Evaluation of upper limb lymphoedema and diagnostic accuracy of bioimpedance spectroscopy. A comprehensive validation in a Brazilian population.

Lymphoedema is a complication of breast cancer treatment. Its early diagnosis is related to a good prognosis for lymphoedema treatment. The bioimpedance spectroscopy (BIS) evaluates changes in extracellular fluid. The objective of our study was to evaluate the validity, agreement and accuracy of BIS in the diagnosis of breast cancer-related lymphoedema in a Brazilian population. Methods: This is a prospective, cross-sectional study of a convenience sample of 462 women who underwent surgical treatment for breast cancer (mastectomy or breast-conserving treatment). The validity, agreement and accuracy were performed comparing BIS (lymphoedema index (L-DEX) ≥ 6.5 or 10) with volumetry by water displacement, which is the gold standard for evaluating lymphoedema. Receiver operating characteristic curve was performed. Additionally, other methods like perimetry and indirect volumetry of the upper limbs were compared with water displacement volumetry (direct volumetry), and the BIS were compared with subjective evaluation. Results: Considering L-DEX ≥ 10 the sensitivity of the BIS was 44.1%, specificity 95.4%, positive predictive value (PPV) was 70.7%, negative predictive value (NPV) was 87% and kappa was 0.459. The BIS with L-DEX ≥ 6.5, the sensitivity, specificity, PPV, NPV and kappa were 57%, 88.5%, 55.8%, 89% and 0.452, respectively. Area under curve was 0.724 and a possible cut-off point of L-DEX ≥ 7.35 with sensitivity of 57%, specificity of 90.7% and kappa value = 0.489. Conclusion: Although BIS was significantly associated with the subjective evaluation of lymphoedema, it showed low sensitivity and agreement and moderate correlation when used as a method for diagnosing the condition. Thus, it is not the most valid method for evaluating lymphoedema. In addition, it was not the most accurate method when compared with other objective evaluation tools. Public health resources are scarce and must be used consciously. The knowledge that BIS is not a more accurate method than other, lower-cost instruments allows for better targeting of these resources.

Lymphatic Filariasis: A Systematic Review on Morbidity and Its Repercussions in Countries in the Americas.

The Global Program to Eliminate Lymphatic Filariasis (GPELF) is a program that aims to eliminate lymphatic filariasis by 2030. The GPELF strategy is based on interrupting transmission using mass drug administration (MDA) and, in parallel, managing morbidity cases. However, it has been seen that there is a shortage of research in the literature and public policies regarding this last pillar. In this study, we reviewed the literature and available information regarding the burden of filarial morbidity. In addition, we identified that in the Americas, the implementation of structured services with regard to morbidity assistance in the Americas was scarce. We formed a review that aimed to assess the pathogenesis, epidemiology, repercussions, and treatment of filarial morbidity in countries in the Americas where lymphatic filariasis is endemic. Structured searches were carried out on PubMed, LILACS, Scopus, and Web of Science databases without time and language restrictions. Three reviewers evaluated the 2150 studies and performed data extraction, and quality assessment by assigning scores to the studies found. The current literature and available information on the burden of filarial morbidity, as well as the implementation of structured services with regard to morbidity assistance in the Americas, were all found to be scarce. Now that this knowledge gap has been identified, both health services and researchers need to seek the implementation and enhancement of the maintenance of GPELF strategies that relate to the morbidity pillar.

With Bare Feet in the Soil: Podoconiosis, a Neglected Cause of Tropical Lymphoedema.

Podoconiosis is a form of lymphoedema that occurs in tropical highland areas in genetically susceptible individuals who are exposed to irritant volcanic soils. The disease is preventable through consistent use of footwear and attention to foot hygiene; however, in endemic areas there is a strong barefoot tradition, and many cannot afford shoes. Patients with podoconiosis face significant physical disability, psychological comorbidity, reduced quality of life and experience frequent episodes of systemic illness due to acute dermatolymphangioadenitis. This review provides an overview of this important and neglected tropical skin disease and summarizes the latest research findings.

Lipoedema and overweight leading to generalised oedema: a case report

The aim of the case report was to discuss generalised oedema in a patient with lipoedema and obesity, describing a novel concept of a stage 0 lymphoedema that was denominated as subclinical systemic lymphoedema. A 35-year-old female patient reported to the clinic due to telangiectasia of the lower limbs and leg pain that increased in the heat and when she spend a lot of time in a standing position. The patient had a physical appearance of lipoedema involving the upper and lower limbs associated with a family history of lipoedema, Body Mass Index (BMI) of 33.9 kg/m2 . Bioelectrical impedance analysis demonstrated important changes in intracellular and extracellular water as well as in all limbs and the thorax beyond the limits of normality. The telangiectasia was treated with sclerotherapy and pateint was instructed to lose weight and perform physical activity.

