- MeSH
- biologická terapie MeSH
- hidradenitis suppurativa * diagnóza farmakoterapie patofyziologie MeSH
- klindamycin farmakologie terapeutické užití MeSH
- kouření cigaret škodlivé účinky MeSH
- kvalita života MeSH
- lidé MeSH
- lymfedém etiologie MeSH
- obezita komplikace MeSH
- retinoidy farmakologie terapeutické užití MeSH
- rizikové faktory MeSH
- tetracykliny farmakologie terapeutické užití MeSH
- Check Tag
- lidé MeSH
- MeSH
- diuretika farmakologie klasifikace škodlivé účinky terapeutické užití MeSH
- edém diagnóza etiologie farmakoterapie klasifikace MeSH
- flavonoidy farmakologie klasifikace terapeutické užití MeSH
- lidé MeSH
- lymfedém * diagnóza etiologie farmakoterapie MeSH
- lymfoscintigrafie metody MeSH
- proteasy farmakologie klasifikace terapeutické užití MeSH
- saponiny farmakologie klasifikace terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND: Contraction-type lymphatic vessels (LV) are considered suboptimal for lymphaticovenous anastomosis (LVA). However, despite these pathological changes, their functionality and link to outcomes have not been fully elucidated. The aim of this study was to determine the impact on outcomes when contraction-type LVs were used for LVA compared to the noncontraction-type (normal + ectatic) counterpart for treating lower limb lymphedema. STUDY DESIGN: Eighty-three patients with gynecologic cancer-related unilateral lower-limb lymphedema who underwent LVA as their primary treatment were enrolled in this study. The study group included 20 patients who used only contraction-type LVs. An additional 63 patients (control group) received noncontraction-type LVs only. Patients with a history of LVA, liposuction, or excisional therapy were excluded. Patient characteristics, intraoperative findings, functional parameters, and pre-LVA and post-LVA volume changes were recorded and matched using propensity scores. The primary endpoint was the volume change at 6/12 months after LVA. RESULTS: After matching, 20 patients were included in each group. All parameters were matched, except that the study group still had a significantly inferior indocyanine green (ICG)-positive ratio, lymph flow-positive ratio, and washout-positive ratios ( P <0.001, P =0.003, and P <0.001, respectively) when compared to the control group after matching. However, at 1-year follow-up, the postoperative percentage volume reduction was comparable between the groups ( P= 0.619). CONCLUSION: The use of contraction-type LVs for LVA is encouraged when no other LVs are available.
- MeSH
- anastomóza chirurgická * MeSH
- dolní končetina * chirurgie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- lymfatické cévy * chirurgie MeSH
- lymfedém * chirurgie etiologie MeSH
- nádory ženských pohlavních orgánů chirurgie komplikace MeSH
- retrospektivní studie MeSH
- senioři MeSH
- tendenční skóre * MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
- MeSH
- deficit GATA2 * diagnóza MeSH
- dospělí MeSH
- infekce dýchací soustavy etiologie MeSH
- lidé MeSH
- lymfedém etiologie MeSH
- plicní nemoci etiologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Primary lymphedema of the foot and toes could be sometimes misdiagnosed by lymphoscintigraphy as a whole lower limb lymphatic insufficiency (LLLI). This is caused by using standard lymphoscintigraphic protocol based on one interstitial injection of radiotracer applied into the first interdigital space followed by image analysis of lower limb lymphatic vessels and lymph nodes. Here, we show that a modification of the lymphoscintigraphic protocol and introduction of a second dose of radiotracer right above the inner ankle to the clinically healthy tissue can more accurately describe morphological abnormalities of the superficial lymphatic system at the lower limb and thereby refine the diagnosis of the LLLI. Fourteen patients with swelling of the foot and toes (16 lower limbs) were examined using standard lymphoscintigraphic protocol. Subsequently, modified lymphoscintigraphy was performed. While standard lymphoscintigraphy showed severe lymphatic insufficiency of the superficial lymphatic system in all 14 patients (in 16 lower limbs), including significantly reduced number of inguinal nodes, modified lymphoscintigraphy revealed almost normal morphology of superficial lymphatic vessels in 11 patients (in 13 lower limbs) throughout the entire lower limb proximal to the application site. In conclusion, using the modified lymphoscintigraphy protocol in patients with foot and toes primary lymphedema can refine diagnosis and follow-up medical management.
