Compressive taping to prevent postmastectomy seroma: patient adherence and satisfaction.

OBJECTIVE: Evaluate patient adherence and satisfaction concerning postmastectomy compressive taping. METHODS: This comprises a preintervention and postintervention study carried out with women ≥18 years old who underwent taping during the first 7 postoperative days at the Cancer Hospital III/National Cancer Institute. Good adherence was considered as taping maintenance for 7 days. Satisfaction levels were classified as satisfied and dissatisfied. RESULTS: A total of 124 women with a mean age of 56.54 (±11.24) were included in the study. Most lived without a partner (58.1%), had more than 8 years of study (59.7%), referred to themselves as white (68.5%) and considered their health status to be good or very good (69.4%). Regarding treatment adherence, 90.3% patients displayed adherence. Patients with no bullous lesions were more likely to adhere to taping (OR 7.00; 95% CI 1.98 to 24.74; p=0.003). Regarding satisfaction, 78.2% of the patients felt satisfied. The absence of local discomfort (OR 4.51; 95% CI 1.73 to 11.74; p=0.002) and non-existence of self-reported oedema (OR 5.81; 95% CI 1.81 to 18, 66; p=0.003) were associated with greater patient satisfaction. CONCLUSION: Patients exhibited good adherence and felt very satisfied with the use of postmastectomy compressive taping. TRIAL REGISTRATION NUMBER: NCT04471142.

Acompanhamento Fisioterapêutico após Tratamento Cirúrgico do Câncer de Mama por Teleconsulta: Percepção e Adesão das Pacientes / Physiotherapeutic Follow-up after Surgery for Breast Cancer Treatment by Telehealth: Patients' Perception and Adherence / Seguimiento Fisioterapéutico Posquirúrgico para el Tratamiento del Cáncer de Mama por Teleconsulta: Percepción y Adherencia de las Pacientes

Introdução: O serviço de fisioterapia do Hospital do Câncer III do Instituto Nacional de Câncer (HCIII/INCA) inseriu as teleconsultas em suas atividades assistenciais para o acompanhamento das pacientes submetidas ao tratamento cirúrgico do câncer de mama durante a pandemia. Objetivo: Avaliar a percepção das pacientes quanto aos atendimentos por teleconsulta no HCIII/INCA, além da compreensão e da adesão quanto às orientações fisioterapêuticas domiciliares no pós-operatório de câncer de mama. Método: Estudo observacional, de abordagem qualiquantitativa, no qual foram incluídas pacientes submetidas ao tratamento cirúrgico do câncer de mama, de março a maio de 2020, que realizaram teleconsultas com a fisioterapia. Foi utilizado um questionário com perguntas semiestruturadas e uma pergunta aberta sobre teleconsulta. Resultados: Foram incluídas 129 mulheres, 81,4% referiram conforto com as teleconsultas, 72,1% sentiram-se muito seguras e 71,3% sentiram-se satisfeitas com esse tipo de atendimento. Quanto às orientações fisioterapêuticas fornecidas, 89,1% das pacientes relataram que as entenderam e 66,7% que as seguiram totalmente; 63,6% realizaram os exercícios de membros superiores diariamente. Quanto à questão qualitativa, as pacientes relataram que a teleconsulta foi necessária, válida e importante por evitar a exposição ao vírus no período da pandemia, além de evitar os deslocamentos até a instituição, a economia de tempo e de dinheiro. Conclusão: A modalidade de teleconsulta nas avaliações da fisioterapia pós-cirurgia do câncer de mama geraram percepções de segurança, conforto e satisfação, tendo boa compreensão e adesão tanto das orientações fornecidas quanto da prática de exercícios domiciliares

Introduction: The physiotherapy service at the Cancer Hospital III of the National Cancer Institute (HCIII/INCA) has included telehealth in its care activities for monitoring patients undergoing surgical treatment for breast cancer during the pandemic. Objective: To evaluate the perception of patients about telehealth at HCIII/INCA, in addition to understanding and adherence to home physiotherapeutic guidelines in the postoperative breast cancer period. Method: Observational, qualitative and quantitative approach study, which included patients who received surgical treatment for breast cancer from March to May 2020 and attended physiotherapy telehealth. A semi-structured questionnaire with an open question about telehealth was utilized. Results: 129 women were included, 81.4% reported comfort with telehealth, 72.1% felt very safe and 71.3% felt satisfied with this type of service. Regarding physiotherapeutic guidelines provided, 89.1% of the patients claimed they understood the content, 66.7% followed them completely and 63.6% performed daily upper limb exercises. In relation to the quality, the patients reported that telehealth was necessary, valid and important to avoid exposure to the virus during the pandemic, in addition to being cost-effective, time-saving and avoiding trips to the institution. Conclusion: The modality of telehealth as evaluated by physiotherapy after breast cancer surgery generated a feeling of security, comfort and satisfaction, with good understanding and adherence to the guidelines and practice of home exercises

