Psychological Changes During Inpatient Conservative Treatment for Lymphedema.

Background: Learning self-care for lymphedema is essential for patients to maintain their quality of life; however, it is sometimes difficult and stressful. There are only few studies about the psychological changes in patients hospitalized for conservative therapy. The purpose of this study was to evaluate the psychological changes in patients admitted for conservative therapy and training in self-care for lymphedema. Methods and Results: Nine patients who were hospitalized for conservative treatment of lymphedema of the lower limbs were administered the Profile of Moods States questionnaire twice: day of admission or the following day and after 5 days of hospital stay. Eight female patients and one male patient were included in this retrospective study. The mean age was 67.2 years. We provided standard compression therapy, manual lymph drainage, and exercise therapy to the patients. The Profile of Moods States 2nd edition, Japanese version of the Profile of Moods States, was used as an evaluation method of the psychological state. The results of the psychological tests were evaluated by a certified public psychologist. The scores for negative mood (anger or hostility, confusion or bewilderment, depression or rejection, fatigue or inertia, and tension and anxiety) were all lower on the fifth day of hospitalization compared with those at admission. In particular, the tension or anxiety scores decreased significantly (p = 0.019). However, the vigor or activity scores tended to increase. Conclusions: It was found that inpatient conservative therapy for lymphedema had a positive effect on the psychological state of the patients. Despite stressors such as a change in environment and introduction of new treatments (compression therapy and exercise therapy), the improvement in edema helped elevate the mood of the patients by the fifth day of hospitalization.

Therapeutic lymphangiography for traumatic chylothorax.

Chylothorax is a challenging disease. We present a case of traumatic chylothorax that was successfully treated using lymphangiography through intranodal injection of contrast agent. A 17-year-old girl had chylothorax. It did not improve despite medical treatment. We performed lymphangiography through intranodal injection of an oil contrast agent (Lipiodol). The amount of chylothorax was reduced from 1000 to 120 mL/d, and we could remove the thoracotomy tube. Thereafter, although she had a small amount of pleural effusion, she has not demonstrated aggravation for 19 months. Lymphangiography with oil contrast agent can be one of the options to treat chylothorax.

Local anesthesia for lymphaticovenular anastomosis.

Lymphaticovenular anastomosis is well documented for its effectiveness in treating lower limb lymphedema. However, local anesthesia (LA) is not the usual choice of anesthesia. In this study, 14 patients having such operation done under LA were recruited to see how well they tolerated the operations. Visual analogue scale was used to grade both intraoperative and postoperative pain. It was shown that the mean intraoperative pain score was never greater than 1, in the scale from 0 to 10. The mean postoperative pain score was 1.6 on the first postoperative day and then dropped gradually. No complication of surgery was reported. In-depth preoperative counseling and complementary intraoperative measures were emphasized to make LA a possible choice of anesthesia.

Early lymph-drainage massage using a cosmetic roller after lymphatico-venous anastomosis compared to manual lymph drainage: a case report.

Conservative and surgical treatment for lymphedema are performed independently, and combined treatment with lymphatico-venous anastomosis (LVA) followed by manual massage is increasingly reported. However, a problem with this approach is that manual massage cannot be initiated immediately after LVA because of concerns of injuring surgical wounds and anastomosed regions. To overcome this problem, we developed a treatment method using a cosmetic roller instead of manual massage, which allows lymph drainage to be initiated immediately after surgery. In this study, we treated a patient with bilateral lower limb lymphedema using this method. Conventional manual massage starting 3 weeks after surgery was used for the left lower limb, while early massage using a cosmetic roller was used for the right lower limb from the day after surgery. A higher therapeutic effect was obtained in the right lower limb compared to that in the left lower limb. The results in this case suggest that further studies should be performed to examine the new method in various types of patients.

Lymphaticovenous anastomosis for facial lymphoedema after multiple courses of therapy for head-and-neck cancer.

Lymphaticovenous anastomosis (LVA) is a treatment for lymphoedema that can improve lymph circulation by the anastomosis of lymph vessels and veins. A therapeutic effect of LVA for lymphoedema has been shown in limbs, but efficacy for other regions has not been shown. Lymphoedema in the head-and-neck region following cancer resection and radiotherapy is mainly treated with manual lymphatic drainage. However, there is no alternative when this treatment is ineffective because application of compression treatment using a bandage is difficult in this region. We used LVA for lymphoedema in the head-and-neck region and achieved a good outcome. Functional and dilating lymph vessels were identified using pre- and intra-operative fluorescent lymphography, and a lymph vessel with a diameter of about 0.2-1.0 mm was anastomosed with a vein using supermicrosurgery. The outcome of this case suggests that LVA is applicable for treatment of lymphoedema in the head-and-neck region.

Differences in relaxation by means of guided imagery in a healthy community sample.

OBJECTIVE: This study investigated differences in relaxation induced by guided imagery in healthy community samples. METHODS: One hundred forty-eight people took part in our investigation. The mean age of the 50 males and 98 females was 39.36 +/- 11.86 years. We took saliva samples to measure salivary cortisol (SC) before the first session, after the first session, and after the second session. Subjects were asked to complete the short form of the Multiple Mood Scale (MMS) questionnaire before the first session and after the second session. The shortened form of Betts' Questionnaire upon Mental Imagery (QMI) was collected once before the first session, and vividness of the imagery was measured using a visual analogue scale once after the second session. RESULTS: SC levels were significantly decreased after the first session and after the second session in all participants. We found, most significantly, that age and QMI scores were strongly related to changes in SC level throughout the relaxation sessions. CONCLUSIONS: Unpleasant information, a cause of mental stress, is replaced by a comfortable image, and this replacement affects a participant's SC level. The greater one's imagery ability is, the more successful the displacement of stress and the shift toward a comfortable mental and emotional state will be. This study provides a basis for explaining the mechanism through which relaxation by means of guided imagery is effective in reducing stress.