RESUMO
Resumen El lipedema es una enfermedad común, frecuentemente subdiagnosticada, crónica y progresiva, que genera un gran deterioro en la calidad de vida. Consiste en el depósito anormal de tejido adiposo subcutáneo principalmente en las extremidades inferiores, afectando casi exclusivamente a mujeres. Sus síntomas principales son el dolor, la sensibilidad y la facilidad para producir equimosis. Desde el punto de vista fisiopatológico, existiría una susceptibilidad poligénica combinada con trastornos hormonales, microvasculares y linfáticos que pueden ser en parte responsables del desarrollo del lipedema. Se clasifica, según la distribución de la grasa en cinco tipos y, según la gravedad de la enfermedad, en cuatro etapas. El diagnóstico es eminentemente clínico y se debe diferenciar de otras patologías que producen aumento de volumen de las extremidades, especialmente el linfedema y obesidad. Es importante realizar un estudio funcional del sistema linfático cuando el diagnóstico es dudoso o para la etapificación del lipedema, por lo que la correcta interpretación de estos resultados es fundamental. El tratamiento está enfocado en disminuir la discapacidad y evitar la progresión, con el fin de mejorar la calidad de vida. Actualmente, la liposucción es un tratamiento efectivo para el lipedema, sin embargo, las técnicas empleadas para la lipectomía en el lipedema son diferentes a las técnicas utilizadas para la liposucción con fines estéticos. Las técnicas selectivas que respetan los vasos linfáticos tienen mejor rendimiento para reducir el volumen de grasa, retrasar la progresión, reducir el dolor, reducir la alteración marcha y mejorar la calidad de vida en estos pacientes.
Lipedema is a common, frequently under-diagnosed, chronic and progressive disease that generates an important detriment in quality of life. It consists in an abnormal deposit of subcutaneous adipose tissue mainly in the lower extremities, almost exclusively affecting women. Its main symptoms are pain, sensitivity and the ease of causing bruising. From the pathophysiological point of view, there would be a polygenic susceptibility combined with hormonal, microvascular and lymphatic disorders that may be partly responsible for the development of lipedema. It is classified according to the distribution of fat into five types and, according to the severity of the disease, in four stages. The diagnosis is eminently clinical and must be differentiated from other diseases that cause an increase in the volume of the extremities, especially lymphedema and obesity. It is important to carry out a study of the lymphatic system functionality when the diagnosis is not clear or for lipedema staging, so the correct interpretation of these results is essential. Treatment is focused on reducing disability and preventing progression, in order to improve quality of life. Liposuction is currently an effective treatment for lipedema, however, the techniques used for lipectomy in lipedema are different from the techniques used for liposuction for cosmetic purposes. Selective techniques that spare the lymphatic vessels have better results reducing fat volume, delaying progression, reducing pain, reducing gait disturbance, and improving quality of life of these patients.
Assuntos
Humanos , Lipedema/cirurgia , Lipedema/diagnóstico , Lipedema/fisiopatologia , Qualidade de Vida , Linfedema/fisiopatologiaRESUMO
BACKGROUND: Lymphoedema is a chronic condition that has significant detrimental impact on patients' quality of life. Secondary lymphoedema often results from anti-tumour treatment, in contrast to primary lymphoedema which is the result of genetic abnormalities that leads to an abnormal development of the lymphatic system. OBJECTIVE: To describe and compare the experience of individuals with primary and secondary lymphoedema. METHODS: A total of 19 patients (mean⯱â¯standard deviation age: 56.7⯱â¯16.2 years), 8 with primary and 11 with secondary lymphoedema, participated in this qualitative phenomenological study. Purposeful sampling method was applied. We recruited participants from specialised lymphoedema units of two physical therapy clinics and the Lymphoedema Patient Association in Spain. Data collection methods included unstructured and semi-structured interviews. An inductive thematic analysis was used. RESULTS: The findings suggest differences between the experience of living with primary or secondary lymphoedema. Also, those with lower extremity lymphoedema have more pain, fatigue, and functional limitations. Three primary themes emerged: "Emotional challenge", "Adapting your life to a new situation," and "lymphoedema management". CONCLUSIONS: The experience of living with lymphoedema involves aspects of fear, suffering, coping, and management of the disease and differs between secondary and primary causes. However, it seems to be more dependent on its location than its cause.
