Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 28
Filtrar
1.
Rev. cir. (Impr.) ; 73(3): 370-377, jun. 2021. tab
Artigo em Espanhol | LILACS | ID: biblio-1388834

RESUMO

Resumen El lipedema es una enfermedad común, frecuentemente subdiagnosticada, crónica y progresiva, que genera un gran deterioro en la calidad de vida. Consiste en el depósito anormal de tejido adiposo subcutáneo principalmente en las extremidades inferiores, afectando casi exclusivamente a mujeres. Sus síntomas principales son el dolor, la sensibilidad y la facilidad para producir equimosis. Desde el punto de vista fisiopatológico, existiría una susceptibilidad poligénica combinada con trastornos hormonales, microvasculares y linfáticos que pueden ser en parte responsables del desarrollo del lipedema. Se clasifica, según la distribución de la grasa en cinco tipos y, según la gravedad de la enfermedad, en cuatro etapas. El diagnóstico es eminentemente clínico y se debe diferenciar de otras patologías que producen aumento de volumen de las extremidades, especialmente el linfedema y obesidad. Es importante realizar un estudio funcional del sistema linfático cuando el diagnóstico es dudoso o para la etapificación del lipedema, por lo que la correcta interpretación de estos resultados es fundamental. El tratamiento está enfocado en disminuir la discapacidad y evitar la progresión, con el fin de mejorar la calidad de vida. Actualmente, la liposucción es un tratamiento efectivo para el lipedema, sin embargo, las técnicas empleadas para la lipectomía en el lipedema son diferentes a las técnicas utilizadas para la liposucción con fines estéticos. Las técnicas selectivas que respetan los vasos linfáticos tienen mejor rendimiento para reducir el volumen de grasa, retrasar la progresión, reducir el dolor, reducir la alteración marcha y mejorar la calidad de vida en estos pacientes.


Lipedema is a common, frequently under-diagnosed, chronic and progressive disease that generates an important detriment in quality of life. It consists in an abnormal deposit of subcutaneous adipose tissue mainly in the lower extremities, almost exclusively affecting women. Its main symptoms are pain, sensitivity and the ease of causing bruising. From the pathophysiological point of view, there would be a polygenic susceptibility combined with hormonal, microvascular and lymphatic disorders that may be partly responsible for the development of lipedema. It is classified according to the distribution of fat into five types and, according to the severity of the disease, in four stages. The diagnosis is eminently clinical and must be differentiated from other diseases that cause an increase in the volume of the extremities, especially lymphedema and obesity. It is important to carry out a study of the lymphatic system functionality when the diagnosis is not clear or for lipedema staging, so the correct interpretation of these results is essential. Treatment is focused on reducing disability and preventing progression, in order to improve quality of life. Liposuction is currently an effective treatment for lipedema, however, the techniques used for lipectomy in lipedema are different from the techniques used for liposuction for cosmetic purposes. Selective techniques that spare the lymphatic vessels have better results reducing fat volume, delaying progression, reducing pain, reducing gait disturbance, and improving quality of life of these patients.


Assuntos
Humanos , Lipedema/cirurgia , Lipedema/diagnóstico , Lipedema/fisiopatologia , Qualidade de Vida , Linfedema/fisiopatologia
2.
Braz J Phys Ther ; 25(2): 203-213, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32518025

RESUMO

BACKGROUND: Lymphoedema is a chronic condition that has significant detrimental impact on patients' quality of life. Secondary lymphoedema often results from anti-tumour treatment, in contrast to primary lymphoedema which is the result of genetic abnormalities that leads to an abnormal development of the lymphatic system. OBJECTIVE: To describe and compare the experience of individuals with primary and secondary lymphoedema. METHODS: A total of 19 patients (mean ±â€¯standard deviation age: 56.7 ±â€¯16.2 years), 8 with primary and 11 with secondary lymphoedema, participated in this qualitative phenomenological study. Purposeful sampling method was applied. We recruited participants from specialised lymphoedema units of two physical therapy clinics and the Lymphoedema Patient Association in Spain. Data collection methods included unstructured and semi-structured interviews. An inductive thematic analysis was used. RESULTS: The findings suggest differences between the experience of living with primary or secondary lymphoedema. Also, those with lower extremity lymphoedema have more pain, fatigue, and functional limitations. Three primary themes emerged: "Emotional challenge", "Adapting your life to a new situation," and "lymphoedema management". CONCLUSIONS: The experience of living with lymphoedema involves aspects of fear, suffering, coping, and management of the disease and differs between secondary and primary causes. However, it seems to be more dependent on its location than its cause.


