Journals at the University of Arizona
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THE EFFECTIVENESS OF EXTRACORPOREAL SHOCK WAVE THERAPY ON BREAST CANCER-RELATED LYMPHEDEMA: A LITERATURE REVIEW
No full textLymphedema is one of the most dreaded complications related to breast cancer surgery, commonly resulting in upper limb functional, esthetic, and psychological impairment. The necessity to improve the efficacy of conventional treatments and the promising effect of extracorporeal shock wave therapy (ESWT) on lymphangiogenesis in vitro and animal models, has prompted studies involving women affected by breast-cancer related lymphedema. Since intervention modalities and treatment protocols used are different, a review is necessary to verify the effectiveness of ESWT, evaluating the quality of existing studies and the eventual need for further research. Data were obtained from PubMed, Scopus, Google Scholar, Cochrane Library and PEDro, including articles published until January 2019. Five studies met the inclusion criteria. Evident heterogeneity emerged among selected studies permitting only a purely descriptive analysis of their data and strongly limiting their comparison. When compared to other treatment modalities, ESWT showed a significant effect on measured outcomes. It is clear that further high quality research is necessary to assert with confidence the effects and possible superiority of ESWT over other conservative therapies in the management of breast-cancer related lymphedema
BONE DEVELOPMENT AND FRACTURE HEALING IS NORMAL IN MICE THAT HAVE A DEFECT IN THE DEVELOPMENT OF THE LYMPHATIC SYSTEM
No full textEctopic lymphatics form in bone andpromote bone destruction in diseases such asGorham-Stout disease, generalized lymphaticanomaly, and kaposiform lymphangiomatosis.However, the role lymphatics serve in normalbone development and repair is poorly understood.The objective of this study was tocharacterize bone development and fracturehealing in mice that have a defect in thedevelopment of the lymphatic vasculature. Wefound that bones in wild-type adult mice andmouse embryos did not have lymphatics. Wealso found that bone development was normalin Vegfr3(Chy/Chy) embryos. These mice do nothave lymphatics and die shortly after birth. Todetermine whether lymphatics serve a role inpostnatal bone development and fracturehealing, we analyzed bones from Vegfr3(wt/Chy)mice. These mice are viable and have fewerlymphatics than wild-type mice. We found thatpostnatal bone development and fracturehealing was normal in Vegfr3(wt/Chy) mice. Takentogether, our results suggest that lymphatics donot play a major role in normal bonedevelopment or repair
FOREARM AND BICEPS CIRCUMFERENTIAL VARIATIONS IN SKIN TISSUE DIELECTRIC CONSTANT AND FIRMNESS
No full textTissue dielectric constant (TDC) andskin firmness assessed via indentation force(FORCE) help quantify lymphedema and trackchanges. We sought to determine potentialdifferences in these parameters dependent onarm circumferential locations. Thus, TDC andFORCE were measured in 40 healthy womenat medial, anterior and lateral locations onforearm and biceps. In five other women withunilateral lymphedema (68.6±7.6 years), TDCwas measured at corresponding circumferentialforearm positions. Measurements were done intriplicate using compact noninvasive devices.Results for healthy women (23.8±2.7 years)showed forearm medial TDC values (26.7±2.2)were less than anterior (28.0±2.4) or lateral(28.0±2.5) positions (p0.001). Lymphedemapatients had elevated values but similar medialanterior-lateral patterns (33.7±8.0, 39.8±10.2and 42.9±10.0). Biceps medial TDC values(24.1±2.2) were also less than either anterior(27.0±2.1) or lateral (28.2±3.3). Contrastingly,medial FORCE values at forearm and bicepswere less than at anterior and lateral locations(p0.001) and increased in the order of medialanterior-lateral on forearm (p0.001). Thepresent findings provide reference values forboth TDC and FORCE of commonly measuredarm sites with specificity as to circumferentialvariations. This observed variation indicatesthe need for care in locating measurementpositions for tracking patients withlymphedema
PHYSICAL THERAPY AFFECTS ENDOTHELIAL FUNCTION IN LYMPHEDEMA PATIENTS
No full textLymphedema arises due to a malfunction of the lymphatic system and can lead to massive tissue swelling. Complete decongestive therapy (CDT), consisting of manual lymphatic drainage (MLD) and compression bandaging, is aimed at mobilizing fluid and reducing volume in affected extremities. Lymphatic dysfunction has previously been associated with chronic inflammation processes. We investigated plasma ADMA as an indicator of endothelial function/inflammation before-, during- and after-CDT. Also assessed were vascular function parameters such as carotid-femoral pulse wave velocity (PWVcf), flow-mediated dilatation (FMD) and retinal microvasculature analysis. 13 patients (3 males and 10 females, 57 ± 8 years old (mean ± SD), 167.2 ± 8.3 cm height, 91.0 ± 23.5 kg weight), with lower limb lymphedema were included. Vascular function parameters were assessed on day 1, 2, 7, 14 and 21 of CDT, pre- and post-MLD. ADMA was significantly lower post-MLD (p=0.0064) and tended to reduce over three weeks of therapy (p=0.0506). PWVcf weakly correlated with FMD (r=0.361, p=0.010). PWVcf, FMD and retinal microvasculature analysis did not show changes due to physical therapy. The novel results from this study indicate that lymphedema does not affect endothelial function and lymphedema patients may therefore not have a higher risk of cardiovascular diseases. Our results further suggest that manual lymphatic drainage with or without full CDT could have potentially beneficial effects on endothelial function in lymphedema patients (by reducing ADMA levels), which has not been reported previously
SKIN LYMPHATIC SYSTEM IN THE PATHOGENESIS OF ARTERIAL HYPERTENSION – REVIEW AND CRITIQUE
No full textAlthough numerous studies have confirmed the relationship between high salt intake and elevated blood pressure, the exact molecular mechanisms of this relationship are still unclear. There is growing evidence that skin interstitium, as well as the skin lymphatic system, are important regulators of both sodium (Na+) balance and blood pressure. Skin is in itself a large reservoir of Na+ ions which are stored in an osmotically inactive form on glycosaminoglycans (GAGs). Local hypertonicity due to extensive accumulation of Na+ within the skin as a result of a high-salt diet was demonstrated to induce macrophages to express a transcription factor termed tonicity-responsive enhancer binding protein (TonEBP) and subsequently to secrete vascular endothelial growth factor-C (VEGF-C), activating lymphangiogenesis within the skin. This regulatory axis seems to be adaptive in maintaining blood pressure in high salt-load states. Recent studies have added new insights into the functioning of lymphatic vessels and the pathogenesis of salt-sensitive hypertension as well as questioned the classic view of Na+ homeostasis. This review aims to summarize recent findings pertaining to the involvement of the skin lymphatic system in Na+ and blood pressure regulation
