| 1. |
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| 2. |
- Brorson, Håkan, et al.
(författare)
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Controlled compression and liposuction treatment for lower extremity lymphedema.
- 2008
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Ingår i: Lymphology. - 0024-7766. ; 41:2, s. 52-63
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Tidskriftsartikel (refereegranskat)abstract
- In 1987 we noticed excess adipose tissue in a patient with arm lymphedema and later, objective studies confirmed this clinical finding in patients with non-pitting arm lymphedema following breast cancer. A prospective study was begun in 1993, and its long-term results (15 years) shows overall complete reduction of the excess volume in patients with non-pitting arm lymphedema and that adipose tissue dominates the excess volume. Encouraged by these results we operated on a patient with primary and secondary elephantiasis of the leg. The edema was first transferred from a pitting to a non-pitting state by controlled compression therapy. Then liposuction was performed to remove the remaining excess adipose tissue, and complete reduction was finally achieved. The patient wears compression garments continuously and during the 11 years of followup, no recurrence has occurred. This paper explains our philosophical approach: a pitting lymphedema first should be treated conservatively to remove excess fluid, then liposuction can be performed to remove remaining excess volume bothersome to the patient.
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| 3. |
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| 4. |
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| 5. |
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| 6. |
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| 7. |
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| 8. |
- HYLLANDER KLERNÄS, PIA, et al.
(författare)
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Assessment of quality of life in lymphedema patients: validity and reliability of the Swedish version of the Lymphedema Quality of Life Inventory (LQOLI)
- 2010
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Ingår i: Lymphology. - 0024-7766. ; 43:3, s. 135-145
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Tidskriftsartikel (refereegranskat)abstract
- The Lymphedema Quality of Life Inventory (LQOLI) is an instrument developed for patients with different types of lymphedema. It contains physical, emotional, social, and practical dimensions and consists of 58 items, each with three sub items concerning life quality, daily life changes, and difficulties of changing and two items concerning life quality in general and in relation to lymphedema. The purpose of this study was to adapt the Australian LQOLI to Swedish conditions and to test it for clarity, face validity, content validity, construct validity, and reliability. Content and face validity was completed by experts (n=11) and patients with different types of lymphedema (n=16). For construct validation the SF-36 (n=63) was used. Test-retest reliability was evaluated with lymphedema patients (n=58) answering the questionnaire twice, within median 3 weeks. Three items were added in the Swedish version of LQOLI (SLQOLI). The kappa coefficients in test-retest for all items and sub items varied (range=0.25-0.83). Construct validity showed moderate correlation with SF-36. The SLQOLI is adapted and valid, with moderate reliability, and it can be used in clinic to describe life quality for patients with lymphedema. In this study, 67% of the patients experienced an effect on life quality within the physical dimension and 54-58% within the emotional, social, and practical dimensions.
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| 9. |
- Johansson, K., et al.
(författare)
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A historical account of the role of exercise in the prevention and treatment of cancer-related lymphedema
- 2020
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Ingår i: Lymphology. - 0024-7766. ; 53:2, s. 55-62
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Tidskriftsartikel (refereegranskat)abstract
- In the absence of guidance from scientific evidence, a range of lymphedema prevention and management, guidelines were developed by relevant organizations around the world. These became publicly available, promoted and endorsed, particularly to women with breast cancer. The recommendations advised avoidance of any activity that could overload or restrict the lymphatic system and need for caution when participating in specific physical activities. However, over the past 20 years evidence has accumulated which has significantly challenged the safety of these recommendations, in particular for those with cancer. There now exists consistent and compelling evidence in support of exercise following a diagnosis of cancer. Participating in exercise during and following cancer treatment improves function and quality of life, reduces treatment-related morbidity, and may improve survival. Further, exercise, including resistance exercise at moderate or high load, is considered safe for those at risk- or with lymphedema. That is, exercise has not been shown to cause or worsen cancer-related lymphedema. This article provides a historical account of the advice given to patients in the prevention and management of lymphedema and how this advice has evolved.
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| 10. |
- Johansson, Karin, et al.
(författare)
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A Home-Based Weight Lifting Program for Patients with Arm Lymphedema Following Breast Cancer Treatment: A Pilot and Feasibility Study
- 2014
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Ingår i: Lymphology. - 0024-7766. ; 47:2, s. 51-64
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 11. |
- Johansson, Karin, et al.