Introducción: El servicio de fisioterapia del Hospital Oncológico III del Instituto Nacional del Cáncer (HCIII/INCA) ha incluido la teleconsulta en su actividad asistencial para el seguimiento de las pacientes sometidas a tratamiento quirúrgico por cáncer de mama durante la pandemia. Objetivo: Evaluar la percepción de las pacientes sobre la teleconsulta en el HCIII/INCA, además de su comprensión y adherencia a las pautas de fisioterapia domiciliaria en el posoperatorio de cáncer de mama. Método: Estudio observacional, con abordaje cualitativa y cuantitativa, que incluyó pacientes que se sometieron a tratamiento quirúrgico por cáncer de mama, de marzo a mayo de 2020, a quienes se les realizó teleconsultas con fisioterapia. Se utilizó un cuestionario con preguntas semiestructuradas y una pregunta abierta sobre teleconsulta. Resultados: Se incluyeron 129 mujeres, el 81,4% refirió comodidad con las teleconsultas, el 72,1% se sintió muy segura y el 71,3% se sintió satisfecha con este tipo de atención. En cuanto a las pautas fisioterapéuticas brindadas, el 89,1% de las pacientes reportó que las entendían y el 66,7% que las seguía completamente; el 63,6% realizaba ejercicios de miembros superiores diariamente. En cuanto a la pregunta cualitativa, las pacientes relataron que la teleconsulta fue necesaria, válida e importante para evitar la exposición al virus durante el período de pandemia, además de evitar desplazamientos a la institución, ahorrando tiempo y dinero. Conclusión: La modalidad de teleconsulta en las evaluaciones de fisioterapia después de la cirugía de cáncer de mama generó percepciones de seguridad, comodidad y satisfacción, con buena comprensión y adherencia tanto a las orientaciones brindadas como a la práctica de ejercicios domiciliarios

Clinical Experience with Compression Taping to Treat Seroma After Breast Cancer Surgery: A Medical Device Clinical Study.

OBJECTIVE: To evaluate the safety of compressive taping in patients with seroma secondary to breast cancer surgery. METHODS: This study was a nonrandomized clinical study of medical devices applied to women indicated for seroma aspiration puncture after breast cancer surgery in a public reference hospital in Brazil. The intervention consisted of applying compressive taping over the seroma fluctuation area and maintained for 5 days. Evaluated outcomes comprised dermal changes caused by taping, subjective symptoms reported during the intervention period, and percent change in the punctured volume before and after the intervention. RESULTS: A total of 35 women (mean age, 56.7 ± 12.2 years) were included. Most presented with an advanced disease stage (≥IIB; 62.9%). Although a 28.6% incidence of dermal changes caused by taping was observed, an average reduction in the aspirated volume of -28.2 mL was identified (95% confidence interval, -48.3 to -8.0; P = .008). Treatment adherence was high (91.4%), and most patients reported satisfaction with the treatment (85.7%). CONCLUSIONS: The use of compressive taping on seroma areas can be considered safe, is well accepted by patients, and might be used as a noninvasive treatment option for seroma developing after breast cancer surgery.

Linear Relationship between the Effective Radiation Area and Thermal Images on a Thermochromatic Test Body with 1-MHz Ultrasonic Transducers.

The performance of therapeutic ultrasonic (TUS) devices has a high degree of variability because of the fragility of the equipment (its transducer in particular) and its handling. These facts raise doubts about the effectiveness and safety of treatments employing such devices. Currently there is no simple way to adequately verify the performance of these devices. In our first experiments, we used a thermochromatic test body (typically a cylindrical plate 3.7 cm in diameter and 5.8 mm high) irradiated with therapeutic transducers driven by a standard radiofrequency (RF) generator. Results revealed a linear relationship between the thermal image areas, generated by the transducer's irradiation, and their respective effective radiation areas (ERAs), suggesting a good correlation. With five 3-MHz transducers, our group also observed the linear relationship using commercial TUS RF driving devices. In the present work, we used four 1-MHz transducers with their respective TUS RF driving devices and verified that there is a linear relationship between the thermal images and the ERAs at intensities of 1.0 ± 0.1 and 0.5 ± 0.05 W/cm2. The linear relationship obtained at both intensities confirms the suggestion that these thermochromatic test bodies can be used as the first evaluation of the ERAs and can monitor their changes with use. Moreover, if a previous assessment of the ERA and transducer intensities is performed, it is possible to follow the variation in ERA simply by monitoring the test body thermal stain.

