Variation in Leg Tissue Dielectric Constant Values of Healthy Young Adult Females With and Without Compression Bandaging.

Background The clinical efficacy of a compression application has been often limited to the assessment of the change in limb volume, change in clinical symptoms (i.e., wound size, pain, range of motion, incidence of cellulitis), or vascular hemodynamics of the whole limb. Assessing compression-related biophysical changes of a localized area, such as around a wound, or in an area outside of an extremity cannot be objectively assessed by these measurements. Tissue dielectric constant (TDC) values, which provide a measure of the local tissue water (LTW) content, offer an alternative method to document variation in the LTW content of the skin in a specific location. The goals of the present research were (1) to characterize TDC values, expressed as percentage tissue water, from multiple areas along the medial aspect of the lower leg of healthy volunteers and (2) to explore the potential utilization of the TDC values to assess change in tissue water content in a localized area following compression applications. Methods TDC was measured at 10, 20, 30, and 40 cm proximal to the medial malleolus on the medial aspect of the right leg of 18 young adult healthy women with an age range of 18-23 years and a body mass index of 18.7 to 30.7kg/

Venous, Arterial, and Neuropathic Leg Ulcers With Emphasis on the Geriatric Population.

Leg ulcers are a common and often serious problem in older adults. Underlying conditions that increase risk include age-related increases in chronic venous insufficiency, peripheral artery disease, connective tissue and autoimmune conditions, reduced mobility, and diabetes mellitus (DM). Geriatric patients have a higher risk of multiple wound-related complications including infection, cellulitis, ischemia, and gangrene, any of which may lead to further complications including amputation. The very presence of these lower extremity ulcers in the elderly negatively impacts their quality of life and ability to function. Understanding and early identification of the underlying conditions and wound features are important for effective ulcer healing and complication mitigation. This targeted review focuses on the three most common types of lower extremity ulcers: venous, arterial, and neuropathic. The goal of this paper is to characterize and discuss the general and specific aspects of these lower extremity ulcers and their relevancy and impact on the geriatric population. The top five main results of this study can be summarized as follows. (1) Venous ulcers, caused by inflammatory processes secondary to venous reflux and hypertension, are the most common chronic leg ulcer in the geriatric population. (2) Arterial-ischemic ulcers are mainly due to lower extremity vascular disease, which itself tends to increase with increasing age setting the stage for an age-related increase in leg ulcers. (3) Persons with DM are at increased risk of developing foot ulcers mainly due to neuropathy and localized ischemia, both of which tend to increase with advancing age. (4) In geriatric patients with leg ulcers, it is important to rule out vasculitis or malignancy as causes. (5) Treatment is best made on a case-by-case basis, considering the patient\u27s underlying condition, comorbidities, overall health status, and life expectancy

Programmable intermittent pneumatic compression as a component of therapy for breast cancer treatment-related truncal and arm lymphedema

Abstract Lymphedema is a chronic condition often requiring lifelong treatment to avoid worsening of extremity and trunk swelling with concomitant complications. The physiological basis for truncal treatment, although clinically recognized, until recently, was not well documented. Herein, we expand on earlier work by reporting on clinical outcomes, therapist observations, and subjective impressions of five patients with truncal lymphedema whose in-home self-treatment includes the Flexitouch ® system (FT) pneumatic device. Patients received in-clinic complete decongestive therapy and in-home self-care including FT. Results, determined after 2 months of treatment, showed reductions in trunk and arm swelling, fibrotic tissue softening, pain reduction, and improved range of motion and flexibility. Patients reported that FT was easy and comfortable to use and enhanced in-home compliance. Results suggest that limb and trunk lymphedema can be effectively treated in the home with an advanced programmable pneumatic device with truncal coverage, such as the FT system

Longitudinal Effects of a Novel Advanced Pneumatic Compression Device on Patient-Reported Outcomes in the Management of Cancer-Related Head and Neck Lymphedema: A Preliminary Report

BACKGROUND: Head and neck cancer (HNC) survivors experience head and neck lymphedema (HNL), which requires treatment to prevent morbidity. We explore the self-reported outcomes and satisfaction of patients with HNC receiving treatment for HNL with an advanced pneumatic compression device (APCD). METHODS: HNC survivors (n = 205) prescribed with an at-home Flexitouch head and neck APCD completed pretreatment and posttreatment self-reported assessments addressing efficacy, function, and symptoms. Participant average age was 60 years with 74% male. Pre-post responses for ≥25 days of use were assessed via the non-parametric Wilcoxon Signed Rank test. RESULTS: Analysis revealed statistically significant improvement in all symptoms and all function items (P \u3c 0.00001). Compliance with prescribed therapy (at least 30 minutes daily) was high with 71% of participants reporting daily use and 87% reporting overall satisfaction. CONCLUSIONS: The reported improvements in function and symptoms, and high compliance rate, provide a rationale for a subsequent randomized controlled trial

