[Rationale for early rehabilitation of patients with uterine corpus cancer]. / Obosnovanie rannei reabilitatsii bol'nykh rakom tela matki.

OBJECTIVE: To study the dynamics of hemorheologic changes and the frequency of early complications of laparoscopic radical hysterectomy in patients with uterine corpus cancer depending on conducting rehabilitation activities in the early postoperative period. MATERIAL AND METHODS: The number of patients with uterine corpus cancer equal 49 (mean age 54.8±2.2 years), divided into 2 comparable groups, was examined: experimental group - 23 patients, who received local magnetotherapy since the first day after surgery for 5-6 days, and control group - 26 patients without physiotherapy. Comparative group included 24 healthy women. The basic rheological parameters, namely blood viscosity at high and low shear rate, hematocrit, erythrocytes' aggregation and deformability, erythrocytes and platelets electrophoretic mobility, were evaluated in all patients initially, on the 1st and 5th days after surgery and in comparison group. RESULTS: There were changes in the rheological properties of the blood before surgery in patients of both groups: increase of blood viscosity, enhancement of aggregation activity of its formed elements, decrease of erythrocytes' deformability properties. The laparoscopic radical hysterectomy was accompanied by the exacerbation of these disorders. The early magnetotherapy in patients reduced hemorheological abnormalities up to the preoperative parameters (p<0.05) for 5 days, as well as reduced the incidence of early postoperative complications by 2.4 times compared to the control group. CONCLUSION: The application of local low-frequency low-intensity magnetotherapy since the first postoperative day allows to reduce the level of postoperative hemorheological abnormalities up to the level of preoperative parameters, as well as the frequency of early postoperative complications.

[Potential use of thermoneutral «dry immersion¼ in oncological rehabilitation]. / Potentsial'noe ispol'zovanie termoneitral'noi «sukhoi immersii¼ v onkoreabilitatsii.

OBJECTIVE: To conduct an analytical review of the available literature data on thermoneutral «dry immersion¼ (TSI) - a method that simulates the state of weightlessness/microgravity. MATERIAL AND METHODS: The review included data from electronic databases: Scopus, Web of Science, MedLine, Wiley, World Health Organization, The Cochrane Central Register of Controlled Trials, ScienceDirect, PubMed, elibrary, CyberLeninka, disserCat. RESULTS: The extensive database of in vitro studies contains information on the reduction of cell proliferation, invasion, migration and increased apoptosis of thyroid, breast, lung, stomach, colon cancer cells, Hodgkin's lymphoma, glioblastoma, leukemia, melanoma, osteosarcoma of a human under the influence of microgravity. The vast majority of works are devoted to experiments on healthy people to finding out the mechanisms of action of long-term continuous microgravity. The study of the therapeutic effect of TSI as a physiotherapeutic procedure of one or repeated sessions was carried out by individual authors. Positive results of a short stay in the unsupported model were obtained in the treatment of children with perinatal disorders, cerebral palsy, patients with hypertension in a state of hypertensive crisis, Parkinson's disease, skin burn II gr. The results of the analytical review provide an opportunity to begin scientific research on the effectiveness and safety of thermoneutral «dry immersion¼ in the complex rehabilitation of cancer patients.

[Pilot study of oncological safety of extracorporeal shock wave therapy for post-mastectomy lymphedema in patients with breast cancer]. / Pilotnoe issledovanie onkologicheskoi bezopasnosti ekstrakorporal'noi udarno-volnovoi terapii postmastektomicheskoi limfedemy u bol'nykh rakom molochnoi zhelezy.

