MOH Summary

Breast cancer treatment is the leading cause of secondary lymphedema, an accumulation of high or low protein fluid in consequence of lymphatic dysfunction. The underlying pathophysiology includes lymph drainage failure and hemodynamic imbalance. Both, arterial and venous components can be affected in arms with lymphedema. In her engaging presentation within the MOH Talk “Navigating the challenges of lymphedema in cancer care: expert insights” on October 28, 2023, Dr Linda T. Miller discussed new evidence on breast cancer lymphedema and clinical applications for its management.

Arm swelling is common following axillary lymph node dissection. Once established, reversing this condition is a challenge. Hence it is important to prevent arm swelling in order to avoid chronic lymphedema and associated tissue changes, which lead to poor quality of life. Within the MOH Talk “Navigating the challenges of lymphedema in cancer care: expert insights” on October 28, 2023, Dr Vincent Singh Paramanandam discussed two approaches to avoid arm swelling.

Prof. Whiteley's lecture focused on increasing interest in Pelvic Congestion Syndrome (PCS) in males and how PCS was previously assumed to only impact fertile women who have had children, but this has been disproven by their unit's research.

Dr. Tobias Hirsch from Germany provided an overview of PCS, how to diagnose and treat it, and what the current guidelines are in that field.

Breast-cancer related lymphoedema is a serious and concerning condition that can occur after breast cancer surgery, lymph node excision, or radiation therapy. Awareness and care of this condition is still being neglected by healthcare professionals. In her engaging talk within the current global medical online hub (MOH) webinar “Cancer-related lymphoedema - prophylaxis and management” on October 22, 2022, Prof Pinar Borman discussed the importance of preventing lymphoedema in breast cancer patients.

Lipoedema is a challenging problem as detailed knowledge is limited. Even today, only a small fraction of practitioners acknowledge the disorder. In his engaging talk within the current global medical online hub (MOH) webinar “Latest insights in the lipoedema pathophysiology and potential new therapeutic pathways” on August 27, 2022, Dr Stanley Rockson unravels the clinical problem of lipoedema and presented perspectives on how to move forward.

Women undergoing axillary lymph node dissection as part of their breast cancer surgery are at high risk for lymphoedema. Since arm swelling in the first postoperative year is a predictive factor of lymphoedema, these women may benefit from the prophylactic use of compression sleeves in combination with standard care. Within this global medical online hub (MOH) webinar “Cancer-related lymphoedema – prophylaxis and management” on October 22, 2022, Dr Vincent Paramanandam presented results from a clinical trial that investigated the prophylactic use of compression sleeves to reduce the incidence of lymphoedema.

Lipoedema is a chronic disease of high unmet need. Challenges include lack of diagnostic tools and animal models, ignorance and prejudice, as well as getting international consensus due to limited research in this field. Drs Ramin Shayan and Tara Karnezis present their cutting-edge research on this topic within the current global medical online hub (MOH) webinar “Latest insights in the lipoedema pathophysiology and potential new therapeutic pathways” on August 27, 2022.

During pregnancy the body undergoes various changes which may impair quality of life. There is some evidence demonstrating that compression therapy is a safe and simple way to treat pregnancy-related physical complaints. Dr Erika Mendoza, resident phlebologist in Germany and general secretary of the German Society of Phlebology, shares her evidence-based opinion on compression therapy during pregnancy within the MOH Talk “CVI, DVT and nausea in pregnancy: What to expect and how to deal with it?” on June 4, 2022.

Chronic venous insufficiency (CVI) is one of the consequences of pregnancy-related haemodynamic and physical changes, which can be treated in a safe and simple way by compression therapy. At the current global medical online hub (MOH) webinar “CVI, DVT and nausea in pregnancy: What to expect and how to deal with it?” on June 4, 2022, Prof Dr Caitlin W. Hicks, Associate Professor of surgery at The Johns Hopkins University School of Medicine in the US, provided detailed insights on the mechanisms leading to venous insufficiency and how compression therapy may help.

