Health-related quality of life (QOL) has gained importance due to the increasing incidence of breast cancer and the survival rate of breast cancer patients. We aimed to investigate the relationship between lymphedema, fatigue, and QOL in breast cancer survivors with axillary lymph node dissection. A total of 122 female breast cancer survivors with axillary lymph node dissection who applied to the oncology center of a teaching and research hospital between April 1, 2022, and July 1, 2022, were included in the cross-sectional study. An individual identification form, the EQ-5D General Quality of Life Scale, and the Cancer Fatigue Scale were used to collect data. Mann-Whitney test, Kruskal-Wallis test, Bonferroni post hoc test, and Spearman's correlation were used to assess differences between the survivor groups. The study found that 40.2% of breast cancer survivors experienced lymphedema. The mean scores on the EQ-5D index, Visual Analogue Scale (VAS), and Cancer Fatigue Scale were 0.27 ± 0.25, 71.12 ± 14.21, and 35.86 ± 6.98, respectively. The Cancer Fatigue Scale total score and the EQ-5D VAS showed a strong positive correlation ( = 0.630; < 0.05). Conversely, the total Cancer Fatigue Scale and the EQ-5D VAS scores showed a significant negative correlation ( = -0.626; < 0.05). The study found that almost half of the breast cancer survivors experienced lymphedema. They also had excellent general health, moderate fatigue, and a good overall QOL.

Research has indicated a link between obesity and a greater likelihood of venous disorders. However, the specific relationship between obesity in children and conditions such as phlebitis and thrombophlebitis remains undetermined. To explore this, we undertook a two-sample Mendelian randomization (MR) study to investigate the possible causal impact of childhood body mass index (BMI) on the development of phlebitis and thrombophlebitis. This study utilized genome-wide association studies data from European populations. Childhood BMI was assessed in a sample of 39,620 individuals, while data on phlebitis and thrombophlebitis were obtained from 1613 cases and 335,586 controls. We selected 16 single nucleotide polymorphisms significantly associated with childhood BMI as instrumental variables (IVs). The inverse variance weighting (IVW) method was applied as the primary approach, with weighted median, MR-Egger regression, and weighted mode methods used as complementary analyses. The IVW analysis indicates a significant causal link between childhood BMI and the occurrence of phlebitis and thrombophlebitis (Beta = 0.002739, Standard error (SE) = 0.000740, = 0.0002147). Results from the weighted median method (Beta = 0.002446, SE = 0.001046, = 0.01933) aligned with the IVW findings. However, the MR-Egger and weighted mode analyses did not show a significant association ( = 0.1051 and = 0.2525, respectively). Leave-one-out sensitivity tests and heterogeneity assessments were performed, revealing no evidence of horizontal pleiotropy. The findings from the MR analysis suggest a potential causal relationship between childhood BMI and an elevated risk of phlebitis and thrombophlebitis. This study provides new insights into the impact of childhood obesity on venous health, emphasizing the need for early intervention and prevention strategies.

We report the usefulness of a tapered cutting needle, which has a polyhedral tip similar to that of a square needle and transitions to a round tip in the middle, for super-microsurgery. We have performed more than 500 lymphaticovenular anastomoses (LVAs) using tapered cutting needles. Therefore, we investigated the caliber of the anastomosed lymphatic vessels and veins, characteristics of the lymphatic vessels, the time required to perform the anastomosis, damage to the lymphatic vessels and veins during anastomosis, and patency of 30 recently performed consecutive anastomoses. The mean caliber of the anastomosed lymphatic vessels was 0.68 mm (range, 0.4-1.2 mm), and the mean caliber of the veins was 0.87 mm (range, 0.5-1.5 mm). Regarding the progression of fibrosis, 14 cases were classified as no degeneration, 13 cases were classified as mild degeneration, 2 cases were classified as moderate degeneration, and 1 case was classified as severe degeneration. The average time required to perform the anastomosis was 10.53 minutes (range, 8-13 minutes). No cases of lymphatic or venous injury or laceration occurred during the anastomosis procedure. After the anastomosis was created, intraoperative patency was observed in all patients. The tapered cutting needle is useful for LVAs because of its excellent thread-ability and protective properties for blood vessels. Furthermore, the tapered cutting needle is useful for short anastomoses, regardless of the diameter or condition of the lymphatic vessels. In the future, the tapered cutting needle is expected to become the needle of choice for LVAs.

