Leg Lymphedema Research Articles

Lymphedema Leads to Fat Deposition in Muscle and Decreased Muscle/Water Volume After Liposuction: A Magnetic Resonance Imaging Study.

Background: Lymphedema leads to adipose tissue deposition. Water–fat magnetic resonance imaging (MRI) can quantify and localize fat and water. The presence of excess fat and excess water/muscle in the subfascial compartment of the lymphedematous limb has not been investigated before. The aim of this study was to investigate epifascial and subfascial fat and water contents in patients with chronic lymphedema before and after liposuction.Methods and Results: Seven patients with arm lymphedema and six with leg lymphedema were operated on. The limbs were examined with water–fat MRI before liposuction (baseline) and at five time points. Complete reduction of the excess limb volumes was achieved. The excess epifascial fat was evident in the edematous limbs and a drop was seen following surgery. There were differences in excess water at all time points. At 1 year there was a decrease in excess water. Excess subfascial fat was seen in the edematous limbs at all time points. Subfascial excess water/muscle did not show any differences after surgery. However, starting from 3 months there was less subfascial water/muscle compared with baseline.Conclusions: Subfascial fat in the lymphedematous limbs did not change. In contrast, the water in the subfascial compartment was reduced over time, which may represent a decrease of muscle volume after treatment due to less mechanical load after liposuction. Using water–fat MRI-based fat quantification, the fat and water contents may be quantified and localized in the various compartments in lymphedema.

Correlation Between Changes in Extremity Volume and Bioelectrical Impedance in Arm and Leg Lymphedema.

To clarify the differences in the mode of fluid accumulation between arm and leg lymphedema using bioelectrical impedance analysis (BIA). In 22 arms with lymphedema (ALE) and 65 legs with lymphedema (LLE), as well as 54 legs with venous edema (VE) for comparison, BIA was performed twice between April 2015 and March 2017. Then, the changes in BIA-derived parameters were correlated with the changes in extremity volumes. In ALE, the change in extracellular fluid resistance (Re) was negatively correlated with the change in arm volume (r = 0.51), while the change in intracellular fluid resistance (Ri) was constant, irrespective of the change in arm volume (r = 0.19). In LLE, the change in Re was negatively correlated with the change in leg volume (r = 0.67), but the change in Ri was also negatively correlated with the change in leg volume (r = 0.51). These correlations were similar to those in VE, in which the changes in Re and Ri were each negatively correlated with the change in leg volume (r = 0.66 and 0.53, respectively). The modes of change in BIA-derived parameters according to the change in extremity volume were different in ALE and LLE. The changes in LLE were similar to that in VE.

Venous hemodynamics assessed with air plethysmography in legs with lymphedema.

This study was conducted to identify specific abnormalities using the results from air plethysmography in legs with lymphedema. A routine air plethysmography exercise protocol was performed in 31 patients with unilateral leg lymphedema, and the results were compared with those of 53 patients with unilateral great saphenous vein reflux and 15 normal subjects. The venous filling index in legs with lymphedema (2.1 ± 1.2 mL/sec) was smaller than in legs with great saphenous vein reflux (6.4 ± 4.1 mL/sec, p < 0.05), but was not different from that in normal legs (1.9 ± 1.2 mL/sec). The ejection fraction was similar in all groups. The residual volume fraction in legs with lymphedema (35 ± 32%) was larger than that in normal subjects (13 ± 23%, p < 0.05), but was not significantly different from that in the contralateral leg of the lymphedema patients (32 ± 27%). In conclusion, we found no specific air plethysmography findings in uncomplicated lymphedema.

Treatment outcomes of patients with stage II pure endometrioid-type endometrial cancer: a Taiwanese Gynecologic Oncology Group (TGOG-2006) retrospective cohort study.

