scholarly journals Liposuction in cancer-related lower extremity lymphedema: an investigative study on clinical applications

2022 ◽  
Vol 20 (1) ◽  
Author(s):  
Jianfeng Xin ◽  
Yuguang Sun ◽  
Song Xia ◽  
Kun Chang ◽  
Chao Dong ◽  
...  

Abstract Background Lymphedema is a progressive, noncurable condition consisting of increases in subcutaneous fat and interstitial fluid in the limbs and fibrosis during later stages. The disease most commonly affects the limbs following injury to or removal of the lymph nodes. The aim of this study was to investigate the therapeutic outcomes of liposuction for cancer-related lower extremity lymphedema. Methods Sixty-two patients with cancer-related lymphedema in the unilateral lower extremity were recruited for this study, and all patients underwent liposuction. The volume of hemorrhage and lipids, the operation time, and the volume changes of the affected extremity were compared by applying the t tests, and the subjective feelings of patients were compared with the chi-square tests. Results The total lipid volume was 2539 ± 1253.5 ml, and the hemorrhage volume was 828 ± 311.8 ml. For the comparison of objective indices, (1) the percent volume differences (PVDs) before surgery, intraoperatively, and at the 3-month follow-up were 5.5 ± 12.2 vs. 11.6 ± 18.4 vs. 43.2 ± 23.7, P < 0.05, respectively; (2) greater lipid volumes and higher liposuction rates were observed for female patients, as was a smaller volume of hemorrhage; (3) greater hemorrhage volumes were observed in patients with a history of recurrent erysipelas; and (4) greater lipid volumes and liposuction rates (LRs) and smaller hemorrhage volumes were observed for stage II than for stage III patients. Conclusions Liposuction is an effective therapy for cancer-related lower extremity lymphedema. Sex, stage, and recurrent erysipelas history influence the course and effect of liposuction.

2021 ◽  
Author(s):  
Jianfeng Xin ◽  
Yuguang Sun ◽  
Song Xia ◽  
Kun Chang ◽  
Chao Dong ◽  
...  

Abstract Background: Lymphedema is a progressive, noncurable condition consisting of increases in subcutaneous fat and interstitial fluid in the limbs and fibrosis during later stages. The disease most commonly affects the limbs because of injury to or removal of lymph nodes. The aim of this study was to investigate therapeutic outcomes of liposuction for cancer-related lower extremity lymphedema.Methods: 62 patients with cancer-related lymphedema in unilateral lower extremity were recruited in this study, and all the patients underwent liposuction. The volume of hemorrhage and lipid, the operation time, and the volume changes of the affected extremity were compared by applying t-test, and the subjective feelings of patients were also assessed by applying Chi-square. Results: Total lipid volume is (2539±1253.5) ml, and the hemorrhage volume is (828±311.8) ml during liposuction. For the comparison of objective indexes, (1) Percent volume differences(PVDs) before surgery, in-operation and 3-month follow-up were (5.5±12.2 Vs. 11.6±18.4 Vs. 43.2±23.7, P<0.05) respectively. (2) Higher lipid volume and liposuction rate for female patients, with a lower volume of hemorrhage. (3) Higher volume of hemorrhage in patients with a history of recurrent erysipelas. (4) Higher lipid volume and liposuction rate(LR), with lower hemorrhage for stage II than stage III patients. Conclusions: Liposuction is an effective therapy for cancer-related lower extremity lymphedema. Gender, stage and recurrent erysipelas history influence the course and effect of liposuction.


2021 ◽  
Author(s):  
Jianfeng Xin ◽  
Yuguang Sun ◽  
Song Xia ◽  
Kun Chang ◽  
Yiyin Li ◽  
...  

Abstract Background: Lymphedema is a progressive, noncurable condition consisting of increases in subcutaneous fat and interstitial fluid in the limbs and fibrosis during later stages. The disease most commonly affects the limbs because of injury to or removal of lymph nodes. The aim of this study was to investigate therapeutic effects of liposuction for cancer-related lower extremity lymphedema.Methods 62 patients with cancer-related lymphedema in unilateral lower extremity were recruited in this study, and all the patients underwent liposuction. The volume of hemorrhage and lipid, the operation time and the volume changes of affected extremity were compared by applying t-test, and the subjective evaluation of the patients were also assessed by applying Chi-square. Results Total lipid volume is (2539±1253.5) ml, and the hemorrhage volume is (828±311.8) ml during liposuction. For the comparison of objective indexes, (1) Comparison of percent volume difference before surgery, in-operation and 3-month follow-up was (5.5±12.2 Vs. 11.6±18.4 Vs. 43.2±23.7, P<0.05) respectively. (2) Higher lipid volume and liposuction rate for female patients, with lower volume of hemorrhage. (3) Higher volume of hemorrhage in patients with erysipelas (4) Higher lipid volume and liposuction rate, with lower hemorrhage for stage II than stage III patients.Conclusions Liposuction is an effective therapy for cancer-related lower extremity lymphedema, and it is necessary to combine with other therapeutic methods to improve lymph circulation.


