Unilateral Lymphedema Research Articles

Diagnosis of filariasis: A case report of a reemerging neglected tropical disease

Filariasis is a neglected tropical disease (NTD) of humans caused by the helminthic filarial species Wuchereria (W.) bancrofti, Brugia (B.) timori, and B. malayi. Diverse species of mosquitoes transmit the microfilariae of these worms to cause filaria infection, with the disease presenting classical clinical manifestations such as lymphedema, adenolymphangitis, and hydrocele, which result in permanent disfigurement and psychosocial and economic stigmatization. These sequelae necessitate the need for proper identification and characterization of the etiological agent for therapy and prevention. In this study, we report a case of unilateral lymphedema in a 28-year-old gateman/farmer from the Sabon Gari Local Government Area of Kaduna State, Northern Nigeria. Microscopy of the patient’s blood sample demonstrated the presence of microfilariae, leading to PCR characterization to be W. bancrofti. Upon diagnosis, the patient was treated with tablets of doxycycline 200 mg daily and albendazole 200 mg bid for six weeks, followed by a single dose of ivermectin 150 mg/kg (15 mg) at the 4th week of initiating treatment. This treatment regimen was complemented by a combination of bed rest, use of compression bandage, and limb elevation at night, resulting in remarkable improvement of the patient’s health after six weeks. In conclusion, lymphatic filariasis diagnosis was microscopically confirmed by the demonstration of microfilaria in the blood film obtained at night, leading to molecular characterization by PCR to be W. bancrofti. This is a workup for treating filarial infections in patients with unilateral leg swelling and a history of living in or traveling to endemic areas. This should also be a wake-up call to policymakers and practitioners regarding the possible recrudescence of filariasis in Nigeria.

Leg Edema Unveiled: The Uncommon Culprit of Follicular Lymphoma

Follicular Lymphoma is a type of Non-Hodgkin's Lymphoma. It is defined as a lymphoma of germinal center B cells and a complex disease involving genetic and epigenetic mutations of Follicular B cell. Some of the commonly known alterations are cell in BCL-2 oncogene and somatically mutated genes. Follicular Lymphoma is the second most prevalent malignancy in the west accounting for about 10-20% of all lymphomas although an alarming rise has been seen in Pakistan as well. A lot of diagnostic challenges are being faced as this disease is indolent and presents atypical features. An effective treatment regime for follicular lymphoma fluctuates depending on the extent of disease and the medical history of the patient. Various methods are available for the risk assessment of the disease. Radiotherapy, rituximab monotherapy or combination therapy are the first line of treatment for restricted spread for follicular lymphoma. For aggressive stage of disease is managed with disease surveillance with imaging and rituximab is given in low grade tumors while chemotherapy and along with immunotherapy is the choice of treatment in high grade tumors. We report a patient here who presented with gross and progressing edema of the right lower limb that started in the foot and progressed proximally up to the thigh. Literature shows that unilateral lymphoedema could be an initial symptom of malignancy and is more common in woman than in males so must be sought as a potential diagnosis.

Association of Lower Extremity Lymphedema and Nonmelanoma Skin Cancers

ObjectiveTo determine whether patients with lymphedema of a lower extremity (LE) had a greater risk of skin cancer than those without lymphedema. Patients and MethodsThis retrospective cohort study included patients with LE lymphedema examined at Mayo Clinic in Rochester, MN, USA, from January 1, 2000, through December 31, 2020. All patients with the phrase “lower extremity lymphedema” and a diagnostic code for lymphedema present in their electronic health record, as well as their age-, race-, and sex-matched controls without lymphedema, were included in the study. A Kaplan-Meier curve was constructed to examine the time to development of the first skin cancer for the lymphedema cohort and the controls. A Cox proportional hazards regression model was used to calculate hazard ratios. ResultsIn total, 4437 patients had lymphedema within the study period. Compared with the matched control group, the lymphedema group had a significantly increased risk of skin cancer. For the subset of patients with unilateral lymphedema, the lymphedematous extremity was 2.65 times as likely as the nonlymphedematous LE to have skin cancer, particularly basal cell carcinoma. ConclusionLower extremity lymphedema appears to be a risk factor for squamous cell carcinoma, basal call carcinoma, and as expected, angiosarcoma. Clinicians caring for patients with LE lymphedema should be aware of this increased risk and monitor at-risk patients accordingly.

