Terapia complexa descongestiva no tratamento de linfedema pós-mastectomia / Descongestive complex therapy in the treatment of lymphedema after mastectomy

Introdução: O linfedema é a complicação mais frequente no pós-operatório do câncer de mama. Objetivo: Identificar a efetividade do uso da Terapia Complexa Descongestiva (TCD) na redução do volume e no tratamento intensivo do linfedema em pacientes submetidas ao procedimento cirúrgico com esvaziamento axilar devido ao câncer de mama. Métodos: Trata-se de uma revisão sistemática, para o qual foram consultados os bancos de dados Bireme e Pubmed, utilizando artigos científicos em português e inglês de revistas indexadas nas bases de dados Medline, Scielo, Lilacs, Register of Controlled Trials (Cochrane Central) e Physiotherapy Evidence Database (PEDro), publicados entre os anos de 2004 e 2019. Para a construção do trabalho foram incluídos estudos que estivessem disponíveis na íntegra, que a população alvo fosse composta por mulheres submetidas ao procedimento cirúrgico devido ao câncer de mama, com esvaziamento axilar, que apresentassem linfedema e que incluíssem em seus tratamentos, um protocolo fisioterapêutico de TCD. Também de forma independente, foi avaliada a qualidade metodológica dos estudos selecionados com a Escala de Qualidade de JADAD. Resultados: Atualmente, o padrão-ouro dentre as principais técnicas fisioterapêuticas utilizadas para o tratamento do linfedema é a TCD, a qual é composta por drenagem linfática manual, cuidados com a pele e unhas, bandagem de compressão e exercícios terapêuticos. Conclusão: A TCD é considerada o método mais utilizado e eficiente na redução do volume e no tratamento intensivo do linfedema pósmastectomia. (AU)

Introduction: The lymphedema is the most common postoperative complication of breast cancer. Objective: The present study aims to identify the effectiveness of the use of Complex Decongestive Therapy (CDT) in reducing volume and intensive treatment of lymphedema in patients undergoing axillary emptying due to breast cancer. Methods: This was a systematic review, for which Bireme and Pubmed databases were consulted, using scientific articles in Portuguese and English from journals indexed in Medline, Scielo, Lilacs, Register of Controlled Trials (Cochrane Central) databases and Physiotherapy Evidence Database (PEDro), all of them published between the years 2004 to 2019. For the construction of this study, we included articles available in full, with a target population consisting of women undergoing the surgical procedure due to breast cancer, with axillary emptying, who presented lymphedema and who included in their treatments a physical therapy protocol of CDT. Also, independently, the methodological quality of the studies selected was evaluated using the JADAD Quality Scale. Results: Currently, the gold standard among the main physiotherapeutic techniques used for the treatment of lymphedema is CDT, which consists of manual lymphatic drainage, skin and nail care, compression bandaging and therapeutic exercises. Conclusion: The CDT is considered the most used and efficient method for volume reduction and intensive treatment of post-mastectomy lymphedema. (AU)

Estudo comparativo entre drenagem linfática manual e endermoterapia no edema de membros inferiores / Comparative study between manual lymphatic drainage and endermotherapy in the edema of lower limbs

O edema é uma das disfunções associadas ao sistema linfático caracterizado pelo acúmulo de líquido no espaço intersticial. Para a redução e melhora deste problema existe diversas técnicas que possuem como objetivo estimular o sistema linfático aumentando sua capacidade de absorção e circulação da linfa por entre seus vasos até a corrente sanguínea, de modo manual ou eletrônico, como o caso da drenagem linfática manual e da endermoterapia. O presente estudo teve como objetivo verificar se a endermoterapia como drenagem linfática eletrônica possui os mesmo efeitos que a drenagem linfática manual na redução do edema de membros inferiores. Devido ao seu caráter experimental qualitativo pertinente ao tema escolhido, optou-se por um estudo de caso. Este estudo contou com um voluntário do sexo feminino, com idade de 25 anos, apresentando edema nos membros inferiores. Após avaliação feita por anamnese, perimetria e exame físico, foram realizadas 10 sessões de drenagem linfática manual no membro direito e no membro esquerdo drenagem linfática eletrônica por meio do aparelho de endermoterapia Beauty Dermo Vacuoterapia® da marca HTM, para comparação de ambas as técnicas. As sessões foram realizadas duas vezes na semana em um período de 30 dias. Os resultados obtidos mostraram que houve diminuição de 0,5 cm no membro que recebeu a drenagem linfática manual, enquanto aquele que recebeu a técnica de drenagem linfática eletrônica com aparelho de endermoterapia um total de 5,5 cm, além da melhora no aspecto da pele ocasionado pelos efeitos secundários do aparelho. Com o estudo pode-se concluir que a endermoterapia usada como drenagem linfática eletrônica obteve melhores resultados que a drenagem linfática manual, na redução do edema nos membros inferiores, contudo são necessárias novas pesquisas com um grupo maior de indivíduos para melhores resultados. (AU)

Edema is one of the dysfunctions associated with the lymphatic system characterized by the accumulation of fluid in the interstitial space. To reduce and improve this problem, there are several techniques that aim to stimulate the lymphatic system by increasing its capacity for absorption and circulation of lymph through its vessels into the bloodstream, either manually or electronically, such as manual lymphatic drainage and endermotherapy. This study aimed to verify if the endermotherapy as electronic lymphatic drainage has the same effects as manual lymphatic drainage in the reduction of lower limb edema. This case study had a female volunteer, aged 25 years, presenting edema in the lower limbs. After anamnesis, perimetry and physical examination, 10 sessions of manual lymphatic drainage were performed on the right limb and left lymphatic drainage using the HTM brand Beauty Dermo Vacuoterapia® endermoterapia, for comparison of both techniques. The sessions were held twice a week over a period of 30 days. The results showed that there was a decrease of 0.5 cm in the limb that received manual lymphatic drainage, while the one who received the electronic lymphatic drainage technique with an endermotherapy device, a total of 5.5 cm, besides the improvement in the appearance of the skin caused by the side effects of the appliance. We concluded that the endermotherapy used as electronic lymphatic drainage obtained better results than manual lymphatic drainage, in the reduction of the edema in the lower limbs, however, new studies are necessary with a larger group of individuals for better results. (AU)

The effect of amifostine on bacterial translocation after radiation induced acute enteritis

ABSTRACT PURPOSE: To investigate the effects of amifostine on bacterial translocation and overgrowth in colonic flora after acute radiation enteritis in a rat model. METHODS: Thirty-two female Wistar albino rats were divided into four groups: Group-1 (n=8): only normal saline was administered intraperitoneally. Group-2 (n=8): first serum saline was administered intraperitoneally and 30 minutes later 20 Gy radiation was applied to abdominopelvic region. Group-3 (n=8): only amifostine 200 ml/kg was administered intraperitoneally and radiation was not applied. Group-4 (n=8): first amifostine 200 ml/kg was administered intraperitoneally and 30 minutes later 20 Gy radiation was applied to abdominopelvic region. On the 5th day after radiation, samples of mesenteric lymph tissues and cecal contents were taken by laparotomy for microbiological culture. RESULTS: Intraperitoneal amifostine administration significantly decreased the bacterial overgrowth related to radiation in colon but did not significantly decrease the bacterial translocation. CONCLUSİON: Although not providing a full protection on the damaged mucosal barrier, amifostine significantly decreased the bacterial overgrowth in the cecal content after high dose radiation. There is a need to find out appropriate amifostine dose under different radiation applications avoiding bacterial translocation in gastrointestinal system.

Post-hemorrhagic shock mesenteric lymph is an important contributor to cardiac dysfunction following hemorrhagic shock

