RESUMO
OBJECTIVE: Adhesive capsulitis is a condition characterized by shoulder pain and stiffness. Breast cancer treatment has been linked to the development of this condition, but its mechanisms are still little known. This study's objective was to identify predictors factors associated with the development of adhesive capsulitis in breast cancer patients. METHODS: A case control study was performed with women undergoing treatment for breast cancer in a single center. The sampling was nonprobabilistic and consecutive. Adhesive capsulitis was defined as constant pain associated with decreased active and passive shoulder movement in anterior elevation, external rotation at 0°/90° abduction, and internal rotation at 90° abduction. The study group consisted of patients with shoulder pain and range of motion limitations, while the control group consisted of women without any shoulder abnormalities. Sociodemographic and clinical variables were collected. A univariate logistic regression was used to assess the influence of variables on the studied outcome. For p < 0.20, a multivariate logistic regression was used. The probability of null hypothesis rejection was 5%. RESULTS: A total of 145 women were assessed, with 39 (26.9%) on the study group and 106 (73.1%) on the control group. The majority was under 60 years old. In the multivariate analysis, variables correlated to the outcome under study were shoulder immobilization (OR = 3.09; 95% CI: 1.33-7.18; p = 0.009), lymphedema (OR = 5.09; 95% CI: 1.81-14.35; p = 0.002), and obesity (OR = 3.91; 95% CI: 1.27-12.01; p = 0.017). CONCLUSION: Lymphedema, postsurgery immobilization, and obesity are predictive factors for the development of adhesive capsulitis in breast cancer patients.
OBJETIVO: Capsulite adesiva é uma afecção caracterizada por dor e limitação dos movimentos do ombro. O tratamento do câncer de mama está relacionado ao desenvolvimento dessa doença por meio de mecanismos ainda pouco conhecidos. O objetivo do estudo foi identificar os fatores associados ao desenvolvimento de capsulite adesiva em pacientes com câncer de mama. MéTODOS: Um estudo caso-controle foi realizado com mulheres em tratamento para câncer de mama em um centro único. A amostra foi consecutiva e não-probabilística. A capsulite adesiva foi pré-definida como dor constante e diminuição da amplitude de movimentos em elevação anterior, rotação externa em 0°/90° abdução e rotação interna em 90° abdução. O grupo caso foi constituído por pacientes com dor e limitação de todos os movimentos do ombro, enquanto o controle por pacientes sem qualquer alteração nesta articulação. Variáveis sociodemográficas e clínicas foram coletadas. Foi realizada uma análise de regressão logística univariada para avaliar a influência das variáveis em relação ao desfecho estudado. Para valores de p < 0,20, realizou-se a análise de regressão logística multivariada. A probabilidade de se rejeitar a hipótese nula foi de 5%. RESULTADOS: Foram avaliadas 145 mulheres, sendo 39 casos (26,9%) casos e 106 controles (73,1%). Na análise multivariada, as variáveis associadas ao desfecho estudado foram imobilização do ombro (OR = 3,09; 95% IC: 1,337,18; p = 0,009), linfedema (OR = 5,09; 95% IC: 1,8114,35; p = 0,002) e obesidade (OR = 3,91; 95% IC: 1,2712,01; p = 0,017). CONCLUSãO: Linfedema, imobilização pós-cirúrgica e obesidade são fatores preditores associados ao desenvolvimento de capsulite adesiva em pacientes com câncer de mama.
Assuntos
Neoplasias da Mama , Bursite , Linfedema , Humanos , Feminino , Pessoa de Meia-Idade , Dor de Ombro/complicações , Neoplasias da Mama/complicações , Estudos de Casos e Controles , Bursite/complicações , Bursite/terapia , Obesidade/complicações , Linfedema/complicaçõesRESUMO
Background: Lymphedema is a chronic, progressive clinical condition that evolves with intense fibrosis, the most advanced stage of which is stage III (lymphostatic fibrosclerosis). Aim: The aim of the present study was to show the possibility to reconstruct the dermal layers with the intensive treatment of fibrosis using the Godoy method. Case description: A 55-year-old patient with an eight-year history of edema of the lower limb of the leg had constant episodes of erysipelas, despite regular treatments. The edema progressed continually, associated with a change in the color of the skin and the formation of a crust. Intensive treatment (eight hours per day for three weeks) was proposed with the Godoy method. The ultrasound was performed and results revealed substantial improvement in the skin, with the onset of the reconstruction of the dermal layers. Conclusion: It is possible to reconstruct the layers of the skin in fibrotic conditions caused by lymphedema.
