Combined Conservative Treatment and Lymphatic Venous Anastomosis for Severe Lower Limb Lymphedema with Recurrent Cellulitis

2015 ◽  
Vol 29 (6) ◽  
pp. 1318.e11-1318.e15 ◽  
Author(s):  
Makoto Mihara ◽  
Hisako Hara ◽  
Hiromi Tsubaki ◽  
Takiko Suzuki ◽  
Naomi Yamada ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Lower Limb ◽  
Venous Anastomosis

scholarly journals The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction

2017 ◽  
Vol 52 (6) ◽  
pp. 387-407 ◽  
Author(s):  
Vasileios Korakakis ◽  
Rodney Whiteley ◽  
Alexander Tzavara ◽  
Nikolaos Malliaropoulos
Keyword(s):  
Systematic Review ◽  
Conservative Treatment ◽  
Lower Limb ◽  
Risk Of Bias ◽  
Eccentric Training ◽  
Level Of Evidence ◽  
Extracorporeal Shockwave Therapy ◽  
Low Level ◽  
Shockwave Therapy

ObjectiveTo evaluate extracorporeal shockwave therapy (ESWT) in treating Achilles tendinopathy (AT), greater trochanteric pain syndrome (GTPS), medial tibial stress syndrome (MTSS), patellar tendinopathy (PT) and proximal hamstring tendinopathy (PHT).DesignSystematic review.Eligibility criteriaRandomised and non-randomised studies assessing ESWT in patients with AT, GTPS, MTSS, PT and PHT were included. Risk of bias and quality of studies were evaluated.ResultsModerate-level evidence suggests (1) no difference between focused ESWT and placebo ESWT at short and mid-term in PT and (2) radial ESWT is superior to conservative treatment at short, mid and long term in PHT. Low-level evidence suggests that ESWT (1) is comparable to eccentric training, but superior to wait-and-see policy at 4 months in mid-portion AT; (2) is superior to eccentric training at 4 months in insertional AT; (3) less effective than corticosteroid injection at short term, but ESWT produced superior results at mid and long term in GTPS; (4) produced comparable results to control treatment at long term in GTPS; and (5) is superior to control conservative treatment at long term in PT. Regarding the rest of the results, there was only very low or no level of evidence. 13 studies showed high risk of bias largely due to methodology, blinding and reporting.ConclusionLow level of evidence suggests that ESWT may be effective for some lower limb conditions in all phases of the rehabilitation.

The Effect of Lumbar Sympathetic Ganglion Block on Gynecologic Cancer-Related Lymphedema

2013 ◽  
Vol 4;16 (4;7) ◽  
pp. 345-352
Author(s):  
Hahck Soo Park
Keyword(s):  
Quality Of Life ◽  
Conservative Treatment ◽  
Cancer Treatment ◽  
Pain Score ◽  
Lower Limb ◽  
Sympathetic Ganglion ◽  
Gynecological Cancer ◽  
Gynecologic Cancer ◽  
Ganglion Block

Background: Eighteen to 25% of patients after gynecological cancer treatment suffer from lower limb lymphedema (LLL) that decreases the quality of life of gynecological cancer survivors. Lumbar sympathetic ganglion block (LSGB) is widely used in practice for the evaluation and management of sympathetically mediated pain in the lower limbs. Several articles have suggested that sympathetic ganglion block could be an effective treatment for lymphedema. Objectives: To investigate the effect of LSGB on patients with secondary lymphedema related to the treatment of gynecologic cancer, who do not respond to a conservative treatment. Study Design: Prospective clinical study. Setting: A single academic medical center, outpatient setting. Methods: Eighteen patients with stage II lower limb lymphedema who did not response to the conservative treatment were recruited. The patients underwent fluoroscopy-guided LSGB 3 times at 2-week intervals. The circumference of the thigh and calf was measured in the upright position at the first visit and 2 weeks after each session of LSGB. The pain score of the lower limb was checked at the same time by a numeric rating scale (NRS) from 0 to 10. The patients were asked about their satisfaction with the procedure at the last follow-up visit. The Wilcoxon signed rank test was used for data analysis. Significance was accepted at a P-value less than 0.05/3. Results: The circumferences of affected thighs and calves decreased from 56.38 ± 4.77 and 35.33 ± 3.51cm to 54.42 ± 5.27 and 34.41 ± 3.35cm, respectively, in a significant manner after 3 consecutive LSGBs (P < 0.05/3). The maximal decrease after the third LSGB was 4 cm in the thigh and 2cm in the calf. The pain score also showed a significant decrease after 3 consecutive LSGBs from 2.17 to 1.28. The tightness and heaviness of the affected limb decreased after the first LSGB in 15 patients (83.3%) and after the second LSGB in 2 patients (11.1%). Five of 18 patients (27.8%) answered that the result of the LSGB met their expectations, 10 (55.6%) answered they would undergo the same treatment for the same outcome, 2 (11.1%) answered they did not improve as much as they had hoped, and they would not undergo the same treatment for the same outcome, and only one patient (5.6%) answered the LSGB showed no effect. Limitations: This study lacks a placebo control group and has only 18 patients. We did not evaluate the quality of life of the patients. Conclusion: We suggest that LSGB can be one of the treatment options for patients suffering from LLL after gynecologic cancer treatment. Our result could provide a basis for a randomized controlled trial in future investigations. The pain physicians can play an important role as one of the multidisciplinary team for a comprehensive treatment of LLL. Key words: Lumbar sympathetic ganglion block;gynecologic cancer;lymphedema