Assuntos
Linfedema/fisiopatologia , Doença Crônica , Fadiga , Humanos , Linfedema/genética , Pessoa de Meia-Idade , Pesquisa Qualitativa , Qualidade de Vida/psicologia , Espanha
3.
Braz J Phys Ther ; 23(6): 532-540, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30448062

RESUMO

BACKGROUND: The traditional overflow method for measuring limb volume remains the gold standard, but many disadvantages still inhibit its routine use in clinical practice. OBJECTIVE: To assess the intra-rater and inter-rater reliability and criterion validity of the 'communicating vessels volumeter' (CVV) for volume measurement of lymphedematous upper extremities (LUE) by using the overflow volumeter (OV) as the reference standard. METHODS: Twelve LUE of 12 women undergoing mastectomy for breast cancer were measured three times each by three raters using both methods, totaling 216 volume measurements. Criterion validity was estimated by 33 volume measurements of one cylinder of known volume by three raters using both methods, totaling 198 measurements. RESULTS: Measurement time was short with both CVV and OV. The intraclass correlation coefficient3,1 was high for both CVV and OV in intra-rater (0.99 vs 0.99) and inter-rater (0.99 vs 0.99) analyses. The bias between methods was low (7.50mL; 0.40%) and the limits of agreement were narrow (-5.80 to 6.50%). The volumes were statistically equal with a strong correlation (R2=0.98) between methods. CVV was more accurate than OV (0.00 vs 0.02%) in cylinder measurements. CONCLUSION: The high intra-rater and inter-rater reliability rates of CVV were comparable to those of OV, and the volumes resulting from LUE measurements were statistically equal in the two methods. Criterion validity rates indicated that CVV measurements were closer to the actual value of the cylinder than those obtained with the OV.


Assuntos
Neoplasias da Mama/cirurgia , Linfedema/fisiopatologia , Mastectomia/métodos , Feminino , Humanos , Padrões de Referência , Reprodutibilidade dos Testes , Projetos de Pesquisa , Extremidade Superior/patologia
4.
Disabil Rehabil ; 40(13): 1485-1493, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28325132

RESUMO

PURPOSE: The aim of this systematic review was to summarize and systematize the information about physical symptoms and its relation with work activity on female Breast Cancer Survivors (BCS). METHODS: A systematic search was performed on the databases MEDLINE/PubMed (via National Library of Medicine), SCOPUS (Elsevier), Web of Science (Thomson Reuters Scientific) and CINAHL with full text (EBSCO), including papers about physical impairments experienced by female workers who have had breast cancer. RESULTS: The search retrieved 238 studies, and another 5 were identified in the articles' references, totaling 243 papers. After removing duplicates and applying the inclusion criteria and a full text reading, 13 articles were included for qualitative analysis. Concerning physical limitations, most complaints were related to the elevation of upper limbs, carrying heavy objects, driving and holding manual movements. The most referred symptoms were breast/arm pain, fatigue, lymphedema, reduced range of motion and weakness in the upper limbs, scar tissue adherence in the breast/axilla and paresthesia in the arm/breast. CONCLUSION: These symptoms and physical limitations led to the difficulty or impossibility of performing work tasks, which also diminished work productivity, as well as the increase in time to return to work. The present results suggest higher unemployment rates and the need for modifying work conditions. Implication for Rehabilitation Health professionals should include risk assessment at daily routine to identify possible sources of physical impairments for upper limbs. Provide the support and orientations according to personal and job characteristics of the patient. Focus the aims of treatment over upper limbs impairments, reducing the prevalence and the gravity of symptoms.


