Showing papers by "Stanley G. Rockson published in 2005"

Treprostinil for the treatment of severe digital necrosis in systemic sclerosis

Abstract: We report a case of severe digital ulcerations associated with systemic sclerosis, successfully treated with treprostinil (Remodulin®). There was improve- ment within days of the treatment initiation; complete healing was accomplished after 16 weeks of therapy. Patients with systemic sclerosis and peripheral small ves- sel disease have limited therapeutic options. Treprostinil is a prostacyclin analogue that can be delivered by subcutaneous infusion and is approved in the USA only for treatment of primary pulmonary hypertension. This report provides an impressive example of an alternative, complementary indication for the use of treprostinil.

Solving the puzzle of breast cancer-associated lymphedema: the role of imaging.

Abstract: 1 Lymphatic Research and Biology has, as its stated mission, the dissemination of data and ideas relevant to the lymphatic system. In this light, it should be implicit that the long-term goal of many of these research endeavors is to identify, treat, and eradicate human diseases of this vital organ system. Thus, in the current issue of the journal, two original publications are devoted, directly1 and indirectly2 to the problem of breast cancer-related lymphedema. There is no clinical problem more central to the lymphatic clinician than this one, at least in the developed parts of the world. The most commonly encountered form of lymphatic circulatory insufficiency in the Western world,3 the condition is a source of morbidity and psychosocial dysfunction for a significant proportion of breast cancer survivors. Nevertheless, despite its prevalence and its identity as a subject of rather intense clinical scrutiny, several compelling unanswered questions remain.4 Among these, one can ponder the unexplained latency phase between surgical trauma and the appearance of the lymphedema in the preponderance of identified cases; the predisposing factors to the overt appearance of arm swelling;5 and, of great importance, why at least 75% of the population at theoretical risk is spared from lymphatic complications. As we await results of basic preclinical investigative scrutiny of the biology of lymph stagnation, much can be learned in a clinical context from functional radionuclide imaging of the lymphatic circulation.6 In this issue of the journal, using the approach of investigative clinical imaging, Modi et al.1 address one of the unsolved apparent mysteries of breast cancer lymphedema, namely, the phenomenon of ‘sparing’, the phenomenon that protects portions of the edematous arm (i.e., the hand) from swelling.4 Through an assessment of variability in the lymph drainage rate constant in the epifascial compartment, the authors elegantly demonstrate that epifascial lymphatic function is less closely coupled to the phenomenon of edema than is the lymphatic function in the subfascial compartment. To be maximally effective as a clinical and research modality, radionuclide imaging of lymphatic function (lymphoscintigraphy) should ideally possess a standardized approach to the assessment of individual patients. This would facilitate intercomparison among individuals, over time, and among individual studies. In this issue, Lane et al.2 present the data related to such an effort. They specifically address the impact of standardized muscular effort of the upper extremity in the dynamic assessment of lymphatic function through imaging. Their results suggest that the mode of exertion, more than its duration, has an influence on the rates of radionuclide clearance from the limb through lymphatic flow. While these studies were performed in normal, healthy females, the findings of Lane et al. should prove extremely useful in future investigative efforts designed to facilitate risk stratification and to elucidate the functional impairments in breast cancer-associated lymphedema.