Academic literature on the topic 'Secondary lymphoedema'

Objective: The purpose of this prospective study was to evaluate patients with clinically diagnosed lymphoedema of the lower extremities. The proportions of primary and secondary lymphoedema, the possible aetiologic factors and the concomitance of chronic venous diseases and lymphoedema were focused on. Method: The male patients who attended our outpatient clinic during 2000 and 2004 were evaluated. In all, 160 male patients with 5 cm circumference difference at calf level between two lower extremities or with clinically diagnosed bilateral leg oedema were enrolled. All patients underwent duplex venous ultrasonography and lymphoscintigraphy. Venography was performed in 12 patients with normal lymphoscintigraphy and ultrasonography. Results: The age distribution was between 20 and 54 years (mean ± SD; 22.9 ± 4.3). Among 160 patients, 70.0% had lymphoedema, while 7.5% had chronic venous insufficiency, 3.75% chronic deep venous thrombosis, 7.5% concomitant venous disease and lymphatic obstruction, and 7.5% idiopathic oedema. In the last 3.75% the pathology was Klippel–Trenaunay syndrome. Of the primary lymphoedema patients (16.25%), 18 were praecox, six tarda and two were congenital types. Conclusion: In young male patients, the causes of secondary lymphoedema are lymphadenectomy, neoplastic metastasis, cellulitis, lymphangitis, etc. Further techniques confirmed the clinical diagnosis of lymphoedema in 77.5% (sum of lymphoedema and concomitant disease) of all patients. With these findings lymphoedema can be diagnosed clinically, and further diagnostic techniques can be reserved unless treatment is effective.

Abstract. Lymphoedema is a common and progressive disease which causes deterioration of the quality of life of patients. It is divided into two groups: primary and secondary lymphoedema. Nowadays, the majority of patients with lymphoedema are associated with a malignancy or its treatment modalities, such as cancer surgery and radiation therapy. Accurate diagnosis and effective treatment are crucial for alleviating the symptoms, preventing progression and reducing the potential risks of lymphoedema. This report provides an overview of the management of lymphoedema.

Lymphoedema is a chronic debilitating condition characterised by diffuse swelling caused by lymphatic obstruction. The secondary form of lymphoedema is more common than the primary form. Untreated filariasis remains an important cause of lymphoedema in developing countries. The most common complication of chronic lymphoedema is cellulitis. It is also a risk factor for the development of neoplasms such as lymphangiosarcoma, squamous cell carcinoma, melanoma, lymphoma and malignant fibrous histiocytoma. We report a case of a woman in her 60s who developed squamous cell carcinoma in the background of chronic lymphoedema.

Objectives To determine whether bioimpedance spectroscopy was suitable for detection of hand lymphoedema. Methods The hands of 50 participants without a history of lymphoedema were measured with perometry and bioimpedance spectroscopy after positioning two ways for three minutes: (a) both hands rested at heart height and (b) the dominant hand at heart height and the non-dominant hand at head height. In addition, 10 women with secondary hand lymphoedema were also measured. Results Impedance and volume measurements were found to be strongly related (dominant hand r = −0.794). Both measurements were reliable (ICC2,1 = 0.900–0.967 and 0.988–0.996, respectively). Impedance was more sensitive to small changes in hand volume due to the postural change (position × device interaction: F = 23.9, P < 0.001). Finally, impedance measurements had better discrimination of women with lymphoedema than volume measurements. Conclusions Bioimpedance spectroscopy is a promising tool for the detection of secondary hand lymphoedema.

Lymphoedema is a chronic problem with various skin changes that lead to impaired care for the affected limb. These skin changes also lead to recurrent infections. The difficulty in care and the subsequent neglect leads to further spread of the infection and increased risk of future infections. Prevention of infections and prevention of progress of the skin changes is one of the main components of the treatment of the lymphoedema. There are various materials available to enhance the healing of the knobs and fissures secondary to lymphoedema. We would like to present our case report on the usage of chitosan in a patient with stage 7 skin changes of lymphedema.

Purpose. To assess the quality of life (QOL) as a predictor of volume reduction in women undergoing complex physical therapy (CPT) for lymphoedema following breast cancer.Methods. Clinical trial in 57 women undergoing CPT.Results. At baseline, in measuring quality of life for the EORTC QLQ-C30 questionnaire subscale of functionality, the worst scores for emotional function (55 points) and better social function (89 points) were observed. The symptom scales showed the worst pain averaged (66 points). The overall quality of life showed a low score (40 points). In the BR 23 module, low scores were observed in the field of future perspective (47 points). After treatment of lymphoedema, absolute reduction of excess volume between the upper limbs of 282 mL was observed, representing a reduction of 15%. No association was observed between the domains of quality of life and response to treatment of lymphoedema.Conclusion. This study included 57 women with advanced and chronic lymphoedema in early treatment with CPT and low scores for quality of life. The lymphoedema therapeutic response was not influenced by the QOL at the beginning of treatment.