Assuntos
Neoplasias da Mama/fisiopatologia , Sobreviventes de Câncer , Fadiga/fisiopatologia , Feminino , Humanos , Linfedema/fisiopatologia , Debilidade Muscular/fisiopatologia , Dor/fisiopatologia , Parestesia/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Aderências Teciduais/fisiopatologia , Extremidade Superior/fisiopatologia
5.
J Manipulative Physiol Ther ; 40(4): 241-245, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28410763

RESUMO

OBJECTIVE: The purpose of this study was to correlate upper limb volume and arterial and venous blood flow velocity in breast cancer survivors. METHODS: A cross-sectional study was conducted on 30 women with lymphedema and a mean age of 55.60 years (standard deviation = 8.12). For the assessment of upper limb volume, perimetry was performed with measures at 6 points on the limb, which were mathematically calculated as volume. The blood flow velocity of the axillary and brachial arteries and veins were assessed by Doppler ultrasound with a probe at 4 MHz. In the statistical analysis, a Shapiro-Wilk test determined a non-normal data distribution. Spearman correlation coefficients (ρ) were calculated to determine the association between the variables blood flow velocity and lymphedema volume. RESULTS: We identified significant and positive associations between all variables correlated with limb volume: blood flow velocity of the axillary artery (ρ = 0.381, P = .041), axillary vein (ρ = 0.383, P = .039), brachial artery (ρ = 0.375, P = .044), and the brachial vein (ρ = 0.373, P = .045). CONCLUSION: There is a positive association between limb volume and blood flow velocity in the upper limbs of women with lymphedema secondary to breast cancer treatment.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Linfedema/diagnóstico por imagem , Mastectomia/efeitos adversos , Ultrassonografia Doppler/métodos , Adulto , Idoso , Artéria Axilar/diagnóstico por imagem , Artéria Braquial/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Estudos Transversais , Feminino , Humanos , Linfedema/etiologia , Linfedema/fisiopatologia , Mastectomia/métodos , Pessoa de Meia-Idade , Valores de Referência , Índice de Gravidade de Doença
6.
Perm J ; 21: 16-010, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28080951

RESUMO

INTRODUCTION: Lymphedema is characterized by a defect in the lymphatic system that causes limb swelling. Impaired uptake and transport of lymphatic fluid through lymphatic vessels causes accumulation of protein-rich fluid in the interstitial spaces, which leads to swelling of the limb. Primary lymphedema often presents at birth. The rare cases that arise after age 35 years are described as lymphedema tarda. The great majority of patients with lymphedema have swelling of the lower limbs-upper limb lymphedema is a rare disorder. CASE PRESENTATION: An 84-year-old woman presented with a 3-year history of unilateral swelling of the right upper limb. There were no constitutional symptoms and no evidence of lymphadenopathy or systemic disease. Blood tests, carcinoembryonic antigen test, computed tomography scans, and venous Doppler ultrasound were all normal. The diagnosis was primary upper limb lymphedema. DISCUSSION: The swelling that occurs in upper limb lymphedema is permanent and usually extends to the hand. About one-third of patients with this condition also present with lower limb lymphedema. Thorough investigations are warranted in cases of unilateral upper limb lymphedema to rule out occult malignancy and systemic disease.


