Effects of Alexithymia to Stigma of Patients with Lymphedema

BACKGROUND: Secondary lymphedema is one of the common complications after malignant tumor surgery. It is a chronic and complex disease. Once lymphedema occurs, there will be discomfort such as limb swelling, pain, numbness and tension, which will eventually lead to changes in the appearance of the affected limb and will seriously affect the quality of life and require lifelong treatment and psychosocial support. This study investigated the current situation of stigma and alexithymia in patients with lymphedema, and discussed the impact of alexithymia on stigma in patients with lymphedema. AIMS: To understand the current situation of stigma and alexithymia in patients with lymphedema, and to analyze the influence of alexithymia on stigma. METHODS: 195 patients with lymphedema in a hospital were selected by convenient sampling. General information questionnaire, Toronto Alexithymia Scale and social impact scale were used to investigate respectively, to study the general situation, stigma and alexithymia of the respondents. RESULTS: The results showed that the total score of stigma in 195 patients with lymphedema was (60.36 ± 11.08), and the total score of alexithymia was (56.53 ± 8.43). Multiple linear regression analysis showed that alexithymia and family relationship were the influencing factors of stigma in patients with lymphedema. CONCLUSIONS: The patients with lymphedema have obvious stigma, and alexithymia and family relationship are the influencing factors.

Management of lymphedema is really a matter in patients with breast cancer

Lymphedema is a prevalent complication affecting patients with breast cancer,greatly impacting their quality of life.This editorial describes diagnostic methods and therapeutic interventions for managing lymphedema in patients with breast cancer.Diagnosis relies on clinical evaluation and objective measures,including arm circumference and volumetric assessments,along with lymphoscintigraphy and ultrasonic measurements.Treatment primarily involves complex decongestive physical therapy,comprising manual lymphatic drainage,compression therapy,exercise,and meticulous skin care.These interventions aim to reduce swelling,alleviate discomfort,and prevent further complications.Additionally,lifestyle modifications such as avoiding extreme temperatures and maintaining proper hygiene are essential.Flavonoids can be used for drug therapy.Despite its prevalence,lymphedema often receives inadequate attention in clinical practice,emphasizing the importance of raising awareness and enhancing medical services for affected individuals.Clinicians play a pivotal role in educating patients about preventive measures and ensuring timely intervention.Overall,a comprehensive approach encompassing early diagnosis,multidisciplinary management,and patient education is essential to mitigate the burden of lymphedema in patients with breast cancer and improve their overall well-being.

Tuberous sclerosis complex combined with primary lymphedema:A case report

BACKGROUND Tuberous sclerosis complex(TSC)and primary lymphedema(PLE)are both rare diseases,and it is even rarer for both to occur in the same patient.In this work,we have provided a detailed description of a patient's clinical presentation,imaging findings,and treatment.And a retrospective analysis was conducted on 14 published relevant case reports.CASE SUMMARY A 16-year-old male came to our hospital for treatment due to right lower limb swelling.This swelling is already present from birth.The patient’s memory had been progressively declining.Seizures had occurred 1 year prior at an unknown frequency.The patient was diagnosed with TSC combined with PLE through multimodal imaging examination:Computed tomography,magnetic resonance imaging,and lymphoscintigraphy.The patient underwent liposuction.The swelling of the patient's right lower limb significantly improved after surgery.Epilepsy did not occur.after taking antiepileptic drugs and sirolimus.CONCLUSION TSC with PLE is a rare and systemic disease.Imaging can detect lesions of this disease,which are important for diagnosis and treatment.