Lethal outcome of bilateral pulmonary embolism combined with ascending varicophlebitis of the lower limb. Case report

2015 ◽  
Vol 156 (16) ◽  
pp. 644-649
Author(s):  
Imre Nagy ◽  
Levente Skribek ◽  
Anna Barbara Dienes ◽  
Csaba Rédei ◽  
Márton Tar
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Case Report ◽  
Conservative Treatment ◽  
Lower Limb ◽  
Thromboembolic Events ◽  
Lethal Outcome

The authors review the history and risk factors of thrombophlebitis of the lower limb, and describe the main points of surgical and conservative treatment of varicophlebitis. They present the case of a 71-year-old woman who had ascending varicophlebitis and bilateral pulmonary embolism. The authors draw attention to important points: patients must be followed after phlebitis of the lower limb, and their thrombotic factors must be examined to prevent the new thromboembolic events. Orv. Hetil., 2015, 156(16), 644–649.

Popliteal lymphatico-venous anastomosis for lower limb lymphedema to allow patients to adopt the traditional Japanese “seiza” sitting position

2011 ◽  
Vol 64 (11) ◽  
pp. 1544-1546 ◽  
Author(s):  
Makoto Mihara ◽  
Noriyuki Murai ◽  
Yohei Hayashi ◽  
Hisashi Moriguchi ◽  
Takuya Iida ◽  
...  
Keyword(s):  
Lower Limb ◽  
Sitting Position ◽  
Venous Anastomosis

scholarly journals Surgical debulking, lymphatico venous anastomosis, vascularised lymph node transfer in lower limb lymphoedema

2020 ◽  
Vol 2020 ◽  
Author(s):  
Hari Venkatramani ◽  
Rajasabapathy Raja Shanmugakrishnan ◽  
Murugesan Senthil Kumaran ◽  
Shanmuganathan Raja Sabapathy
Keyword(s):  
Lymph Node ◽  
Lower Limb ◽  
Venous Anastomosis ◽  
Surgical Debulking ◽  
Lymph Node Transfer

scholarly journals Conservative treatment for intermittent claudication

2021 ◽  
Vol 5 (4) ◽  
pp. 212-217
Author(s):  
M.R. Kuznetsov ◽  
◽  
I.V. Reshetov ◽  
S.V. Sapelkin ◽  
N.V. Yasnopol’skaya ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Intermittent Claudication ◽  
Lower Limb ◽  
Management Strategy ◽  
Evidence Base ◽  
Walking Distance ◽  
Atherosclerotic Plaques ◽  
Antithrombotic Effect ◽  
The Common ◽  
Russian Medical