Assuntos
Linfedema/patologia , Linfedema/fisiopatologia , Extremidade Superior/patologia , Extremidade Superior/fisiopatologia , Idoso de 80 Anos ou mais , Feminino , Humanos , Linfedema/etiologia
7.
Int Angiol ; 36(4): 382-385, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26344512

RESUMO

BACKGROUND: The aim of this study was to evaluate lymphoscintigraphic changes in patients who developed erysipelas after saphenous vein stripping. METHODS: Lymphoscintigraphic changes related to erysipelas were evaluated in a retrospective, cross-sectional and quantitative study of 21 saphenectomy patients. Patients with infections, those weighing over 120 kg, with chronic arterial disease or heart failure were excluded from the study. A control group was formed of 21 patients submitted to saphenectomies matched by age and gender but with no history of erysipelas. All patients underwent lymphoscintigraphy of both legs. The Fisher's Exact and χ2 tests were used for statistical analysis with an alpha error of 5% being considered acceptable. RESULTS: Associations of dermal reflux and popliteal lymph nodes with erysipelas were observed in operated patients compared to non-operated patients (P value= 0.002 and 0.03, respectively). Semiquantitative analysis showed a variation in the Kleinhans transport indexes of 0.15 to 20.5 for the entire sample. Group I showed a mean semiquantitative index of 2.42 (0.3 to 14.5), group II of 3.15 (0.225 to 15.125) and group III of 10.2 (0.15 to 38.25). The comparison of semiquantitative indexes of the groups by χ2 analysis showed that there was a statistically significant difference between the first two groups (I and II) and group III (P value <0.05). CONCLUSIONS: Erysipelas is a synergistic mechanism of injury of the lymphatic system in patients submitted to saphenectomies.


Assuntos
Erisipela/etiologia , Sistema Linfático/fisiopatologia , Linfedema/etiologia , Veia Safena/cirurgia , Varizes/cirurgia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Idoso , Distribuição de Qui-Quadrado , Estudos Transversais , Erisipela/diagnóstico , Feminino , Humanos , Sistema Linfático/diagnóstico por imagem , Linfedema/diagnóstico por imagem , Linfedema/fisiopatologia , Linfocintigrafia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
8.
Physiother Theory Pract ; 33(1): 1-8, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27918865

RESUMO

PURPOSE: Lower limb lymphedema (LLL) is characterized as a physical-functional chronic complication that impacts the quality of life of women who have gone through treatment for gynecological cancer. The present study aims to check the conservative treatments available for lymphedema after gynecological cancer in the context of evidence-based practice. METHODS: The selection criteria included papers from May 1993 discussing treatment protocols used in LLL after treatment for gynecological cancer. The search was performed until October 2014 in MEDLINE, SciVerse, and PEDro using "rehabilitation," "treatment outcome," "therapeutics," "clinical protocol," "gynecologic surgery," "lower extremity," "lower limb," and "lymphedema" as keywords, focused on women with a previous diagnosis of gynecological cancer who received radiation and/or chemotherapy and/or surgery and/or lymphadenectomy as part of their treatment. RESULTS: From 110 studies found, 3 articles that used the complex decongestive therapy (CDT) as a treatment protocol were selected. There were no randomized clinical trials associated with the conservative treatment of LLL post-treatment of gynecological cancer. The three selected articles are retrospective, and had the same outcome - decreased volume of the affected limb lymphedema. CONCLUSIONS: Although LLL is more or as frequent and detrimental as upper limb lymphedema post-cancer treatment, there are only a few studies about this subject. Publications are even scarcer when considering studies with interventional approach. Randomized controlled trials are necessary to support rehabilitation resources on lymphedema post-gynecological cancer treatment.


Assuntos
Medicina Baseada em Evidências , Neoplasias dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Sistema Linfático/fisiopatologia , Linfedema/terapia , Modalidades de Fisioterapia , Doença Crônica , Efeitos Psicossociais da Doença , Feminino , Humanos , Extremidade Inferior , Linfedema/etiologia , Linfedema/fisiopatologia , Linfedema/psicologia , Qualidade de Vida , Fatores de Risco , Resultado do Tratamento
9.
Blood ; 128(9): 1169-73, 2016 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-27385789