The Risk Factors of Lymphedema in Breast Cancer Patients Post Axillary Clearance

Introduction: Breast cancer is the number one malignancy affecting females in Saudi Arabia with a prevalence of 22.4%. Breast cancer incidence increases annually due to the aid of established screening programs, leading to the discovery of breast cancer in its early stages. Surgical treatment is an integral part of early breast cancer management to achieve local control. Axillary surgical interventions such sentinel lymph node biopsy (SLNB) and axillary lymph node clearance (ALND) aim to stage the axilla as an adjunct to the management of the primary breast tumor. In this paper, we reviewed female breast cancer patients aged 30 - 60 who underwent surgical treatment of SLNB and/or ALND with reporting the prevalence of lymphedema and other associated complications and risk factors. Methodology: A cross-sectional non-interventional study, with a sample size of 250 including breast cancer cases from 2016 to 2019 at National Guard Hospital (NGH) in Jeddah, Saudi Arabia. Results: A total of 253 breast cancer cases were included in this study, with a mean age of 53 years, 52.7% were postmenopausal and positive family history was present among 21% of cases. Further, 90.9% of the cases had unilateral disease. Staging was as follows: stage I 14.5%, stage II 45.2%, stage III 37.1%, and stage IV 3.2%. Mastectomy was done in 73.4% cases and lumpectomy was performed in 34.1% of cases. In addition, 93.3% of patients had SLNB and 49% of them were positive. Axillary dissection was performed in 69.6% of our patients. Radiotherapy and chemotherapy were given to 71.8% and 80.4% of cases respectively. Among the chemotherapy (chemo) recipients, 40.2% received adjuvant chemo, 54.5% received neoadjuvant chemo, and the remaining 5.3% received both. Further, the most prevalent complication was pain accounting for 42.1% of total complications, and the least prevalent was cellulitis 4%. Also, seroma developed in 18.3% cases, paresthesia noted in 5.6% of cases, winged scapula was reported as 2%, weakness and necrosis were seen in 6% and 13.1% of cases respectively. Axillary vein thrombosis and lymphangiosarcoma were reported in none of the patients (0%). Lymphoedema accounted for 16.1% of overall complications, 85% of the patients who developed lymphedema had undergone ALND, and 12.9% and 14.4% received radiotherapy and chemotherapy respectively. Lymphedema was observed in breast cancer stages as follows: stage I 1.2%, stage II 7.2%, and stage III 5.2%. Patients with body mass index (BMI) of 30 - 39 kg/m2 had 7.2% prevalence of lymphedema compared to other BMI groups. Overall mortality was 8.3%. Conclusion: The findings of our study suggest that the prevalence of lymphedema was higher in ALND patients with locally advanced tumors, and higher BMI, compared to patients with stage I breast cancer and low BMI. Further, the prevalence of lymphedema in patients who underwent ALND was significantly lower than those who were treated by lumpectomy 10.3% (p-value = 0.034) in comparison to mastectomy 19.3%.

Breast cancer-related lymphedema:A literature review for clinical practice

Lymphedema is the swelling of soft tissues as a result of the accumulation of protein-rich fluid in extracellular spaces.Secondary lymphedema is precipitated by an event causing blockage or interruption of the lymphatic vessels.Secondary lymphedema is a potential complication that may affect the quality of life of patients treated for breast cancer.Lifelong risk factors of post-breast cancer lymphedema are related to the extent of axillary node involvement,type of breast surgery,and radiation therapy.These factors decrease lymphatic drainage and increase stasis of fluids in the areas of skin and subcutaneous tissues that drain to regional lymph nodes.Breast cancer-related lymphedema can involve the arm and hand,as well as the breast and trunk on the operative side.Clinical symptom assessment and circumferential measures are widely used to evaluate lymphedema.Treatment of lymphedema associated with breast cancer can include combined modality approaches,compression therapy,therapeutic exercises,and pharmacotherapy.

Breast cancer-related lymphedema: Symptoms, diagnosis, risk reduction, and management

The global burden of breast cancer continues to increase largely because of the aging and growth of the world population. More than 1.38 million women worldwide were estimated to be diagnosed with breast cancer in 2008, accounting for 23% of all diagnosed cancers in women. Given that the 5-year survival rate for breast cancer is now 90%, experiencing breast cancer is ultimately about quality of life. Women treated for breast cancer are facing a life-time risk of developing lymphedema, a chronic condition that occurs in up to 40% of this population and negatively affects breast cancer survivors' quality of life. This review offers an insightful understanding of the condition by providing clinically relevant and evidence based knowledge regarding lymphedema symptoms, diagnosis, risk reduction, and management with the intent to inform health care professionals so that they might be better equipped to care for patients.

