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PMID:28462719
Autor:Hung TJ; Burrage J; Bourke A; Taylor D
Endereço:Department of Nuclear Medicine, Royal Perth Hospital, Perth. Australia.
Título:Intraoperative Localisation of Impalpable Breast Lesions Utilising the ROLLIS Technique Following Peritumoral 99mTc-colloid Sentinel Node Lymphoscintigraphy.
Fonte:Curr Radiopharm; 10(2):111-114, 2017 Aug 24.
ISSN:1874-4729
País de publicação:United Arab Emirates
Idioma:eng
Resumo:BACKGROUND: Ultrasound or stereotactic guided hook-wire localisation has been the standard-of-care for the pre-surgical localisation of impalpable breast lesions, which account for approximately a third of all breast cancer. Radioguided occult lesion localisation using I-125 seeds (ROLLIS) is a relatively new technique for guiding surgical excision of impalpable breast lesions, and is a promising alternative to the traditional hook-wire method. When combined with Tc-99m labelled colloid for sentinel node mapping in clinically indicated cases, there has been uncertainty regarding whether the downscatter of Tc-99m into the I-125 energy spectrum could adversely affect the intra-operative detection of the I-125 seed, especially pertaining to a peritumoral injection. OBJECTIVE: To evaluate the percentage contribution of downscattered activity from Tc-99m into the I-125 energy spectrum in simulated intra-operative resections of an I-125 seed following different sentinel node injection techniques. METHOD: Two scenarios were simulated using breast phantoms with lean chicken breast. The first scenario, with a 2cm distance between the Tc-99m injection site and the I-125 seed, simulated a periareolar ipsiquadrant injection with the subdermal or intradermal technique. The second scenario simulated a peritumoral injection technique with the Tc-99m bolus and an I-125 seed at the same site. Count rates were acquired with a hand-held gamma probe, and the percentage contribution of downscattered Tc-99m gamma photons to the I-125 energy window was calculated. RESULTS: In scenarios one and two, downscattered Tc-99m activity contributed 0.5% and 33% respectively to the detected count rate in the I-125 energy window. In both scenarios, the I-125 seed was successfully localised and removed using the gamma probe. CONCLUSION: There is no significant contribution of downscattered activity associated with a peritumoral injection of Tc-99m to adversely affect the accurate intra-operative localisation of an I- 125 seed.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância:0 (Iodine Radioisotopes); 0 (Iodine-125); 0 (Radiopharmaceuticals); 0 (Technetium Tc 99m Aggregated Albumin); 0 (technetium Tc 99m nanocolloid); A0730CX801 (Sodium Pertechnetate Tc 99m)


  2 / 789 MEDLINE  
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PMID:29304140
Autor:Oliveira MMF; Gurgel MSC; Amorim BJ; Ramos CD; Derchain S; Furlan-Santos N; Dos Santos CC; Sarian LO
Endereço:Department of Obstetrics and Gynecology- University of Campinas, School of Medicine, Campinas, São Paulo, Brazil.
Título:Long term effects of manual lymphatic drainage and active exercises on physical morbidities, lymphoscintigraphy parameters and lymphedema formation in patients operated due to breast cancer: A clinical trial.
Fonte:PLoS One; 13(1):e0189176, 2018.
ISSN:1932-6203
País de publicação:United States
Idioma:eng
Resumo:PURPOSE: evaluate whether manual lymphatic drainage (MLD) or active exercise (AE) is associated with shoulder range of motion (ROM), wound complication and changes in the lymphatic parameters after breast cancer (BC) surgery and whether these parameters have an association with lymphedema formation in the long run. METHODS: Clinical trial with 106 women undergoing radical BC surgery, in the Women's Integrated Healthcare Center-University of Campinas. Women were matched for staging, age and body mass index and were allocated to performed AE or MLD, 2 weekly sessions during one month after surgery. The wound was evaluated 2 months after surgery. ROM, upper limb circumference measurement and upper limb lymphoscintigraphy were performed before surgery, and 2 and 30 months after surgery. RESULTS: The incidence of seroma, dehiscence and infection did not differ between groups. Both groups showed ROM deficit of flexion and abduction in the second month postoperative and partial recovery after 30 months. Cumulative incidence of lymphedema was 23.8% and did not differ between groups (p = 0.29). Concerning the lymphoscintigraphy parameters, there was a significant convergent trend between baseline degree uptake (p = 0.003) and velocity visualization of axillary lymph nodes (p = 0.001) with lymphedema formation. A reduced marker uptake before or after surgery predicted lymphedema formation in the long run (>2 years). None of the lymphoscintigraphy parameters were shown to be associated with the study group. Age ≤39 years was the factor with the greatest association with lymphedema (p = 0.009). In women with age ≤39 years, BMI >24Kg/m2 was significantly associated with lymphedema (p = 0.017). In women over 39 years old, women treated with MLD were at a significantly higher risk of developing lymphedema (p = 0.011). CONCLUSION: Lymphatic abnormalities precede lymphedema formation in BC patients. In younger women, obesity seems to be the major player in lymphedema development and, in older women, improving muscle strength through AE can prevent lymphedema. In essence, MLD is as safe and effective as AE in rehabilitation after breast cancer surgery.
Tipo de publicação: CONTROLLED CLINICAL TRIAL; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T