PURPOSE OF THE STUDY: Studying the long-term results of extracorporeal shock wave therapy (ESWT) in patients with breast cancer (BC) to obtain preliminary data on the oncological safety of the method, necessary for planning further extensive studies. MATERIAL AND METHODS: The pilot study included 18 women aged 45 to 70 years (mean age 55.6 years) with breast cancer of stages I-IIIA (stage I - in 4 cases, stage IIA - in 8 cases, stage IIIA - in 6 cases) and postmastectomy lymphedema. 11 (61%) patients received complex treatment, 7 (39%) patients received combined treatment. ESWT from the MasterPuls MP200 apparatus was performed with a radial shock wave on the axillary region on the side of the surgical operation using a dynamic technique: R-SW applicator with a standard D20-S nozzle, penetration depth 50 mm, pressure 2-2.5 bar, pulse frequency 8-10 Hz, 2000-4000 pulses each session, 1 time per week, 5 procedures in 1 course. RESULTS: After a course of ESWT, the average decrease in the volume of the edematous upper limb for the entire group of patients was 41.8±4.6% (p<0.05) with the effect maintained for 3 years. During 3 years of observation, none of the patients developed breast cancer progression - ESWT did not have a negative effect on the course of breast cancer and did not worsen oncological parameters. CONCLUSION: Obtained data can serve as a basis for well-organized cohort studies of the expediency of using shock wave therapy in oncology rehabilitation of patients.

[Shock wave therapy in oncology: in vitro, in vivo, rehabilitation]. / Udarno-volnovaya terapiya v onkologii: in vitro, in vivo, reabilitatsiya.

Extracorporeal shock wave therapy (ESWT) is a relatively new branch of physiotherapy. PURPOSE OF THE STUDY: Conduct an analytical review of the available literature data on the use of ESWT in oncology. MATERIAL AND METHODS: A review was conducted, including data from electronic databases: Scopus, Web of Science, MedLine, World Health Organization, The Cochrane Central Register of Controlled Trials, ScienceDirect, US National Library of Medicine National Institutes of Health, PubMed, Google Scholar, elibrary, CyberLeninka, disserCat. RESULTS AND CONCLUSION: The study of ESWT in oncology is carried out in two directions: 1) impact on the tumor with the aim of its disintegration, inhibition of growth, enhancement of the action of radiation and/or chemotherapy; 2) rehabilitation of cancer patients. Shock waves in vitro and in vivo significantly reduce the viability and activate apoptosis of cell lines of osteosarcoma, cancer of the stomach, colon, rectum, bladder, breast, urothelial cancer of the upper urinary tract, adenocarcinoma of the cervix, Burkitt's lymphoma, sarcoma, anaplastic thyroid cancer glands, glioblastoma multiforme. Shock waves also sensitize tumor cells for adjuvant chemotherapy and increase its antitumor activity. The lack of a stimulating effect on a number of malignant tumors in this physical factor makes it possible to conduct ESWT studies in the rehabilitation of cancer patients. The data obtained by a number of authors indicate the clinical efficacy of ESWT in the rehabilitation of patients with erectile dysfunction after radical prostatectomy, with postmastectomy lymphedema of the upper limb, with myofascial pain syndrome after cervical lymph node dissection due to malignant neoplasms of the head and neck, with peripheral polyneuropathy induced by cytostatics. However, in order to develop indications and contraindications for the appointment of ESWT in the rehabilitation of cancer patients, it is not enough just to evaluate its clinical effectiveness; currently absent scientific studies with long-term follow-up of patients who received this method of physiotherapy are needed.

[Physical therapy for vertebrogenic pain syndrome in patients with non-aggressive vertebral hemangioma]. / Rezul'taty primeneniya fizicheskikh metodov lecheniya patsientov s vertebrogennymi bolevymi sindromami pri nalichii neagressivnoi gemangiomy pozvonka.