A scoring system for predicting the risk of breast cancer-related lymphedema

Objective:We aimed to establish a scoring system to predict the risk of breast cancer-related lymphedema.Methods:From April 2017 to December 2018,533 patients who previously underwent surgery for breast cancer were enrolled in this cross-sectional study.Univariate analysis was performed to explore and define the risk factors.A scoring system was then established on the basis of odds ratio values in the regression analysis.Results:The additive scoring system values ranged from 6 to 22.The receiver operating characteristic(ROC)curve of this scoring system showed a sensitivity and specificity of 83.3%and 57.3%,respectively,to predict the risk of lymphedema at a cut-off of 15.5 points;the area under the curve was 0.736(95%confidence interval:0.662-0.811),with x2=5.134(P=0274)for the Hosmer-Lemeshow test.Conclusions:The predictive efficiency and accuracy of the scoring system were acceptable,and the system could be used to predict and screen groups at high risk for breast cancer-related lymphedema.

Application and prospect of adipose stem cell transplantation in treating lymphedema

BACKGROUND Lymphedema is a chronic,debilitating and incurable disease that affects 0.13%-2%of the global population.Emerging evidence indicates that adipose-derived stem cells(ADSCs)might serve as suitable seed cells for lymphatic tissue engineering and lymphedema therapy.AIM To summarize applications of ADSCs for treating lymphedema in both animal studies and clinical trials.METHODS A systematic search was performed on four databases-PubMed,Clinicaltrials.gov,the evidence-based Cochrane Library,and OVID-using the following search string:(“lymphedema”or“lymphoedema”or“lymphangiogenesis”)and(“adipose-derived stem cells”or“adipose-derived stromal cells”or“adipose-derived regenerative cells”).A manual search was performed by skimming the references of relevant studies.Animal studies and clinical trials using adipose-derived cells for the treatment of any kind of lymphedema were included.RESULTS A total of eight research articles published before November 2019 were included for this analysis.Five articles focused on animal studies and another three focused on clinical trials.ADSC transplantation therapy was demonstrated to be effective against lymphedema in all studies.The animal studies found that coadministration of ADSCs and controlled-release vascular endothelial growth factor-C or platelet-rich plasma could improve the effectiveness of ADSC therapy.Three sequential clinical trials were conducted on breast cancer-related lymphedema patients,and all showed favorable results.CONCLUSION ADSC-based therapy is a promising option for treating lymphedema.Large-scale,multicenter randomized controlled trials are needed to develop more effective and durable therapeutic strategies.

Adipose-derived stem cell therapy shows promising results for secondary lymphedema

Lymphedema is mainly identified by progressive soft tissue swelling in impaired lymphatic system.Secondary lymphedema attributed to cancer therapy,parasite infection,and trauma remains a serious global disease.Patients with lymphedema suffer swelling,pain,and fatigue,with the dysfunction of the deformed extremities reducing the quality of life and increasing the risk of infection and lymphangiosarcoma.Adipose-derived stem cells(ADSCs)possess prominent regenerative potential to differentiate into multilineage cells,and produce various lymphangiogenic factors,making ADSC therapy a promising approach for lymphedema.The development of lymphedema consists of local inflammation,the fibrosis of lymphatic vessels,and the deposition of adipose fat.Existing animal models do not mimic the chronic inflammation environment,therefore suitable models are required in further studies.Some signal pathways and molecular mechanisms in physiological and pathological lymphagiogenesis remain unclear.In previous animal and human trials,ADSC therapy reduced edema in varying degrees.A larger number of trials with larger samples and longer follow-up periods are required to verify the efficiency and feasibility of ADSC therapy.ADSCs are of easy availability and immune exemption,making them a candidate for lymphedema treatment.Whether ADSCs enhance malignant characteristics or trigger the malignant change deserves further exploration and study before ADSC therapy can be made widely available.

