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The aim of the current study is to report on the treatment of primary lymphedema using a new form of therapy: cervical stimulation. In a prospective cohort study, 9 boys and 5 girls with primary congenital lymphedema were evaluated over two years. Age ranged from two months to 8.5 years. After diagnosis, all mothers were trained in the new technique. The Godoy & Godoy cervical stimulation technique consists of between 20 to 30 stimuli per minute using light movements in the cervical region. All the children were submitted to perimetric evaluations of the feet and legs; however, in this study only two points, 3 and 6 cm from the base of the big toe nail, were used. The two-tailed t-test was used for statistical analysis with an alpha error of 5% (P<0.05) considered acceptable. The size of the lymphedematous feet was reduced and even normalized (P<0.0001) for all treated children. Cervical stimulation is a new option in the treatment of primary congenital lymphedema; its association with compression stockings has a synergistic effect in reducing the volume of lymphedema.
LINKThe estimated number of cases of cancer of the lips and mouth in Brazil in 2007 was 10 380 among men and 3780 among women.1 Of the cancers of lips and mouth (buccal mucous membranes, gum, hard palate, tongue and mouth floor), lip cancer is the most common in Caucasians.1 Cancer of the other regions of the mouth mainly affect over 40-
year-old men, in whom the risk increases with smoking, alcohol ingestion, bad buccal hygiene and inappropriate use of dental prosthesis.2 The symptoms include the appearance of superficial ulcers, white or red blotches in the buccal mucous membrane, or even cervical lymphadenomegalia.2 Surgery, radiotherapy and chemotherapy, either alone or combined are the applicable therapeutic methods for cancer of the mouth.
Lymphedema is defined as the abnormal accumulation of macromolecules in the interstitial space which, in turn, leads to an accumulation of fluids due to a failure in the formation and drainage of lymph as a result of congenital or acquired lesions of the lymphatic system [1]. Lymphedema in children is rare; the prevalence is around 1.15/100.000 in under 20 year olds [2]. One study of 312 patients under 36 years old with primary lymphedema identified ten individuals who had had the disease at birth. A frequency of 1/6000 live births has been reported with a ratio of one male to every three females [3]. In respect to congenital lymphedema, there is variability in signs and symptoms between families and the age at onset varies; there are more than four known genetically distinct conditions andmutations in three genes have been discovered in families with lymphedema [4]. The diagnosis of congenital lymphedema is still a challenge. Primary lymphedema is classified into two subgroups: idiopathic and familial (hereditary) [5]. In general, it is recommended thatwhen peripheral lymphedema of undetermined etiology andwith dimorphisms is found, an evaluation of associated syndromes should be carried out [6]. The recommended treatment of lymphedema is an association of therapies such as Manual and Mechanical Lymphatic Therapy, compressionmechanisms (stockings and bandages), myolymphokinetic activities, and exercises and care with hygiene [7].
LINKGodoy and Godoy describe in this study a new lymph drainage technique which is different from those previously described. It can be performed in isolation, as in cases of the face, or in conjunction with body lymph drainage. The technique is extremely simple and, with due care, we believe the method is easily reproduced in the clinical setting.[1,2] Fifteen female and three male patients with ages between 34 and 86 years and a mean age of 57.8 years with grade II lymphedema of lower limbs in its initial phase (within three to four months of onset as reported by the patient) were selected over a two-year period. Grade I lymphedema is deÞ ned as lymphedema that evolves during the day with patients having no signs of the disease after a nights rest. With Grade II lymphedema, the patient awakens with swelling of the limbs.[3] Diagnosis of lymphedema was clinical, confirmed by lymphoscintigraphy.
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