The vertebral hemangioma (VH) and vertebrogenic pain syndromes of other etiologies are currently not a problem in terms of the choice of treatment method. However, the combination of these conditions makes the situation much more challenging. The question of the safety of physical treatment methods in these patients remains open, since there is no scientific evidence in this area. OBJECTIVE: To study the long-term results of electrotherapy, magnet therapy, lazer therapy, therapeutic exercises (TE), and therapeutic massage (in different combinations) in patients with degenerative-dystrophic processes of the spine and nonaggressive VH. MATERIAL AND METHODS: The study included 104 patients (75 females, 29 males) with degenerative-dystrophic processes of the spine and non-aggressive VH. The time between the treatment course and follow-up examination was 12 months. RESULTS: VHs remained unchanged in 86.5% of patients. An increase in size was noted in 13.5%. In no case did the VH become aggressive. After the TE course, the rate of VH size increase was 10.8%. The combination of TE with massage and electrotherapy (including a combination of all methods) resulted in an increase in VH size in 17.9, 20.0, 23.8% of cases, respectively. When magnet therapy was used, an increase in VH size was recorded significantly less frequently (p=0.021). No differences in the rate of VH size increase depending on sex, age (40-70 years), localization, and size were observed. In case of multiple VHs, the rate of growth was 23.1. CONCLUSION: A limitation of the study was the relatively small number of patients, which could, in some cases, affect the correctness of statistical data. Nevertheless, there is a general trend of the effect of physical treatments on the course of non-aggressive VH in patients with vertebrogenic pain syndromes. Such patients may be recommended low-frequency low-intensity electro- and magnet therapy, therapeutic back massage, and TE.

[Rehabilitation methods for cancer patients with peripheral polyneuropathy induced by cytostatics]. / Metody reabilitatsii onkologicheskikh bol'nykh s perifericheskoi polineiropatiei, indutsirovannoi tsitostatikami.

An analytical review of the methods of cancer patients' rehabilitation with peripheral polyneuropathy induced by cytostatics (PNPIC) was carried out. Studies from electronic databases were investigated: Scopus, Web of Science, MedLine, World Health Organization, The Cochrane Central Register of Controlled Trials, ScienceDirect, US National Library of Medicine National Institutes of Health, PubMed Cancer, eLIBRARY, CyberLeninka. Despite the improvement of anticancer therapy and an increase in patients' life expectancy, the emerging peripheral polyneuropathy remains an urgent problem, since it significantly affects both the patients' life quality and the selection of adequate therapy. The frequency of detection of PNPIC is 90%, after discontinuation of treatment; symptoms of damaged peripheral nerve fibers remain in 30% of patients. The clinical symptoms of PNPIC are varied and most often include numbness in the extremities and / or increased sensitivity to thermal or mechanical stimuli, neuropathic pain. Currently, to prevent PNPIC, treatment is being modified with a reduction in the duration of courses and doses of cytostatics, and interruption of treatment. Official guidelines do not recommend any prophylaxis other than the possible use of duloxetine or a topical gel containing baclofen, amitriptyline, and ketamine. Over the past few years, there has been no significant progress in the prevention and treatment of PNPIC. The most common drug treatment method in clinical practice is the prescription of vitamins B. Among the non-drug treatment methods of PNPIC, the authors used acupuncture, electro-acupuncture, manual therapy, massage, gymnastics, yoga, sensorimotor training, general vibration therapy, percutaneous electro-neuro-stimulation, electro-analgesia, local cryotherapy, hydrotherapy, low-intensity alternating magnetic radiation. The studies included in the review are heterogeneous in design and protocol, number of patients, and time points for assessing outcomes. In connection with the existing differences, it is not possible to carry out a comparative analysis of the results of these rehabilitation types and to give an unambiguous answer about their effectiveness. As the analysis has shown, peripheral PNPIC is well known all over the world, however, the search for methods of its treatment is far from complete.

[Physiotherapy in early rehabilitation of patients with bone sarcomas after arthroplasty of large bones and joints]. / Fizioterapiya pri rannei reabilitatsii bol'nykh s kostnymi sarkomami posle endoprotezirovaniya krupnykh kostei i sustavov.