Author(s):  
Eka Prasetya Budi Mulia ◽  
Kevin Yuwono ◽  
Raden Mohammad Budiarto

Abstract Objectives We aimed to investigate the association between hypertension and asymptomatic lower extremity artery disease (LEAD) in outpatients with known history of coronary artery disease (CAD). Methods Patients with known history of CAD who have been undergone coronary angiography and have significant coronary artery stenosis (more than 60%) were included. LEAD was defined as ankle-brachial index (ABI) < 0.9 in either leg. The risk of LEAD in hypertensive group was analyzed using chi-square test, and correlation between blood pressure (BP) and ABI was analyzed using Pearson correlation test in SPSS v.25. Results One hundred and four patients were included. 82.7% of patients were male. Mean age was 57.05 ± 7.97. The prevalence of hypertension was 35.6%, and the prevalence of LEAD was 16.3%. A higher proportion of LEAD was found in hypertensive (18.9%) compared to non-hypertensive (14.9%), although not statistically significant (OR: 1.33; 95% CI: 0.46 to 3.85; p=0.598). There was an association between ABI and systolic BP (p=0.016), but not with diastolic BP (p=0.102). Conclusions Our study showed that the prevalence of LEAD in hypertension, especially in the CAD population, is relatively high. There was no association between hypertension and LEAD, but a higher prevalence of LEAD was found in hypertensive patients. Nevertheless, LEAD screening is still recommended in hypertensive patients, especially in the CAD population, given the fact that outcomes of health and mortality are worse for those with concomitants of these diseases.


2021 ◽  
Author(s):  
Rong Xue ◽  
Ningdao Li ◽  
Zhurong Ji ◽  
Xingdong Cheng ◽  
Zhuqiu Zhang ◽  
...  

Abstract Background: Dysphagia is one of the most common complications after anterior cervical spine surgery. The study aimed to evaluate the risk factors for dysphagia after anterior cervical discectomy and fusion (ACDF) with the Zero-P Implant System by multidimensional analysis and investigated the predictive values of these risk factors for dysphagia. Methods: A retrospective analysis of 260 patients who underwent ACDF with the Zero-P Implant System and had at least 2 year of follow-up ware performed. All patients were divided into a non-dysphagia group and a dysphagia group. Sex, age, body mass index (BMI), intraoperative time, estimated blood loss, diabetes mellitus, hypertension, smoking, alcohol consumption, prevertebral soft-tissue thickness, the levels of surgery, O-C2 angle, C2–7 angle, T1 slope and segmental angle were analyzed. Chi-square test and logistic regression were performed to analyze the predictive value of each dimension for dysphagia. Results: In total, the non-dysphagia group comprised 170 patients and the dysphagia group comprised 90 patients. Chi-square test results indicated that number of operated levels, operation time dT1 slope, dO-C2 angle, dC2–7 angle, segmental angle and dPSTT were associated with a high incidence of dysphagia. Multivariate logistic regression analysis showed that number of operated levels, operation time, dC2–7 angle and dPSTT were significantly associated with postoperative dysphagia.Conclusions: Number of operated levels, operation time, dC2–7 angle and dPSTT were significantly associated with postoperative dysphagia. In additionally, sufficient preoperative preparation, evaluation combining with proficient and precise treatment measures are suggested to reduce the incidence of postoperative dysphagia when ACDF is performed.


CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S61
Author(s):  
L. Gaudet ◽  
L. Eliyahu ◽  
J. Lowes ◽  
J. Beach ◽  
M. Mrazik ◽  
...  

