Fotobiomodulação na Síndrome de Stevens-Johnson no Câncer de Mama Metastático: Relato de Caso / Photobiomodulation in Stevens-Johnson Syndrome in a Metastatic Breast Cancer: Case Report / La Fotobiomodulación en el Síndrome de Stevens-Johnson en el Cáncer de Mama Metastásico: Informe de Caso

Introdução: A síndrome de Stevens-Johnson é uma condição rara e potencialmente fatal que requer diagnóstico precoce e tratamento adequado para garantir bom prognóstico. Em virtude da complexidade da síndrome e da falta de tratamento padrão para as feridas, o uso da fotobiomodulação tem sido discutido. Relato do caso: Mulher, 30 anos, com câncer de mama metastático, portadora das síndromes de Stevens-Johnson e de Li-Fraumeni Like, em uso da fotobiomodulação como estratégia adjuvante no tratamento da dor e das feridas na pele. As feridas cutâneas eritematosas envolveram quase toda a superfície corpórea, com lesões escamosas, crostosas e bolhosas, dolorosas, com pontos hemorrágicos em região posterior de ambos os lóbulos das orelhas e na região occipital, dificultando a acomodação da paciente em decúbito lateral e em posição semirreclinada. Foram realizadas duas aplicações da fotobiomodulação (vermelho, com comprimento de onda de 660 nm) nas regiões occipital e de orelhas, com dose de 2 Joules por ponto; e 4 Joules em região escapular para analgesia (infravermelho, com comprimento de onda de 808 nm). Ambas as aplicações foram seguidas de mobilização e liberação miofascial na região escapular. Em 48 horas, houve regressão das lesões cutâneas e melhora da dor, facilitando posicionamento adequado e indolor no leito. Após 15 sessões de fisioterapia, a paciente recebeu alta hospitalar. Conclusão: O uso da fotobiomodulação se mostrou eficaz para o tratamento complementar da fase aguda da síndrome de Stevens-Johnson no que diz respeito à regeneração tecidual e analgesia.

Introduction: Stevens-Johnson syndrome is a rare but potentially fatal condition, which requires early diagnosis and treatment to ensure good prognosis. Due to the complexity of the syndrome and the lack of a standard wound care treatment, the use of photobiomodulation has been discussed. Case report: A 30-year-old woman with metastatic breast cancer and Stevens-Johnson and Li-Fraumeni Like syndromes using photobiomodulation as an adjuvant strategy in the treatment of pain and skin wounds. The erythematous cutaneous lesions involved almost the entire body surface with painful, scaly, crusted and bullous lesions with bleeding spots in the posterior region of both ears lobes and in the occipital region which made it difficult to accommodate the patient in lateral decubitus and in semi-recumbent position. Two photobiomodulation applications (red, with a wavelength of 660 nm) were performed, where lesions in the occipital region and ears were treated with a dose of 2 Joules per point and 4 Joules in the scapular region for pain relief (infrared, with a wavelength of 808 nm), followed by mobilization and myofascial release in the scapular region. In 48 hours, the cutaneous lesions reduced, and the pain improved, which facilitated the adequate and painless positioning in bed. After 15 physiotherapy sessions, the patient was discharged. Conclusion: Photobiomodulation has been shown to be effective in the complementary treatment of the acute phase of Stevens-Johnson Syndrome regarding tissue regeneration and analgesia.

