Effects of physical therapy on hyaluronan clearance and volume regulating hormones in lower limb lymphedema patients: A pilot study

Lymphedema is manifested as a chronic swelling arising due to stasis in the lymphatic flow. No cure is currently available. A non-invasive treatment is a 3 week complete decongestive therapy (CDT), including manual lymphatic drainage and compression bandaging to control swelling. As CDT leads to mobilization of several liters of fluid, effects of CDT on hyaluronan clearance (maker for lymphatic outflow), volume regulating hormones, total plasma protein as well as plasma density, osmolality and selected electrolytes were investigated. In this pilot study, we assessed hyaluronan and volume regulating hormone responses from plasma samples of nine patients (three males, six females, aged 55 ± 13 years) with lower limb lymphedema stage II-III, before - and after - CDT. A paired non-parametric test (Wilcoxon) was used to assess hormonal and plasma volume changes. Correlation was tested using Spearman’s correlation. The main findings of this novel study are that lymphedema patients lost volume and weight after therapy. Hyaluronic acid did not significantly change pre- compared to post-CDT. Aldosterone increased significantly after therapy, while plasma renin activity increased, but not significantly. Plasma total protein, density, osmolality and sodium and chloride did not show differences after CDT. To our knowledge, no study has previously investigated the effects of CDT on volume regulating hormones or electrolytes. To identify the time-course of volume regulating hormones and lymphatic flow changes induced by CDT, future studies should assess these parameters serially over 3 weeks of therapy.

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PHYSICAL THERAPY AFFECTS ENDOTHELIAL FUNCTION IN LYMPHEDEMA PATIENTS

Lymphology ◽

10.2458/lymph.4663 ◽

2021 ◽

Vol 53 (3) ◽

Author(s):

B Brix ◽

G Apich ◽

C Ure ◽

A Roessler ◽

N Goswami

Keyword(s):

Physical Therapy ◽

Endothelial Function ◽

Vascular Function ◽

Lymphatic Drainage ◽

Manual Lymphatic Drainage ◽

Beneficial Effects ◽

Compression Bandaging ◽

Complete Decongestive Therapy ◽

Plasma Adma ◽

Retinal Microvasculature

Lymphedema arises due to a malfunction of the lymphatic system and can lead to massive tissue swelling. Complete decongestive therapy (CDT), consisting of manual lymphatic drainage (MLD) and compression bandaging, is aimed at mobilizing fluid and reducing volume in affected extremities. Lymphatic dysfunction has previously been associated with chronic inflammation processes. We investigated plasma ADMA as an indicator of endothelial function/inflammation before-, during- and after-CDT. Also assessed were vascular function parameters such as carotid-femoral pulse wave velocity (PWVcf), flow-mediated dilatation (FMD) and retinal microvasculature analysis. 13 patients (3 males and 10 females, 57 ± 8 years old (mean ± SD), 167.2 ± 8.3 cm height, 91.0 ± 23.5 kg weight), with lower limb lymphedema were included. Vascular function parameters were assessed on day 1, 2, 7, 14 and 21 of CDT, pre- and post-MLD. ADMA was significantly lower post-MLD (p=0.0064) and tended to reduce over three weeks of therapy (p=0.0506). PWVcf weakly correlated with FMD (r=0.361, p=0.010). PWVcf, FMD and retinal microvasculature analysis did not show changes due to physical therapy. The novel results from this study indicate that lymphedema does not affect endothelial function and lymphedema patients may therefore not have a higher risk of cardiovascular diseases. Our results further suggest that manual lymphatic drainage with or without full CDT could have potentially beneficial effects on endothelial function in lymphedema patients (by reducing ADMA levels), which has not been reported previously.

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MULTIPLE LYMPHATIC-VENOUS ANASTOMOSES (MLVA) FOR MICROSURGICAL DRAINAGE OF PRIMARY PENO-SCROTAL LYMPHEDEMA: A CASE REPORT

Lymphology ◽

10.2458/lymph.4636 ◽

2020 ◽

Vol 52 (3) ◽

Author(s):

PG di Summa ◽

M Guiotto ◽

P Zaugg ◽

A Van Der Gucht ◽

M Ryan ◽

...