PURPOSE: To evaluate whether post-hemorrhagic shock mesenteric lymph (PSML) is involved in cardiac dysfunction induced by hemorrhagic shock. METHODS: The hemorrhagic shock model (40±2 mmHg, 3h) was established in rats of the shock and shock+drainage groups; and PSML drainage was performed from hypotension 1-3h in the shock+drainage rats. Then, the isolated hearts were obtained from the rats for the examination of cardiac function with Langendorff system. Subsequently, the isolated hearts were obtained from normal rats and perfused with PSML or Krebs-Henseleit solution, and the changes of cardiac function were observed. RESULTS: The left ventricular systolic pressure (LVSP) and the maximal rates of LV developed pressure (LVDP) rise and fall (±dP/dt max) in the shock and shock+drainage groups were lower than that of the sham group; otherwise, these indices in the shock+drainage group were higher compared to the shock group. In addition, after isolated hearts obtained from normal rats perfusing with PSML, these cardiac function indices were gradual decline along with the extension of time, such as heart rate, LVSP, ±dP/dt max, etc. CONCLUSION: Post-hemorrhagic shock mesenteric lymph is an important contributor to cardiac dysfunction following hemorrhagic shock. .

Equivalent Lever Principle of Ossicular Chain and Amplitude Reduction Effect of Internal Ear Lymph / 生物医学工程学杂志

This paper makes persuasive demonstrations on some problems about the human ear sound transmission principle in existing physiological textbooks and reference books, and puts forward the authors' view to make up for its literature. Exerting the knowledge of lever in physics and the acoustics theory, we come up with an equivalent simplified model of manubrium mallei which is to meet the requirements as the long arm of the lever. We also set up an equivalent simplified model of ossicular chain--a combination of levers of ossicular chain. We disassemble the model into two simple levers, and make full analysis and demonstration on them. Through the calculation and comparison of displacement amplitudes in both external auditory canal air and internal ear lymph, we may draw a conclusion that the key reason, which the sound displacement amplitude is to be decreased to adapt to the endurance limit of the basement membrane, is that the density and sound speed in lymph is much higher than those in the air.

Exogenous normal lymph alleviates lipopolysaccharide-induced acute lung injury through lessening the adhesion molecules

PURPOSE: To evaluate the role of exogenous normal lymph (ENL) on lipopolysaccharide (LPS)-induced acute lung injury (ALI) in rats. METHODS: ALI was induced by the jugular vein injection of LPS (iv, 15 mg/kg) in rats of the LPS and LPS+ENL groups within 15 min, then, ENL without cell components (5 ml/kg) was infused at the speed of 0.5 ml per minute in the LPS+ENL group, the same amount of saline was administered in the LPS group. The rats in the sham group received the same surgical procedure and saline. The histomorphology and the levels of P-selectin, intercellular adhesion molecule-1 (ICAM-1), myeloperoxidase (MPO) in pulmonary tissue were assessed. RESULTS: LPS induced pulmonary injury as well as increased the wet/dry weight ratio (W/D) and the levels of P-selectin, ICAM-1, and MPO in pulmonary tissues. These deleterious effects of LPS were significantly ameliorated by ENL treatment. CONCLUSION: Exogenous normal lymph could markedly alleviate the acute lung injury induced by lipopolysaccharide, and its effects might be related to lessening the adhesion molecules. .

Mesenteric lymph reperfusion exacerbates spleen injury caused by superior mesenteric artery occlusion shock

The intestinal lymph pathway plays an important role in the pathogenesis of organ injury following superior mesenteric artery occlusion (SMAO) shock. We hypothesized that mesenteric lymph reperfusion (MLR) is a major cause of spleen injury after SMAO shock. To test this hypothesis, SMAO shock was induced in Wistar rats by clamping the superior mesenteric artery (SMA) for 1 h, followed by reperfusion for 2 h. Similarly, MLR was performed by clamping the mesenteric lymph duct (MLD) for 1 h, followed by reperfusion for 2 h. In the MLR+SMAO group rats, both the SMA and MLD were clamped and then released for reperfusion for 2 h. SMAO shock alone elicited: 1) splenic structure injury, 2) increased levels of malondialdehyde, nitric oxide (NO), intercellular adhesion molecule-1, endotoxin, lipopolysaccharide receptor (CD14), lipopolysaccharide-binding protein, and tumor necrosis factor-α, 3) enhanced activities of NO synthase and myeloperoxidase, and 4) decreased activities of superoxide dismutase and ATPase. MLR following SMAO shock further aggravated these deleterious effects. We conclude that MLR exacerbates spleen injury caused by SMAO shock, which itself is associated with oxidative stress, excessive release of NO, recruitment of polymorphonuclear neutrophils, endotoxin translocation, and enhanced inflammatory responses.

