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The aim of this study was to report a case of factitious lymphedema of the arm and related lymphoscintigraphic aspects. The case of a 36-year-old patient is reported who started to present with pain, in the 3rd finger of the right hand three years prior to this report, which she associated with her work. Joint effusion was identified and treated using a splint that restricted blood flow leading to edema of the distal third of the forearm. Since then the patient was treated however her condition worsened resulting in edema of the entire arm. Subsequently she was referred to our service. A physical examination identified a restrictive band in the axillary region of the arm that delimited the edema. Volumetry and lymphoscintigraphic examinations of the limb were performed. The lymphoscintigraphy demonstrated acceleration of the flow in the affected limb and dermal reflux. Clinical treatment with removal of the restriction allowed a rapid reduction in the volume of the limb.
LINKThe objective of this study is to describe the evolution of the skin during rehabilitation for elephantiasis using intensive treatment. We report on the case of a 55-year-old patient with a seven-year history of leg edema. The patient reported that it began with repeated outbreaks of erysipelas over several years. One leg evolved with significant edema leading to an inability to ambulate and for about one month the patient said that he could not get out of bed. Moreover the patient was obese weighing 130 kilos and with a BMI of 39. Intensive treatment was performed over three weeks resulting in a significant reduction in limb volume. The treatment consisted ofMechanical LymphaticTherapy (RAGodoy), Cervical Lymphatic Stimulation (Godoy & Godoy technique), and a custom-made inelastic stocking of a grosgrain textile. What caught the attention during therapy were the open wounds resulting from fragmentation of the plaque as the edema reduced; the plaque was about 0.5 cm thick. As the treatment evolved the plaque disappeared and the wounds healed. The limb size decreased bymore than 80% in three weeks after which the patient began to be treated in an outpatient setting with ambulation using a grosgrain stocking.
LINKTreatment of breast cancer generally involves quadrantectomy and mastectomy followed by radiotherapy and chemotherapy depending on indication. The object of the present study was to verify the extent of movement of the shoulder after breast cancer treatment and the influence of the type of surgery (quadrantectomy and mastectomy). A total of 90 women submitted to surgery for breast cancer in the Region of Catanduva, Brazil and a control group of 20 women without surgical compromise were evaluated. The extents of bilateral flexion and abduction movements of the shoulders were assessed by goniometry. The non-matched student t-test and Fisher exact test were utilized for statistical analysis with an alpha error of up to 5% being considered acceptable. Differences of 20 degrees or more in the extent of movement of the shoulders of women submitted to surgery were seen in 47.7% of the cases for flexion and in 56.6% for abduction. The compromise to the movement of the shoulder in the control group was less than 20 degrees in 9 (45%) of the women. On comparing the incidence of alterations in the movements of the arms of women submitted to surgery with the control group, a significant difference was identified
for both limbs (p-value < 0.01). The articular mobility of both arms of patients submitted to treatment for breast cancer can be affected.
One current concern relates to the report of a multidisciplinary outpatient approach to treatment that adapted existing conducts. Breast cancer-related lymphoedema results from impaired lymph drainage after axillary surgery (1). Destruction of the lymphatic system causes a progressive and chronic condition with functional impairment and disabilities, limiting patients in their daily activities and involving nearly all aspects of their quality of life. The follow-up of the clinical treatment of 20 patients with breast cancer-related lymphedema was evaluated over a period of 3 years in the Godoy Clinic in São José do Rio Preto, Brazil. All patients were women with ages that ranged from 35 to 79 years old. Lymphedema was diagnosed by differences of more than 200 mL between the affected and normal arms as identified using water-displacement volumetry. All patients were assessed by a physician, psychologist, nutritionist, physiotherapist, occupational therapist, physical educator, and a professional seamstress. The treatment included manual lymph drainage using the Godoy & Godoy technique, active and passive exercising utilizing facilitating apparatuses developed for these patients, a compression sleeve made of ‘‘gorgurão’’ (a cotton-polyester material) by the seamstress and programed hydrogymnastics (2–6). Lymph drainage was performed one or two times weekly associated with cervical stimulation for 20 minutes followed by manual lymph drainage. The patients had two-onehour sessions of hydrogymnastics per week during which they always used compression sleeves. These sessions included stretching exercises and walking around the swimming pool, group dynamics involving movements of the limbs without exertion that utilized contraction and flection of the elbow, lifting the shoulder, and adduction and abduction of the arm.