Keyword(s):

Case Report ◽

Complete Remission ◽

Laser Treatment ◽

Lower Limb ◽

Lymphatic Drainage ◽

Complication Rates ◽

Recurrent Infections ◽

Lymphatic Flow ◽

Genital Lymphedema

Single site Multiple Lymphatic-Venous Anastomoses (MLVA) provides optimal functional and cosmetic results with low complication rates in treatment of lower limb lymphedema. However, no evidence exists in literature concerning the use of this technique in treatment of peno-scrotal lymphedema. We report a case of a 44-year-old male patient who developed secondary peno-scrotal lymphedema with severe lymphorrhea, following a laser treatment for scrotal pustolosis, leading to recurrent infections and finally an established peno-scrotal lymphedema. Utilizing MLVA, a complete remission of scrotal lymphedema was achieved with significant volume reduction of the penile lymphedema. The post-operative course was uneventful with clear improvement in lymphatic flow demonstrable on lymphoscintigraphy (6 months) and no recurrence of scrotal lymphedema at 2 years follow-up. This article reports very promising results of a novel application of MLVA in the treatment of genital lymphedema and suggests that MLVA provides the possibility to shunt both superficial and deep lymphatics to improve the lymphatic drainage from the peno-scrotal area using a single surgical site.

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Lay Caregivers Education in Multicomponent Compression Bandaging in Obese Patients with Lower Limb Edema: A Case–Control Pilot Study

Lymphatic Research and Biology ◽

10.1089/lrb.2019.0081 ◽

2020 ◽

Vol 18 (5) ◽

pp. 428-432

Author(s):

Tomasz Gradalski ◽

Katarzyna Ochalek

Keyword(s):

Pilot Study ◽

Lower Limb ◽

Case Control ◽

Obese Patients ◽

Compression Bandaging ◽

Limb Edema

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627-P: Efficacy and Safety of Allogeneic Platelet Rich Plasma in Treatment of Diabetic Patients with Lower Limb Ulcers: A Pilot Study

Diabetes ◽

10.2337/db19-627-p ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 627-P

Author(s):

WUQUAN DENG ◽

MIN HE ◽

BING CHEN ◽

YU MA ◽

DAVID ARMSTRONG ◽

...

Keyword(s):

Pilot Study ◽

Lower Limb ◽

Platelet Rich Plasma ◽

Diabetic Patients ◽

Efficacy And Safety

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Different Morphology of Neuritic Plaques in the Archicortex of Alzheimer’s Disease with Comorbid Synucleinopathy: A Pilot Study

Current Alzheimer Research ◽

10.2174/1875692117999201215162043 ◽

2020 ◽

Vol 17 ◽

Author(s):

Nikol Jankovska ◽

Tomas Olejar ◽

Jaromir Kukal ◽

Radoslav Matej

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Pilot Study ◽

Time Course ◽

Clinical Course ◽

Lewy Bodies ◽

Dystrophic Neurites ◽

Neuritic Plaques ◽

Structural Differences ◽

Lewy Body Variant

Background: Bulbous neuritic changes in neuritic plaques have already been described, and their possible effect on the clinical course of the disease has been discussed. OBJECTIVE: In our study, we focused on the location and density of these structures in patients with only Alzheimer’s disease (AD) and patients with AD in comorbidity with synucleinopathies. Methods: Utilizing immunohistochemistry and confocal microscopy, we evaluated differences of neocortical and archicortical neuritic plaques and the frequency of bulbous changes in the archicortex of 14 subjects with Alzheimer’s disease (AD), 10 subjects with the Lewy body variant of Alzheimer's disease (AD/DLB), and 4 subjects with Alzheimer's disease with amygdala Lewy bodies (AD/ALB). Also, the progression and density of neuritic changes over the time course of the disease were evaluated. Results: We found structural differences in bulbous dystrophic neurites more often in AD/DLB and AD/ALB than in pure AD cases. The bulbous neuritic changes were more prominent in the initial and progressive phases and were reduced in cases with a long clinical course. Conclusion: Our results indicate that there is a prominent difference in the shape and composition of neocortical and archicortical neuritic plaques and, moreover, that bulbous neuritic changes can be observed at a higher rate in AD/DLB and AD/ALB subjects compared to pure AD subjects. This observation probably reflects that these subacute changes are more easily seen in the faster clinical course of AD patients with comorbidities.

