Effectiveness of an Adapted Physical Activity Protocol for Upper Extremity Recovery and Quality of Life Improvement in a Case of Seroma after Breast Cancer Treatment.

Growing evidence indicates that physical activity (PA) interventions may reduce upper limb function-limiting side effects of treatments and improve quality of life (QoL) of breast cancer (BC) survivors. However, the possible effectiveness of PA in cases developing seroma after BC treatment has yet to be demonstrated. Here, we describe for the first time the impact of a structured PA pathway (i.e., two cycles of eight-week adapted PA followed by eight-week adapted fitness) on upper limb disability and QoL in a peculiar case of chronic seroma as complication of reconstructive plastic surgery after left breast mastectomy and lymphadenectomy. A 56-year-old female BC survivor underwent a functional test battery (i.e., shoulder-arm mobility, range of motion, back flexibility and indirect assessment of pectoralis minor muscle) at baseline, during and after ending the structured PA pathway. Upper limb and back pain intensity and QoL were evaluated by numerical rating scale and Short Form-12 questionnaire, respectively. A relevant seroma reduction, an improvement in upper limb mobility and pain perception, and an overall increase in QoL were achieved after the structured PA intervention. Our findings suggest that an adapted PA intervention may represent an effective strategy for seroma treatment in BC survivors.

Interrater Reliability of Dynamic Muscle Testing After Breast Cancer Surgery in Women at High Risk of Lymphedema: To Improve Quality in Clinical Practice.

Background: The purpose of this study is to determine the interrater reliability of dynamic muscle tests in the early rehabilitation phase in women after breast cancer surgery with axillary lymph node dissection (ALND) based on the "preventive intervention against lymphedema after breast cancer" (LYCA) randomised controlled trial. Methods: Fifteen women treated with breast cancer surgery including ALND were recruited from participants in the LYCA trial. In this interrater reliability study, women were tested in 4 dynamic muscle tests by 2 physiotherapists at a Capital Hospital in Denmark. Intraclass correlation coefficients (ICCs) with 95% confidence intervals (CIs) was used to assess the relative reliability between raters. A Bland-Altman plot and limits of agreement were calculated to describe the absolute reliability. Results: All 6 subtests displayed high interrater reliability. ICC values were: leg press 0.96 (95% CI = 0.87-0.99), elbow flexion (contralateral) 0.94 (0.83-0.98), elbow flexion (affected arm) 0.93 (0.80-0.98), elbow extension 0.80 (0.41-0.93), shoulder abduction (contralateral) 0.89 (0.68-0.96), and shoulder abduction (affected arm) 0.91 (0.74-0.97). Cumulated interrater reliability for the test battery was very high (ICC = 0.99, 95% CI = 0.990-1.0). The absolute reliability of this study was considered high, and the absence of large shifts between mean and the line of 0 difference suggest no systematic bias that could influence clinical interpretation. Conclusions: The dynamic muscle tests evaluated in this study had high interrater reliability and can be used reliably in women in the postoperative phase after breast cancer surgery with ALND.

Effectiveness of therapeutic inflatable ball self-exercises for improving shoulder function and quality of life in breast cancer survivors after sentinel lymph node dissection.

BACKGROUND: The survival rate of breast cancer survivors (BCSs) is > 90%. Particular issues are upper arm dysfunction caused by surgery and treatments. Physical activity has been recommended to improve shoulder function and quality of life (QoL) in BCSs. However, rehabilitation programs tend not to be continuous. PURPOSE: To explore the effectiveness of therapeutic inflatable ball self-exercise for improving shoulder function and QoL in breast cancer survivors (BCSs) following breast cancer surgery. PATIENTS AND METHODS: Seventy-two BCSs were allocated to two groups, conventional self-exercise (CSE; n = 34; age, 48.9 ± 7.2 years) and therapeutic inflatable ball self-exercise (IBE; n = 38; age, 47.7 ± 8.9 years); 22 in the CSE and 23 in the IBE group completed the interventions. Both groups performed intervention for 12 weeks, three times per week and 15 min a day at least. Measurement was performed three times for shoulder range of motion (ROM), handgrip strength, Shoulder Pain and Disability Index (SPADI), and Functional Assessment of Cancer Therapy-Breast (FACT-B). RESULT: Flexion and extension of shoulder ROM showed significant differences between the two groups at 12 weeks. Flexion and extension of shoulder ROM showed significant differences for t1-t2 (p = 0.02) and t0-t1 (p = 0.04). Abduction showed a significant difference for t0-t1 (p = 0.03), t1-t2 (p = 0.02), and t0-t2 (p = 0.01). CSE (7 points) and IBE (20 points) satisfied the MDC in FACT-B total score. The MDC of the SPADI total score was 13 points in the CSE group and 9 points in the IBE group. CONCLUSION: IBE would be more appropriate to start the rehabilitation for BCSs and CSE would be effective after the pain has improved.