Assuntos
Derme , Fibrose , Linfedema , Dermatopatias , Humanos , Pessoa de Meia-Idade , Doença Crônica , Fibrose/diagnóstico por imagem , Fibrose/etiologia , Fibrose/patologia , Fibrose/terapia , Linfedema/complicações , Linfedema/diagnóstico por imagem , Linfedema/patologia , Linfedema/terapia , Pele/diagnóstico por imagem , Pele/patologia , Dermatopatias/complicações , Dermatopatias/diagnóstico por imagem , Dermatopatias/patologia , Dermatopatias/terapia , Derme/diagnóstico por imagem , Derme/patologia , Ultrassonografia/métodosRESUMO
BACKGROUND: stewart-treves syndrome (STS) is an angiosarcoma associated with chronic lymphedema. OBJECTIVES: This article analyses the characteristics of twenty-two patients and proposes active intervention in lymphedema and the early diagnosis of STS. METHODS: Twenty-two patients with STS were diagnosed at the centre over an 11-year period. Clinical manifestations, a series of conventional analyses, and histopathology were used to study these cases retrospectively. RESULTS: The age range of 22 patients with STS was 15 to 78 years. The main clinical manifestations included multiple skin and subcutaneous nodules and scattered red or purplish-red rashes in the lymphoedematous limbs. These patients often showed clinical symptoms such as lymphedema, weakness, emaciation, pain, mass, lymphadenopathy and so on. The positive rates of ultrasonography, MRI and radionuclide imaging were 66.7% (6/9), 92.3% (12/13) and 18.2% (2/11), respectively. The main points regarding active intervention in lymphedema and early diagnosis of STS were summarized. STUDY LIMITATIONS: Since this was a retrospective study, the main points summarized by the author need to be further quantified in clinical work to guide the diagnosis of this kind of disease more conveniently. In addition, further clinical trials are needed to evaluate the role of lymphedema in the occurrence and development of malignant tumors. CONCLUSIONS: STS can appear in lymphoedematous tissue many years after lymphedema onset. To avoid delays in the diagnosis and therapy of STS, physicians should actively look for signs or symptoms of malignant lymphedema during the follow-up period and promptly manage patients developing problems.
Assuntos
Hemangiossarcoma , Linfangiossarcoma , Linfedema , Humanos , Adulto Jovem , Adulto , Estudos Retrospectivos , Linfangiossarcoma/complicações , Linfangiossarcoma/diagnóstico , Hemangiossarcoma/complicações , Hemangiossarcoma/diagnóstico , Hemangiossarcoma/patologia , Linfedema/complicações , Linfedema/patologia , Doença CrônicaRESUMO
Background: Lymphedema is a chronic, progressive clinical condition that evolves with intense fibrosis, the most advanced stage of which is stage III (lymphostatic fibrosclerosis). Aim: The aim of the present study was to show the possibility to reconstruct the dermal layers with the intensive treatment of fibrosis using the Godoy method. Case description: A 55-year-old patient with an eight-year history of edema of the lower limb of the leg had constant episodes of erysipelas, despite regular treatments. The edema progressed continually, associated with a change in the color of the skin and the formation of a crust. Intensive treatment (eight hours per day for three weeks) was proposed with the Godoy method. The ultrasound was performed and results revealed substantial improvement in the skin, with the onset of the reconstruction of the dermal layers. Conclusion: It is possible to reconstruct the layers of the skin in fibrotic conditions caused by lymphedema.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Fibrose/terapia , Fibrose/diagnóstico por imagem , Linfedema/complicações , Dermatopatias/complicações , Dermatopatias/terapia , Fibrose/patologia , Doença Crônica , Ultrassonografia/métodos , Derme/patologia , Derme/diagnóstico por imagemRESUMO
The treatment of breast cancer is often complicated by lymphedema of the upper limbs. Standard lymphedema evaluation methodologies are not able to measure tissue fibrosis. The ultrasound aspects related to tissue microstructures of lymphedema are neglected in clinical evaluations. The objective of this study was to identify and measure the degree of impairment, topography, and biophysical alterations of subcutaneous lymphedema tissue secondary to the treatment of breast cancer by ultrasonography. Forty-two women at a mean age of 58 (±9.7) years, with unilateral lymphedema due to breast cancer treatment, were evaluated. The upper limbs were divided into affected (affected by lymphedema) and control (contralateral limb). Each limb was subdivided into seven areas, defined by perimetry, evaluated in pairs. The biophysical characteristics thickness, entropy, and echogenicity were evaluated by ultrasonography. The results showed a significant difference in the echogenicity and thickness variables between the affected and unaffected upper limb, in all the extent of the upper limb, while entropy showed no significant difference. The findings indicate that the data presented were consistent both in identifying and measuring the degree of impairment and biophysical changes in the subcutaneous tissue of lymphedema secondary to the treatment of breast cancer.