(författare)
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A randomized study comparing manual lymph drainage with sequential pneumatic compression for treatment of postoperative arm lymphedema
- 1998
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Ingår i: Lymphology. - 0024-7766. ; 31:Jun, s. 56-64
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Tidskriftsartikel (refereegranskat)abstract
- We compared manual lymph drainage (MLD) with sequential pneumatic compression (SPC) for treatment of unilateral arm lymphedema in 28 women previously treated for breast cancer. After 2 weeks of therapy with a standard compression sleeve (Part I) with maintenance of a steady arm volume, each patient was randomly assigned to either one of two treatment regimens (Part II). MLD was performed according to the Vodder technique for 45 min/day and SPC was performed with a pressure of 40-60 mmHg for 2 hours/day. Both treatments were carried out for 2 weeks. Arm volume was measured by water displacement. Arm mobility, strength, and subjective assessments were also determined. Lymphedema was reduced by 49 ml (7% reduction) (p = 0.01) in the total group during Part I. During Part II, the MLD group decreased by 75 ml (15% reduction) (p < 0.001) and the SPC group by 28 ml (7% reduction) (p = 0.03). The total group reported a decrease of tension (p = 0.004) and heaviness (p = 0.01) during Part I. During Part II, only the MLD group reported a further decrease of tension (p = 0.01) and heaviness (p = 0.008). MLD and SPC each significantly decreased arm volume but no significant difference was detected between the two treatment methods.
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| 12. |
- Johansson, Karin, et al.
(författare)
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Effects of compression bandaging with or without manual lymph drainage treatment in patients with postoperative arm lymphedema
- 1999
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Ingår i: Lymphology. - 0024-7766. ; 32:Sep, s. 103-110
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Tidskriftsartikel (refereegranskat)abstract
- We examined the effects of low stretch compression bandaging (CB) alone or in combination with manual lymph drainage (MLD) in 38 female patients with arm lymphedema after treatment for breast cancer. After CB therapy for 2 weeks (Part I), the patients were allocated to either CB or CB + MLD for 1 week (Part II). Arm volume and subjective assessments of pain, heaviness and tension were measured. The mean lymphedema volume reduction for the total group during Part I was 188 ml (p < 0.001), a mean reduction of 26% (p < 0.001). During Part II the volume reduction in the CB + MLD group was 47 ml (p < 0.001) and in CB group 20 ml. These differences were not significant (p = 0.07). A percentage reduction of 11% (p < 0.001) in the CB + MLD group and 4% in the CB group was significantly different (p = 0.04). In both the CB and the CB + MLD group, a decrease of feeling of heaviness (p < 0.006 and p < 0.001, respectively) and tension (p < 0.001 for both) in the arm was found, but only the CB + MLD group showed decreased pain (p < 0.03). Low stretch compression bandaging is an effective treatment giving volume reduction of slight or moderate arm lymphedema in women treated for breast cancer. Manual lymph drainage adds a positive effect
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| 13. |
- Johansson, Karin, et al.
(författare)
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Evidence-based Or Traditional, Treatment of Cancer-related Lymphedema
- 2015
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Ingår i: Lymphology. - 0024-7766. ; 48:1, s. 24-27
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Tidskriftsartikel (refereegranskat)abstract
- The incidence of lymphedema (LE) related to treatment of women's cancer (breast and gynecologic) is as high as 40%. Treatment of LE varies around the world but was decades ago initially based on programs including manual lymph drainage (MLD), compression, skin care and easy exercise. With accumulating evidence and experience, it is time to consider if altering these treatment principles is needed. Based on accumulating evidence, we suggest less emphasis on manual lymph drainage and more on early diagnosis, compression, weight control and exercise for improvement of strength and circulation.
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| 14. |
- Johansson, Karin, et al.
(författare)
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Factors associated with the development of arm lymphedema following breast cancer treatment: a match pair case-control study.