Introducción: El síndrome de Stevens-Johnson es una condición rara y potencialmente fatal que requiere diagnóstico temprano y tratamiento adecuado para asegurar un buen pronóstico. Debido a la complejidad del síndrome y la falta de un tratamiento estándar de las heridas, se ha discutido el uso de fotobiomodulación. Informe del caso: Mujer, 30 años, con cáncer de mama metastásico, portadora de los síndromes de Stevens-Johnson y Li-Fraumeni Like en uso de la fotobiomodulación como estrategia adyuvante para el tratamiento del dolor y las heridas cutáneas. Las heridas cutáneas eritematosas comprometían casi toda la superficie corporal, con lesiones dolorosas, descamativas, costrosas y ampollosas, con puntos hemorrágicos en la región posterior de ambos lóbulos de las orejas y en la región occipital, que dificultaban la acomodación del paciente en decúbito lateral y en posición cómoda semirrecostada. Se realizaron dos aplicaciones de fotobiomodulación (rojo, con longitud de onda de 660 nm) en región occipital y auricular con dosis de 2 Joules por punto; y 4 Joules en la región escapular para analgesia (infrarrojo, con longitud de onda de 808 nm). Ambas aplicaciones fueron seguidas de movilización y liberación miofascial en la región escapular. En 48 horas hubo una regresión de las lesiones cutáneas y mejoría del dolor, lo que facilitó una adecuada e indolora posición en la cama. Después de 15 sesiones de fisioterapia, la paciente fue dada de alta del hospital. Conclusión: El uso de la fotobiomodulación demostró ser efectivo para el tratamiento complementario de la fase aguda del síndrome de Stevens-Johnson en lo que respecta a la regeneración tisular y la analgesia.

Cerebral blood flow assessment of preterm infants during respiratory therapy with the expiratory flow increase technique / Avaliação do fluxo sanguíneo cerebral de recém-nascidos prematuros durante a fisioterapia respiratória com a técnica do aumento do fluxo expiratório

Objective: To assess the impact of respiratory therapy with the expiratory flow increase technique on cerebral hemodynamics of premature newborns. Methods: This is an intervention study, which included 40 preterm infants (≤34 weeks) aged 8-15 days of life, clinically stable in ambient air or oxygen catheter use. Children with heart defects, diagnosis of brain lesion and/or those using vasoactive drugs were excluded. Ultrasonographic assessments with transcranial Doppler flowmetry were performed before, during and after the increase in expiratory flow session, which lasted 5min. Cerebral blood flow velocity and resistance and pulsatility indices in the pericallosal artery were assessed. Results: Respiratory physical therapy did not significantly alter flow velocity at the systolic peak (p=0.50), the end diastolic flow velocity (p=0.17), the mean flow velocity (p=0.07), the resistance index (p=0.41) and the pulsatility index (p=0.67) over time. Conclusions: The expiratory flow increase technique did not affect cerebral blood flow in clinically-stable preterm infants.

Objetivo: Avaliar a repercussão da fisioterapia respiratória com a técnica de aumento do fluxo expiratório sobre a hemodinâmica cerebral de recém-nascidos prematuros. Métodos: Estudo de intervenção no qual foram incluídos 40 neonatos prematuros (≤34 semanas) com 8-15 dias de vida, clinicamente estáveis em ar ambiente ou em uso de cateter de oxigênio. Foram excluídas crianças com malformações cardíacas, diagnóstico de lesão cerebral e/ou em uso de drogas vasoativas. Exames de ultrassonografia com avaliação por dopplerfluxometria cerebral foram feitos antes, durante e depois da sessão de aumento do fluxo expiratório, que durou cinco minutos. Foram avaliadas as velocidades de fluxo sanguíneo cerebral e os índices de resistência e pulsatilidade na artéria pericalosa. Resultados: A fisioterapia respiratória não alterou significativamente a velocidade de fluxo no pico sistólico (p=0,50), a velocidade de fluxo diastólico final (p=0,17), a velocidade média de fluxo (p=0,07), o índice de resistência (p=0,41) e o índice de pulsatilidade (p=0,67) ao longo do tempo. Conclusões: A manobra de aumento do fluxo expiratório não afetou o fluxo sanguíneo cerebral em recém-nascidos prematuros clinicamente estáveis.

[Cerebral blood flow assessment of preterm infants during respiratory therapy with the expiratory flow increase technique]. / Avaliação do fluxo sanguíneo cerebral de recém-nascidos prematuros durante a fisioterapia respiratória com a técnica do aumento do fluxo expiratório.