Axillary surgical approach in T1-T2N0M0 clinical breast cancer staging: Survival in a women's hospital cohort in Rio de Janeiro

The concerns regarding the prognosis and quality of life of patients with early breast cancer staging without lymph node involvement have increased, especially with regard to the axillary surgical approach. The aim of the present study was to determine overall survival and disease-free survival according to the axillary surgical approach. Methods: Retrospective cohort study of 827 women with clinical T1-T2N0M0 diagnosis attended at the Cancer Hospital III of the Brazilian National Cancer Institute, from January 2007 to December 2009, with a follow-up period of 60 months. Data were obtained from the Hospital Registry of Cancer through the medical records. Results: 683 women underwent sentinel lymph node biopsy and 144 underwent sentinel lymph node biopsy followed by axillary lymphadenectomy. After 5 years of follow-up, considering adjustment, it was observed overall survival (96.2% vs 93.6%; HR 0.98; 95%CI 0.42­2.29) and disease-free survival (93.7% vs 91.2%; HR 0.78; 95%CI 0.39­1.48) similar among patients undergoing either one or the other approach. In patients with micrometastasis, both overall (93.3%) and diseasefree survival (100%) were higher in women who underwent only sentinel lymph node biopsy compared to those who underwent this procedure followed by axillary lymphadenectomy (OS: 87.5%; DFS: 90,7%), albeit not statistically significant.

Guidelines for the prevention of secondary lymphedema following breast cancer treatment: adhesion and associated factors

Introduction: Lymphedema is the most feared complication that may take place after breast cancer treatment. With treatment progression, doubts have arisen regarding the real benefits of lymphedema prevention care, as well as of patient adherence to guidelines. Objective: In this context, the aim of this study was to assess patient adherence to preventive lymphedema guidelines and the distribution of sociodemographic, clinical, and treatment variables according to adherence to treatment. Methods: A cross­sectional study conducted at the Cancer Hospital III/INCA, Rio de Janeiro, Brazil, concerning patients with breast cancer undergoing surgical treatment with an axillary approach. Participants were questioned about assistance care performance, exercise-related care, and limb ipsilateral to surgery care. A descriptive analysis of patient demographic, clinical, treatments, postoperative complications variables, and main outcomes (adherence to the guidelines) was performed through a central tendency measure and data dispersion and frequency measures analyses. Differences between means were assessed using the Student's t-test, while differences between proportions were evaluated using the chi-square test. A significance level of 5% was considered for all assessments. Results: Of the 103 women included in this study, 89.3% adhered to assistance care, 61.2% adhered to limb care, and 42.7% performed exercise-related care. Women undergoing chemotherapy (p = 0.030) and axillary lymphadenectomy (AL) (p = 0.017) exhibited greater adherence to care. Non-white patients (p = 0.048) and those who underwent AL (p = 0.025) adhered to limb care more frequently. Finally, patients displaying lower education levels (p = 0.013) and those who underwent AL (p = 0.009) adhered more frequently to limb exercises. Conclusion: Patients adhered the most to assistance care and limb care compared to exercise practice. Patients undergoing chemotherapy displayed greater adherence to care and non-white patients adhered the most to limb care. Women who underwent AL displayed greater adherence to all types of care and those presenting lower education levels adhered more frequently to exercise guidelines.

Prevenção e Cuidado do Linfedema após Câncer de Mama: Entendimento e Adesão às Orientações Fisioterapêuticas / Prevention and Care of Lymphedema after Breast Cancer: Understanding and Adherence to Physiotherapeutic Guidelines / Prevención y Cuidado del Linfedema después del Cáncer de Mama: Comprensión y Adhesión a las Orientaciones Fisioterapéuticas