Bloodletting puncture and cupping as an adjuvant therapy for breast cancer-related lymphedema in female adults: A non-randomized controlled pragmatic trial

Objective:To evaluate the effectiveness of bloodletting puncture and cupping in relieving breast cancer-related lymphedema.Methods:We conducted a non-randomized controlled study at the Galactophore Department of the 3rd Affiliated Hospital of Beijing University of Chinese Medicine from March 2013 to December 2014.Seventy-five patients undergoing treatment for breast cancer-related lymphedema were divided into two groups in accordance with the patients' treatment choices:the treatment group (n =50) underwent bloodletting puncture and cupping every 5 days for 15 min/session (one session per day) combined with exercise training once a day for 30 minutes;the control group (n =25) underwent the same exercise training alone.Evaluation indexes were measured before and after treatment;these included arm circumference (at the wrist crease,10 cm distal to the wrist crease,the elbow crease,and 10 cm distal to the elbow crease)and visual analogue scale (VAS) score for pain.The safety of the treatment was also evaluated.Results:The treatment period was 50 days for all 75 patients.At the end of the treatment period,the mean reduction in arm circumference was 1.21 (0.65) cm the treatment group,and 0.58 (0.78) cm in the control group.Compared with the control group,the treatment group had a significantly greater reduction in arm circumference (P =.03) and a significantly lower VAS score for pain (P =.01).No patient in either group experienced any adverse events.Conclusion:Bloodletting puncture and cupping effectively reduces arm circumference and relieves upper limb pain in patients with breast cancer-related lymphedema.Our results provide sufficient basis for exploring cupping as long-term therapy for managing breast cancer-related lymphedema.

Concise review on the safety of exercise on symptoms of lymphedema

Lymphedema is an atypical accumulation of high-proteinfluid located just beneath the skin, which often occurs in the arm or leg. Exercising with lymphedema was traditionally considered to be unsafe. However, recent research indicates that exercise may be beneficial to individuals with lymphedema. Studies indicate that exercise can improve the range of motion and strength of the afflicted limb(s), as well as overall fitness and functional quality of life, and can be performed without exacerbating symptoms of lymphedema.

Study of the Possible Use of a Home-Visit Nursing Interventional Lymphedema Care Program for Secondary Lymphedema in the Elderly at Home

Objective: This study aimed to clarify the possible use of and points to improve a home-visit nursing interventional lymphedema care program (plan) we developed. Methods: The subjects were visiting nurses with at least three years of home-visit nursing experience and experience with lymphedema care for the elderly at home. Semi-structured interviews were conducted, and the collected opinions were aggregated and summarized. Results: Based on interviews with nine subjects, opinions regarding the use of the program, such as “The assessment perspective at the time of introduction helps to grasp the needs for a wide variety of subjects”, and regarding points to improve, such as “It is necessary to set the duration and timing of the section considering the frequency of visits and degree of edema at the time of introduction” and “It is necessary to have a perspective concerning efforts to maintain motivation for care of the elderly and their families”, were aggregated. Discussion: The results of the interviews were generally useful for the structure and development of the program, care methods and content, and interventions for influencing factors. Consideration of setting the timing according to the degree of lymphedema, modification of the program’s development, development of a program that fully considers the degree of edema at the time of introduction and the acceptance of edema among the elderly, and the need to consider the care content that should be given priority were suggested as points for improvement.

Supermicrosurgical lymphoevenous anastomosis for the treatment of peripheral lymphedema:A systematic review of the literature

The effectiveness of supermicrosurgical lymphovenous anastomosis(LVA)for lymphedema treatment remains controversial.Currently,no evidence has been summarized.This study aimed to review the published literature on supermicrosurgical LVAs in the treatment of peripheral lymphedema and to analyze the surgical outcomes.Studies from databases(PubMed/MEDLINE,Cochrane Controlled Trial Data,and Embase)were collected to determine the effectiveness of supermicrosugrical LVAs for lymphedema.A systematic review was performed using individual patient data.Fifteen studies,including 578 patients(482 female,72 male,and 24 unknown)with a mean age of 51 years,satisfied the needs of the study requirements.Supermicrosurgical LVAs for peripheral lymphedema have demonstrated substantial improvements in both objective and subjective findings in many patients.Moreover,in the long-term follow-up,the effectiveness of this treatment modality maintained a high efficacy of LVA in lymphedema cases.However,most studies provided low-quality evidence,and the conclusion is still not finalized.

