Effect of exercise while utilizing a device with an arm compression sleeve to reduce lymphedema.

BACKGROUND: Lymphedema is one complication of breast cancer treatment and there is no consensus that identified one single therapy in the treatment of lymphedema; therfore an association of methods is recommended and one of these is exercising. The aim of this study was to evaluate the utilization of exercising with a facilitating device along with an arm compression sleeve to reduce the size of lymphedematous arms. MATERIALS AND METHODS: Thirty women from a rehabilitation group with arm lymphedema resulting from the surgical, chemotherapeutic, and radiotherapeutic treatment of breast cancer were enrolled sequentially on arriving in the clinic. While sitting in an upright position and wearing an arm compression sleeve, patients were submitted to a one-hour session of active exercising consisting of four 12-minute stints with three-minute intervals to rest. The change in lymphedema was evaluated by water volumetry before and immediately after the session. The active exercising device is similar to the pedaling system of a bicycle. The paired t-test was employed for statistical analysis. An alpha error of 5% (p-value < 0.05) was considered acceptable. RESULTS: A statistically significant reduction (p-value < 0.004) was noted in the size of the arm. CONCLUSION: Active exercising using a facilitating device and under supervision may reduce the size of lymphedematous arms.

Factitious lymphedema of the arm: case report and review of publications.

The aim of this study was to report a case of factitious lymphedema of the arm and related lymphoscintigraphic aspects. The case of a 36-year-old patient is reported who started to present with pain, in the 3rd finger of the right hand three years prior to this report, which she associated with her work. Joint effusion was identified and treated using a splint that restricted blood flow leading to edema of the distal third of the forearm. Since then the patient was treated however her condition worsened resulting in edema of the entire arm. Subsequently she was referred to our service. A physical examination identified a restrictive band in the axillary region of the arm that delimited the edema. Volumetry and lymphoscintigraphic examinations of the limb were performed. The lymphoscintigraphy demonstrated acceleration of the flow in the affected limb and dermal reflux. Clinical treatment with removal of the restriction allowed a rapid reduction in the volume of the limb.

Mobilization of fluids in large volumetric reductions during intensive treatment of leg lymphedema.

AIM: The aim of the current study was to evaluate fluid mobilization during the intensive treatment of leg lymphedema. METHODS: The mobilization of intracellular and extracellular fluids in the lower and upper extremities and trunk was evaluated with the intensive treatment of leg lymphedema in a prospective study. Mobilization of fluids was assessed by bioelectrical impedance using the InBody S10 device in ten patients with leg lymphedema, regardless of the cause. Treatment consisted of six to eight hours per day of Manual Lymphatic Therapy (Godoy & Godoy technique), Mechanical Lymphatic Therapy (RAGodoy device®) and a non-elastic cotton-polyester stocking. RESULTS AND CONCLUSION: A significant reduction in total water was observed for the lymphedematous limb, but with an increase in intracellular water of from 59% to 61%. Additionally, total water increases were observed in the limbs without lymphedema and in the trunk. There was an increase in total intracellular water of the extremities and trunk, but without any change in the extracellular water. In high-volume reductions during lymphedema treatment, fluids are displaced from the lymphedematous limb to extremities without lymphedema and to the trunk.

Clinical aspects of advanced stage lipo-lymphedema: case report.

The aim of the current study was to alert about dermatological alterations in the clinical evolution of lipo-lymphedema. The case of a 48-year-old patient is reported with clinical diagnosis of stage II lipo-lymphedema treated in the Angiology and Vascular Surgery Service of FAMERP. On physical examination the edema was hard, not reversible during rest, with nodules in the lower one-third of the limbs and a positive Stemmer's sign. The sizes of the nodules were different between legs. This report stresses the clinical findings and the differences in each disease. Additionally a review of publications is presented. The dermatological changes occurring in the evolution of lipedema may be associated with the evolution of lipo-lymphedema.

Lymph drainage in patients with joint immobility due to chronic ulcerated lesions.

The fibrous process of chronic ulcerated lesions of lower limbs can impair the mobility of the affected limb. The aim of this work was to assess the benefits of lymph drainage in patients who suffer from this disease. Twenty female and five male patients with ages ranging from 53 to 69 years (mean age 60.6 years) were evaluated. All had a history of at least 10 years of varicose veins and/or ulcerated lesions of the lower limbs with initial dermatofibrosis, with the positive Godet sign during the physical examination of the limb. Patients with intermittent claudication, diabetes and trauma were excluded from the study, as well as patients with chronic dermatofibrosis, and in whom positive Godet sign was not seen. Patients with immobility or very limited movement of the ankle and with some limitation in the toe joints were selected. The patients were randomly divided into group A comprising 15 individuals, and group B 10. All the individual treatments were established before the start of the evaluation period. Lymph drainage was performed on the patients of group A four or five times per week. Group B was subjected to a type of massage for the same period and at the same frequency. The mobility of the ankle joints was evaluated using goniometry before the start and after 30 days of treatment. In all the patients who underwent lymph drainage, an improvement of the joint mobility was seen, whereas in the control, group B, there was no obvious change. In conclusion, lymph drainage gave an improvement in the mobility of the ankle joint after impairment due to initial dermatofibrosis in patients with chronic ulcerated lesions.