Is There a Relationship Between Insulin Resistance and Breast Cancer-Related Lymphedema? A Preliminary Study.

Background: High blood insulin levels, insulin resistance (IR), and obesity are components of metabolic syndrome (MetS). The literature has indicated a high risk of breast cancer in patients with MetS. However, no studies have been conducted evaluating the relationship between breast cancer-related lymphedema (BCRL), one of the most frequently encountered postbreast cancer treatment conditions, and IR. Therefore, the aim of this study was to evaluate whether there is a relationship between BCRL and IR. Methods and Results: A total of 28 patients diagnosed with breast carcinoma were included in this preliminary study. Patients were divided into BCRL (n = 15; mean age: 55.2 ± 11.2 years) and non-BCRL (control) groups (n = 13; mean age: 55.17 ± 6.57 years). Body mass index (BMI), waist and hip circumference, and fasting blood glucose and blood insulin levels of all patients were recorded. The Homeostasis Model Assessment (HOMA) test was used for the calculation of IR measurement with a value of 2.5 taken as an indicator of IR. Parameters were compared between groups. BMI, waist circumference measurements, blood insulin, and HOMA-IR levels were statistically significantly higher in the BCRL group than the control group (p < 0.05). HOMA-IR values >2.5 were found in 14 patients in the BCRL group. In the control group, only three patients had IR based on HOMA-IR criteria (p = 0.000). Hip circumference measurements and fasting blood glucose levels were similar between the groups (p > 0.05). Conclusions: BCRL appears to be associated with waist circumference, fasting blood insulin level, and HOMA-IR levels. In routine clinical practice, evaluation of IR may be important in the follow-up of this patient population.

Effect of Kidney Transplant on Balance and Fall Risk.

OBJECTIVES: Kidney transplant offers an improved quality of life and prolonged survival for patients with end-stage renal disease. This study aimed to compare balance and fall risk between kidney transplant recipients and healthy adults and to determine the relationship between biochemical parameters and fall risk and balance in kidney transplant recipients. As far as we know, this is the first study in the literature that evaluated whether balance changes occur in kidney transplant recipients using the Tetrax Interactive Balance System (Sunlight Medical Ltd., Ramat Gan, Israel). MATERIALS AND METHODS: Our study included 131 kidney transplant recipients (80 male/53 female; mean age of 39 ± 12 y) and 158 healthy volunteers (86 male/69 female; mean age of 40 ± 15 y). Groups were statistically matched in age, male/female patients, and body mass index. Fall index percentages were calculated using the Tetrax posturography device. Risk of falling was compared between kidney transplant recipients and healthy participants. Kidney transplant recipients were divided into 3 groups based on risk of falling. Demographic and clinical characteristics of kidney transplant recipients were recorded, and statistical analyses were performed to analyze these parameters versus balance measurements. RESULTS: Risk of falling was not significantly different between groups according to Tetrax measurements (32.4 ± 23.4 vs 31.6 ± 21.7; P = .08). Serum creatinine levels were significantly higher in kidney transplant recipients with a higher risk of falling (1.17 ± 0.37 vs 1.63 ± 1.18 mg/dL; P = .01). The use of oral antidiabetic drugs was shown to increase the risk of falling (P = .02). CONCLUSIONS: Although patients with end-stage renal disease are thought to have balance impairments, kidney transplant recipients in our study had balance control similar to that shown in the healthy population. Graft function in kidney transplant recipients is important for the balance system.

The Effect of Serum 25(OH)D3 Level on Breast Cancer-Related Lymphedema.

Background: The aim of this study was to evaluate the effect of serum 25-hydroxyvitamin D3 [25(OH)D3] levels on the presence and severity of lymphedema, and on the levels of pain, disability, and function in patients with breast cancer-related lymphedema (BCRL). Methods and Results: This controlled study included 71 patients diagnosed with breast carcinoma. Participants were divided into two groups. The BCRL group included 37 breast cancer patients with lymphedema and the control group included 34 breast carcinoma patients without lymphedema. Demographic information, dominant extremity, affected breast, duration of malignancy, and serum 25(OH)D3 levels were recorded for all patients. The 25(OH)D3 levels were then compared between groups. The correlations between serum 25(OH)D3 levels and the visual analog scale (VAS) and Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire (Q-DASH) scales and the volumetric and diametric differences between the upper extremities were analyzed in the BCRL group. Serum 25(OH)D3 levels did not show statistically significant differences between groups (p > 0.05). There was no correlation in the BCRL group between 25(OH)D3 levels and the VAS and Q-DASH scores or the diametric and volumetric differences of extremities (r ≤ 0.3; p > 0.05). Conclusions: Serum 25(OH)D3 levels do not appear to affect the presence or severity of lymphedema, pain, disability, or physical function in BCRL patients. In routine clinical practice, evaluation of this vitamin level does not appear to be necessary for lymphedema in BCRL patients.

Postural Stability in Patients with Lower Limb Lymphedema.

Background: Impaired mobility and musculoskeletal dysfunctions are commonly seen in patients with lymphedema and can affect the balance system in patients in whom the lower limb is affected. This study aims at comparing postural stability between patients with lower limb lymphedema (LLL) and healthy subjects. Methods and Results: This controlled study included 36 patients with LLL (LLL group) and 36 healthy subjects (control group). Fall risk, stability index, and Fourier index measurements of Tetrax® Interactive Balance System were compared. There were no statistically significant differences between groups in terms of demographics parameters (p > 0.05). Some stability and Fourier index measurements were significantly higher in subjects in the LLL group than in the control group. However, the fall risk was not statistically different in patients with LLL than healthy subjects (p > 0.05). Conclusion: LLL may cause balance impairments. However, this impairment may not lead to increased fall risk. The evaluation of postural stability in LLL patients would be a useful addition to routine clinical practice due to the relationship between LLL and balance impairments.

Factors Associated with Fibromyalgia Syndrome in Peritoneal Dialysis Patients.

Purpose: We evaluated the prevalence of fibromyalgia syndrome (FMS) in peritoneal dialysis (PD) patients and whether this syndrome is associated with gender, age, duration of PD, or other laboratory parameters. Methods: A total of 60 chronic PD patients (26 women, 34 men) and 60 healthy controls (30 women, 30 men) were included. We recorded each participant's age, gender, cause of kidney failure, PD duration, laboratory parameters, education level, and symptoms related to FMS, diagnosed according to the 2010 American College of Rheumatology criteria. Results: Eleven patients (18%) in the PD group and nine (15%) in the control group met the diagnostic criteria for FMS. There were no statistically significant differences in age; gender; education level; PD duration; laboratory parameters; or sleepdisturbance, fatigue, or cognitive symptoms between the FMS and non-FMS groups among the PD patients. We next compared control and PD patients with FMS. Both groups were of a similar age and gender and had similar sleep disturbance and cognitive symptoms, but more patients had fatigue in the control group. Conclusions: The prevalence of FMS among PD patients was similar to that in the general population, and FMS was not associated with gender, age, duration of PD, or other laboratory parameters.

Objectif : les chercheurs ont évalué la prévalence du syndrome de fibromyalgie (SFM) chez les patients sous dialyse péritonéale (DP) et de son association avec le sexe, l'âge, la durée de la DP ou d'autres paramètres de laboratoire. Méthodologie : au total, 60 patients sous DP chronique (26 femmes et 34 hommes) et 60 sujets témoins en santé (30 femmes et 30 femmes) ont participé à l'étude. Les chercheurs ont consigné l'âge, le sexe, la cause de l'insuffisance rénale, la durée de la DP, les paramètres de laboratoire, le niveau de scolarité et les symptômes de chaque participant, liés au SFM diagnostiqués conformément aux critères de l'American College of Rheumatology établis en 2010. Résultats : onze patients (18 %) du groupe sous DP et neuf (15 %) du groupe témoin respectaient les critères diagnostiques de SFM. Ils ne présentaient pas de différence statistiquement significative sur le plan de l'âge, du genre, du niveau de scolarité, de la durée de la DP, des paramètres de laboratoire, des perturbations du sommeil, de la fatigue ou des symptômes cognitifs entre les groupes sous DP ayant un SFM et ceux n'en ayant pas. Les chercheurs ont ensuite comparé les sujets témoins et les patients sous DP ayant un SFM. Les deux groupes étaient d'âge et de sexe semblables et présentaient des perturbations du sommeil et des symptômes cognitifs analogues, mais plus de patients témoins ressentaient de la fatigue dans le groupe témoin. Conclusion : la prévalence de SFM chez les patients sous DP était semblable à celle de la population générale, et la SMF ne s'associait ni au sexe, ni à l'âge, ni à la durée de la DP ni à d'autres paramètres de laboratoire.

Association Between the Elasticity of Hip Muscles and the Hip Migration Index in Cerebral Palsy.

OBJECTIVES: Cerebral palsy (CP) increases the risk of hip displacement during childhood. Abnormal hip muscle forces have been proposed as the predisposing factors. In CP, the amount of hip displacement is commonly evaluated by the Reimers hip migration index (MI) on an anteroposterior pelvic radiograph. To the best of our knowledge, the association between the elasticity of hip muscles measured by shear wave elastography and the MI has not been studied yet. Herein, we aimed to analyze the correlation between the elasticity of hip muscles and the MI. METHODS: Bilateral hips of 25 children with spastic CP were included prospectively in this study. Anteroposterior pelvic radiographs were used to measure the MI. Shear wave elastography was performed to evaluate the elasticity of muscles. The correlation between the MI and the elasticity of hip flexor and adductor muscle groups was assessed. Also, the association between the elasticity of agonist/antagonist muscles was analyzed. RESULTS: The MI showed fair to good correlations with hip flexors and adductors for both readers (0.71 ≥ r ≥ 0.52). The mean MIs of the patients ± SDs were 22.64% ± 7.79% for reader 1 and 21.55% ± 8.83% for reader 2. The elasticity of agonist/antagonist muscle groups showed little/no to a weak correlation for both readers (0.32 ≥ r ≥ -0.07). CONCLUSIONS: Although, hip flexor and adductor muscle elasticity showed a correlation with MI, it seems very hard to say that increased elasticity of hip flexor and adductor muscles causes hip dislocation.