drainage in the legs.

Like other blood vessels, the veins in the leg tend to enlarge during pregnancy. Varicose veins often develop, which will result in a further filtration of fluid from the blood into the tissues of the leg and so make oedema worse.

Pre-eclampsia

Pre-eclampsia (used to be called toxaemia of pregnancy) is specific to pregnancy and manifests with hypertension (raised blood pressure), a leak of protein by the kidney, and oedema. The cause is not known, but the syndrome of pre-eclampsia usually develops from the mid-point in the pregnancy (20 weeks onwards), and resolves completely after delivery. Generalised oedema is an inconsistent feature. It may develop suddenly and is associated with accelerated weight gain (due to fluid retention). Although the ankles and feet will be the commonest site for the swelling due to the effects of gravity, oedema can occur anywhere in the body including the chest and the abdomen (ascites is free fluid in the abdominal cavity). The generalised nature of the oedema would suggest that the fault lies with the blood vessels leaking more fluid into the tissues rather than any failure of the lymphatic system, but nobody knows. As mentioned earlier, any such increase in tissue fluid will inevitably demand more of the lymphatic vessels to drain the fluid and any failure to do so will increase the oedema further.

Diuretics are best avoided in pregnancy because they result in an even greater 'under fill' of the blood circulation. Drugs called 'calcium channel blocking agents' are recommended for the raised blood pressure, but do tend to interfere with the working of lymphatic vessels and may increase ankle oedema.

Lymphoedema in Pregnancy

A major concern of any young female patient with lymphoedema is “What will happen to my lymphoedema if I become pregnant?” The answer is that it is likely to get worse because of the fluid retention, but it should be manageable and fully recover once the baby is born. The extra bodily fluid retained during the pregnancy will include the part of the body affected by the lymphoedema; so extra effort will be required to ensure that this extra fluid is drained by the local lymphatic system that is already failing. So if a leg is affected by lymphoedema, for example, then extra measures to control the swelling may be necessary. These measures may include longer periods of rest with the leg elevated, manual lymphatic drainage, or an additional compression garment. Not every woman with lymphoedema suffers any exacerbation of swelling during pregnancy. In many, the lymphoedema remains unaffected, and so what is described here is the worst case scenario.

There is no reason to believe pregnancy harms the lymphatic system, and so a full recovery would be expected following delivery. Nevertheless, as with returning to one's original weight and bodily shape, recovery of the lymphoedematous limb may take a bit of time and effort. Increasing levels of exercise and dieting may be necessary.

Genetics, Lymphoedema and Pregnancy

Primary lymphoedema is due to an underlying abnormality in the lymphatics. Although the swelling may not be present until later in life, the abnormality is probably present at birth. It is now recognised that there are some causes of primary lymphoedema that are inherited.

Therefore a woman (or man) with primary lymphoedema may have a child with the same condition.

Family History

The best indicator that there is a genetic cause of lymphoedema is the presence of other affected individuals in the family. The commonest way that primary lymphoedema is inherited is from parent to child. This mode of inheritance is called autosomal dominant inheritance. There are two copies of most genes. An autosomal dominant condition is due to an alteration, or 'spelling mistake', in one of the copies. The baby can inherit either the affected gene or the unaffected gene, so the risk to the offspring of inheriting an autosomal dominant condition is 1 in 2, or 50%. Some of the genetic causes of primary lymphoedema are well recognised and are described in more detail below.

Milroy's Disease

Milroy first described a large family with lymphoedema presenting at birth in 1892. It was clear from the family history that this condition was autosomal dominant, and therefore being transmitted from parent to child.Milroy's disease presents predominantly at birth with swelling of the lower limbs, usually the feet. The swelling can increase, or improve, or remain stable. Boys sometimes have extra fluid in the scrotum, but this rarely causes any problems. Milroy's disease is not usually associated with any other abnormalities.Most of the carriers of this condition have some swelling of the lower limbs, but it is recognised that some carriers of the condition are not affected, but may have affected offspring. The lymphoedema in Milroy's disease is due to a lack of lymphatic channels in the lower limbs (hypoplasia or aplasia). The gene for this condition, Vascular Endothelial Growth Factor Receptor 3 (VEGFR3) was identified only recently. This gene is important in the development of the lymphatics of the baby.

Lymphoedema-Distichiasis Syndrome

This condition is another autosomal dominant cause of primary lymphoedema. However, the lymphoedema usually presents in late childhood or puberty. The age of onset and severity of the swelling varies even within families. The swelling is usually associated with the presence of extra eyelashes on the inner side of the eyelids.

Although the swelling presents later, it is still due to an underlying abnormality of the lymphatic channels. Lymph scans in affected individuals have shown that there are a normal or excess number of lymphatic channels with delayed uptake of lymph in the inguinal lymph nodes, suggesting an abnormality in the function of the lymphatic channels. The mechanism is still unknown. This condition is sometimes associated with other congenital abnormalities. About one third of affected individuals have drooping of the eyelid (ptosis) which occasionally requires surgical correction. There is a slightly increased risk of heart disease at birth (8%). This is not usually severe, but may require surgical repair. A few affected individuals also have a cleft palate (3%).

The gene for this condition has been identified; it is a very small gene called FOXC2. It clearly has a role in the development of the lymphatics and eye, but very little is understood about its function.

Risk of Inheriting Lymphoedema

The risk of inheriting lymphoedema for those types where the gene is known and in which a family history exists, is approximately 50%, i.e. 1 in every 2 births. There are, of course, many other causes of primary lymphoedema.Many of these may be genetic but not inherited. Often the underlying cause is not known. The baby is at an increased risk of inheriting the lymphoedema if any of the following are present:

1. If one parent is affected and has a family history of lymphoedema
2. If the affected parent has distichiasis (extra eyelashes)
3. If the lymphoedema is symmetrical and bilateral.

The baby is at low risk of inheriting lymphoedema if:

1. The affected parent has no family history of lymphoedema
2. There is no distichiasis
3. The swelling is unilateral (including lower limbs)
4. The swelling is not in the lower limbs.

Even if a baby inherits the gene for lymphoedema, it does not mean to say he or she will be as severely affected as the parent. Indeed, the lymphoedema may be very mild despite a severely affected parent.

How Can You Tell If the Baby is Affected

Ultrasound examinations performed during the pregnancy may pick up oedema in a foot or around the back of the neck, both signs that the child may be affected. In the majority of cases, no abnormalities will be observed, and it may only be after birth or sometime later in life that the lymphoedema becomes obvious. In the future it may be possible to test the baby for the offending gene during the pregnancy, but this is not possible at present.

Prevention of Lymphoedema

In the years to come, we hope it will be possible to correct the faulty gene before the baby is born so that the lymphoedema can be reversed. This has been achieved in animals, but not yet in humans. Insertion of the normal gene instead of the faulty one is called gene therapy. It may be possible to do this in adults already affected by lymphoedema. There is hope!

Lipoedema and Pregnancy

Pregnancy may trigger or exacerbate lipedema and worsen the lymphoedema component of lipoedema.

Lipoedema is a condition that results in swelling of the hips, thighs or legs in females. Fluid does contribute to the swelling, but the main component is fat, but in a way different from obesity. In addition to swelling, which gives rise to a 'bottom heavy' or 'chunky, shapeless legs' appearance, symptoms of tissue tenderness and easy bruising are commonplace. Lipoedema tends to develop or deteriorate at times of hormonal change, e.g. puberty, pregnancy and menopause. The condition may not be apparent during the pregnancy because of all the other changes that take place. Following the pregnancy, however, weight loss may prove difficult from the lower half of the body (bottom, thighs and legs). Dieting tends to result in fat loss from face, neck and chest, but not the legs. Treatment is difficult, but a vigorous exercise regimen and healthy eating are recommended. The fluid component of lipoedema appears to be related to poor lymph drainage from the areas of fat deposition. As the fluid increases, so more noticeable oedema develops, particularly in the feet. This is called lipoedemalymphoedema syndrome (lipolymphoedema). Pregnancy may therefore trigger or exacerbate lipoedema.

Conclusions

In summary, in female patients with lymphoedema, pregnancy may create additional concerns with regard to adverse effects on the swelling and the fear of passing on the condition to any offspring. In most cases these concerns are unfounded. Any increase in swelling can usually be managed satisfactorily with the help of a lymphoedema therapist, with a full return to normal once the baby is born. In many individuals the lymphoedema will not change. In the event of a child inheriting lymphoedema, it does not follow that their condition will be the same or worse than that of the parent. The recent upsurge in our knowledge of the genes and proteins involved in lymphatic growth

Lymphedema Association of Australia

Be well - Be Safe - Enjoy that Baby

Arm swelling after breast cancer surgery common

2008-08-08T02:14:00.000-07:00

Arm swelling after breast cancer surgery common

Thu Aug 7, 2008 11:58am EDT

By Megan Rauscher

NEW YORK (Reuters Health) - Following surgery for breast cancer, many women will experience arm swelling - a bothersome condition doctors refer to as lymphedema.

Lymphedema is a public health issue "deserving greater attention," doctors from Australia wrote in a recently published paper.

Among 287 women with breast cancer, 190 took part in all assessments during 18 months of follow-up after surgery and arm swelling developed in 62 (33 percent) of them during that time, Dr. Sandra C. Hayes and colleagues from Queensland University of Technology in Kelvin Grove found.
Roughly 60 percent of these women had fleeting symptoms, whereby the lymphedema dissipated with or without treatment. However, 40 percent of women experienced long-term arm swelling lasting more than 3 months, with or without intermittent periods of relief.

Women with lymphedema, Hayes told Reuters Health, "were twice as likely to have poorer upper-body function when compared with women who had not developed arm swelling. Poor upper body function is associated with reduced quality of life," she noted.

More extensive breast surgery increased the odds of lymphedema six-fold and having more than 20 cancerous lymph nodes removed increased odds four-fold.

Hayes noted that two identified risk factors for arm swelling post-surgery -- insufficient physical activity and not using the affected arm -- "are amenable to interventions and should be investigated for their preventive and therapeutic effects among women after treatment for breast cancer."

"It was found that use of the treated side likely decreases risk of developing lymphedema," Hayes said.

SOURCE: Journal of Clinical Oncology, July 20, 2008.

11th Annual Georgia Lymphedema Education & Awareness Program

2008-08-04T01:53:00.000-07:00

11th Annual Georgia Lymphedema Education & Awareness Program

An educational and awareness conference for patients, caregivers and professionals!

at: Piedmont Hospital

Richard H. Rich Auditorium

1968 Peachtree Road, NW, Building 77

Atlanta, Georgia

Saturday, October 18, 2008

7:30 am - 5:30 pm

Program includes:

What to expect of tissue after radiation? What is the physiology response of radiation? What does radiation do to the lymph nodes? - Peter Rossi, MD

How does vascular flow affect the lymphatics? - Ken Harper, MD

Expectations of surgery. - Christopher Hart, MD, FACS

The Lymphatic System, Wound Care, Infections and Treatment - Paula Stewart, MD

Parent Networking

Aquatic Exercises

The Connection of obesity and increased swelling in people with lymphedema and lipedema and more.

Additional information and registration form: Registration Form

Lighthouse Lymphedema Network

See you there

Toe bandaging for lymphedema and venous ulceration.

2008-08-04T01:49:00.000-07:00

Toe bandaging for lymphoedema and venous ulceration.
Br J Nurs. 2008 Apr 10-23

McCann M.
St Georges Hospital, London.

Lymphoedema and chronic venous insufficiency with venous leg ulceration have long been viewed as distinctly separate entities. This article explores how toe bandaging, a skill used routinely in lymphoedema practice, might benefit people being bandaged to treat venous leg ulcers. A small research study identified that 12 out of 124 people receiving high compression bandaging for venous leg ulcers without toe bandaging developed toe ulceration during a 2-year period. A second study has found no episodes of toe ulceration in patients receiving toe bandaging as part of their care. Unfortunately, there was significant heterogeneity between the two trials in terms of the client group, duration of bandaging and bandaging techniques, meaning that firm conclusions could not be extrapolated. A brief discussion of the pathophysiology and bandaging techniques used for lymphoedema and venous leg ulcers is used in this article to try and explore the rationale behind whether to bandage the toes or not, and to try and help practitioners decide whether toe bandaging should become part of all compression bandaging regimens.

PMID: 18642684 [PubMed - in process]

Advocates for Lymphedema

2008-07-17T03:10:00.000-07:00

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Join us as we work for lymphedema patients everywhere:

Advocates for Lymphedema

Dedicated to be an advocacy group for lymphedema patients. Working towards education, legal reform, changing insurance practices, promoting research, reaching for a cure.

ADVOCATES FOR LYMPHEDEMA home page

To subscribe:

AdvocatesforLymphedema-subscribe@yahoogroups.com

Join us today to learn about, for daily discussions and for advocacy on behalf of lymphedema.

Pat O'Connor

Lymphedema People / Advocates for Lymphedema

======================================

Cystic lymphangioma: An unusual cause of lower limb lymphedema.]

2008-07-13T03:12:00.000-07:00

Cystic lymphangioma: An unusual cause of lower limb lymphedema.

J Mal Vasc. 2008 Jul 3

Hadj-Henni A, Ladan-Marcus V, Javerliat I, Bouhzam N, Fouilhe L, Marcus C, Long A.
Unité de médecine vasculaire, hôpital Robert-Debré, CHU de Reims, rue du Professeur-Kochman, 51100 Reims, France.