RESUMO

Aside from the established role for platelets in regulating hemostasis and thrombosis, recent research has revealed a discrete role for platelets in the separation of the blood and lymphatic vascular systems. Platelets are activated by interaction with lymphatic endothelial cells at the lymphovenous junction, the site in the body where the lymphatic system drains into the blood vascular system, resulting in a platelet plug that, with the lymphovenous valve, prevents blood from entering the lymphatic circulation. This process, known as "lymphovenous hemostasis," is mediated by activation of platelet CLEC-2 receptors by the transmembrane ligand podoplanin expressed by lymphatic endothelial cells. Lymphovenous hemostasis is required for normal lymph flow, and mice deficient in lymphovenous hemostasis exhibit lymphedema and sometimes chylothorax phenotypes indicative of lymphatic insufficiency. Unexpectedly, the loss of lymph flow in these mice causes defects in maturation of collecting lymphatic vessels and lymphatic valve formation, uncovering an important role for fluid flow in driving endothelial cell signaling during development of collecting lymphatics. This article summarizes the current understanding of lymphovenous hemostasis and its effect on lymphatic vessel maturation and synthesizes the outstanding questions in the field, with relationship to human disease.


Assuntos
Plaquetas/metabolismo , Quilotórax/metabolismo , Vasos Linfáticos/metabolismo , Linfedema/metabolismo , Ativação Plaquetária , Trombose/metabolismo , Animais , Plaquetas/patologia , Quilotórax/patologia , Quilotórax/fisiopatologia , Humanos , Lectinas Tipo C/metabolismo , Vasos Linfáticos/patologia , Linfedema/patologia , Linfedema/fisiopatologia , Glicoproteínas de Membrana/metabolismo , Camundongos , Trombose/patologia
10.
J. vasc. bras ; 14(2): 161-167, Apr.-June 2015. tab
Artigo em Inglês | LILACS | ID: lil-756466

RESUMO

Lymphedema secondary to breast cancer causes physical and psychological morbidity and compromises quality of life. The objective of this literature review was to study lymphatic compensation after surgery for breast cancer and the factors that influence this process, with a view to understanding the etiopathogenesis of lymphedema. Articles indexed on Pubmed published from 1985 to 2012 were reviewed. According to the literature, lymphangiogenesis reduces damage to lymph vessels; there is little evidence that Vascular Endothelial Growth Factor is elevated in women with lymphedema; lymphovenous communications can be observed 60 days after surgery; women without lymphedema have acquired alternative mechanisms for removal of proteins from the interstitial space; and active exercise stimulates lymphatic and venous pumping. Health professionals should teach these patients about the risk factors for lymphedema. The effects of lymphangiogenesis, proteolysis and lymphovenous communications on development of lymphedema should be studied, since these events are intimately related.


Linfedema secundário ao câncer de mama resulta em morbidade física e psicológica, e compromete a qualidade de vida. O objetivo desta revisão da literatura foi estudar as compensações linfáticas após cirurgia para câncer de mama e os fatores que interferem neste processo, visando a compreender a etiopatogenia do linfedema. Foram incluídos artigos publicados de 1985 a 2012, da base de dados Pubmed. Segundo a literatura, a linfangiogênese reduz danos nos vasos linfáticos; há pouca evidência de que o fator de crescimento vascular endotelial linfático é aumentado nas mulheres com linfedema; anastomoses linfovenosas são observadas 60 dias após a cirurgia; mulheres sem linfedema adquiriram mecanismos alternativos para remoção das proteínas do interstício, e exercício ativo estimula bombeamento linfático e venoso. Orientações dos fatores de risco para linfedema devem ser empregadas por profissionais da saúde. O efeito de linfangiogênese, proteólise e anastomoses linfovenosas sobre o desenvolvimento do linfedema deve ser estudado, pois são eventos intimamente relacionados.


Assuntos
Humanos , Feminino , Sistema Linfático , Linfedema/etiologia , Linfedema/fisiopatologia , Neoplasias da Mama/etiologia , Mulheres , Artéria Axilar , Modalidades de Fisioterapia/métodos , Pessoal de Saúde , Cuidados Pós-Operatórios , Fatores de Risco
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA