The problems of patients with lymphoedema. Pilot study of breast cancer survivors

Background and aims: Lymphoedema is a serious problem for many breast cancer survivors. It is a chronic condition, which can often limit patients’ activities and result in dramatic life changes. The aim of the study was to define problems the patients contended with. Material and methods: The clinical study involved 22 patients suffering from post-mastectomy lymphoedema. They were asked to fill in a special lymphoedema physiotherapy assessment form. Results: All the patients included in the study underwent physiotherapy within lymphoedema treatment. Only three patients (14%) used complex decongestive therapy and most of the patients (82%) had therapy only once a year for twenty days. The results of the study confirm the fact, that lymphoedema is a chronic condition. Fourteen patients (63%) described their lymphoedema as permanent and increasing in time and only three patients (14%) as periodically retreating. The post-mastectomy pain syndrome is another serious problem of patients after surgery. Four of the patients (18%) suffered from pain with the average intensity of 9 on NRS scale (0-10). None of the patients received any special analgetic treatment, which proves that the post-mastectomy pain syndrome is rarely diagnosed and treated. Conclusion: The study presents the outline of problems and needs of patients after breast cancer surgery. It also emphasizes the importance of physiotherapy in post-mastectomy patients. However, it ought to be continued in a bigger group of patients as to authenticate the observations.Background and aims: Lymphoedema is a serious problem for many breast cancer survivors. It is a chronic condition, which can often limit patients’ activities and result in dramatic life changes. The aim of the study was to define problems the patients contended with. Material and methods: The clinical study involved 22 patients suffering from post-mastectomy lymphoedema. They were asked to fill in a special lymphoedema physiotherapy assessment form. Results: All the patients included in the study underwent physiotherapy within lymphoedema treatment. Only three patients (14%) used complex decongestive therapy and most of the patients (82%) had therapy only once a year for twenty days. The results of the study confirm the fact, that lymphoedema is a chronic condition. Fourteen patients (63%) described their lymphoedema as permanent and increasing in time and only three patients (14%) as periodically retreating. The post-mastectomy pain syndrome is another serious problem of patients after surgery. Four of the patients (18%) suffered from pain with the average intensity of 9 on NRS scale (0-10). None of the patients received any special analgetic treatment, which proves that the post-mastectomy pain syndrome is rarely diagnosed and treated. Conclusion: The study presents the outline of problems and needs of patients after breast cancer surgery. It also emphasizes the importance of physiotherapy in post-mastectomy patients. However, it ought to be continued in a bigger group of patients as to authenticate the observations

In Vitro Cultivation of 'Unculturable' Oral Bacteria, Facilitated by Community Culture and Media Supplementation with Siderophores

Over a third of oral bacteria are as-yet-uncultivated in-vitro. Siderophores have been previously shown to enable in-vitro growth of previously uncultivated bacteria. The objective of this study was to cultivate novel oral bacteria in siderophore-supplemented culture media. Various compounds with siderophore activity, including pyoverdines-Fe-complex, desferricoprogen and salicylic acid, were found to stimulate the growth of difficult-to-culture strains Prevotella sp. HOT-376 and Fretibacterium fastidiosum. Furthermore, pyrosequencing analysis demonstrated increased proportions of the as-yet-uncultivated phylotypes Dialister sp. HOT-119 and Megasphaera sp. HOT-123 on mixed culture plates supplemented with siderophores. Therefore a culture model was developed, which incorporated 15 μg siderophore (pyoverdines-Fe-complex or desferricoprogen) or 150 μl neat subgingival-plaque suspension into a central well on agar plates that were inoculated with heavily-diluted subgingival-plaque samples from subjects with periodontitis. Colonies showing satellitism were passaged onto fresh plates in co-culture with selected helper strains. Five novel strains, representatives of three previously-uncultivated taxa (Anaerolineae bacterium HOT-439, the first oral taxon from the Chloroflexi phylum to have been cultivated; Bacteroidetes bacterium HOT-365; and Peptostreptococcaceae bacterium HOT-091) were successfully isolated. All novel isolates required helper strains for growth, implying dependence on a biofilm lifestyle. Their characterisation will further our understanding of the human oral microbiome

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Plate cultures showing unusual helper- / dependent-strain relationships.

<p>(a) 14d-culture of <i>Fretibacterium fastidiosum</i> with bilateral cross-streaks of <i>F</i>. <i>nucleatum</i>–small circular zone of inhibition (top left) localised to an area beside the ‘helper’; (b) Five-day culture of <i>Prevotella</i> sp. HOT-376 showing self-satellitism–growth restricted to the site of, and immediately beside two vertical cross-streaks of self.</p

Secondary cultures of colonies of interest.

<p>(a) Growth of an unknown strain limited to the surface of a <i>Propionibacterium acnes</i> cross-streak (on left); (b) Secondary culture of <i>Bacteroidaceae</i> bacterium HOT-272 showing satellitism beside the <i>P</i>. <i>acnes</i> cross-streak (on left) and around red colonies of <i>Actinomyces odontolyticus</i> (indicated with arrows).</p

Growth stimulation of ‘difficult-to-culture’ oral bacterial strains by siderophores.

<p>(a-f) Growth of <i>Prevotella</i> sp. HOT-376: (a) <i>Fusobacterium nucleatum</i> cross-streak, (b-f) 4- & 8-d plates with pyoverdines-Fe, <i>F</i>. <i>nucleatum</i> culture supernatant (positive control) or water (negative control); (g-i) <i>Fretibacterium fastidiosum</i>: 28-day spread plates supplemented with desferricoprogen, positive or negative control solutions (as described above).</p