ObjectiveChoice of hysterectomy and adjuvant treatment for International Federation of Gynecology and Obstetrics (FIGO) 2009 stage II endometrioid endometrial cancer (EEC) is still controversial. Aims of this study were to evaluate survival benefits and adverse effects of different hysterectomies with or without adjuvant radiotherapy (RT), and to identify prognostic factors.MethodsThe patients at 14 member hospitals of the Taiwanese Gynecologic Oncology Group from 1992 to 2013 were retrospectively investigated. Patients were divided into simple hysterectomy (SH) alone, SH with RT, radical hysterectomy (RH) alone, and RH with RT groups. Endpoints were recurrence-free survival (RFS), overall survival (OS), disease-specific survival (DSS), adverse effects and prognostic factors for survival.ResultsTotal of 246 patients were enrolled. The 5-year RFS, OS, DSS and recurrence rates for the entire cohort were 89.5%, 94.3%, 96.2% and 10.2%, respectively. Patients receiving RH had more adverse effects including blood loss (p<0.001), recurrent urinary tract infections (p=0.013), and leg lymphedema (p=0.038). Age over 50-year (HR=9.2; 95% confidence interval [CI], 1.2–70.9) and grade 3 histology (HR=7.28; 95% CI, 1.45–36.6) were independent predictors of OS. Grade 3 histology was an independent predictor of RFS (HR=5.13; 95% CI, 1.38–19.1) and DSS (HR=5.97; 95% CI, 1.06–58.7). Patients receiving adjuvant RT had lower locoregional recurrence (p=0.046), but no impact on survival.ConclusionDifferent treatment modalities yield similar survival outcomes. Patients receiving SH with RT had lower locoregional recurrent with acceptable morbidity. Age and tumor grading remained significant predictors for survival among patients with FIGO 2009 stage II EEC.

Sentinel lymph node biopsy in endometrial cancer—Feasibility, safety and lymphatic complications

ObjectiveTo compare the rate of lymphatic complications in women with endometrial cancer undergoing sentinel lymph node biopsy versus a full pelvic and infrarenal paraaortic lymphadenectomy, and to examine the overall feasibility and safety of the former. MethodsA prospective study of 188 patients with endometrial cancer planned for robotic surgery. Indocyanine green was used to identify the sentinel lymph nodes. In low-risk patients the lymphadenectomy was restricted to removal of sentinel lymph nodes whereas in high-risk patients also a full lymphadenectomy was performed. The impact of the extent of the lymphadenectomy on the rate of complications was evaluated. ResultsThe bilateral detection rate of sentinel lymph nodes was 96% after cervical tracer injection. No intraoperative complication was associated with the sentinel lymph node biopsy per se. Compared with hysterectomy alone, the additional average operative time for removal of sentinel lymph nodes was 33min whereas 91min were saved compared with a full pelvic and paraaortic lymphadenectomy. Sentinel lymph node biopsy alone resulted in a lower incidence of leg lymphedema than infrarenal paraaortic and pelvic lymphadenectomy (1.3% vs 18.1%, p=0.0003). ConclusionThe high feasibility, the absence of intraoperative complications and the low risk of lymphatic complications supports implementing detection of sentinel lymph nodes in low-risk endometrial cancer patients. Given that available preliminary data on sensitivity and false negative rates in high-risk patients are confirmed in further studies, we also believe that the reduction in lymphatic complications and operative time strongly motivates the sentinel lymph node concept in high-risk endometrial cancer.

Use of a Novel Portable Three-Dimensional Imaging System to Measure Limb Volume and Circumference in Patients with Filarial Lymphedema.