Assuntos
Linfedema/fisiopatologia , Doença Crônica , Fadiga , Humanos , Linfedema/genética , Pessoa de Meia-Idade , Pesquisa Qualitativa , Qualidade de Vida/psicologia , EspanhaRESUMO
BACKGROUND: The traditional overflow method for measuring limb volume remains the gold standard, but many disadvantages still inhibit its routine use in clinical practice. OBJECTIVE: To assess the intra-rater and inter-rater reliability and criterion validity of the 'communicating vessels volumeter' (CVV) for volume measurement of lymphedematous upper extremities (LUE) by using the overflow volumeter (OV) as the reference standard. METHODS: Twelve LUE of 12 women undergoing mastectomy for breast cancer were measured three times each by three raters using both methods, totaling 216 volume measurements. Criterion validity was estimated by 33 volume measurements of one cylinder of known volume by three raters using both methods, totaling 198 measurements. RESULTS: Measurement time was short with both CVV and OV. The intraclass correlation coefficient3,1 was high for both CVV and OV in intra-rater (0.99 vs 0.99) and inter-rater (0.99 vs 0.99) analyses. The bias between methods was low (7.50mL; 0.40%) and the limits of agreement were narrow (-5.80 to 6.50%). The volumes were statistically equal with a strong correlation (R2=0.98) between methods. CVV was more accurate than OV (0.00 vs 0.02%) in cylinder measurements. CONCLUSION: The high intra-rater and inter-rater reliability rates of CVV were comparable to those of OV, and the volumes resulting from LUE measurements were statistically equal in the two methods. Criterion validity rates indicated that CVV measurements were closer to the actual value of the cylinder than those obtained with the OV.
Assuntos
Neoplasias da Mama/cirurgia , Linfedema/fisiopatologia , Mastectomia/métodos , Feminino , Humanos , Padrões de Referência , Reprodutibilidade dos Testes , Projetos de Pesquisa , Extremidade Superior/patologiaRESUMO
PURPOSE: The aim of this systematic review was to summarize and systematize the information about physical symptoms and its relation with work activity on female Breast Cancer Survivors (BCS). METHODS: A systematic search was performed on the databases MEDLINE/PubMed (via National Library of Medicine), SCOPUS (Elsevier), Web of Science (Thomson Reuters Scientific) and CINAHL with full text (EBSCO), including papers about physical impairments experienced by female workers who have had breast cancer. RESULTS: The search retrieved 238 studies, and another 5 were identified in the articles' references, totaling 243 papers. After removing duplicates and applying the inclusion criteria and a full text reading, 13 articles were included for qualitative analysis. Concerning physical limitations, most complaints were related to the elevation of upper limbs, carrying heavy objects, driving and holding manual movements. The most referred symptoms were breast/arm pain, fatigue, lymphedema, reduced range of motion and weakness in the upper limbs, scar tissue adherence in the breast/axilla and paresthesia in the arm/breast. CONCLUSION: These symptoms and physical limitations led to the difficulty or impossibility of performing work tasks, which also diminished work productivity, as well as the increase in time to return to work. The present results suggest higher unemployment rates and the need for modifying work conditions. Implication for Rehabilitation Health professionals should include risk assessment at daily routine to identify possible sources of physical impairments for upper limbs. Provide the support and orientations according to personal and job characteristics of the patient. Focus the aims of treatment over upper limbs impairments, reducing the prevalence and the gravity of symptoms.
Assuntos
Neoplasias da Mama/fisiopatologia , Sobreviventes de Câncer , Fadiga/fisiopatologia , Feminino , Humanos , Linfedema/fisiopatologia , Debilidade Muscular/fisiopatologia , Dor/fisiopatologia , Parestesia/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Aderências Teciduais/fisiopatologia , Extremidade Superior/fisiopatologiaRESUMO
OBJECTIVE: The purpose of this study was to correlate upper limb volume and arterial and venous blood flow velocity in breast cancer survivors. METHODS: A cross-sectional study was conducted on 30 women with lymphedema and a mean age of 55.60 years (standard deviation = 8.12). For the assessment of upper limb volume, perimetry was performed with measures at 6 points on the limb, which were mathematically calculated as volume. The blood flow velocity of the axillary and brachial arteries and veins were assessed by Doppler ultrasound with a probe at 4 MHz. In the statistical analysis, a Shapiro-Wilk test determined a non-normal data distribution. Spearman correlation coefficients (ρ) were calculated to determine the association between the variables blood flow velocity and lymphedema volume. RESULTS: We identified significant and positive associations between all variables correlated with limb volume: blood flow velocity of the axillary artery (ρ = 0.381, P = .041), axillary vein (ρ = 0.383, P = .039), brachial artery (ρ = 0.375, P = .044), and the brachial vein (ρ = 0.373, P = .045). CONCLUSION: There is a positive association between limb volume and blood flow velocity in the upper limbs of women with lymphedema secondary to breast cancer treatment.
Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Linfedema/diagnóstico por imagem , Mastectomia/efeitos adversos , Ultrassonografia Doppler/métodos , Adulto , Idoso , Artéria Axilar/diagnóstico por imagem , Artéria Braquial/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Estudos Transversais , Feminino , Humanos , Linfedema/etiologia , Linfedema/fisiopatologia , Mastectomia/métodos , Pessoa de Meia-Idade , Valores de Referência , Índice de Gravidade de DoençaRESUMO
INTRODUCTION: Lymphedema is characterized by a defect in the lymphatic system that causes limb swelling. Impaired uptake and transport of lymphatic fluid through lymphatic vessels causes accumulation of protein-rich fluid in the interstitial spaces, which leads to swelling of the limb. Primary lymphedema often presents at birth. The rare cases that arise after age 35 years are described as lymphedema tarda. The great majority of patients with lymphedema have swelling of the lower limbs-upper limb lymphedema is a rare disorder. CASE PRESENTATION: An 84-year-old woman presented with a 3-year history of unilateral swelling of the right upper limb. There were no constitutional symptoms and no evidence of lymphadenopathy or systemic disease. Blood tests, carcinoembryonic antigen test, computed tomography scans, and venous Doppler ultrasound were all normal. The diagnosis was primary upper limb lymphedema. DISCUSSION: The swelling that occurs in upper limb lymphedema is permanent and usually extends to the hand. About one-third of patients with this condition also present with lower limb lymphedema. Thorough investigations are warranted in cases of unilateral upper limb lymphedema to rule out occult malignancy and systemic disease.
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Linfedema/patologia , Linfedema/fisiopatologia , Extremidade Superior/patologia , Extremidade Superior/fisiopatologia , Idoso de 80 Anos ou mais , Feminino , Humanos , Linfedema/etiologiaRESUMO
BACKGROUND: The aim of this study was to evaluate lymphoscintigraphic changes in patients who developed erysipelas after saphenous vein stripping. METHODS: Lymphoscintigraphic changes related to erysipelas were evaluated in a retrospective, cross-sectional and quantitative study of 21 saphenectomy patients. Patients with infections, those weighing over 120 kg, with chronic arterial disease or heart failure were excluded from the study. A control group was formed of 21 patients submitted to saphenectomies matched by age and gender but with no history of erysipelas. All patients underwent lymphoscintigraphy of both legs. The Fisher's Exact and χ2 tests were used for statistical analysis with an alpha error of 5% being considered acceptable. RESULTS: Associations of dermal reflux and popliteal lymph nodes with erysipelas were observed in operated patients compared to non-operated patients (P value= 0.002 and 0.03, respectively). Semiquantitative analysis showed a variation in the Kleinhans transport indexes of 0.15 to 20.5 for the entire sample. Group I showed a mean semiquantitative index of 2.42 (0.3 to 14.5), group II of 3.15 (0.225 to 15.125) and group III of 10.2 (0.15 to 38.25). The comparison of semiquantitative indexes of the groups by χ2 analysis showed that there was a statistically significant difference between the first two groups (I and II) and group III (P value <0.05). CONCLUSIONS: Erysipelas is a synergistic mechanism of injury of the lymphatic system in patients submitted to saphenectomies.
Assuntos
Erisipela/etiologia , Sistema Linfático/fisiopatologia , Linfedema/etiologia , Veia Safena/cirurgia , Varizes/cirurgia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Idoso , Distribuição de Qui-Quadrado , Estudos Transversais , Erisipela/diagnóstico , Feminino , Humanos , Sistema Linfático/diagnóstico por imagem , Linfedema/diagnóstico por imagem , Linfedema/fisiopatologia , Linfocintigrafia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: Lower limb lymphedema (LLL) is characterized as a physical-functional chronic complication that impacts the quality of life of women who have gone through treatment for gynecological cancer. The present study aims to check the conservative treatments available for lymphedema after gynecological cancer in the context of evidence-based practice. METHODS: The selection criteria included papers from May 1993 discussing treatment protocols used in LLL after treatment for gynecological cancer. The search was performed until October 2014 in MEDLINE, SciVerse, and PEDro using "rehabilitation," "treatment outcome," "therapeutics," "clinical protocol," "gynecologic surgery," "lower extremity," "lower limb," and "lymphedema" as keywords, focused on women with a previous diagnosis of gynecological cancer who received radiation and/or chemotherapy and/or surgery and/or lymphadenectomy as part of their treatment. RESULTS: From 110 studies found, 3 articles that used the complex decongestive therapy (CDT) as a treatment protocol were selected. There were no randomized clinical trials associated with the conservative treatment of LLL post-treatment of gynecological cancer. The three selected articles are retrospective, and had the same outcome - decreased volume of the affected limb lymphedema. CONCLUSIONS: Although LLL is more or as frequent and detrimental as upper limb lymphedema post-cancer treatment, there are only a few studies about this subject. Publications are even scarcer when considering studies with interventional approach. Randomized controlled trials are necessary to support rehabilitation resources on lymphedema post-gynecological cancer treatment.
