Letters to the Editor
Identifieur interne : 001839 ( Istex/Corpus ); précédent : 001838; suivant : 001840Letters to the Editor
Auteurs : Leigh C. Ward ; J. J. Guex ; M. PerrinSource :
- Vascular Diseases [ 0003-3197 ] ; 2000-07.
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DOI: 10.1177/000331970005100712
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Perrin</name><affiliation><mods:affiliation>26, Chemin de Decines F-69680 Chassieu France</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:80D5FA79C124075902DF5C2208687FCE01BFE197</idno><date when="2000" year="2000">2000</date><idno type="doi">10.1177/000331970005100712</idno><idno type="url">https://api.istex.fr/document/80D5FA79C124075902DF5C2208687FCE01BFE197/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">001839</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">001839</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Letters to the Editor</title><author wicri:is="90%"><name sortKey="Ward, Leigh C" sort="Ward, Leigh C" uniqKey="Ward L" first="Leigh C." last="Ward">Leigh C. 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<contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Ward</surname><given-names>Leigh C.</given-names></name><degrees>PhD</degrees><aff>University of Queensland Brisbane Qld 4072 Australia</aff></contrib></contrib-group>
<contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Guex</surname><given-names>J.J.</given-names></name><degrees>MD</degrees><aff>26, Chemin de Decines F-69680 Chassieu France</aff></contrib></contrib-group>
<contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Perrin</surname><given-names>M.</given-names></name><degrees>MD</degrees><aff>26, Chemin de Decines F-69680 Chassieu France</aff></contrib></contrib-group>
<pub-date pub-type="ppub"><month>07</month><year>2000</year></pub-date><volume>51</volume><issue>7</issue><fpage>615</fpage><lpage>616</lpage><custom-meta-wrap><custom-meta xlink:type="simple"><meta-name>sagemeta-type</meta-name><meta-value>Letter</meta-value></custom-meta><custom-meta xlink:type="simple"><meta-name>search-text</meta-name><meta-value>615 Letters to the Editor SAGE Publications, Inc.2000DOI: 10.1177/000331970005100712 Leigh C. Ward PhD University of Queensland Brisbane Qld 4072 Australia J.J. Guex MD 26, Chemin de Decines F-69680 Chassieu France M. Perrin MD 26, Chemin de Decines F-69680 Chassieu France Regarding "Edema and Leg Volume: Methods of Assessment" To the Editor: I noted with interest the article by Drs Perrin and Guex, entitled "Edema and leg volume: Methods of assessment," published in Angiology 51:9-12, 2000. This was a timely and comprehensive review of the various methods in clinical use for the assessment of peripheral edema, notably in the leg. I would like to take this opportunity to alert readers to a further technique useful for this purpose, namely, bioelectrical impedance analysis. An early reportl described its use for the measurement of edema in the leg, but other than its successful use for the assessment of edema in the arm following masteCtoMy,2,1 the potential of the method remains to be fully realized. This is unfortunate since the method directly and quantifi- ably measures edema. Bioelectrical impedance analysis is a technique for the assessment of body composition based on measurement of the electrical properties of the human body. The principle of the method is simple. The impedance (or opposition) of the body to the flow of an electric current is dependent on the amount of conductive material, principally the water and dissolved electrolytes, present. Thus a change in impedance reflects a change in the water content of the body. The tis- sues and organs of the body are composed of cells surrounded by a cell membrane. This membrane separates the fluid inside cells (the intracellular fluid, ICF) from that surrounding the cells and in the blood (collectively termed the extracellular fluid, ECF). An alternating electric current has two possible pathways through a biological tissue ; at low frequencies it will pass only through the extracellular fluid since the capacitance of the cell membrane acts as a barrier to penetration by the current, whereas at high frequencies the current may cross the cell membrane and take a path through both the ICF and ECF, ie, the total fluid volume. Under these circumstances, impedance measured at a low frequency is determined by the volume of ECF while that measured at a high frequency is determined by the total fluid volume. Since edema is primarily accumulation of ECF, measurements of impedance at low frequency allow assessment of the extent of ECF accumulation or edema. In practice the method is simple, noninvasive, and inexpensive to perform, and the necessary impedance analyzers are commercially available. The subject lies supine on a nonelectrically conductive surface. Two pairs of skin electrodes are placed at the extremities of the body segment to be measured. The outer pair of electrodes drive a low-level current (approximately 200 fLA) into the tissues, and the inner pair of electrodes measure the impedance of the tissues to the current flow. The analyzer records the measured impedances for frequencies, typically in the range 5 to 1,000 kHz. Computer software then analyzes these data to provide the best estimates of impedances reflecting the ECF and total fluid contents of the volume of tissue defined by the innermost pair of electrodes. Measurements take about a minute with a further minute for data processing. In our research in patients with lymphedema, the technique has proved reliable and more sensitive than the anthropometric and displacement volumetric techniques described by Perrin and Guex.4 Indeed, the high sensitivity of the method has provided a diagnostic tool for the onset of postmastectomy lymphedema.5 There is every expectation that similar results would be realized if the method were applied to the assessment of leg The Editors invite readers to submit letters commenting on the contents of articles that appear in the Journal. Also welcome are brief communications in letter form reporting investigative or clinical observations without extensive documentation and with brief bibliography (five titles or less), not requiring peer review but open to critique by readers. Letters to the Editors should be no more than 500 words in length and they may have to be edited for publication. ©2000 Westminster Publications, Inc., 708 Glen Cove Avenue, Glen Head, NY 11545, U.S.A. 94616 edema. This could fill the need for a precise and objective measure of chronic venous insufficiency- associated edema, and to quote Perrin and Guex,4 "might be the future investigation of choice." Sincerely, References Kanai H., Haeno M., Sakamoto K.: Electrical measurement of fluid distribution in legs and arms. Medical Progress Through Technology 12:159-170, 1987. Ward LC, Bunce IH, Cornish BH, et al: Multi-frequency bioelectrical impedance augments the diagnosis and management of lymphoedema in post-mastectomy patients. Eur J Clin Invest 22:751-754, 1992. Cornish BH, Chapman M., Thomas BJ, et al: Early diagnosis of lymphoedema in postsurgery breast cancer patients. Proc 5th Int Symp in Vivo Body Comp Studies . Brookhaven National Laboratory, NY, Oct 7-10, 1999; Ann NY Acad Sci (in press). Perrin M., Guex JJ: Edema and leg volume: Methods of assessment. Angiology 51:9-12, 2000. Cornish BH, Mirolo B., Bunce IH, et al: Sweep frequency bioelectrical impedance analysis for the diagnosis of lymphoedema. Breast Cancer Res Treat 38:169-176, 1995. In Response Reply to Dr Ward . To the Editor: Dr Ward's kind comments emphasize the general interest for the evaluation of leg edema. Such techniques as impedancemetry are very promising indeed and have already been validated with the upper limb in lymphedema. However, they need to be validated with the lower limb since the many differences in anatomy and patho- physiology do not ensure an immediate applicability of the method to the legs. The cost and availability of tools will also favor the use of measuring tapes and water displacement method until the availability of cheap impedancemeters suitable for clinical use. Vascular Surgery</meta-value></custom-meta></custom-meta-wrap></article-meta></front><back><ref-list>
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