Exogenous normal lymph reduces liver injury induced by lipopolysaccharides in rats

The liver is one of the target organs damaged by septic shock, wherein the spread of endotoxins begins. This study aimed to investigate the effects of exogenous normal lymph (ENL) on lipopolysaccharide (LPS)-induced liver injury in rats. Male Wistar rats were randomly divided into sham, LPS, and LPS+ENL groups. LPS (15 mg/kg) was administered intravenously via the left jugular vein to the LPS and LPS+ENL groups. At 15 min after the LPS injection, saline or ENL without cell components (5 mL/kg) was administered to the LPS and LPS+ENL groups, respectively, at a rate of 0.5 mL/min. Hepatocellular injury indices and hepatic histomorphology, as well as levels of P-selectin, intercellular adhesion molecule 1 (ICAM-1), myeloperoxidase (MPO), and Na+-K+-ATPase, were assessed in hepatic tissues. Liver tissue damage occurred after LPS injection. All levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in plasma as well as the wet/dry weight ratio of hepatic tissue in plasma increased. Similarly, P-selectin, ICAM-1, and MPO levels in hepatic tissues were elevated, whereas Na+-K+-ATPase activity in hepatocytes decreased. ENL treatment lessened hepatic tissue damage and decreased levels of AST, ALT, ICAM-1, and MPO. Meanwhile, the treatment increased the activity of Na+-K+-ATPase. These results indicated that ENL could alleviate LPS-induced liver injury, thereby suggesting an alternative therapeutic strategy for the treatment of liver injury accompanied by severe infection or sepsis.

Myosin light chain kinase is necessary for post-shock mesenteric lymph drainage enhancement of vascular reactivity and calcium sensitivity in hemorrhagic-shocked rats

Vascular hyporeactivity is an important factor in irreversible shock, and post-shock mesenteric lymph (PSML) blockade improves vascular reactivity after hemorrhagic shock. This study explored the possible involvement of myosin light chain kinase (MLCK) in PSML-mediated vascular hyporeactivity and calcium desensitization. Rats were divided into sham (n=12), shock (n=18), and shock+drainage (n=18) groups. A hemorrhagic shock model (40±2 mmHg, 3 h) was established in the shock and shock+drainage groups. PSML drainage was performed from 1 to 3 h from start of hypotension in shock+drainage rats. Levels of phospho-MLCK (p-MLCK) were determined in superior mesenteric artery (SMA) tissue, and the vascular reactivity to norepinephrine (NE) and sensitivity to Ca2+ were observed in SMA rings in an isolated organ perfusion system. p-MLCK was significantly decreased in the shock group compared with the sham group, but increased in the shock+drainage group compared with the shock group. Substance P (1 nM), an agonist of MLCK, significantly elevated the decreased contractile response of SMA rings to both NE and Ca2+ at various concentrations. Maximum contractility (Emax) in the shock group increased with NE (from 0.179±0.038 to 0.440±0.177 g/mg, P<0.05) and Ca2+ (from 0.515±0.043 to 0.646±0.096 g/mg, P<0.05). ML-7 (0.1 nM), an inhibitor of MLCK, reduced the increased vascular response to NE and Ca2+ at various concentrations in the shock+drainage group (from 0.744±0.187 to 0.570±0.143 g/mg in Emax for NE and from 0.729±0.037 to 0.645±0.056 g/mg in Emax for Ca2+, P<0.05). We conclude that MLCK is an important contributor to PSML drainage, enhancing vascular reactivity and calcium sensitivity in rats with hemorrhagic shock.

Intestinal torsion causing chylous ascites: a rare occurrence

Intestinal torsion and chylous ascites are very rarely associated. We present the case of a 19-year-old man who presented with acute abdomen. Computed tomography of his abdomen showed features suggestive of intestinal torsion. Chylous ascites was incidentally discovered on exploratory laparotomy. The chylous fluid was drained, the small bowel detorted and the coloduodenal adhesion band taken down. The patient's retroperitoneum was explored to exclude occult masses and malformations of the lymphatics. Post surgery, the patient recovered uneventfully. In this case, we postulate that intestinal malrotation had caused the obstruction of the lymphatic flow from the mesenteric lymphatic channels, leading to the exudation of chyle, which then resulted in the accumulation of chylous fluid in the peritoneal cavity. It is important to exclude the more common causes of atraumatic chylous ascites, such as enlarged retroperitoneal lymph nodes or lymphatic malformations.