ACTUALITY: The modern method of treating patients with tumor lesions of the bones is the replacement of large bones and joints with the inclusion of reconstructive plastic component. The main functional postoperative disorders of this method (limitation of mobility in the operated joint, pain, muscle hypotrophy and edema of the operated limb) obstruct the ability of patients to return to a full life, which makes their early rehabilitation extremely urgent. Orthopedics uses a number of physical factors for this. The literature presents data on the absence of negative effects of low-frequency electro- and magnetotherapy in the treatment of late complications of oncopedic surgery on a number of bone sarcomas, which allowed them to be included in early rehabilitation for the first time. AIM OF STUDY: Development of a complex of early rehabilitation of patients with bone tumors after arthroplasty of large bones and joints and evaluation of its effectiveness. MATERIALS AND METHODS: A prospective, open, nonrandomized, controlled study included 36 patients aged 19-67 years (Me 42 years old) with primary malignant and metastatic bone tumors who underwent endoprosthesis replacement of large bones and joints with the inclusion of reconstructive plastic component (plastic by displaced muscles, synthetic mesh) and received local low-frequency magnetotherapy, low-intensity infrared laser radiation, electroneuromyostimulation and therapeutic exercises. Physiotherapy began from the first day after the operation and lasted for 10 days. To assess the functional result, the international MSTS scale was used. RESULTS: The combined use of the reconstructive plastic component during radical surgery and physiotherapy made it possible to obtain good functional result at 63,9% of patients, satisfactory functional results in 36.1% of patients according to the MSTS scale at the time of discharge. The function of the saved limb in 10 patients after distal femoral resection with knee replacement was 80% of normal function, in 7 patients after proximal tibia resection - 72%; in 13 patients after proximal resection of the femur with hip replacement - 59%; in 5 patients after proximal resection of the humerus with endoprosthetics of the shoulder joint - 61.3%; and in 1 patient after proximal resection of the ulna with endoprosthetics of the elbow joint - 70%. CONCLUSION: The multidisciplinary approach to the early rehabilitation of patients with bone tumors made it possible to achieve functional results in a short time, reduce the time spent by patients in the surgical department without increasing the number of postoperative complications. Based on the preliminary obtained results, it is necessary to continue the study on a larger number of patients and with a longer follow-up period.

[The set of International Classification of Functioning, Disability and Health categories for the study of the effectiveness of rehabilitation of breast cancer patients with the main late complications of the surgical treatment]. / Nabor kategorii Mezhdunarodnoi klassifikatsii funktsionirovaniia, ogranichenii zhiznedeiatel'nosti i zdorov'ia dlia izucheniia éffektivnosti reabilitatsii bol'nykh rakom molochnoi zhelezy s osnovnymi pozdnimi oslozhneniiami khirurgicheskogo lecheniia.

The author selected the set of ICF (International Classification of Functioning, Disability and Health) categories selected for breast cancer patients presenting with the major late complications of the surgical treatment, such as upper limp lymphedema, pain syndrome, and mobility limitation in the shoulder joint on the side of the intervention. The problems associated with each component of ICF are described including the body functions - 26 categories, body structures - 15, activities and participation - 49, environmental factors - 31 categories. The author's original classifications are adapted to the ICF terminology. The criteria for estimating the determinants of the structure of spinal nerves, lymph nodes and vessels, veins, the mammary gland, upper extremities, muscles of the trunk, the skin and the related structures have been developed. All the changes in the body functions are described and the methods are proposed for the evaluation of the determinants or the mental and sensory functions, the cardiovascular, immune and respiratory systems, neuromuscular and skeletal functions, the functions of the skin and the related structures. The principles of coding for the components of activity and participation are illustrated (general tasks and requirements, mobility, self-service, everyday life, interpersonal interactions and relationships, main spheres of life, community life, social and civil life) and the environmental factors. The coding is presented in the form of detailed and readily intelligible tables with the explanatory remarks.

[What physiotherapeutic method for the treatment of post-mastectomy lymphedema is the most effective?] / Kakoi metod fizioterapii postmastéktomicheskoi limfedemy naibolee éffektiven?