PRELIMINARY REPORT ON THE MECHANISM OF HEAT AND BANDAGE TREATMENT FOR LYMPHEDEMA

Objective Study the mechanism of heat and bandage treatment for lymphedema. Methods Using biochemical assessment technique and histological examination, a comparative study of the cutaneous tissues in 15 patients with lymphedema of the lower extremity before and afer the heating and bandage theropy. ResuIts 1. The content of hydroxyproline in the affected skin was decreased. 2. The thickness of skin was decreased and the water content was reduced. 3. The microcirculation of local tissues was enhanced. 4. The activity of the macrophages was increased. Conclusion The mechanism of heat and bandage therapy might be as follows: 1. improving the local microcirculation and enhancing the resorption of tissue fluid and protein, 2. increasing the activity of the macrophages, and diminishing librosis of the allcted tisues.

Lymphedema: Complications and Management

Introduction: Lymphedema is a condition of the lymphatic system characterized by tissue swelling of body parts especially the limbs as a result of fluid retention. This debilitating condition may result in morbidity and immobility, incapacitating and causing economic burdens as well as affects the individual’s physiological and psychological well being. Aim: The aim of the review is to expound extensively on lymphedema and its associated complications and their management. Methods: Information was obtained by searching on-line literatures, published articles and news reports on lymphedema, causes, diagnoses, complications and personal clinical experience. Also patients’ data were obtained from Komfo Anokye Teaching Hospital Plastic Surgery Consulting Room and Surgical Operative Records in Kumasi, Ghana. Results: Extensive information was obtained from the various sources which formed the basis of this article highlighting especially the complications which include infections and lymphangiosarcoma resulting from long-standing untreated lymphedema.Conclusion: Since management of the condition is possible, patients are encouraged to seek early treatment when they experience any form of swelling. Long-standing lymphedema may result in serious complications includinginfections: cellulitis, lymphangitis and lymphangiosarcoma resulting from severe cases of untreated lymphedema.

Ultrasound-Guided Peri-Lymphatic and Peri-Neural Corticosteroid Injection as an Adjuvant to Pain and Lymphedema Management in Terminal Cancer: Two Case Reports

We are reporting two patients presented with intractable cancer pain that was treated with a novel application of an ultrasound-guided peripheral nerve block using corticosteroid. This technique offered relief to both patients whom otherwise their cancer pain was difficult to manage. The first patient developed lymphedema to the right axilla from metastatic squamous cell carcinoma. After multiple injections were deposited around the brachial plexus, lymphedema on the right axilla decreased slightly in size;however, range of motion improved post-procedure prior to his discharge one week later. In the second patient with left inguinal lymphadenopathy from metastatic left ureteral transitional cell carcinoma, there was a dramatic reduction in lymphedema in the left groin and leg as well as a considerable decrease in pain score during a two week follow-up after the peri-neural and peri-lymphatic femoral block. A 75% improvement in patient satisfaction was reported in the office visit’s questionnaire form. Corticosteroids can be used as an adjuvant to peripheral nerve block to decrease the pain secondary to lymphedema caused by the inflammatory response from metastatic cancer. This application can provide an alternative way to manage severe cancer-related pain caused by lymphedema in both upper and lower limbs.

Lymphedema and rheumatological disorders

In the literature, although the prevalence of lymphedema is low in inflammatory rheumatological diseases, rigorous approaches to diagnosis and treatment have led to significant improvement in patients' quality of life. Lymphedema is observed more frequently in patients with rheumatoid arthritis with respect to case presentations, but it is also observed in psoriatic arthritis, ankylosing spondylitis, systemic sclerosis, and childhood inflammatory rheumatological diseases. Other rheumatological diseases and tumor-related secondary causes should also be kept in mind in the diagnosis of lymphedema. Complex decongestive therapy-skin care, manual lymph drainage, compression and exercise are the primary treatment approaches. Both basic drugs and tumor necrosis factor-α inhibitors have been tried in addition to complex decongestive physiotherapy programs. However, the success of alternative medical treatments is controversial in the literature. It may be useful to include the disease in post-diagnosis complex decongestive physiotherapy program and to use the drugs mentioned in the literature. However, more data are needed to reach conclusive results.