The effects of mesenteric lymph drainage on erythrocyte rheology in rats with hemorrhagic shock / 中国应用生理学杂志

<p><b>OBJECTIVE</b>To observe the effects of mesenteric lymph drainage on erythrocyte rheology and blood viscosity in hemorrhagic shock rats.</p><p><b>METHODS</b>Wistar rats were randomly divided into sham-shock group, shock group (establishing hemorrhagic shock model), drainage group (establishing hemorrhagic shock model plus drainaging shock mesenteric lymph from hypotension 1 h). At 3 h of hypotension or corresponding time, blood samples were harvested from the abdominal aorta for determining the erythrocytic parameters, erythrocyte electrophoresis, erythrocyte sedimentation rate (ESR) and blood viscosity, and the erythrocytes aggregation index and erythrocyte deformability index were calculated.</p><p><b>RESULTS</b>Compared with the sham-shock group, the red cell contents, hematocrit (HCT), hemoglobin (Hb), mean corpuscular hemoglobin concentration (MCHC), erythrocyte electrophoretic rate and mobility, erythrocyte deformability index, whole blood viscosity, whole blood relative or reduced viscosity at low and high shear rates in shock group were observably lower, and mean corpuscular volume, electrophoretic time of erythrocyte, ESR, K value of equation and K value of emendation, erythrocytes aggregation index, plasma viscosity in shock group were increased markedly; the MCHC, erythrocyte electrophoretic rate and mobility, whole blood viscosity, whole blood relative viscosity at low and high shear rates in drainage group were reduced, and the red blood cell volume distribution width -SD (RDW-SD) was increased remarkably. At the same time, in drainage group, the HCT, RDW-SD, erythrocyte deformability index, whole blood viscosity and relative viscosity at low and high shear rates were higher, the ESR, K value of equation and K value of emendation, erythrocytes aggregation index, plasma viscosity were lower than that of shock group.</p><p><b>CONCLUSION</b>The results indicate that the mesenteric lymph drainage could improve the erythrocyte rheological behavior, as a result, improve the hemorrheological properties in hemorrhagic shock rats.</p>

Involvement of protein kinase C in enhancement of vascular calcium sensitivity by blocking mesenteric lymph return in hemorrhagic shock rats / 生理学报

The aim of the present study was to investigate whether protein kinase C (PKC) was involved in the effect of mesenteric lymph duct ligation or mesenteric lymph drainage on vascular calcium sensitivity in hemorrhagic shock rats. Male Wistar rats were randomly divided into Sham, Shock (hemorrhagic shock), Shock+Ligation (mesenteric lymph duct ligation plus shock) and Shock+Drainage (mesenteric lymph drainage plus shock) groups. After being in shock (hypotension 40 mmHg) for 3 h, the tissue of superior mesenteric artery (SMA) was taken out for detecting the PKC expression and phospho-PKC (p-PKC) activity, and the vascular rings of SMA were prepared and used to measure the response to gradient calcium concentration for assaying the calcium sensitivity, the parameters of which including tension, maximum tension (E(max)) and negative logarithm of EC(50), called the pD(2). Other vascular rings from Shock+Ligation and Shock+Drainage groups were incubated with PKC regulator PMA or Staurosporine before the measurement of calcium sensitivity. The results showed that, PKC expression, p-PKC activity and calcium sensitivity of SMA in Shock group was significantly lower than that of Sham group, whereas the above-mentioned indexes were significantly elevated in Shock+Ligation and Shock+Drainage groups compared with those in Shock group. PKC agonist PMA enhanced the contractile activity of vascular rings to gradient calcium ions, and increased E(max) of SMA in Shock+Ligation and Shock+Drainage groups. On the contrary, PKC inhibitor Staurosporine significantly decreased the response to gradient calcium ions and E(max) of SMA in Shock+Ligation and Shock+Drainage groups. These results suggest that PKC plays a role in the improvement of vascular calcium sensitivity by blockade of mesenteric lymph return in hemorrhagic shock rats.