Technical aspects and validation of custom digital algorithms for hand volumetry.

Establishing baseline measurements on normative data is essential to evaluate standards of care and the impact of clinical or surgical treatments. Hand volume determination is relevant in pathological conditions where the anatomical structures might undergo modifications like post-treatment chronic edema. For example, one of the consequences of breast cancer treatment is the possibility of developing uni-lateral lymphedema on the upper limbs. Arm and forearm volumetrics are well-studied techniques, whereas hand volumetry computation poses several challenges both from the clinical and digital perspectives. The current work has explored routine clinical and customized digital methodologies for hand volume appraisal on healthy subjects. Clinical hand volumes computed by water displacement or circumferential measurements were compared to digital volumetry calculated from 3D laser scans. Digital volume quantification algorithms exploited the gift wrapping concept or cubic tessellation of acquired 3D shapes. This latter digital technique is parametric, and a calibration methodology to define the resolution of the tessellation has been validated. Results on a group of normal subjects demonstrated that the volumes computed from digital hand representations extracted by tessellation return values similar to the clinical water displacement volume assessment at low tolerances. The current investigation suggested that the tessellation algorithm could be considered a digital equivalent of water displacement for hand volumetrics. Future studies are needed to confirm these results in people with lymphedema.

WTP1.6 Unmask Latent Lymphoedema through bipedal Lymphoscintigraphy

Abstract Aim Lymphoscintigraphy (LSG) is the gold standard investigation in Lymphoedema. The study aimed to determine the presence of Latent Lymphoedema (LL) in the unaffected limb when a patient presents with unilateral lymphoedema. Methods All new and follow up patients seen in the Lymphoedema clinic between the January and May 2023 by either a vascular consultant or a lymphoedema nurse were included in the study. Their electronic patient records were retrospectively reviewed. Clinical presentation and findings were compiled from clinic letters and if the signs and symptoms were suggestive of lymphoedema they were then offered an LSG scan. Protocol involved determining the uptake of nano colloid tracer at the ilio-inguinal lymph nodes 2 hours post subcutaneous injection in the 1st web space of each foot. Quantitative uptake of < 8% at 2 hours was considered abnormal. Results 114 patients with a median age of 63.2 (Range 24-83) were seen in the Lymphoedema clinic. Of those, 62 patients had LSG scans. About 37% (n = 23) patients presented with unilateral swelling of lower limb. On LSG scan they had average uptake of 1.6 1.6% in the clinically affected limb. However 57% (n = 13) of these patients had an average of 2.7 2 % uptake in the unaffected Ilio-inguinal lymph nodes, unmasking latent Lymphoedema on that side. Conclusion Presence of lymphatic dysfunction on the unaffected limb should be considered as unmasking of LL. This will allow initiation of preventative measures to prevent development of gross disease in future.

Lymphatic Vascular Insufficiency and Focal Edema in Early Stages of Noncancer-Related Lymphedema.