TISSUE DIELECTRIC CONSTANT (TDC) MEASUREMENTS AT 300 MHZ AS A METHOD TO CHARACTERIZE LOCALIZED TISSUE WATER IN ARMS OF WOMEN WITH AND WITHOUT BREAST CANCER RELATED LYMPHEDEMA

Objective. To compare tissue dielectric constant (TDC) values between lymphedematous and non-lymphedematous tissue. Background. Quantitative measurements to early detect breast cancer (BC) treatment-related lymphedema (BCRL) can aid clinical evaluations. Earliest BCRL changes likely occur in skin and subcutis and might be detected via local skin-tissue water (LTW) changes assessed by TDC measurements at 300 MHz. Methods. TDC measurements were made in both forearms (2.5 mm depth) of three groups of women (80 subjects per group); 1)healthy women with no BC (NOBC), 2)women with BC but with TDC measurements made prior to their surgery and 3)women with unilateral lymphedema (LE). Results. Except for affected arms of the LE group, measured TDC values for all other arms were on average close to each other, ranging (mean±SD) between 24.8±3.3 to 26.8±4.9. Contrastingly, TDC values for the LE affected arms were 42.9±8.2 which was significantly greater than all other arm TDC values (p \u3c 0.001). Arm TDC ratios, dominant/non-dominant for NOBC, were 1.001±0.050 and atrisk/ contralateral for BC were 0.998±0.082 with both significantly less (p \u3c 0.001) than LE group affected/control arm ratios (1.663±0.321). Conclusion. TDC values, used as an index of local tissue water, show that breast cancer 61 per se does not significantly change arm tissue water and also shows that the presence of BCRL does not significantly change local tissue water of non-affected arms. Further, based on the standard deviation of measured arm TDC ratios, an at-risk arm/contralateral arm TDC ratio between 1.165 and 1.200 is suggested as a possible threshold to detect pre-clinical lymphedema. Grants. NON

Linkages Between Geomagnetic Activity and Blood Pressure

This review aims to critically examine and present evidence for and against potential linkages between geomagnetic activity and its effects on blood pressure (BP). Four databases were searched for peer-reviewed papers written in English: PubMed, Web of Science, EMBASE, and Biomedical Reference Collection. Retrieved titles were first screened for potential relevance followed by an abstract review for further clarifications if warranted. The preponderance of the reported evidence is consistent with the concept that space weather and related events that cause sufficiently large changes in the geomagnetic field (GMF) can impact BP. The associated BP change in most but not all cases is one in which both systolic blood pressure (SBP) and diastolic blood pressure increase, with SBP appearing to be more consistently involved. The magnitude of the reported BP increase ranges from about 3 to 8 mmHg depending on the intensity of the geomagnetic activity. The initiation of these BP changes has been variably reported to occur shortly before the GMF change or in synchrony with the abrupt change in the GMF. Such GMF-linked BP changes are not present in all persons and there appears to be increased sensitivity in women and in persons with co-existing hypertension. The utility of these findings in assessing or treating persons with known or suspected hypertension remains to be determined via future research. Further, research directed at determining the factors that determine responders from non-responders to GMF changes is warranted

Potential Physiological Impacts of Eccrine Glands on Skin Tissue Dielectric Constant (TDC)

Objective: To clarify the physiological basis of potential eccrine gland impacts on TDC values. Background: TDC values largely depend on tissue water and are used to assess edema extent and changes. The effect of eccrine glands and their activation on TDC values is unknown. Methods: Major factors whereby eccrine glands may affect TDC values have been investigated and methods for experimental assessment of the likely dependency has been formulated. Results: Whole body has approximately 4 X 106 eccrine sweat glands with the forehead containing 360 ± 50 /cm2 and forearm 225 ± 25 /cm2. Eccrine tube length and diameter are on average 5mm and 0.02-0.05mm respectively. Sweat is composed of 99.0-99.5% water with about 75 Mm Na+ and Cl- thus is likely to affect TDC values in a pore-density and activation state dependent manner. Pilot measurements on forehead and forearm suggest that heat-induced sweating can elevate TDC-measured estimates of tissue water by as much as 30% and possibly more. To relate such changes to pore-density a method to measure pore-density is needed and is being developed along with a mathematical model to assess the possible range of effects Conclusion: The amount and content of sweat released upon activation appears to have the potential to significantly impact TDC values. The significance of this fact lies in the way such activation may confound TDC measurements aimed at detecting and tracking edema or lymphedema. The future research focus should thus be to characterize TDC value dependency in relation to measured pore-density