A mapping study and recommendations for a joint NGO (Think Pink) and Bahrain Government Breast Cancer project.

AIMS: Breast cancer within the region continues to present challenges to the healthcare services. Strategies to shed light on clinical gaps could better support country-specific circumstances. The aims of the mapping study were to identify the gaps in the evidence base, for the management of breast cancer with relevance to Bahrain and the Gulf Region. In parallel, focusing on areas and directions of research, which are compatible with international and local clinical interests. It was envisaged that the mapping project would expose not only opportunities to improve support to the community but also illustrate the possible engagement of a government entity and a Nongovernment Organization in a private-public partnership. METHOD: An extensive literature review of local and international publications from the period between 1979 and 2015 was undertaken. Searches were conducted using free-text terms, singularly or combined, with no limiters, to provide unrestricted retrieval of available English studies. RESULTS: A total of 326 citations were identified, which after deduplication provided 277 unique citations of which included 236 studies within 13 different categories, relevant to breast cancer within the Gulf Cooperation Council (GCC). CONCLUSION: Contextualizing gaps in literature and, therefore, providing evidence-based decisions, not only support the enduser, but better support the country-specific challenges and burdens to healthcare. Three broad but key areas were identified after mapping of the literature, covering:screening and mammography, knowledge translation and dissemination, and lymphoedema postsurgical resection. Similar mapping projects could be undertaken by other national NGO's to better support the government and solidify the framework for a public-private partnership.

Does the speed of aquatic therapy exercise alter arm volume in women with breast cancer related lymphoedema? A cross-over randomized controlled trial.

OBJECTIVE: To identify whether slow aquatic exercise in the form of modified Ai Chi is more effective than conventional (faster pace) aquatic therapy at reducing arm volume in women with or at risk of breast cancer related lymphoedema. METHODS: Randomized, cross-over controlled trial with concealed allocation and blinded assessment. Eighteen women with a history of breast cancer related lymphoedema were recruited. Participants received two intervention sessions (randomized order) with one week apart. Interventions were a 50min conventional aquatic intervention or a 50min modified Ai Chi. Arm volume was measured as the difference between affected and unaffected arm; bio-impedance was measured as an index of extracellular fluid; satisfaction was measured via a 12 question form. Outcomes were measured before, immediately after and one hour after intervention. RESULTS: Comparison between interventions showed larger decreased arm volume of 140mL (95%CI 17-263) immediately after intervention in favor of the Ai Chi intervention, however it was not sustained at 1h follow-up. A post hoc analysis showed 72% of participants had a decrease in arm volume immediately after Ai Chi compared to 28% immediately after conventional aquatic therapy; with a number needed to treat of 3 (95%CI 1.4-6.6). There were no differences between interventions for bio-impedance. Satisfaction was good for both interventions. CONCLUSION: Slow pace aquatic exercise is more effective than conventional aquatic exercise immediately after intervention for arm volume. Also, undesirable increase in arm volume seems to subside after 1h, which can be beneficial if therapy does not address arm volume. TRIAL REGISTRATION: ACTRN12614000557639 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000557639).

Axillary web syndrome is not a risk factor for lymphoedema after 10 years of follow-up.

OBJECTIVE: The objective of this study was to evaluate the association between axillary web syndrome and the development of lymphoedema after 10 years of follow-up. METHODOLOGY: A prospective observational study in a hospital cohort of women diagnosed with breast cancer and treated at a referral centre for cancer. Patients were followed according to the routine of the hospital's physical therapy service. In addition, a review of medical records was conducted for the period between 5 and 10 years of follow-up. Data on patient characteristics, treatment, tumour and postoperative complications were collected. RESULTS: In all, 964 patients were included, mostly <65 years old (75 %) and classified as being overweight (68 %). Disease was diagnosed as being up to stage IIA in 54.9 % of the cases; 65.1% underwent mastectomy and 83.8% had total axillary dissection. As adjuvant treatment, 61 % underwent chemotherapy, 63.5 % radiotherapy and 68 % hormone therapy. Among surgical complications, 62.6 % of patients had seroma, 40.7 % had necrosis, 35.9 % axillary web syndrome and 31.4 % lymphoedema. There was no association between axillary web syndrome and the development of lymphoedema (OR = 0.87, 95 % CI 0.65 to 1.15, p = 0.329). CONCLUSION: The occurrence of axillary web syndrome was not a risk factor for lymphoedema after 10 years of follow-up.

