A randomized controlled crossover study of manual lymphatic drainage therapy in women with breast cancer-related lymphoedema.

This paper describes a randomized controlled crossover study examining the effects of manual lymphaticdrainage (MLD) in 31 women with breast cancer-related lymphoedema. MLD is a type of massage used incombination with skin care, support/compression therapy and exercise in the management of lymphoedema.A modified version of MLD, referred to as simple lymphatic drainage (SLD), is commonly taught as a selfhelpmeasure. There has been limited research into the efficacy of MLD and SLD. The study reported hereexplores the effects of MLD and SLD on a range of outcome measures. The findings demonstrate that MLDsignificantly reduces excess limb volume (difference, d = 71, 95% CI = 16–126, P = 0.013) and reduced dermalthickness in the upper arm (d = 0.15, 95% CI = 0.12–0.29, P = 0.03). Quality of life, in terms of emotionalfunction (d = 7.2, 95% CI = 2.3–12.1, P = 0.006), dyspnoea (d = -4.6, 95% CI = -9.1 to -0.15, P = 0.04) andsleep disturbance (d = -9.2, 95% CI = -17.4 to -1.0, P = 0.03), and a number of altered sensations, such as painand heaviness, were also significantly improved by MLD. The study provides evidence to support the use ofMLD in women with breast cancer-related lymphoedema. The limitations of the study are outlined and futureareas for study are highlighted

A randomised, controlled, parallel group clinical trial comparing multi-layer bandaging followed followed by hosiery versus hosiery alone in the treatment of lymphoedema of the limb

BACKGROUND: Multilayered, low stretch bandages (MLB) combined with exercises, skin care, and manual lymphatic drainage therapy are recommended as an intensive phase of treatment for lymphedema patients. The relative efficacy of each of the components of this comprehensive treatment program have not been determined. This study aimed to compare the effect of multilayer bandaging as an initial phase of lymphedema treatment followed by elastic hosiery versus hosiery alone. METHODS: A randomized, controlled, parallel-group trial was undertaken in the setting of the Lymphedema Clinic, The Royal Marsden Hospital, London. Ninety women with unilateral lymphedema (of the upper or lower limbs) were enrolled in the study. The interventions consisted of 18 days of multilayer bandaging followed by elastic hosiery or hosiery alone, each for a total period of 24 weeks. The main outcome measure was the percentage reduction in excess limb volume. RESULTS: The reduction in limb volume by MLB followed by hosiery was approximately double that from hosiery alone and was sustained over the 24-week period. The mean overall percentage reduction at 24 weeks was 31% (n = 32) for MLB versus 15.8% (n = 46) for hosiery alone, for a mean difference of 15. 2% (95% confidence interval, 6.2-24.2) (P = 0.001). CONCLUSIONS: Multilayer bandaging as an initial phase of treatment for lymphedema patients, followed by hosiery, achieves greater and more sustained limb volume reduction than hosiery alone

Primary erythermalgia as a sodium channelopathy: screening for SCN9A mutations: exclusion of a causal role of SCN10A and SCN11A.

Contains fulltext : 71357.pdf (publisher's version ) (Closed access)OBJECTIVES: To elucidate the rate of missense mutations in the SCN9A gene (which encodes sodium channel Na(v)1.7) (OMIM 603415) among patients with primary erythermalgia and to examine the possibility that other sodium channels can cause the disease. DESIGN: Case series. SETTING: Department of Medicine, Radboud University Nijmegen, the Netherlands. PARTICIPANTS: Six patients with sporadic and 9 with unique familial primary erythermalgia. Interventions Questionnaire to determine clinical profile and sequencing of all coding exons from SCN9A and those of SCN10A (OMIM 604427) and SCN11A (OMIM 604385) in 2 selected cases with a clear family history of the disease. MAIN OUTCOME MEASURES: Detection of SCN9A mutation. RESULTS: We identified 1 patient with an SCN9A mutation. This mutation (I848T) has been associated with primary erythermalgia. Sequencing of 2 other candidate genes did not show mutations in 2 patients with familial primary erythermalgia. CONCLUSIONS: The Na(v)1.7 voltage-gated sodium channels are related to syndromes of altered nociception. We detected a low SCN9A mutation rate in patients with primary erythermalgia, suggesting that pain syndromes in the skin may have a polygenic basis

Lymphoedema: an underestimated health problem.

Background: Lymphoedema/chronic oedema is an important cause of morbidity in the population, but little is known of its epidemiology and impact on patients or health services.Aim: To determine the magnitude of the problem of chronic oedema in the community, and the likely impact of oedema on use of health resources, employment and patient’s quality of life.Design: Questionnaire-based survey.Methods: Health professionals from dedicated lymphoedema services, specific out-patient clinics, hospital wards and community services (GP clinics and district nurses) were contacted to provide information on patients from within South West London Community Trust. A subset of the identified patients was interviewed.Results: Within the catchment area, 823 patients had chronic oedema (crude prevalence 1.33/1000). Prevalence increased with age (5.4/1000 in those aged > 65 years), and was higher in women (2.15 vs. 0.47/1000). Only 529 (64%) were receiving treatment, despite two specialist lymphoedema clinics within the catchment area. Of 228 patients interviewed, 78% had oedema lasting > 1 year. Over the previous year, 64/218 (29%) had had an acute infection in the affected area, 17/64 (27%) being admitted for intravenous antibiotics. Mean length of stay for this condition was 12 days, estimated mean cost £2300. Oedema caused time off work in > 80%, and affected employment status in 9%. Quality of life was below normal, with 50% experiencing pain or discomfort from their oedema.Discussion: Chronic oedema is a common problem in the community with at least 100 000 patients suffering in the UK alone, a problem poorly recognized by health professionals. Lymphoedema arising for reasons other than cancer treatment is much more prevalent than generally perceived, yet resources for treatment are mainly cancer-based, leading to inequalities of care