Current understanding of changes in fluid distribution in response to the application of compression in primary lymphedema (PLE) is limited. This study measured fluid distribution before and after one application of standardized intermittent pneumatic compression (IPC) in the lower limbs of people with PLE, compared with those without lymphedema. High-frequency ultrasound (HFU) was used to measure dermal fluid, bioimpedance to measure segmental fluid, and percent water content (PWC) to measure fluid at specific anatomical points. Fifteen people with PLE aged 11-40 years were matched for age, gender, and ethnicity to a person without lymphedema (NLE). PWC and HFU measures (low echogenic pixels) were taken bilaterally on the posterior leg and dorsum of the foot. Segmental bioimpedance (Extracellular Fluid/Intracellular Fluid, ECF/ICF) was measured in the foot, leg, and lower limb. Differences between groups, using the affected leg of unilateral and the more affected leg of bilateral PLE, were analyzed using the mixed ANOVA. There was significantly less ECF/ICF in the leg of NLE ( = 0.005) and PLE ( = 0.022) following IPC, and in the whole treated lower limb of NLE ( = 0.013), but no change in the treated limb of PLE. In contrast, the limb showed significantly higher ECF/ICF in PLE ( = 0.040), a change not seen in NLE. The lack of response to compression in the foot, commonly affected in PLE, and the increase in fluid in the untreated PLE limb, indicates the need for further investigation of the effect of compression on fluid distribution in PLE.

Lymphaticovenular anastomosis (LVA) is the first-line surgical treatment for lymphedema. The therapeutic effects of LVA, including edema reduction and cellulitis prevention, vary among patients. We examined cases of palliative LVA in patients with lymphedema who were in the terminal stage due to recurrence or distant metastasis of the primary disease, with a focus on the course and usefulness of palliative LVA. A total of 13 palliative LVAs were performed in 12 patients undergoing palliative treatment. LVA was performed without interfering with chemotherapy or radiation. Data on site and stage of edema, compression treatment status, number of anastomoses, percentage change in circumferential diameter (the total circumference at six locations was compared), treatment efficacy, and patient prognosis were collected. Edema was present in the upper and lower extremities of 10 and 2 patients, respectively. The average postoperative decrease in circumferential diameter was 8.6%. Psychological evaluation was based on the self-reports of patients, and 11 out of 12 patients showed improvement in their mental state. Two patients died during the observation period due to deterioration in the underlying disease. We reported our experience with palliative LVA in patients with advanced malignancies. Many patients had favorable physical and psychological outcomes. Surgery can be performed safely with appropriate planning based on the condition of the patients. Palliative LVA may be a treatment option for patients with recurrent or distant metastases of the primary disease who are refractory to edema treatment.

Lower extremity lymphedema is a chronic and incurable condition. Treatment options for lymphedema have continued to advance and prognosis has improved; however, the condition still poses a substantial negative impact on patients' mental health. Therefore, the key questions raised in this study are "How many patients with lower limb lymph have depression symptoms?" and "Are there any differences in the symptoms and distress factors of patients with lower extremity lymphedema, and how do they experience distress?" A total of 112 lower extremity lymphedema patients from June 2021 to December 2023 were enrolled in the study. Quantitative and qualitative data of patients were collected and analyzed. Participants completed the Patient Health Questionnaire (PHQ-9), and we interviewed participants with moderate/severe depressive symptoms with score ≥10. A total of 83 participants completed this study. Overall, 39.76% of the participants had a PHQ-9 score ≥5, indicating that they had mild depressive symptoms; 13.25% of the participants had a PHQ-9 score ≥10, indicating that they had moderate or severe depressive symptoms. Compared with participants who had received treatment before the study, participants who did not receive any treatment before the study had a higher risk of depression (χ = 6.705, = 0.031). There was no significant difference in the degree of depression in patients with different stages of lymphedema (χ = 8.430, = 0.077). From the qualitative interview data, we extracted five common themes: "loss of self," "isolation from surroundings," "discomfort caused by symptoms and complications," "concern about the progression or deterioration of the original malignant tumor," and "fear that surgical treatment may be ineffective." This study found that patients with lower extremity lymphedema are prone to psychological symptoms of depression. To clarify the reason that affect psychological distress is important information to improve the psychological health support for patients with lower extremity lymphedema.