We have undertaken the search for the publications of interest in the following databases: Scopus, Web of Science, MedLine, The Cochrane Library, CyberLeninka, and Russian science citation index. In addition, we evaluated the effectiveness of the physical agents and procedures having different mechanisms of action of the known factors responsible for the development of post-mastectomy lymphedema. Such agents and procedures include self-massage, manual lymphatic drainage, therapeutic physical exercises, compression bandaging, wearing elastic compression garments, Kinesio Tex taping, pneumatic compression, ultrasonic, electrostatic, extracorporeal shock wave therapy, electrical muscle stimulation, microcurrent and low-intensity laser therapy. These methods and products were used by the authors of selected publications either separately or in the combined modes taking into consideration the significant differences between effects of the application of individual techniques. The results of the treatment are presented for different time periods, either in absolute units (cm or ml) in the majority of the cases or in relative units (%) only in part of them without information concerning the statistical significance of the results obtained. There is thus far neither the universal classification of post-mastectomy lymphedema nor the generally accepted approaches to its diagnostics and treatment. Therefore, it is impossible to give an unambiguous answer as regards the effectiveness of one or another method for the diagnostics and treatment of this condition. The author of the present article observed 172 patients at the age of 56.8±9.7 years suffering from late grade I-IV lymphedema treated with the use of local low-intensity low-frequency electric and magnetic therapy in the combination with pneumatic compression applied during 15 days. The results of the treatment were evaluated using water and impedance plethysmography. Within 4 weeks after the onset of therapy, the volume of the upper limb decreased on the average for all stages of lymphedema by 37.7±9.3% under effect of pneumatic compression alone, by 49.5±10.7% under the influence of its combination with electrotherapy, by 59.9±5.4% under the action of the combination of pneumatic compression with magnetotherapy, and by 76.3±7.3% after the application of all the three techniques together (p<0.05). Electrical neurostimulation of the blood vessels and skeletal muscles proved especially effective for the treatment of I-II grade lymphedema while magnetic therapy was most efficient for the management of grade III-IV lymphedema. The proposed method of combined physiotherapy looks very encouraging for the treatment of late lymphedema but does not completely solve all problems pertaining to the management of this pathological condition.

[The indications for medical rehabilitation of certain oncological patients presenting with the complications of the radical treatment under the conditions of a multi-disciplinary hospital].

This article was designed to help the practitioners by proposing the recommendations for diagnostics and evaluation of the severity of complications of the radical treatment of the patients presenting with breast cancer, stomach cancer, endometrial cancer, cervical cancer, bone sarcoma (osteosarcoma, chondrosarcoma, periosteal sarcoma, et al.). The indications for medical rehabilitation of the patients with these problems are described with special reference to their treatment under the conditions of a multidisciplinary hospital depending on the type and severity of complications of the radical treatment. The results of the long-term investigations and analysis of a large number of observations were used to substantiate the application of the available physiotherapeutic technologies for the medical rehabilitation of the oncological patients belonging to clinical group III.

[The effectiveness of magnetic therapy of grade I-II radiation pneumofibrosis].

Radiation therapy of malignant tumours of the chest organs may result in radiation damage of the lungs. To prevent and reduce radiation-induced lung injuries, new types of radiation therapy have been developed, a number of various modifiers investigated, the methods of pharmacotherapy and physiotherapy proposed. The present study involved 37 patients presenting with radiation pneumofibrosis, including 7 ones with lung cancer and 30 patients with breast cancer. Based on the results of clinical, radiographic, and functional investigations, grade 1 and II pneumofibrosis was diagnosed in 20 and 17 patients respectively. After the application of an alternating magnetic field during 15 days, all the patients experience the overall regression of clinical symptoms and disorders of respiratory biomechanics. However, it seems premature to draw a definitive conclusion about the effectiveness of magnetic therapy of grade 1 and II radiation pneumofibrosis before the extensive in-depth investigations are carried out based on a large clinical material including the results of long-term follow-up studies and continuous monitoring.

[Variations of the volume and segmental blood flow in the upper extremity of the patents presenting with breast cancer treated with the application of various regimes of pneumatic compression].

Post-mastectomy lymphedema on the side of the surgical intervention is a major complication of radical therapy of breast cancer patients. Pneumatic compression (compression pump technology) of various types, modes and techniques is used for their rehabilitation. A total of 192 breast cancer patients with I-IV degree lymphedema were available for the examination in the present study. All of them were treated with the application of different modes of one- and multi-chambered pneumatic compression. Based on the results of aqueous and impedance plethysmography, the multi-chambered pneumatic compression was identified as the most effective methods for the purpose, with the pressure inside the chambers below 60-80 mm Hg and the duration of the treatment 45-60 min per day. It is recommended to perform three treatment courses each consisting of 15 procedures with the intervals of 3-6 months between them (depending on the severity of the edema).

[Malignant tumours and physiotherapy].

The analysis of the major studies on the treatment of malignant tumours with the application of physical factors has demonstrated that at present time no such factor can serve as an alternative to the standard combined treatment of malignant tumours, including surgery, radio- and chemotherapy. Certain physical factors can be used to improve the efficiency of conventional treatment, but large-scale well-planned randomized clinical trials are necessary to estimate and confirm their role in the treatment of cancer and other malignant tumours.

[Use of artificial magnetic field for rehabilitation of children with malignant tumors]. / Ispol'zovanie iskusstvennykh magnitnykh polei v reabilitatsii detei so zlokachestvennymi opukholiami.

Local complications of standard intravenous injections for chemotherapy and due to error of administration were compared in 400 patients (200 of them children) and general wound pathologies described. Treatment for wounds included two modalities: standard medication and alternating or pulsating magnetic field. Magnetic therapy proved highly effective: wound healing was 3-3.5 times faster while duration of treatment--2-3 times shorter than in standard procedure. Clinically-verified partial adhesion-related intestinal obstruction was eliminated by magnetic procedure in 18 children after combined treatment for lymphosarcoma involving the ileum.

[A complex of conservative rehabilitation measures in postmastectomy edema]. / Kompleks konservativnykh vosstanovitel'nykh meropriiatii pri postmastéktomicheskom oteke.

An effective complex of rehabilitative procedures was developed on the basis of the data on 440 tumor-free patients suffering postmastectomy edema as a result of radical treatment for primary breast cancer. The complex included pneumatic compression for edema of the arm, low-frequency electric and magnetic therapy, massage, calisthenics and drug treatment.

[Use of physical therapy measures in the rehabilitation of patients having undergone radical mastectomy]. / Primenenie nekotorykh fizicheskikh vozdeistvii v vosstanovitel'nom lechenii bol'nykh, perenesshikh radikal'nuiu mastéktomiiu.

Low-frequency electrotherapy, magnetotherapy, massage, exercise therapy and drugs were used in 90 patients who after radical treatment for breast cancer suffered pain and limited mobility in the shoulder joint. These procedures were intended to treat said complications, to normalize reflexes and to cut down the period of rehabilitative therapy. The treatment proved effective. No untoward effects on the course of the disease were observed within the first 3-5 years.

[Pneumatic compression of the arm in the treatment of postmastectomy edema]. / Pnevmaticheskaia kompressiia verkhnei konechnosti v lechenii postmastéktomicheskogo oteka.

The paper discusses the histories and results of examination of 200 cases of lymphedema of the upper extremity developing after radical surgery for breast cancer. Forty percent of patients had suffered erysipelas, its frequency being higher in a group of pronounced edema. The incidence of erysipelas dropped 5.7 times following application of pneumatic compression, suggesting the use of the procedure for erysipelas by stimulating lymph drainage.