Prof. Tobias Bertsch began his presentation by stating that many physicians have a misconception regarding the difference between lipedema and lymphedema, which necessitates a clinical paradigm shift for adequate patient management.

Lipedema (or the "pole leg" disease) is a rare and painful disorder of adipose tissue. It mainly affects females and is generally misdiagnosed as lymphedema or obesity.

Lipoedema is an abnormal build-up of fat in the legs and sometimes arms. Susan Butcher highlighted several cases where the correct garment use helped lipoedema patients in treating the symptoms.

Lymphatic pathologies in primary lymphedema: The clinical symptoms are diverse and can happen in the arm, leg, or face. The pathogenesis is complicated, underlying the following symptoms, it can happen in the lymphatic vessels or the lymph nodes. It can also be an anatomical problem or a functional problem.

Dr. Corrado Cesara Campisi, a lymphatic surgeon from Italy, talks about his protocol for lymphedema treatment. The idea is that this will help improve lymph flow, reduce swelling, and improve mobility. There is much confusion regarding the indication for surgery, and there are many options, such as ICG green lymphography and lymphangial magnetic resonance.

Compression wraps are low stretch bandages made from soft, inelastic materials wrapped tightly around the lower forearm or lower leg. They are wrapped then secured with a band or hook for fastening. Their elasticity means one can choose the appropriate compression level needed, reducing swelling while increasing circulation around a given spot.

Compression therapy is the use of compression socks, stockings, boots, or bandages to apply gentle pressure to the legs. Doctors prescribed compression therapy for thousands of years. Modern science continues to discover new benefits of compression therapy. Dr. Christopher started by introducing compression classification and its importance as he discussed tension devices, and not pure pressure devices because we believe the tension is the root of most of the complications and the law of Laplace; they can be divided into two elastic compression devices, which have sustained pressure and a rise in tissue pressure, and inelastic compression, which have rapid elevations in tissue pressure.

Dr. Tomasz Urbanek starts the speech by the general recommendation: "We recommend that every patient receiving compression therapy should be screened for conditions that increase the risk of complications and every compression device should be checked for appropriate fit and application."

Dr. Eberhard Rabe started his presentation with studies showing improvement in using medical compression stockings. He said that 51 new pieces of evidence recommend using these stockings for various diseases. In this presentation, the objectives are to provide update of the recommendations in the 2008 consensus statement, fill gaps identified in the earlier consensus statement and provide graded recommendations for the clinical goal of treatment using medical compression stockings (MCS).

Dr Tobias Hirsch presented topics about oedema drainage and cardiac insufficiency as well borderline indications.

Prof. Joseph Caprini, Emeritus at the NorthShore University Health System in Evanston, Illinois and a senior clinician-educator at the University of Chicago Pritzker School of Medicine, believes that individual risk assessment of thrombosis in Covid-19 patients is a fundamental part of analyzing the pandemic! As the number and power of risk factors increase in the Caprini Score, the incidence of thrombosis increases, resulting in a score that has been validated in 5 million patients. There is a non-linear increase in clinical venous thromboembolism incidence as the score increases! But capturing the 40 elements in the Caprini Score is a time-consuming process! However, it can be facilitated by having the patient complete a preliminary form in advance of elective surgery with the help of family members. That is why physicians should review the initial documents filled by the patients and their families. However, is there really a connection between Thrombosis and Covid-19?

Prof. Jinsong Wang started the taking with the Covid 19 started in December 2019 broke out worldwide and how the frontline medical staff is at high risk for occupational exposure and infection also preventing nosocomial infections is a particularly important and challenging task during the pandemic.

Venous thromboembolism (VTE) prophylaxis consists of pharmacologic and nonpharmacologic measures to diminish the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE). Dr. Kirill Lobastov started his talk by the incidence of venous thromboembolism in patients with covid infection. It was found in 11 studies with more than 1500 thousand participants. In most of these studies, patients used low molecular heparins in prophylactic intermediate therapeutic toes. It was about 13 percent, and pulmonary embolism was about eight. In the intensive care unit, it was high that pulmonary embolism occurred in about 18 percent of all patients.