OBJECTIVE: To assess the impact of respiratory therapy with the expiratory flow increase technique on cerebral hemodynamics of premature newborns. METHODS: This is an intervention study, which included 40 preterm infants (≤34 weeks) aged 8-15 days of life, clinically stable in ambient air or oxygen catheter use. Children with heart defects, diagnosis of brain lesion and/or those using vasoactive drugs were excluded. Ultrasonographic assessments with transcranial Doppler flowmetry were performed before, during and after the increase in expiratory flow session, which lasted 5minutes. Cerebral blood flow velocity and resistance and pulsatility indices in the pericallosal artery were assessed. RESULTS: Respiratory physical therapy did not significantly alter flow velocity at the systolic peak (p=0.50), the end diastolic flow velocity (p=0.17), the mean flow velocity (p=0.07), the resistance index (p=0.41) and the pulsatility index (p=0.67) over time. CONCLUSIONS: The expiratory flow increase technique did not affect cerebral blood flow in clinically-stable preterm infants.

Manual lymphatic drainage and multilayer compression therapy for vulvar edema: a case series.

BACKGROUND AND OBJECTIVE: Vulvar edema is a condition rarely reported and without defined treatment that may result in functional limitation. The aim of the report is to describe a case series of patients with disabling vulvar edema of different etiologies that were treated with manual lymphatic drainage (MLD) and multilayer compression therapy (MCT). CASE SERIES: Four cases of vulvar edema are described: one in a woman with cervical cancer; one in a woman in the postoperative period of bilateral adrenalectomy for pheocromocytoma; and two in pregnant women with preeclampsia. All cases were treated with MLD and MCT during hospitalization. OUTCOMES: Total resolution of the edema occurred in 2 to 5 d of treatment. CONCLUSION: The present case series is the first to report the use of the MLD and MCT in the successful management of female genital edema. This report suggests that the vulvar edemas for these four patients treated with MLD and MCT seem to resolve faster than expected based on previously reported untreated edemas or edemas treated with different therapeutic approaches.

An evaluation of peak inspiratory pressure, tidal volume, and ventilatory frequency during ventilation with a neonatal self-inflating bag resuscitator.

BACKGROUND: Although the self-inflating bag is widely used in the hospital setting, variability of delivered ventilatory parameters is usually high, which might result in both hypoventilation and lung injury. The aims of this study were to assess possible sources of the high variability and to evaluate the adequacy of obtained values in relation to the recommended values for neonatal resuscitation. METHODS: This was an experimental study in which 172 health professionals (physicians, resident physicians, physiotherapists, nurses, and nursing technicians) who work with neonatal intensive care manually ventilated a test lung (adjusted to simulate the lungs of an intubated term newborn) with a self-inflating bag in 5 different handling techniques, using 10, 5, 4, 3, and 2 fingers. Delivered values of peak inspiratory pressure (PIP), tidal volume (V(T)), and ventilatory frequency (f) were compared, taking into account the different handling modalities and professions by analysis of variance for repeated measures. Chi-square, the Friedman test and the Fisher exact tests were performed to compare the delivered and standard values. RESULTS: PIP and V(T) were significantly affected by the handling technique, with higher values for a greater number of fingers used for ventilation. Profession also influenced V(T) and f significantly: physiotherapists tended to deliver higher volumes and lower rates. Nevertheless, we observed high variability of all studied ventilatory parameters and overall inadequacy of obtained values. Most volunteers delivered excessive pressures and volumes at insufficient ventilatory frequency. CONCLUSIONS: Delivered values seem to depend on operators' individual and professional differences, as well as on the number of fingers used to compress the bag. However, from the clinical point of view, it is important to point out the high occurrence of inadequate delivered values, regardless of handling technique and profession.