Introduction: Patients with mild traumatic brain injury (mTBI) frequently present to the emergency department (ED); however, wide variation in diagnosis and management has been demonstrated in this setting. Sub-optimal mTBI management can contribute to post-concussion syndrome (PCS), affecting vocational outcomes like return to work. This study documented the work-related events, ED management, discharge advice, and outcomes for employed patients presenting to the ED with mTBI. Methods: Adult (&gt;17 years) patients presenting to one of three urban EDs in Edmonton, Alberta with Glasgow coma scale score ≥13 within 72 hours of a concussive event were recruited by on-site research assistants. Follow-up calls ascertained outcomes, including symptoms and their severity, advice received in the ED, and adherence to discharge instructions, at 30 and 90 days after ED discharge. Dichotomous variables were analyzed using chi-square testing; continuous variables were compared using t-tests or Mann-Whitney tests, as appropriate. Work-related injury and return to work outcomes were modelled using logistic or linear regression, as appropriate. Results: Overall, 250 patents were enrolled; 172 (69%) were employed at the time of their injury and completed at least one follow-up. The median age was 37 years (interquartile range [IQR]: 24, 49.5), both sexes were equally represented (48% male), and work-related concussions were uncommon (16%). Work-related concussion was related to manual labor jobs and self-reported history of attention deficit disorder. Patients often received advice to avoid sports (81%) and/or work (71%); however, the duration of recommended time off varied. Most employed patients (80%) missed at least one day of work (median=7 days; IQR: 3, 14); 91% of employees returned to work by 90 days, despite 41% reporting persistent symptoms. Increased days of missed work were linked to divorce, history of sleep disorder, and physician’s advice to avoid work. Conclusion: While work-related concussions are uncommon, most employees who sustain a mTBI at any time miss some work. Many patients experience mTBI symptoms past 90 days, which has serious implications for workers’ abilities to fulfill their work duties and risk of subsequent injury. Workers, employers, and the workers compensation system should take the necessary precautions to ensure that workers return to work safely and successfully following a concussion.


2013 ◽  
Vol 95 (8) ◽  
pp. 586-590 ◽  
Author(s):  
JK Randall ◽  
CS Good ◽  
JM Gilbert

Introduction We report the outcomes of a long-term surveillance programme for individuals with a family history of colorectal cancer. Methods The details of patients undergoing a colonoscopy having been referred on the basis of family history of colorectal cancer were entered prospectively into a database. Further colonoscopy was arranged on the basis of the findings. The outcomes assessed included incidence of cancer and adenoma identification at initial and subsequent colonoscopy. Results The records of 2,293 patients (917 men; median patient age: 51 years) were entered over 22 years, giving data on 3,982 colonoscopies. Eight adverse events (0.2%) were recorded. Twenty-seven cancers were found at first colonoscopy and thirteen developed during the follow-up period. There were significantly more cancers identified in those with more than one first-degree relative with cancer than in other groups (p=0.01). The number of adenomas identified at subsequent surveillance colonoscopies remained constant with between 9.3% and 12.0% of patients having adenomas that were removed. Two-thirds (68%) of patients with cancer and three-quarters (77%) with adenomas fell outside the British Society of Gastroenterology (BSG) 2006 guidelines. Conclusions Repeated colonoscopy continues to yield significant pathology including new cancers. These continue to occur despite removal of adenomas at prior colonoscopies. The majority of patients with cancers and adenomas fell outside the BSG 2006 guidelines; more would have fallen outside the 2010 guidelines.


2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S474-S474
Author(s):  
Melissa E Badowski ◽  
R Kane Stafford ◽  
Brian W Drummond ◽  
Thomas D Chiampas ◽  
Sarah M Michienzi ◽  
...  

Abstract Background Although prison presents an opportunity to achieve virologic suppression (VS) among people living with HIV, continued success is not guaranteed upon release. Methods A retrospective cohort study was performed in reincarcerated Illinois prisoners from January 1, 2016 to July 31, 2018. Patients were included if they were age ≥18 years, carried a diagnosis of HIV/AIDS, on antiretroviral therapy (ART) at the time of release, and had CD4 and HIV-1 RNA labs drawn within 6 months of release and reincarceration. Potential subjects were excluded if reincarcerated within 30 days due to a technical violation and not receiving ART at the time of prison release. Primary and secondary endpoints were percent of patients achieving VS upon reincarceration and percent of patients following at an HIV clinic while released. Statistical analysis included descriptive statistics, chi-square, and paired t-tests. Results Among 505 patients released during the study period, 95 patients were reincarcerated and 80 were included (Figure 1). Demographic information can be found in Table 1. Fifty-one patients (64%) reported follow-up at an HIV clinic while released, whereas 29 (36%) did not. Patients who had VS at the time of prison release were more likely to make their follow-up appointment (90%) compared with those who did not (69%) (P < 0.001). In addition, patients making their follow-up appointment were also more likely to have VS at the time of reincarceration (86% vs. 10%, P < 0.001). Recidivist patients adherent to ART were less likely to experience decreases in mean CD4 count (P = 0.03) (Table 2). Subjects reporting a history of substance use were more likely not to re-engage in post-release HIV care (P = 0.001), but no difference was noted in patients with a documented psychiatric history (P = 0.2). Conclusion Patients failing to meet VS at the time of prison release should be targeted for more intensive re-entry medical and case management support to ensure adherence to follow-up and maintenance of immunologic function. Disclosures All authors: No reported disclosures.


