Antibiogram in the biopsy of chronic venous ulcers related to sudden changes in the pain profile.

INTRODUCTION: Chronic venous insufficiency (CVI) has an important impact on the public health system in particular due to the occurrence of chronic venous ulcers (UCV) and infections. OBJECTIVE: To evaluate cultures of biopsies of chronic venous ulcers of patients who suffered an acute change in the intensity of pain of the lesion. METHOD: Antibiograms of the cultures of chronic venous ulcer biopsies of patients who suffered an acute change in the lesion with significant pain for 24 hours were evaluated. All patients were treated between 2011 and 2015 in the Vascular Surgery Outpatient Clinic of the Medical School in São José do Rio Preto. Other causes of pain such as chronic arterial insufficiency and problems with the dressings were ruled out. RESULTS: Positive cultures were detected in 34 of the 35 patients whose pain was resolved by antibiotic therapy. CONCLUSION: Acute changes in the intensity of pain associated with chronic venous ulcers seem to be related to local infectious disease.

Effect of exercise while utilizing a device with an arm compression sleeve to reduce lymphedema.

BACKGROUND: Lymphedema is one complication of breast cancer treatment and there is no consensus that identified one single therapy in the treatment of lymphedema; therfore an association of methods is recommended and one of these is exercising. The aim of this study was to evaluate the utilization of exercising with a facilitating device along with an arm compression sleeve to reduce the size of lymphedematous arms. MATERIALS AND METHODS: Thirty women from a rehabilitation group with arm lymphedema resulting from the surgical, chemotherapeutic, and radiotherapeutic treatment of breast cancer were enrolled sequentially on arriving in the clinic. While sitting in an upright position and wearing an arm compression sleeve, patients were submitted to a one-hour session of active exercising consisting of four 12-minute stints with three-minute intervals to rest. The change in lymphedema was evaluated by water volumetry before and immediately after the session. The active exercising device is similar to the pedaling system of a bicycle. The paired t-test was employed for statistical analysis. An alpha error of 5% (p-value < 0.05) was considered acceptable. RESULTS: A statistically significant reduction (p-value < 0.004) was noted in the size of the arm. CONCLUSION: Active exercising using a facilitating device and under supervision may reduce the size of lymphedematous arms.

Factitious lymphedema of the arm: case report and review of publications.

The aim of this study was to report a case of factitious lymphedema of the arm and related lymphoscintigraphic aspects. The case of a 36-year-old patient is reported who started to present with pain, in the 3rd finger of the right hand three years prior to this report, which she associated with her work. Joint effusion was identified and treated using a splint that restricted blood flow leading to edema of the distal third of the forearm. Since then the patient was treated however her condition worsened resulting in edema of the entire arm. Subsequently she was referred to our service. A physical examination identified a restrictive band in the axillary region of the arm that delimited the edema. Volumetry and lymphoscintigraphic examinations of the limb were performed. The lymphoscintigraphy demonstrated acceleration of the flow in the affected limb and dermal reflux. Clinical treatment with removal of the restriction allowed a rapid reduction in the volume of the limb.

[Systolic pressure in wound scarring].

The recommended goal of a systolic pressure under 13 mmHg in hypertensive diabetic patients results in a significant drop in blood pressure that often has caused conflicts in respect to maintaining a minimum systolic pressure for wound scaring in patients with peripheral artery disease. This, as long as the patient remains asymptomatic, is no problem, however if the patient has a peripheral wound, the low systolic pressures may affect scarring.

Mobilization of fluids in large volumetric reductions during intensive treatment of leg lymphedema.

AIM: The aim of the current study was to evaluate fluid mobilization during the intensive treatment of leg lymphedema. METHODS: The mobilization of intracellular and extracellular fluids in the lower and upper extremities and trunk was evaluated with the intensive treatment of leg lymphedema in a prospective study. Mobilization of fluids was assessed by bioelectrical impedance using the InBody S10 device in ten patients with leg lymphedema, regardless of the cause. Treatment consisted of six to eight hours per day of Manual Lymphatic Therapy (Godoy & Godoy technique), Mechanical Lymphatic Therapy (RAGodoy device®) and a non-elastic cotton-polyester stocking. RESULTS AND CONCLUSION: A significant reduction in total water was observed for the lymphedematous limb, but with an increase in intracellular water of from 59% to 61%. Additionally, total water increases were observed in the limbs without lymphedema and in the trunk. There was an increase in total intracellular water of the extremities and trunk, but without any change in the extracellular water. In high-volume reductions during lymphedema treatment, fluids are displaced from the lymphedematous limb to extremities without lymphedema and to the trunk.

Compression stockings have a synergistic effect with walking in the late afternoon to reduce edema of the lower limbs.