- 2002
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Ingår i: Lymphology. - 0024-7766. ; 35:2, s. 59-71
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Tidskriftsartikel (refereegranskat)abstract
- We examinedfactors that may influence the development of arm lymphedema following breast cancer treatment including the specific mode of therapy, patient occupation and life style. Medical record data and a questionnaire were used to collect information after surgery concerning such issues as wound seroma, infection, adjuvant treatment, vessel string (phlebitis), body mass index, smoking habits and stress. Occupational workload was assessed after surgery whereas housework, exercise, hobbies and body weight were assessed both before and after surgery. Seventy-one breast cancer treated women with arm lymphedema lasting more than 6 months but less than 2 years were matched to women similarly treatedfor breast cancer but without arm lymphedema (controls). The matching factors included axillary node status, time after axillary dissection, and age. In the lymphedema group, there was a higher body mass index at time of surgery (p=0.03) as well at time of study (p=0.04). No differences were found in occupational workload (n=38) or housework, but the lymphedema group reduced their spare time activities including exercise after surgery compared with the controls (p<0.01). In conclusion, women treated for breast cancer with axillary node dissection with or without adjuvant radiotherapy could maintain their level of physical activity and occupational workload after treatment without an added risk of developing arm lymphedema. On the other hand, a higher BMI before and after operation increases the lymphedema risk.
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| 15. |
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| 16. |
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| 17. |
- Lee, D., et al.
(författare)
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Liposuction of postmastectomy arm lymphedema decreases the incidence of erysipelas
- 2016
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Ingår i: Lymphology. - 0024-7766. ; 49:2, s. 85-92
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to assess erysipelas incidence before and after liposuction treatment for patients suffering from post-mastectomy lymphedema. A prospective cohort study of 130 patients at Skåne University Hospital in Malmö, Sweden with postmastectomy arm lymphedema, who had poor outcomes from prior conservative treatment and clinical signs of subcutaneous adipose tissue hypertrophy, underwent liposuction between 1993-2012. Pre- and postoperative incident data on erysipelas were available for all of them. Mean duration of lymphedema prior to liposuction was 8.8 years (range 1-38, standard deviation (SD) 7.0 years). Mean age at liposuction was 63 years (range 39-89, SD 10 years). Total preliposuction observation years were 1147, and total post-liposuction observation years were 983. Erysipelas incidence dropped significantly (p<0.001) from 0.47 attacks/year (range 0-5.0, SD 0.8 attacks/year) to 0.06 attacks/year (range 0-3.0, SD 0.3 attacks/year) after liposuction, a reduction of 87%. Also, compared to 76 patients who experienced at least 1 erysipelas episode preoperatively, only 13 patients experienced erysipelas postoperatively. Of the 54 patients who did not have erysipelas preoperatively, 6 patients had erysipelas postoperatively. The total number of erysipelas attacks observed decreased from 534 to 60 bouts after liposuction. The excess arm volume of 1607 ml (range 570-3950, SD 707) was reduced to -43 ml (range -945 to 1390, SD 379) after 6 months and was maintained during the postoperative follow-up period of, at most, 18 years. Our data suggest that liposuction can significantly reduce incidence of erysipelas in patients with post mastectomy arm lymphedema who prior to the intervention suffered one or more attacks.
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| 18. |
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| 19. |
- Lindquist, H., et al.
(författare)
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WATER EXERCISE COMPARED TO LAND EXERCISE OR STANDARD CARE IN FEMALE CANCER SURVIVORS WITH SECONDARY LYMPHEDEMA
- 2015
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Ingår i: Lymphology. - 0024-7766. ; 48:2, s. 64-79
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Tidskriftsartikel (refereegranskat)abstract
- There are few studies showing that physical exercise can improve secondary lymphedema. We hypothesized that water exercise would be more effective than land exercise in reducing limb volume. Secondary objectives were joint movement, BMI, daily function, well-being, and body image. Limb volume was measured with circumference or was volumetric. Well-being and body image were measured with a study-specific questionnaire and daily function with DASH and HOOS questionnaires. Eighty-eight eligible patients with secondary lymphedema after breast or gynecological cancer participated in this controlled clinical intervention study. There was a higher proportion of women who participated in water exercises who reduced their secondary arm limb volume (p=0.029), and there were also significant differences for BMI (p=0.047) and self-reported frequency of swelling (p=0.031) in the water exercise group after intervention. Women with arm lymphedema in the land exercise group improved DASH scores (p=0.047) and outer rotation in the shoulder (p=0.001). Our results suggest that to reduce objective and self-reported swelling, lymphedema patients may be offered water exercise training while to improve daily shoulder function, land exercises are preferred. To guide female cancer survivors with lymphedema to effective exercise resulting in reduced limb volume and improved function, adequate evidenced-based programs are needed.
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| 20. |
- Noon, A, et al.
(författare)
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Comparative lymphatic, ocular, and metabolic phenotypes of Foxc2 haploinsufficient and aP2-FOXC2 transgenic mice.
- 2006
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Ingår i: Lymphology. - 0024-7766. ; 39:2, s. 84-94
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Tidskriftsartikel (refereegranskat)abstract
- FOXC2 mutations cause the lymphatic/ocular disorder Lymphedema-Distichiasis (LD), and Foxc2 haploinsufficient mice mimic this disorder. To determine if FOXC2 overexpression might also cause lymphatic and/or ocular abnormalities, we performed dynamic lymphatic imaging (Evans blue dye), ocular tissue examination, and metabolic profiles in mice: transgenic for FOXC2 with an adipocyte (aP2) promoter (aP2-FOXC2 Tg), heterozygous for targeted disruption of Foxc2 (Foxc2+/-), or compound heterozygous and transgenic (Foxc2+/-, Tg) compared to wild-type controls (WT). Foxc2+/-; aP2-FOXC2 Tg; and Foxc2+/-, Tg, exhibited LD's distinctive hyperplastic lymphatic phenotype characterized by increased number of lymphatic channels and lymph nodes as well as retrograde lymph reflux. Foxc2+/-, and Foxc2+/-, Tg but not aP2-FOXC2 Tg or WT showed an abnormal ocular phenotype. Previously described alterations in brown/ white fat distribution and lean phenotype in aP2-FOXC2 transgenics were confirmed. AP2-FOXC2 Tg immunohistochemistry disclosed aberrant FOXC2 expression in ectopic sites, especially embryonic heart. Lymphatic system links with fat metabolism are discussed.
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| 21. |
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| 22. |
- Perbeck, L
(författare)
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Untitled - Response
- 2006
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Ingår i: LYMPHOLOGY. - 0024-7766. ; 39:4, s. 201-202
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 23. |
- Sjöberg, Trygve, et al.
(författare)
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Antagonism of thromboxane receptor induced contractions in isolated human groin lymphatics
- 1989
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Ingår i: Lymphology. - 0024-7766. ; 22:3, s. 135-140
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Tidskriftsartikel (refereegranskat)abstract
- In vitro studies were performed on lymphatics obtained from the groin in 19 patients undergoing vascular surgery. The lymphatics were mounted in tissue baths, and isometric contractions were induced by increasing concentrations of the thromboxane A2 (TXA2) mimetic U-46619. In comparison to K+ (124mM)-induced contraction, which were used as an internal standard, the response to U-46619 had an Emax of 105 +/- 5.9%. The pEC50-value was 8.14 +/- 0.09. The effects of two thromboxane receptor (TP-receptor) antagonists, L-636,499 and BM-13,505, were investigated. Both antagonists caused concentration-dependent right-ward shifts without depression of Emax of the U-46619 concentration-response curves. The slopes of the regression lines in a Schild plot for both antagonists did not differ from one, indicating competitive antagonism. The pA2-value of BM-13,505 (7.89) was 65 times higher than that of L-636,499 (6.08). The results suggest that the receptor involved in the prostanoid contraction in human groin lymphatics is of the TP-subtype.
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| 24. |
- Sjöberg, Trygve, et al.
(författare)
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Contractile properties of lymphatics from the human lower leg
- 1991
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Ingår i: Lymphology. - 0024-7766. ; 24:1, s. 16-21
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Tidskriftsartikel (refereegranskat)abstract
- Lower leg lymphatics, taken from seven volunteers, were investigated in vitro. Isometric contractions were induced by noradrenaline, 5-hydroxytryptamine (5-HT), prostaglandin F2 alpha (PGF2 alpha), and the thromboxane A2 (TXA2)-mimetic U-44069. Noradrenaline induced phasic contractions in 6 of 7 segments. The amplitude of the contractions were up to 100% of a previous K+ (124mM)-induced contraction and the frequency at 10(-6)M of noradrenaline was 5-13 min-1. These contractions were unaffected by propranolol (10(-6)M), but they were abolished by phentolamine (10(-6)M). Noradrenaline had an Emax (tonic contraction) of 7% of the K+ (124mM) contraction (n = 7) and the pEC50-value was 6.9 (n = 3). The corresponding values for 5-HT were 21% (n = 5) and 6.4 (n = 3). PGF2 alpha elicited contractions in all segments investigated (Emax = 87%, pEC50 = 5.8, n = 5). U-44069 had high contractile capacity and potency in all investigated segments (Emax = 137%, pEC50 = 8.9, n = 7). Phasic contractions were elicited also by 5-HT, PGF2 alpha and U-44069. Compared to earlier studies of human peripheral lymphatics, these results show that there are regional differences in susceptibility to these vasoactive agents.
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| 25. |
- Sjöberg, Trygve, et al.
(författare)
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Contractile response in isolated human groin lymphatics
- 1987
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Ingår i: Lymphology. - 0024-7766. ; 20:3, s. 152-160
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Tidskriftsartikel (refereegranskat)abstract
- Lymphatics from the human superficial groin removed at operation in 21 patients (one with lymphedema) were examined in vitro. Histochemically no nerves were identified with either specific catecholamine fluorescence or immunoreactivity to tyrosine hydroxylase or dopamine beta-hydroxylase. Ring preparations of the lymphatics were mounted in tissue baths and isometric induced contractions were recorded after administration of K+ (124 mM), acetylcholine, selected amines and prostanoids. Noradrenaline (NA), adrenaline, dopamine, and acetylcholine had no or only weak contractile effects. In some segments, serotonin induced contractions. Prostaglandin E2 showed no contractile effect and prostaglandin F2 alpha induced contraction in most of the tested lymphatics. The prostaglandin-endoperoxide analogue U44069 uniformly elicited marked concentration-dependent contraction. In the lymphatic segment from the patient with lymphedema, a slightly greater contractile response to NA and serotonin was observed. The results overall suggest an absence of sympathetic innervation and contraction-mediating alpha adrenergic receptors in human superficial groin lymphatics, and support that certain prostanoids may be important regulators of human lymphatic contractility.
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| 26. |
- Sjöberg, Trygve, et al.
(författare)
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Contractility of human leg lymphatics during exercise before and after indomethacin
- 1989
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Ingår i: Lymphology. - 0024-7766. ; 22:4, s. 186-193
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Tidskriftsartikel (refereegranskat)abstract
- Subcutaneous lymphatics in the lower leg were catheterized in the retrograde direction in 6 healthy male subjects. The catheter was connected to a pressure transducer, and pressure was measured during three stages of exercise including standing, tip-toeing, and running in place. Before the third stage, indomethacin (50mg) was given i.v. Rhythmic pressure waves were registered in each subject. During the second stage, when the subjects were "warmed up," the frequency (min-1) was 2.4 +/- 0.5 (mean +/- SEM). The corresponding values during tip-toeing and running were 5.8 +/- 0.7 (p less than 0.05) and 5.4 +/- 0.5 (p less than 0.05), respectively. The amplitudes (mean values between 3.2-4.7mmHg while standing) were not consistently altered during tip-toeing or running in any of the three stages. During standing there was a negative correlation between frequency and amplitude. No such correlation was found during tip-toeing or running, or after injection of indomethacin. Indomethacin did not significantly alter any of the measured parameters, but in two subjects the frequencies and amplitudes were decreased (about 50%) during standing, tip-toeing, and running.
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| 27. |
- Sjöberg, Trygve, et al.
(författare)
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In vitro effects of a thromboxane A2-analogue U-46619 and noradrenaline on contractions of the human thoracic duct
- 1991
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Ingår i: Lymphology. - 0024-7766. ; 24:3, s. 113-115
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Tidskriftsartikel (refereegranskat)abstract
- A piece of a human thoracic duct removed at operation was investigated in organ baths. The duct was cut in 8 ring segments each about 1mm long and isometric tension recorded. The segments were exposed to a potassium rich (124mM) Krebs buffer solution. In only two of the segments were contractions induced (7.2 and 1.0mN, respectively). Noradrenaline and the thromboxane mimetic U-46619 induced tonic and phasic contractions. At a noradrenaline concentration of 10(-5)M the phasic contractions had a frequency of 5 min-1. The highest frequency, 9 min-1, was recorded with 3 x 10(-10)M of U-46619 present in the bath. Noradrenaline had a mean Emax of 50% of the previous K+ (124mM)-induced contraction, and the mean pEC50-value was 6.7. The Emax and pEC50-values of U-46619 were 142% and 9.5, respectively. Postjunctional alpha-adrenoceptors and thromboxane A2-receptors may play a role in the contractility of the human thoracic duct.
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| 28. |
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