Mycobacterium bovis infection in goats from the Northeast region of Brazil

A total of 8,058 male and female mixed-breed goats and 1-4 years of age were slaughtered over a period of 7 months at the public slaughterhouse of Patos city, Paraíba state, in the Northeast region of Brazil; 822 animals were inspected for gross lesions of tuberculosis, and 12 (1.46 percent) had lesions suggestive of tuberculosis in the mammary gland, lungs, liver and mediastinal, mesenteric, submandibular, parotid and prescapular lymph nodes. Presence of granulomatous lesions was confirmed in the submandibular lymph node of one (8.3 percent) goat at the histopathological examination and at the mycobacterium culture the same sample was confirmed positive. Isolate was confirmed as belonging to the M. tuberculosis complex by PCR restriction enzyme analysis (PRA). Spoligotyping identified the isolate into spoligotype SB0295 on the M. bovis Spoligotype Database website (www.mbovis.org), and it was classified as M. bovis. The occurrence of M. bovis in goats in this study suggests that this species may be a potential source of infection for humans and should be regarded as a possible problem in the advancement of control and eradication program for bovine tuberculosis in Brazil.

Interference effects of lymph plasma on endotoxic shock in rats / 中国应用生理学杂志

<p><b>OBJECTIVE</b>To investigate the interference effects of lymph plasma on endotoxic shock and its mechanism.</p><p><b>METHODS</b>Sixty Wistar male rats were randomly divided into three groups: control group, model group and lymph plasma group. The endotoxic shock model of rats were duplicated by jugular intravenous injection with LPS (15 mg/kg), and after 15 minutes the normal lymph plasma was infused in lymph plasma group rats, which amount of lymph plasma was one fifteenth of whole blood volume. The effects of lymph plasma on the mean arterial pressure (MAP), microcirculation of mesentery near the ileum lower, the numbers of leukocytes adherent to the venular wall, the P-selectin and intercellular adhesion molecule-1 (ICAM-1) in plasma were observed.</p><p><b>RESULTS</b>The normal lymph plasma might be prevent from progressive decreased of MAP, depress the pathologic diameter constriction of mesenteric microvessels, reduce leukocytes adherent to the venular wall, improve blood flow condition of microcirculation, and decrease the level of P-selectin and ICAM-1 in plasma (P < 0.05, P < 0.01).</p><p><b>CONCLUSION</b>A little of normal lymph plasma plays a positive interference effect on microcirculatory dysfunction and hypotension with endotoxic shock induced by LPS challenge. Those mechanisms may be concerned with decreasing the production of cell adhesion molecules.</p>

Absorption transport mechanism of puerarin oil-in-oil nanoemulsion / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate the mechanisms of the oil-in-oil nanoemulsions transport through the gastrointestinal tract and the transport efficiency changed with its different particle size in the lymphatic channels.</p><p><b>METHOD</b>The behavior of nanoemulsions in vivo and their absorption via lymph after oral administration was investigated, with the transport efficiency and absorption pathway of nanoemulsions clarified by lymph duct cannulation in rats.</p><p><b>RESULT</b>It suggested about 36.8% of puerarin nanoemulsions was transported into systematic circulation via lymph. Nanoparticles with different size absorbed by the lymphatic channels varied as the degree of transportion.</p><p><b>CONCLUSION</b>The degree of absorption and particle transport is inversely proportional to the size.</p>

Method for drainage of lymph fluid and determining the change of active materials in lymph fluid after rat ischemia-reperfusion injury / 中国医学科学院学报

