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Abstract Background Arm and shoulder problems (ASP), including lymphedema, were common among women with breast cancer in high-income countries before sentinel lymph node biopsy became the standard of care. Although ASP impair quality of life, as they affect daily life activities, their frequency and determinants in Sub-Saharan Africa remain unclear. Methods All women newly diagnosed with breast cancer at the Namibian, Ugandan, Nigerian, and Zambian sites of the African Breast Cancer-Disparities in Outcomes (ABC-DO) cohort study were included. At each 3-month follow-up interview, women answered the EORTC-QLQ-Br23 questionnaire, including three ASP items: shoulder/arm pain, arm stiffness, and arm/hand swelling. We estimated the cumulative incidence of first self-reported ASP, overall and stratified by study and treatment status, with deaths treated as competing events. To identify determinants of ASP, we estimated cause-specific hazard ratios using Cox models stratified by study site. Results Among 1476 women, up to 4 years after diagnosis, 43% (95% CI 40–46), 36% (33–38) and 23% (20–25), respectively, self-reported having experienced arm/shoulder pain, stiffness and arm/hand swelling at least once. Although risks of self-reported ASP differed between sites, a more advanced breast cancer stage at diagnosis, having a lower socioeconomic position and receiving treatment increased the risk of reporting an ASP. Conclusion ASP are very common in breast cancer survivors in Sub-Saharan Africa. They are influenced by different factors than those observed in high-income countries. There is a need to raise awareness and improve management of ASP within the African setting.

Background: Arm and shoulder problems (ASP), including lymphedema, were common among women with breast cancer in high-income countries before sentinel lymph node biopsy became the standard of care. Although ASP impair quality of life, as they affect daily life activities, their frequency and determinants in Sub-Saharan Africa remain unclear.Methods: All women newly diagnosed with breast cancer at the Namibian, Ugandan, Nigerian, and Zambian sites of the African Breast Cancer-Disparities in Outcomes (ABC-DO) cohort study were included. At each 3-month follow-up interview, women answered the EORTC-QLQ-Br23 questionnaire, including three ASP items: shoulder/arm pain, arm stiffness, and arm/hand swelling. We estimated the cumulative incidence of first self-reported ASP, overall and stratified by study and treatment status, with deaths treated as competing events. To identify determinants of ASP, we estimated cause-specific hazard ratios using Cox models stratified by study site.Results: Among 1476 women, up to 4 years after diagnosis, 43% (95% CI 40-46), 36% (33-38) and 23% (20-25), respectively, self-reported having experienced arm/shoulder pain, stiffness and arm/hand swelling at least once. Although risks of self-reported ASP differed between sites, a more advanced breast cancer stage at diagnosis, having a lower socioeconomic position and receiving treatment increased the risk of reporting an ASP.Conclusion: ASP are very common in breast cancer survivors in Sub-Saharan Africa. They are influenced by different factors than those observed in high-income countries. There is a need to raise awareness and improve management of ASP within the African setting. [ABSTRACT FROM AUTHOR]

Aim: To report results of patients followed in physical medicine and rehabilitation (PMR) in CNHUHKM of Cotonou. Patients and methods: Retrospective, transversal study, aimed to be descriptive and analytical type. Were enrolled, 39 files of patients treated in PMR / CNHU-HKM, from 1st January 2014 to 31st December 2018, for unilateral lymphedema, who had done beginning and ending evaluations. Were excluded, venous, systemic or lipid edema. The severity and the result of the sessions were assessed taking into account the reports of perimeters of the member segments. Factors associated with the result were sought, by the Mann-Whitney test. Results: The localization of lymphedema was in thoracic and pelvic limbs, respectively in 64.1 and 35.9%. Were associated with the oedema functional difficulties (61.54%), muscle paresis (33.33%) and joint stiffness (30.77%). Patients benefited from 5 to 20 physiotherapy sessions. Has been associated with physiotherapy, the use of compression stockings (58.97%). The results have been satisfactory, mainly influenced by the development time. Conclusion: Satisfactory results in the physiotherapy management of lymphedema have been noted in our context, especially in patients seen early. [ABSTRACT FROM AUTHOR]