Assuntos
Medicina Baseada em Evidências , Neoplasias dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Sistema Linfático/fisiopatologia , Linfedema/terapia , Modalidades de Fisioterapia , Doença Crônica , Efeitos Psicossociais da Doença , Feminino , Humanos , Extremidade Inferior , Linfedema/etiologia , Linfedema/fisiopatologia , Linfedema/psicologia , Qualidade de Vida , Fatores de Risco , Resultado do TratamentoRESUMO
Aside from the established role for platelets in regulating hemostasis and thrombosis, recent research has revealed a discrete role for platelets in the separation of the blood and lymphatic vascular systems. Platelets are activated by interaction with lymphatic endothelial cells at the lymphovenous junction, the site in the body where the lymphatic system drains into the blood vascular system, resulting in a platelet plug that, with the lymphovenous valve, prevents blood from entering the lymphatic circulation. This process, known as "lymphovenous hemostasis," is mediated by activation of platelet CLEC-2 receptors by the transmembrane ligand podoplanin expressed by lymphatic endothelial cells. Lymphovenous hemostasis is required for normal lymph flow, and mice deficient in lymphovenous hemostasis exhibit lymphedema and sometimes chylothorax phenotypes indicative of lymphatic insufficiency. Unexpectedly, the loss of lymph flow in these mice causes defects in maturation of collecting lymphatic vessels and lymphatic valve formation, uncovering an important role for fluid flow in driving endothelial cell signaling during development of collecting lymphatics. This article summarizes the current understanding of lymphovenous hemostasis and its effect on lymphatic vessel maturation and synthesizes the outstanding questions in the field, with relationship to human disease.
Assuntos
Plaquetas/metabolismo , Quilotórax/metabolismo , Vasos Linfáticos/metabolismo , Linfedema/metabolismo , Ativação Plaquetária , Trombose/metabolismo , Animais , Plaquetas/patologia , Quilotórax/patologia , Quilotórax/fisiopatologia , Humanos , Lectinas Tipo C/metabolismo , Vasos Linfáticos/patologia , Linfedema/patologia , Linfedema/fisiopatologia , Glicoproteínas de Membrana/metabolismo , Camundongos , Trombose/patologiaRESUMO
Lymphedema secondary to breast cancer causes physical and psychological morbidity and compromises quality of life. The objective of this literature review was to study lymphatic compensation after surgery for breast cancer and the factors that influence this process, with a view to understanding the etiopathogenesis of lymphedema. Articles indexed on Pubmed published from 1985 to 2012 were reviewed. According to the literature, lymphangiogenesis reduces damage to lymph vessels; there is little evidence that Vascular Endothelial Growth Factor is elevated in women with lymphedema; lymphovenous communications can be observed 60 days after surgery; women without lymphedema have acquired alternative mechanisms for removal of proteins from the interstitial space; and active exercise stimulates lymphatic and venous pumping. Health professionals should teach these patients about the risk factors for lymphedema. The effects of lymphangiogenesis, proteolysis and lymphovenous communications on development of lymphedema should be studied, since these events are intimately related.
Linfedema secundário ao câncer de mama resulta em morbidade física e psicológica, e compromete a qualidade de vida. O objetivo desta revisão da literatura foi estudar as compensações linfáticas após cirurgia para câncer de mama e os fatores que interferem neste processo, visando a compreender a etiopatogenia do linfedema. Foram incluídos artigos publicados de 1985 a 2012, da base de dados Pubmed. Segundo a literatura, a linfangiogênese reduz danos nos vasos linfáticos; há pouca evidência de que o fator de crescimento vascular endotelial linfático é aumentado nas mulheres com linfedema; anastomoses linfovenosas são observadas 60 dias após a cirurgia; mulheres sem linfedema adquiriram mecanismos alternativos para remoção das proteínas do interstício, e exercício ativo estimula bombeamento linfático e venoso. Orientações dos fatores de risco para linfedema devem ser empregadas por profissionais da saúde. O efeito de linfangiogênese, proteólise e anastomoses linfovenosas sobre o desenvolvimento do linfedema deve ser estudado, pois são eventos intimamente relacionados.
Assuntos
Humanos , Feminino , Sistema Linfático , Linfedema/etiologia , Linfedema/fisiopatologia , Neoplasias da Mama/etiologia , Mulheres , Artéria Axilar , Modalidades de Fisioterapia/métodos , Pessoal de Saúde , Cuidados Pós-Operatórios , Fatores de RiscoRESUMO
PURPOSE: This study investigated short-term changes in body composition, handgrip strength, and presence of lymphedema in women who underwent breast cancer surgery. METHODS: Ninety-five women participated in a cross-sectional study, divided into two groups: Control (n=46), with healthy women, and Experimental (n=49), with women six months after breast cancer surgery. The Experimental Group was subdivided into right total mastectomy (RTM, n=15), left total mastectomy (LTM, n=11), right quadrant (RQ, n=13), and left quadrant (LQ, n=10). It was also redistributed among women with presence (n=10) or absence (n=39) of lymphedema. Presence of lymphedema, handgrip strength, and body composition were assessed. RESULTS: Trunk lean mass and handgrip strength were decreased in the Experimental Group. Total lean mass was increased in the LTM compared to RTM or LQ. Left handgrip strength in LTM was decreased compared to RTM and RQ and in LQ compared to RTM and RQ. Finally, total lean mass, trunk fat mass, trunk lean mass, right and left arm lean mass were increased in women with lymphedema. CONCLUSIONS: Breast cancer survivors have changes in their body composition and in handgrip strength six months after surgery; however, the interaction between the type of surgery and its impact is unclear. Furthermore, women who developed lymphedema in this period showed more significant changes in the body composition, but they were not enough to cause impairment in handgrip strength.