Protective myoelectric activity at performing upper limb neurodynamic test 1 in breast cancer survivors. A cross-sectional observational study.

Myoelectric activity and range of motion during ULNT1 were recorded in 62 breast cancer (BC) survivors who had axillary lymph node dissection (n = 30) or sentinel lymph node biopsy (n = 32) within the previous 18 months, and 63 age-matched healthy women. BC survivors' symptoms were reproduced by ULNT1 and exhibited greater myoelectric activity in the biceps brachii than healthy women (MD (95% CI): 21,26 (10,83-31,70)). No differences between the axillary lymph node dissection and sentinel lymph node biopsy groups (MD (95% CI): 8,47 (-7,84-24,79)) were found. Myoelectric activity in the triceps brachii was greater in the sentinel lymph node biopsy group (MD (95% CI): 2,70 (-2,06-7,60)). BC survivors exhibited less shoulder and elbow range of motion during ULNT1 than healthy women. Increased upper limb nerve mechanosensitivity in BC survivors was associated with a greater protective muscle response during ULNT1.

Effects of Chin-Down Maneuver on the Parameters of Swallowing Function After Esophagectomy With 3-Field Lymphadenectomy Examined by Videofluoroscopy.

OBJECTIVES: To determine the effect of the chin-down maneuver after esophagectomy with 3-field lymphadenectomy (3FL) on pharyngeal residue, upper esophageal sphincter (UES) opening, and laryngeal closure. DESIGN: Prospective data were collected from a pharyngeal videofluoroscopic swallowing study. SETTING: Dysphagia clinics. PARTICIPANTS: Patients selected according to the inclusion criteria (N=14; mean age, 65.9y) from a total of 43 patients who underwent esophagectomy with 3FL from May to December 2014 were enrolled. INTERVENTIONS: Videofluoroscopy was conducted in head-neutral and chin-down positions to measure the pharyngeal constriction ratio (PCR), amount of residue in the vallecula and pyriform sinus after the first swallow, UES opening diameter, duration of UES opening, and duration of laryngeal vestibule closure. MAIN OUTCOME MEASURES: The aforementioned parameters were compared statistically between the head-neutral and chin-down positions. RESULTS: In comparison with the neutral group, the PCR and residue in the pyriform sinus were significantly smaller in the chin-down group (P<.01). However, the residue in the vallecula did not differ significantly from that of the neutral group (P=.44). The UES opening diameter, duration of UES opening, and duration of laryngeal vestibule closure were all significantly larger in the chin-down group than in the neutral group (P<.05). CONCLUSIONS: This study demonstrates that use of the chin-down maneuver after esophagectomy with 3FL can help expedite swallowing by strengthening pharyngeal constriction, widening the UES, and enhancing laryngeal closure.

Estudio de la influencia del ejercicio con levantamiento de pesos en pacientes con disección axilar / Effects of weightlifting exercise in patients with axillary dissection

Introducción. Los pacientes intervenidos quirúrgicamente con disección axilar supervivientes de cáncer de mama, a partir de las recomendaciones actuales, restringen su actividad física por miedo e incertidumbre a padecer linfedema secundario, lo que puede limitar su recuperación física y psicosocial. En este estudio, observamos los efectos de un programa de entrenamiento controlado, que incluyó ejercicios con levantamiento de pesos. Material y métodos. Ensayo clínico prospectivo abierto y controlado. Se seleccionaron 22 pacientes diagnosticados de cáncer de mama, con disección axilar de, al menos, un nódulo linfático, con o sin diagnóstico de linfedema. El grupo intervención (grupo de actividad física con pesas, GAFP, n=11) mantuvo su estilo de vida habitual, incorporando un protocolo terapéutico de ejercicios bisemanal diseñado por fisioterapeutas, que incluyó levantamiento de pesos de forma controlada y progresiva, realizado siempre bajo su supervisión. El grupo control (GC, n=11) mantuvo su estilo de vida sin cambios durante las 6 semanas de duración del estudio (febrero-marzo de 2013). Se valoraron el volumen del brazo (midiendo la circunferencia de cada brazo), las sensaciones de dolor y pesadez del brazo mediante la Escala Visual Analógica (EVA), el índice de masa corporal (BMI) y la calidad de vida (FACT-B+4), Resultados. Ninguna de las participantes en el grupo de intervención experimentó un aumento de los síntomas. No hubo diferencias significativas entre ambos grupos, aunque se advirtió una tendencia (p = 0,341) hacia el descenso del volumen del brazo afecto en los pacientes del grupo GAFP. Conclusiones. De acuerdo con estudios previos, es segura la realización de un protocolo de ejercicios que incluya levantamiento de pesos, en un entorno controlado y progresivo (AU)