Introdução: O linfedema é a complicação mais frequente após a cirurgia do câncer de mama. A intervenção fisioterapêutica precoce é fundamental para melhorar a qualidade de vida e prevenir tal sequela, porém as orientações preventivas podem gerar um sentimento de incapacidade e limitação. Objetivo: Identificar o nível de compreensão e a adesão das pacientes às orientações fisioterapêuticas na prevenção e cuidado do linfedema. Método: Pesquisa descritiva, qualitativa, realizada no Hospital do Câncer III do Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA). Foram incluídas 14 pacientes, submetidas a tratamento cirúrgico para o câncer de mama, sendo realizadas entrevistas semiestruturadas. Resultados: As pacientes entrevistadas relataram que receberam orientações da equipe de fisioterapia e compreenderam a importância das recomendações. Os principais sentimentos despertados, ao serem questionadas sobre a adesão aos cuidados preventivos, foram a preocupação, o medo e o pânico, além do fantasma do linfedema. As entrevistadas reconheceram que, logo após a cirurgia, aderiram mais aos cuidados preventivos, mas que com o passar do tempo, essa rotina de cuidados tornou-se mais complicada, especialmente diante de seus compromissos domésticos. Conclusão: Pôde-se perceber que essas mulheres convivem com um grande medo de desenvolver o linfedema, porém têm a forte necessidade de retomar suas tarefas domésticas. Foi marcante nas falas o quanto as orientações fisioterapêuticas geram angústia, tristeza e sensação de inutilidade nessas mulheres. A fisioterapia deve estar atenta à maneira como apresenta as orientações preventivas de linfedema, devendo buscar sempre a adaptação e nunca a proibição, de forma a trazer compreensão e promover a cooperação, compartilhando com as mulheres a responsabilidade por seu autocuidado.

Introduction: Lymphedema is the most common complication after breast cancer surgery. Early physiotherapeutic intervention is essential to improve quality of life and prevent such sequelae, but preventive guidelines can generate a feeling of incapacity and limitation. Objective: To identify the level of understanding and adherence of patients to physiotherapeutic guidelines in the prevention and care of lymphedema. Method: Descriptive, qualitative research, performed at Hospital de Cancer III the National Cancer Institute José Alencar Gomes da Silva (INCA). Fourteen patients were submitted to surgical treatment for breast cancer, and semi-structured interviews were performed. Results: The patients interviewed reported that they received guidance from the physiotherapy team and understood the importance of the recommendations. The main feelings aroused when asked about adherence to preventive care were worry, fear and panic, as well as the phantom of lymphedema. The interviewees recognized that soon after the surgery, they adhered more to preventive care, but that with the passage of time, this routine of care became more complicated, especially in front of their domestic commitments. Conclusion: We can see that these women coexist with a great fear of developing lymphedema, but they have a strong need to resume their domestic tasks. It was remarkable in the speeches how much the physiotherapeutic orientations generate anguish, sadness and sense of uselessness in these women. Physiotherapy should be attentive to the way it presents the preventive guidelines for lymphedema, and should always seek adaptation and never prohibition, in order to bring understanding and promote cooperation, sharing with women the responsibility for their self-care.

Introducción: El linfedema es la complicación más frecuente después de la cirugía del cáncer de mama. La intervención fisioterapéutica precoz es fundamental para mejorar la calidad de vida y prevenir tal secuela, sin embargo, las orientaciones preventivas pueden generar un sentimiento de incapacidad y limitación. Objetivo:Identificar el nivel de comprensión y adhesión de las pacientes a las orientaciones fisioterapéuticas en la prevención y cuidado del linfedema. Método: Investigación descriptiva, cualitativa, realizada en el Hospital del Cáncer III del Instituto Nacional de Cáncer José Alencar Gomes da Silva (INCA). Se incluyeron 14 pacientes, sometidos a tratamiento quirúrgico para el cáncer de mama, realizándose entrevistas semiestructuradas. Resultados: Las pacientes entrevistadas relataron que recibieron orientaciones del equipo de fisioterapia y comprendieron la importancia de las recomendaciones. Los principales sentimientos despertados al ser cuestionados sobre la adhesión a los cuidados preventivos fueron la preocupación, el miedo y el pánico, además del fantasma del linfedema. Las entrevistadas reconocieron que luego de la cirugía, se adhirieron más a los cuidados preventivos, pero que, con el paso del tiempo, esa rutina de cuidados se volvió más complicada, especialmente ante sus compromisos domésticos. Conclusión: Se puede percibir que esas mujeres conviven con un gran miedo a desarrollar el linfedema, pero tienen la fuerte necesidad de reanudar sus tareas domésticas. Fue marcante en las conversaciones cuanto las orientaciones fisioterapéuticas generan angustia, tristeza y sensación de inutilidad en esas mujeres. La fisioterapia debe estar atenta a la manera como presenta las orientaciones preventivas de linfedema, debiendo buscar siempre la adaptación y nunca la prohibición, para traer comprensión y promover la cooperación, compartiendo con las mujeres la responsabilidad por su autocuidado.