Introduction: Lymph flows along the lymphatics due to spontaneous contraction. However, injury and inflammation may deteriorate lymphatic' s endothelial and muscle cells and valves. In consequence, lymphatic vessels (LVs) become insufficient. Their contraction strength and rate slow down, and then lymph flow stops. Our study aimed to investigate the changes in lymph flow in early lymphedema cases. Methods and Results: In 36 patients with unilateral lymphedema stages 0 and I, we performed indocyanine green (ICG) lymphography, lymphoscintigraphy, skin water concentration, and stiffness measurement. We compared lymph flow velocity, LVs' appearance, contraction pattern, and rate between swollen and healthy limbs. ICG lymphography revealed (1) slower lymph flow after 3 minutes of foot movement; in lower calf level, lymphatics are seen in 22 (61.1%) swollen limbs compared with 36 (100%) healthy limbs (p < 0.0001); (2) dye spots in the foot (47.1%) and calves (13.9%) in swollen limbs; (3) dilated foot (41.7%) and calves' lymphatics (52.8%); (4) different patterns of lymphatics contractility with slower contractions rate and (5) higher fluorescent intensity in edema limbs. There was higher skin water concentration at foot and ankle level and higher skin stiffness in the foot. Conclusions: Our studies have shown the distortion in lymphatic function as dilatation, slower lymph flow, slower contraction rate, presence of areas with occluded lymphatics (dermal backflow in foot and calves-focal edema), and higher skin water concentration in these regions in limbs with early lymphedema. ICG lymphography can be used for the early detection of LV insufficiency, which allows early prophylactic implementation.

Unilateral lymphoedema after a second dose of BNT162b2 COVID-19 mRNA vaccine.

Unilateral lymphoedema after a second dose of BNT162b2 COVID-19 mRNA vaccine.

Comparison of the Effectiveness of Liposuction for Lower Limb versus Upper Limb Lymphedema

Liposuction is the most frequently performed debulking procedure in patients with lymphedema. However, it remains uncertain whether liposuction is equally effective for upper extremity lymphedema (UEL) and lower extremity lymphedema (LEL). In this study, we retrospectively compared the effectiveness of liposuction according to whether it was performed for LEL or UEL, and identified factors associated with outcomes. All patients had been treated at least once by lymphovenous anastomosis or vascularized lymphatic transplant before liposuction but without sufficient volume reduction. The patients were divided into an LEL group and a UEL group, and then subdivided further according to whether they completed their planned compression therapy into an LEL compliance group, an LEL non-compliance group, a UEL compliance group, and a UEL non-compliance group. The reduction rates in LEL (REL) and in UEL (REU) were compared between the groups. In total, 28 patients with unilateral lymphedema were enrolled (LEL compliance group, n = 12; LEL non-compliance group, n = 6; UEL compliance group, n = 10; UEL non-compliance group, n = 0). The non-compliance rate was significantly higher in the LEL group than in the UEL group (p = 0.04). REU was significantly higher than REL (100.1 ± 37.3% vs. 59.3 ± 49.4%; p = 0.03); however, there was no significant difference between REL in the LEL compliance group (86 ± 31%) and REU in the UEL group (101 ± 37%) (p = 0.32). Liposuction seems to be more effective in UEL than in LEL, probably because the compression therapy required for management after liposuction is easier to implement for UEL. The lower pressure and smaller coverage area required for postoperative management after liposuction in the upper limb may explain why liposuction is more effective in UEL than in LEL.

Ankylosing Spondylitis and Right Lower Limb Lymphoedema A Rare Association: A Case Report and Review of the Literature

Introduction: Ankylosing spondylitis or rheumatic pelvispondylitis is a chronic inflammatory rheumatism characterized by an axial localization predominantly in the spine and sacroiliac joints, an involvement of the entheses and a tendency to bone ankylosis by ossification of these entheses. We report an observation of right lower limb lymphedema associated with ankylosing spondylitis. Observation: This was a 63-year-old patient with a history of inflammatory rheumatism (his older sister) and osteoporosis (his mother), He was diagnosed with ankylosing spondylitis based on enthesis involvement (bilateral tilted gluteal pain and low inflammatory back pain) with a positive HLA-B27 antigen by the 8-point Amor criteria for spondyloarthritis (right unilateral sacroiliitis, low inflammatory back pain, bilateral tilted gluteal pain, HLA-B27+ and NSAID sensitivity). The unilateral lymphedema with positive Stemmer's sign affected the lower 2/3 of the right lower limb. It occurred one year after the onset of ankylosing spondylitis. The echo-Doppler scan showed no signs of thrombosis or venous infiltration of the lower limbs, and diffuse infiltration of the subcutaneous tissue of the right leg without inflammatory character. Treatment of ankylosing spondylitis gradually improved the lymphedema. Conclusion: Lymphedema is a rare complication of ankylosing spondylitis. Dermatologists should be alert to early swelling of the extremities in patients with ankylosing spondylitis so as not to delay specific multidisciplinary treatment and measures to avoid irreversible lymphatic damage.

