Management of Axillary Web Syndrome after Breast Cancer: Evidence-Based Practice / Tratamento da síndrome de rede axilar pós-câncer de mama: prática baseada em evidências

Abstract Axillary web syndrome is characterized as a physical-functional complication that impacts the quality of life of women who have undergone treatment for breast cancer. The present study aims to verify the physiotherapy treatment available for axillary web syndrome after surgery for breast cancer in the context of evidence-based practice. The selection criteria included papers discussing treatment protocols used for axillary web syndrome after treatment for breast cancer. The search was performed in the MEDLINE, Scopus, PEDro and LILACS databases using the terms axillary web syndrome, lymphadenectomy and breast cancer, focusing on women with a previous diagnosis of breast cancer who underwent surgery with lymphadenectomy as part of their treatment. From the 262 studies found, 4 articles that used physiotherapy treatment were selected. The physiotherapy treatment was based on lymphatic drainage, tissue mobilization, stretching and strengthening. The four selected articles had the same outcome: improvement in arm pain and shoulder function and/or dissipation of the axillary cord. Although axillary web syndrome seems to be as frequent and detrimental as other morbidities after cancer treatment, there are few studies on this subject. The publications are even scarcer when considering studies with an interventional approach. Randomized controlled trials are necessary to support the rehabilitation resources for axillary web syndrome.

Resumo A síndrome da rede axilar (ou cordão axilar) é uma complicação físico-funcional que interfere na qualidade de vida de mulheres que foram submetidas a tratamento para o câncer de mama. O objetivo do presente estudo foi verificar os tratamentos fisioterapêuticos disponíveis para a síndrome da rede axilar após o tratamento cirúrgico do câncer de mama no contexto da prática clínica baseada em evidências. Utilizou-se como critério de inclusão artigos que discutissem protocolos de tratamento para a síndrome da rede axilar após o tratamento para o câncer de mama. A pesquisa foi realizada nas bases de dados MEDLINE, Scopus, PEDro e LILACS, utilizando como palavras-chave síndrome da rede axilar linfadenectomia e câncer de mama, com foco em mulheres com diagnóstico de câncer de mama que realizaram cirurgia com linfadenectomia como parte do tratamento. Dos 262 estudos encontrados, foram selecionados 4 artigos que utilizaram fisioterapia, os quais incluíram drenagem linfática, mobilização tecidual, alongamento e fortalecimento. Os quatro artigos selecionados tiveram desfechos similares: melhora da dor no membro superior e na função do ombro e/ou desaparecimento do cordão axilar. Embora a síndrome da rede axilar seja tão frequente e prejudicial quanto as outras morbidades após tratamento para o câncer, existem poucos estudos sobre esse tema. As publicações são ainda mais escassas quando se considera uma abordagem intervencionista. Estudos randomizados controlados são necessários para embasar as técnicas de reabilitação na síndrome da rede axilar após tratamento para o câncer de mama.

Linfangioma cavernoso de la lengua / Cavernous lymphangioma of the tongue

Los linfangiomas son malformaciones congénitas de los vasos linfáticos. Son raros en la cavidad oral y cuando se presentan en la misma pueden provocar trastornos funcionales del sistema estomatognático. El objetivo es presentar un caso de linfangioma cavernoso del dorso de la lengua, revisando los aspectos clínicos y de tratamiento de la enfermedad, con énfasis en la ubicación en la cavidad oral, fundamentalmente en la lengua. Un paciente de 17 años de edad se presenta con una lesión en el dorso de la lengua de aproximadamente 10 años de evolución. La lesión tiene una apariencia pedregosa y una base sésil, y mide aproximadamente 3 cm. El paciente es sometido a escisión quirúrgica de la lesión, sin intercurrencias. Actualmente el paciente se encuentra en seguimiento, sin signos clínicos de recidiva del tumor después de 2 años de tratamiento. La escisión quirúrgica de la lesión parece ser el tratamiento más apropiado para los linfangiomas de la lengua, con bajas tasas de recidiva(AU)

Lymphangiomas are congenital malformations of the lymphatic vessels. They are rare in the oral cavity and when present in this area they may cause functional disturbances of the stomatognathic system. The objective is to report a case of cavernous lymphangioma of the dorsum of the tongue, reviewing the clinical and treatment features of the disease, with emphasis on the oral cavity location, mainly the tongue. A 17-year-old male patient presented with a lesion on dorsum of his tongue of approximately 10 years of evolution. The lesion had a pebbly appearance and a sessile base, and measured about 3 cm. The patient was submitted to surgical excision of the lesion, without any intercurrences. Currently, the patient is under clinical follow-up, without any clinical sign of tumor recurrence after 2 years of treatment. Surgical excision of the lesion seems to be the most adequate treatment for tongue lymphangiomas, with low rates of recurrence(AU)

Comparative Study of Real-Time PCR with Culture in the Diagnosis of Tubercular Lymphadenopathy.