Axillary surgery in breast cancer: acute postoperative complications in a hospital cohort of women of Rio de Janeiro, Brazil / Abordagem cirúrgica axilar no câncer de mama: complicações pós-operatórias agudas em uma coorte hospitalar de mulheres do Rio de Janeiro

Objective: To analyze the incidence of early postoperative complications in women with breast cancer according to the axillary surgery. Methods: An observational study of a cohort of women diagnosed with T1-T2N0M0 clinical stage breast cancer attended at the Brazilian National Cancer Institute from January 2007 to December 2009. The outcome was defined as postsurgical complications in the affected upper limb, such as: axillary web syndrome, winged scapula, paraesthesia and surgical wound, seroma and wound infection. The incidence of simple complications was estimated. The crude and adjusted Odds Ratios, with their respective 95% confidence intervals, were estimated by Multiple Logistic Regression analysis. Results: The incidence of postoperative complications was significantly lower in sentinel lymph node biopsy (axillary web syndrome: 6.0%; paraesthesia: 45.2%; winged scapula: 9.1%; seroma: 28.5%; wound infection: 3.8%) than in axillary lymphadenectomy (axillary web syndrome: 22.5%; paraesthesia: 89.8%; winged scapula: 50.0%; seroma: 69.4%; wound infection: 12.9%). Compared to those who underwent axillary lymphadenectomy, the risk of postoperative complications in those in whom sentinel lymph node biopsy was performed was significantly lower. Conclusion: The sentinel lymph node biopsy technique was an independent protective factor for acute postoperative complications when compared to axillary lymphadenectomy

Objetivo: Analisar a incidência de complicações pós-operatórias precoces em mulheres com câncer de mama de acordo com a cirurgia axilar. Métodos: Estudo observacional de uma coorte de mulheres diagnosticadas com câncer de mama em estágio clínico T1-T2N0M0 atendidas no Instituto Nacional de Câncer do Brasil de janeiro de 2007 a dezembro de 2009. O desfecho foi definido como complicações pós-cirúrgicas no membro superior afetado, tais como: síndrome da rede axilar, escápula alada, parestesia e ferida cirúrgica, seroma e infecção da ferida. A incidência de complicações simples foi estimada. Os Odds Ratios bruto e ajustado, com seus respectivos intervalos de confiança de 95%, foram estimados por análise de Regressão Logística Múltipla. Resultados: A incidência de complicações pós-operatórias foi significativamente menor na biópsia de linfonodo sentinela (síndrome da rede axilar: 6,0%; parestesia: 45,2%; escápula alada: 9,1%; seroma: 28,5%; infecção da ferida: 3,8%) do que na linfadenectomia axilar (síndrome da rede axilar: 22,5%; parestesia: 89,8%; escápula alada: 50,0%; seroma: 69,4%; infecção da ferida: 12,9%). Em comparação com aqueles que foram submetidos a linfadenectomia axilar, o risco de complicações pós-operatórias naqueles nos quais a biópsia de linfonodo sentinela foi realizada foi significativamente menor. Conclusão: A técnica de biópsia de linfonodo sentinela foi um fator de proteção independente para complicações pós-operatórias quando comparadas à linfadenectomia axilar

Abordagem Fisioterapêutica de uma Paciente com Linfedema de Membro Superior Prévio à Cirurgia para Câncer de Mama: Relato de Caso / Physiotherapeutic Approach of a Patient with Upper Limb Lymphedema Prior to Surgery for Breast Cancer: Case Report / Enfoque Fisioterapéutico de um Paciente con Linfedema de Miembro Superior Previo a la Cirugía para Cáncer de Mama: Relato de Caso

Introdução: O linfedema é a complicação mais comum após o tratamento do câncer de mama. Quando se manifesta antes do tratamento cirúrgico, como condição clínica por si só, é visto como um critério de inoperabilidade, representando um fator de mau prognóstico. Relato do caso: Este artigo visa a descrever a evolução clínica de uma paciente com linfedema de membro superior prévio à cirurgia para o câncer de mama, à condução do tratamento fisioterapêutico e à viabilidade do procedimento cirúrgico. Conclusão: Por meio deste relato de caso, foi possível descrever o tratamento fisioterapêutico de uma paciente com linfedema prévio à cirurgia para o câncer de mama. A equipe de fisioterapia pôde atuar em parceria com a equipe médica, controlando a descompensação linfática e auxiliando no caminho até a realização do procedimento cirúrgico. O cuidado fisioterapêutico se mostra fundamental desde o início do tratamento oncológico, de forma a detectar precocemente sintomas e distúrbios, intervindo de maneira eficaz e resolutiva e buscando proporcionar qualidade de vida e os melhores resultados possíveis para as pacientes.

