[Compressive therapy of lymphedema].

Lymphedema is a simple complication after mastectomy. On current data there are two main methods of treatment of this disease that include different physical exercises, massage, compression of the edematous tissue and limb bandaging. One of this methods is based on the serial compression of the limb with an intermittent pump that is followed by physical exercises. Another method is known as the complex decongestive therapy (CDP) by Földi. Individual treatment program is worked out for each woman. The positive effect of treatment can be reached after a year of strict adherence to the program.

[Lymphedema: clinic-therapeutic aspect].

Lymphedema may be presented in mild or less severe form. Nowadays, accurate diagnosis and effective therapy are available. Wearing surgical bandage, massage, exercise, and pumps form the core program for most patients with lymphedema. The application of pharmacological therapies has been notably absent from the management strategies for lymphatic vascular insufficiency states but lately some progress has been made by applying wobenzym in the treatment. Surgical approaches to improve lymphatic flow through vascular anastamosis have been, in large part, unsuccessful, but controlled liposuction affords lasting benefit in selected patients.

[Influence of direct electric current on hydrodynamic diameter of human serum albumin].

The effect of the weak electric current (2 mA/cm2) on structural characteristics (hydrodynamic diameter and molecular weight) of the human serum albumin (HSA) was studied using photon correlation spectroscopy (PCS). The average diameter of initial HSA globule is approximately 7 nm (66.8 kDa). After electric current treatment during 2-5 min the diameter of HSA monomer increases to 7.5 nm. The duration of electric current treatment being increased to 20 min the size of HSA monomers decreases to 6.4 nm. The behaviour of HSA oligomers is close to that of monomers. Consequently, changes in the sizes of monomers and oligomers of HSA under the electric current treatment are caused by the change in the charge density stimulating change of tertiary structure of molecules and possible addition of ions from the buffer solution to them.

[Erythrocyte membrane as an object of influence of physiotherapeutic factors].

The authors presented in the article the survey of literature data and own observations on the influence of the most practiced therapeutic physical factors (electrical, ultrasound and light) on red blood cell membrane. Low intensive laser makes an impact on protein-lipid interactions in membranes of red blood cells, has antioxidant effect and improves the function of red blood cells. It proves the use of laser irradiation in the treatment of different diseases. Heat liberation and cavitation are the most important factors of ultrasound effect on red blood cell membrane. It was established by the method of the correlation spectroscopy that direct and alternating current at its 0.22 mA/cm density decreases the diameter of monomolecular protein globules of human serum albumin. This effect is seen increased under the augmentation of exposure time and current strength. Obtain results show direct effect of the electric current on albumin as well as protein component of blood cell membrane that may be of importance in molecular mechanisms of treatment effects of this physiotherapy factor. The effect of laser irradiation, ultrasound and electrical current depend on the intensity and the duration of the effect. Clarification of the effects of molecular mechanisms on red blood cell membrane may help to develop effective physiotherapeutic technologies to use in different areas of medicine.

[Clinical and experimental aspects of the treatment effect of laser irradiation].

The article summarizes literature data and results of the authors' studies on clinical experimental aspects of the treatment effect of laser emission. The literature shows that among different therapeutic effects of laser emission, the most studied are neurotropic, methabolic, immunomodulating, antioxidant, anti-inflammatory as well as its ability to stimulate the regeneration of wounds and bones. The authors stressed on biostimulative effect of laser therapy.

[Protein component in therapeutic effect of electric current].

Literature data and authors' own observation on the role of albumin in realization of curative effect of electric current are summarized in the article. Electric current action on albumin leads to physical and chemical changes (conformational ones, membrane process are also involved, development of free forms of biologically active substances) and biochemical changes (enzymes activity, lipid peroxidation). It furthers the normalization of function of body organs and systems. Curative effect of electric current depends on the dose, physical characteristic, functional specialization of tissues and peculiarities of a pathological process. Protein component is primary one in treatment effect of electric currents and should be further studied using physical, physical and chemical and biochemical techniques.

[Clinical and experimental aspects of influence of ultrasound on tissue regeneration].

The article summarizes literature and own obtained data on influence of low intensity ultrasound on tissue regeneration. Improvement of tissue regeneration is directly caused by influence of ultrasound on albumin, chondrocytes, intensity of DNA synthesis, immune system function. An important aspect of ultrasound action is its antioxidant effect.

[Ultrasound effects on lipid peroxidation in the liver and erythrocytes in experimental post-traumatic osteoarthrosis].

We studied low frequency ultrasound effects on lipid peroxidation in the liver and erythrocytes of rabbits with experimental posttraumatic osteoarthrosis induced by transchondrial damage of the medial condyle of the right femoral bone (2 mm in diameter and 1 cm in depth in the direction of the medullar canal). Prior to treatment, rabbits with experimental osteoarthrosis had enhanced lipid peroxidation in the liver and erythrocytes. Ultrasound normalizes the above disorders in lipid peroxidation.

Thermographic parameters in the diagnosis of secondary Raynaud's phenomenon.