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Tuning of a Basic Coordination Pattern Constructs Straight-Ahead and Curved Walking in Humans

Journal of Neurophysiology ◽

10.1152/jn.00817.2003 ◽

2004 ◽

Vol 91 (4) ◽

pp. 1524-1535 ◽

Cited By ~ 96

Author(s):

Grégoire Courtine ◽

Marco Schieppati

Keyword(s):

Principal Components ◽

Lower Limb ◽

Time Course ◽

Body Movement ◽

The Body ◽

Whole Body ◽

Coordination Pattern ◽

Data Set ◽

Coordination Patterns ◽

Straight Ahead

We tested the hypothesis that common principles govern the production of the locomotor patterns for both straight-ahead and curved walking. Whole body movement recordings showed that continuous curved walking implies substantial, limb-specific changes in numerous gait descriptors. Principal component analysis (PCA) was used to uncover the spatiotemporal structure of coordination among lower limb segments. PCA revealed that the same kinematic law accounted for the coordination among lower limb segments during both straight-ahead and curved walking, in both the frontal and sagittal planes: turn-related changes in the complex behavior of the inner and outer limbs were captured in limb-specific adaptive tuning of coordination patterns. PCA was also performed on a data set including all elevation angles of limb segments and trunk, thus encompassing 13 degrees of freedom. The results showed that both straight-ahead and curved walking were low dimensional, given that 3 principal components accounted for more than 90% of data variance. Furthermore, the time course of the principal components was unchanged by curved walking, thereby indicating invariant coordination patterns among all body segments during straight-ahead and curved walking. Nevertheless, limb- and turn-dependent tuning of the coordination patterns encoded the adaptations of the limb kinematics to the actual direction of the walking body. Absence of vision had no significant effect on the intersegmental coordination during either straight-ahead or curved walking. Our findings indicate that kinematic laws, probably emerging from the interaction of spinal neural networks and mechanical oscillators, subserve the production of both straight-ahead and curved walking. During locomotion, the descending command tunes basic spinal networks so as to produce the changes in amplitude and phase relationships of the spinal output, sufficient to achieve the body turn.

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Excessive Pressure in Multichambered Cuffs Used for Sequential Compression Therapy

Physical Therapy ◽

10.1093/ptj/82.10.1000 ◽

2002 ◽

Vol 82 (10) ◽

pp. 1000-1008 ◽

Cited By ~ 33

Author(s):

Patrick Segers ◽

Jean-Paul Belgrado ◽

Andre Leduc ◽

Olivier Leduc ◽

Pascal Verdonck

Keyword(s):

Time Course ◽

Compression Therapy ◽

Lymphatic Drainage ◽

Chamber Pressure ◽

Excessive Pressure ◽

Ellipsoidal Model ◽

Order Of Magnitude ◽

Pneumatic Compression Devices ◽

Target Pressure ◽

The Relationship

Abstract Background and Purpose. Pneumatic compression devices, used as part of the therapeutic strategy for lymphatic drainage, often have cuffs with multiple chambers that are inflated sequentially. The purpose of this study was to investigate (1) the relationship between cuff chamber pressure (Pchamber) and the pressure on the cuff-skin interface (Pinterface) and (2) the mechanical interaction of cuff chambers and consequences for device control. Subjects and Methods. In this study, we used 3 cylindrical (60-, 80-, and 100-mm-diameter) model limbs and 1 ellipsoidal model of the arm to test a commercially available pressure controller using “target pressures,” indicated by the controller, of 30, 60, 80, and 100 mm Hg. We studied the time course of Pchamber and Pinterface during the inflation sequence and the effect of local curvature on Pinterface. Results. Our data indicated that, overall, Pinterface is of the same order of magnitude as Pchamber. There was some effect of model diameter and shape, with the smaller curvatures yielding the highest Pinterface. Cuff chamber interaction led to Pchamber and Pinterface values in the most distal (first inflated) chamber that were up to 80% higher than the target pressure. For the 80-mm cylindrical model, for instance, pressure in this chamber reached 54, 98, 121, and 141 mm Hg, respectively, instead of the 30, 60, 80, and 100 mm Hg indicated by the controller. Discussion and Conclusion. The discrepancy between the target pressure, indicated by the controller, and the pressure measured inside the cuff chambers undermines the therapeutic control and efficacy of the pneumatic compression devices. Because the measured pressures were far beyond the pressure level indicated by the controller, it is recommended that pneumatic compression devices be used at much lower target pressures (<30 mm Hg) than those applied in clinical practice.

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