Journals at the University of Arizona
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CONGENITAL CHYLOTHORAX: CURRENT EVIDENCE-BASED PRENATAL AND POST-NATAL DIAGNOSIS AND MANAGEMENT
No full textCongenital chylothorax is an uncommon condition but represents the main cause of congenital pleural effusion during the neonatal period. It usually appears before birth, both as an isolated disorder or in association with hydrops fetalis, negatively affecting the subsequent neonatal outcome. Prenatal treatment is usually considered to ensure a satisfactory lung development in case of moderate to severe pleural effusion or in the presence of hydrops, although consensus on treatment timing and modalities has not been reached to date. Both medical and surgical therapeutic strategies are available to treat this condition and novel treatment options have been recently attempted with acceptable results in both prenatal and post-natal setting. The heterogeneous clinical presentation of congenital chylothorax together with its rarity, its numerous etiologies and the absence of a highly effective treatment renders the diagnostic and therapeutic approach difficult to standardize. In addition, adequate visualization of the lymphatic system is complex, especially in small neonates, although new promising techniques have been developed lately and may contribute to improved management of this serious but infrequent condition. This review focuses on the current evidence base for the diagnosis and treatment options for congenital chylothorax, suggesting a rational diagnostic and therapeutic approach both in the prenatal and in the neonatal period
EFFECT OF PREGNANCY ON LOWER LIMB LYMPHEDEMA IN PATIENTS TREATED WITH MULTISITE LYMPHATICOVENULAR ANASTOMOSES (MLVAS)
No full textLymphaticovenular anastomosis (LVA) usingsupermicrosurgical techniques is effective fortreating and preventing progression of lymphedema.We analyzed the influence of pregnancyon LVA in five patients from a total 2179 LVAcases. Previous studies offer conflicting reportson whether pregnancy worsens pre-existinglymphedema. This is the first report on theinfluence of pregnancy on lower limb lymphedemapreviously treated by multisite LVA(mLVA). Five patients with primary (n=4) andsecondary (n=1) lower leg lymphedema wereanalyzed for this study. Patient age rangedfrom 18 to 31 (average 22.6) years old with 4right and 1 left extremities involved. Durationof symptoms ranged from one to 19 (average7.4) years and the periods of compressiontherapy were from 1 to 19 years (6.6 years).Four patients had single pregnancies and onepatient was multiparous with 3 pregnancies.Final follow-up ranged from 5.8 to 18 years(average 8.9 years) after the primary mLVA. Allpatients had normal pregnancy, birth, and noserious complications after surgeries. Followingpregnancy three patients had complete functionalrecovery (limb volume reduction and nocompression requirement), one with functionalimprovement (limb volume reduction butrequired compression), and one with no changein symptoms (not worse and continued needfor compression). There were no occurrencesof infection following pregnancy. Based on thiscase series, it is suggested that pregnancy doesnot worsen the pre-existing lymphedema inpatients who had previously undergone mLVA.Further studies with larger number of patientsare needed to confirm these results
INCLUSION OF TARGETED SKIN PRODUCTS IN THE PRE-SURGICAL TREATMENT REGIMEN OF PERIPHERAL LYMPHEDEMA & LIPEDEMA
No full textAdvanced lymphedema is associated witha number of adverse skin changes includingcolor, thickening of the epidermis, dryness, andhyperkeratosis. These changes are related toprolonged lymph stasis and contribute to anincreased risk of infection. Similarly, lipedemais associated with skin thickening and appearanceof nodular adipose deposition. Skin careis essential in both conditions. We examinedwhether inclusion of targeted skin products for2 weeks to an established pre-surgical conservativetreatment program was associated withbeneficial effects on the skin condition in 150patients with lymphedema and lipedema. Patientswere randomly assigned to control or oneof two treatment groups. All three groups (andfor both lymphedema and lipedema) demonstrateda significant reduction in softness. Dimpling/redness was significantly reduced in thetargeted skin product groups for both patientswith lymphedema or lipedema. Only patientswith lipedema demonstrated a significantreduction in dryness/ hyperkeratosis followingtargeted skin product treatment. This studydemonstrates that short-term use of targetedskin products in both patients with lymphedemaand lipedema can be of benefit and furtherstudies are needed to replicate these results andexplore possible mechanisms
IN MEMORIAM
No full textMANUEL VIAMONTE, JR., MD“Lymphographer-Lymphologist-Radiologist Extraordinaire” –Co-Founder of the International Society of LymphologyMarch 19, 1930 - January 15, 201
Diné (Navajo) Youth Experiences in Education from 1928 to 1946
No full text In 1928, a group of researchers from the Brookings Institute released a report, The Problem of Indian Administration, popularly known as the Meriam Report, which heavily criticized the Bureau of Indian Affairs (BIA), including the disturbing conditions of Native American boarding schools. This report led to significant changes in federal policies for Native Americans between 1928 to 1946. During the 1930s, newly appointed Commissioner of Indian Affairs John Collier and other progressive U.S. officials believed they knew how to adjust the “Indian Problem.” Their new policies however, greatly troubled some Native American communities, including the Diné. This paper argues that despite the fact that the Meriam Report praised some of the educational efforts made on the Navajo Reservation, the new assimilationist policies continued to hinder Diné youth education. Building on a rich scholarly literature on the history of Native American education and using historical research methods, this study analyzes archival primary documents to uncover and interpret Diné youth experiences during this era of changing U.S. federal policies of Native American education from 1928 to 1946. The documents analyzed included correspondence between various individuals such as U.S officials and school coordinators, letters and report cards from Diné students, school curricula, legal documents, and images. These archival records reveal the voices of Diné youth and their experiences during this time frame
The 'nature' of fisheries governance: narratives of environment, politics, and power and their implications for changing seascapes
No full textThis article responds to recent calls for more engagement from political ecologists in ocean and coastal governance concerns, and employs a controversy over the practice of gill netting in North Carolina as a lens into questions about how narratives of nature and power affect fisheries policymaking processes. The article analyzes commercial and recreational fisher narratives about marine 'nature,' including perceptions of resource health, expressions of blame or responsibility, and storylines about the different roles of fishers and managers in the process of governing fisheries. The article focuses particularly on how fishers perceive the politics of fisheries management and where they believe power lies in negotiations about the 'right' ways to steward and allocate fishery resources. Fisher narratives are then compared to those of fishery regulators themselves. The article asks how the perceptions of different groups about politics and power in fisheries management affect their levels of trust and engagement with each other and with the policymaking process. It offers insights into the complex negotiations over the meaning of terms like 'conservation,' 'endangered,' and 'livelihood,' and analyzes the implications of these narratives for stimulating material changes in the coastal seascape and the lives of fishers.Key Words: political ecology, governance, fisheries, nature, narrative analysi
Can the subaltern protect forests? REDD+ compliance, depoliticization and Indigenous subjectivities
No full textREDD+ regimes are accompanied by capacity-building and educational practices, which play an important role in REDD+ governance. These practices address subaltern local and indigenous actors, seek their compliance and thereby contribute to the stabilization of otherwise all-too-fragile global carbon governance systems. In this article I analyze the governing effects of such practices by drawing on Robert Fletcher's concept of "multiple environmentalities" and Tania Murray Li's "analytic of assemblage." Empirically I focus on educational materials that have been designed for REDD+ projects in cooperation with one of the world's largest REDD+ funds, Norway's International Climate and Forest Initiative. I identify several strategies that aim at aligning diverse actors, seek to de- or re-politicize REDD+ concepts, authorize knowledge, and, most significantly, address local actors as responsible ecological stewards, who contribute to stabilizing REDD+ regimes on the ground. In total, these strategies promote programmatic subjectivities among indigenous 'stakeholders' and contribute to a new, 'glocal' understanding of nature-society relations.Keywords: global environmental governance, REDD+, governmentality, environmentality, capacity-buildin
BIOIMPEDANCE SPECTROSCOPY IS NOT ASSOCIATED WITH A CLINICAL DIAGNOSIS OF BREAST CANCER-RELATED LYMPHEDEMA
No full textThe objective of this study was to evaluate the accuracy of bioimpedance spectroscopy measurements (L-Dex) in the diagnosis of breast cancer-related lymphedema. A retrospective review of a prospectively maintained database was performed of all patients that underwent surgical treatment for breast cancer at a tertiary medical center. Patients who had preoperative and postoperative evaluation for possible lymphedema by limb circumference measurements and bioimpedance were eligible for inclusion in the study. No significant demographic differences were found between the group of patients clinically diagnosed with lymphedema (N=134) and those without a clinical diagnosis of lymphedema (N=261). The ability of bioimpedance to diagnose lymphedema based on the manufacturer's criteria demonstrated low sensitivity, which was 7.5% when lymphedema was defined as an absolute L-Dex value greater than 10, and 24.6% when defined as a relative change of 10 between preoperative and postoperative measurements. This corresponded with a positive predictive value of 61-71% and a negative predictive value of 67-70%. We are unable to recommend the use of bioimpedance as a screening tool or for measurement of breast cancer-related lymphedema