OBJECTIVE: To determine the major infrared thermographic parameters in discriminating between patients with and without secondary Raynaud's phenomenon. DESIGN: A cross-sectional study. SETTING: Outpatient clinic of a university department of physical medicine and rehabilitation in Vienna. PATIENTS: Consecutive sample of 86 patients (72 women, 14 men) referred from the Division of Rheumatology for the clarification of a possible secondary Raynaud's phenomenon. MAIN OUTCOME MEASURES: According to color changes induced by cold exposure, clinical classification of Raynaud's phenomenon was performed as follows: no, unlikely, probable, and definite Raynaud's phenomenon. The following thermographic parameters were applied to a stepwise logistic regression analysis: the absolute temperature of the fingertips before, 10, and 20 minutes after cold challenge (Tpre, T10, T20); the longitudinal temperature difference before, 10, and 20 minutes after cold challenge (LTDpre, LTD10, LTD20); the mean area under the rewarming curve of the fingertips; the recovery index 20 minutes after cold challenge (RI20); and the most rapid phase of rewarming of the fingertips of both hands (Gmax right, Gmax left). The sensitivity of thermographic classification into the 4 groups of clinical evaluation was assessed by discriminant analysis using significant parameters from logistic regression analysis. RESULTS: Only LTDpre reached the level of significance (p < .0001). Using LTDpre, 22 of 23 subjects without clinical Raynaud's phenomenon and 20 of 26 patients with definite clinical Raynaud's phenomenon were classified correctly. Patients with unlikely or probable Raynaud's phenomenon were classified as no Raynaud's phenomenon or definite Raynaud's phenomenon. CONCLUSION: LTDpre is the major thermographic parameter to discriminate between patients with and without definite Raynaud's phenomenon by clinical history.

Acupuncture in the treatment of posttraumatic pain syndrome.

To test the hypothesis that classical Chinese acupuncture provides an additional benefit subjectively as well as objectively in patients suffering from reflex sympathetic dystrophy, a double-blind, placebo-controlled prospective trial was performed. Fourteen patients suffering clinically and scintigraphically from acute CRPS of the upper limb lasting of more than one but less than 6 months were studied. Patients were randomly assigned to either the classical acupuncture (group A) or sham acupuncture (group S), which was applied five times a week for three weeks and required 30 minutes. Both groups received the same defined standard treatment. The current state of pain was assessed by means of a visual analogue scale. Subjective success of treatment was rated by the patients by means of a rating scale. Each patient underwent a clinical examination and was investigated by 5-phase bone scan in order to confirm the diagnosis. The current state of pain as well as clinical parameters were almost identical in patients of group A and of group S at the beginning. During therapy clinical parameters as well as pain improved in both groups and reached nearly normal levels after 6 months. Owing to the small number of patients in our study, no differences between sham and treatment group could be recognized. For a definitive statement the treatment of further patients in both groups is planned. Determinations of the effect of acupuncture on clinical parameters, based on long-term follow-ups are projected.

The evaluation and hazard classification of toxicological information for Workplace Hazardous Materials Information System material safety data sheets.

Hazardous materials used occupationally in Canada are subject to the legislated requirements of the Workplace Hazardous Materials Information System (WHMIS). This paper describes the administrative framework of WHMIS and how toxicological data are evaluated to determine if a substance triggers WHMIS classification for the toxicological endpoints of acute toxicity, skin irritation, eye irritation, corrosion, dermal sensitization, respiratory sensitization, chronic toxicity, mutagenicity, teratogenicity/embryotoxicity, and carcinogenicity. Problems encountered with the information on material safety data sheets are also discussed for each of the toxicological endpoints.

The evaluation and hazard classification of toxicological information for workplace hazardous materials information system material safety data sheets

Hazardous materials used occupationally in Canada are subject to the legislated requirements of the Workplace Hazardous Materials Information System (WHMIS). This paper describes the administrative framework of WHMIS and how toxicological data are evaluated to determine if a substance triggers WHMIS classification for the toxicological endpoints of acute toxicity, skin irritation, eye irritation, corrosion, dermal sensitization, respiratory sensitization, chronic toxicity, mutagenicity, teratogenicity/embryotoxicity, and carcinogenicity. Problems encountered with the information on material safety data sheets are also discussed for each of the toxicological endpoints. Copyright 1998 Academic Press.

[Acupuncture in the treatment of a posttraumatic pain syndrome]. / Akupunktura v likuvanni pisliatravmatychnoho bol'ovoho syndromu.

Overall, fourteen patients with reflex sympathetic dystrophy (Sudeck's disease) presenting with pain syndrome were examined. The diagnosis was made on the basis of clinical symptomatology and was confirmed by thermographic and scintigraphic investigations. The patients were divided into two groups and they were administered double blind classical and sham acupuncture treatments, under the exposure to which treatments the pains began to subside in the above patients, with their general wellbeing having gotten improved.

Five phase bone scintigraphy supports the pathophysiological concept of a subclinical inflammatory process in reflex sympathetic dystrophy.

This study evaluates quantitative and qualitative patterns of bone scintigraphy and correlates them to laboratory findings and clinical signs to reveal possible inflammatory reactions in RSD. Activity ratios between the affected hand/foot and the contralateral side were calculated in 99mTc DPD-bone scintigraphy for five phases (arterial: 0-30 sec, early blood pool: 0.5-5 min. late blood pool: 5-15 min, 3 hrs early bone, 24 hrs late bone phase) and the presence of five scintigraphic signs in the bone phases was assessed. Activity ratios of all phases correlated with ESR those in the early and late bone phase correlated with alpha 2 globulin and beta globulin concentrations and those in the arterial, the early and late blood pool phase with the gamma globulin concentrations, respectively. Clinical features such as pain, swelling, physical force, temperature differences and the duration of symptoms did not correlate to the activity ratios. However, three signs in the bone phase were negatively correlated to albumin concentrations. Positive correlations were found for alpha 2, gamma globulin concentrations, ESR, neutrophil cell counts and individual uptake patterns. We conclude that the quantitative analysis of five phase bone scintigraphy in RSD reveals different aspects of tracer kinetics and provides different pathophysiological information. Lateralization of regional hyperemia, increased micro vascular permeability and bone metabolism in RSD parallels shifts in protein concentrations and blood cell counts that are suggestive of a subacute inflammatory process, even in patients with no overt signs of inflammation.

Pattern recognition in five-phase bone scintigraphy: diagnostic patterns of reflex sympathetic dystrophy in adults.

The objective of this study was to assess qualitative and quantitative patterns of tracer accumulation to increase the diagnostic utility of bone scintigraphy in reflex sympathetic dystrophy (RSD). Of 120 patients with high clinical suspicion for RSD, 96 were confirmed as having RSD during follow-up, while the remaining 24 were used as controls. Clinical parameters were measured and correlated to five activity ratios (0-30 s, 0.5-5 min, 5-15 min, 3 h, 24 h) and five scintigraphic signs. Monitoring three dynamic phases revealed different tracer kinetics of potential diagnostic utility; however, the 24-h bone phase offered no additional diagnostic contribution and can be omitted. Quantification provided objective parameters for the duration of symptoms, pain and impairment of movement but not for surface temperature differences, swelling and impairment of physical force. It is of limited use for diagnosis except for the exclusion of disease. Discriminant analysis revealed the combination of three signs (diffuse uptake in carpus/tarsus+diffuse uptake in all small joints+increased activity ratio in the late blood pool phase) to be the pattern with the highest diagnostic accuracy independent of localisation, sex, age and precipitating factors. It is concluded that the scintigraphic confirmation of RSD is based on lateralisation in the late blood pool phase and the described pattern in the early bone phase.

Impaired hemorheology in patients with postmastectomy lymphedema.

Lymphedema of the arm is one of the most disabling and serious complications of breast cancer. Apart from tumor infiltration or fibrosis of lymphatic pathways, little is known about factors favoring the development of lymphedema. In the present study, we investigated the impact of rheologic parameters, e.g. red cell aggregation (EA) and plasma viscosity (PV), and of capillary morphology and capillary flow in patients with breast cancer with (n = 18) and without (n = 18) lymphedema. Patients with lymphedema showed a significant increase of red cell aggregation (p < 0.001) that indicates a systemic component of lymphedema and might offer a possibility of prevention and therapy of this condition. A hitherto unclassified protein factor favoring red cell aggregation and lymphedema might be postulated.

[Wobenzyme and diuretic therapy in lymphedema after breast operation]. / Wobenzym- und Diuretikatherapie beim Lymphödem nach Mammaoperation.

The authors of this clinical study report the results of a controlled clinical trial in randomized parallel groups (Wobenzym vs. diuretics) of 55 female patients suffering from brachial arm lymph edema subsequent to ablatio mammae. All patients received manual and machine lymph drainage as well as gymnastics as concomitant therapy. After 7 weeks of therapy the results of the volometric assessments of the arm, the circumference of the arm and the skinfold thickness showed significant improvements compared to diuretics. In addition, the patients receiving Wobenzym reported a significantly higher proportion of patients free of pain compared to the diuretics patients. Overall safety assessment results are satisfactory thus resulting in a superior benefit/risk relation of the Wobenzym group.

[Personality markers in patients with Sudeck's disease. A psychoanalytic study]. / Persönlichkeitsmerkmale bei Patienten mit M. Sudeck. Eine tiefenpsychologische Untersuchung.

We examined 22 patients suffering from reflex sympathetic dystrophy with psychoanalytic interviews. In all 22 patients we found a common psychological structure corresponding to Balint's basic fault (Balint, 1970). For people with this structure the accident that preceded the reflex sympathetic dystrophy and the following pain, immobilisation and need to help are promoting the patient's regression in a specific way ending in the developing of reflex sympathetic dystrophy. The dispair of the patients about their reflex sympathetic dystrophy expresses unsolved fears of early childhood.