O uso da ventilação mecânica não-invasiva nos cuidados paliativos de paciente com sarcoma torácico metastático: relato de caso / The use of noninvasive mechanical ventilation in the palliative care of a patient with metastatic thoracic sarcoma: case report

JUSTIFICATIVA E OBJETIVOS: Os cuidados paliativos se baseiam na prevenção e alívio do sofrimento, identificando, avaliando e tratando a dor e outros problemas físicos, psicossociais e espirituais. Quadros súbitos de dispnéia são freqüentes em pacientes oncológicos em fase terminal. Nestes casos, a ventilação mecânica não-invasiva pode ser uma boa opção no manuseio da dispnéia, promovendo conforto e permitindo o contato do paciente com seus familiares. O objetivo deste estudo foi apresentar os benefícios obtidos com a ventilação mecânica não-invasiva no paciente sob cuidados paliativos. RELATO DO CASO: Paciente com 29 anos, em pós-operatório imediato de cesariana, admitida na unidade de terapia intensiva (UTI) para tratamento de insuficiência respiratória aguda. À radiografia de tórax visualizava-se massa pulmonar a direita. Após investigação clínica e de imagem foi diagnosticado sarcoma torácico metastático em fase avançada, sendo indicadas pela equipe de Oncologia medidas e cuidados paliativos. Para alivio da dispnéia, a equipe multidisciplinar da UTI optou pelo uso de ventilação mecânica não-invasiva (modalidade CPAP + PSV), permitindo a interação da mãe com o bebê e familiares. CONCLUSÕES: No contexto de cuidados paliativos, a VMNI mostrou-se ser um método capaz de contribuir para o controle da dispnéia provendo conforto e alívio ao paciente.

BACKGROUND AND OBJECTIVES: Palliative care is based on prevention and relief of suffering, identifying, assessing and treating pain and other physical, psychological, social and spiritual problems. Sudden dyspnea is frequently observed in terminal oncologic patients. In these cases, noninvasive ventilation can be an adequate option to control dyspnea promoting comfort and allowing patient interaction with their relatives. The aim of this article was to present the benefits of noninvasive ventilation in the palliative care setting. CASE REPORT: The case of a 29 year old patient, admitted in intensive care unit (ICU), after cesarean section delivery, for clinical treatment of acute respiratory failure is reported. Chest X-ray showed pulmonary mass in the right lung. After clinical and image investigation, metastatic thoracic sarcoma was diagnosed and palliative cares were introduced. The ICU interdisciplinary team chose to use noninvasive ventilation (modality CPAP + PSV) to relieve dyspnea and discomfort, as well as to allow interaction with her baby and family. CONCLUSIONS: Palliative care with noninvasive ventilation contributed to increase comfort of the patient by controlling dyspnea.

The use of noninvasive mechanical ventilation in the palliative care of a patient with metastatic thoracic sarcoma: case report. / O uso da ventilação mecânica não-invasiva nos cuidados paliativos de paciente com sarcoma torácico metastático: relato de caso.

BACKGROUND AND OBJECTIVES: Palliative care is based on prevention and relief of suffering, identifying, assessing and treating pain and other physical, psychological, social and spiritual problems. Sudden dyspnea is frequently observed in terminal oncologic patients. In these cases, noninvasive ventilation can be an adequate option to control dyspnea promoting comfort and allowing patient interaction with their relatives. The aim of this article was to present the benefits of noninvasive ventilation in the palliative care setting. CASE REPORT: The case of a 29 year old patient, admitted in intensive care unit (ICU), after cesarean section delivery, for clinical treatment of acute respiratory failure is reported. Chest X-ray showed pulmonary mass in the right lung. After clinical and image investigation, metastatic thoracic sarcoma was diagnosed and palliative cares were introduced. The ICU interdisciplinary team chose to use noninvasive ventilation (modality CPAP + PSV) to relieve dyspnea and discomfort, as well as to allow interaction with her baby and family. CONCLUSIONS: Palliative care with noninvasive ventilation contributed to increase comfort of the patient by controlling dyspnea.