Assuntos
Composição Corporal , Neoplasias da Mama/cirurgia , Força da Mão , Linfedema/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Transversais , Feminino , Humanos , Linfedema/etiologia , Mastectomia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Fatores de TempoRESUMO
PURPOSE: This study investigated short-term changes in body composition, handgrip strength, and presence of lymphedema in women who underwent breast cancer surgery. METHODS: Ninety-five women participated in a cross-sectional study, divided into two groups: Control (n=46), with healthy women, and Experimental (n=49), with women six months after breast cancer surgery . The Experimental Group was subdivided into right total mastectomy (RTM, n=15), left total mastectomy (LTM, n=11), right quadrant (RQ, n=13), and left quadrant (LQ, n=10). It was also redistributed among women with presence (n=10) or absence (n=39) of lymphedema. Presence of lymphedema, handgrip strength, and body composition were assessed. RESULTS: Trunk lean mass and handgrip strength were decreased in the Experimental Group. Total lean mass was increased in the LTM compared to RTM or LQ. Left handgrip strength in LTM was decreased compared to RTM and RQ and in LQ compared to RTM and RQ. Finally, total lean mass, trunk fat mass, trunk lean mass, right and left arm lean mass were increased in women with lymphedema. CONCLUSIONS: Breast cancer survivors have changes in their body composition and in handgrip strength six months after surgery; however, the interaction between the type of surgery and its impact is unclear. Furthermore, women who developed lymphedema in this period showed more significant changes in the body composition, but they were not enough to cause impairment in handgrip strength. .
OBJETIVO: Este estudo investigou alterações de curto prazo na composição corporal, na força de preensão palmar e na presença de linfedema em mulheres submetidas à cirurgia do câncer de mama. MÉTODOS: Noventa e cinco mulheres participaram de um estudo transversal, sendo divididas em dois grupos: Controle (n=46), mulheres saudáveis, e Experimental (n=49), mulheres seis meses após cirurgia do câncer de mama. O Grupo Experimental foi subdividido em mastectomia total direita (RTM, n=15), mastectomia total esquerda (LTM, n=11), quadrantectomia direita (RQ, n=13) e quadrantectomia esquerda (LQ, n=10). Também foi redistribuído entre mulheres com presença (n=10) ou ausência (n=39) de linfedema. Foram avaliadas a presença de linfedema, a força de preensão palmar e a composição corporal. RESULTADOS: A massa magra de tronco e a força de preensão palmar estavam diminuídas no Grupo Experimental. Massa magra total estava aumentada na LTM comparada à RTM ou LQ. Força de preensão palmar esquerda na LTM estava diminuída comparada à RTM e RQ e em LQ comparada à RTM e RQ. Finalmente, massa magra total, magra e gorda de tronco e massa magra de braço esquerdo e direito estavam aumentadas em mulheres com linfedema. CONCLUSÕES: Sobreviventes do câncer de mama possuem alterações na composição corporal e na força de preensão palmar seis meses após a cirurgia, porém a interação entre o tipo de cirurgia e seu impacto não está clara. Além disso, mulheres que desenvolveram linfedema neste período mostraram alterações mais significantes na composição corporal, mas que não foram suficientes para causar prejuízo na força de preensão palmar. .
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Composição Corporal , Neoplasias da Mama/cirurgia , Força da Mão , Linfedema/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Transversais , Linfedema/etiologia , Mastectomia , Complicações Pós-Operatórias/etiologia , Fatores de TempoRESUMO
AIM: The aim of the current study was to evaluate fluid mobilization during the intensive treatment of leg lymphedema. METHODS: The mobilization of intracellular and extracellular fluids in the lower and upper extremities and trunk was evaluated with the intensive treatment of leg lymphedema in a prospective study. Mobilization of fluids was assessed by bioelectrical impedance using the InBody S10 device in ten patients with leg lymphedema, regardless of the cause. Treatment consisted of six to eight hours per day of Manual Lymphatic Therapy (Godoy & Godoy technique), Mechanical Lymphatic Therapy (RAGodoy device®) and a non-elastic cotton-polyester stocking. RESULTS AND CONCLUSION: A significant reduction in total water was observed for the lymphedematous limb, but with an increase in intracellular water of from 59% to 61%. Additionally, total water increases were observed in the limbs without lymphedema and in the trunk. There was an increase in total intracellular water of the extremities and trunk, but without any change in the extracellular water. In high-volume reductions during lymphedema treatment, fluids are displaced from the lymphedematous limb to extremities without lymphedema and to the trunk.