The effect of complex decongestive therapy on spatio-temporal parameters and balance in women with breast cancer-related upper extremity unilateral lymphedema

BackgroundThe aim of this study was to investigate the effect of complex decongestive therapy on spatio-temporal parameters and balance in individuals with breast cancer-related upper extremity unilateral lymphedema. MethodsThe study was designed as a prospective, cross-sectional study. Thirty sessions of complex decongestive therapy were applied. Participants' pre-and post-treatment spatio-temporal parameters and balance parameters were evaluated with the Win Track platform. In addition, the Timed Up and Go test was used to evaluate the dynamic balance. Plethysmography, a water displacement method, was used to measure upper extremity volume. FindingsSignificant improvement was observed in limb volume asymmetry after complex decongestive therapy. While the stride length of the affected side was 409.93 mm before the treatment, it increased to 500.93 mm after the treatment, and a significant increase was observed (p = 001). Significant improvements were found in the other spatio-temporal parameters of the participants. Compared to the pre-treatment, a significant decrease was detected in the average cadence value, Timed Up and Go value, double stance time, and maximum plantar pressure point of the participants. Significant improvements were found in the participants' balance. InterpretationComplex decongestive therapy applied to individuals with unilateral upper extremity lymphedema provides significant improvement in both spatio-temporal and balance parameters. However, we recommend complex decongestive therapy as an effective and safe treatment to reduce the volume of lymphedema. Patients with unilateral lymphedema that may cause postural asymmetry should be informed about balance and gait disturbance and should be encouraged to receive lymphedema treatment as soon as possible.

THROMBOCYTOPENIA, HYPOGAMMAGLOBULINEMIA, AND POOR VACCINE RESPONSE IN A PATIENT WITH TAKENOUCHI-KOSAKI SYNDROME

<h3>Introduction</h3> Takenouchi-Kosaki Syndrome (TKS) is a rare congenital developmental disorder characterized by thrombocytopenia, facial abnormalities, and varied multisystemic anomalies including immunodeficiency. Heterozygous deficiency of CDC42, an intracellular signaling GTPase, has been found in all TKS patients described to date. The immunological phenotypes of TKS patients are heterogeneous: recurrent infections have been noted in some patient series but with variable penetrance. Herein we describe a case of TKS causing hypogammaglobulinemia, B-cell lymphopenia, and poor vaccine response. <h3>Case Description</h3> A fifteen-year-old girl with history of developmental delay, multiple congenital defects, and lymphedema was referred to the immunology clinic for evaluation of recurrent ear infections that began at 3 months of age requiring tympanostomy tube placement at 18 months. Her physical exam was notable for abnormal facies, scoliosis, strabismus, abnormal thumbs, and unilateral lymphedema. Her laboratory evaluation revealed macrothrombocytopenia, mild leukopenia with low T-cells and markedly low B-cells by flow cytometry, and notably low IgA (11.7, RR 69 – 309) and IgG (423, RR 613 – 1295). She had a poor response to a full course of PCV7 with PPSV23 booster (9 of 23 > 1.3). Whole exome sequencing identified a heterozygous p.Y64C mutation in CDC42 consistent with TKS. <h3>Discussion</h3> The Y64C mutation in CDC42 is a TKS Group I lesion causing ineffective intracellular signaling, resulting in <i>in vitro</i> defects including abnormal cellular proliferation and disruption of cell polarity. Actin remodeling disorders such as Wiskott-Aldrich Syndrome and TKS should be considered in patients with immunodeficiency and congenital thrombocytopenia.