Assuntos
Neoplasias da Mama , Linfedema , Neoplasias da Mama/complicações , Feminino , Humanos , Linfedema/complicações , Linfedema/etiologia , Pessoa de Meia-Idade , Tela Subcutânea , Ultrassonografia/métodos , Extremidade Superior/diagnóstico por imagemRESUMO
A Síndrome de Stewart-Treves é uma rara condição onde um angiossarcoma se desenvolve sobre área de linfedema crônico. Afeta mais frequentemente os membros superiores e representa 5% dos casos de angiossarcoma. Apesar de ser mais comum em mulheres submetidas a mastectomia radical e esvaziamento axilar por neoplasia de mama, pode ocorrer a partir de linfedema de outras etiologias. Clinicamente as lesões são caracterizadas por nódulos únicos ou múltiplos de cor avermelhada ou azulada no estágio inicial e, em estágio avançado, podem evoluir para massas hemorrágicas e até gangrena. O prognóstico é ruim e a conduta cirúrgica com excisão ampla ou amputação oferecem uma maior chance de sobrevida. Relata-se um caso de Síndrome de Stewart-Treves na perna direita, apresentando-se de forma exuberante e com acometimento de linfonodos pélvicos e abdominais.
Stewart-Treves syndrome is a rare condition characterized by the development of an angiosarcoma at sites of chronic lymphedema. It most often affects the upper limbs and accounts for 5% of cases of angiosarcoma. Although the syndrome is more common in women undergoing radical mastectomy and axillary dissection for breast cancer, it may result from lymphedema of other etiologies. Clinically, the lesions are characterized by single or multiple bluish-red nodules in the early stage and may progress to hemorrhagic masses and even gangrene in advanced stages. The prognosis is poor, and surgical management with wide excision or amputation offers a greater chance of survival. We report a case of profuse Stewart-Treves syndrome in the right leg, with involvement of pelvic and abdominal lymph nodes.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Extremidade Inferior/lesões , Hemangiossarcoma/patologia , Linfangiossarcoma/patologia , Linfedema/complicações , Amputação CirúrgicaRESUMO
Este estudo objetivou analisar, por meio de uma revisão sistemática da literatura, a influência da reconstrução imediata na prevalência de linfedema após mastectomia em pacientes portadoras de câncer de mama. Foram analisados os mais relevantes estudos publicados originalmente em qualquer idioma até agosto de 2018, indexados às bases de dados US National Library of Medicine, Cochrane Central Register of Controlled Trials, Web of Science e Scientific Electronic Library Online. A amostra foi composta por 10 publicações que se adequaram aos critérios de inclusão e exclusão estabelecidos, incluindo 2.425 pacientes submetidas a apenas mastectomia e 2.772 pacientes submetidas à mastectomia associada à reconstrução imediata da mama. A prevalência de linfedema foi 20,95% nas pacientes submetidas a apenas mastectomia (n = 508) e de 5,23% nas pacientes submetidas à mastectomia associada à reconstrução imediata (n = 145), havendo diferença estatisticamente significativa (p < 0,001). Concluiu-se que a mastectomia associada à reconstrução imediata influencia positivamente o prognóstico das pacientes portadoras de câncer de mama, proporcionando um índice significativamente menor de linfedema, quando comparada à realização de apenas mastectomia.
This study aimed to analyze, through systematic review of literature, the influence of immediate reconstruction on the prevalence of lymphedema after mastectomy, in women living with breast cancer. The analysis considered the most relevant studies originally published, in any language, up to August 2018, indexed on the databases of the US National Library of Medicine, Cochrane Central Register of Controlled Trials, Web of Science, and Scientific Electronic Library Online. The sample comprised 10 publications that met the established criteria for inclusion and exclusion, including 2,425 patients who were subjected to mastectomy alone, and 2,772 patients who were subjected to mastectomy associated with immediate reconstruction of the breast. The prevalence of lymphedema was 20.95% in patients who had been subjected to mastectomy alone (n = 508), and 5.23% among those patients who were subjected to mastectomy associated with immediate reconstruction of the breast (n = 145), the difference being statistically significant (p < 0.001). We concluded that mastectomy, when associated with immediate breast reconstruction, has a positive influence on the prognosis of patients living with breast cancer, thereby providing a much lower rate of lymphedema when compared with mastectomy alone.