  3 / 789 MEDLINE  
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PMID:29091562
Autor:Greene AK; Voss SD; Maclellan RA
Endereço:Boston Children's Hospital, Boston, MA arin.greene@childrens.harvard.edu.
Título:Liposuction for Swelling in Patients with Lymphedema.
Fonte:N Engl J Med; 377(18):1788-1789, 2017 11 02.
ISSN:1533-4406
País de publicação:United States
Idioma:eng
Tipo de publicação: CASE REPORTS; LETTER


  4 / 789 MEDLINE  
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PMID:29059186
Autor:Kar SK; Dwibedi B; Das BK; Agrawala BK; Ramachandran CP; Horton J
Endereço:Director of Medical Research, IMS & Sum Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India.
Título:Lymphatic pathology in asymptomatic and symptomatic children with Wuchereria bancrofti infection in children from Odisha, India and its reversal with DEC and albendazole treatment.
Fonte:PLoS Negl Trop Dis; 11(10):e0005631, 2017 Oct.
ISSN:1935-2735
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Once interruption of transmission of lymphatic filariasis is achieved, morbidity prevention and management becomes more important. A study in Brugia malayi filariasis from India has shown sub-clinical lymphatic pathology with potential reversibility. We studied a Wuchereria bancrofti infected population, the major contributor to LF globally. METHODS: Children aged 5-18 years from Odisha, India were screened for W. bancrofti infection and disease. 102 infected children, 50 with filarial disease and 52 without symptoms were investigated by lymphoscintigraphy and then randomized to receive a supervised single oral dose of DEC and albendazole which was repeated either annually or semi-annually. The lymphatic pathology was evaluated six monthly for two years. FINDINGS: Baseline lymphoscintigraphy showed abnormality in lower limb lymphatics in 80% of symptomatic (40/50) and 63·5% (33/52) of asymptomatic children. Progressive improvement in baseline pathology was seen in 70·8, 87·3, 98·6, and 98·6% of cases at 6, 12, 18, and 24 months follow up, while in 4·2, 22·5, 47·9 and 64·8%, pathology reverted to normal. This was independent of age (p = 0·27), symptomatic status (p = 0·57) and semi-annual/bi-annual dosing (p = 0·46). Six of eleven cases showed clinical reduction in lymphedema of legs. INTERPRETATION: A significant proportion of a young W. bancrofti infected population exhibited lymphatic pathology which was reversible with annual dosage of DEC and albendazole. This provides evidence for morbidity prevention & treatment of early lymphedema. It can also be used as a tool to improve community compliance during mass drug administration. TRIAL REGISTRATION: ClinicalTrials.gov No CTRI/2013/10/004121.
Tipo de publicação: JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
Nome de substância:0 (Filaricides); F4216019LN (Albendazole); V867Q8X3ZD (Diethylcarbamazine)


  5 / 789 MEDLINE  
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PMID:28669886
Autor:Maclellan RA; Zurakowski D; Voss S; Greene AK
Endereço:Department of Plastic and Oral Surgery, Lymphedema Program, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Título:Correlation Between Lymphedema Disease Severity and Lymphoscintigraphic Findings: A Clinical-Radiologic Study.
Fonte:J Am Coll Surg; 225(3):366-370, 2017 Sep.
ISSN:1879-1190
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Lymphoscintigraphy is used to confirm the diagnosis of lymphedema; pathologic findings are abnormal transit time to regional nodes and dermal backflow. A universal protocol for the test does not exist. The purpose of this study was to determine whether the clinical severity of lymphedema correlates with lymphoscintigraphy findings. STUDY DESIGN: Patients treated in our Lymphedema Program between 2009 and 2017 were reviewed. Diagnosis of lymphedema was determined by history, physical examination, and lymphoscintigraphy. Severity was defined by increased volume of the limb as follows: mild (<20%), moderate (20% to 40%), and severe (>40%). Candidate variables included location (arm, leg), age, duration of symptoms, infection history, and lymphedema type (primary, secondary). An association between lymphedema severity and lymphoscintigraphy findings was determined using the Pearson chi-square test and multivariate logistic regression. RESULTS: One hundred and thirty-four patients with 181 affected extremities (24 upper, 157 lower) were included. Clinical severity was as follows: 54% mild, 30% moderate, and 16% severe. Delayed tracer transit to the regional nodes was as follows: 45 minutes (34%), 2 hours (18%), and 4 hours or longer (48%). Thirty-six percent of extremities demonstrated dermal backflow. Abnormal transit time or dermal backflow was identified in 97% of extremities by 45 minutes and in 3% of limbs by 2 hours. Transit time and dermal backflow were not predictive of clinical severity when adjusting for candidate variables (p > 0.1). CONCLUSIONS: Clinical severity of lymphedema is not associated with lymphoscintigraphy findings. A lymphoscintigram should be interpreted as normal or abnormal, and does not need to exceed 2 hours.
Tipo de publicação: JOURNAL ARTICLE


  6 / 789 MEDLINE  
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PMID:28420899
Autor:Yamada K; Shinaoka A; Kimata Y
Endereço:Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama 700-8558, Japan.yam_kiy@yahoo.co.jp.
Título:Three-Dimensional Imaging of Lymphatic System in Lymphedema Legs Using Interstitial Computed Tomography-lymphography.
Fonte:Acta Med Okayama; 71(2):171-177, 2017 Apr.
ISSN:0386-300X
País de publicação:Japan
Idioma:eng
Resumo:As a new trial, we used interstitial computed tomography-lymphography (CT-LG) in 10 patients with lower extremity lymphedema (n=20 limbs) at stage 0, 1, 2, or 3 under the International Society of Lymphology (ISL) classification. In all cases, CT-LG, lymphoscintigraphy, and indocyanine green fluorescence-lymphography (ICG-LG) were performed. In the examination of the ascending level of depicted lymphatic vessels, we measured the diameters of lymphatic vessels detected with CT-LG and conducted an image analysis of dermal backflow of lymph (DB). CT-LG had better resolution than lymphoscintigraphy and enabled the clear visualization of lymphatic vessels with a minimum lumen size of 0.7 mm. CT-LG also showed the three-dimensional architecture of the DB, which originated from deep lymphatic collectors via branched small lymphatic vessels. Our findings are quite valuable not only for detailed examinations of lymphedematous sites and for the lymphedema surgery, but also for investigations of the pathogenesis of lymphedema which has not yet been established. We observed that lymphoscintigraphy could show the lymphatic vessels up to the thigh level in all cases, whereas CT-LG enabled the vessels' visualization up to the leg level at maximum. In conclusion, CT-LG provided adequate and detailed three-dimensional imaging of the lymphatic system in lymphedema patients.
Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE
Nome de substância:0 (Coloring Agents); IX6J1063HV (Indocyanine Green)


  7 / 789 MEDLINE  
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PMID:28350688
Autor:Yamamoto T; Yamamoto N; Ishiura R
Endereço:Department of Plastic Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
Título:Evaluation of the Upper Limb Lymphatic System: A Prospective Lymphoscintigraphic Study in Melanoma Patients and Healthy Controls.
Fonte:Plast Reconstr Surg; 139(4):1028e-1029e, 2017 04.
ISSN:1529-4242
País de publicação:United States
Idioma:eng
Tipo de publicação: LETTER; COMMENT


  8 / 789 MEDLINE  
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PMID:28346283
Autor:Schuitevoerder D; Grinlington L; Stevens J; Nance R; Fortino J; Vetto JT
Endereço:Departments of aSurgery bDivision of Surgical Oncology cDiagnostic Radiology, Division of Nuclear Medicine, Oregon Health & Science University, Portland, Oregon, USA dDeakin University, Waurn Ponds, Victoria, Australia.
Título:Nonvisualized sentinel lymph nodes on lymphoscintigraphy in melanoma: predictive factors and surgical outcomes.
Fonte:Nucl Med Commun; 38(5):383-387, 2017 May.
ISSN:1473-5628
País de publicação:England
Idioma:eng
Resumo:PURPOSE: Preoperative lymphoscintigraphy is the standard for the identification of sentinel lymph nodes (SLNs) in melanoma. The impact of negative scintigraphy [nonvisualization (NV) of the SLN] on surgical outcomes is inadequately reported in the literature. The objectives of this study were to determine the incidence, predictive factors, and surgical outcomes of NV in clinically node-negative melanoma patients. PATIENTS AND METHODS: A retrospective review of a prospective, Institutional Review Board approved, melanoma sentinel node database from January 2005 to August 2015 was performed. RESULTS: Twenty-seven of the 897 (3%) patients had negative scintigraphy. Single-photon emission computed tomography/computed tomography was performed in addition to planar imaging in four patients and failed to locate the SLN in all cases. NV was associated with older age (71 vs. 59 years, P<0.001), head and neck primaries (41%), and previous operations adjacent to the primary tumor or nodal beds (37%). NV was not associated with sex, BMI, or T stage. Despite a negative scintigram, the SLN was still found at operation in 10 of the 27 (37%) patients using the hand-held gamma probe, with one (10%) patient having nodal metastasis. Two patients with NV had nodal recurrence, with a mean follow-up of 3 years. DISCUSSION: Preoperative lymphoscintigraphy in clinically node-negative melanoma patients is associated with a low NV rate. Predictors for NV include age, head and neck location, and previous operations at adjacent sites. NV should not preclude surgical exploration as the SLN can still be found at operation in over one-third of patients.
Tipo de publicação: JOURNAL ARTICLE