Consideration of the Self-Care Supporting Program Including Simple Exercise for Patients with Early Stages of Secondary Lower-Limb Lymphedema

Aim: We devised a self-care supporting program targeting patients with early stages of secondary lower-limb lymphedema. The program incorporates “Simple exercises to replace lymphatic drainage” based on lymphatic flow. The purpose of this study was to consider the feasibility of continuing this program. Methods: The participants were patients in the early stages of secondary lower-limb lymphedema after gynecological cancer surgery and lymphedema therapists with more than five years of experience. Patients continued self-care at home after being briefed on the program, and they were analyzed on their self-care continuity status one month later based on a self-administered questionnaire survey and self-care notes. We interviewed the lymphedema therapists about this program to discuss the feasibility of continuing it and obtain feedback. Results: The patients who participated in the study were six women who underwent surgery with lymph node dissection for gynecological cancer. The therapists were five nurses and one occupational therapist. The patient understood the importance of all items in the self-care. “Observation,” “Touching,” and “Skin care” were relatively easy to continue. “Lymph drainage” and “Exercise” were continued with “Simple exercises to replace lymphatic drainage”. “Other exercises” were able to continue by adding distance and time to daily activities. Furthermore, “Measurement” and “Recording” became a burden and were difficult to continue. Nonetheless, this program was generally approved by the lymphedema therapists. They also pointed out the content and format of the self-care notes as improvements. Conclusions: We found that the self-care supporting program that incorporated “Simple exercises to replace lymphatic drainage” might be feasible to continue self-care for patients with early stages of secondary lower-limb lymphedema. Furthermore, we found that we needed to improve the “Measurement” and “Recording” sections of this program.

Effect of pneumatic compression therapy on lymph movement in lymphedema-affected extremities,as assessed by near-infrared fuorescence lymphatic imaging.

Previous studies have shown cost effectiveness and quality-of-life benefit of pneumatic compression therapy(PCT)for lymphedema(LE).Insurers,such as the Centers for Medicare/Medicaid(CMS),however,desire visual proof that PCT moves lymph.Near infrared fuorescence lymphatic imaging(NIRFLI)was used to visualize lymphatic anatomy and function in four subjects with primary and cancer treatment-related LE of the lower extremities before,during,and after PCT.Optically transparent and windowed PCT garments allowed visualization of lymph movement during single,1h PCT treatment sessions.Visualization revealed significant extravascular and lymphatic vascular movement of intradermally injected dye in all subjects.In one subject with sufficient patent lymphatic vessels to allow quantification of lymph pumping velocities and frequencies,these values were significantly increased during and after PCT as compared to pre-treatment values.Lymphatic contractile activity in patent lymphatic vessels occurred in concert with the sequential cycling of PCT.Direct visualization revealed increased lymphatic function,during and after PCT therapy,in all LE-affected extremities.Further studies are warranted to assess the effects of PCT pressure and sequences on lymph uptake and movement.

Innovative microsurgical treatment of male external genitals lymphedema

Secondary lymphedema of male external genital organs,characterized by increase in genital organs volume,tissue fibrosis,erysipelas,and objective difficulties in the normal use of lower limbs and the penis,is a very common and impairing consequence of invasive surgery,radical lymphadenectomy and radiotherapy of the pelvic-inguinal area.Standard surgical approach to lymphedema are either very invasive and/or at high risk of lymphedema recurrence and do not guarantee an efficient long-term treatment.Alternatively,we developed a microsurgical technique to perform direct anastomoses between the lymphatic collectors of the spermatic funiculum afferent to the external iliac chains and the vessels tributary to the spermatic vein.This innovative approach,although surgically demanding,provided a long term successful treatment of external genitals with no clinical complications,low invasivity,rapid post-surgical recovery,minor tissue demolition and satisfactory post-surgical functional and esthetic results.In addition,lympho-venous microsurgery seems to trigger the local development of new lymphatic vessels that notonly canalize along new collecting channels,but also form complex meshes in proximity to the anastomosis area,thus improving lymphedema also in adjacent tissues like lower limbs,supplied by lymphatics emptying into common developed lymphatic shunt.