Penile and sexual rehabilitation in a patient with lymphedema of the penis.

The aim of this study is to report on penile rehabilitation in lymphedema of the penis with a new compression mechanism and the implantation of a penile prosthesis for sexual rehabilitation. The case of a 72-year-old patient with a history of edema of the penis for 6 years is reported. The patient reported that he had had periods of edema and redness and that the swelling had worsened over time. A clinical diagnosis of lymphedema of unknown etiology was made; the hypotheses were that the etiology was late congenital lymphedema of the penis or lymphedema aggravated by inflammation and/or infection. A new compression mechanism made using a cotton-polyester fabric (low elasticity and ribbed) was employed. The continued use of compression therapy led to almost complete reduction of the edema and the patient tried to return to be sexually active. A specific medication was used for erectile dysfunction; however, it resulted in no improvement and so a penile prosthesis was implanted.

Treatment of Elephantiasis with Physiological Retraction of the Skin to Clinical Standards of Normality.

Stage III lymphedema, also known as elephantiasis, is the most advanced stage and involves the occurrence of large deformities. This article reports the case of a 30-year-old woman with bilateral stage III lymphedema who weighed 109 kg. The largest circumference measurements below the knee were 97 cm on the right leg and 76 cm on the left leg. Intensive treatment was performed, involving 8 hour per day of mechanical lymphatic therapy with the RAGodoy® device, which performs passive plantar flexion and extension, 15 min of cervical lymphatic therapy per day, and the use of non-elastic laced compression stockings. Treatment resulted in a considerable loss of edema as well as the occurrence of folds of excess skin, which were resolved by continuing treatment in a slower, non-intensive manner. Folds of excess skin are common during the treatment of large lymphedemas until reaching standards of normality or near normality but can be resolved with further clinical treatment.

Clinical aspects of congenital primary lymphedema.

PURPOSE: Lymphedema is a specific type of edema with a chronic, progressive nature. The aim of the present study is to report clinical findings related to edema and its location in children with primary lymphedema. METHODS: Sixty-eight children with congenital primary lymphedema were evaluated at the Godoy Clinic in São Jose do Rio Preto, Brazil, between 2014 and 2017. A retrospective, cross-sectional study was conducted involving the analysis of clinical data on the location of edema in 68 children with congenital primary lymphedema. We evaluated the charts of all children with this condition in the period analyzed, recording the affected limbs and conditions associated with lymphedema. RESULTS: Sixty-eight children, 37 girls (54.41%) and 31 boys (45.58%), were evaluated. CONCLUSION: We found that congenital primary lymphedema predominantly affects the lower limbs and is more prevalent in girls than boys.

Physiological Stimulation of the Synthesis of Preelastic Fibers in the Dermis of a Patient with Fibrosis.

OBJECTIVE: The aim of the present study was to report the physiological stimulation of the synthesis of preelastic fibers in the dermis of a patient with fibrosis. DESIGN: A clinical study was conducted involving the analysis of histological changes in preelastic fibers following treatment for stage II primary lymphedema for the clinical reversal of lymphedema and fibrosis. Setting. University Hospital of the São Jose do Rio Preto of School of Medicine in 2020. Participant was a 67-year-old male patient with late-onset primary lymphedema diagnosed 12 years earlier. Intervention is the lymphatic stimulation using the Godoy method adapted to the treatment of fibrosis. Main outcomes and measures are biopsies before and after treatment. Ten randomly selected histological fields were evaluated using the multipoint morphometric method. The values with this method are relative and expressed as percentages. Statistical analysis was performed with the t-test, considering a 95% significance level. RESULTS: A visible, significant difference in the percentage of preelastic fibers was found between the preintervention and postintervention slides, which were confirmed by the microscopic evaluation and quantification (4.95 ± 0.64% and 14.70 ± 1.06%, respectively). CONCLUSION: The physiological stimulation of the lymphatic system using a specific method resulted in the clinical reduction of fibrosis, the return of the elasticity of the skin, and the stimulation of the synthesis of preelastic fibers.