The World Health Organization's Global Program to Eliminate Lymphatic Filariasis (LF) has reduced LF transmission worldwide, but millions remain affected by filarial lymphedema. Tools for clinically monitoring lymphedema in developing nations are limited. We tested a novel, portable, infrared three-dimensional imaging system (3DIS) against water displacement (WD) and tape measurement of limb circumference (TMLC) among patients with filarial leg lymphedema in Galle, Sri Lanka. Outcomes were accuracy and reproducibility of imaging system measurements. In parallel, we also tested the reproducibility of skin thickness ultrasound (STU) measurements. We examined 52 patients (104 limbs) with lymphedema of stages 0-6 (N = 28, 19, 20, 21, 2, 4, and 10, respectively). 3DIS measurements correlated nearly perfectly with WD (r2 = 0.9945) and TMLC values (r2 > 0.9801). The median time required to acquire imaging system measurements for both legs was 2.1 minutes, compared with 17, 7, and 29 minutes, respectively, for WD, TMLC, and STU. Median interexaminer coefficients of variation (CVs) for volume measurements were 1.1% (interquartile range [IQR] 0.5-2.1%) for WD and 1.7% (IQR 1.2-2.4%) for the 3DIS. CVs for circumference measurements were 1.4% (IQR 0.8-2.4%) by TMLC and 1.3% (0.8-1.9%) by 3DIS. Median interexaminer CV for STU was 13.7% (IQR 8.5-21.3%). The portable imaging system noninvasively provided accurate and reproducible limb volume and circumference measurements in approximately 2 minutes per patient. This portable technology has the potential to greatly improve assessment and monitoring of lymphedema in the clinic and in the field.

Computed Tomographic Evaluation of Posttreatment Soft-Tissue Changes by Using a Lymphedema Scoring System in Patients with Oral Cancer.

This study aimed to evaluate posttreatment soft-tissue changes in patients with oral cancer with computed tomography (CT). To accomplish that purpose, a scoring system was established, referring to the criteria of lower leg lymphedema (LE). One hundred and six necks in 95 patients who underwent oral oncologic surgery with neck dissection (ND) were analyzed retrospectively using routine follow-up CT images. A two-point scoring system to evaluate soft-tissue changes (so-called "LE score") was established as follows: Necks with a "honeycombing" appearance were assigned 1 point. Necks with "taller than wide" fat lobules were assigned 1 point. Necks with neither appearance were assigned 0 points. Comparisons between patients with LE score ≥1 and LE score = 0 at 6 months postoperatively were performed using the Fisher exact test for discrete variables and the Mann-Whitney U test for continuous variables. Univariate predictors associated with posttreatment changes (i.e., LE score ≥1 at 6 months postoperatively) were entered into a multivariate logistic regression analysis. Values of p < 0.05 were considered to indicate statistical significance. The occurrence of the posttreatment soft-tissue changes was 32%. Multivariate logistic regression analysis showed that postoperative radiation therapy (RT) and bilateral ND were potential risk factors of posttreatment soft-tissue changes on CT images. Sequential evaluation of "honeycombing" and the "taller than wide" appearances on routine follow-up CT revealed the persistence of posttreatment soft-tissue changes in patients who underwent oral cancer treatment, and those potential risk factors were postoperative RT and bilateral ND.

Accelerated Lymph Flow in Early-Stage Secondary Lymphedema Detected by Indocyanine Green Fluorescence Lymphography.

Background The purpose of this study was to evaluate the lymph function of the lower extremities and to identify early symptoms of lymph dysfunction in secondary lymphedema by observing lymph flow with indocyanine green (ICG) fluorescence lymphography (LG). Methods We retrospectively evaluated the lymph flow of 108 limbs in 54 female patients with leg lymphedema secondary to pelvic lymphadenectomy for gynecological carcinoma and 14 limbs in 7 female controls without a history of pelvic lymphadenectomy or radiotherapy. ICG was injected into four points at the distal part of the lower extremity. Lymph flow was evaluated by measuring the proximal point where the ICG could be observed 5 minutes after rest and 15 minutes after a walking exercise. Results In the controls, lymph flow was stable at rest and was well enhanced by exercise. In patients with early-stage lymphedema, lymph flow was already enhanced at rest (p = 0.005) and was further enhanced by exercise. In advanced-stage lymphedema, lymph flow was not enhanced, even by exercise (p = 0.001). Conclusion ICG-LG could evaluate lymph flow and functions of lymph systems and detect accelerated lymph flow in early-stage secondary lymphedema. Detecting accelerated lymph flow may facilitate early detection and treatment of secondary lymphedema.