Síndrome de Sweet localizado sobre linfedema: descripción de un caso y revisión de la literatura / Sweet´s syndrome located on lymphoedema: a case report and review of literature

Comunicamos el caso de una mujer de 63 años de edad, que desarrolló lesiones compatibles con un síndrome de Sweet, localizadas en el miembro sometido a linfadenectomía e irradiación, debido a una neoplasia maligna neural. Efectuamos comentarios del caso y los comparamos con la bibliografía publicada.

A 63 years-old woman treated wit lymphadenectomy and radiotherapy due a malignant neural neoplasia, developed lesions of a Sweet's syndrome, localized in the area treated. A review and comparative study of the previous papers are made.

Síndrome de Sweet localizado sobre linfedema: descripción de un caso y revisión de la literatura / Sweet´s syndrome located on lymphoedema: a case report and review of literature

Comunicamos el caso de una mujer de 63 años de edad, que desarrolló lesiones compatibles con un síndrome de Sweet, localizadas en el miembro sometido a linfadenectomía e irradiación, debido a una neoplasia maligna neural. Efectuamos comentarios del caso y los comparamos con la bibliografía publicada.(AU)

A 63 years-old woman treated wit lymphadenectomy and radiotherapy due a malignant neural neoplasia, developed lesions of a Sweets syndrome, localized in the area treated. A review and comparative study of the previous papers are made.(AU)

Yellow nail syndrome in a medical clinic / El síndrome de las uñas amarillas en una clínica médica

Yellow nail syndrome is a very rare clinical entity usually diagnosed from a combination of yellow dystrophic nails, lymphoedema and respiratory diseases. The aetiology is not known though dysfunctional hypoplastic lymphatics is speculated. Most cases occur sporadically but few cases may be associated with systemic diseases or may be inherited. This report documents another case in a 56-year old Caribbean female who presented with a six-year history of recurrent respiratory symptoms and later yellow dystrophic nails and lymphoedema. She responded well to vitamin E and oral fluconazole. We also did a short literature review of yellow nail syndrome.

El síndrome de las uñas amarillas es una entidad clínica muy rara, la cual usualmente se diagnostica a partir de una combinación de uñas amarillas distróficas, linfedemas, y enfermedades respiratorias. Se desconoce la etiología, aunque se especula que se debe a vasos linfáticos hipoplásticos disfuncionales. La mayoría de los casos ocurre esporádicamente pero pocos casos pueden asociarse con las enfermedades sistémicas o pueden ser heredados. Este informe documenta el caso de una mujer caribeña de 56 años, que se presentó con antecedentes de síntomas respiratorios recurrentes y más tarde con uñas amarillas distróficas y linfedemas. Durante el tratamiento, respondió bien a la vitamina E y al fluconazol oral. El trabajo también realiza una breve revisión de la literatura del síndrome de las uñas amarillas.

Linfangite granulomatosa de genitália infantil: relato de caso e revisão da literatura / Granulomatous lymphangitis of children's genitalia: report of a case and review of the literature

Linfangite granulomatosa de genitália não-infecciosa é causa rara de linfedema genital autolimitado e idiopático em crianças(4, 6, 9). A maioria dos casos de linfedema com granuloma não-infeccioso de genitália em pacientes jovens ocorre em associação à doença de Crohn subseqüente ou concomitante(1, 3, 4, 9). O caso relatado é de um menino de 14 anos que apresentava história de linfedema genital principalmente em região dorsal do corpo do pênis, poupando prepúcio, parte distal do pênis e saco escrotal. Estudos laboratoriais não revelavam doenças sistêmicas. O exame anatomopatológico da peça revelou tratar-se de linfangite granulomatosa não-infecciosa.

Non-infectious granulomatous lymphangitis of genitalia is a rare cause of self-limited and idiopathic genital lymphoedema in children(4, 6, 9). Most cases of lymphoedema with non-infectious genital granulomas in young patients occur subsequent to or concomitant with Crohn's disease(1, 3, 4, 9). The case described is of a 14-year-old boy with history of genital lymphoedema mainly on the dorsal region of the body of the penis, sparing the prepuce, the distal part of the penis and the scrotum. Laboratory studies did not reveal systemic diseases. The histopathological analysis showed it was non-infectious granulomatous lymphangitis.