<p><b>OBJECTIVE</b>To set up a method for the drainage of lymph fluid and explore the change of active materials in lymph fluid and serum after rat ischemia-reperfusion injury.</p><p><b>METHODS</b>The method of the drainage of lymph fluid was well established. Sixteen healthy male rats of SPF grade were selected and randomly divided into 2 groups: intestinal ischemia-reperfusion + drainage group (I/R + drainage group) and drainage group. All the rats were subjected to superior mesenteric artery occlusion for 60 minutes, followed by 120 minutes of reperfusion. We compared the change of high mobility group box-1 (HMGB1) protein, endotoxin tumor necrosis factor alpha (TNF-alpha), interleukin (IL) -1 beta, IL-6, and soluble vascular cell adhesion molecular-1 (sICAM-1) by draining lymph fluid and collecting serum in 2 groups.</p><p><b>RESULTS</b>The drainage of lymph fluid was successfully performed. The HMGB1, endotoxin, and cytokines in serum and lymph fluid were significantly higher in ischemia-reperfusion group than in drainage group (P < 0. 05).</p><p><b>CONCLUSIONS</b>The method for drainage of lymph fluid is simple and feasible. Endotoxin, HMGB1, and some cytokines in serum and lymph fluid may mediate the ischemia-reperfusion injury.</p>

Drenaje linfatico manual, como parte del tratamiento en el síndrome del dolor regional complejo tipo I de extremidad superior / Manual lymphatic drainage in the treatment of complex regional pain syndrome type I of upper extremity

Síndrome de Dolor Regional Complejo Tipo -1 (SDRC- 1) constituye un conjunto de manifestaciones clínicas que se caracterizan, por dolor e impotencia funcional. Se relacionan con trastornos vasomotores intensos y prolongados, entre ellos edema y con alteraciones tróficas que afectan a parte o la totalidad de un miembro. El origen traumático es la causa más frecuente de SDRC - 1, aunque también puede desarrollarse a partir de una complicación iatrogénica de un tratamiento quirúrgico o médico. En el SDRC 1 se presenta un funcionamiento alterado del sistema nervioso simpático, lo cual produce una alteración vasomotora que contribuirá a la formación de un edema local de tipo mixto. El Drenaje Linfático Manual (Leduc) podría incorporarse dentro de un plan de tratamiento de esta patología. Con el DLM se pretende disminuir el edema, con lo que se atenuaría parte del dolor que presenta el paciente, ya que se lograría reducir, por un lado el estímulo mecánico que genera una presión anormal en los tejidos blandos de la extremidad afectada y el estímulo químico, causado por la acumulación de metabolitos en estos tejidos. Con esto se podría obtener mejores resultados en el tratamiento del SDRC 1.

The Complex Regional Pain Syndrome Tipe- I (SDRC-I) constitutes a set of clinical manifestations that are characterized, by pain and functional impotence. Theyare related to intense and prolonged vasomotors upheavals, among them edema and with trophics alterations that affect to a part or the totality of a member. The traumatic origin is the most frequent cause of SDRC- 1, although also can be developed from a iatrogenic complication of a surgical or medical treatment. In SDRC- I an altered operation of the likeable nervous system appears, which produces a vasomotor alteration that will contribute to the formation of a local edema of mixed type. The Manual Lymphatic Drainage (Leduc) could be gotten up within a plan of treatment of this pathology. With the DLM it is tried to diminish the edema, with which part of the pain that the patient presents would be attenuated, since it would be reduced, on one hand the mechanical stimulus that generates an abnormal pressure in soft weaves of the affected extremity and the chemical stimulus, caused by the accumulation of metabolitos in these weaves. With this it would be possible to obtain better results in the treatment of SDRC- 1.

A dynamic model describing lymphatic circulation / 生物医学工程学杂志

Based on the morphology and function of lymphatic vessel, and on the achievements of researches in the regulatory mechanism of lymphatic circulation, we fully considered the dynamic interaction of blood, interstitial fluid and lymph fluid; then we imitated and used Sungawa's method of analyzing the heart output, and finally set up a dynamic model for describing lymphatic circulation. Comparison of our calculating results with the data from Ikomi's experiment showed that they were identical, thus indicating that our model is of value in explaining the dynamic mechanism of lymphatic circulation. In this paper is especially calculated the relationship between lymph flow and massage frequency, which is useful for analyzing the effect of massage on the lymph flow rate with respect to this model.