LINKLipedema is a clinical syndrome that was first described in 1940 by Allen and Hines [1]. It is characterized by a bilateral and symmetrical increase in size of the lower limbs, involving the feet, with the Stemmer sign being negative and may include, among other conditions, cutaneous hypothermia, alterations in the plantar support and hyperalgesia [2]. Lymphedema is an excessive increase of fluids, proteins and other macromolecules in the subcutaneous tissue, resulting from failure of the lymph drainage system [3]. An association has been reported between lipedema and anatomic alterations of the lymphatic system [4]. Lipolymphedema is the progression of lipedema to lymphedema [5]. No association of lipolymphedema with erysipelas and ulcerated lesions has been previously described in indexed publications. A 41-year-old female Caucasian reported that since childhood she had had large thigh and leg circumferences without involvement of the feet and said that her relatives presented with similar characteristics. After the last episode of erysipelas, one year previous to this interview, an ulcerated lesion had formed in the medial and lateral malleolar region of the left leg that did not heal. On physical examination, hard edema with Stemmer sign of both legs was observed, devoid of thumb pitting and cold, but without pain. Verrucous nodular lesions and dermatosclerosis of the anterior face of the ankle of the right foot were observed.
LINKAim: The aim of this study was to evaluate the prevalence of erysipelas and lymphangitis in a group of patients under treatment for lymphedema after breast-cancer therapy.
Methods: A random observational prospective study of the incidences of lymphangitis and erysipelas was performed for 66 patients with arm lymphedema after breast-cancer treatment. The study was carried out between March 2006 and December 2007 at the Godoy Clinic in São José do Rio Preto, Brazil. The clinical evaluation of the participants was performed weekly before the start of treatment, with patients being required to immediately report any complications to the attending service.
Results: The mean time of follow-up of the patients between their treatment for breast cancer and the start of this study was 12.3 months, and three complications (4.5%) occurred; two cases of lymphangitis were reported after insect bites and one case of erysipelas after a hand injury, with repeat episodes reported by all three patients.
Conclusion: In spite of prophylactic advice regarding lymphangitis and erysipelas during treatment for lymphedema after breast-cancer therapy, patients are subject to complications; however, this in itself does not justify the use of prophylactic antibiotic therapy.
Lymphedema usually affects poor populations; there is no cure and little prospect of therapies being developed by the private health sector. This situation is aggravated in less developed countries where the lack of government resources and specialized health care professionals has led to the marginalization of this disease [1]. An association of therapies, which generally includes manual lymph drainage, compression therapy, exercises, and hygienic care, is recommended for the treatment of lymphedema [1, 2]. More recently other options, such as mechanical lymph drainage employing devices that use either active or passive muscle movements, pressure therapy, daily life activities, and hygienic, nutritional and psychological care, have been added to this arsenal [1, 3, 4]. Intensive treatment of lymphedema, which offers the possibility of the rapid control of swelling, has been reported in the literature [5]. However major problems of patients with elephantiasis are dermal lesions and lymphorrhea that make hygiene and the use of compression, which are essential for treatment, more difficult. The aim of this study is to report on the use of an Unna boot that allowed the use of an associated compressionmechanism with a resulting faster reduction in leg volume,thereby offering a new perspective in the treatment of warty excrescences and lymphorrhea in this most severe form of lymphedema.
LINKThe aim of this study is to report on a multidisciplinary outpatient approach to the clinical treatment of lymphedema adapting the conditions of an existing work. The reduction in breast-cancer related lymphedema over two years was evaluated in a retrospective study for a group of 31 women with ages ranging between 35 and 83 years old (mean 56.6 years) in the Godoy Clinic in São José do Rio Preto. The treatment involved manual lymph drainage using the Godoy & Godoy technique, active and passive exercises utilizing facilitating apparatuses designed for these patients, a home-made compression sleeve made of a cotton-polyester fabric, nutritional guidance, psychological support, guidance about occupational activities (day-to-day activities, work and handicraft activities) and directed hydrogymnastics. Constant readjustments were made to the compression sleeves by a professional seamstress. Monthly evaluations were made by water-displacement volumetry. Analysis of variance was employed for statistical analysis with an alpha level of 5% (p-value < 0.05) being considered acceptable. The mean reduction in the first year was 55.2% and in the second year it was 75.8%, respectively, both of which were statistically significant (p-value < 0.001). Significant reduction of breast-cancer related lymphedema and maintenance of the results is possible, however routine check-ups and guidance should continue for periods determined by the treatment team.
LINKOne of the main complications in the treatment of breast cancer is lymphedema. The tests are more specific for the diagnosis of lymphedema in the extremities, though the lymphatic drainage of the chest is also compromised and in need. The aim of the current study was to evaluate the prevalence of chest edema in patients who had been submitted to breast cancer treatment. The prevalence of chest edema in 35 women being treated for arm lymphedema due to breast cancer treatment was evaluated in a retrospective randomized quantitative, blind study in the Clinica Godoy in the period from January to October 2012 using bioimpedance of the thorax. For the descriptive analysis of the results will be used prevalence of the event. The patients’ ages ranged from 42 to 82 years old with an average of 63.7 years. Eight patients had a body mass index (BMI) of less than 25, 16 had between 25 to 30 and 10 had a BMI greater than 30. Chest edema was detected by bioimpedance in four (11.42%) patients. Chest lymphedema is less prevalent than upper limb lymphedema in patients submitted to axillary dissection or it improves faster.
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