Forearm Skin Water Assessed by Tissue Dielectric Constant

Objective. To quantitatively characterize forearm skin tissue water (STW) and its variability using tissue dielectric constant (TDC) measurements. Background. Previous work showed forearm TDC useful as an indicator of local STW in patients with lymphedema. However, TDC dependence on arm anatomical site is unknown. Knowledge of normal patterns of variations is needed to help interpret future clinical studies. Methods. Variations in STW were assessed by measuring the TDC of epidermal-dermal tissue in triplicate at nine sites on the non-dominant forearm of seated female volunteers. TDC values depend on tissue water content (pure water = 78) and on the depth of the tissue included in the measurement. Herein measurements to depths of 1.5 and 2.5 mm were made at sites 4, 8 and 12 cm distal to the antecubital crease along the midline, and one cm medial and lateral to the midline. 25 Measurements were done by touching skin with a probe for 10 seconds. Results. Results to date (based on 10 subjects) show an overall significant difference among sites (p \u3c 0.001) but insignificant site-probe interactions (p=0.861). TDC midline values (mean±sd) increased from proximal to distal sites (p \u3c 0.001) being 27.2±2.9 at 4 cm, 28.7±3.0 at 8 cm and 29.6±3.6 at 12 cm at the 1.5 mm depth. Corresponding values at the 2.5 mm depth were 25.4±3.5, 27.4±4.8 and 28.8±5.8. TDC values obtained at a 1.5 mm depth were all significantly greater than at a 2.5 mm depth (p \u3c 0.001). Conclusions. These seminal findings provide data needed for clinical comparisons and assessing departures from normal

Coping Mechanisms for Lymphedema: An Analysis of Patient Experiences.

Background and objective Lymphedema is a condition caused by impaired lymphatic function. Acquired lymphedema is often due to neoplasia, infection, trauma, or radiation damage. Most patients rely on advice from fellow patients and personal research to manage their symptoms. We believe coping mechanisms for lymphedema can be more streamlined and made easily accessible if the most common effective strategies are determined and collected in a single repository for reference. To that end, we aimed to assess the experiences of lymphedema patients and the coping mechanisms they employed. Methods Feedback from lymphedema patients was obtained using a 19-item questionnaire-based survey distributed to multiple online lymphedema support groups. It focused on the type of lymphedema and its effect on the respondents and sought data to characterize coping mechanisms that individuals with lymphedema use and their effectiveness. Results The respondents (n=400) had a median age of 55 years (range: 18-83 years). The overall mean BMI was 35.8 kg/m2 , with respondents with lower extremity (LE) lymphedema having a greater mean BMI (38.4 vs. 31.0, p\u3c0.05). Most of the respondents were female (n=382, 95.5%). LE lymphedema was more common (n=280, 70%) than the upper extremity (UE) variant (n=120, 30%). Within the LE group, 99 were unilateral (35.4%) and 181 were bilateral (64.6%). Moderate restriction was the most reported level with 44% in the unilateral group and 64% in the bilateral group. Stretching, low-impact exercise, manual lymphatic drainage (MLD), and compression bandages were the most commonly used coping methods and most of the respondents rated them as somewhat effective. Of note, 30% of respondents in either group rated increased water intake as either slightly, moderately, or very helpful; 25% of respondents also rated decreased alcohol intake as very helpful. The use of a therapist and family and doctor support was rated as extremely helpful. Within the UE group, 105 were unilateral (87.5%) and 15 were bilateral (12.5%). The most common cause of UE lymphedema was breast cancer-related (98/120, 81.7%) followed by melanoma treatment. Mild restriction was the most reported level (n=48, 45.7%). The UE group had similar results as the LE group in terms of coping mechanisms, dietary changes, and psychosocial support. Conclusion Based on the experiences of the lymphedema patients surveyed, the management of the condition is multifactorial and hence not compatible with a one-size-fits-all strategy. LE lymphedema was more common than the UE variant; but both groups reported engaging in stretching, low-impact exercise, manual lymphatic drainage, and compression bandages with similar rates of satisfaction reported in both groups. Dietary changes were not commonly employed. Therapy, doctor, and family support were the most commonly used support mechanisms, with high satisfaction among both groups. The overall coping mechanisms and their ratings in terms of efficacy between UE and LE groups were similar although the impact of quality of life was greater for bilateral conditions. We believe our findings represent the first steps to providing information potentially useful to aid future and current lymphedema patients in finding the coping methods that work best for them