BACKGROUND: Lymphedema is a chronic condition characterized by progressive edema with complicated treatment. Recently, new treatment strategies inducing lymphangiogenesis were proposed. The aim of our study was to examine the effect of vascular endothelial growth factor C (VEGF-C) and adipose-derived stem cells (ADSCs) on lymphatic regeneration and drainage re-establishment in vascularized lymph node transfer (VLNT) model using a pedicled vascularized lymph node (VLN) groin flap. METHODS: Female Lewis rats with groin VLN flaps were utilized as a lymphedema model. Group A served as the control. Group B received VEGF-C. Group C received both VEGF-C and ADSCs. Group D received ADSCs only. Lymphatic drainage re-establishment was evaluated by ultrasound-photoacoustic imaging (US-PAI) after indocyanine green (ICG) injection. RESULTS: The fastest regeneration of elevated flaps was observed in Groups B and C in all monitored periods. After the first month, ICG positivity was detected in 14.3% of animals in Group A, 71.43% of animals in Group B (odds ratio [OR] = 15; p = 0.048), and 83.33% in Group C (OR = 30; p = 0.027). On the contrary, the difference between control group and Group D (16.67%; p = 0.905) was statistically insignificant. Administration of VEGF-C, ADSC + VEGF-C, and ADSC led to full flap regeneration after 6 months. The control group had the lowest percentage of ICG positivity at all monitored time points. CONCLUSION: We found that the fastest regeneration occurred with the combination of the VLN flap and VEGF-C. The addition of ADSC had an insignificant effect in our study. Furthermore, we proved the feasibility of PAI as an assessment tool of the lymphatic drainage recovery in a VLNT model.
- MeSH
- indokyanová zeleň MeSH
- kmenové buňky MeSH
- krysa rodu rattus MeSH
- lymfatické uzliny krevní zásobení MeSH
- lymfedém * chirurgie etiologie MeSH
- potkani inbrední LEW MeSH
- regenerace MeSH
- vaskulární endoteliální růstový faktor C * MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Composite haemangioendothelioma is a rare vascular neoplasm with indolent to intermediate malignant potential. Diagnosis of this disease relays on histopathological identification of at least two different morphologically distinctive vascular components in proper clinical settings. Exceedingly rare cases of this neoplasm can exhibit areas resembling high-grade angiosarcoma, which does not change the biological behaviour. Such lesions tend to occur in the setting of chronic lymphoedema and thus, can mimic Stewart-Treves syndrome, which has a much worse clinical outcome and prognosis. CASE PRESENTATION: We present a case of 49 years old male suffering from chronic lymphoedema of the left lower extremity who had developed a composite haemangioendothelioma with high grade angiosarcoma-like areas mimicking the Stewart-Treves syndrome. Given the multifocality of the disease, the only potentially curable surgical treatment would be hemipelvectomy, which was refused by the patient. The patient has been followed-up, with no signs of local progression of the remaining disease, nor a distant spread outside the involved extremity for two years. CONCLUSIONS: Composite haemangioendothelioma represents a rare malignant vascular tumour, with significantly more favourable biological behaviour than angiosarcoma, even in cases where angiosarcoma-like areas are present. For that reason, composite haemangioendothelioma can be easily misdiagnosed as true angiosarcoma. The rarity of this disease unfortunately hampers the development of clinical practice guidelines and the implementation of treatment recommendations. Most of the patients with localized tumour are treated by wide surgical resection, without neo- or adjuvant radiotherapy or chemotherapy. However, in the case of this diagnosis, the watch-and-wait approach is better than mutilating procedure, highlighting the necessity of establishing of the correct diagnosis.
- MeSH
- hemangioendoteliom * diagnóza MeSH
- hemangiosarkom * patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lymfangiosarkom * diagnóza etiologie patologie MeSH
- lymfedém * diagnóza etiologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
BACKGROUND: Lymphedema is a common adverse consequence of breast cancer therapy, while still relatively little is known about its pathophysiology. Several treatment options emerged over the past decades, and among them, vascularized lymph node transfer (VLNT) seems to be particularly promising. Animal models are indispensable to improve our understanding of the underlying processes surrounding the transplantation of a vascularized lymph node. This review aimed to systematically evaluate animal models of VLNT and compare their advantages and disadvantages. MATERIALS AND METHODS: A systematic review of literature in the Scopus, Web of Science, and Ovid MEDLINE databases was conducted according to the PRISMA guidelines to identify all studies on animal models used for the research of VLNT. The algorithm used in search of articles was "Vascularized Lymph Node Transfer" AND "Model". Articles were manually verified for relevance to the topic. The resulting models were assessed for their suitability for VLNT research. RESULTS: The literature search yielded a total of 233 studies after duplicates removal. Of those, 217 were excluded based on title and abstract review. Another study was excluded after reviewing the full-text article leaving 15 eligible studies to be included in this review article. CONCLUSIONS: Rats were found to be the most dominantly used animal model in the VLNT research, although other models had their benefits. The main areas of study were the functionality of VLNT within or without a preinduced lymphedema, its response to ischemia, and clarification of lymphatic pathways reestablishment following VLNT.