Functional classification of secondary lymphedema.

The epidemiological classifications of primary lymphedema based on age at emergence and the severity of the edema are fundamental to the transmission of information about this condition. In the secondary type, the lymphatic system is intact at birth but is injured during the course of life, causing a deficiency that leads to lymphedema. However, years of clinical experience and progress in treatment suggest new classifications to assist in the therapeutic planning of each patient. In clinical practice, we have observed inappropriate treatments that can cause more harm than good. Such observations are important and suggest the need for a proper diagnosis that considers all physiopathological processes involved for the establishment of the best form of treatment.

Using bioelectrical impedance analysis to compare the treatment of edema with the Unna's boot and noncompression in individuals with venous ulcers.

Venous insufficiency is related to aging. Edema, pathological evolution of venous insufficiency, favors the appearance of venous ulcers as the main complication. Leg ulcers can be treated with compression, the Unna's boot being one of them, and noncompression therapies (conventional dressing). Bioelectrical impedance analysis accurately measures the patient's body fluids. The objective of this study was to evaluate the edema evolution of the venous ulcer-affected lower limb by means of electric bioimpedance with the use of Unna's boot and noncompressive dressing. Fifteen legs with active ulcers were treated from September 2014 to December 2016. The legs were treated with Unna's boot and noncompression therapies on different days with randomized order of events. Bioimpedance was performed in the morning and afternoon to evaluate the increase in edema over the day. All patients were female with ages ranging from 50 to 76 years (mean age: 63 years). According to bioimpedance, the volume of the legs increased with both types of therapy. However, compression therapy was significantly more effective than noncompression therapy. Bioimpedance confirmed that compression therapy (Unna's boot) gives better results than noncompression therapy in relation to the formation of edema over a day in patients with chronic venous ulcers.

Intermittent Massage as a Therapeutic Option for Compartment Syndrome after Embolectomy of the Lower Limbs.

The case of a 54-year-old cardiac patient is reported, who was admitted to hospital with a complaint of sudden pain in the legs associated with edema, paresthesia, and coldness. Arterial embolism of the lower limbs was diagnosed and the patient was submitted to bilateral embolectomy. The patient evolved with a burning sensation, hypersensitivity in the right leg, swelling, and difficulty bending and stretching the sole of the foot and the knee. A physical examination detected edema and increased tension in the anterior, lateral, and posterior compartments. Treatment using intermittent massage of the leg during the evaluation of the patient was chosen in an attempt to stimulate lymphatic and venous drainage. After a few minutes of stimulation, there was significant improvement in the pain and edema. In 40 minutes, there was total reduction of the pain in the posterior and lateral compartments and improvement of over 50% in the anterior compartment. After this, the patient started to bend the knee without pain and bend the sole of the foot with slight pain. On the following day, the patient was walking around the hospital ward without difficulty. It seems that intermittent massage is a therapeutic option in selected cases of compartment syndrome.

Lymph Drainage of Posttraumatic Edema of Lower Limbs.

OBJECTIVE: The present study was aimed at evaluating the use of mechanical and manual lymphatic therapy as a treatment for lymphedema resulting from orthopedic surgery that became painful after an episode of erysipelas. CASE REPORT: A 70-year-old male patient suffered direct trauma resulting in a compound fracture of the tibia and fibula of the left leg. He was treated with an external fixator for four months followed by plaster cast immobilization for three weeks. He presented with fever and paresthesia in the lower left limb that resulted in an episode of erysipelas, and the patient evolved with painful lymphedema. Treatment using the Godoy and Godoy technique was proposed, including manual and mechanical lymphatic therapy. Water displacement volumetry was used to quantify the leg size reduction. RESULTS: After 10 sessions of therapy, the patient presented a significant reduction in the limb volume and remission of symptoms. CONCLUSIONS: The method used may be a promising option for the treatment of posttraumatic edemas with pain.