Assuntos
Água Corporal/metabolismo , Drenagem , Deslocamentos de Líquidos Corporais , Linfedema/terapia , Modalidades de Fisioterapia , Meias de Compressão , Adolescente , Adulto , Idoso , Composição Corporal , Terapia Combinada , Drenagem/métodos , Impedância Elétrica , Feminino , Humanos , Extremidade Inferior , Linfedema/diagnóstico , Linfedema/metabolismo , Linfedema/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Extremidade Superior , Adulto JovemRESUMO
OBJECTIVES: To investigate the occurrence and severity of lymphoedema of the lower extremities (LLE), quality of life (QoL), and urinary and sexual dysfunction in women with vulvar cancer submitted to surgical treatment. STUDY DESIGN: Twenty-eight patients with vulvar cancer submitted to vulvectomy and inguinofemoral lymphadenectomy and 28 healthy, age-matched women (control group) were evaluated. The occurrence and severity of LLE were determined by Miller's Clinical Evaluation. QoL, urinary function and sexual function were assessed by the EORTC QLQ-C30, SF-ICIQ and FSFI questionnaires, respectively. The differences between groups and correlations were assessed using Student's t-test, Chi-squared test, Mann-Whitney U-test and Spearman's rho test. RESULTS: The groups were similar in terms of marital status, educational status, menopausal status, hormone therapy and height. The occurrence and severity of LLE were higher in women with vulvar cancer compared with the control group (p<0.001 and p = 0.003, respectively). A significant association was found between the severity of LLE and advanced age (p = 0.04), and the severity of LLE and higher body mass index (BMI; p = 0.04) in patients with vulvar cancer. In the patients with vulvar cancer, there was a significant correlation between the severity of LLE and worse QoL in the following domains: physical, cognitive, emotional, social, fatigue, pain, sleep and financial questions (p < 0.05). There was no difference in urinary function between the two groups (p = 0.113). Age and number of deliveries were the only variables associated with the occurrence of urinary incontinence (p = 0.01). Urinary incontinence was present in women with a mean age of 74.9 ± 4.6 years and a mean of 7.3 ± 1.3 normal deliveries. There was no difference between the groups in terms of the sexual function. Multivariate analysis showed an association between sexual function and age (p = 0.01), and sexual function and being in a stable relationship (p=0.02). CONCLUSION: Patients submitted to vulvectomy or inguinofemoral lymphadenectomy for vulvar cancer are at higher risk of developing LLE compared with healthy, age-matched women. This has a negative effect on QoL, but does not interfere with urinary or sexual function.
Assuntos
Excisão de Linfonodo/efeitos adversos , Linfedema/etiologia , Qualidade de Vida , Vulva/cirurgia , Neoplasias Vulvares/cirurgia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Brasil/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos , Incidência , Extremidade Inferior , Linfedema/epidemiologia , Linfedema/fisiopatologia , Estado Civil , Pessoa de Meia-Idade , Paridade , Índice de Gravidade de Doença , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/prevenção & controle , Transtornos Urinários/epidemiologia , Transtornos Urinários/etiologia , Transtornos Urinários/prevenção & controleRESUMO
OBJECTIVE: To evaluate postoperative lymphatic compensation in the upper limb after mastectomy with axillary dissection. SUBJECTS AND METHODS: Twenty-three patients who underwent lymphoscintigraphy before and 60 days after surgery were enrolled from September 2006 to June 2007, in Campinas, Brazil. Protocol examination consisted in static imaging of each upper limb in semi-flexion and thoracic imaging after 10 min and 1 and 2 hr after subcutaneous injection of 1 mCi (37 MBq) of 99mTc dextran into the dorsum of the hand. A comparative analysis was made of hepatic uptake of the radiopharmaceutical, velocity of axillary lymph node visualization (I, visible at 10 min; II, at 1 hr; III, at 2 hr; IV, not visible) and degree (intensity) of uptake (a, marked; b, moderate; c, mild; d, absent) before and 60 days after surgery. RESULTS: In the preoperative period, 3 (13%) patients were considered to have an optimal pattern (Ia) and 2 (9%) showed total involvement (IVd). Compared to velocity in the postoperative period, 9 (39%) patients showed no difference, 5 (22%) improved, 9 (39%) became worse, and one was considerably worse. Regarding the degree, 10 (43%) patients showed no difference, 9 (39%) became worse, and 4 (17%) improved. Regarding classification, 2 (9%) patients had an optimal lymphatic pattern (Ia) and 3 (13%) had total involvement (IVd). No patient presented decreased hepatic uptake after surgical treatment. CONCLUSIONS: The study found relevant changes in preoperative and postoperative lymphoscintigraphy, demonstrating the existence of functional differences in the lymphatic system of the upper limb. Alterations in lymphatic drainage pattern may already be perceived 60 days postoperatively, as can signs of lymphovenous anastomoses.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Excisão de Linfonodo/efeitos adversos , Sistema Linfático/fisiopatologia , Mastectomia/métodos , Recuperação de Função Fisiológica , Extremidade Superior , Adulto , Idoso , Axila , Brasil , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/cirurgia , Feminino , Humanos , Sistema Linfático/cirurgia , Vasos Linfáticos/fisiopatologia , Linfedema/etiologia , Linfedema/fisiopatologia , Linfocintigrafia , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Período Pós-Operatório , Fatores de Risco , Resultado do Tratamento , Extremidade Superior/diagnóstico por imagem , Extremidade Superior/fisiopatologiaRESUMO
AIM: The aim of this study was to investigate the effects of manual and mechanical lymph drainage on the bioelectrical composition of body tissues of patients with lymphoedema of the lower limbs. METHOD: Twenty-one patients with lymphoedema of one leg were evaluated using single frequency bioelectrical impedance with four electrodes (SF-BIA4) immediately before and after a combination of manual and mechanical lymph drainage. Statistical analysis used the two-tailed paired t-test with an alpha error of 5% being considered acceptable. RESULTS: On comparing the results before and after lymph drainage, statistically significant differences were identified for both lymphoedematous and apparently healthy legs, but there were no significant differences in the alterations caused by the treatment between the healthy and lymphoedematous limbs of the same patient. CONCLUSION: It was concluded that the association of manual and mechanical lymph drainage both modified the body composition as identified by bioelectrical impedance, and reduced the oedema.
Assuntos
Composição Corporal , Perna (Membro)/fisiopatologia , Linfa , Linfedema/fisiopatologia , Impedância Elétrica , Feminino , Humanos , MasculinoRESUMO
In this report, we describe a case of bilateral non-syndromic hereditary lymphedema praecox of lower legs. The patient was diagnosed at age 16. Ten years later, he was unable to ambulate due to increased bilateral lower leg volume, continuous pain, and recurrent episodes of cellulitis. He was treated at our tertiary-care center with compression therapy and circumferential liposuction of lower legs, ankles, and dorsum of feet in order to remove hypertrophic fat deposits, facilitate conservative therapy, and decrease further risk of cellulitis. No complications were seen and compression therapy was continued. Fourteen month follow-up reveals no increase in leg volume over time, absence of pain, and no further episodes of cellulitis with complete ability to ambulate and return to normal activities. Even when it does not eliminate the underlying cause of primary lymphedema, combined therapy consisting of compression and liposuction is safe and is able to achieve control, at least on a short term, of clinically disabling conditions associated with advanced stages.
Assuntos
Elefantíase/terapia , Perna (Membro)/fisiopatologia , Lipectomia , Linfedema/terapia , Meias de Compressão , Adulto , Celulite (Flegmão)/genética , Celulite (Flegmão)/terapia , Terapia Combinada , Elefantíase/complicações , Elefantíase/genética , Elefantíase/fisiopatologia , Elefantíase/cirurgia , Humanos , Perna (Membro)/patologia , Linfedema/complicações , Linfedema/genética , Linfedema/fisiopatologia , Linfedema/cirurgia , Masculino , Dor/genética , Manejo da Dor , Medição da Dor , Recuperação de Função Fisiológica , Resultado do Tratamento , CaminhadaRESUMO
O linfedema vem afetando milhões de pessoas em todo o mundo. É uma doença crônica, caracterizada pelo acúmulo de líquidos e proteínas nos tecidos, decorrente da deficiência do sistema linfático. A drenagem linfática manual é um dos recursos de grande auxílio ao terapeuta, com o objetivo básico de drenar o excesso de líquido acumulado nos espaços intersticiais. O presente estudo tem como objetivo descrever as técnicas e verificar os efeitos da drenagem linfática manual na prevenção e tratamento do lindedema primário em em membros inferiores. Foi realizada revisão bibliográfica (Bireme, Lilacs, Medline e Pubmed). Concluiu-se que o tratamento deve ser combinado, utilizando-se a drenagem linfática manual com outras técnicas, como a cinesioterapia, tornando os efeitos significativos.
Linfedema affects millions of people in the whole world. It is a chronic illness characterized by the accumulation of liquids and proteins in decurrent fabrics of the deficiency of the lymphatic system. The manual lymphatic draining is one of the resources of great help to the physical therapist, with the basic objective to drain the excess of liquid accumulated in the interstitials spaces. This study has as objective to describe the techniques and to verify the effect of the manual lymphatic draining in the prevention and treatment of primary linfedema in inferior members. A bibliographical revision was made (the Bireme, Lilacs, Medline and Pubme). It could be concluded that the treatment should be combined, using the manual lymphatic drainage with other technique such as kinesiotherapy, making significant effects.