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Neoplasias da Mama/cirurgia , Mamoplastia/efeitos adversos , Mamoplastia/métodos , Mamoplastia/reabilitação , Linfedema Relacionado a Câncer de Mama/cirurgia , Linfedema Relacionado a Câncer de Mama/patologia , Linfedema/complicaçõesAssuntos
Imunodeficiência de Variável Comum/diagnóstico , Linfangiectasia Intestinal/diagnóstico , Linfedema/diagnóstico , Infecções Bacterianas/etiologia , Criança , Erros de Diagnóstico , Edema/etiologia , Feminino , Humanos , Linfangiectasia Intestinal/complicações , Linfangiectasia Intestinal/dietoterapia , Linfangiectasia Intestinal/patologia , Linfedema/complicações , Linfedema/dietoterapia , Linfedema/patologia , Enteropatias Perdedoras de Proteínas/etiologia , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
O linfedema de membros inferiores é uma doença crônica decorrente de dano no sistema linfático que influencia a mobilidade, a funcionalidade e a qualidade de vida dos indivíduos. Questionários e o teste físico são métodos bastante práticos, de fácil aplicação e baixo custo, que fornecem dados importantes para a avaliação desses pacientes. Objetivos Avaliar a influência do linfedema unilateral de membro inferior na funcionalidade e na qualidade de vida, correlacionando três ferramentas de avaliação. Métodos Estudo descritivo com 25 indivíduos com linfedema unilateral em membro inferior, de ambos os sexos. Foi avaliada a perimetria e foram aplicados The Medical Outcome Study Short Form-36 Health Survey (SF-36) para avaliação da qualidade de vida, Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL) para estudo das habilidades físicas, mentais e sociais relacionadas ao linfedema e o Timed Up and Go (TUG) para avaliação da funcionalidade. Resultados Houve a presença de linfedema em todo o membro inferior dos participantes. Os domínios mais prejudicados pelo linfedema foram os aspectos físicos (25,0 ± 31,4) e emocionais (36,0 ± 42,9) no SF-36 e o domínio mobilidade (6,0 ± 2,6) no Lymph-ICF-LL. O TUG foi realizado em 9,88 ± 1,98 s. Houve correlação entre o TUG e os questionários e entre os dois questionários utilizados. Conclusões Indivíduos com linfedema unilateral em membro inferior apresentam um impacto negativo na qualidade de vida e na funcionalidade avaliadas através de questionários, que correlacionam entre si. Não foi encontrada alteração no TUG, mas houve correlação entre ele e os questionários utilizados
Lymphedema of the lower limbs is a chronic disease caused by damage to the lymphatic system that influences people's mobility, functionality, and quality of life. Questionnaires and physical test are very practical, easy to apply, and low cost methods that provide important data for evaluation of these patients. Objectives To evaluate the influence of unilateral lower limb lymphedema on functionality and quality of life, correlating 3 assessment tools. Methods This was a descriptive study investigating 25 patients of both sexes with unilateral lymphedema in a lower limb. Limb volume was assessed using circumferential tape measurements, the Medical Outcomes Study Short Form-36 Health Survey (SF-36) was used to assess quality of life, the Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL) was used to assess physical, mental, and social skills related to lymphedema, and the Timed Up and Go (TUG) test was used for functional assessment. Results Lymphedema was present throughout the affected lower limb of participants. The domains most affected by lymphedema were physical aspects (25.0 ± 31.4) and emotional aspects (36.0 ± 42.9) from the SF-36 and the mobility domain (6.0 ± 2.6) from the Lymph -ICF-LL. Patients performed the TUG in 9.88 ± 1.98 seconds. The TUG was correlated with the questionnaires and the questionnaires were correlated with each other. Conclusions People with unilateral lower limb lymphedema exhibited negative impacts on quality of life and functionality, as evaluated by questionnaires, which were correlated with each other. TUG performance was within normal limits, but results correlated with the questionnaires used