We report an unusual cause of unilateral lymphedema of the right limb rapidly increasing in a young woman. Ultrasonography ruled out the diagnosis of iliac deep venous thrombosis or extrinsic compression: the B mode scan revealed a mass located below the aortic bifurcation and along the iliac vessels, without any compressive effect. The lesion was heterogeneous associating both tissular and cystic aspects. The lower limb lymphoscintigraphy showed an interruption of the colloid circulation at the right iliac level. Computed tomography did not give any additional information. Magnetic resonance imaging before then after gadolinium showed typical aspects of cystic lymphangioma and confirmed the ultrasonography hypothesis. Considering that this tumor is benign, that surgery would be difficult because of the anatomic situation of the mass, and that post-operative involution of the edema is uncertain, the treatment was based on compressive stockings and regular follow up.

EM/Consulte

Relationship between lymphoscintigraphy and clinical findings in lower limb lymphedema (LO): toward a comprehensive staging.

2008-06-29T06:35:00.000-07:00

Relationship between lymphoscintigraphy and clinical findings in lower limb lymphedema (LO): toward a comprehensive staging.
Lymphology. 2008 Mar

Pecking AP, Albérini JL, Wartski M, Edeline V, Cluzan RV.
Department of Nuclear Medicine, Centre René Huguenin, Saint-Cloud, France. pecking_ap@yahoo.com

Although radionuclide lymphoscintigraphy (RNL) is widely used diagnostically for patients with lymphedema (LE), it has not been utilized for LE staging, which is still based upon clinical findings. The aim of this work is to establish whether the results of both conventional RNL and fusion imaging obtained from hybrid detectors may be used for a comprehensive clinicoimaging staging in LE. Radiolabeled nanocolloids (0.2 ml) were subcutaneously injected in 4,328 patients (23-78 years) with clinical lower limb LE and without venous disease. Patients were classified according to the ISL classification and had a minimal follow-up of 2 years. Images were taken 60 minutes after the injection as a whole body scanning and fusion images of functional SPET and anatomical CT. Clinical and RNL results were not in accordance, and a specific RNL staging was established. The association of clinical and functional staging yields a new method to grade LE patients, and this staging correlated with treatment efficacy. RNL is an important tool in lymphology, and its association with the clinical evaluation offers a new grading system which may be able to delineate patients with good prognosis, patients at risk for a complex decongestive physiotherapy (CDP) failure, and patients who may benefit from other therapeutic protocols.

PubMed

Candidate gene analysis in primary lymphedema

2008-06-27T02:41:00.000-07:00

Candidate gene analysis in primary lymphedema
Lymphat Res Biol. 2008

Ferrell RE, Kimak MA, Lawrence EC, Finegold DN.
University of Pittsburgh, Department of Human Genetics, Pittsburgh, Pennsylvania.

Abstract Background: Primary lymphedema, the accumulation of protein-rich fluid in the interstitial space, is the clinical manifestation of mutations involved in lymphatic development and function. Mutations in three genes, VEGFR3, FOXC2, and SOX18, cause primary lymphedema. However, mutations in these three genes only account for a fraction of primary lymphedema. To identify other genes mutated in primary lymphedema, we resequenced twenty-five biologically plausible candidate genes for lymphedema in a large collection of primary lymphedema families.

Methods and Results: Candidate genes were selected on the basis of gene expression in lymphatic endothelial cells, differential antigenic expression in lymphatics, and mouse studies of lymphatic development. The gene sequence was downloaded from GenBank and sequence primers designed to amplify 1 Kb of the 5' sequence, exons and flanking intron-exon boundaries, and 500 bp of the UTR of each gene. No common causative mutations were observed among the 25 genes screened.

Single mutations were observed in elastin microfibril interfacer (EMILIN1), lymphocyte cytosolic protein 2 (LCP2), fatty acid binding protein 4 (FABP4), protein tyrosine kinase SYK (SYK), neuropilin-2 (NRP2), SpSRY-box 17 (SOX17), vascular cell adhesion molecule 1 (VCAM1), ROR orphan receptor C (RORC), and vascular endothelial growth factor B (VEGFB). Among these, the mutations in EMILIN1, RORC, LCP2, SYK, and VEGFB failed to segregate with lymphedema. The mutations in FABP4 (2), NRP2, SOX17, and VACM1 are consistent with being causative mutations, but occur in families too small to convincingly confirm cosegregation of mutation and phenotype.

Conclusion: We excluded mutation in 21 biological candidate genes as a common cause of primary lymphedema. Mutations in FABP4, NRP2, SOX17 and VCAM1 are consistent with causality and follow up of these four genes are warranted. The evidence for FABP4 harboring lymphedema mutations is discussed.

Mary Ann Liebert

HGF and MET Mutations in Primary and Secondary Lymphedema.

2008-06-27T02:36:00.000-07:00

HGF and MET Mutations in Primary and Secondary Lymphedema.

Lymphat Res Biol. 2008

inegold DN, Schacht V, Kimak MA, Lawrence EC, Foeldi E, Karlsson JM, Baty CJ, Ferrell RE.
Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania., Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania., DNF, CJB, and REF contributed equally to this work.

Abstract 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 hepatocyte growth factor receptor (HGF/MET) were new candidate lymphedema genes.

Methods and Results: The coding exons and flanking regions of HGF and MET were directly sequenced in 145 lymphedema probands, 59 unrelated women with secondary lymphedema following treatment for breast cancer, 21 individual patients with lymphedema and intestinal lymphangiectasia, and at least 159 unrelated ethnic matched control individuals. Mutations leading to truncation or missense changes in evolutionarily conserved residues of HGF and MET were identified. These mutations were not polymorphic in control individuals.

Conclusions:The identification of HGF/MET mutations in primary lymphedema, lymphedema/lymphangiectasia, and breast cancer-associated secondary lymphedema suggests that the HGF/MET pathway is causal or alters susceptibility for a broad range of lymphedema phenotypes. The HGF/MET pathway provides a new target for the prevention and/or treatment of lymphedema.

Mary Ann Liebert

Estimating the population burden of lymphedema

2008-06-10T06:44:00.000-07:00

Estimating the population burden of lymphedema

Ann N Y Acad Sci. 2008 May

Rockson SG, Rivera KK.
Stanford Center for Lymphatic and Venous Disorders, Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305. srockson@cvmed.stanford.edu.

Lymphedema is a complex, regional edematous state that ensues when lymph transport is insufficient to maintain tissue homeostasis. The disorder is remarkably prevalent, but the population implications of lymphatic dysfunction are not well-studied. Prevalence estimates for lymphedema are relatively high, yet its prevalence is likely underestimated. The ability to estimate the burden of disease poses profound implications for current and future lymphedema patients, but the challenge to correctly surmise the incidence and prevalence of lymphedema is complex and the relevant medical literature is scanty. In the absence of the highly desired, prospectively designed and rigorously performed relevant epidemiologic studies, it is instructive to look at the existing studies of lymphedema disease burden. In the current review, the extant literature is examined in the context of the disease setting in which tissue edema is encountered. Incidence or prevalence estimates are provided or inferred, and, where feasible, the size of the subject population is also identified. It is extremely attractive to contemplate that future approaches will entail formal, prospectively designed studies to objectively quantitate incidence and prevalence statistics for individual categories, as well as for the global lymphedema population prevalence.

Annals of the New York Academy of Sciences

Complications after polymethylmethacrylate injections: report of 32 cases - lymphedema

2008-05-14T03:40:00.000-07:00

Complications after polymethylmethacrylate injections: report of 32 cases - lymphedema

Plast Reconstr Surg. 2008 May

Salles AG, Lotierzo PH, Gemperli R, Besteiro JM, Ishida LC, Gimenez RP, Menezes J, Ferreira MC.

Division of Plastic Surgery, Faculty of Medicine, University of São Paulo, Brazil. agsalles@uol.com.br

BACKGROUND: During the past 15 years, polymethylmethacrylate has been used as a synthetic permanent filler for soft-tissue augmentation.

METHODS: This article reports 32 cases of complications seen at Hospital das Clínicas, Faculty of Medicine, University of São Paulo, for procedures performed elsewhere.

RESULTS: The average age of the patients was 43.6 years (range, 22 to 70 years). Twenty-five patients were women. Sixteen injection procedures were performed by certified plastic surgeons, nine by dermatologists, two by urologists, and one by a nonphysician. Complications were classified into five groups according to main presentation as follows: tissue necrosis (five cases), an acute complication that can be related to technical mistakes but that can also be dependent on patient factors or caused by local infection; granuloma (10 cases), which usually presents as a subacute complication 6 to 12 months after the procedure; chronic inflammatory reactions (10 cases), which usually occur years later and can be related to a triggering event, such as another operation or infection in the area that was injected (these reactions are immunogenic in origin and may have cyclic periods of activation and remission); chronic inflammatory reaction in the lips (six cases), which may be present with severe symptoms, especially with lymphedema, because of mobility of the lip; and infections (one case), which are rare but possible complications after filling procedures.

CONCLUSIONS: Polymethylmethacrylate filler complications, despite being rare, are often permanent and difficult or even impossible to treat. Safety guidelines should be observed when considering use of polymethylmethacrylate for augmentation.

Plastic and Reconstructive Surgery

Intravascular B-cell lymphoma with febrile inflammatory lymphedema of the lower limbs and lower back

2008-04-22T06:07:00.000-07:00

Intravascular B-cell lymphoma with febrile inflammatory lymphedema of the lower limbs and lower back

Ann Dermatol Venereol. 2008 AprPallure V, Dandurand M, Stoebner PE, Habib F, Colonna G, Meunier L.Service de dermatologie, groupe hospitalo-universitaire Carémeau, ruedu Professeur-Robert-Debré, 30900 Nîmes, France.

BACKGROUND: Intravascular lymphomas are diffuse large-cell lymphomas belonging to a group of high-grade non-Hodgkin's lymphomas and are generally of phenotype B. They are rare and carry a severe prognosis.Clinical polymorphism is dominated by neurological and cutaneous involvement.

PATIENTS AND METHODS: We report the case of an 80-year-old woman with cutaneous intravascular B-cell lymphoma as revealed by an isolated episode of febrile bilateral inflammatory lymphedema. Following combined chemotherapy with rituximab and mini-CHOP (cyclophosphamide,adriamycin, oncovin and prednisone), complete remission was obtained rapidly, with no relapse at two years.

DISCUSSION: Diagnosis of these tumours is rendered difficult by theclinical polymorphism and multifocal nature of lymphocytic proliferations. In the present case, diagnosis was based on histology results since presentation of the disease in the form of bilateral inflammatory edema of the lower limbs is not sufficient to establish lymphoma. Combined rituximab and polychemotherapy comprising a CHOP regimen appears to yield the best results.

Elsevier/Science Direct

Disseminated cutaneous leishmaniasis secondary to lymphedema: Two cases

2008-03-20T17:20:00.000-07:00

Disseminated cutaneous leishmaniasis secondary to lymphoedema: Two cases
Ann Dermatol Venereol. 2008 Feb

Meziou TJ, Chaabène H, Masmoudi A, Boudaya S, Cheikhrouhou H, Bouassida S, Turki H.
Service de dermatologie, EPS Hédi Chaker, Sfax 3029, Tunisie.

BACKGROUND: Dissemination of cutaneous leishmaniasis may take various forms: satellite papules, sporotrichoid nodules and widespread papulonodular lesions (disseminated cutaneous leishmaniasis). We describe a particular clinical form of dissemination in two patients with erysipelas secondary to lymphoedema.

PATIENTS AND METHODS: Case 1. A 75-year-old man with diabetes consulted for erysipelas of the leg secondary to lymphoedema. The site of entry was an infected cutaneous leishmaniasis lesion. The initial outcome was favourable under intravenous penicillin G treatment. Twelve days later, some fifty papulonodular lesions appeared and were strictly limited to the erythematous erysipelas plaque. PCR screening of papulonodular lesion smears for Leishman bodies was positive. Histological examination of skin biopsy samples showed lobular panniculitis. Case 2. A 64-year-old woman with diabetes presented erysipelas in the right upper limb secondary to lymphoedema scattered with multiple erythematous, infiltrated, papular lesions in a setting of cutaneous leishmaniasis lesions. PCR analysis of smears taken from the secondary nodular lesions demonstrated the presence of leishmaniasis, while histological analysis of biopsy samples revealed panniculitis.

DISCUSSION: Disseminated cutaneous leishmaniasis is characterized by the appearance of multiple (>10) pleomorphic lesions on two or more noncontiguous areas of the body. Our two patients presented certain features of disseminated cutaneous leishmaniasis. However, they were unusual in terms of the strict localisation of nodular lesions to the erysipelas plaque. This particular aspect suggests haemolymphatic dissemination of the protozoan infection from the initial lesion as a result of local factors.

Elsevier

Lymphedema Seminar Boca Raton Florida

2008-03-20T17:16:00.000-07:00

Lymphedema Seminar Boca Raton Florida

For our friends in south Florida:

Living Well with Lymphedema

10 a.m. to 1 p.m. April 12

Ruth Rales Jewish Family Service will host the event at the Jerusalem Room of the Jewish Community Center 9801 Donna Klein Blvd. Boca Raton, FL.

Seminar will feature Dr. Harvey Mayrovitz, professor, and Susan Lanham, a physical therapist at Boca Raton Community Hospital.

Call (561) 852-3330 to register.

