Prevalence Of Lymphedema Research Articles

Prevalence of lymphoedema and quality of life among patients attending a hospital-based wound management and vascular clinic.

Lymphoedema is a chronic, incurable, debilitating condition, usually affecting a limb and causes discomfort, pain, heaviness, limited motion, unsatisfactory appearance and impacts on quality of life. However, there is a paucity of prevalence data on this condition. This study aimed to determine the prevalence of lymphoedema among persons attending wound management and vascular clinics in an acute tertiary referral hospital. Four hundred and eighteen patients meeting the inclusion criteria were assessed. A prevalence rate of 2.63% (n = 11) was recorded. Thirty-six percent (n = 4) had history of cellulitis and broken skin, 64% (n = 7) had history of broken skin and 36% (n = 4) had undergone treatment for venous leg ulcers. The most common co-morbidities were hypertension 55% (n = 6), deep vein thrombosis (DVT) 27% (n = 3), hypercholesterolemia 36% (n = 4) and type 2 diabetes 27% (n = 3). Quality of life scores identified that physical functioning was the domain most affected among this group. This study has identified the need to raise awareness of this condition among clinicians working in the area of wound management.

Prevalence and Prognostic Significance of Secondary Lymphedema Following Breast Cancer

The adverse consequences of lymphedema following breast cancer in relation to physical function and quality of life are clear; however, its potential relationship with survival has not been investigated. Our purpose was to determine the prevalence of lymphedema and associated upper-body symptoms at 6 years following breast cancer and to examine the prognostic significance of lymphedema with respect to overall 6-year survival (OS). A population-based sample of Australian women (n = 287) diagnosed with invasive, unilateral breast cancer was followed for a median of 6.6 years and prospectively assessed for lymphedema (using bioimpedance spectroscopy [BIS], sum of arm circumferences [SOAC], and self-reported arm swelling), a range of upper-body symptoms, and vital status. OS was measured from date of diagnosis to date of death or last follow-up. Kaplan-Meier methods were used to calculate OS and Cox proportional hazards models quantified the risk associated with lymphedema. Approximately 45% of women had reported at least one moderate to extreme symptom at 6.6 years postdiagnosis, while 34% had shown clinical evidence of lymphedema, and 48% reported arm swelling at least once since baseline assessment. A total of 27 (9.4%) women died during the follow-up period, and lymphedema, diagnosed by BIS or SOAC between 6-18 months postdiagnosis, predicted mortality (BIS: HR = 2.5; 95% CI: 0.9, 6.8, p = 0.08; SOAC: 3.0; 95% CI: 1.1, 8.7, p = 0.04). There was no association (HR = 1.2; 95% CI: 0.5, 2.6, p = 0.68) between self-reported arm swelling and OS. These findings suggest that lymphedema may influence survival following breast cancer treatment and warrant further investigation in other cancer cohorts and explication of a potential underlying biology.

293 INVITED Lymphoedema: How the Prevalence and Severity of Lymphoedema Related to Cancer has Changed

293 INVITED Lymphoedema: How the Prevalence and Severity of Lymphoedema Related to Cancer has Changed

Prevalence of Secondary Lymphedema in Patients With Head and Neck Cancer

Context Because surgery, radiation, and/or chemotherapy disrupt lymphatic structures, damage soft tissue leading to scar tissue formation and fibrosis, and further affect lymphatic function, patients with head and neck cancer may be at high risk for developing secondary lymphedema. Yet, no published data are available regarding the prevalence of secondary lymphedema after head and neck cancer treatment. Objectives The aim of this study was to examine prevalence of secondary lymphedema in patients with head and neck cancer. Methods The study included 81 patients with head and neck cancer who were three months or more post-treatment. External lymphedema was staged using Foldi's lymphedema scale. Internal lymphedema was identified through a flexible fiber-optic endoscopic or mirror examination. Patterson's scale was used to grade degrees of internal lymphedema. Results Of the 81 patients, 75.3% (61 of 81) had some form of late-effect lymphedema. Of those, 9.8% (6 of 61) only had external, 39.4% (24 of 61) only had internal, and 50.8% (31 of 61) had both types. Conclusion Lymphedema is a common late effect in patients with head and neck cancer, and it develops in multiple external and internal anatomical locations. During physical examination and endoscopic procedures, clinicians should assess patients with head and neck cancer for late-effect lymphedema. Referral for treatment should be considered when lymphedema is noted. Research is needed to examine risk factors of lymphedema in patients with head and neck cancer and its effects on patients' symptoms, function, and quality of life.

Does the effect of weight lifting on lymphedema following breast cancer differ by diagnostic method: results from a randomized controlled trial

The lymphedema diagnostic method used in descriptive or intervention studies may influence results found. The purposes of this work were to compare baseline lymphedema prevalence in the physical activity and lymphedema (PAL) trial cohort and to subsequently compare the effect of the weight-lifting intervention on lymphedema, according to four standard diagnostic methods. The PAL trial was a randomized controlled intervention study, involving 295 women who had previously been treated for breast cancer, and evaluated the effect of 12 months of weight lifting on lymphedema status. Four diagnostic methods were used to evaluate lymphedema outcomes: (i) interlimb volume difference through water displacement, (ii) interlimb size difference through sum of arm circumferences, (iii) interlimb impedance ratio using bioimpedance spectroscopy, and (iv) a validated self-report survey. Of the 295 women who participated in the PAL trial, between 22 and 52% were considered to have lymphedema at baseline according to the four diagnostic criteria used. No between-group differences were noted in the proportion of women who had a change in interlimb volume, interlimb size, interlimb ratio, or survey score of ≥5, ≥5, ≥10%, and 1 unit, respectively (cumulative incidence ratio at study end for each measure ranged between 0.6 and 0.8, with confidence intervals spanning 1.0). The variation in proportions of women within the PAL trial considered to have lymphoedema at baseline highlights the potential impact of the diagnostic criteria on population surveillance regarding prevalence of this common morbidity of treatment. Importantly though, progressive weight lifting was shown to be safe for women following breast cancer, even for those at risk or with lymphedema, irrespective of the diagnostic criteria used.

Associated factors of lymphedema in breast cancer patients

to determine the prevalence of lymphedema and its associated factors in breast cancer patients. Two hundred and fifty women that had undergone more than six months of breast cancer treatment and were being treated at an oncology reference hospital in Juiz de Fora, Minas Gerais, Brazil. They were interviewed and submitted to physical evaluation. Data from the patients' medical records regarding the treatment of breast cancer, the extent of axillary intervention and the tumor were analyzed. Lymphedema was diagnosed when the difference between both upper limbs was 2 cm or more by perimetry. The groups of women with and without lymphedema were compared regarding the possible risk factors, and central tendency, dispersion, and prevalence were measured, with a significance level of 95%. One hundred and twelve women (44.8%) presented lymphedema. A significant difference was found between the groups of women with and without lymphedema regarding the median numbers of removed lymph nodes (p=0.02); presentation of superficial lymphatic thrombosis in the arm ipsilateral to the surgery (p<0.01); local application of radiotherapy, use of chemotherapy (p<0.01 for both); removal of the cuticles of the ipsilateral hand with pliers, and weightlifting after the treatment (p<0.01 and p=0.05, respectively). the association between lymphedema and the mentioned factors requires an interdisciplinary approach to this condition. It is of paramount importance that health teams and patients become aware of the prevention and treatment of lymphedema, a condition often undervalued.

El papel de la escuela de linfedema y la cinesiterapia en la prevención y el tratamiento del linfedema

The high prevalence of lymphedema along with its impact on quality of life and incomplete efficacy of current therapies makes the establishment of prevention programs that enable detection and early treatment recommendable. The School of Lymphedema aims to educate the at-risk and affected patients regarding preventive measures, self-care and early identification of lymphedema and its complications. Active exercises are part of lymphedema prevention programs and its treatment in the so-called complex physical therapy. Recent studies show that in addition to the recommended regular exercises, development of personalized protocols including aerobic, resistance and flexibility exercises is indicated since they neither trigger nor exacerbate lymphedema but contribute to improving the quality of life of these patients.

A Prospective Study of Postoperative Lymphedema After Surgery for Cervical Cancer

Lymphedema is a severe postoperative complication in oncological surgery. Multifrequency bioelectrical impedance analysis (MFBIA) is a new method for early lymphedema detection. The objective was to establish the methodology of MFBIA for lower-limb lymphedema and to detect a lymphedema in patients undergoing cervical cancer surgery. From a population of 60 patients undergoing cervical cancer surgery, 39 underwent radical hysterectomy Wertheim III (RAD group), and 21 underwent conservative surgery (laparoscopic lymphadenectomy plus simple trachelectomy/simple hysterectomy--CONS group). A control group of 29 patients (CONTR group) was used to determine the SD of impedance at zero frequency (R0). Patients were examined before surgery and at 3 and 6 months after surgery by MFBIA and by measuring the circumference of the lower limbs. No differences were found between the CONS and RAD groups on age, height, weight, and histopathologic type of tumor. However, the number of dissected lymph nodes differed significantly between the groups (17.3 in the CONS group vs 25.8 in the RAD group, P = 0.0012). The SD of R0 in the CONTR group was 36.0 and 39.0 for the right and the left leg, respectively. No difference in prevalence of lymphedema based on circumference method was found (35.9% in the RAD and 47.6% in the CONS groups, not statistically significant). No difference in the prevalence of lymphedema was found between the CONS and RAD groups. A methodology for MFBIA for the detection of lower-limb lymphedema was described.

Thyroid ultrasound in patients with Turner syndrome: Influence of clinical and auxological parameters

To determine thyroid volume and structure by ultrasound (US) in patients with Turner syndrome (TS) compared to healthy controls; to evaluate the frequency and characteristics of autoimmune thyroid disease (ATD) and its association with clinical and auxological parameters. 73 patients and 93 height-matched healthy female controls in the same age range were included in the study. Thirty-two TS patients (43.8%) presented ATD. They had a larger body mass index (BMI) and presented the 45,X karyotype more frequently than those without. They were older, with a higher prevalence of lymphoedema at birth and pterygium colli without statistical significance. Thyroid volume was 20% larger in the presence of ATD (p=0.037). A dyshomogeneous thyroid structure was observed in all patients with ATD and less frequently in those without (p=0.016). Dyshomogeneity in TS without ATD was also associated with older age (p<0.001), larger BMI (p=0.003) and larger thyroid volume (p=0.006). Six TS patients presented solitary thyroid nodules (5 benign nodules). We observed a significant interaction between diagnosis and height (p=0.035) and age (p=0.047), indicating that both age and height conditioned the observed differences in thyroid volume. Most TS patients presented ATD with a normal thyroid function or subclinical hypothyroidism, without goiter. Dyshomogeneous thyroid structure was also observed in TS patients without ATD. In TS, the evaluation of thyroid volume according to chronological age does not seem to be efficient because of a link between height and thyroid volume. The prevalence of nodular thyroid disease is similar to that observed in the general population.

Tissue Expander Breast Reconstruction is Not Associated with an Increased Risk of Lymphedema

Recent reports have demonstrated that lymphedema can occur after even minor pertubation of the axillary region such as sentinel lymph node biopsy (SLNB). The impact of breast reconstruction on the development of lymphedema, however, remains unknown. Therefore, the purpose of this study was to determine the impact of immediate tissue expander breast reconstruction on the risk of developing lymphedema. We identified patients who had undergone mastectomy with SLNB or SLNB and axillary lymph node dissection (ALND) with or without breast reconstruction using our prospectively maintained lymphedema and breast reconstruction databases. The development of lymphedema was evaluated prospectively using arm measurements and a validated questionnaire. Associations between variables were examined. Logistic regression was used to examine the association of reconstruction on prevalence of lymphedema while adjusting individually for BMI, age, and weight gain after surgery. Characteristics of patients with or without reconstruction were similar except for age, BMI, and weight gain since surgery. Median follow-up was 5years. Among patients treated with mastectomy with SLNB or SLNB/ALND, those undergoing reconstruction had a lower rate of measured lymphedema than those who did not (5% vs. 18%, P < .0004). The reconstructed group also had fewer patients with both measured and self-reported lymphedema (3% vs. 12%, P < .002). Differences in the rates of measured lymphedema between groups persisted following univariate logistical regression for differences in age, BMI, and weight gain. Tissue expander breast reconstruction in patients undergoing SLNB or SLNB/ALND does not increase the risk of developing measured or perceived lymphedema.

Prevalence of lymphedema and upper-limb impairments after axillary lymph node dissection or sentinel lymph node dissection in breast cancer: A 2-year follow-up study.

9137 Background: Arm lymphedema and limb morbidity in patients going through axillary lymph node dissection (ALND) or sentinel lymph node dissection (SLND) were investigated pre-operatively and after two years. Aims: to evaluate possible differences in arm morbidities between groups and to examine changes over time within groups. Methods: Two prospective female cohorts (n=393) treated with primary breast cancer surgery with ALND (n=204, mean age 55 ±10) or SLND (n=189, mean age 57 ±10) were examined for arm lymphedema (ALE), defined as > 10% increased arm volume relative to control arm volume, grip strength (kg), shoulder function, shoulder abduction endurance (sec) and BMI (kg/m2). Arm pain and sensation of heaviness in the affected arm was assessed on a 100 mm visual analogue scale (VAS). Descriptive statistics, t-tests and ANCOVA were employed. Results: Of the 393 women, 314 (80%) participated at the two-year follow-up (ALND n=152, SLND n=162). The number of patients with impairments was significantly higher (P< 0.05) in the ALND group after two years; 15 % had developed ALE, 36% reported pain and 32% had a sensation of heaviness, relative to 2% with ALE, 16% with pain and 2% with a sensation of heaviness in the SLND group. There were no significant differences between groups in shoulder function. Grip strength and shoulder abduction endurance in the affected limb significantly decreased from baseline to follow-up in the ALND group with mean reduction of 2.2 kg (CI 1.28-3.03) and 17 sec (CI 5.46- 28.60) (P< 0.05) respectively, while no significant decreases were observed in the SLND group. Both groups had a significant increase in BMI, but with less than 1 unit BMI (P< 0.05). Conclusions: Upper limb impairments two years after breast cancer surgery with ALND were significantly more prevalent compared to SLND surgery. Furthermore, there were significant decreases in grip strength and shoulder abduction endurance in the ALND group only. The ALND group may benefit from post-operative physical therapy focusing on muscle strength and endurance exercises. No significant financial relationships to disclose.

360 Prevalence of lymphoedema 5 years after breast cancer surgery

Percutaneous osseointegrated prosthetics (POP), which consist of a metallic post attached to the bone that extends outward through the skin to connect to an external prosthesis, have become a clinically relevant option to replace the typical socket-residual limb connection. POP devices offer several advantages such as mechanical off-loading of soft tissues, direct force transfer to the musculoskeletal system, greater proprioception, and overall improvement in limb kinesis compared to a socket system. However, POP devices create several challenges including epidermal downgrowth, increased infection risk, and mechanical tearing at the skin-implant interface. To address these issues, biomimetic surfaces and coatings have been developed in an attempt to create an infection-free and cohesive interface between POP devices and skin. The fingernail is a prime example of a natural system with a skin interface that is both mechanically and biologically stable. Exploiting keratins’ previously demonstrated tissue compatibility and creating a biomimetic coating for POP devices that can imitate the human fingernail, and demonstrating its ability to promote a stable interface with skin tissue is the goal of this work. Silane coupling aided in producing a coating on titanium substrates consisting of human keratin proteins. Several combinations of silane and keratin derivatives were investigated, and in general showed a nano-scale coating thickness that supported skin cell (i.e. fibroblast and keratinocyte) adhesion. Initial enzyme-mediated degradation resistance was also demonstrated, but the coatings appeared to degrade at long time periods. Importantly, keratinocytes showed a stable phenotype with no indication of wound healing-like activity. These data provide justification to further explore keratin biomaterials for POP coatings that may stabilize the implant-skin interface.

Manual for guided home exercises for osteoarthritis of the knee

INTRODUCTION:Physiotherapy is one of the most important components of therapy for osteoarthritis of the knee. The objective of this prospective case series was to assess the efficiency of a guidance manual for patients with osteoarthritis of the knee in relation to pain, range of movement , muscle strength and function, active goniometry, manual strength test and function.METHODS:Thirty-eight adults with osteoarthritis of the knee (≥ 45 years old) who were referred to the physiotherapy service at the university hospital (Santa Casa de Misericórdia de São Paulo) were studied. Patients received guidance for the practice of specific physical exercises and a manual with instructions on how to perform the exercises at home. They were evaluated for pain, range of movement, muscle strength and function. These evaluations were performed before they received the manual and three months later. Patients were seen monthly regarding improvements in their exercising abilities.RESULTS:The program was effective for improving muscle strength, controlling pain, maintaining range of movement of the knee joint, and reducing functional incapacity.DISCUSSION:A review of the literature showed that there are numerous clinical benefits to the regular practice of physical therapy exercises by patients with osteoarthritis of the knee(s) in a program with appropriate guidance. This study shows that this guidance can be attained at home with the use of a proper manual.CONCLUSIONS:Even when performed at home without constant supervision, the use of the printed manual for orientation makes the exercises for osteoarthritis of the knee beneficial.

Is a Weekly Supervised Upper Limb Exercise Program of Value for Women with Early Breast Cancer?

Abstract The aim of this randomised single blinded study was to determine whether an upper limb exercise program, commencing 4-weeks after surgery for early breast cancer, prevents upper limb symptoms, such as pain, swelling, stiffness and weakness.Methods: 156 women, aged 52.5 ± 11.7 y, who had undergone either axillary node dissection (AND; n=94) or sentinel node biopsy (SNB; n=62) for unilateral breast cancer in combination with either mastectomy (n=74) or wide local excision (n=82) within the previous 4 weeks, participated. Women were randomised to either an 8-week exercise program (n=79) or to usual care (n=77); participants were stratified for type of axillary surgery (SNB or AND) and treatment site. The exercise program comprised a home program of daily passive stretching for shoulder muscles and resistance training using Thera-Band® on alternate days for muscles about the shoulder. Women also attended a weekly exercise session. Usual care included routine follow-up with their medical specialists, a breast nurse and a post-operative visit with the physiotherapist and occupational therapist who provided instructions about exercises. The primary outcome was self-reported arm and chest symptoms derived from the EORTC breast cancer specific questionnaire (BR23) which was scored out of 100 with a low score indicative of fewer symptoms. The secondary outcomes included physical measures of shoulder range of motion, strength, and swelling. Presence of lymphoedema (LE) was determined by the inter-limb impedance ratio, using bioimpedance spectroscopy.Results: After the 8-week intervention period, there was no significant difference between groups in either the self-reported or the physical measurements (Table 1).Table 1. Baseline and 8 weeks data (mean ± SD). Usual care group Exercise group Baseline8 weeksBaseline8 weeksSelf-report symptoms (max 100) Arm24.5 ± 14.514.6 ± 14.225.9 ± 18.512.5 ± 12.9Breast25.8 ± 16.219.2 ± 17.725.6 ± 19.217.1 ± 16.7Range of motion interlimb difference (deg) Flexion19.8 ± 19.06.9 ± 7.023.9 ± 19.05.4 ± 7.3Abduction14.5 ± 14.04.7 ± 8.821.1 ± 18.43.8 ± 8.1Inter-limb strength difference (Newtons) Flexion15.9 ± 21.55.6 ± 19.417.0 ± 21.84.0 ± 15.8Abduction20.0 ± 25.85.7 ± 19.725.2 ± 28.61.0 ± 19.3Swelling (n) Prevalence of LE (by impedance)7/7714/745/789/74 Conclusion: A weekly, supervised, 8-week upper limb exercise program is not warranted for all women with early breast cancer treated with surgery to the axilla. Usual care in which women are seen post-operatively by a physiotherapist, occupational therapist, and breast nurse with ongoing monitoring by the specialists is sufficient for most women.Acknowledgement: Supported by NSW Cancer Council Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 811.

Post-Operative Resistance Training for Early Breast Cancer Survivors Is Not Associated with Increased Prevalence of Lymphedema.

Abstract Introduction: Women treated for early breast cancer are routinely advised against lifting heavy objects on the affected side as it may precipitate lymphedema (LE). Women often therefore report that their arm feels weak. As part of a single-blinded randomised trial, we investigated whether an exercise program that included resistance training, commencing 4 weeks post-operatively, was associated with higher prevalence of LE.Methods: Women (mean age: 52.5 ± 11.7 y) who had undergone either axillary node dissection (AND; n=94) or sentinel node biopsy (SNB; n=62) in combination with mastectomy (n=74) or wide local excision (n=82) within the previous 4 weeks for unilateral early stage breast cancer were randomised to an exercise group (79) or usual care group (n=77). Women were stratified for axillary surgery (AND or SNB) and treatment site. The exercise group received a weekly supervised program that comprised resistance training and passive stretching for muscles about the shoulder. The muscles targeted for resistance training included the flexors, abductors, external rotators and horizontal flexors. Women completed two sets of 8 to 12 repetitions for each muscle group. For weekly supervised sessions, the resistance was provided by free weights; for the home program, women were provided with an appropriate grade of elastic Thera-Band®. Each week, the exercises were monitored, and progressed as required, aiming to achieve 'Hard' (15) on the 6 – 20 Borg Effort Scale. Presence of swelling was assessed by self-report, and by circumferential measurements at 10 cm-intervals, commencing at the ulnar styloid and by bioimpedance spectroscopy. Women in the usual care group received advice regarding active stretching.Results: Following an 8-week exercise program, women in the exercise group were not more likely to have LE or changes suggestive of LE. The results for women who had undergone AND are shown in Table 1; results are similar for women who underwent SNB. At baseline, more women in the exercise group had signs and symptoms indicative of LE but at 8 weeks, they had similar or fewer signs.Table 1. Prevalence of lymphoedema in women treated with AND Usual Care Exercise Baseline (n=46)8 weeks (n=44)Baseline (n=48)8 weeks (n=46)SELF REPORTED a) on exertion6 (13)4 (9)6 (12)4 (9)b) During ADL's2 (4)1 (2) 1 (2)c) Consistent, minor disability10 (22)3 (7)13 (26)7 (15)d) Consistent, major disability 4 (8)1 (2)ARM CIRCUMFERENCE (&amp;gt;2cm interlimb diff) a) 1 measure &amp;gt;2 cm1 (2)5 (11)8 (16)3 (7)b) 2+ measures &amp;gt;2 cm2 (4)3 (7) 5 (11)BIOIMPEDANCE SPECTROSCOPY a) Above interlimb ratio cut-off5 (11)11 (25)5 (106 (13)b) &amp;gt;10 % change from baseline to week 8 5 (11) 3 (7) Conclusion: An 8-week resistance training program for women at risk of LE did not result in greater numbers of women having measures associated with LE than those who did not participate in the training program. Weakness, following surgery for breast cancer, can commence early as 4 weeks post-operatively. Women will be re-assessed in 6 months to determine whether the low prevalence of LE in the exercise group is maintained.Acknowledgements: Cancer Council NSW for funding. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1057.

A multicentre cross-sectional study of arm lymphedema four or more years after breast cancer treatment in Iranian patients

We performed a cross-sectional multicentre study to assess the prevalence of lymphedema after breast cancer treatment in Iran. All female breast cancer patients who attended our follow-up clinics four or more years after their surgery with no sign of disease were asked to participate in this study. Lymphedema was defined as an increase of 10% in the circumference of the arm on the involved side compared to the opposite arm. The total number of patients participating in this study was 355. The prevalence of lymphedema in the study patients was 17.5%, with the rate varying significantly (between 4 and 21%) among the three study centres (p=0.007). The mean number of months post surgery was larger for patients with lymphedema (84months) than for those without (79months), though this was not statistically significant (p>0.1). The relationships of various treatment factors and the education levels of the patients to the presence of lymphedema were also evaluated. None of the observed differences were statistically significant aside from those for the type of surgery (mastectomy vs. conservative surgery, p=0.055), treatment with radiotherapy (p=0.099), and prescription of a supraclavicular radiation field (p=0.057), which were only just significant. The rate of lymphedema in our patients was 17.5%, ranging from 4 to 21% in different study centres. Time post surgery, treatment with radiotherapy and the technique used, and nodal radiation seem to be factors that are related to this large variation.