Secondary lymphoedema and venous oedema of the limb are the consequence of an imbalance between tissue fluid infiltrate and drainage, which leads to interstitial fluid accumulation, tissue changes, limb discomfort and morbidity. Numerous conservative therapies have been developed to address some of these negative outcomes, with a proportion of these being labour and cost intensive. This makes the investigation of cost effective and easy to implement home based regimes very important. One such therapy is limb exercise, which can be beneficial for limb oedemas through changes in both interstitial pressure and calf muscle activation. Therefore, this thesis explored the benefits of different exercise regimes for limb oedema of both lymphatic and vascular origin. This was achieved through a systematic review of existing conservative therapies for limb oedemas and four clinical trials investigating the benefits of home based exercise regimes. Results demonstrated that various positive and significant outcomes could be gained from the implementation of such regimes, including improvements in both subjective and objective parameters. These results reveal how these chronic and disabling conditions can be maintained by the patient in the home environment in between health care visits. It also demonstrates how self maintenance may alleviate the burden on the health care system.

This research provides valuable insight into exercise barriers and prescription for individuals with cancer-related lymphoedema, particularly following breast cancer. Findings from this work demonstrate that by identifying and addressing exercise barriers, exercise confidence improves and, as such, enables longer-term exercise participation. Further, the findings demonstrating similar lymphoedema-related and physical and psychosocial benefits are achieved through participation in either resistance- or aerobic-based exercise highlights that exercise programs can be individualised, taking into consideration participants' interests, without jeopardising a woman's recovery and longer-term function, health, quality of life and survival.

Lymphoedema is a chronic condition predominantly affecting the limbs, although it can involve the trunk and other areas of the body. It is characterised by swelling due to excess accumulation of fluid in body tissues. Secondary lymphoedema, which arises following cancer treatment, is the more common form of lymphoedema in developed countries. At least 20% of those diagnosed with the most common cancers will develop lymphoedema. This is a concern in Australia as incidence of these cancers is increasing. Cancer survival rates are also increasing. Currently, this equates to 9 300 new cases of secondary lymphoedema diagnosed each year. Considerable physical and psychosocial impacts of lymphoedema have been reported and its subsequent impact on health-related quality of life can exacerbate other side effects of cancer treatment. Exercise following cancer treatment has been shown to significantly reduce the impact of treatment side effects, improve quality of life and physical status. While participating in exercise does not increase risk nor exacerbate existing lymphoedema, reductions in incidence of lymphoedema exacerbations and associated symptoms have been observed in women participating in regular weight lifting following breast cancer treatment. Despite these benefits, lymphoedema prevention and management advice cautions people with lymphoedema against „repetitive use. or „overuse. of their affected arm. It is possible that this advice creates a barrier to participation in physical activity; however, little is known about the relationship between physical activity and lymphoedema. In addition, the majority of studies examining the experiences of people living with lymphoedema and the impact of the condition have been predominantly conducted internationally and have focused on women following breast cancer. This study sought to explore firstly, how men and women construct their experience of living with lymphoedema following treatment for a range of cancers in the context of everyday life in Australia; and secondly, to analyse the role of physical activity in the lives of those living with lymphoedema following cancer treatment. A social constructivist grounded theory approach was taken to explore these objectives as it is acknowledged that human actions and the meanings associated with these actions are influenced by the interaction between the self and the social world. It is also acknowledged that the research process itself is a social construction between the researcher and participant. Purposive sampling techniques were used to recruit a total of 29 participants from a variety of sources. Telephone interviews and focus groups were conducted to collect data. Data were concurrently collected and analysed and analysis was conducted using the constant comparative method. The core category that developed in objective one was „sense of self‟. The self was defined by perceptions participants held of themselves and their identity prior to a lymphoedema diagnosis and changes to their perceptions and identity since diagnosis. Three conceptual categories which related to each other and to „sense of self‟ were developed through the process of coding that represented the process of how participants constructed their experiences living with secondary lymphoedema in the context of everyday life. Firstly, altered normalcy reflected the physical and psychosocial changes experienced and the effect it had on their lives. Secondly, „accidental journey‟ reflected participants‟ journey with the heath care system prior to diagnosis through to longer term management. Thirdly, renegotiating control revealed participants perceived control over lymphoedema and their ability to participate in daily activities previously enjoyed. These findings revealed the failure of the broader health system to recognise the significant and chronic nature of a lymphoedema diagnosis following cancer treatment with greater understanding, knowledge and support from health professionals being needed. The findings also reveal access to health professionals trained in lymphoedema management, a comprehensive approach encompassing both physical and psychosocial needs and provision of practical and meaningful guidelines supported by scientific evidence would contribute to improved treatment and management of the condition. The key findings for objective two were that people with lymphoedema define physical activity in different ways. Physical activity post-diagnosis was perceived as important by most for a variety of reasons ranging from everyday functioning, to physical and psychosocial health benefits. Issues relating to the impact of lymphoedema on physical activity related to the impact on peoples‟ ability to be physically active, confusion about acceptable forms of physical activity and barriers that lymphoedema presented to being physically active. A relationship between how people construct their experiences with lymphoedema and the role of physical activity was also established. The contribution of physical activity to the lives of people living with lymphoedema following cancer treatment appeared to be influenced by their sense of self as socially constructed through their experiences prior to diagnosis and following diagnosis with lymphoedema. The influence of pre-lymphoedema habits, norms and beliefs suggests the importance of effective health promotion messages to encourage physical activity among the general population and specific messages and guidelines particular to the needs of those diagnosed with lymphoedema following cancer treatment. The influence of participant.s social constructions on the lymphoedema experience highlights the importance of improving interactions between the overall health care system and patients, providing a clear treatment plan, providing evidence-based and clear advice about participation in appropriate physical activity, which in doing so will limit the physical and psychosocial effect of lymphoedema and providing comprehensive physical and psychosocial support to those living with the condition and their families. This study has contributed to a deep understanding of people.s experiences with lymphoedema following cancer treatment and the role of physical activity in the context of daily life in Australia. Findings from this study lead to recommendations for advocacy, a comprehensive approach to diagnosis, treatment and management, and specific areas for future research.

Magister Curationis - MCur
In this minithesis a systematic review of all of the available contemporary literature on post-breast cancer lymphoedema was undertaken. The purpose of this systematic review was to search for, collate, synthesize and thereby provide the reader with a comprehensive, evidence-based account of all the available research published between 1988 and 2008 on the treatment of post-breast cancer lymphoedema with natural medicine.Because the large number of articles published every year across a plethora of biomedical journals makes it incredibly difficult for practitioners to keep up-to-date within their specialized areas, systematic reviews are particularly useful as they summarize high quality, contemporary scientific knowledge on a topic in one place (Antman, Lau, Kupelnik, Mosteller & Chalmers, 1992). One such topic on which many health practitioners have a paucity of information regarding management and risk reduction is lymphoedema (Radina, Armer, Culbertson & Dusold,2004) The primary objective of this research project was to assess the effects of natural medicine on post-breast cancer lymphoedema in regard to 1) life style improvement including any signs and symptoms related to the condition such as heaviness, tightness, pain, ache, itch, mobility of the affected arm, skin texture as well as psychological symptoms like distress;2) arm volume changes of the affected limb; 3) adverse effects; and 4) modification or cessation of treatment.Several online databases were searched for articles that contain the term lymphoedema, lymphedema, limb swelling or "linfedema" (Spanish and Portuguese); thereby including all possible spellings in English, Spanish and Portuguese. Relevant information was extracted and recorded in tabular format. The quality of each study was analysed using a checklist,which was drawn up by the primary researcher and study supervisor based on the CONSORT guidelines (Altman, 1996).To ensure quality, only randomized controlled trials, quasi-randomized controlled trials or clinical trials that met the inclusion or exclusion criteria, reporting benefits or adverse effects of natural medicines for the treatment of post-breast cancer lymphoedema were included. In addition,studies had to focus on natural medicine versus placebo or routine treatment or no treatment as types of intervention; and participants had to include women of all ages that had been diagnosed with post-breast cancer lymphoedema.The relevant data from included studies was entered into Review Manager 5 (Revman 5) software for meta-analysis. The primary studies included in this systematic review generally suffered from small sample sizes, varied somewhat in their operationalisation of outcomes and the format for presenting results, making meta-analysis very difficult. However, results suggest that sodium selenite taken orally and CYCLO 3 FORT also taken orally are effective in the reduction of limb volume. The results also suggested that aromatherapy using an intervention cream containing wheat germ oil and essential oils of fennel, sage, geranium, black pepper and juniper; and vitamin E plus pentoxifylline taken orally are not effective.Seeing as these results are drawn from single studies with heterogeneous outcome variables, they should be seen as tentative until they are confirmed by replication. Gaps in the literature regarding natural medicine as a treatment for post-breast cancer lymphoedema were identified, and recommendations for further research are proposed.