For more information, visit Ruth Rales Jewish Family Service Center

One-sided limb lymphedema in a liver transplant recipient receiving sirolimus

2008-03-14T05:55:00.000-07:00

One-sided limb lymphedema in a liver transplant recipient receiving sirolimus
Acta Gastroenterol Belg. 2007 Oct-Dec
van Onna M, Geerts A, Van Vlierberghe H, Berrevoet F, de Hemptinne B, Troisi R, Colle I.
Department of Gastroenterology and Hepatology, Ghent University Hospital, Belgium.

Sirolimus (SRL) is associated with many side effects including hypercholesterolemia, anaemia, impaired wound healing and abnormal liver function tests. Limb lymphedema has only been reported several times in renal transplant recipients. We present a case of lower limb lymphedema that occurred in a 59-year-old liver transplant recipient after being on a SRL regimen for seven months. Extensive diagnostic investigations could not reveal signs of infection, venous obstruction or malignancy. After discontinuation of SRL, the lymphedema gradually resolved during the next three months. The pathologic mechanism behind this phenomenon is unknown, but antiangiogenetic and antiproliferative properties of SRL have been hold responsible. Further studies are necessary to explain this rare side effect.

PMID: 18330092 [PubMed - in process]

For further information, please see:

Lymphedema From Sirolimus Treatment

The management of genital lymphedema.

2008-03-08T18:03:00.000-08:00

The management of genital lymphedema.

BJU Int.

2008 Mar 4

Garaffa G, Christopher N, Ralph DJ.
St Peter’s Department of Andrology, and The Institute of Urology, London, UK.

OBJECTIVES

To report our experience and management of genital lymphoedema, as this condition can be extremely debilitating and difficult to manage.

PATIENTS AND METHODS

The clinical records of 90 patients with genital lymphoedema who presented between 1998 and 2007 were retrospectively reviewed. The surgical management of 34 patients consisted of the excision of the affected skin and of the subcutaneous layers. This involved scrotal excision in 15 patients with primary closure. Skin grafts were required in seven patients for penile shaft cover. The results for cosmesis, recovery of sexual function, patient's satisfaction and complications are discussed.

RESULTS

In all, 56 patients were successfully managed conservatively by treating the underlying condition, antibiotic administration, compression and elevation of the genitalia. The remaining 34 patients required surgical management with an overall excellent cosmetic result and a significant improvement in sexual function.

CONCLUSIONS

When surgery is necessary for genital lymphoedema, the new techniques described provide excellent cosmetic and functional results.

Blackwell

For additional Information:

Female Genital Lymphedema

Male Genital Lymphedema

Learning from a lymphedema clinic: an algorithm for the management of localized swelling.

2008-03-01T19:51:00.000-08:00

Learning from a lymphedema clinic: an algorithm for the management of localized swelling.

Plast Reconstr Surg. 2008 Feb

Garfein ES, Borud LJ, Warren AG, Slavin SA.
Boston, Mass. From the Harvard Plastic Surgery Program, Harvard Medical School, and the Division of Plastic Surgery, Beth Israel Deaconess Medical Center.

BACKGROUND: Lymphedema is a chronic disease causing significant morbidity for affected patients. It can be difficult to diagnose, and patients are often frustrated by multiple referrals and inadequate therapies. Centralized, comprehensive care for the patient presenting with lymphedema or other causes of localized swelling allows for appropriate evaluation and provides improved management and treatment.

METHODS: A 4-year review of the first 100 patients seen at the Beth Israel Deaconess Medical Center Lymphedema Clinic was performed. On the basis of the clinical experience from these patients, an algorithm for diagnosing and managing patients with localized swelling was developed.

RESULTS: The mean age of the patients was 50 years, and 81 percent of the patients were women. On average, patients had experienced their symptoms for 11.6 years (range, 3 months to 60 years). Lymphoscintigraphy was performed on 43 patients, 81 percent of whom showed lymphatic obstruction or dysfunction. In total, 75 percent of patients were diagnosed with lymphedema based on clinical presentation or additional testing. Fourteen of these patients underwent subsequent excisional procedures, whereas the rest were managed conservatively with compression garments.

CONCLUSIONS: Patients presenting with swollen extremities can frequently be diagnosed through history and physical examination alone, but many patients require more extensive diagnostic workup. An algorithm for the management of these patients can facilitate evaluation and treatment.

Plastic and Reconstructive Surgery

Risk factors for arm lymphedema following breast cancer diagnosis in Black women and White women

2008-02-26T19:17:00.000-08:00

Risk factors for arm lymphedema following breast cancer diagnosis in Black women and White women

Breast Cancer Res Treat. 2008 Feb 24

Meeske KA, Sullivan-Halley J, Smith AW, McTiernan A, Baumgartner KB, Harlan LC, Bernstein L.
Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.

Purpose

Lymphedema of the arm is a potential complication of breast cancer therapy. This study examines pre-disposing factors that may operate in conjunction with treatment-related factors in the development of arm lymphedema in a large cohort of White and Black breast cancer survivors. Methods 494 women (271 White and 223 Black) with in situ to Stage III-A primary breast cancer completed a baseline interview within 18 months of diagnosis. Information on lymphedema was collected during a follow-up interview, conducted on average 50 months after diagnosis. Self-reported data were used to classify women with or without lymphedema. Multivariable logistic regression models were developed to identify risk factors for arm lymphedema. Results Arm lymphedema was associated with younger age at diagnosis (odds ratio, OR per year of age = 0.96; 95% confidence interval, CI = 0.93-0.99), positive history of hypertension (OR = 2.31; 95% CI = 1.38-3.88), obesity (OR for body mass index, BMI>/=30 = 2.48; 95% CI = 1.05-5.84) and having had surgery where 10 or more lymph nodes were excised (OR = 2.16; 95% CI = 1.12-4.17). While Black women had higher prevalence of arm lymphedema than White women (28% vs. 21%), race was not associated with lymphedema risk in models adjusted for multiple factors (adjusted OR = 1.01; 95% CI = 0.63-1.63). Conclusion Risk of arm lymphedema did not differ significantly for Black and White women. Risk factors identified in this study offer opportunities for interventions (weight loss, control of blood pressure, use of sentinel node biopsy where possible) for reducing incidence of lymphedema or controlling the symptoms associated with this condition.

SpringerLink

A Way to Help Prevent Arm Lymphedema - Fine Needle Aspiration

2008-02-23T03:27:00.000-08:00

Accuracy of fine-needle aspiration cytology of axillary lymph nodes in breast cancer patients: a study of 115 cases with cytologic- histologic correlation.

Cancer. 2008 Feb 19 Alkuwari E, Auger M.
Department of Pathology, McGill University Health Center, McGill University, Montreal, Quebec, Canada.