Assuntos
Humanos , Masculino , Feminino , Linfedema/fisiopatologia , Linfedema/terapia , Manipulações Musculoesqueléticas , Sistema Linfático/fisiopatologia , Cinesiologia Aplicada/métodos , Cinesiologia Aplicada , Drenagem/métodos , Massagem , Terapias Complementares/métodos , Terapias ComplementaresRESUMO
En el tratamiento del cáncer de mama, la complicación más frecuente que se presenta es el linfedema secundario del miembro superior. El linfedema es una enfermedad crónica provocada por una destrucción de la anatomía linfática normal. Aparece en un 20% -25% de los casos y hasta un 35% cuando la cirugía se asocia a radioterapia. Pese a los importantes avances existentes en el tratamiento de linfedema, no hay un consenso entre los investigadores respecto a la elección de la terapia adecuada, debido a la falta de criterios uniformes de diagnósticos, que se traducen en la derivación tardía de los pacientes hacia los profesionales especializados. El enfoque terapéutico actual consiste en la integración de equipos multidisciplinarios reunidos en un Programa Integral de Rehabilitación del Edema (PIR), el que reúne enfoques preventivos - a través de la educación del paciente - y conservadores tales como el Drenaje Linfático Manual, presoterapia secuencial intermitente, ejercicios específicos, vendaje multicapas y elementos de contención. Estos tratamientos si bien no buscan la cura del Linfedema, permiten minimizar las secuelas funcionales y mejorar la calidad de vida de las pacientes portadoras de esta patología.
In breast cancer treatment, the most common complication is the Secondary Lymphedema of the upper limb. Lymphedema is a chronic disease caused by the destruction of the normal lymphatic anatomy. It is produced in a 20-25% of the cases, and up to 35% when the surgery is associated to radiotherapy. Despite the important existing advances in the management of Iymphedema, there is no consensus between the investigators with respect to the election of the suitable therapy, due to the lack of uniform criteria of diagnosis, which are translated in a delayed derivation of the patients towards the specialized professionals. The present therapeutic approach, consists of the integration of multidisciplinary teams joined in an Integral Program of Rehabilitation of Edema (IPR), which gathers preventive approaches - through the education of the patient - and conservative approaches, such as the MDL (Manual Lymphatic Drainage), Intermittent Sequential Pressotherapy specific. Exercises, multi layer Bandage, and elements of containment. These treatments, although do not aim at the cure of the Lymphedema, allow the decrease of the functional sequels and improve the quality of life of the patients who carry this pathology.
Assuntos
Humanos , Feminino , Linfedema/etiologia , Linfedema/terapia , Neoplasias da Mama/complicações , Drenagem , Terapia por Exercício , Linfedema/fisiopatologia , Linfedema/reabilitação , Mastectomia/efeitos adversos , Linfonodos/anatomia & histologia , Equipe de Assistência ao Paciente , Radioterapia/efeitos adversos , Vasos Linfáticos/anatomia & histologiaRESUMO
El linfedema se debe a depósito de proteínas con alto Peso Molecular (PM) en el intersticio, debido a una falla en el transporte de linfa, originando edema. Es un cuadro lentamente progresivo de origen primario o secundario principalmente a cirugía oncológica en la extremidad superior e infecciosa en las inferiores. Clínicamente se manifiesta por edema irreversible al fallar la función de los linfáticos en la reabsorción de proteínas de alto PM, las que al permanecer en el intersticio provocan la atracción de agua y electrolitos, favoreciendo la fibrasis. Sin tratamiento evoluciona a elefantiasis y paquidermitis por linfangectasia.Las complicaciones más frecuentes son las infecciones bacterianas de la piel recidivantes que agravan el cuadro, rara vez evoluciona a un linfangiosarcoma.Su tratamiento se basa fundamentalmente en el drenaje linfático manual (DLM), presoterapia, elastocompresión y benzopironas.A pesar de ser una patología irreversible, detectada a tiempo y bien manejada permite detener su evolución y mejorar la calidad de vida.
Lymphedema is caused by a deficiency in the lymph transport system, that produce deposit of high molecular weight protein in the interticial space, derivating edema. It is a slowly progressive disease of primary origin, or secondary to oncologic surgery in the upper extremities, and infectious in the lower extremities. It is clinically manifested by an irreversible edema when the lymphatic vessels' function fail to reabsorb high molecular weight proteins. These proteins remain in the interstice, producing water and electrolytes attraction, thus favoring fibrosis. If it is not treated, lymphedema results in elephantiasis and paquidermitis due to lymphagectasy. The most frequent complications are recurrent skin infections due to bacteria that complica te the whole illness. Very rarely results in lymphagiosarcome. Its treatment is essentially based on manual linfatic drainage (MLD), pressotherapy, elastocompressure, and benzopirones. Though lymphedema is an irreversible pathology, if detected timely and well treated, it allows for a detention in its evolution and improvement in quality of life.