AIM: The aim of this study was to evaluate whether an association of elastic stockings and walking for a short period in the late afternoon reduces leg edema. METHODS: Volume changes of the legs of sixteen patients (32 limbs), who walked on a treadmill for 30 minutes using elastic compression stockings, were analyzed in a quantitative, cross-over randomized (in order of arrival at the clinic) study. They were submitted to volumetry using the water displacement technique and subsequently required to put on 20/30 made-to-measure compression stockings (Sigvaris). The patients walked on a treadmill for 30 minutes and after removing the stockings volumetry of the legs was again performed. Legs were assessed using the CEAP classification and divided into groups. Analysis of variance was used for statistical analysis with an alpha error of 5% being considered acceptable. RESULTS: When participants walked wearing compression stockings, there was a reduction in leg volume. When the CEAP classification was evaluated, it was noted that there was a statistically significant difference for the CEAP C0, C1 and C2 categories of legs using stockings compared to those that did not use. CONCLUSION: Compression stockings have a synergistic effect with walking in the late afternoon thus reducing edema of the lower limbs.

Intensive outpatient treatment of elephantiasis.

AIM: The aim of this paper was to report on a novel approach to the intensive outpatient treatment of elephantiasis of an underprivileged population. METHODS: Prospective, random study, the diagnosis of lymphedema was clinical and the inclusion of patients was by order of arrival in the treatment center where all were invited to participate in the study. Intensive outpatient therapy was performed for 6 to 8 hours daily over a period of four weeks. Eleven legs with grade III elephantiasis of 8 patients were evaluated in a random prospective study. Three patients were men and five were women with ages ranging between 28 and 66 years old. Treatment included mechanical lymph drainage using the RAGodoy® apparatus for a period of 6 to 8 hours daily and the Godoy & Godoy cervical stimulation technique for 20 minutes per day, both associated to the use of a home-made medical compression stocking using a low-stretch cotton-polyester material. Additionally, manual lymph drainage using the Godoy & Godoy technique was performed for one hour. Perimetry was used to compare measurements made before and after treatment, of the three points of the limb with the largest circumferences. The paired t-test was utilized for statistical analysis with an alpha error greater than 5% (P-value <0.05). RESULTS: Reductions in the perimeter of affected limbs were significant over this 4-week treatment program (P-value=0.001). CONCLUSION: Intensive outpatient treatment is an option for all types of lymphedema with large volumetric reductions being possible in a short period when treating elephantiasis.

Clinical aspects of advanced stage lipo-lymphedema: case report.

The aim of the current study was to alert about dermatological alterations in the clinical evolution of lipo-lymphedema. The case of a 48-year-old patient is reported with clinical diagnosis of stage II lipo-lymphedema treated in the Angiology and Vascular Surgery Service of FAMERP. On physical examination the edema was hard, not reversible during rest, with nodules in the lower one-third of the limbs and a positive Stemmer's sign. The sizes of the nodules were different between legs. This report stresses the clinical findings and the differences in each disease. Additionally a review of publications is presented. The dermatological changes occurring in the evolution of lipedema may be associated with the evolution of lipo-lymphedema.

Erysipelas and lymphangitis in patients undergoing lymphedema treatment after breast-cancer therapy.

AIM: The aim of this study was to evaluate the prevalence of erysipelas and lymphangitis in a group of patients under treatment for lymphedema after breast-cancer therapy. METHODS: A random observational prospective study of the incidences of lymphangitis and erysipelas was performed for 66 patients with arm lymphedema after breast-cancer treatment. The study was carried out between March 2006 and December 2007 at the Godoy Clinic in Sãoo José do Rio Preto, Brazil. The clinical evaluation of the participants was performed weekly before the start of treatment, with patients being required to immediately report any complications to the attending service. RESULTS: The mean time of follow-up of the patients between their treatment for breast cancer and the start of this study was 12.3 months, and three complications (4.5%) occurred; two cases of lymphangitis were reported after insect bites and one case of erysipelas after a hand injury, with repeat episodes reported by all three patients. CONCLUSION: In spite of prophylactic advice regarding lymphangitis and erysipelas during treatment for lymphedema after breast-cancer therapy, patients are subject to complications; however, this in itself does not justify the use of prophylactic antibiotic therapy.

Psychosocial effects of otoplasty in children with prominent ears.

This study aimed to investigate changes experienced by children during the pre- and postoperative periods of prominent ear corrective surgery. A total of 30 patients with prominent ears, sometimes called "lop ears" or "cup ears," ranging in age from 6 to 14 years were consecutively enrolled in this study. Half of the patients (n = 15, 50%) were male. The inclusion criteria specified children with prominent ears and reports of evident anatomic deformity. Clinical evaluations, routine laboratory tests, and interviews were performed in the pre- and postoperative periods. To assess the dissatisfaction or social maladjustment caused by the prominent ears, questionnaires, which are used routinely in psychological and psychiatric practices, were applied in the pre- and postoperative periods. The tests used were the Child Behavior Check List, the State-Trait Anxiety Inventory for Children, and the Children's Depression Inventory. The patients themselves and their parents or guardians reported improvements in terms of anatomic aspect. For the psychological tests, improvements in almost all the assessed items were observed. In conclusion, psychological problems caused by anatomic deformities, such as prominent ears, can be improved by adequate corrective surgery. Psychological support is necessary for the patients.