- MeSH
- krysa rodu rattus MeSH
- lidé MeSH
- lymfatické cévy * chirurgie MeSH
- lymfatické uzliny MeSH
- lymfedém * etiologie MeSH
- modely u zvířat MeSH
- nádory prsu * MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- lidé MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
- systematický přehled MeSH
Cíl: Zhodnocení vlivu manuální lymfodrenáže na lymfedém horní končetiny v udržovací fázi po předchozí axilární lymfadenektomii/exstirpaci sentinelové lymfatické uzliny pro karcinom prsu. Soubor a metodika: Celkem 30 pacientek s lymfedémem horní končetiny po chirurgické léčbě jednostranného karcinomu prsu podstoupilo v průběhu 8 konsekutivních týdnů 10 manuálních lymfodrenáží postižené končetiny. Všechny pacientky podstoupily před začátkem a po ukončení studie měření definovaných obvodů horních končetin a vyplnily dva specializované dotazníky EORTC (QLQ-C30 a QLQ-BR23). Výsledky: Pacientky byly průměrně 32,5 měsíců po chirurgické léčbě karcinomu prsu. Při vstupu do studie byl lymfedém horní končetiny přítomen průměrně 19,8 měsíců. Po ukončení série manuálních lymfodrenáží byl zaznamenán 3% (1,5–5,6%) úbytek objemu končetiny s lymfedémem. Ve srovnání s tímto úbytek objemu zdravé (kontrolní) končetiny dosáhl pouze 0,4 %. Objem lymfedému se po terapii snížil průměrně o 57 % (37–88 %). Výsledky dotazníku EORTC QLQ-C30 prokázaly po lymfodrenážích statisticky významné zlepšení fyzických a rolových funkcí, únavy, nauzey a zvracení, bolesti, dušnosti a zácpy. Výsledky dotazníku EORTC QLQ-BR23 prokázaly po ukončení manuálních lymfodrenáží statisticky významné zlepšení symptomů paže a prsu. V žádném ze sledovaných parametrů nebylo zaznamenáno statisticky významné zhoršení stavu. Závěr: Výsledky studie prokázaly příznivý vliv manuální lymfodrenáže na redukci otoku horní končetiny v udržovací fázi lymfedému po operaci pro karcinom prsu. Parametry specializovaných dotazníků zaznamenaly výrazné zlepšení symptomů paže a dalších funkcí a symptomů ovlivňujících kvalitu života. Naše výsledky by měly být potvrzeny obdobnými studiemi na souborech pacientek v udržovací fázi lymfedému horní končetiny.
Objective: Evaluation of the effect of manual lymphatic drainage on lymphedema of the upper limb after previous axillary lymphadenectomy/sentinel node biopsy during the maintenance phase of lymphedema after the breast cancer surgery. Material and methods: A total of 30 patients after surgical treatment of unilateral breast cancer underwent 10 manual lymphatic drainages within 8 consecutive weeks. All patients underwent upper limb circumference measurements before and after the study and completed two specialized EORTC questionnaires (QLQ-C30 and QLQ-BR23). Results: The average time between surgery and admission into this study was 32.5 months. In the beginning of the study, lymphedema was present for an average of 19.8 months. At the end of a series of manual lymphatic drainages, the average volume decrease of the limb with lymphedema was 3% (1.5–5.6%). In contrary, the average loss of volume on the healthy (control) upper limb was only 0.4%. The average reduction of lymphedema volume after therapy achieved 57% (37–88%). After a series of manual lymphatic drainages, the results of the EORTC QLQ-C30 questionnaire showed a statistically significant improvement in physical and role functions, fatigue, nausea and vomiting, pain, dyspnea and constipation, while the results of the EORTC QLQ-BR23 questionnaire showed a statistically significant improvement in the arm and breast symptoms. There was no statistically significant deterioration in any of the monitored parameters. Conclusion: The results of the study showed a positive effect of manual lymphatic drainage on the maintenance phase of lymphedema in patients after breast cancer surgery. The questionnaires showed a significant improvement in hand and arm symptoms as well as an improvement of the other functions and symptoms affecting quality of life. Further studies should be performed on groups of patients with the maintenance phase of upper limb lymphedema to confirm or disprove our results.