Background Prior to carrying out clinical trials, it is important to assess the health status of the study participants to be able to interpret subsequent changes that may be related to the effects of the treatments during the follow-up of patients. This study presents the clinical, haematological and biochemical profiles of podoconiosis patients prior to their involvement in the PodoLEDoxy clinical trial. Methods All lower limb lymphoedema patients visiting the centre were screened and a podoconiosis diagnosis was based on clinical manifestation and detailed medical history. Patients who satisfied the eligibility criteria were enrolled in the study and their demographic data, vital signs and medical history were collected followed by biochemical and haematological examinations. Results Of the 222 participants enrolled in the study, 55.4% and 41.4% had either stage 3 or 2 podoconiosis as their highest stages, respectively. On physical examination, gastritis (46%) and poor vision (2.7%) were the most prevalent health issues identified. The majority of haematological and biochemical values were within the normal range except for mean platelet volume (47.7%), plateletcrit (58.1%), platelet distribution width (66.2%), mean corpuscular volume (67.6%) and red cell distribution width-standard deviation (79.3%), where >40% of the study participants had values out of the normal. Conclusion The clinical, haematological and biochemical profiles of the study participants were largely within the normal range except for certain haematological parameters that might be worth investigating. [ABSTRACT FROM AUTHOR]

Lymphoedema can be classified into primary and secondary. Primary lymphoedema arise in patients where the cause is not known. Secondary lymphoedema are those in which the lymph system has been damaged by some well recognised pathological process, such as extensive malignancy, filariasis, radiation etc. The changes may occur either in the lymph node, or in lymph vessels or both. The clinical evolution and the prognosis of the oedema in the limb involved will depend on the extension and evolution of these lesions. The degree of fibrosis and its distribution in lymph node play an important role on the prognosis, clinical course and treatment of the patient. Hence pathologist should be aware of the microscopic distribution and patterns of lymph node fibrosis in primary lymphoedema. We hereby report two cases- a 50-year-old male diabetic patient and a 35-year-old male patient presenting with varicose veins, lymphoedema showing lymph node fibrosis.

Frequently misdiagnosed as obesity, lipoedema is chronic condition involving an abnormal build-up of fat cells in the legs, thighs and buttocks that cannot be shifted by exercise or dieting. Estimated to affect up to 11% of the female population, the condition is widely unknown by health professionals. This means women typically wait for many years before diagnosis. This allows the condition to progress unchecked, resulting in unnecessary deterioration and the development of associated comorbidities, as well as significant pain and mental anguish. A free, 30-minute Royal College of General Practitioners (RCGP) e-learning course created in partnership with Lipoedema UK aims to rectify this situation by educating nurses, GPs and other health professionals on how to diagnose and manage lipoedema in primary care. This article aims to describe the condition of lipoedema, how to recognise/diagnose it, current treatment options and the findings of a 240-patient survey carried out by Lipoedema UK in 2013 that included documenting the difficulties for patients in obtaining a diagnosis as well as the mental and physical effects of the condition. [ABSTRACT FROM AUTHOR]