Deep learning-based quantitative estimation of lymphedema-induced fibrosis using three-dimensional computed tomography images

In lymphedema, proinflammatory cytokine-mediated progressive cascades always occur, leading to macroscopic fibrosis. However, no methods are practically available for measuring lymphedema-induced fibrosis before its deterioration. Technically, CT can visualize fibrosis in superficial and deep locations. For standardized measurement, verification of deep learning (DL)-based recognition was performed. A cross-sectional, observational cohort trial was conducted. After narrowing window width of the absorptive values in CT images, SegNet-based semantic segmentation model of every pixel into 5 classes (air, skin, muscle/water, fat, and fibrosis) was trained (65%), validated (15%), and tested (20%). Then, 4 indices were formulated and compared with the standardized circumference difference ratio (SCDR) and bioelectrical impedance (BEI) results. In total, 2138 CT images of 27 chronic unilateral lymphedema patients were analyzed. Regarding fibrosis segmentation, the mean boundary F1 score and accuracy were 0.868 and 0.776, respectively. Among 19 subindices of the 4 indices, 73.7% were correlated with the BEI (partial correlation coefficient: 0.420–0.875), and 13.2% were correlated with the SCDR (0.406–0.460). The mean subindex of Index 2 left( {frac{{P_{Fibrosis, in, Affected} - P_{Fibrosis, in, Unaffected} }}{{P_{Limb, in, Unaffected} }}} right) presented the highest correlation. DL has potential applications in CT image-based lymphedema-induced fibrosis recognition. The subtraction-type formula might be the most promising estimation method.

Identification of lymph vessels using an indocyanine green camera-integrated operative microscope for lymphovenous anastomosis in the treatment of secondary lymphedema

ObjectiveLymphedema is a debilitating disease that impairs a patient’s quality of life. Although lymphovenous anastomosis (LVA) can cure lymphedema, successful LVAs rely on the precise identification of the lymph vessels. In the present study, we assessed the use of a near-infrared camera-integrated operating microscope for preoperative mapping of the lymphatic vessels and evaluated the outcome of LVAs in patients with secondary lymphedema of a limb. MethodsWe retrospectively reviewed patients with secondary unilateral lymphedema who had undergone LVA surgery with the lymph vessels identified using a near-infrared camera-integrated operating microscope (Moller 3-1000; Möller-Wedel Optical GmbH, Wedel, Germany) between 2020 and 2021. The lymph vessels identified using near-infrared fluorescence lymphography, diameter of the vessels used for anastomosis, anastomosis configuration, and perioperative limb circumference were recorded. ResultsOverall, 35 LVAs were performed in six patients with secondary lymphedema, with a mean number of 5.8 LVAs per limb. The anastomotic configurations were end-to-end in 26 LVAs, side-to-end in 2 LVAs, and end-to-side in 7 LVAs. The diameter of the lymph vessels ranged from 0.3 to 0.9 mm (mean, 0.62 ± 0.18 mm) and that of the vein from 0.4 to 1.2 mm (mean, 0.75 ± 0.21 mm). The changes in the lymphedema index and estimated limb volume indicated a postoperative decrease in edema. ConclusionsWe found a near-infrared camera-integrated operating microscope useful for the preoperative identification of functional lymph vessels. Our results have shown that microsurgical LVAs can be performed using an integrated indocyanine green camera without an independent indocyanine green detector.

Rate of Incidental Edema in the Contralateral Arm of Patients with Unilateral Postsurgical Secondary Upper Extremity Lymphedema.