One-third of the world’s population is estimated to be infected with M.tuberculosis. Timely and accurate diagnosis is pivotal in the management of the disease. Conventional tests, although accurate, are time consuming as compared to the more promising latest molecular techniques like real-time PCR which are rapid, reproducible and reliable. Objective : The aim of the study is to compare the real-time PCR with culture method in the diagnosis of tubercular lymphadenopathy. Material and Methods: Present study included 40 patients belonging to the age group 0-40 years and presenting as cervical lymphadenopathy, attending the indoor and out-patient of Department of TB & Chest Diseases, S.N. Medical College, Agra (U.P.) from Jan’2009 to June’2010. All patients were subjected to routine investigations, e.g. hemogram, montoux test, Chest skiagram, AFB staining, and sputum examination. Lymph node aspirate were subjected to decontamination, DNA isolation and Real time PCR( q PCR). Also specimen were simultaneously put to culture on L.J. Media. Results of both modalities compared. Results: Conventional culture method was able to detect M.tuberculosis in 75% of the cases as compared to real-time PCR which was positive in 77.5% with comparable sensitivity (100% vs 96.7%) and specificity (100% vs 87.5%). Conclusion: Conventional culture method is gold standard in the diagnosis of tuberculosis since long but recent molecular assays like Real-time PCR is one of the latest addenda to the armamentarium for the rapid and accurate diagnosis of M.tuberculosis. Needless to say, early diagnosis is advantageous to the management of tuberculosis.

Linfadenopatia cervical na infância: etiologia, diagnóstico diferenciale terapêutica: [revisão] / Cervical lymphadenopathy in children: etiology, differential diagnosis and management: [review]

Linfadenopatia é o termo empregado em qualquer alteração em tamanho e consistência de linfonodos. A linfadenopatia cervical é um problema muito frequente nos pacientes da faixa etária pediátrica e, em geral, representa reação transitória a processos inflamatórios ou infecciosos locorregionais ou sistêmicos. Porém, em uma pequena parcela, há neoplasias como fator etiológico. Na grande maioria das vezes, esses pacientes são efetivamente tratados pelo pediatra, porém, quando não há resposta à terapia inicial ou quando há suspeita de malignidade, o cirurgião pediátrico ou de cabeça e pescoço deve ser consultado. Este trabalho teve por objetivo revisar a etiologia, o diagnóstico diferencial e a terapêutica da linfadenopatia cervical na infância.

Lymphadenopathy refers to any alteration in size and consistency involving lymph nodes. Cervical lymphadenopathy is a very frequent problem in the pediatric group and, in general, represents a transitory reaction to locoregional or systemic inflammatory or infectious process. However, in a few cases, there is neoplasia as etiologic factor. Although most patients are successfully treated by their pediatrician, the pediatric or head and neck surgeon should be consulted for patients who fail to respond to initial therapy or for those in whom there is a suspiciousness of malignancy. The aim of this article was to review the etiology, the differential diagnosis, and the management of cervical lymphadenopathy in children.

Drenagem linfática em paciente com dermatofibrose e flebite de membro inferior: relato de caso / Lymph drainage in patients with dermatofibrosis and phlebitis of the lower limb: case report

O presente estudo objetivou avaliar a drenagem linfática como forma coadjuvante de tratamento, em uma paciente idosa com dermatofibrose, flebite de membro inferior e queixa de dores na perna, localizada em região pós-flebítica. Foi realizado tratamento clínico inicial por três meses com drogas venotônicas (diosmin), anti-inflamatórios, analgésicos e repouso, porém com pouca melhora clínica. Foi, então, associada ao tratamento clínico, a drenagem linfática manual e mecânica. Os resultados obtidos incluíram a redução dos sintomas dolorosos e da hiperpigmentação do local acometido. Este trabalho sugere que a drenagem linfática obteve melhora do quadro clínico de paciente portadora de dermatofibrose, sugerindo novas pesquisas para caracterização mais específica dessa abordagem.

This study aimed at evaluating lymphatic drainage as a complementary form of treatment in an elderly patient with dermatofibrosis and phlebitis of the lower limb. The patient complained of pain in the post-phlebitic region. Initially three months of clinical treatment was performed using vasotonic(diosmine), anti-inflammatory and analgesic drugs and the patient was told to rest. However this treatment was not very effective. Manual and mechanical lymph drainage was associated to the clinical treatment. The results gave a significant improvement in the symptoms and the hyperpigmentation of the affected area. This study suggests that lymph drainage obtained improves the clinical of patient with dermatofibrosis, suggesting new research for more specific characterization of this approach.