Introduction: Lymphedema is the most common complication after breast cancer treatment. When it manifests itself before surgical treatment, as a clinical condition alone, it is seen as a criterion of inoperability, representing a factor of poor prognosis. Case report: This article aims to describe the clinical evolution of a patient with upper limb lymphedema prior to surgery for breast cancer, the conduct of the physiotherapeutic treatment and the feasibility of the surgical procedure. Conclusion: Through this case report it was possible to describe the physiotherapeutic treatment of a patient with lymphedema prior to surgery for breast cancer. The physiotherapy team can work in partnership with the medical team, controlling the lymphatic decompensation and assisting in the way until the surgical procedure is performed. Physiotherapeutic care has been fundamental since the beginning of cancer treatment, in order to detect early symptoms and disorders, intervening effectively and resolutely and seeking to provide quality of life and the best possible outcomes for patients.

Introducción: El linfedema es la complicación más común después del tratamiento del cáncer de mama. Cuando se manifiesta antes del tratamiento quirúrgico, como condición clínica por sí solo, es visto como un criterio de inoperabilidad, representando un factor de mal pronóstico. Relato del caso: En este artículo se pretende describir la evolución clínica de una paciente con linfedema de miembro superior previo a la cirugía para el cáncer de mama, la conducción del tratamiento fisioterapéutico y la viabilidad del procedimiento quirúrgico. Conclusión: A través de este relato de caso fue posible describir el tratamiento fisioterapéutico de una paciente con linfedema previo a la cirugía para el cáncer de mama. El equipo de fisioterapia puede actuar en asociación con el equipo médico, controlando la descompensación linfática y auxiliando en el camino hasta la realización del procedimiento quirúrgico. El cuidado fisioterapéutico se muestra fundamental desde el inicio del tratamiento oncológico, para detectar precozmente síntomas y disturbios, interviniendo de manera eficaz y resolutiva y buscando proporcionar calidad de vida y los mejores resultados posibles para las pacientes.

Evaluation of gloves as a water bag coupling agent for therapeutic ultrasound

Abstract Introduction Therapeutic ultrasound (TUS) is a widespread modality in physiotherapy, and the water bag technique is a coupling method employed in the presence of anatomical irregularities in the treatment area. The aim of the present study is to evaluate the acoustic attenuation of the water bag and its effectiveness as a TUS coupling agent. Methods The rated output powers (ROPs) of the TUS equipment were evaluated based on IEC 61689. Then, a radiation force balance was used to measure ROP with and without a water bag (latex and nitrile gloves filled with deionized water) between a TUS transducer and the cone-shaped target of the balance. Each experiment was performed five times for each nominal power (0.5, 1.0, 2.0, 3.0, 4.0, 5.0, 6.0, and 7.0 W) and in the following configurations: without the water bag (A), with nitrile gloves and with (B) and without (C) a height controller, and latex gloves with (D) and without (E) height controller. ROPs obtained in different media were compared. Results The highest relative error of ROP was 16.72% for 0.5 W. Although the power values of the equipment were within the range recommended by IEC, there was a significant difference between the ROP values measured with A and with B, C and D. Conclusion As intensity differences below 0.5 W/cm2 are considered clinically not relevant, conditions A, B, C, D, or E can be used interchangeably.

Why we should care about soft tissue interfaces when applying ultrasonic diathermy: an experimental and computer simulation study.