This study aimed to evaluate and compare the effectiveness of telerehabilitation (TR) and home exercise program (HEP) in patients with breast cancer-related lymphedema and the patients' compliance with these treatment processes. 23 patients were prospectively included in the HEP group and 22 patients in the TR group, who were followed up in the Lymphedema Outpatient Clinic of the Department of Physical Medicine and Rehabilitation of a University Hospital. These patients were randomized. The volume difference between the extremities of the patients was calculated with the truncated cone formula, before and after treatment. The patients' pain, tightness, heaviness, and stiffness symptoms associated with lymphedema were questioned using a numerical scale. The patients' functionality and participation in daily life activities were evaluated with disabilities of arm, shoulder, and hand Quick Questionnaire (Quick-DASH) and the Lymphedema Life Impact Scale (LLIS). Patients' treatment satisfaction and compliance with treatment were questioned using Likert scales. A total of 45 patients were included in the study. The mean age and body mass index were similar between the groups ( ≥ 0.05). In the evaluations performed, no significant differences were observed within groups or between groups in terms of volume difference, quick DASH, pain, tightness, heaviness, stiffness, and LLIS scores ( ≥ 0.05). Patient satisfaction was significantly higher in the TR group ( ≤ 0.001). During treatment follow-up, only one person from the TR group missed the 5th-week checkup (4.5%), whereas five patients from the HEP missed the 5th-week checkup and three missed the 8th-week checkup. Overall, eight patients discontinued treatment (34%). Although there were no significant differences in clinical assessments between TR and HEP groups, patient satisfaction, and treatment adherence were significantly higher in the TR group.

Upper limb lymphedema is the most common complication after breast cancer therapy. Suddenly disturbed lymphatic transport in the affected arm causes tissue fluid accumulation in tissue spaces, limb enlargement, and secondary changes in tissue. Early compression therapy is necessary. We aim to evaluate the effectiveness of intermittent pneumatic compression (IPC) in fluid movement along the limb and the possibility of creating compensatory drainage pathways. We investigated 25 patients with Breast Cancer Related Lymphedema (BCRL) stages II and III. Indocyanine green observation and measurement of skin water concentration and skin and subcutaneous tissue stiffness were done before and after a single 45-minute session of IPC. After IPC, we observed the movement of edema fluid upper in the arm (92%) and in three main directions not seen before IPC: to the ipsilateral supraclavicular lymph node (30%), to the ipsilateral axilla (22%), and to the axilla, chest, and scapula (26%). We noticed two changes in fluorescent intensity along the entire limb: a decrease in the hand and forearm, an increase in the arm (64%), and a decrease along some parts or the entire limb (36%). Skin and subcutaneous tissue stiffness decreased at all limb levels. The highest, statistically significant reduction of subcutaneous tissue stiffness was noticed in the middle forearm and elbow (36.4% and 33.4%, respectively). IPC can effectively move edema fluid from the distal to the proximal part of the limb, promote compensatory drainage pathways, and decrease tissue stiffness. This compression type should be applied even in the early stages to prevent limb enlargement and secondary tissue changes.

The aim of this study was to comparatively determine the frequency of breast cancer-related lymphedema (BCRL) by using prospective monitoring with perometer and circumferential measurements in a group of patients who underwent breast cancer surgery. We also aimed to evaluate the relationship between volume changes and functional status and quality of life (QoL) in patients with breast cancer-related subclinical lymphedema. Patients who had unilateral breast cancer surgery for breast were assessed with circumferential and perometer, respectively, for volumes at baseline, 3rd-month, 6th-month, 9th-month, and 12th-month by the same physiotherapist. Every patient was informed about lymphedema symptoms and prevention. The demographic and clinical properties were recorded. Functional status and QoL were evaluated by Q-DASH and the Lymphedema Quality of Life Questionnaire-Arm questionnaires. A total of 101 female patients with a mean age of 49.02 + 10.59 years completed the 12-month follow-up. Most of the patients were overweight, had an axillary dissection in addition to breast surgery, and received radiotherapy. The frequency of subclinical and clinical BCRL at the end of 12 months was determined by 34.7% and 23.8% with circumferential measures and perometer, respectively. QoL and functional scores did not differ between patients with and without subclinical lymphedema. After the first 12 months after surgery, the frequency of BCRL assessed by circumferential measurements was higher than the frequency assessed by perometer. Periodic monitoring of women with breast cancer for the presence of BCRL, preferably by the same person together with patient education is suggested in order to allow early detection and timely intervention for BCRL.

We currently perform noncontrast lymphatic ultrasound, which has a higher resolution and is less invasive than contrast lymphatic ultrasound. This study aimed to clarify the usefulness of screening lymphatic ultrasound (SLUS) to evaluate lymphatic function. A retrospective study was conducted on 22 patients with leg lymphedema. We performed SLUS by dividing the leg into four areas (thigh and calf, lateral and medial) and the dorsum of the foot. Lymphatic findings were recorded according to NECST (Normal, Ectasis, Contraction, and Sclerosis type) classification. If no lymphatics were found, we recorded them as "not found." To differentiate between lymphatic vessels and veins, we referred to D-CUPS (Doppler, Crossing, Uncollapsible, Parallel, and Superficial fascia). The time required for SLUS was recorded. Indocyanine green (ICG) lymphography was also performed in 10 patients. The mean age of the 22 patients was 63.9 years (range 50-86 years). The average time required for SLUS was 6 minutes 45 seconds for both legs. The identification rate of the lymphatic vessels was 95.5% for the medial thigh and medial calf, but decreased in the lateral calf and dorsum of the foot. When examining the distribution of the NECST classification, the ectasis type tended to be more common on the medial side than on the lateral side. Combined with the ICG lymphographic findings, dermal backflow (DB)-positive areas had significantly more ectasis type, and DB-negative areas had significantly more normal type and were not found ( < 0.01). SLUS should be useful for screening lymphatic vessel function.

Lymphedema is a chronic condition characterized by dysfunction of the lymphatic system. There is currently no available cure. The standard of care is complete decongestive physiotherapy performed by a lymphedema therapist. However, lymphedema may flare between appointments, making home care important. There are several medical devices available to treat lymphedema at home, but they can be expensive, noisy, and bulky, restricting patient mobility. Thus, there is a demand for other devices that can be utilized at home, between appointments. The overall goal of this research study is to assess the safety of a newly developed vibratory device that may be utilized to supplement lymphedema treatment. Fourteen healthy subjects were recruited and treated with the device, all while measuring pre-treatment and post-treatment upper extremity circumference/induration, vital signs, pain, side effects, and intra-treatment acceleration produced by the device. There were no significant changes in reported pain or vital signs, and side effects were largely mild and transient. We believe that this device is safe for use in healthy subjects, and further studies should assess the efficacy of this device in treating patients with lymphedema.

Secondary lymphedema is acquired and caused by obstruction or injury to a normally developed lymphatic system. Loss of mobility is a common problem in patients with secondary lower limb lymphedema (LLL) following cancer treatment. In this study, we examined the effect of complex decongestive therapy (CDT) on motor function and mobility in patients with LLL. A quasi-experimental study was performed with 24 participants with stage 2 LLL (56.04 ± 14.23 years). Participants received 15 sessions of CDT. Motor function was assessed with a foot tapping test (FTT). Gait speed was measured in single-task (ST) and dual-task (DT) conditions, and DT cost was calculated. All assessments were performed before and after the intervention. The paired test and Wilcoxon signed-rank test were used to analyze the effect of CDT on FTT, gait speed, and DT cost. ST and DT gait speed ( = 0.002, < 0.001) and DT cost ( = 0.001) decreased following the CDT, whereas bilateral FTT scores did not change. CDT improves mobility and dual-tasking in LLL, thereby promoting independence in daily life. Future prospective controlled studies are required to corroborate our results.

This study aimed to investigate, characterize, and provide quantitative reference data on tissue dielectric constant (TDC) values of female breasts when measurements were made to 5 mm depths and determine the utility of these measurements to differentiate between benign and malignant breast tumors. Breast TDC was measured bilaterally in 82 women just prior to an ultrasound-guided diagnostic biopsy of one tumor in one breast. TDC was measured in triplicate over the tumor and the contralateral healthy breast. Considering all paired breasts, the average TDC (mean ± SD) for healthy breasts was less than for tumor-bearing breasts (26.7 ± 4.5 vs. 29.9 ± 8.5, = 0.0003). Breast TDC values measured to 5 mm in 82 healthy nonedematous breasts provide a two-SD threshold reference value of 35.7. This represents a TDC value above which the presence of breast edema/lymphedema may be indicated based on the two-SD threshold criterion. For unilateral cases, an interbreast TDC ratio exceeding 1.275 may be considered a breast edema/lymphedema indicator also based on the two SD criteria used. These thresholds may have utility for early detection and to track breast edema/lymphedema changes. A comparison of these TDC values obtained from benign versus malignant tumors indicates no statistically significant difference between them. However, interbreast TDC ratios were statistically higher for breasts with malignant versus benign tumors. However, the large overlap of the ratio values renders this method of discrimination between benign vs. malignant tumors inadequate based on the present findings.

The aim of this study was to investigate the validity and reliability and identify determinants of the 6-minute walk test (6MWT) in patients with lower limb lymphedema (LLL). The study included 28 patients with LLL and 28 healthy subjects. To investigate the convergent validity and determinants of the 6MWT, patients were assessed using the following measurements: circumference measurement for lymphedema severity, hand-held dynamometry for muscle strength, time up and go for functional mobility, five-time sit-to-stand test for functional lower extremity strength, Lower Extremity Functional Scale for lower extremity functionality, Lymphedema Life Impact Scale for quality of life, and International Physical Activity Questionnaire-Short Form for physical activity level. The test-retest reliability of the 6MWT was assessed using intraclass correlation coefficients (ICCs). 6MWT, a test-retest reliability analysis was carried out with 28 patients within 3-7 days. The receiver operating characteristic (ROC) curve was employed to determine the cut-off point of 6MWT. The test-retest reliability of 6MWT was detected as excellent (ICC [95%] 0.93 [0.87-0.97]). Significant correlations were found between the 6MWT health-related and disease-specific parameters, indicating sufficient convergent validity ( ≥ 0.3). The ROC curve indicated a cut-off point of 504 meters (area under the curve [AUC] 0.712 [95%CI: 0.575-0.849]). Multiple linear regression analysis demonstrated that lymphedema severity, hip abduction muscle strength, and lower limb functionality were the predictors of 6MWT. The 6MWT has been shown to be a reliable and valid tool for assessing the functional capacity of patients with LLL.

Lipedema is a chronic condition characterized by abnormal deposition of subcutaneous adipose tissue, leading to pain. The lack of internationally recognized diagnostic criteria complicates the characterization of pain. Physiological parameters such as pain pressure threshold (PPT) represent promising prognostic markers for diagnosing lipedema, yet they remain understudied. This study aimed to evaluate the reliability and validity of two pain pressure measurements, PPT and the hand-held sphygmomanometer (HHS) in lipedema. A total of 28 adult females diagnosed with lipedema were recruited. Both PPT, using a digital algometer, and HHS, using a manual aneroid HHS, were performed to assess pain in the lower limbs. The testing was performed in a standing position with PPT and HHS placed on the calf. Intraclass correlation coefficient (ICC) and coefficient of variation (CV) were employed to assess the within session reliability, while the validity between PPT and HHS was analyzed using in a linear regression model. The results showed excellent reliability for both PPT and HHS, with ICC indicating high consistency (ICC = 0.93 to 0.97) and CV showing acceptable scores (CV = 3.62% to 9.06%). In addition, good validity between PPT and HHS was also observed ( = 0.69 to 0.74), suggesting that HHS can be a reliable alternative to PPT for pain assessment in lipedema. These findings have important clinical implications, as they expand the knowledge of pain characterization in people with lipedema, potentially aiding in diagnostic refinement. In addition, a cost-effective and accessible method for assessing pain was examined (i.e., HHS), showing promising findings and providing an objective method to help diagnose lipedema.

Lymphedema is a chronic, progressive condition that has major physical and psychological consequences. It was aimed to examine the respiratory functions, respiratory muscle strength, physical activity level, and functionality of patients with lower extremity lymphedema and to compare them with healthy controls. A total of 82 individuals (29.3% male, 70.7% female, with a mean age of 49.89 ± 15.07 years) with lower extremity lymphedema (Group 1) and healthy individuals (Group 2) were included. Respiratory functions of the participants were evaluated by spirometry, respiratory muscle strength by maximum oral pressure measurements, physical activity levels using the International Physical Activity Questionnaire-Short Form (IPAQ-SF), functionality by Lower Extremity Functional Scale (LEFS) and Timed Up and Go test (TUG test). All respiratory function test measurements were lower in mean Group 1 than in Group 2 ( < 0.05). While inspiratory muscle strength did not differ between the groups ( > 0.05), expiratory muscle strength was lower in Group 1 than Group 2 ( < 0.05). Although spent time and energy for sitting were higher in Group 1 ( < 0.05), IPAQ vigorous-, moderate-, and light-intensity physical activity (MET-min/week) and IPAQ-total score did not differ between groups ( > 0.05). In Group 1, mean of LEFS score was lower and TUG test (seconds) in Group 1 was longer compared to Group 2 ( < 0.05). Respiratory functions, expiratory muscle strength, and functionality in patients with lower extremity lymphedema were adversely affected; however, inspiratory muscle strength and physical activity levels were similar to those of healthy controls.

Lymphedema is one of the disturbing complications after breast cancer treatment that may affect the quality of life (QoL) of breast cancer survivors (BCSs). In this double-blind randomized clinical trial, 63 patients with breast cancer-related lymphedema (BCRL) were included in the study. Group A received standard complete decongestive therapy (CDT), group B received CDT with olive oil, and group C received CDT with chamomile and olive oil. Lymphedema volume and range of motion (RoM) were measured at the beginning of the study and at sessions 7, 14, and 21. Patients' QoL was measured using the Short Form 36 questionnaire at baseline, at the end of the trial, and 1 month after the trial. For statistical analysis, SPSS software with a significance level of < 0.05 was used. The mean age of patients was 55.4 ± 10.1 years. Although the volume of lymphedema was reduced and RoM was increased in all groups, there was no significant difference between the three groups. However, the change in volume and RoM was more evident in group C. Moreover, the effect of interventions on health-related QoL dimensions in all groups was not statistically significant. However, in some dimensions, the score did not decrease in group B during follow-up. Chamomile and olive oils are tolerable for BCSs with BCRL; however, adding this intervention to CDT seems to have no superiority to CDT alone.

It is known that particles released from the prosthesis due to wear after joint replacement surgery affect the lymphatic system. This study aimed to investigate the effect of the manual lymphatic drainage (MLD) technique on pain, edema, and blood lactate dehydrogenase (LDH) levels in the early period of lymphatic transport affected by total knee arthroplasty (TKA). Twenty-four patients who underwent TKA were randomly allocated (control: 12; MLD: 12). Both groups received postoperative rehabilitation. The MLD group also received MLD in the first 3 days after surgery. Clinical assessment was undertaken on the third day and at the sixth week postoperatively. The Visual Analog Scale (VAS) was used for pain during activity, algometer measurements for pain threshold levels, and the Frustum method for leg volumes. The LDH was recorded using laboratory measurements. A significant difference was found in the VAS activity-related pain scores of the groups according to the assessment time (MLD: = 47.175; = 0.000; control; = 30.995; < 0.000). The pain threshold significantly increased in the MLD group from postoperative day 2 (2nd day, 3rd day, 6th week, respectively; = 0.015; = 0.001; < 0.000). Leg volume significantly decreased over time in both groups after surgery ( < 0.001); however, there was no significant difference between the groups (first-third postoperative days and sixth week; = 0.192; = 0.343; = 0.453; = 0.908, respectively). While the LDH significantly decreased after drainage in the MLD group (first-third postoperative days; = 0.002; = 0.005; = 0.006, respectively), it increased with exercise in the control group, first day ( = 0.004) and second day ( = 0.019). MLD added to exercise therapy is more effective than exercise therapy alone in reducing the LDH level, a marker of pain and muscle damage, but is not effective for edema due to surgery.