Background: Secondary upper extremity lymphedema occurs after an insult such as surgery. One theory suggests underlying lymphatic dysfunction predisposing certain patients into developing secondary lymphedema. We aim to determine the rate of incidental edema in the contralateral upper extremity of patients with secondary unilateral lymphedema. Methods and Results: MRI of the upper extremities were obtained in patients with lymphedema who were referred by a lymphedema clinic from 2017 to 2019. Axial short-tau inversion recovery MR images of the symptomatic and contralateral arms were retrospectively reviewed and edema severity was graded. Interobserver agreement was calculated. Indocyanine green (ICG) lymphography was compared against MRI stage in symptomatic and contralateral. Age, symptom duration, body mass index (BMI), and history of chemotherapy were compared between patients with and without contralateral limb lymphedema. ICG severity was compared against MRI stage. Seventy-eight patients were analyzed. The MRI stages of symptomatic versus contralateral arms were 1.7 ± 1.1 versus 0.1 ± 0.4 (p < 0.00001). Interobserver agreement was 0.86 (0.79-0.94). Of the patients with MRI Stage 1 or above in the symptomatic arm (n = 64), 55 (82.1%) patients demonstrated no abnormality in the contralateral arm. Nine patients (14.1%) demonstrated asymptomatic edema (MRI Stage 1). The mean ICG lymphography stage of symptomatic versus contralateral arms was 1.83 ± 0.96 versus 0.04 ± 0.25 (p < 0.00001). There was no difference in the age, symptom duration, BMI, or history of chemotherapy between patients with or without edema in the contralateral arm. Conclusion: Asymptomatic contralateral edema was detected in 14.1% of patients with unilateral secondary upper extremity lymphedema using MRI modality.

Virtual reality balance training versus core stability exercises on balance in patients with unilateral lymphedema

Purpose: The purpose of this study is to compare the effects between Wii fit balance board and core stability exercises on balance dysfunction in patients with unilateral lymphedema. Method: Sixty patients (women) aged 40-60 years with grade 1 or 2 lymphedema were randomly assigned into the following two groups. Group A received the Wii fit balanced exercises for three times per week for four weeks as total treatment duration in form of (Ski Slalom, Advanced Skiing, Ski Jumping followed by Header and Jump Rope).; Group B received core stability exercises for 4 weeks (3times/week) in form of {1- Abdominal bracing (10 repetitions x10 second holds), 2- Curl up (3 sets x 10 repetitions), 3- Supine bridge (3 sets x 10 repetitions), 4- Supine unilateral bridge (3 sets x 10 repetitions for each leg), 5- Plank (3 sets x 10 repetitions) and 6- Bird dog (3 sets x 10 repetitions for each limb)}. Balance was determined using time up and go (TUG) and Wii fit results by using the Wii fit balance board. Balance was measured before and 4 weeks after the treatment program.

Alt Ekstremite Lenfödem Hastalarında Kinezyofobi, Fiziksel Performans ve Denge Arasındaki İlişki

Purpose: Lymphedema is an important situation that causes physical and psychological life-threatening problems. This study researches kinesiophobia in lower extremity patients and scrutinizes the relationship between kinesiophobia, physical performance and balance.&#x0D; Methods: This cross-sectional controlled study included 40 individuals diagnosed with lower extremity lymphedema with a mean age of 42.58±10.30 years and 31 healthy individuals with a mean age of 40.65 ± 9.53 years. The evaluation of patients with unilateral lymphedema without cognitive and visual problems and those without orthopedic and neurological disorders that would prevent walking and those without heart disease and hypertension was carried out between November 2018 and March 2019. Static balance was evaluated with standing on One leg Balance Test, fear of movement was evaluated with Tampa Scale Kinesiophobia and functional levels were evaluated with Timed Up and Go test. &#x0D; Results: Static balance and physical performance of lower extremity lymphedema patients were found to be statistically different than healthy individuals (p

Relationship between lymphedema after breast cancer treatment and biophysical characteristics of the affected tissue.

The treatment of breast cancer is often complicated by lymphedema of the upper limbs. Standard lymphedema evaluation methodologies are not able to measure tissue fibrosis. The ultrasound aspects related to tissue microstructures of lymphedema are neglected in clinical evaluations. The objective of this study was to identify and measure the degree of impairment, topography, and biophysical alterations of subcutaneous lymphedema tissue secondary to the treatment of breast cancer by ultrasonography. Forty-two women at a mean age of 58 (±9.7) years, with unilateral lymphedema due to breast cancer treatment, were evaluated. The upper limbs were divided into affected (affected by lymphedema) and control (contralateral limb). Each limb was subdivided into seven areas, defined by perimetry, evaluated in pairs. The biophysical characteristics thickness, entropy, and echogenicity were evaluated by ultrasonography. The results showed a significant difference in the echogenicity and thickness variables between the affected and unaffected upper limb, in all the extent of the upper limb, while entropy showed no significant difference. The findings indicate that the data presented were consistent both in identifying and measuring the degree of impairment and biophysical changes in the subcutaneous tissue of lymphedema secondary to the treatment of breast cancer.