BACKGROUND: One goal of therapeutic ultrasound is enabling heat generation in tissue. Ultrasound application protocols typically neglect these processes of absorption and backscatter/reflection at the skin/fat, fat/muscle, and muscle/bone interfaces. The aim of this study was to investigate the heating process at interfaces close to the transducer and the bone with the aid of computer simulation and tissue-mimicking materials (phantoms). METHODS: The experimental setup consists of physiotherapeutic ultrasound equipment for irradiation, two layers of soft tissue-mimicking material, and one with and one without an additional layer of bone-mimicking material. Thermocouple monitoring is used in both cases. A computational model is used with the experimental parameters in a COMSOL® software platform. RESULTS: The experimental results show significant temperature rise (42 °C) at 10 mm depth, regardless of bone layer presence, diverging 3 °C from the simulated values. The probable causes are thermocouple and transducer heating and interface reverberations. There was no statistical difference in the experimental results with and without the cortical bone for the central thermocouple of the first interface [t(38) = -1.52; 95% CI = -0.85, 0.12; p = 14]. Temperature rise (>6 °C) close to the bone layer was lower than predicted (>21 °C), possibly because without the bone layer, thermocouples at 30 mm make contact with the water bath and convection intensifies heat loss; this factor was omitted in the simulation model. CONCLUSIONS: This work suggests that more attention should be given to soft tissue layer interfaces in ultrasound therapeutic procedures even in the absence of a close bone layer.

Axillary web syndrome is not a risk factor for lymphoedema after 10 years of follow-up.

OBJECTIVE: The objective of this study was to evaluate the association between axillary web syndrome and the development of lymphoedema after 10 years of follow-up. METHODOLOGY: A prospective observational study in a hospital cohort of women diagnosed with breast cancer and treated at a referral centre for cancer. Patients were followed according to the routine of the hospital's physical therapy service. In addition, a review of medical records was conducted for the period between 5 and 10 years of follow-up. Data on patient characteristics, treatment, tumour and postoperative complications were collected. RESULTS: In all, 964 patients were included, mostly <65 years old (75 %) and classified as being overweight (68 %). Disease was diagnosed as being up to stage IIA in 54.9 % of the cases; 65.1% underwent mastectomy and 83.8% had total axillary dissection. As adjuvant treatment, 61 % underwent chemotherapy, 63.5 % radiotherapy and 68 % hormone therapy. Among surgical complications, 62.6 % of patients had seroma, 40.7 % had necrosis, 35.9 % axillary web syndrome and 31.4 % lymphoedema. There was no association between axillary web syndrome and the development of lymphoedema (OR = 0.87, 95 % CI 0.65 to 1.15, p = 0.329). CONCLUSION: The occurrence of axillary web syndrome was not a risk factor for lymphoedema after 10 years of follow-up.

Atenção fisioterapêutica no controle do linfedema secundário ao tratamento do câncer de mama: rotina do Hospital do Câncer III/Instituto Nacional de Câncer / Care physical therapy in control of secondary lymphedema treatment of breast cancer: routine Cancer Hospital III/National Cancer Institute

O câncer de mama é o tipo de neoplasia mais incidente na população eminina brasileira. Devido ao diagnóstico ainda ser realizado em estadiamentos avançados, os tratamentos precisam ser mais agressivos, o que aumenta o risco de morbidades. Dentre essas complicações, a mais frequente é o linfedema, caracterizado por insuficiência do sistema linfático decorrente da obstrução causada pelo tratamento. É uma afecção crônica que pode evoluir com importantes alterações físicas e psicossociais, afetando a qualidade de vida dessas pessoas. A fisioterapia dispõe de diferentes condutas que podem ser aplicadas em todas as fases do tratamento oncológico, potencializando as ações de prevenção primária, secundária e terciária do linfedema. O objetivo deste artigo foi divulgar ascondutas adotadas no Serviço de Fisioterapia do Hospital do Câncer III, do Instituto Nacional de Câncer (INCA), para prevenção, diagnóstico e tratamento do linfedema de membros superiores em pacientes submetidas ao tratamento para o câncer de mama. Por meio desta divulgação, uscamosproporcionar um objeto de discussão entre os profissionais de saúde dos diferentes níveis de atenção, com o intuito de colaborar para o controle do linfedema secundário ao câncer de mama.

Breast cancer is the most frequent type of cancer among women in Brazil. Because the diagnosis is still held in advanced staging, treatments need to be more aggressive, which increases the risk of morbidity. Among these complications, the most prevalent is the lymphedema, characterized by failure of the lymphatic system resulting from the obstruction caused by the treatment of breast cancer. It is a chronic disease that can evolve with significant physical changes and psychosocial affecting the quality of life of these people. Physical therapy has different behaviors that can be implemented at all stages of cancer treatment, boosting shares of primary, secondary and tertiary prevention of lymphedema. The aim of this paper is to disseminate the approaches adopted in the Department of Physical Therapy of Cancer Hospital III, in the National Cancer Institute, for prevention, diagnosis and treatment of lymphedema of the upper limbs in patients undergoing treatment for breast cancer. Through this publication, we seek to provide a subject of discussion among health professionals of different levels of care, with the goal of collaborating to control lymphedema secondary to breast cancer.