BACKGROUND: Fine-needle aspiration (FNA) cytology of axillary lymph nodes is a simple, minimally invasive technique that can be used to improve preoperative determination of the status of the axillary lymph nodes in patients with breast cancer, thereby serving as a tool with which to triage patients for sentinel versus full lymph node dissection procedures. The aim of the current study was to determine the sensitivity and specificity of FNA cytology to detect metastatic breast carcinoma in axillary lymph nodes.

METHODS: A total of 115 FNAs of axillary lymph nodes of breast cancer patients with histologic follow-up (subsequent sentinel or full lymph node dissection) were included in the current study.

The specificity and sensitivity, as well as the positive and negative predictive values, were calculated.

RESULTS: The positive and negative predictive values of FNA cytology of axillary lymph nodes for metastatic breast carcinoma were 1.00 and 0.60, respectively. The overall sensitivity of axillary lymph node FNA in all the cases studied was 65% and the specificity was 100%. The sensitivity of FNA was lower in the sentinel lymph node group than in the full lymph node dissection group (16% vs 88%, respectively), which was believed to be attributable to the small size of the metastatic foci in the sentinel lymph node group (median, 0.25 cm). All false-negative FNAs, with the exception of 1 case, were believed to be the result of sampling error. There was no 'true' false-positive FNA case in the current study.

CONCLUSIONS: FNA of axillary lymph nodes is a sensitive and very specific method with which to detect metastasis in breast cancer patients. Because of its excellent positive predictive value, full axillary lymph node dissection can be planned safely instead of a sentinel lymph node dissection when a preoperative positive FNA result is rendered. Cancer (Cancer Cytopathol) 2008. (c) American Cancer Society.

PMID: 18286535 [PubMed - as supplied by publisher]

GROUNDBREAKING MEDICARE APPEALS COUNCIL DECISION COMPRESSION GARMENTS USED IN LYMPHEDEMA TREATMENT MEET MEDICARE DEFINITION OF PROSTHETIC DEVICES

2008-02-23T01:35:00.000-08:00

GROUNDBREAKING MEDICARE APPEALS COUNCIL DECISION COMPRESSION GARMENTS USED IN LYMPHEDEMA TREATMENT MEET MEDICARE DEFINITION OF PROSTHETIC DEVICES

On February 20, 2008 a Medicare Administration Appeals Judge affirmed an earlier Administrative Law Judge's determination that compression garments used as part of the medical treatment of lymphedema meet the definition of “prosthetic devices” in the Social Security Act, and are coverable by Medicare.

This most recent case follows two earlier cases where the Appeals Council reversed two different ALJs who supported providers who denied reimbursement based on the unsubstantiated claim that compression garments “were not covered by Medicare”. Three other ALJs decided in favor of three different Medicare Beneficiaries, finding that the compression bandages, sleeves, stockings, devices and directional flow garments were medically necessary and coverable in the treatment of lymphedema as “prosthetic devices”.

Unfortunately these cases are not precedent-setting, and there is no desire by the Centers for Medicare and Medicaid Services (CMS) to change their medically unsound policies. CMS has also recently denied a formal request to change their HCPCS Coding manual to recognize the function of these items in the treatment of lymphedema, and to code them as prosthetic devices.

What actions can be taken to move CMS into action?

Every denial of compression bandages or compression garments must be appealed by the patient. The procedures for appeal are found in the denial letter. The appeal process will involve a redetermination appeal and a reconsideration appeal to Medicare Administrative Contractors, who will side with the denial, and then to an Administrative Law Judge where a fair hearing can be obtained.

Every lymphedema supply manufacturer must make a formal request to CMS for a recoding of their products with an “L-Code” as prosthetic devices when used in the treatment of lymphedema.

And every affected citizen, whether suffering for or at risk for lymphedema must write his of her Congress Member requesting that CMS revise their policies to cover the treatment of lymphedema according to current standards.

Since CMS has refused repeatedly to even consider a change, urge your legislator to consider sponsoring the proposed “Lymphedema Diagnosis and Treatment Cost-Saving Act” which has been presented to legislators over the last 5 years.

I am prepared to help in all these matters, and have materials which will be helpful. Please contact Robert Weiss at: LymphActivist@aol.com

Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema.

2008-02-18T16:53:00.000-08:00

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.
Breast Cancer Res Treat. 2008 Feb 13
Damstra RJ, Voesten HG, van Schelven WD, van der Lei B.
Department of Dermatology, Phlebology and Lymphology, Nij Smellinghe Hospital, Compagnonsplein 1, 9202 NN, Drachten, The Netherlands, r.damstra@nijsmellinghe.nl.

Keywords

Lympho-venous anastomosis (LVA) - Microsurgery - Evidence-based medicine - Lymphoscintigraphy - Inverse water volumetry - Review - Breast cancer related lymphedema

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 literature.

Study design and methods

Ten patients who were previously treated for breast cancer by surgery, radiotherapy, and chemotherapy, and were unresponsive to 12-weeks of non-operative treatment, underwent an LVA procedure (Degni-Cordeiro).

Objective measurements were gathered for circumferential measurement and water volumetry, and quality of life. Various types of lymphoscintigraphy were carried out pre-operatively and post-operatively at 3 and 12 months. Treatment was embedded in a multidisciplinary setting. Results Post-operative volume measurements initially showed a 4.8% reduction of lymphedema at 3 months and a 2% reduction after one year. Various scintigraphic parameters showed some improvement. Quality of life questionnaires reported minimal improvement. Reviewing the literature, only retrospective studies were found; these reported varying results for LVA procedures.

The selection of patients, classification of lymphedema, indications and types of LVA, and additional therapeutic options were heterogeneous, not comparable, and lacked a validated method of effect-assessment.

Conclusions

Our results showed a minimal reduction in volume of lymphedema following LVA; in the literature, there was no convincing evidence of the success of LVA. Non-operative treatment and elastic stockings are still preferred by most patients with lymphedema, especially in early stages with few irreversible changes.

Springer Link

Lymphedema in the morbidly obese patient: unique challenges in a unique population.

2008-02-16T06:19:00.000-08:00

Lymphedema in the morbidly obese patient: unique challenges in a unique population.

Ostomy Wound Manage. 2008 Jan

Fife CE, Carter MJ.
Department of Anesthesiology, University of Texas Health Science Center, Houston, Texas, USA. Caroline.E.Fife@uth.tmc.edu

The population of morbidly obese patients, along with the incidence of lymphedema and massive localized lymphedema associated with this condition, is increasing. A 5-year retrospective review of data (2000-2005) shows that the percentage of patients >350 lb in the authors' clinic population increased from approximately 7% to 11% and 75% of their morbidly obese patients (body mass index >40) had or have lymphedema. After a differential diagnosis between lipedema and lymphedema (primary or secondary) has been made, lymphedema management options include compression bandaging, manual lymphatic drainage, and localized surgeries. The treatment of morbidly obese lymphedema patients requires additional staff time and specialized equipment to move or position them and may be confounded by other conditions (eg, heart failure and venous insufficiency) that contribute to edema. Lymphedema treatments have been found to be useful, providing patients are able to follow treatment guidelines, especially with regard to weight control. In the authors' experience, massive localized lymphedema will recur unless the primary issue of obesity is addressed. Establishing clear criteria and patient participation guidelines before initiating a comprehensive localized lymphedema program will improve outcomes.