This paper discusses the issues emerging during the treatment of lower-limb arterial diseases and intermittent claudication. According to the international and Russian guidelines, the common management strategy for intermittent claudication is as follows: conservative treatment is recommended in patients without limiting intermittent claudication who can walk 30 m or more without pain. Drugs that are prescribed is these patients are addressed. No large well-designed studies on most of these drugs were conducted, therefore, it is challenging to assess their efficacy in patients with intermittent claudication. The authors focus on cilostazol that has the largest evidence base. This drug is included in the Russian and international clinical guidelines. Several students demonstrate that cilostazol provides antithrombotic effect, stabilizes atherosclerotic plaques, prevents hyperplasia of neointima and restenosis after vascular procedures, improves lipid metabolism, and significantly increases pain-free walking distance (intermittent claudication distance). Recent studies show that cilostazol can be used in the complex treatment for COVID-19 due to pleiotropic mechanism of action. KEYWORDS: lower-limb arterial diseases, intermittent claudication, conservative treatment, cilostazol, COVID-19, restenosis, antiplatelet therapy. FOR CITATION: Kuznetsov M.R., Reshetov I.V., Sapelkin S.V., Yasnopol’skaya N.V. Conservative treatment for intermittent claudication. Russian Medical Inquiry. 2021;5(4):212–217 (in Russ.). DOI: 10.32364/2587-6821-2021-5-4-212-217.

scholarly journals Long term outcomes from lymphatic venous anastomosis after total hysterectomy to prevent postoperative lymphedema in lower limb

BMC Surgery ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Masahiro Ezawa ◽  
Hiroshi Sasaki ◽  
Kyosuke Yamada ◽  
Hirokuni Takano ◽  
Tsuyoshi Iwasaka ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Lower Limb ◽  
Abdominal Hysterectomy ◽  
Node Dissection ◽  
Long Term Outcomes ◽  
Venous Anastomosis ◽  
Total Hysterectomy ◽  
Sleeve Anastomosis

Abstract Background Lymphedema in lower limb is one of major postoperative complications followed by a total hysterectomy with lymph node dissection. The objective of this report is to examine a long-term result of lymphaticovenous anastomosis procedure as a preventive surgery. Methods Sixteen patients with endometrial cancer underwent an abdominal hysterectomy with a bilateral salpingo-oophorectomy. Just after pelvic lymph node dissection, either end-to-end or sleeve anastomosis utilizing venules and suprainguinal lymph vessels was performed. During the observation period from 4 to 13 years, the symptom of lymphedema in lower extremities has been assessed. Results Among 16 patients, 1 presented postoperative lymphedema grade 3 (CTCAE (Common Terminology Criteria for Adverse Events) Ver. 4.0, 10025233) in lower limb, and a second surgery at 7 years after the first one was required. Other 6 patients showed non-severe symptoms of lymphedema, diagnosed as grade 1. The rest 9 patients did not show any symptoms of postoperative lymphedema in a long term (up to 13 years). Conclusion From the long term outcomes of our 16 cases, we propose that a direct lymphaticovenous microsurgery immediately after a hysterectomy with lymphadenectomy of external inguinal lymph node is one of the appropriate therapeutic choices to prevent severe lymphedema in lower limb.

scholarly journals Conservative Treatment of a Patient with Epidermolysis Bullosa Presenting as Bart Syndrome: A Case Report

2010 ◽  
Vol 2010 ◽  
pp. 1-3 ◽  
Author(s):  
Samet Vasfi Kuvat ◽  
Mehmet Bozkurt
Keyword(s):  
Case Report ◽  
Conservative Treatment ◽  
Epidermolysis Bullosa ◽  
Fusidic Acid ◽  
Lower Limb ◽  
Povidone Iodine ◽  
Aplasia Cutis Congenita ◽  
Conservative Method ◽  
Sterile Gauze ◽  
Aplasia Cutis

We presented a case of a newborn male with aplasia cutis congenita on the lower limb. The case was treated with conservative method. As for the conservative treatment, daily hydrodebridement with 1/200 diluted povidone-iodine and serum physiologic was performed, followed by closure of the wound with a dexpanthenol chlorhexidine fusidic acid-impregnated sterile gauze bandage. the followup that occured after three weeks, the wound was completely epithelialized, but a hypopigmented scar remained in the limb.

scholarly journals Conservative treatment of a psoas hematoma revealed by a lower limb palsy

2017 ◽  
Vol 28 ◽  
Author(s):  
Zidouh Saad ◽  
Belkouch Ahmed ◽  
Rafai Mostafa ◽  
Bakkali Hicham ◽  
Belyamani Lahcen
Keyword(s):  
Conservative Treatment ◽  
Lower Limb
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