Effect of manual lymph drainage massage on hand edema and shoulder pain in hemiplegic-paretic patients post stroke

Shoulder pain and hand edema associated with hemiparesia and hemiplegia are common complications after the stroke and restricts the patient's daily activities. Therefore, this study was conducted to evaluate the effect of manual lymph drainage [MLD] massage on hand edema and shoulder pain in hemiplegic-paretic patients post stroke. In this randomized clinical trial study, 62 stroke patients with age ranging of 35-70 years and having shoulder pain and hand edema associated with hemiparesia or hemiplegia were selected and randomly divided into two groups of case and control. Then, manual lymph drainage massage [MLD] was performed in the case group for five sessions and each session last 20 minutes. The MLD was not performed for the control group. Sensory, affective, intensity and general condition of shoulder pain and also circle size of wrist and middle part of the arm were assessed using of McGill Pain Questionnaire-Short Form: [MPQ-SF] and tape gauge, before and 24 hours after last session of MLD in both the case and control group. The acquired data were analyzed using independent t and paired t-tests. The means of sensory components of shoulder pain before and after massage was 2.3 +/- 0.9 and 1.3 +/- 0.4, respectively [p<0.05]. Based on the Visual Analogue Scale [VAS], the mean of shoulder pain intensity, after massage, in the case and control group was 3.3 +/- 1.2 and 4.8 +/- 1.5, respectively. The mean of arm circle size before and after massage in the case group was 29 +/- 4.6 and 28.1 +/- 3.9 centimeter, and in the control group was 29.4 +/- 4.1 and 29.7 +/- 3.9 centimeter, respectively [p<0.05]. Also, the mean of wrist circle size, before and after massage in case group was 17.2 +/- 1.1 and 16.4 +/- 0.9 centimeter, while in the control group, it was 16.9 +/- 0.8 and 17.1 +/- 1.1 centimeter, respectively [p<0.05]. Based on the results of this study application of MLD by the health care personnel would be effective in prevention or decrease of shoulder pain and hand edema

The changes in the tumor necrosis factor alpha, interleukin-6 and interleukin-8 levels in the lymph and of the dynamics of the lymphokines during shock stage of rats with major burns / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study the dynamic changes in the lymphokines and the changes in tumor necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), interleukin-8 (IL-8) levels in the lymph during shock stage of rats with major burns.</p><p><b>METHODS</b>Forty-two male adult Wistar rats were randomly divided into burn resuscitation group (A, n = 18), burn non-resuscitation (B, n = 18) and the control (C, n = 6) groups. The TNF-alpha, IL-6 and IL-8 levels in the lymph were determined with radioimmunoassay at 6, 24, 48 postburn hours (PBH). The lymphokines in the mesenteric lymphatic vessels was observed at 6, 24 and 48 PBH with inverted microscopy and digital image processing, and the contraction frequency of the lymphatic was calculated. The lymph was collected by cannulation of the chylous cistern, and its speed of flow was calculated.</p><p><b>RESULTS</b>The lymphatic contents of TNF-alpha and IL-6 in both A and B groups began to increase at 6PBH, reaching the peak values at 24 PBH (TNF-alpha in A and B groups were 1.61 +/- 0.27 ug/L and 1.86 +/- 0.34 ug/L, respectively; IL-6 in A and B groups were 398 +/- 67 ng/L and 572 +/- 97 ng/L, respectively), and they were significantly higher than those in C group at each time points (P < 0.01), meanwhile there was also obvious difference in them between A and B groups (P < 0.01). The lymphatic contents of IL-8 in A and B groups began to increase at 24 PBH, and continued to increase till 48PBH (540.29 +/- 0.32 ng/L in A group, 863.48 +/- 105.16 ng/L in B group), which were evidently higher than those in C group (P < 0.01). There was significant difference in IL-8 contents between A and B groups (P < 0.01). The contraction frequency of the mesenteric lymphatic vessels in A and B groups were decreased, especially so at 24 PBH (P < 0.01). The speed of lymphatic flow in A and B groups was increased at each time points (P < 0.01). The central chylous vessels in the villi of the small intestine were extremely dilated as seen under microscope.</p><p><b>CONCLUSION</b>After burn injury, the lymphatic vessels dilated, with its motility decreased and speed of flow increased, and the contents of TNF-alpha, IL-6 and IL-8 in lymph were increased during the shock stage of burn rats. Fluid resuscitation could improve the lymph circulation.</p>