Aminaphtone in idiopathic cyclic oedema syndrome.

OBJECTIVES: Idiopathic cyclic oedema syndrome is a group of clinical conditions that exhibit a vascular capillary hyperpermeability accompanied by oedema caused by the interstitial retention of fluid. The objective of the current study was to evaluate the efficacy of aminaphtone in the treatment of idiopathic cyclic oedema. METHODS: A total of 15 female patients with clinical diagnosis of idiopathic cyclic oedema and aged between 22 and 49 years and a mean of 37.7 years were evaluated. After diagnosis, the patients were submitted to lower limb volumetry and asked to record the weight in the morning and evening at fixed times. One tablet of aminaphtone was prescribed every 8 h and on the fifth day the patients were reassessed. Percentages and the paired t-test were utilized for statistical analysis, with an alpha error of 5% considered acceptable (P value <0.05). RESULTS: A significant reduction in limb size was detected after treatment using aminaphtone (P value <0.0001) with losses between 9 g and 370 g, and an average loss of 116.9 g. Variations in weights in the morning and evening were significant (P value <0.00001) with a maximum difference of 3 kg and a minimum of 120 g. Improvements were reported for 70% of patients. CONCLUSION: Aminaphtone is efficacious in the reduction of oedema in patients with idiopathic cyclic oedema.

Lymph drainage in patients with joint immobility due to chronic ulcerated lesions.

The fibrous process of chronic ulcerated lesions of lower limbs can impair the mobility of the affected limb. The aim of this work was to assess the benefits of lymph drainage in patients who suffer from this disease. Twenty female and five male patients with ages ranging from 53 to 69 years (mean age 60.6 years) were evaluated. All had a history of at least 10 years of varicose veins and/or ulcerated lesions of the lower limbs with initial dermatofibrosis, with the positive Godet sign during the physical examination of the limb. Patients with intermittent claudication, diabetes and trauma were excluded from the study, as well as patients with chronic dermatofibrosis, and in whom positive Godet sign was not seen. Patients with immobility or very limited movement of the ankle and with some limitation in the toe joints were selected. The patients were randomly divided into group A comprising 15 individuals, and group B 10. All the individual treatments were established before the start of the evaluation period. Lymph drainage was performed on the patients of group A four or five times per week. Group B was subjected to a type of massage for the same period and at the same frequency. The mobility of the ankle joints was evaluated using goniometry before the start and after 30 days of treatment. In all the patients who underwent lymph drainage, an improvement of the joint mobility was seen, whereas in the control, group B, there was no obvious change. In conclusion, lymph drainage gave an improvement in the mobility of the ankle joint after impairment due to initial dermatofibrosis in patients with chronic ulcerated lesions.

Quality of life and peripheral lymphedema.

Evaluation of the health-related quality of life (QOL) is becoming commonplace, seeking to provide information about the everyday well-being of a patient. This work examined the QOL of 23 consecutive patients with lymphedema of the upper or lower extremities. Five were men and the other eighteen were women. Their ages ranged from 19 to 74 years (mean 48.3). After clinical examination, and with informed consent of each patient, they were assessed by a psychologist and submitted to a QOL test (SF-36). For controls, twenty-three women and five men with age range of 28 to 66 years (mean 47) were similarly evaluated. The results showed the lymphedema group had a statistically significantly reduced QOL in both physical and mental health as well as social interaction.

Prevalence of antithrombin deficiency in patients with chronic leg ulcer.

Antithrombin is one of the main endogenous anticoagulants and its deficiency is associated with deep venous thrombosis. The aim of the present study was to evaluate the prevalence of antithrombin deficiency in patients with chronic lower extremity ulcers. Forty-eight patients with chronic lower limb ulcers for longer than 10 years, evaluated during 1997, were studied: 40 were female (83.3%) and eight were male (16.6%), with ages ranging from 43 to 73 years (mean, 55.2 years). Antithrombin was dosed by the coagulometric method, with evaluation of the functional activity. Measurement was repeated in those cases where deficiency was found to be present. The highest prevalence rate for antithrombin deficiency in the general population was one in every 2000 cases. Data analysis was performed by utilizing the odds ratio with a confidence interval of 95% and P < 0.05. Deficiency in antithrombin levels was recorded in two (4.1%) of the patients with chronic ulcer. These results indicate a higher prevalence rate of antithrombin deficiency in those patients with chronic leg ulcers, suggesting that an association may be present. Further studies with a larger number of patients are required to confirm this hypothesis.

Bilateral pulmonary artery aneurysm associated with bilateral pulmonary thromboembolism, superior vena caval thrombosis, and Chagas' disease--a case report.

The authors report a case of bilateral pulmonary artery aneurysm in a patient with chronic Chagas' disease and compensated congestive heart failure in whom clinical clues suggested pulmonary thromboembolism, and the actual nature of the lesions was discovered at the time of conventional imaging investigations. This case shows the rarity of bilateral pulmonary aneurysm associated with bilateral pulmonary thromboembolism and the importance of an awareness of this condition in the differential diagnosis for lung masses.