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PMID:28346247
Autor:Roman M; Barbieux R; Leduc O; Bourgeois P
Endereço:From the *Department of Mammo-Pelvic Surgery, †Multidisciplinary Clinic of Lymphology, ‡Service of Kinesitherapy, §Service of Nuclear Medicine, Jules Bordet Institute, Brussels; and ∥HE PHSpaak, Brussels, Belgium.
Título:Lymphatic Drainages to the Paravertebral and Pararenal Lymph Nodes in Breast Cancer Patients.
Fonte:Clin Nucl Med; 42(6):e297-e299, 2017 Jun.
ISSN:1536-0229
País de publicação:United States
Idioma:eng
Resumo:An efficient evaluation of the lymphatic drainage from the breasts (thoracic wall) and/or the upper limbs is essential in the management of patients with breast cancer (BC) and/or BC-related lymphedema. Lymphoscintigraphy was performed in 2 patients with lymphedema. Lymphatic drainage was observed from the upper limb or breast to the posterior paravertebral and/or pararenal lymph nodes. The cases demonstrate lymphatic drainage pathways toward unusual and mostly unrecognized lymph nodes, which may be at risk for further evolution of BC and may be important for the physical treatment of BC-related lymphedema.
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE


  10 / 789 MEDLINE  
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PMID:28323573
Autor:Kitayama S; Maegawa J; Matsubara S; Kobayashi S; Mikami T; Hirotomi K; Kagimoto S
Endereço:1 Department of Plastic and Reconstructive Surgery, Yokohama City University School of Medicine , Yokohama, Japan .
Título:Real-Time Direct Evidence of the Superficial Lymphatic Drainage Effect of Intermittent Pneumatic Compression Treatment for Lower Limb Lymphedema.
Fonte:Lymphat Res Biol; 15(1):77-86, 2017 Mar.
ISSN:1557-8585
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Intermittent pneumatic compression (IPC) is a widely used lymph drainage therapy that can be performed at home. However, the effectiveness of IPC for lymph drainage remains unclear. The aim of this study is to investigate the real-time change in the lymph flow velocity during IPC and consider which mode and pressure are best for treating lower limb lymphedema. METHODS AND RESULTS: Eight lower left limbs of 8 healthy volunteers and 17 lower limbs of 15 secondary lymphedema patients were investigated. Indocyanine green lymphography was performed with the subject covered with a transparent six-chambered IPC garment. The IPC treatment was administered in several modes (sequential or nonsequential inflation mode, sequential or interrupted deflation mode, and under high or low pressure). Using a brightness intensity analysis software program, the real-time change in the fluorescence intensity during the treatment was recorded and graphed. The maximum inclination of the graph between 2 seconds in the inflation phase (SLOPE) and the mean SLOPE value of all subjects (average SLOPE) were calculated. The average SLOPEs of each mode of treatment were then compared. The average SLOPEs were also compared between patients with mild and moderate lymphedema. There were no significant differences among the SLOPEs in the healthy group. However, in the patient group, the average SLOPE was significantly higher in the sequential inflation mode as well as under high pressure than in the nonsequential inflation mode. On comparing the mild and moderate lymphedema groups, the average SLOPE tended to be higher in the mild group; however, the difference was not statistically significant. CONCLUSIONS: Sequential programs and high pressure resulted in a faster lymphatic flow than other modes. These results suggest that a greater treatment effect could be obtained by adjusting the mode of treatment and the pressure of IPC.
Tipo de publicação: JOURNAL ARTICLE



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