OBJECTIVE: To summarize the research progress of rodent models of secondary lymphedema (SL) and provide a reference for selecting appropriate animal models in SL research. METHODS: Recent literature on rodent SL models at home and abroad was comprehensively analyzed, summarizing model categories, development techniques, strengths, and weaknesses. RESULTS: Current research primarily utilizes rats and mice to establish SL models. The main model types include hind limb, forelimb, tail, and head/neck models. The hind limb model is the most frequently employed, typically requiring surgery combined with irradiation to induce stable chronic edema. Forelimb models primarily simulate upper limb lymphedema, but exhibit relatively rapid edema resolution. Tail models offer operational simplicity and are predominantly used for studying acute edema mechanisms and interventions; however, they demonstrate poor clinical relevance. Emerging head/neck models provide a valuable tool for investigating head and neck cancer-associated lymphedema. These models exhibit variations in lymphedema duration, degree of fibrosis, and edema incidences. CONCLUSION Existing models still fall short in faithfully replicating the chronicity, fibrosis, fat deposition, and complex microenvironment characteristic of human chronic lymphedema. Future research must integrate multidisciplinary approaches, optimize model construction strategies, and explore novel modeling approaches to more accurately mimic the human disease and advance SL prevention and treatment research.
Lymphedema/pathology* ; Animals ; Disease Models, Animal ; Rats ; Mice ; Humans ; Head and Neck Neoplasms/complications* ; Rodentia

OBJECTIVE: To compare the effectiveness of single-stage vascularized lymph node transfer (VLNT) combined with lymphaticovenular anastomosis (LVA) and liposuction (LS) (3L) versus LVA combined with LS (2L) for the treatment of moderate-to-late stage upper limb lymphedema following breast cancer surgery. METHODS: A retrospective analysis was conducted on the clinical data of 16 patients with moderate-to-late stage upper limb lymphedema after breast cancer surgery, treated between June 2022 and June 2024, who met the selection criteria. Patients were divided into 3L group (n=7) and 2L group (n=9) based on the surgical approach. There was no significant difference (P>0.05) in baseline data between the groups, including age, body mass index, duration of edema, volume of liposuction, International Society of Lymphology (ISL) stage, preoperative affected limb volume, preoperative circumferences of the affected limb at 12 levels (from 4 cm distal to the wrist to 42 cm proximal to the wrist), preoperative Lymphoedema Quality of Life (LYMQoL) score, and frequency of cellulitis episodes. The 2L group underwent LS on the upper arm and proximal forearm and LVA on the middle and distal forearm. The 3L group received additional VLNT in the axilla, with the groin serving as the donor site. Outcomes were assessed included the change in affected limb volume at 12 months postoperatively, and comparisons of limb circumferences, LYMQoL score, and frequency of cellulitis episodes between preoperative and 12-month postoperative. Ultrasound evaluation was performed at 12 months in the 3L group to assess lymph node viability. RESULTS: Both groups were followed up 12-20 months, with an average of 15.13 months. There was no significant difference in the follow-up time between the groups (t=-1.115, P=0.284). All surgical incisions healed by first intention. No adverse events, such as flap infection or necrosis, occurred in the 3L group. At 12 months after operation, ultrasound confirmed good viability of the transferred lymph nodes in the 3L group. Palpation revealed significant improvement in skin fibrosis and improved skin softness in both groups. Affected limb volume significantly decreased in both groups postoperatively (P<0.05). The reduction in limb volume significantly greater in the 3L group compared to the 2L group (P<0.05). Circumferences at all 12 measured levels significantly decreased in both groups compared to preoperative values (P<0.05). The reduction in circumference at all 12 levels was better in the 3L group than in the 2L group, with significant differences observed at 7 levels (8, 12, 16, 30, 34, 38, and 42 cm) proximal to the wrist (P<0.05). Both groups showed significant improvement in the frequency of cellulitis episodes and LYMQoL scores postoperatively (P<0.05). While the improvement in LYMQoL scores at 12 months did not differ significantly between groups (P>0.05), the reduction in cellulitis episodes was significantly greater in the 3L group compared to the 2L group (P<0.05). CONCLUSION The combination of VLNT+LVA+LS provides more durable and comprehensive outcomes for moderate-to-late stage upper limb lymphedema after breast cancer surgery compared to LVA+LS, offering an improved therapeutic solution for patients.
Humans ; Female ; Lipectomy/methods* ; Retrospective Studies ; Anastomosis, Surgical/methods* ; Lymphedema/etiology* ; Middle Aged ; Upper Extremity/surgery* ; Breast Neoplasms/surgery* ; Lymph Nodes/blood supply* ; Adult ; Lymphatic Vessels/surgery* ; Iliac Artery/surgery* ; Postoperative Complications/surgery* ; Perforator Flap/blood supply* ; Treatment Outcome ; Mastectomy/adverse effects* ; Quality of Life ; Aged

OBJECTIVE: To observe the clinical efficacy of transcutaneous electrical acupoint stimulation (TEAS) combined with warm acupuncture in treating breast cancer associated with upper limb lymphedema (BCRL). METHODS: This was a retrospective cohort study using a paired control design. Fifty-two BCRL patients were assigned to the control group (27 cases) and the treatment group (25 cases). The patients in the control group were treated with lymphedema comprehensive detumescence treatment (CDT) for 4 weeks, including systematic therapy composed of manual lymphatic drainage, compression bandage, skincare, and functional exercise. The patients in the treatment group were treated with TEAS combined with warm acupuncture based on the control group methods. Each treatment lasted for 30 min and was applied twice a week for 4 weeks. The arm circumference (AC) of different positions of the affected limb and the degree of swelling of the affected limb were evaluated before the first treatment and after the last treatment. The clinical efficacy was evaluated according to the degree of edema before and after treatment. All adverse events during treatment were recorded. RESULTS: The patients' AC and the swelling feeling of the affected limb in the treatment group and the control group were both reduced compared with those before treatment. Compared with the control group, AC of the wrist joint transverse stria, the midpoint between the wrist joint transverse stria and the elbow joint transverse stria in the treatment group were significantly reduced (P<0.05). The decrease in AC diameter at the midpoint between the elbow joint transverse stria and the axillary transverse stria was the most significant (P<0.01). The swelling degree of the affected limbs in the treatment group was significantly lower than before treatment, and was significantly lower compared with the control group after treatment (P<0.01). The total effective rate was 72% in the treatment group, significantly higher than that in the control group (55.56%, P<0.05). No serious adverse events occured in either group. CONCLUSIONS TEAS combined with warm acupuncture can effectively reduce AC and swelling feeling of the affected limb in patients with BCRL. The effect is better than that of CDT therapy alone. (Registration No. ChiCTR2200062075).
Humans ; Female ; Breast Neoplasms/therapy* ; Acupuncture Points ; Retrospective Studies ; Lymphedema/complications* ; Acupuncture Therapy/adverse effects* ; Upper Extremity ; Treatment Outcome

An 11-year-old girl was found to have pale complexion and anemia with gradual aggravation for one year. She was weak in the past and developed pneumonia in the right middle lung 3-5 times per year, which was improved after anti-infective therapy. She and her mother had congenital deaf-mutism. Physical examination showed the appearance of anemia, without bleeding, jaundice, hepatosplenomegaly, or lymph node enlargement. Routine blood test results showed reductions in all three blood cell lines, normocytic anemia, and megaloblastoid change in granulocytic and erythroid cell lines in bone marrow, with no obvious increase in primitive cells or metastatic tumor cells. Whole exome sequencing indicated the presence of a known pathogenic mutation for Emberger syndrome (ES), c.1084C>T (p.Arg362*) in the GATA2 gene. The girl was finally diagnosed with ES, and myelodysplastic syndrome (MDS) progressed to acute myeloid leukemia during follow-up. ES is a rare type of MDS with autosomal dominant inheritance in clinical practice, and it is difficult to make a confirmed diagnosis. ES should be considered for children with unexplained lymphedema and congenital deafness, and gene detection should be performed to make a confirmed diagnosis.
Anemia ; complications ; Child ; Female ; GATA2 Transcription Factor ; Humans ; Lymphedema ; Mutism ; complications ; Myelodysplastic Syndromes

OBJECTIVETo investigate the therapeutic effect of heating and bandage treatment for chronic lymphedema of extremities accompanied with erysipelas.

METHODSFrom March 2004 to March 2013, 80 patients with chronic lymphedema of extremities accompanied with erysipelas were analyzed retrospectively. The patients underwent heating treatment (42 degree centigrade) with infrared light machine made by Shanghai Ninth People's Hospital, 2 hours a day, 20 hours for a session. Bandage treatment was adopted after heating treatment. 1 or 2 sessions were performed for each patient every year. The erysipelas occurring frequency, patients subjective feeling, treatment sessions and elastic material usage was recorded during the follow-up period. The erysipelas occurring frequency was tested by the method of rank and inspection. SPSS 17. 0 was used for statistical analysis.

RESULTSAfter heating and bandage treatment, the occurrence frequency of erysipelas was obviously controlled (Z = 7.598, P = 0.000). Erysipelas was not occurred any more in 60 (75%)patients. Remarkable reduction of occurrence frequency of erysipelas caused by various reasons was showed after treatment. Primary and secondary lymphedema after treatment were compared with those before treatment respectively, showing statistical difference (Z = 3.417 and 5.009, P = 0.001 and 0.000). Most of patients felt better subjectively. The relapse rate of erysipelas and lymphedema was lower if keeping using elastic material to give more pressure on extremities after therapy.

CONLUSIONSHeating and bandage treatment can obviously reduce the occurrence frequency of erysipelas. It can improve the quality of patients' lives. Simultaneously, the subsequent elastic material pressure therapy is essential.

Bandages ; Chronic Disease ; Combined Modality Therapy ; methods ; Erysipelas ; complications ; therapy ; Extremities ; Female ; Humans ; Hyperthermia, Induced ; methods ; Lymphedema ; complications ; therapy ; Middle Aged ; Pressure ; Recurrence ; Retrospective Studies ; Time Factors

OBJECTIVETo analyze the postoperative complications in patients with endometrial carcinoma undergoing surgical operation in different modes and to explore the surgical safety of retroperitoneal lymph node dissection.

METHODSTwo hundred and nineteen patients with endometrial cancer treated in our hospital between May 2006 and April 2012 were included in this study. Their clinicopathological data were retrospectively analyzed. Among them, 65 patients received total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH+BSO group), 54 patients received TAH and BSO and pelvic lymph node dissection (PLX group), and 100 patients received TAH and BSO and PLX and para-aortic lymph node dissection (PALX group). The surgical procedures and postoperative complications in different operation modes were analyzed.

RESULTSThe operation time was (114.84 ± 6.45) min in the TAH+BSO group, (182.94 ± 6.62) min in the PLX group, and (188.27 ± 5.77) min in the PALX group. The operation time in the TAH+BSO group was significantly shorter than that in the PLX and PALX group (P < 0.001). The amount of blood loss was (222.97 ± 38.42) ml in the TAH+BSO group, (311.80 ± 21.62) ml in the PLX group, and (391.51 ± 53.20) ml in the PALX group. respectively. The amount of blood loss in the TAH+BSO was significantly less than that in the PLX and PALX group (P = 0.009). Lymphedema of the lower extremities was the most frequent complication of retroperitoneal lymph node dissection and the incidence rate was 31.8%. Lymphocyst was the second frequent complication, with an incidence rate of 27.3%. The incidence rate of ileus in the PALX group was significantly higher than that in the PLX group (P = 0.001). There were no significant differences in the incidence rate of lymphedema, lymphocyst and deep vein thrombosis between the PALX and PLX groups (P > 0.05).

CONCLUSIONSRetroperitoneal lymph node dissection is an acceptable operation mode, although slightly increasing the incidence of ileus, compared with the TAH+BSO group. It is needed to choose appropriate indication in order to decrease the post-operative complications.

Adult ; Blood Loss, Surgical ; Carcinoma, Endometrioid ; pathology ; surgery ; Endometrial Neoplasms ; pathology ; surgery ; Extremities ; Female ; Humans ; Hysterectomy ; adverse effects ; methods ; Lymph Node Excision ; adverse effects ; Lymph Nodes ; Lymphatic Metastasis ; Lymphedema ; etiology ; Lymphocele ; etiology ; Middle Aged ; Operative Time ; Ovariectomy ; adverse effects ; methods ; Pelvis ; Postoperative Complications ; epidemiology ; Retrospective Studies

Acupuncture Therapy ; Breast Neoplasms ; complications ; surgery ; Combined Modality Therapy ; Female ; Humans ; Lymphedema ; etiology ; therapy ; Massage ; Middle Aged ; Postoperative Complications ; etiology ; therapy

Acupuncture Therapy ; Adult ; Female ; Foot Diseases ; complications ; microbiology ; Humans ; Lymphedema ; etiology ; therapy ; Mycoses ; complications ; microbiology

PURPOSE: To inform on shoulder pathology and to identify the disabilities and level of quality of life (QOL) associated with shoulder pain in patients with breast cancer-related lymphedema (BCRL). MATERIALS AND METHODS: Using patient history, physical examination, and ultrasound (US), we classified patients with BCRL into the following three groups: no pain with normal ultrasound (US), pain with normal US, and pain with abnormal US. We evaluated shoulder pathology using US, pain intensity using a visual analogue scale (VAS), and functional disability using the Korean version of the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire. For assessment of QOL, we used the Korean version of the brief form of the World Health Organization Quality of Life Assessment Instrument (WHOQOL-BREF). RESULTS: 28.9% of patients had no pain and normal US, 31.6% had pain with normal US, and 39.5% had pain with abnormal US. The US findings for those with pain and abnormal US revealed the following: 53.3% had a supraspinatus tear, 13.3% had biceps tenosynovitis, 13.3% had acromioclavicular arthritis, 13.3% had subdeltoid bursitis, and 53.3% had adhesive capsulitis. Patients with shoulder pain and abnormal US findings had significantly higher mean DASH and pain scores. Pain scores were positively correlated with DASH scores and negatively correlated with QOL. CONCLUSION: We found that BCRL with shoulder pain and evidence of shoulder pathology on US was associated with reduced QOL and increased disability. Proper diagnosis and treatment of shoulder pain are necessary to improve QOL and decrease disability in patients with BCRL.
Adult ; Aged ; Breast Neoplasms/*complications ; Cross-Sectional Studies ; Female ; Humans ; Lymphedema/*complications/ultrasonography ; Middle Aged ; Pilot Projects ; Quality of Life ; Shoulder Pain/*etiology/ultrasonography

PURPOSE: Breast conserving surgery (BCS) has replaced modified radical mastectomy as the standard treatment for early breast cancer. However, even though the original shape of the breast is preserved, the significant scarring after BCS detracts from the natural appearance of the breast. Endoscopy-assisted breast surgery can be performed with small incisions that become inconspicuous after surgery. We report herein on our preliminary clinical experience for the aesthetic and treatment results of endoscopy-assisted BCS (EA-BCS). METHODS: We retrospectively analyzed 22 consecutive patients who underwent EA-BCS between June 2006 and February 2008. The skin incisions were made at the periareolar and axillary sites. We performed a dye- and/or radioisotope-guided sentinel lymph node biopsy (SLNB), and we dissected the axillary lymph nodes (level I and II), and excised tissue under endoscopic assistance. We carried out frozen section biopsies to rule out tumor invasion on the resection margins. The following information was obtained: the clinical and histopathological characteristics, the operative procedures, the surgical outcomes, the cosmetic evaluation, and the patients' satisfaction. RESULTS: The average age of the patients was 52.0 years (range, 32-74 years). The mean tumor size was 2.2 cm (range, 0.7-5.5 cm). All the patients underwent EA-BCS and SLNB. The postoperative complications were as follows: lymphedema in two patients, wound infection in three patients, and a total mastectomy due to positive margins on the final biopsy report in one patient. No locoregional recurrence was observed on the follow-up study (mean, 24.0 months). There were good to excellent aesthetic results for 95% of the evaluated cases. Almost all the patients were satisfied with the outcome of surgery. CONCLUSION: EA-BCS was a feasible and effective procedure for treating patients with breast cancer and it achieved good aesthetic results with reducing the surgical scarring. However, further study with more patients and long-term follow-up is needed.
Biopsy ; Breast ; Breast Neoplasms ; Cicatrix ; Cosmetics ; Endoscopy ; Follow-Up Studies ; Frozen Sections ; Humans ; Lymph Nodes ; Lymphedema ; Mastectomy, Modified Radical ; Mastectomy, Segmental ; Mastectomy, Simple ; Nitriles ; Postoperative Complications ; Pyrethrins ; Recurrence ; Retrospective Studies ; Sentinel Lymph Node Biopsy ; Skin ; Surgical Procedures, Operative ; Wound Infection