Factors Associated with Lymphoedema Management Success Among Podoconiosis Patients in Wolaita Zone, Southern Ethiopia

Podoconiosis is non-filarial elephantiasis of lower legs which predominantly affects barefooted people. In later clinical stages, the disease manifests lymphoedema of the lower legs with mossy and nodular changes to the skin. The disease progressively disables patients when they are continuously exposed to irritant soils. The present study aimed to assess factors associated with lymphoedema management success among podoconiosis patients. A community based cross-sectional study was conducted from February to May, 2014 among podoconiosis patients. A two-stage sampling technique was employed to randomly select a total of 845 study subjects from 4 districts of Wolaita zone. To collect data, interviewer administered questionnaire was used along with observation. Data were entered and analyzed by using SPSS version 20. Bivariate and multivariable logistic regressions were used to select the candidate and the predictor variables respectively. Majority (71.2%) of the study subjects managed their lymphoedema successfully. Three fourth of the study participants were adhered to the stepwise lymphoedema management procedures. Acute dermato lymphangio adenitis (acute attack), was manifested rarely among 61.4% of the subjects after completion of the treatment. Patients' adherence to stepwise treatment procedures, completion of treatment regimen, duration of follow-up, attitude towards lymphoedema management, age and literacy were found to be the main predictors of lymphoedema management success. The present study assessed main factors associated with lymphoedema management success in podoconiosis. Duration of treatment follow-up, adherence to stepwise treatment procedure, completion of treatment, attitude on disease management and community perceptions towards patients were the main factors associated with successful lymphoedema management. Strict supervision and follow-up of patients to reinforce the home-based lymphoedema care is a vital precondition to successfully manage lymphoedema. Furthermore, longitudinal studies have to be conducted to bring a better lymphoedema management scenario with a higher success rate.

Maintenance of the Results of Stage II Lower Limb Lymphedema Treatment after Normalization of Leg Size.

Objective The aim of this study was to identify strategies to transfer responsibility of the maintenance of the results of lymphedema treatment to the patient. Methods Maintenance of the reduction of edema was evaluated in a prospective clinical trial in patients with Stage II leg lymphedema. Twenty-one lymphedematous lower limbs were evaluated in Clínica Godoy in 2014 and 2016. The evaluation was done by volumetry at baseline and weekly thereafter for volume control. Patients wore Venosan® cotton 20/30 and 30/40 mmHg elastic compression stockings followed by a custom-made inelastic stocking made of grosgrain fabric. The Friedman test for multiple comparisons and Conover post hoc test were used for statistical analysis with an alpha error of 5%. Results On comparing leg volume changes using the different types of stockings, the 20/30 mmHg elastic compression stockings failed in the first week to maintain the volume reductions but the 30/40 mmHg compression stockings did not allow significant increases in volume (p value > 0.05). During one week, the grosgrain stocking reduced leg volumes to baseline values (p value = 0.24). Conclusion Higher compression of elastic stockings is better than lower compression but the inelastic grosgrain stocking is even better than both to maintain the results.

Differentiation of functional venous insufficiency and leg lymphedema complicated by functional venous insufficiency using subcutaneous tissue ultrasonography.

To use subcutaneous ultrasonography to differentiate legs with edema because of obesity-related functional venous insufficiency (FVIob), immobility-related FVI (FVIim), secondary lymphedema (LE), LE complicated by obesity (LEob), and LE complicated by immobility (LEim). Ninety-nine legs with edema (16 FVIob, 32 FVIim, 22 LE, 9 LEob, and 20 LEim), and 10 normal legs were examined. Subcutaneous tissue ultrasonography was performed at eight points (medial, lateral, upper, lower, thigh, and calf) in each leg. Subcutaneous echogenicity (SEG) and subcutaneous echo-free space (SEFS) were assessed, and each graded as 0, 1, and 2 according to their severity. In normal legs, SEG and SEFS were graded 0 in almost all parts of the leg. SEG was diffusely increased in FVIob, whereas SEG was increased in accordance with gravity in FVIim (upper medial thigh, 0.6± 0.5 vs lower medial calf, 1.2±0.4; P< .001). In LE, SEG was increased in the medial side, particularly evident in upper thigh (upper medial thigh, 1.1± 0.4 vs upper lateral thigh, 0.6± 0.6; P< .01). SEFS was increased in accordance with gravity in all of these legs (FVIob: upper medial thigh, 0.2± 0.4 vs lower medial calf, 0.7± 0.8; P= .05; FVIim: upper medial thigh, 0.1± 0.2 vs lower medial calf, 1.3± 0.7; P< .0001; LE: upper medial thigh, 0.4± 0.7 vs lower medial calf, 0.9± 0.9; P< .05). The increases of SEG and SEFS in legs with LEob or LEim were diffuse and similar. As determined via stepwise logistic regression analyses, the increases in SEG in the upper medial thigh and SEFS in the lower medial thigh in LE cases, the increases in SEG in the upper lateral thigh and SEFS in the lower lateral thigh in cases with obesity-related leg edema (ie, FVIob and LEob), and the increase in SEFS in the lower lateral calf in cases with immobility-related leg edema (ie, FVIim and LEim) were determined to be significant factors to characterize each leg edema. Differences in the extent and distribution of SEG and SEFS might help in differentiating LE from FVIob and FVIim, although assessment of LE complicated by obesity vs immobility remains difficult.

Clipping during distal external iliac lymphadenectomy increases lower leg lymphedema in patients with carcinoma of the cervix

Objectives: The distal external iliac lymph nodes were reported to be closely related with lower leg lymphedema (LEL). We hypothesized that complete obstruction of lymphatic channel induced from clipping during distal external iliac lymph node dissection could affect lymphedema after radical hysterectomy performed for cervical cancer. Methods: A retrospective review of 553 patients with carcinoma of the cervix who underwent radical hysterectomy with pelvic lymphadenectomy from January 1993 to December 2012 was performed. The authors included patients with FIGO stage I to stage IIA2 cervical cancer and excluded cases with a history of radiation therapy for cervical cancer to evaluate the pure effect of surgery alone. Lymphadenectomy for distal external iliac lymph nodes was defined as dissection of lymph nodes located on the psoas muscle within 3 cm from the inguinal canal. We evaluated the existence and number of clips in the area of the distal external iliac lymph nodes using magnetic resonance imaging and computed tomography. Results: Of a total of 553 cervical cancer patients, clipping on distal external iliac lymph nodes was performed in 283 patients and nonclipping in 270 patients. The patient’s age, body mass index, and the number of removed lymph nodes were not different between the 2 groups. Interestingly, LEL occurred in 15.2% (43 of 283 cases) of the patients who underwent clipping on distal external iliac lymph nodes compared with 5.2% (14 out of 270 cases) of the nonclipping cases (P < .01, OR 3.28, 95% CI 1.75–6.14). The total duration of LEL was significantly longer in the clipping group compared with the nonclipping group (P < .05). Lymphocyst formation was less frequently noted in the clipping group (3.2%, 9 out of 283 cases) compared with the nonclipping group (7.7%, 21 of 270 cases) (P < .05, OR 0.39, 95% CI 0.18–0.87). Conclusions: We found that clipping on distal external iliac lymph nodes during lymphadenectomy in cervical cancer patients was significantly associated with LEL as a postoperative complication. Therefore, for the prevention of LEL, nonclipping on distal external iliac lymph nodes can be suggested as a routine method for pelvic lymphadenectomy in cervical cancer patients.

Prevalence and distribution of &lt;i&gt;Wuchereria bancrofti&lt;/i&gt; in Ose Local Government Area, Ondo State, Nigeria

Lymphatic filariasis (LF) is one of the neglected tropical diseases endemic in Nigeria. Epidemiological studies were conducted to determine the prevalence, distribution and clinical signs of the disease in three communities of Ose LGA, Ondo State from October 2014 to January 2015. One thousand and ninety consented participants enrolled for the study. 100 μ l of blood from finger-prick, were tested using the Binax Now ® Immunochromatographic Test (ICT) which detects Wuchereria bancrofti antigens. Physical observations were conducted for clinical signs of LF in addition to demographic parameters. Chi -square test was used to establish statistical significance of relationship between variables ( p 0.05). Infection among age-groups was higher in the 36-45 age-group (36%) and varied among the other age-groups but with no significant difference ( p >0.05). Infection was significantly ( p <0.05) higher among the public servants with 34% than the other groups and the least among students (15%). Clinical manifestations found in the study were hydrocele (0.3%) and leg lymphoedema (0.7%). Detection of W. bancrofti antigens indicates that an entomological study has is recommended to determine the transmitting vector and advocate an effective control. Keywords: lymphatic filariasis, immunochromatographic test (ICT), distribution, prevalence, Ose LGA

Efficacy of the Stendo Pulsating suit in patients with leg lymphedema: a pilot randomized study.

The "shear stress like" effect of pulsating suit sessions at 65 mm Hg (Stendo(®) device), evidenced in healthy volunteers, might stimulate venous return and act as a physiological pump in lymphedema patients. To evaluate the lower limb total volume (TV) decrease induced by a pulsating suit versus intermittent pneumatic compression (IPC) sessions during a five-day complex decongestive physiotherapy (CDP) treatment. Twenty-four leg lymphedema patients were randomized into a CDP group according to the current practices and a CDP group where IPC was replaced by the pulsating suit. Daily care consisted of manual lymphatic drainage (MLD), one hour IPC or Stendo sessions, and bandaging. The Stendo inflatable suit generates heart rate synchronized compression/decompression applied to the lower part of the body. The IPC device was TP05/TP07 (Eureduc Company). Efficacy was assessed by leg TV changes after 5 days' CDP treatment. TV decreases were more pronounced in the Stendo than the IPC group when adjusted to the baseline TV; TV decrease was 14.2 L (11.2%) in the Stendo group, 11.0 L (8.8%) in the IPC group (p = 0.052 - %TV change p = 0.08). A trend in improved quality of life was reported in favor of the Stendo group over the IPC groups (14.2% [SD: 23.4%] and 6.7% [SD:31.5%], respectively). No adverse event related to the Stendo device was reported. The promising Stendo results open the way to larger clinical studies targeting CDP maintenance and moderate lymphedema in outpatient settings.

MG-116 Report of 2 families with emberger syndrome (GATA2 mutation): Recognition of variance in clinical phenotype allows detection prior to malignant presentation

Background Emberger syndrome is caused by mutation in GATA2 and predisposes to myelodysplastic syndrome (MDS)/acute myelogenous leukaemia (AML), lymphedema, warts, subtle dysmorphic features, and, rarely, congenital anomalies. Objectives To describe the heterogeneity associated with GATA2 mutation and highlight features that should prompt testing. Design/methods Case report of 2 families with mutation-confirmed Emberger syndrome. Results Family 1: The proband presented with warts and mouth ulcers. WHIM syndrome was considered when neutropenia and B-cell deficiency developed, despite negative CXCR4 testing. Years later, the patient developed AML with monosomy 7 and underwent chemotherapy and stem cell transplantation. Idiopathic leg lymphedema occurred. Family history was significant for warts. Re-examination identified subtle dysmorphisms. GATA2 sequencing detected a missense mutation. Family 2: Sibling 1 had a history of warts, mouth ulcers, ectopic anus, mild sensorineural hearing loss, and new-onset neutropenia. Bone marrow testing diagnosed MDS with monosomy 7. Sibling 2 had hypocellular, mildly dysplastic bone marrow. History included warts and leg lymphedema. Sibling 3 had mild bone marrow hypocellularity. Family history was significant for a parent with childhood warts and mouth ulcers. Siblings 1–3 had subtle dysmorphisms. GATA2 sequencing identified a nonsense mutation. Sibling 1 underwent stem cell transplantation. Siblings 2–3 are closely monitored. Conclusions The literature is biassed towards individuals who present with overt haematological malignancies; however, Emberger syndrome can be recognised earlier. Suspicion should be high in individuals with persistent hematologic/immunologic abnormalities, warts refractory to treatment, and/or lymphedema particularly in the setting of subtle, but typical, dysmorphisms. Intervention before development of AML decreases morbidity/mortality.

Clinical case estimates of lymphatic filariasis in an endemic district of Bangladesh after a decade of mass drug administration.

Bangladesh has a high burden of lymphatic filariasis (LF) disease. This survey estimated the current number of clinical cases in a historically endemic district after a decade of mass drug administration (MDA). A cluster survey was conducted in 30 villages of Nilphamari District. Ten households per village were randomly selected, and individuals with LF clinical conditions identified. Hydrocoele and lymphoedema (leg, arm, breast) cases were quantified and mapped, and differences by sex, age, severity of disease and episodes of acute dermatolymphangioadenitis attacks (ADLA) examined. From 1242 surveyed >10 years old 55 individuals (4.4%) with LF clinical conditions were identified. Males were mostly affected by hydrocoeles, and females by leg lymphoedema. Higher prevalence and more advanced stages of disease were found in older age groups. Overall low prevalence of severe clinical disease was found, which has positive implications for the elimination goal. Future planning of MMDP strategies will need to address the varying clinical conditions, severity of disease and impact of ADLAs affecting different sub-groups of the population. It will also be important to monitor for new cases, and examine the shift in age distribution of cases over time.

Extraperitoneal Para-aortic Lymphadenectomy by Robot-Assisted Laparoscopy in Gynecologic Oncology: Preliminary Experience and Advantages and Limitations.

We are reporting the preliminary multicentric experience in extraperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy (EPLRL) in gynecologic oncology. Two teams from the cancer centers performed EPLRL in 37 patients with gynecologic cancer. There were 30 patients with cervical cancer, 6 with endometrial cancer, and 1 with adnexal cancer. The skin-to-skin operative time, mean lymph node count, and estimated blood loss were 221 (±61) minutes, 18.7 (±11), and 105 (±134) mL.There was no conversion to laparotomy, one laparoscopic conversion for hemorrhage lateral to the inferior mesenteric artery, and one use of hemostatic matrix for an injury to the left gonadal artery (2 nontransfused patients). The proportion of patients who reported postoperative complications was 32.5% (12/37): 7 with lymphocysts with computed tomographic scan drainage (19%), 3 with leg dysesthesia (left genitofemoral nerve), 1 with leg lymphedema, and 1 with lateral aortic hematoma not requiring a transfusion or return to the operating room. The EPLRL technique is feasible and efficient but with a high rate of symptomatic lymphocyst. A marsupialization could be useful to decrease the risk of lymphocyst.

A study of increase in leg volume during complex physical therapy for leg lymphedema using subcutaneous tissue ultrasonography.

The purpose of this study was to discuss the mode of increase in leg volume during complex physical therapy (CPT) for lymphedema using subcutaneous tissue ultrasonography. Thirty-eight patients (51 legs) with secondary lymphedema who were treated by CPT for longer than 2 years (3.0 ± 0.8 years) at our clinic were studied. The leg circumferences were measured at every visit. Subcutaneous tissue ultrasonography was performed at the initial and latest visits. The overall change in leg volume was -284 ± 915 (range, -4588 to 1139) mL. Among them, the increase in leg volume was found in 18 legs; of those, 9 (1 in stage I, 7 in stage II, 1 in stage III) were adherent to hosiery use. In the legs whose average volume was decreased (group A, n = 33; mean, -821 [-4588 to -19] mL), the circumference had decreased in all the leg levels. However, in the legs whose average volumes had increased (group B, n = 18; mean, +449 [18-1139] mL), the circumference had increased in the thigh but remained unchanged or even decreased in the lower leg. In group B, subcutaneous thickness (SCT), subcutaneous echogenicity (SEG), and subcutaneous echo-free space (SEFS), assessed by ultrasonography, were found to have increased particularly in the lower medial thigh compared with those in group A (SCT change: group A, -1.5 ± 5.9 cm vs group B, 3.7 ± 5.4 cm [P < .05]; SEG grade change: group A, -0.3 ± 0.7 vs group B, 0.3 ± 0.7 [P < .05]; SEFS grade change: group A, -0.1 ± 0.7 vs group B, 0.4 ± 0.6 [P < .05]), whereas these remained unchanged or even decreased in the lower leg. Increase in leg volume during CPT might not be caused simply by noncompliance to hosiery use and seemed closely related to the increase in thigh circumferences, particularly the lower thigh, in which SCT, SEG, and SEFS were increased.

Managing lower limb oedema with compression therapy.

British Journal of Community NursingVol. 20, No. 6 CommentManaging lower limb oedema with compression therapyNina LinittNina LinittSearch for more papers by this authorNina LinittPublished Online:4 Jun 2015https://doi.org/10.12968/bjcn.2015.20.6.286AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Damstra RJ, Partsch H (2013) Prospective, randomized, controlled trial comparing the effectiveness of adjustable compression Velcro wraps versus inelastic multi-component compression bandages in the initial treatment of leg lymphedema. J Vasc Surg 1(1): 13–19 Medline, Google ScholarElvin S (2015) Cost efficacy of using Juxta CURES TM and UCS TM debridement cloths. Journal of Community Nursing 29(2) Google ScholarLawrence G (2015) EP471. Compression therapy using an innovative system. Poster presented at EWMA 2015, London, 13–15 May Google ScholarLymphoedema Framework (2006) Best Practice for the Management of Lymphoedema. International Consensus. MEP Ltd, London Google ScholarMoffat C (2015) Patients' concordance with compression therapy. Presentation at EWMA 2015, London, 13–15 May Google ScholarNaylor C, Imison C, Addicott R et al. (2013) Transforming our health care system. Ten priorities for commissioners. bit.ly/1L75WwH (accessed 19 May 2015) Google Scholar FiguresReferencesRelatedDetailsCited byCompression therapy for non‐venous leg ulcers: Current viewpoint13 October 2019 | International Wound Journal, Vol. 16, No. 6 2 June 2015Volume 20Issue 6ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Published online 4 June 2015 Published in print 2 June 2015 Information© MA Healthcare LimitedPDF download

Sarcoidosis with bilateral leg lymphedema as the initial presentation: a review of the literature

Abstract Sarcoidosis is a granulomatous disease, characterized microscopically by noncaseating granulomas, which may involve multiple organs; however, the lung, skin, and lymph nodes are commonly affected. Sarcoidosis is a great imitator; in the skin, it presents with different cutaneous manifestations including lupus pernio, infiltrated plaques, maculopapular eruptions, infiltration of old scars, and subcutaneous sarcoidosis. Lymphedema as an initial presentation is extremely rare; cases are reported in African-American but not Asian patients. Lymphedema associated with sarcoidosis may result from lymphatic obstruction by infiltrating sarcoidosis. We present a case where the symptoms and signs of sarcoidosis were improved after treatment with systemic steroids.