Evidence for the exacerbation of lymphedema of geochemical origin, podoconiosis, by onchocerciasis

The study was conducted to investigate a variation in the distribution of endemic elephantiasis previously determined to be of geochemical origin in three neighbouring and essentially homogenous villages, Bambili, Bambui and Finge of the Bambui Health District of NW Cameroon. A total of 301 subjects were examined for onchocerciasis and lymphatic filariasis in the area using standard procedures. The onchocercal microfilarial prevalence varied from 6.5% in Bambili through 20.4% in Bambui to 60.4% in Finge. The onchocercal serological prevalence based on IgG4 detection followed a similar trend. By contrast, blood microfilariae were absent in the area as verified by use of sensitive techniques. The community prevalence of elephantiasis varied from 1.1% in Bambili to 4.4% in Bambui and 10.4% in Finge. The correlation between the parasitological prevalence of onchocerciasis and the prevalence of lymphedema in the three villages was strong (r=0.99, p<0.05). We confirm that the elephantiasis in the area is of geochemical origin and the results suggest that it is being exacerbated by onchocercal lymphadenitis.

Lymphedema and Quality of Life in Breast Cancer Survivors: The Iowa Women's Health Study

The impact of lymphedema or related arm symptoms on health-related quality of life (HRQOL) in breast cancer (BrCa) survivors has not been examined using a large population-based cohort. The Iowa Women's Health Study (IWHS) collected self-report data for lymphedema, arm symptoms, and HRQOL (Medical Outcomes Study Short Form-36) in 2004 and data for cancer diagnosis, treatment, and behavioral and health characteristics between 1986 and 2003. We studied 1,287 women, age 55 to 69 years at baseline, who developed unilateral BrCa. We used cross-sectional analyses to describe the prevalence of lymphedema and arm symptoms and multivariate-adjusted generalized linear models to compare HRQOL (physical functioning, bodily pain, general health, physical and emotional role limitations, vitality, social functioning, and mental health) between the following three survivor groups: women with lymphedema (n = 104), women with arm symptoms without diagnosed lymphedema (n = 475), and women without lymphedema or arm symptoms (n = 708). The mean (+/- SE) time between BrCa diagnosis and lymphedema survey was 8.1 +/- 0.2 years. Of BrCa survivors, 8.1% self-reported diagnosed lymphedema, and 37.2% self-reported arm symptoms. Knowledge of lymphedema was low among survivors without diagnosed lymphedema (n = 1,183). After multivariate adjustment, women with diagnosed lymphedema or arm symptoms without diagnosed lymphedema had lower physical and mental HRQOL compared with women without lymphedema or arm symptoms. Effect sizes were mild to moderate. There was a dose-response relation between number of arm symptoms and lower HRQOL. In the IWHS, HRQOL was lower for BrCa survivors with diagnosed lymphedema and for those with arm symptoms without diagnosed lymphedema. Clinical trials are needed to determine what interventions can improve lymphedema and impact HRQOL for BrCa survivors.

Lymphoscintigraphy in breast cancer: a short review about the impact on upper limb after surgical treatment

Breast cancer is still associated with high mortality rates and one of the most important factors governing long survival is accurate and early diagnosis. In underdeveloped countries, this disease frequently is only detected in advanced stages; however, through mammography, many women have been diagnosed at early stages. In this context, the sentinel lymph node (SLN) technique is associated with less postoperative morbidity compared to axillary lymphadenectomy. Lymphoscintigraphy has emerged as a method for the evaluation of lymphatic drainage chains in various tumours, being both accurate and non invasive. The aim of this work is to present the main aspects which cause controversy about SLN and lymphoscintigraphy and the impact that these procedures have had on lymphedema after surgical treatment for breast cancer. A short review including papers in English, Spanish and Portuguese, available on Lilacs and Medline database, published between January, 2000 and July, 2008 was performed. The key words breast cancer, lymphoscintigraphy, SLN biopsy, lymphedema were used. Various studies have aimed to compare the incidence and prevalence of lymphedema according to the technique used; however, the population subjected to SLN is different from the one with indication for axillary lymphadenectomy regarding staging. Moreover, little is known about long term morbidity since it is a relatively new technique. In conclusion, the development of surgical techniques has permitted to minimize deformities and the current trend is that these techniques be as conservative as possible. Thus, lymphoscintigraphy plays an important role in the identification of SLN, contributing to the prevention and minimization of postoperative complications.

Breast Cancer–Related Lymphedema: Attention to a Significant Problem Resulting From Cancer Diagnosis

Breast Cancer–Related Lymphedema: Attention to a Significant Problem Resulting From Cancer Diagnosis