Safety and tolerability of Kinesio Taping in patients with arm lymphedema: medical device clinical study.

PURPOSE: The aim of this study is to assess the safety and tolerability of Kinesio Taping (KT) in patients with arm lymphedema. METHOD: Medical device clinical study in women with arm lymphedema. Kinesio Tex Gold bandage was applied by the KT technique. Assessments and interviews were carried out both at the beginning and 4 days after intervention. Skin disorders, reported tolerance and modification of limb volume and function after intervention were assessed. Changes in limb volume and functionality before and after intervention were compared by the Student's t test and the Wilcoxon Signed-Rank test, considering significant p value <0.05. RESULTS: Twenty-four women were studied. After intervention, no patient had cutaneous lesions, vesicle or limb hyperthermia, and 4.2% presented skin peeling and redness. Most patients reported no change in social life and that they felt safer in the daily activity and were very pleased with the treatment. The patients presented improvement of upper limb functionality after intervention (p < 0.001). No difference of limb volume was found after intervention (p = 0.639). CONCLUSIONS: Kinesio Tex Gold bandage by the KT technique proved to be safe and tolerable in patients with lymphedema, with improved functionality and no change of the affected limb volume.

Calorímetro diferencial para estudo do padrão de aquecimento gerado por feixes ultrassônicos terapêuticos / Differential calorimeter for studying the heating pattern generated by therapeutic ultrasonic beams

O presente trabalho descreve o projeto e construção de um calorímetro diferencial com a finalidade de avaliar o aquecimento gerado por feixes ultrassônicos em níveis terapêuticos. O calorímetro consiste em duas câmaras cilíndricas de alumínio idênticas (de medição e de referência), preenchidas com um material mimetizador de tecido biológico (phantom). Cada câmara possui seis termopares tipo E (diâmetro 0,24 mm), posicionados ao longo do eixo central de propagação da onda, entre as profundidades 10-60 mm, distantes 10 mm entre si. Foi levantada a curva de potência e estimado o valor da área de radiação efetiva (ERA) dos dois transdutores utilizados. A partir destes dados, a intensidade efetiva foi determinada. Para avaliar o calorímetro, foi utilizado um equipamento de ultrassom de Fisioterapia, operando nas frequências nominais 1 e 3 MHz, modo contínuo, intensidades nominais 0,5; 1,0; 1,5 e 2,0 W.cm-2 e tempo de irradiação 180 segundos. Uma sequência de oito protocolos de medição foi realizada dez vezes. Para ambas as frequências, houve um declínio do aquecimento ao longo da profundidade e a região do "phantom" que mais aqueceu foi a que corresponde à profundidade de 10 mm, em todas as intensidades. O maior aquecimento ocorreu a 2,0 W.cm-2, com médias de 6,7 ± 1,0 ºC e 12,6 ± 1,2 ºC, a 1 MHz e 3 MHz, respectivamente. O calorímetro proposto mostrou-se útil na caracterização de feixes ultrassônicos aplicados em Fisioterapia, principalmente na identificação de possíveis máximos locais de temperatura (pontos quentes) que ocorrem ao longo do eixo principal do feixe.

The present work describes the project and construction of a differential calorimeter designed to evaluate the heating generated by ultrasound beam in therapeutic levels. The calorimeter consists of two identical aluminum cylindrical chambers (for measurement and reference) filled with biological tissue mimicking material (phantom). Each chamber is fitted with six thermocouples type E (0.24 mm diameter) disposed along the wave propagation central axis, between the depths of 10-60 mm, distant 10 mm from each other. The power curve and the value of the effective radiation area (ERA) of the two transducers were estimated. From these data, the effective intensity was determined. The calorimeter was tested by using an ultrasound equipment of Physiotherapy, operating at the frequencies 1 and 3 MHz, continuous mode, nominal intensities 0.5, 1.0, 1.5 and 2.0 W.cm-2 and irradiation time 180 seconds. A sequence of eight protocols of measurement was repeated 10 times. At both frequencies, there was a decline of heating along the depth and the phantom region that heated the most corresponded to 10 mm of depth, in all intensities employed. The greatest increase in temperature occurred after application of 2.0 W.cm-2, with averages of 6.7 ± 1.0 ºC and 12.6 ± 1.2 ºC, at 1 MHz and 3 MHz, respectively. The proposed calorimeter may be useful for identifying possible local temperature maxima (hot spots) that appear along the central axis beam.