A home-based weight lifting program for patients with arm lymphedema following breast cancer treatment: a pilot and feasibility study.

It is well documented that resistance exercise can be performed by patients with breast cancer-related arm lymphedema. The aim of this pilot study was to evaluate the feasibility and safety of a 12-week self-administered weight lifting program for arm and shoulder, and its influence on arm lymphedema status, upper extremity muscle strength, and disability. Twenty-three patients with breast cancer-related arm lymphedema performed the program 3 times/week. The weight resistance levels were individually adjusted for shoulder flexion and adduction, and elbow extension and flexion corresponding to a repetition range of 8-12 repetition maximum. A log book was used to evaluate adherence to the program, wearing of compression sleeve and perceived exertion. Measurements were performed before a 2-week control period without intervention, and before and after intervention, and with arm volume measurements every fortnight to check for adverse events. Results revealed no significant changes during the control period. Adherence to the intervention program was excellent, and two adverse events were registered during the first weeks. After intervention, an increase of shoulder and arm strength (measured by an isometric muscle strength device) was found in all exercises (p = 0.001-0.003). A reduction of excess volume was shown, in ml (p = 0.03) and percentage (p = 0.005), measured by water displacement method. A tendency towards reduction (p = 0.07) of fat tissue in the upper arm (n = 10) in both arms was found measured by MRI. In this pilot study, we concluded that a home-based weight-lifting program performed by patients with breast cancer-related arm lymphedema is feasible and safe providing that the program includes regular follow-up for safety.

Analysis of brain and muscle activity during low-level tooth clenching--a feasibility study with a novel biting device.

In electromyographic (EMG) and functional magnetic resonance imaging (fMRI) studies, muscle and brain activity was compared during low levels of tooth clenching using a novel biting device to control bite force. A total of 21 healthy subjects performed motor tasks, comprising tooth clenching at 5, 10 and 20 N. During all measurements, subjects kept the novel bite device between the anterior teeth during tooth clenching. The EMG study (n = 15) characterised jaw muscle activity for the three motor tasks and demonstrated significant differences in root mean square (RMS) EMG amplitude between 5-, 10- and 20-N tooth clenching (F = 46.21, P < 0.001). There were no differences in variability of muscle activity between the three tooth-clenching levels. In an fMRI pilot study (n = 6), statistical comparisons were used to identify brain regions with significant activation in the subtraction of baseline from 5- or 20-N tooth-clenching activity. 5- and 20-N tooth clenching significantly and bilaterally activated the sensorimotor cortex, supplementary motor area, cerebellum and basal ganglia (P < 0.05, corrected for multiple comparisons). However, activation of each brain region did not differ significantly between two tooth-clenching tasks. Based on these preliminary findings, we propose that the novel biting device may be useful in further fMRI studies on controlled jaw muscle activation patterns in different craniofacial pain conditions. In addition, our fMRI result suggests that there are no significant differences in brain activity within low levels of tooth clenching with controlled force.

Investigation of spatial resolution, partial volume effects and smoothing in functional MRI using artificial 3D time series.

This work addresses the balance between temporal signal-to-noise ratio (tSNR) and partial volume effects (PVE) in functional magnetic resonance imaging (fMRI) and investigates the impact of the choice of spatial resolution and smoothing. In fMRI, since physiological time courses are monitored, tSNR is of greater importance than image SNR. Improving SNR by an increase in voxel volume may be of negligible benefit when physiological fluctuations dominate the noise. Furthermore, at large voxel volumes, PVE are more pronounced, leading to an overall loss in performance. Artificial fMRI time series, based on high-resolution anatomical data, were used to simulate BOLD activation in a controlled manner. The performance was subsequently quantified as a measure of how well the resulted activation matched the simulated activation. The performance was highly dependent on the spatial resolution. At high contrast-to-noise ratio (CNR), the optimal voxel volume was small, i.e. in the region of 2(3) mm(3). It was also shown that using a substantially larger voxel volume in this case could potentially negate the CNR benefits. The optimal smoothing kernel width was dependent on the CNR, being larger at poor CNR. At CNR >1, little or no smoothing proved advantageous. The use of artificial time series gave an opportunity to quantitatively investigate the effects of partial volume and smoothing in single subject fMRI. It was shown that a proper choice of spatial resolution and smoothing kernel width is important for fMRI performance.

Low intensity resistance exercise for breast cancer patients with arm lymphedema with or without compression sleeve.

Clinical trials of the effect of physical exercise on breast cancer related arm lymphedema (ALE) are very rare. The aim of this study was to examine if controlled low intensity arm exercises with weights, with or without a compression sleeve, influence breast cancer related ALE. Thirty-one breast cancer treated patients with small or moderate ALE were included in the study. A specifically designed arm exercise program was performed with or without compression sleeve on different days and in a randomized order. Measurements were performed before, directly after and 24 hours after the exercise intervention, with water displacement method and multiple frequency bioelectrical impedance analysis (n=10) for volume of the arms and Borg's scale for perceived exertion during training. There was an increase of total arm volume of the lymphedema arm immediately after the exercise intervention for both with and without sleeve conditions (p < 0.01). At 24 hours, no volume increase was found compared to pre-exercise and both groups showed tendency towards reduced lymphedema relative volume (p < 0.05). The patient's rating of perceived exertion was low regardless of whether a sleeve was worn, but was significantly higher when exercising with the sleeve. We conclude that low intensity exercises can be performed by patients with arm lymphedema without risk of worsening the edema. Exercises without the sleeve may be of benefit provided compression sleeve is worn regularly.

[Resectability of papillary and pancreatic cancer assessed by ultrasonography and computer tomography]. / Resektabilitet af papil- og pancreascancer vurderet ved ultralydskanning og computertomografi.

A retrospective study of 65 patients with postoperatively verified pancreatic or peripancreatic cancer was conducted. Before surgery all patients had ultrasonography (US) performed, and 46 patients had computed tomography (CT) performed as well. After operation description of pre-operative radiological findings has been compared to description of operative and pathological findings. Three of the 65 patients were excluded either because of lacking radiological descriptions (two patients) or uncertain operative findings (one patient). When both investigations were performed, they were carried out independently by two skilled radiologists without knowledge of the result of the other investigations. The following criteria were used for non-resectability encasement of splanchnic vessels, liver metastases, peritoneal thickening with ascites, and glandular enlargement. As assessed by US, 15 of 16 (94%) were truly predicted to be non-resectable, whereas only 21 of 38 (55%) were truly predicted resectable. CT was performed in 46 patients of which 19 of 21 (90%) were truly predicted non-resectable, and 17 of 21 (81%) were truly predicted resectable. It was not possible to perform a conclusive radiological investigation in eight of 62 (13%) cases by US, and four of 46 (9%) cases by CT. One patient was falsely predicted non-resectable by US and an additional one by CT. Both were falsely predicted non-resectable on suspicion of vessel involvement. Overall, invasion of vessels was the most common cause for non-resectability, at the same time this was the index of non-resectability that was most often not detected pre-operatively. US is reliable when predicting non-resectability. When resectable tumour is detected by US, supplementary investigations such as CT should be applied, and when necessary endoscopic procedures or laparoscopy as well. Hereby unnecessary laparotomies may be avoided. Care should be taken when suspecting papillary tumour; only 66% of these were detected by either of the two methods.