Lymphatic Drainage of Legs Reduces Edema of the Arms in Children with Lymphedema.

OBJECTIVE: The aim of the present study is to report on the reduction of edema of lymphedematous arms just by treating the lower limbs. METHODS: A 16-year-old girl reported that she has started having right lower limb edema at the age of three. At age 13, she performed a lymphoscintigraphy that confirmed the diagnosis of primary lymphedema of the four limbs. Recently she sought treatment at the Clínica Godoy in São Jose do Rio Preto where she was submitted to intensive treatment for eight hours per day for five days using manual (Godoy & Godoy technique) and mechanical lymphatic therapy (RA Godoy®) of the lower limbs, cervical lymphatic therapy (cervical stimulation), and the continuous use of a grosgrain stocking. RESULTS: At the end of treatment, reductions in the sizes of both arms and legs were noted even without the use of any specific therapy for the arms. After four years, the size of the arms was normal. CONCLUSION: Treatment of lymphedema of the legs has systemic repercussions that may lead to the reduction in swelling of other untreated regions of the body.

Adapting Lymphedema Treatment in Patients with a Mental Disability.

BACKGROUND AND PURPOSE: Mental disability is often characterized by significant limitations in adaptive skills. When this condition is associated with lymphedema, treatment requires greater commitment of the care team. The objective of this study is to report the treatment of lymphedema using only one therapeutic technique, a low-stretch grosgrain stocking. CASE REPORT: We report the case of a 14-year-old mentally challenged female patient with lymphedema of the left leg, motor difficulties, and impaired speech and sight. According to the caregiver, lymphedema was present at birth; however, the patient had not been submitted to specific treatment. Thus, only one technique, an adapted low-stretch grosgrain compression stocking, was proposed as it could be used during daily life activities. The adaptation involved the grosgrain stocking, fastened using eyelets and cord up to the thigh, being sewn onto a pair of cotton shorts. The result was a clinical improvement with reductions in the perimeter and volume due to the compliance of the patient and the family to treatment. CONCLUSION: The use of a single treatment strategy in the form of a low-stretch stocking in such cases together with the involvement of a multidisciplinary team can lead to good treatment outcomes for chronic lymphedema.

Cervical Stimulation in the Treatment of Children with Lymphedema of All Four Extremities: A Case Report and Literature Review.

Aim. The aim of this study is to report on the use of cervical stimulation as monotherapy to reduce swelling and normalize the size of limbs in two children with lymphedema of all four extremities. Case Presentation. One child also had hemifacial edema. In both cases, the mothers were trained to perform cervical stimulation under professional supervision. The cases of two girls, one of eight months and the other of six months, with primary congenital lymphedema are described. Outcome. After clinical diagnosis, the patients started treatment with cervical stimulation three times per week. The mothers were trained in cervical stimulation and, when the therapy team was confident about the mothers' ability to perform the technique, the children began to be treated at home. The Godoy & Godoy cervical stimulation technique consists of around 20 to 30 light stroking movements per minute in the cervical region which stimulate the lymphatics. Perimetric measurements were made of the feet, legs, and the hands. Only two points (3 and 6 cm) along the dorsum of the feet and hands and points at 5 cm intervals up the legs starting at the ankle were considered. Today, the children are 5 and 6 years of age, without edema and with a normal life, without limitations, except with respect to precautions against injuries to the limbs and against infections particularly erysipelas. Conclusion. Cervical Lymphatic Therapy as monotherapy is an option in the treatment of primary congenital lymphedema.

Lipolymphedema Associated with Idiopathic Cyclic Edema: A Therapeutic Approach.