2000 ◽  
Vol 04 (03) ◽  
pp. 221-229
Author(s):  
Ugur Sayli ◽  
Sinan Avci

Lower extremity spasticity in CP interferes with daily living activities, such as ambulation and sitting as well as hygiene. Orthopedic surgery may be needed in the prevention and correction of the deformities and malalignments. Seven girls and nine boys with ages ranging from 7 to 17 years who had at least four surgeries at different levels of their lower extremities in a single stage were presented. Minimum follow-up was two years. The mean number of surgeries performed simultaneously was 6 (4 to 11). The mean operation time was 115 minutes (35 to 225 minutes) and the mean blood loss was 200 ml (100 to 600 ml) during surgery. The hospital stay ranged from two to six days. No complication which may be related to multiple simultaneous surgery was observed. Rehabilitation was begun as soon as the pain permitted. In the postoperative period, the diplegics attended sessions of hippotherapy — therapy by horse riding — in addition to formal therapy modalities. At the latest follow-up postoperatively, all the patients had increase in their level of activities. As a conclusion, whenever needed, simultaneous correction of the lower extremity deformities in spastic CP patients decreases costs and simplifies postoperative rehabilitation without increasing surgical risk for the patients.


Author(s):  
Spela Zerovnik ◽  
Mitja Kos ◽  
Igor Locatelli

Abstract Aims To compare the influence of sodium-glucose co-transporter 2 inhibitors (SGLT2i) and dipeptidyl peptidase-4 inhibitors (DPP-4i) on the risk of lower extremity amputations in patients with type 2 diabetes in Slovenia. Methods This retrospective cohort study included patients aged 40 years or more who were administered a newly introduced SGLT2i or DPP-4i between June 2014 and June 2018. Patients treated with insulin at baseline and patients with a history of amputation were excluded. Patients were matched in a 1:1 ratio using propensity score matching. Survival analysis was performed; hazard ratio (HR) and ratios of cumulative hazards at 1, 2, 3, and 4 years were estimated. On-treatment and intention-to-treat approaches were used. Results The study cohort (mean age: 64 years) consisted of 2,939 new users of SGLT2i (empagliflozin, 59%; dapagliflozin, 41%) matched to 2,939 new users of DPP-4i. In the on-treatment analysis (median follow-up of 2 years), the incidence of amputations was higher in SGLT2i than in DPP-4i users (4.2 vs. 2.7 per 1,000 patient years), resulting in a HR of 1.58 (95% CI 0.85–2.92; p = 0.145). An intention-to-treat analysis yielded to similar HR of 1.86 (95% CI: 1.10–3.14; p = 0.020). There was no difference in amputation rates in the first two years, but SGLT2i users had a 2.81-fold higher (95% CI: 1.63–4.84; p = 0.007) cumulative hazard of amputation at 4 years than did DPP-4i users. Conclusions Compared with DPP-4i use, SGLT2i use did not result in a statistically significant higher overall risk of lower extremity amputations. However, the results suggest that SGLT2i may increase the risk of amputation with long-term use.


Author(s):  
Behnam Shakerian ◽  
Negin Razavi

Warfarin- induced spontaneous breast hematoma is a very rare disease, with only a few cases having been reported in the literature so far. We describe an 80-year-old woman who had warfarin therapy due to deep vein thrombosis in a lower extremity. The patient was admitted with a history of swelling and red area on her bilateral breasts, chest wall, right arm, and right flank. She was treated conservatively with success. She was discharged after about 3 weeks without complications and was well at 6 months’ follow-up.


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