Miscellaneous procedures
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha in Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
Lymphoedema, also known as lymphedema and lymphatic oedema, is a condition whereby localised fluid retention causes tissue swelling due to a compromised lymphatic system. In the normal lymphatic system interstitial fluid returns to the bloodstream. Imaging using radioactive substances may be used to confirm or negate the presence and site of lymphoedema. For lower limb studies the patient is injected with 99mTc-nanocolloid into the first webspace of both feet. If the upper limb lymphatics need to be imaged the nanocolloid is injected into the first web space of both hands. The examination is a safe, well-established, and minimally invasive technique for assessing lymphatic drainage in limbs for lymphoedema. This section is based on the BNMS 2011 professional guidelines [50].
Immunity
David Sturgeon in Introduction to Anatomy and Physiology for Healthcare Students, 2018
Before lymph returns to the venous circulation, it must also pass through numerous bean-shaped masses of tissue called lymph nodes (Figures 6.2, 6.5). These are situated along the course of the lymphatic vessels and in strategic clusters at key areas such as the neck (cervical nodes), the armpits (axillary nodes) and the groin (inguinal nodes). Each lymph node is surrounded by a fibrous capsule and divided into the cortex (outer layer) which contains B and T cells, and the medulla (inner layer) which contains macrophages and antibody-secreting plasma cells. Any harmful material that has been washed into the lymph is filtered through the white blood cells in the lymph nodes and removed before re-entering the venous blood. Lymph nodes act like barracks or garrisons for the immune cells and enable them to ambush and destroy pathogenic material in a series of killing zones. In total, there are between 600 to 700 lymph nodes dispersed throughout the human body. This system is not infallible, however, and we observed earlier in the chapter that the disease elephantiasis is caused by parasitic worms that block the lymphatic vessels leading to thickening of the tissues of the lower limb. Lymphoedema (lymphatic obstruction) can also occur following damage or disruption to the lymphatic system. Finally, lymph nodes frequently become inflamed or enlarged as a result of a wide variety of infections and diseases. These range from simple viral infections such as a sore throat or glandular fever (mononucleosis), to serious cancers such as lymphoma and leukaemia.
Lymphedema: Physical and medical therapy
Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki in Handbook of Venous and Lymphatic Disorders, 2017
A variety of physical treatments are available to reduce the volume within a lymphedematous extremity. The efficacy of CDT has been supported by numerous randomized controlled trials, yet the relative contributions of the separate modalities that impact its efficacy remain cryptic. Patient compliance is important to maintain the volume loss achieved with phase I CDT. Less robust yet increasingly viable and contemporary data support the clinical utility and cost benefit achieved by the use of PCPs. Recognizing and minimizing lymphedema risk factors such as obesity and chronic venous insufficiency is paramount, and appropriate preventative measures should be undertaken, including skin care and exercise. The use of various pharmacotherapies as adjuncts in the lymphedema patient is less defined, but can be considered. Without equivocation, more critically derived long-term and comparative data are needed in order to definitively ascertain what constitutes the most effective noninvasive acute and maintenance treatment for both upper and lower extremity lymphedema at various stages.
Validation of the Lymphoedema Quality of Life Questionnaire (LYMQOL) in Swedish cancer patients
Published in Acta Oncologica, 2020
Madelene Wedin, Mats Fredrikson, Eva Ahlner, Annika Falk, Åsa Sandström, Gabriel Lindahl, Per Rosenberg, Preben Kjølhede
Lymphoedema is a troublesome adverse effect that occurs especially after lymphadenectomy in cancer treatment. It is a chronic condition that may progress and worsen over time if not treated and may in rare cases even be fatal. As lymphoedema can have a substantial impact on QoL [2,3] it is important to have simple validated tools to measure its occurrence and changes. Validation is an important issue in the assessment of QoL instruments to ensure that the instrument correctly is measuring what it is intended for. Validation comprises many different analyses. Although international guidelines exist for how to perform validation of questionnaires [4], no generally accepted guidelines have been adopted to ensure the methodological quality for measurement properties of health status questionnaires. Terwee et al. proposed quality criteria for components of a validation of health status questionnaires in order to ensure comprehensive validation [5] encompassing eight measurement properties: content validity, internal consistency, criterion validity, construct validity, reproducibility concerning agreement and reliability, responsiveness, floor and ceiling effects and interpretability. The criteria of each of the components in the validation were rated based on the outcome of the statistical analysis of the component.
The Danish version of Lymphoedema Functioning, Disability and Health Questionnaire (Lymph-ICF) for breast cancer survivors: Translation and cultural adaptation followed by validity and reliability testing
Published in Physiotherapy Theory and Practice, 2019
Karin R Grarup, Nele Devoogdt, Liv Inger Strand
Breast cancer is the most common site of cancer amongst women worldwide (Ferlay et al., 2015) with a high incidence rate in Western and Northern European countries, including Denmark (Ferlay et al., 2013). Survival among patients with breast cancer in developed countries has improved over the last decades (Ferlay et al., 2015), probably due to implementation of organized mammography screening and changes in adjuvant treatment (Lietzen et al., 2011; Tryggvadóttir et al., 2010). At the end of 2013, 60,200 women and 270 men in Denmark were living with the diagnosis (Association of the Nordic Cancer Registries, 2015). Because of treatment, most frequently related to axillary lymph node dissection (ALND), many patients suffer from constraints in their arm and shoulder. Lymphedema is among the most commonly described impairments (Hidding et al., 2014), caused by damage to the lymphatic vessels and lymph nodes in connection with surgery and radiotherapy. The prevalence of breast cancer-related lymphedema varies with the treatment given (Hidding et al., 2014) and depends on the manner in which lymphedema is clinically detected and defined (Hayes et al., 2008, 2012; Rockson and Rivera, 2008). Findings suggest that approximately 20% of women surviving breast cancer will develop arm lymphedema (DiSipio, Rye, Newman, and Hayes, 2013; Hayes et al., 2012).
The application of indocyanine green (ICG) and near-infrared (NIR) fluorescence imaging for assessment of the lymphatic system in reconstructive lymphaticovenular anastomosis surgery
Published in Expert Review of Medical Devices, 2021
Albert H. Chao, Steven A. Schulz, Stephen P. Povoski
Lymphedema is a chronic condition of pathological swelling or volume increase within tissues due to dysfunction of the lymphatic system, which results in retention of fluid, and in more advanced stages collagen formation and cellular proliferation of adipocytes and fibroblasts[5]. Primary lymphedema is caused by abnormal development of the lymphatic system. Secondary lymphedema is relatively more common and results from injury to a normally developed lymphatic system, such as due to infection, surgery, or radiation therapy. Symptoms of lymphedema include swelling, enlargement, heaviness, and pain in the affected tissues, as well as an increased propensity for soft tissue infections. These changes are responsible for the reduced quality of life and substantial morbidity experienced by patients with lymphedema.
Related Knowledge Centers
- Edema
- Exercise
- Extracellular Fluid
- Manual Lymphatic Drainage
- Parasitic Disease
- Lymphatic System
- Immune System
- Infection
- Circulatory System
- Genetic Disorder