Idiopathic cyclic edema is a type of generalized edema that mainly affects women. Diagnosis is made by the patient's clinical history and an evaluation of the accumulation of weight during the day. The objective of this study is to report the clinical control of lymphedema associated with idiopathic cyclic edema using calcium dobesilate. A 55-year-old female patient reported generalized edema for years in that she woke up in the morning with her legs swollen and the edema worsened during the day. The physical examination revealed generalized edema. After four days of treatment with calcium dobesilate, the patient returned to the Clínica Godoy, Brazil, with less edema and reductions in body weight and the amount of extracellular and intracellular fluid. With further treatment, there was a total reduction of the edema. It is concluded that calcium dobesilate helps to control lymphedema secondary to idiopathic cyclic edema.

Lymphedema in Klippel-Trenaunay Syndrome: Is It Possible to Normalize?

The aim of this study is to report the results of intensive therapy of lymphedema associated with Klippel-Trenaunay syndrome. A 24-year-old female patient reported that her family had observed edema in her right leg and port wine stains from birth. For ten years, they consulted with different specialists in the region but the prognosis did not change and no specific treatment was found. In 2014, at the age of 24, with massive lymphedema, a leg ulcer, and recurrent infections, she started treatment at the Clínica Godoy in São José do Rio Preto. She was evaluated by clinical history, physical examination, water displacement volumetry, and bioimpedance. Intensive therapy (8 hours daily) was proposed using Manual Lymphatic Therapy (Godoy & Godoy), Cervical Stimulation Therapy, Mechanical Lymphatic Therapy, a grosgrain stocking adjusted several times a day, and the use of Unna boot in the region of the ulcer. The volume of edema was reduced by about 44% within the first week with further reductions in the following weeks and healing of the ulcer. Subsequently, it was possible to control and maintain the reduction in swelling with less intense treatment. It is possible to reduce and maintain the treatment results of lymphedema associated with Klippel-Trenaunay syndrome.

Bioimpedance to screen for abdominal fat in patients with breast cancer treatment-related lymphedema.

BACKGROUND: One of the dreaded complications after the treatment of breast cancer is lymphedema. Therapies used in the treatment of breast cancer such as surgery, radiotherapy, hormone therapy and chemotherapy may be adversely affected by obesity. AIM: The objective of this study was to use bioimpedance to assess abdominal fat in women with breast cancer treatment-related lymphedema and suggest this as a screening method. METHODS: Forty-five female patients with clinical diagnosis of breast cancer treatment-related lymphedema were evaluated in this quantitative cross-sectional study. A control group, composed of 38 patients with varicose veins and women attending a social support group, was matched for age and body mass index (BMI). All participants were submitted to a bioimpedance evaluation (In Body S 10), with particular attention being paid to abdominal fat and their BMI. The unpaired t -test, Fisher Exact test and Mann-Whitney test were used for statistical analysis and an alpha error of 5%. RESULTS: There was no significant difference (p -value = 0.23) in the mean BMI between the study group (27.79 kg∕m2) and the control group (28.80 kg∕m2). The mean abdominal circumference, a measure of abdominal fat, of the women in the study group was 130.54 cm2 and for the control group it was 102.24 cm2 (p -value = 0.0037). Thus the study group had more abdominal fat (p -value = 0.0003). Moreover, on comparing obese patients in the two groups, the study group had more abdominal fat (p -value = 0.02). However, no significant difference was observed comparing non-obese patients (p -value = 0.6). The comparison of obese patients with non-obese patients in the control group identifies an association between obesity and abdominal fat (p -value < 0.04). CONCLUSION: Overweight and obese women with breast cancer treatment-related lymphedema are more likely to have increased abdominal fat than the general population with bioimpedance.

Synergistic effect of adjustments of elastic stockings to maintain reduction in leg volume after mechanical lymph drainage.

The objective of the present study was to evaluate the effect of elastic compression stockings on volumetric variations of lymphedematous limbs between mechanical lymph drainage sessions. Eleven patients with Grade II leg lymphedema, regardless of etiology, were evaluated in a randomized clinical trial. The ages ranged from 47 to 83 years old with a mean of 62.4 years. Participants were submitted to mechanical lymph drainage (RAGodoy) associated with adjusted and unadjusted knee-high elastic compression stockings (20/30 Venosan). The effect of these stockings on the maintenance of volumetric reductions between sessions of lymph drainage was assessed. In all, 33 evaluations were carried out, 18 of patients using well-adjusted stockings and 15 with badly-adjusted stockings. The differences in volumes were significant (unpaired t-test; P-value < 0.0001). Adjusting the compression provided by elastic stockings according to the size of the leg has a synergistic effect in reducing volume during mechanical lymph drainage.

