Page 40 - VOL 26 N. 72 - 2015

THORACIC DUCT AND CHYLOUS DISORDERS
THE KEY ROLE OF THE ANATOMY ON THE CLINICAL AND SURGICAL TREATMENT
AMOREMIGUEL1,2,GRANJASANTIAGO1,BERNARDEZ RICARDO1,ENRIQUEZROMINA1,DEFAZIOBELEN1
1 Normal Anatomy Department, Buenos Aires University, Argentine
2 Phlebology and Lymphology Department, Central Military Hospital Buenos Aires, Argentine
Objectives: To carry out a detailed anatomical description of origin, pathway and termination of the thoracic duct, remarking the importance on the pathophysiology of the chylous disorders, translating these findings into the clinical and surgical treatment.
Methods: In this study, 20 cadavers (n=20) were injected. 8 adults and 12 fetuses.
The injection had been performed by a infusión pump directly on the thoracic duct at the inter azigoaortic recess, with a special solution developed by our group at the Buenos Aires University. Dissection had been carried out after appropriate fixation of the specimens in 40% formaldehyde for 10 days, and then immersed in a 100-volume hydrogen peroxide solution for 24 hours. At the end of the anatomical research we evaluated by a retrospective study the clinical presentation and the surgical treatment of 10 patients with chylous disorders at the Central Military Hospital.
Results: We evaluated the thoracic duct with special emphasis on the anatomical variations of the origin, the presence of the cisterna chily, gastrointestinal trunk and others. The high incidense of the plexus formation at different levels and duplication. We extrapolated these concepts to the varied clinical presentation and the surgical treatment.
TWO YEAR FOLLOW-UP OF BREAST EDEMA AFTER BREAST CONSERVING SURGERY AND RADIOTHERAPY
JOHANSSON K. 1, HAJI SEYED EBRAHIM DARKEH M. 2, LA THINEN T. 3, BJÖRK-ERIKSSON T. 4, AXELSSON R. 2
1 Institution of Health Sciences, Lund University, Lund, Sweden
2 Department of Clinical Science, Intervention and Technology, KI, Stockholm, Sweden 3 Cancer Center, Kuopio University Hospital, Kuopio, Finland
4 Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
Introduction: Measurement of local tissue water with tissue dielectric constant (TDC) can improve detection of early edema in patients after breast cancer treatment. The purpose of the present study was to examine development of breast edema and subjective sensations during a 2-year follow-up in breast cancer patients treated with breast conserving surgery and radiotherapy (RT).
Materials and Method: From previous data including 200 breast cancer treated patients (surgery+ RT) it could be identified 65 patients that in common participated in all 10 measurement time-points (before start of RT, three time-points during RT, 2 and 4 weeks after RT and then 3, 6, 12 and 24 months after RT). Definition of breast edema was determined as a TDC ratio≥1.40 between the treated and healthy breast. The experiences of tension, heaviness and pain of the affected breast were each determined on a 100 mm horizontal visual analogue scale (VAS) by the patients. The endpoints were “no discomfort” (0 mm) and “worst imaginable” (100 mm). Each patient was asked to score her subjective sensations at each time-point. Data were analyzed by SPSS using descriptive statistics, Friedman ANOVA test, chi-square test and Wilcoxon matched pairs test.
Results: The mean TDC ratios at the end of the third week of radiotherapy and at 3 and 6 months post-RT were all critical (i.e. over 1.40). Significant differences were found between the mean TDC ratios before the start of RT and the other time-points (p-values between 10-6 and 0.02), and between three/six months post-RT and the other time-points (p-values between 10-6 and 0.001), and between two year post-RT and the other measurement-times (p-values between 0.01 and 0.02). The largest proportions of patients with critical TDC ratios were found at three and six month post-RT (63%) and the smallest proportions at two years post-RT (28%). On the subject edema in the breast or in the arm/axilla in patients with axillary dissection or sentinel node biopsy, no statistically significant differences were found between the groups at any of the 10 different measurement time-points. The ANOVA test showed significant differences between measurement occasions regarding the mean tension, heaviness and pain VAS scores (p <0.01 in each of VAS scores).
Conclusions: Cancer treatment related edema in the breast is very frequent at three to six months after radiation treatment but decreases at one to two years. The subjective sensations of tension, heaviness and pain are each the highest at the third week of the radiotherapy and the lowest two years after the treatment.
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXVI - Nr. 72 - 2015
37