Fluoroscopy guided instillation therapy in chyluria using combination of povidone iodine with contrast agent: is a single instillation sufficient?

PURPOSE: To evaluate the safety and efficacy of a single instillation in a combination of povidone iodine with contrast agent under fluoroscopy guidance for the treatment of chyluria. MATERIALS AND METHODS: From December 1999 to July 2006 a total of 40 patients with chyluria were treated by renal pelvic instillation therapy (RPIS). The sclerosing solution was prepared using povidone iodine with contrast agent diluted with sterile water in a ratio of 1:1:3. It was instilled on the side having chylous efflux using a bulb tip ureteric catheter. Unilateral instillation was done in 26 cases, 10 on the right side and 16 on left. Fourteen patients had bilateral chylous efflux and RPIS was performed on both sides in the same session. Fluoroscopy was used to evaluate the complete filling of the pelvic calyceal system. The sclerosing solution was kept in the system for 5 minutes and the ureteric catheter was then withdrawn. RESULTS: Immediate clearance was observed in 39 patients. Recurrence occurred in five patients. They were treated again using the same procedure with satisfactory results. The longest follow-up was five years and the shortest five months. CONCLUSION: RPIS of chyluria using a single instillation a combination of povidone iodine with contrast agent is safe and effective. Use of fluoroscopy helps to determine the exact amount of sclerosing solution required to completely fill the system and therefore overfilling is avoided. Moreover, the complications, which arise due to pyelointerstitial backflow, are prevented.

Síndrome febril prolongado con linfadenopatías: actualización y revisión del tema / Prolonged febrile syndrome with lymphadenopathy: update and review of this process

Presentamos una serie de 5 pacientes con síndrome febril prolongado con linfadenopatías (S.F.P.LA.), 2 de sexo masculino y 3 de sexo femenino, entre 16 y 55 años de edad. La etiología fue: lupus eritematoso sistémico (n=1), sarcoidosis (n=1), síndrome de Felty (n=1), linfadenopatía angioinmunoblástica (n=1) y mononucleosis infecciosa (n=1). Todos los casos fueron diagnosticados entre 1997 y 2002. Realizamos además una revisión y actualización del tema.

Hallazgos en los niños referidos para estudiar por adenopatías / Findings in children studied for adenopathy

Se revisaron los expedientes de 134 niños atendidos en el Centro de Diagnóstico del Hospital Nacional de Niños "Dr Carlos Sáenz Herrera" del 10 de enero de 1984 al 9 de enero de 1985, referidos por el problema de adenopatías. Hubo una mayor frecuencia de hombres, aunque no fue estadísticamente significativa. La mayoría de los niños eran preescolares. Más de la mitad presentaba un problema crónico-reactivo a infección previa. En segundo lugar presentaban adenitis bacteriana y de tercero linfadenitis toxoplásmica. Menos frecuentes fueron aquellos que presentaban becegitis, absceso bacteriano y quiste tirogloso. La mayoría de lo niños no presentó linfadenopatía generalizada ni recibió ningún tratamiento. Se adjunta un algoritmo para el manejo de los niños con linfadenopatías

Síndrome de Histiocitosis: a propósito de un caso

El síndrome de Histiocitosis abarca un espectro de manifestaciones clínicas que van desde la lesión ósea única hasta el severo compromiso cerebral. La imagen anatomopatológica es la de una proliferación de Histiocitos acompañados de otros tipos celulares. Puede remitir espontaneamente. La radioterapia y quimioterapia son de ayuda lo mismo que la cirugía para hacer la limpieza de los bordes oseos afectados. El caso es el de una niña de 2 años con múltiples lesiones óseas, anemia, exoftalmos, retardo en el crecimiento y retardo mental moderados, con dos masas en el cráneo blandas renitentes no dolorosas que, en el acto quirúrgico se observó provenía del hueso y contenía un líquido achocolatado de aspecto cerebroide. No había compromiso meningeo ni parenquimal. Los estudios anatomopatológicos revelaron la presencia de numerosos histiocitos. Dadas las manifestaciones clínicas y la edad de aparición el caso correspondería a un Síndrome intermedio más cercano al Letterer-Siwe por la manifestación visceral. El pronóstico es incierto. La histiocitosis es una Reticulocendoteliosis caracterizada por una proliferación histiocítica de etiología desconocida que abarca un amplio espectro de manifestaciones clínicas que varían desde la lesión aislada y de crecimiento lento hasta una enfermedad agresiva y ampliamente diseminada. Los estudios realizados hasta la fecha han podido demostrar que no es hereditaria ni familiar, que no han sido aislados de las lesiones bacterias hongos ó virus, que no es una enfermedad neoplásica