PMID: 18250486 [PubMed - in process]

See also:

Obesity and Lymphedema

The Lymphedema Diet

The prognostic significance of facial lymphedema in HIV-seropositive subjects with Kaposi sarcoma.

2008-02-03T06:26:00.000-08:00

The prognostic significance of facial lymphoedema in HIV-seropositive subjects with Kaposi sarcoma.

Jan 2008

Feller L, Masipa JN, Wood NH, Raubenheimer EJ, Lemmer J.

Background

Kaposi Sarcoma (KS) is a multifocal angioproliferative neoplasm characterized by inflammation, oedema, neoangiogenesis and spindle cell proliferation. The pathogenesis of human immunodeficiency virus (HIV)-associated KS (HIV-KS) is multifactorial and is influenced by HIV, by human herpesvirus-8 (HHV-8), and by increased production of cytokines and growth factors. Whether HIV-KS is a true malignancy or a reactive hyperplastic inflammatory condition is debatable.

Results and conclusions

Oedema of the face, legs and hands is a prominent feature of HIV-KS and is probably caused by lymphoedema related to the HIV-KS lesions. The cases of two HIV-seropositive subjects with KS-associated facial lymphoedema are reported. Extensive oral HIV-KS in association with facial oedema in the absence of anti-retroviral treatment appears to be an indication of a poor prognosis.

Aids Research and Therapy

Primary non-syndromic lymphedema (Meige disease) is not caused by mutations in FOXC2.

2008-01-19T05:55:00.000-08:00

Primary non-syndromic lymphedema (Meige disease) is not caused by mutations in FOXC2.

Eur J Hum Genet. 2008 Jan 16

Rezaie T, Ghoroghchian R, Bell R, Brice G, Hasan A, Burnand K, Vernon S, Mansour S, Mortimer P, Jeffery S, Child A, Sarfarazi M. 1Molecular Ophthalmic Genetics Laboratory, Department of Surgery, University of Connecticut Health Center, Farmington, CT, USA.

Primary lymphoedema is a genetic disorder with numerous phenotypic subgroups. The most common form is the non-syndromic Meige disease, which is primarily of pubertal or later onset, with oedema clinically indistinguishable from that found in the lymphoedema-distichiasis syndrome. There are also other very rare forms of lymphoedema such as yellow nail syndrome and lymphoedema with ptosis, which are clinically similar to Meige disease.

The only causative genes so far identified for the non-congenital primary lymphoedemas are the transcription factor FOXC2, where mutations are known to produce lymphoedema with distichiasis, and SOX18 in the very rare condition hypotrichosis- lymphoedema-telangiectasia.

This study has examined FOXC2 gene by sequence analysis in 23 affected individuals with Meige disease. A novel truncating mutation (c.563-584del) was identified in one family and found to segregate with the disease in eight affected relatives over three generations. This deletion creates a frameshift that predicts a premature stop at nucleotide 599 and truncating the normal protein by 38%.

Although the affected patient initially selected for mutation screening from this family had lymphoedema without distichiasis, all but one of his affected relatives who carried the FOXC2 mutation did have accessory eyelashes originating from their meibomian glands. This is further confirmation that of the primary lymphoedemas, only lymphoedema with distichiasis is caused by FOXC2 mutations.

All forms of post-pubertal lymphoedema need careful phenotyping for distichiasis, which may prove difficult to confirm unless several family members are examined, and cannot ever be assumed to be absent from self-report.European Journal of Human Genetics advance online publication, 16 January 2008;doi:10.1038/sj.ejhg. 5201982.

Nature

Manipulative therapy of secondary lymphedema in the presence of locoregional tumors

2007-12-24T05:31:00.000-08:00

Manipulative therapy of secondary lymphedema in the presence of locoregional tumors

Cancer. 2007 Dec 17

Pinell XA, Kirkpatrick SH, Hawkins K, Mondry TE, Johnstone PA.
Radiation Oncology Department, Emory University School of Medicine, Atlanta, Georgia.

BACKGROUND: Complete decongestive therapy (CDT), including manual lymphatic drainage (MLD) is a manipulative intervention of documented benefit to patients with lymphedema (LE). Although the role of CDT for LE is well described, to the authors' knowledge there are no data regarding its efficacy for patients with LE due to tumor masses in the draining anatomic bed. Traditionally, LE therapists are wary of providing therapy to such patients with 'malignant' LE for fear of exacerbating the underlying cancer, and that the obstruction will render therapy less effective. In the current study, the authors' experience providing CDT for such patients is discussed.

METHODS: Cancer survivors with LE were referred to therapists at 2 Atlanta-area clinics. CDT consists of treatment (Phase 1) and maintenance phases (Phase 2). During Phase 1, the patient undergoes manipulative therapy and bandaging daily until the LE reduction plateaus; at that point, Phase 2 (self-care) begins. At the beginning and end of Phase 1, LE is quantified and differences in girth volume calculated. The results for patients completing Phase 1 therapy for LE in the presence of locoregional masses were compared with results for patients with LE in the absence of such disease. Both volume reduction of the affected limb and number of treatments to plateau were analyzed.

RESULTS: Between January 2004, and March 2007, LE of 82 limbs in 72 patients was treated with CDT and Phase 1 was completed. The median number of treatments to plateau was 12 (range, 4-23 treatments); the median limb volume reduction was 22% (range, -23 to 164%). Nineteen limbs (16 patients) with associated chest wall/axillary or pelvic/inguinal tumors had nonsignificant difference in LE reduction (P = .75) in the presence of significantly more sessions to attain plateau (P = .0016) compared with 63 limbs in 56 patients without such masses.

CONCLUSIONS: Patients with LE may obtain relief with CDT regardless of whether they have locoregional disease contributing to their symptoms. However, it will likely take longer to achieve that effect. Manipulative therapy of LE should not be withheld because of persistent or recurrent disease in the draining anatomic bed. Cancer 2008. (c) 2007 American Cancer Society.

Wiley InterScience

Adrenomedullin - hormone for possible treatment of lymphedema?

2007-12-20T21:18:00.000-08:00

Hormone Could Ease Painful Lymphedema

12/20/07

THURSDAY, Dec. 20 (HealthDay News) -- A hormone called adrenomedullin may prove an effective drug target for treating lymphedema, a painful swelling of the limbs that can follow breast cancer or other cancer treatment, U.S. researchers say.

It may also help prevent the spread of cancer, according to a team from the University of North Carolina at Chapel Hill School of Medicine.

Adrenomedullin, which is secreted by cells throughout the body, is known to play a role in cardiovascular disease and other cell functions. In a new study, the UNC group found that adrenomedullin also plays an important role in the formation of the lymphatic system in mice.

They said it may be possible to develop drugs that target this hormone in order to help the more than 100 million people worldwide who suffer from lymphedema. The condition occurs when the lymphatic system fails to work properly. In rare cases, it is genetic, but millions suffer lymphedema due to parasitic infections or as the aftermath of cancer therapies.
Currently, the only treatments for lymphedema include massage and the use of low-compression stockings and other garments. But these aren't much help, the UNC researchers said.

"Our research also may lead to therapies to prevent cancer cells from traveling through these lymphatic vessels to infiltrate other parts of the body," senior study author Kathleen M. Caron, assistant professor of cell and molecular physiology and genetics, said in a prepared statement.
The study is published in the Dec. 20 issue of the Journal of Clinical Investigation.

Health News

Hormone May be New Drug Target for Preventing Lymphedema, Tumor Spread

Keywords: HORMAN - LYMPH SYSTEM - ADRENOMEDULLIN - TUMOR SPREAD

Description

A hormone secreted by cells throughout the body and known to play a role in cardiovascular disease and other cell functions is also critical for proper formation of the lymphatic system in mice, according to research from the University of North Carolina at Chapel Hill School of Medicine.

Newswise -- A hormone secreted by cells throughout the body and known to play a role in cardiovascular disease and other cell functions is also critical for proper formation of the lymphatic system in mice, according to research from the University of North Carolina at Chapel Hill School of Medicine.

By targeting this hormone, called adrenomedullin, researchers may be able to treat the more than 100 million people worldwide affected by lymphedema, a condition that causes painful swelling in arms and legs.

"Our research also may lead to therapies to prevent cancer cells from traveling through these lymphatic vessels to infiltrate other parts of the body," said Kathleen M. Caron, senior study author and assistant professor of cell and molecular physiology and genetics at UNC.

Adrenomedullin is a powerful vascular peptide that can widen existing blood vessels and even promote the growth of new ones. But it also has many more functions, such as helping control metabolism, heart rate, thirst and appetite, stress response, antibacterial activity and nerve signal transmission.

The study, published Dec. 20, 2007, in the Journal of Clinical Investigation, demonstrates that this peptide is necessary for yet another function in our bodies: without it, our lymphatic system - an important part of the body's immune system - does not form normally. The lymphatic system includes lymph nodes and a network of thin tubes that transport fluid and immune cells that have leached out of tissues back into the circulatory system. These tubes branch, like blood vessels, into all the tissues of the body. Between two and three liters of the almost colorless fluid called lymph go through the lymphatic system in a day.

If this system fails to function properly, excess fluid collects and swells in tissue, causing lymphedema. In rare instances, the condition is inherited through genetic mutations. For two to three million cancer survivors, it comes as a consequence of early treatment, as the surgical removal of lymph nodes and radiation therapy creates damage to the lymphatic system that lasts a lifetime. But the most common cause, affecting up to 120 million people worldwide, is a parasitic infection.

"Lymphedema is a very serious problem," Caron said. "Not only does it limit your mobility, but it can be quite painful and disfiguring."

The only current treatments for the condition - using low-compression stockings and other garments, and massage - are not much help, Caron says. Before now, only a dozen or so genes had been implicated in the formation of lymphatic vessels, or lymphangiogenesis, and none of them have yet yielded an effective therapy. But through this study, the researchers have described three new targets, adrenomedullin and two of its partners in the cell, which together hold true promise for a pharmaceutical treatment for lymphedema.

Caron and her team of researchers discovered the importance of this hormone in the formation of the lymphatic system after genetically manipulating mice so that they completely lacked either adrenomedullin or its related cell partners. They found that these mice looked a lot like other mice with impaired lymphangiogenesis. Careful examination showed that the lymph sacs that normally take up excess fluid from the tissues were much smaller than they should be, and the sacs without adrenomedullin were made up of fewer cells than normal.

By increasing adrenomedullin within the cells of the lymphatic system, the researchers believe that they can encourage the lymph sacs to proliferate and take up more fluid. Not only could this approach provide a new treatment for lymphedema, but it may also prove useful in preventing the spread of cancer because invasive cancers sometimes penetrate the lymphatic vessels and metastasize to distant sites.

"In cancer treatments of the future, patients suffering from these aggressive cancers could be identified early and could be treated with a drug to inhibit the growth of the lymph vessels that transport the cancerous cells, thus keeping the cancer in check," Caron said.

The research was funded in part by The Burroughs Wellcome Fund, the National Institutes of Health and the American Heart Association.

Study co-authors are Kimberly L. Fritz-Six, William P. Dunworth and Manyu Li, all of the UNC School of Medicine.

Newswise

Effectiveness of the treatment-phase of two-phase complex decongestive physiotherapy for the treatment of extremity lymphedema.

2007-12-15T03:18:00.000-08:00

Effectiveness of the treatment-phase of two-phase complex decongestive physiotherapy for the treatment of extremity lymphedema.

Int J Clin Oncol. 2007 Dec

Yamamoto R, Yamamoto T.
Rhythmic Obstetrics and Gynecology Clinic, 4F-1, No. 26 Keiwa bldg., Kita 24, Nishi 4, Kita-Ku, Sapporo, 001-0024, Japan, rhythmic@minos.ocn.ne.jp.

BACKGROUND: Complex decongestive physiotherapy (CDP) consists of a two-phase treatment program and is the international standard therapy for lymphedema. However, this therapy is not performed at most hospitals in Japan.

METHODS: The subjects of the present study were 82 Japanese women with lymphedema of an extremity (median age, 64 years; range, 40-86 years). The volume of the affected extremity was compared before and after therapy, and the duration of the CDP treatment phase and rate of edema reduction were ascertained. The associations between the effect of CDP and duration of lymphedema, operative procedure, and radiotherapy were also investigated.

RESULTS: For patients with upper-extremity lymphedema, the median duration of the CDP treatment phase was 6 treatment days (range, 3-26 days), median reduction of edema volume was 328.7 ml (range, 76.6-1258.0 ml; P = 0.0014), and median rate of edema reduction was 58.9% (range, 42.7%-97.1%). For patients with lower-extremity lymphedema, the median duration of the CDP treatment phase was 10 treatment days (range, 2-35 days), median reduction of edema volume was 1573.7 ml (range, 293.9-3471.1 ml; P <>

CONCLUSION: In a study of Japanese women with lymphedema, CDP comprising a two-phase treatment program was clearly effective.

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