RESUMO
Lymphedema is a specific type of edema stemming from a failure in the formation or drainage of lymph. This condition can be congenital or acquired. The clinical treatment of genital lymphedema involves compression mechanisms of the penis. In acquired cases, the individual is born with the lymphatic system intact, but this system is damaged at some point in life, which can lead to lymphatic insufficiency and the development of edema. The non-elastic material for the penis is grosgrain that enable the adjustment to the proper pressure. This report describes a case series of penile lymphedema treated with compression mechanism. Thirteen consecutive patients with penoscrotal lymphedema aged 22 to 56 years (mean: 42.3 years) were treated. Inclusion criteria were patients with primary and secondary penoscrotal lymphedema. Volume larger than three times the normal size of the scrotum was excluded. Reductions in edema occurred in the penis in all patients. Such reductions varied in accordance with the adherence of the patients to the use and duration of compression. The patients used the compression device at times that best fit their schedules. An interesting aspect was the fact that the patients reported the possibility of leaving the penis the size they wished-neither very small nor very large-for sexual activity. All were able to control the size of the edema within the standards they considered acceptable.
RESUMO
Genital lymphedema in men can affect the penis and/or scrotum, causing deformity and causing sexual limitations, social isolation, poor quality of life and recurrent subcutaneous infections due to difficulties in hygiene. There are few studies in the literature emphasizing the treatment of penile fibrosis after penoscrotal lymphedema. The purpose of this report is to describe a case of penile fibrosis treated using a new compression method.
RESUMO
Relata-se o caso de uma paciente de 33 anos de idade que desenvolveu linfedema traumático em membro inferior direito e foi encaminhada pelo serviço de ortopedia em virtude de edema, queixas de formigamento e dor ao pisar. Realizou-se avaliação clínica e linfocintiligrafia que confirmaram a presença do lindedema. A paciente foi submetida à drenagem linfática pela técnica Godoy & Godoy, cinco vezes por semana, uma hora por dia, obtendo-se uma redução clínica do linfedema com melhora do padrão linfocintiligráfico.
The case of a 33-year-old patient, who developed traumatic lymphoedema of the right lower limb and was referred to the orthopedics department owing to the edema and complaints of formication and pain ontreading, is reported. The clinical evaluation and lymphoscintigraphy confirmed the diagnosis of lymphoedema. The patient was submitted to manual lymph drainage using the Godoy & Godoy technique five times weekly for one hour per session. There were improvements in the clinical signs of the lymphoedema and in the lymphoscintigraphic pattern.
Assuntos
Humanos , Feminino , Adulto , Cintilografia/métodos , Drenagem/métodos , Linfedema/terapiaRESUMO
O objetivo do presente estudo foi analisar freqüências alélicas e genotípicas para o gene codificador da cadeia beta do fibrinogênio em pacientes com doença arterial periférica (DAP). Foram estudados 44 pacientes caucasóides do sexo masculino com sintomas clínicos e comprovação angiográfica de DAP, com idade entre 38 e 79 anos (62±8,6 anos). Entre eles, 22 apresentaram obstrução aterosclerótica nas artérias ilíacas, femorais e/ou carótidas e 22 tinham aneurisma de aorta torácica, abdominal ou tóraco-abdominal. O grupo controle foi constituído por 56 indivíduos, sem história clínica de DAP ou alterações ao exame clínico, com idades variando de 43 a 80 anos (59±9,2 anos). Foram excluídos os indivíduos com doença renal, doença hepática ou diabetes mellitus. A análise do polimorfismo genético da cadeia do fibrinogênio foi realizada por PCR (polimerase chain reaction) e RFLP (restriction fragment lenght polimorphism) com a endonuclease Bcl I, identificando-se três genótipos: B1/B1, B1/B2 e B2/B2. A análise estatística incluiu teste exato de Fisher, calculo do odds ratio, teste de Kruskal Wallis e análise de variância (ANOVA). Admitiu-se erro a igual a 5 por cento, com nível de significância para P<0,05. O alelo B1 foi o mais prevalente em pacientes e controles (0,819 e 0,857, respectivamente; P=0,5605), com prevalência do genótipo B1/B1 nos pacientes (65,9 por cento) e controles (71,4 por cento; P=0,6639), seguido de B1/B2 (31,8; 28,6 por cento, respectivamente; P=0,8268). Em conclusão, DAP, independente do tipo de lesão obstrutiva ou aneurismática, apresenta-se indiferente ao polimorfismo Bcl I do fibrinogênio, portanto, sem influência dos alelos B1 e B2 para fibrinogênio e seus respectivos genótipos na doença.
The objective of this study was to analyze the frequencies of thealleles and genotypes of the gene encoder of the fibrinogen bchainin patients suffering from peripheral artery disease. A totalof 62 male Caucasoid patients with ages varying from 38 to 79years old were studied. All the patients had clinical symptoms ofperipheral artery disease, which was later confirmed byangiography. Forty of the patients had atheroscleroticobstructions of the iliac, femoral or carotid arteries and 22 sufferedfrom aneurysms of the thoracic, abdominal or thoracoabdominalaortas. All the patients were submitted to surgery. A controlgroup was formed of 62 individuals, with ages ranging from 43to 80 years old, without clinical histories or alterations in theirclinical examinations of peripheral artery disease. Individualswith renal disease, liver disease or diabetes mellitus wereexcluded. Analysis of the fibrinogen b-chain was performed usingpolymerase chain reaction and restriction fragment lengthpolymorphism with Bcl I endonuclease. Three genotypes, B1/B1,B1/B2 and B2/B2 were identified. Statistical analysis was madeusing the Fisher Exact test, odds ratio, Kruskal-Wallis test andvariance analysis (ANOVA). A p-value = 0.05 was consideredsignificant. The B1 allele was the most prevalent in both patientsand the control group (0.819 and 0.857, respectively), withprevalence of the B1/B1 genotype in patients and controls (65.9%vs. 71.4% respectively), followed by B1/B2 (31.8% vs. 28.6%respectively). No significant difference was observed in relationto the Bcl I polymorphisms of the fibrinogen b-chain andobstructive and aneurysmal peripheral artery disease. Inconclusion, the B1 and B2 polymorphisms of the fibrinogen bchain and teir respective genotypes do not have any influence in peripheral artery disease.