Psychologic and social sequelae of secondary lymphedema

Abstract

Objective Human immunodeficiency virus (HIV) infection of the central nervous system (CNS) is frequently associated with intrathecal immunoglobulin synthesis and cerebrospinal fluid (CSF) pleocytosis, but little is known about the B‐cell response in the CSF of these patients. In this study, we investigated the relation between virus load and the frequency and phenotype of B cells in the CSF of HIV‐infected patients. Methods The distribution of T cells, B cells, short‐lived plasmablasts, and long‐lived plasma cells was analyzed by flow cytometry in CSF and peripheral blood of 33 patients with HIV infection compared with 12 patients with noninfectious CNS diseases. HIV RNA copy number in CSF and serum was quantified by kinetic polymerase chain reaction. Results B‐cell and plasmablast levels were increased in the CSF of HIV‐infected patients compared with patients with noninfectious CNS diseases. Whereas CSF B cells were found at similar frequency during early and late stages of HIV infection, plasmablasts were more prevalent in the CSF during early infection. Plasmablasts in the CSF correlated with intrathecal IgG synthesis and even stronger with HIV RNA copy numbers in CSF, in particular, in untreated, early HIV‐infected individuals. Initiation of antiviral treatment in therapy‐naive patients strongly decreased HIV copy numbers and plasmablasts in CSF. Interpretation Our findings demonstrate that HIV infection of the CNS triggers an early profound B‐cell response, with plasmablasts serving as the main virus‐related B‐cell subset in the CSF. Ann Neurol 2007

The Pathways Study: a prospective study of breast cancer survivorship within Kaiser Permanente Northern California

“…The first study (ACS, RSG-06−209−01-LR) will describe the natural history as well as quantify the direct medical costs of lymphedema, a debilitating condition characterized by irregular swelling of the affected arm that can occur among breast cancer survivors following treatment [42]. The second study (U.S. Department of Defense, BC043120) will examine racial disparities in breast cancer adjuvant therapy by identifying barriers to receipt of optimal treatment among women with nonmetastatic breast cancer; identifying racial differences in the distribution of these barriers; and modeling the effects of these barriers on racial disparities in survival.…”

Breast cancer-related lymphoedema risk reduction advice: A challenge for health professionals

“…4 It is associated with significant functional, psychological and social morbidity and adversely impacts on individuals' quality of life. [5][6][7][8][9][10][11][12] Incidence and prevalence…”

Physical activity, long-term symptoms, and physical health-related quality of life among breast cancer survivors: A prospective analysis

“…These physical symptoms can inhibit psychosocial adaptation, disrupt the ability to perform normal life roles, and decrease health-related quality of life (HRQOL) for years after the conclusion of primary treatment (10,12,13). Persistent physical symptoms can also serve as a continuous reminder of cancer and result in significant psychological morbidity including anxiety, depression, problematic levels of fear of recurrence (13)(14)(15), and symptoms of posttraumatic stress disorder as much as 20 years after treatment (11).…”

“…Persistent physical symptoms can also serve as a continuous reminder of cancer and result in significant psychological morbidity including anxiety, depression, problematic levels of fear of recurrence (13)(14)(15), and symptoms of posttraumatic stress disorder as much as 20 years after treatment (11).…”