Recovery of Dysregulated Genes in Cancer-Related Lower Limb Lymphedema After Supermicrosurgical Lymphaticovenous Anastomosis - A Prospective Longitudinal Cohort Study.

PurposeThis study aims at profiling the expression of dysregulated genes in circulating monocytes of patients with cancer-related lower limb lymphedema before and after treatment with supermicrosurgical lymphaticovenous anastomosis (LVA).Materials and MethodsThis prospective longitudinal cohort study enrolled 51 women with post-treatment gynecological cancer, including those with unilateral lymphedema (study group, n = 25) and those without (control group, n = 26). Venous blood samples obtained from the study group before and after LVA and those from the controls were sent for next-generation sequencing, which was validated by real-time PCR. Dysregulated gene expression in the study group, relative to expression in the controls, was recorded before LVA. After one month, postoperative changes in the expression of the identified genes were evaluated. Protein-protein interaction (PPI) was used to investigate dysregulated genes whose expression returned to baseline levels after LVA.ResultsOf the 148 preoperative dysregulated genes, which comprised 108 up- and 40 down-regulated genes, 78 genes, consisting of 69 up- and 9 down-regulated genes, showed post-LVA recovery to baseline levels. Through PPI analysis, five functional modules involving immunity, lipid metabolism, oxidative stress, transcriptional regulators, and tumor suppression, as well as six hub genes (CCL2, LPL, PDK4, FOXO3, EGR1, and DUSP5), were identified. Cross-linking and co-regulated genes between modules were also identified.ConclusionLocalized lymphedema leads to dysregulated gene expression in circulating monocytes. The current study is the first to identify the hub genes related to lymphedema and demonstrate the recovery of some dysregulated genes after LVA.

LYMPHEDEMA DURATION AS A PREDICTIVE FACTOR OF EFFICACY OF COMPLETE DECONGESTIVE THERAPY

Lymphedema is a common condition with global impact and a multitude of complications, however, only a few professionals specialize in its management. A retrospective analysis of 105 subjects with unilateral lymphedema upper or lower limb was performed to investigate whether the duration of lymphedema constitutes an important factor associated with the efficacy of complete decongestive therapy (CDT). Subjects were classified into two groups according to the duration of lymphedema, prior to CDT: group A (≤1 year) and group B (>1 year). Both groups were treated daily according to the same CDT protocol for four weeks. The CDT efficacy was determined based on the percent reduction of excess volume (PREV) measurements. Lymphedema was significantly reduced in both groups of subjects, but significantly more in group A (p<0.001). In subjects with upper limb lymphedema, median value of PREV was 80.8% (interquartile range, 79.1-105.0%) in group A and 62.0% (interquartile range, 56.7-66.5%) in group B (p<0.001). In subjects with lower limb lymphedema PREV was 80.7% (interquartile range, 74.9-85.2%) and 64.5% (interquartile range, 56.0-68.1%) for groups A and B, respectively (p<0.001). Duration of lymphedema was found to be a strong predictive factor that may significantly impact CDT efficacy. Therapeutic effects were increased in subjects who were detected and treated earlier for lymphedema.

The Effect of Complex Decongestive Therapy on Spatio-Temporal Parameters and Balance in Women with Breast Cancer-Related Upper Extremity Unilateral Lymphedema

The Effect of Complex Decongestive Therapy on Spatio-Temporal Parameters and Balance in Women with Breast Cancer-Related Upper Extremity Unilateral Lymphedema