The effect of mechanical lymph drainage accompanied with heat on lymphedema.

BACKGROUND: Thermotherapy has been indicated by some researchers as a treatment for lymphedema. A study comparing temperatures demonstrated that a temperature of 40°C significantly increased the transportation of lymph compared to other temperatures assessed. The aim of this study was to evaluate the possible benefits of mechanical lymph drainage accompanied with heat in the treatment of lymphedema of the lower limbs. METHODS: In a cross-over randomized study, the effect of heat on lymph drainage was evaluated in the treatment of leg lymphedema. The study, performed in the Godoy Clinic in São Jose do Rio Preto, Brazil, involved seven patients (two males and five females) with leg lymphedema. The patients' ages ranged from 18 to 79 years old with a mean of 48.5 years. The subjects underwent a total of 38 assessments including 19 evaluations of mechanical lymph drainage alone and 19 combined with thermotherapy. Heat was applied using an electric blanket which was wrapped around the legs of the patients. The volume of legs was evaluated by water plethysmography before and after treatment sessions. The paired t-test was used for statistical analysis with an alpha error of p = 0.05 being considered as acceptable. RESULTS: No statistically significant differences were evidenced between mechanical lymph drainage alone and lymph drainage combined with thermotherapy. CONCLUSIONS: There was no obvious synergic effect in the immediate post-treatment period when heat was combined with mechanical lymph drainage in the treatment of lymphedema.

Association of Godoy & Godoy contention with mechanism with apparatus-assisted exercises in patients with arm lymphedema after breast cancer.

AIM: The aim of the current study was to evaluate the reduction in the volume of the upper limbs with lymphedema after exercises using the apparatus-assisted program associated with contention mechanism. PATIENTS AND METHOD: Twenty-eight female patients were selected and referred for evaluation and treatment of lymphedema after breast cancer therapy. The ages of the women ranged from 42 to 72 years with a mean age of 57 years. Inclusion criteria were treatment of cancer associated to a difference of at least 200 mL between the edematous and the contralateral limbs. Patients with active infections, skin lesions, and active disease were not included in the study. Four series of exercises using devices based on pedals, pulleys, a horizontal reflexion bar, and an elevation bar were selected. The participants were advised about the form of exercise: 15 minutes for each device, low intensity (less than 10 movements per minute), in the seated position, and the use of contention. Water displacement volumetry was performed before and after the 60-minute exercise session. The paired t-test was utilized with an alpha error of 5% considered acceptable (P value < 0.05). RESULTS: The mean difference between the volumetric measures before and after exercise was significant, with all the participants having reductions in the volume of the limbs using the four selected devices over time and at an intensity determined by this study. CONCLUSION: Association of a Godoy and Godoy contention during apparatus-assisted exercise reduced the edema in patients with lymphedema of the upper limbs.

Surgical treatment of elephantiasis of the feet in congenital lymphedema to facilitate the use of a compression mechanism.

The aim of the current study is to report on the minimal surgical treatment of elephantiasis of the feet to facilitate the use of compression mechanisms. The cases of two patients with congenital lymphedema that evolved to elephantiasis involving the feet are reported. Intensive treatment of the lymphedema was performed with a significant reduction in size thus allowing a better identification of the limits of tissue masses for the surgical approach. This reduction enabled primary suturing of the lesions to be carried out and fast healing of the wounds. The surgery greatly improved large deformities of the toes and feet and facilitated further treatment of the lymphedema using bandaging. Thus, the skin was preserved, there was a reduction in the size of the feet, and the patients were able to start wearing shoes.