Introduction: Lymphatic complication (LC) after varicose veins (VVs) surgery is an annoying event with a variable frequency in the literature. Method: Retrospective study reviewing all surgeries carried out for VVs from January 2000 to October 2010. Postoperative LC we reported: lymphatic fistula, lymphocele including the minor ones and lymphoedema. Results: During the period studied, 5407 surgical procedures for VVs were performed in 3407 patients (74.7% women) with a mean age of 53.4 years. A postoperative LC occurred in 118 cases (2.2%): lymphocele on limb in 1.3%, inguinal LC (fistula or lymphocele) in 0.7% and a lymphoedema in 0.2%. The population with a LC was older (59.6 vs. 53.3 years, P < 0.05), had a higher frequency of C4-C6 (22.0% vs. 6.5%, P < 0.05), a higher incidence of obesity (31.4% vs. 5.4%, P < 0.05) and was more often treated by a redo surgery or a crossectomy stripping (48.3% vs. 13.4% and 38.1% vs. 21.8%, respectively, P, 0.05). We have observed a dramatic decrease in incidence of LC after January 2004 (1.3% vs. 5.3%, P, 0.05) corresponding to a new surgical practice for the treatment of VVs: stripping, crossectomy and redo surgery at the groin were less frequent (74.6% vs. 7.7%, 74.6% vs. 0.2% and 11.3% vs. 0.1%, respectively, P < 0.05), while isolated phlebectomy was more often performed during this period (78.4% vs. 8.4%, P < 0.05). Conclusion: LC after VVs surgery is not rare but frequently limited to lymphocele on limbs. Older age, more advanced clinical stage and obesity were associated with a higher frequency of LC. A mini-invasive and selective surgery has significantly reduced the occurrence of LC. [ABSTRACT FROM AUTHOR]

This article aims for greater understanding at pre and post-graduate level training of the clinical and economic benefits of using appropriate quality compression hosiery. In particular it focuses on differences between the various types of stockings, their clinical indications and the expected results. This conservative, non-invasive therapy can be managed independently by most patients with vascular or lymphatic problems to improve their quality of life when their functional abilities are assessed and application aids are used appropriately. [ABSTRACT FROM AUTHOR]

Aim: To report results of patients followed in physical medicine and rehabilitation (PMR) in CNHU-HKM of Cotonou., Patients and Methods: Retrospective, transversal study, aimed to be descriptive and analytical type. Were enrolled, 39 files of patients treated in PMR / CNHU-HKM, from 1 st January 2014 to 31 st December 2018, for unilateral lymphedema, who had done beginning and ending evaluations. Were excluded, venous, systemic or lipid edema. The severity and the result of the sessions were assessed taking into account the reports of perimeters of the member segments. Factors associated with the result were sought, by the Mann-Whitney test., Results: The localization of lymphedema was in thoracic and pelvic limbs, respectively in 64.1 and 35.9%. Were associated with the oedema functional difficulties (61.54%), muscle paresis (33.33%) and joint stiffness (30.77%). Patients benefited from 5 to 20 physiotherapy sessions. Has been associated with physiotherapy, the use of compression stockings (58.97%). The results have been satisfactory, mainly influenced by the development time., Conclusion: Satisfactory results in the physiotherapy management of lymphedema have been noted in our context, especially in patients seen early., (Le comité de rédaction se réserve le droit de renvoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de conserver un exemplaire du manuscrit, des figures et des tableaux.)

Lymphoedema can be classified into primary and secondary. Primary lymphoedema arise in patients where the cause is not known. Secondary lymphoedema are those in which the lymph system has been damaged by some well recognised pathological process, such as extensive malignancy, filariasis, radiation etc. The changes may occur either in the lymph node, or in lymph vessels or both. The clinical evolution and the prognosis of the oedema in the limb involved will depend on the extension and evolution of these lesions. The degree of fibrosis and its distribution in lymph node play an important role on the prognosis, clinical course and treatment of the patient. Hence pathologist should be aware of the microscopic distribution and patterns of lymph node fibrosis in primary lymphoedema. We hereby report two cases- a 50-year-old male diabetic patient and a 35-year-old male patient presenting with varicose veins, lymphoedema showing lymph node fibrosis. [ABSTRACT FROM AUTHOR]

Retroperitoneal fibrosis is characterised by diffuse inflammatory proliferation of fibroblasts and the deposition of collagen fibrils throughout the retroperitoneum, especially in perivascular sites. This results in blockage of the ureters and other tubular retroperitoneal structures such as the vasculature and lymphatic channels. Left untreated, it typically follows a progressive and fatal course. The condition responds favourably to tamoxifen and several case reports describe an improvement in renal function on this therapy. This case report describes a subjective and objective functional improvement of lymphoedema secondary to retroperitoneal fibrosis with the use of tamoxifen. [ABSTRACT FROM AUTHOR]