Introduction. In breast cancer survivors who have undergone axillary dissection, current recommendations advise restricting physical activity due to the risk of secondary lymphedema, which may limit these patients’ physical and psychosocial recovery. In this study, we examined the effects of a controlled training program that included weightlifting exercises. Material and methods. An open, prospective, controlled clinical trial was carried out that included a control and an intervention group. We selected 22 patients with a diagnosis of breast cancer and dissection of at least one axillary lymph node, with or without a diagnosis of lymphedema. An intervention group (group of physical activity weights, n=11) maintained their usual lifestyle, incorporating a therapeutic protocol designed by physiotherapists, consisting of twice-weekly exercises that included weightlifting in controlled and progressive sessions, always under supervision. A control group (n=11) maintained their lifestyle unchanged for the 6-week study (February-March 2013). We also assessed arm volume (measurement of the circumference of each arm, sensations of pain and heaviness [Visual Analog Scale], body mass index [BMI], and quality of life [FACT-B +4]). Results. None of the participants in the intervention group had symptom exacerbation or a diagnosis of lymphedema. There were no significant differences between the 2 groups, although a trend (P=.341) toward a decrease in the volume of the affected arm was noted in patients in the intervention group. Conclusions. Consistent with previous studies, this study confirms the safety of an exercise protocol that included weight lifting in a progressive and controlled environment (AU)

Current rehabilitation processes do not prevent long-term impairments after treatment for breast cancer in Australia.

BACKGROUND: Our aims were to determine if and how advice regarding physical rehabilitation (arm-specific and general exercise) was provided after treatment for breast cancer, as well as the prevalence of physical impairments following treatment for breast cancer in an Australian population. METHODS: Members of the Review and Survey Group of the Breast Cancer Network Australia participated in a validated web-based survey. RESULTS: Participants included 186 women who underwent axillary node dissection and 201 who underwent sentinel node biopsy for breast cancer. Of the respondents, 75% reported receiving arm-specific exercise advice following surgery and 44% were advised on the importance of general exercise at some point during treatment. Despite this, upper limb impairments were commonly reported during treatment and 1 year after surgery, particularly for women who had undergone axillary node dissection. DISCUSSION: Although rehabilitation advice is commonly offered to women treated for breast cancer in Australia, pain and reduced arm function remain common in women more than 1 year after surgery.

Eficacia de la fisioterapia en el linfedema posmastectomía / Effectiveness of physiotherapy in postmastectomy lymphedema

Objetivo: Revisar y analizar la evidencia sobre la efectividad de las distintas técnicas fisioterápicas en la reducción del volumen del linfedema asociado a linfadenectomía, y evaluar la mejoría de la sintomatología concomitante y su impacto en la calidad de vida relacionada con la salud. Estrategia de búsqueda y selección de estudios: Se realizó una búsqueda en PubMed, PEDro y Cinahl, completando el proceso con una búsqueda manual. Se identificaron 53 artículos y se incluyeron 14 ensayos clínicos aleatorizados que cumplieron los criterios de inclusión. La calidad metodológica fue evaluada con la escala de Jadad, siendo la de 10 ensayos clínicos aleatorizados aceptable y la de los otros 4 deficiente. Síntesis de resultados: Los estudios contemplan diferentes modalidades terapéuticas utilizadas en el tratamiento del linfedema: drenaje linfático manual, ejercicios terapéuticos, presoterapia, vendaje compresivo, vendaje neuromuscular, hidroterapia, electroestimulación muscular. El drenaje linfático manual es la técnica que mayor eficacia presenta, que se aumenta cuando se combina con otras como los ejercicios terapéuticos, la presoterapia o el vendaje compresivo. No se obtienen datos concluyentes sobre el uso del vendaje neuromuscular, la hidroterapia o la electroestimulación muscular. Conclusión: La fisioterapia aporta técnicas con distinta eficacia demostrada en el tratamiento del linfedema con el objetivo de reducir su volumen, disminuir el dolor, mejorar la calidad de vida relacionada con la salud y la funcionalidad de los sujetos que lo padecen

Objective: To review and analyze the evidence on the effectiveness of different physiotherapy techniques in reducing the volume of lymphedema associated with lymphadenectomy and to assess the improvement of the concomitant symptoms and their impact on health-related quality of life. Search strategy and study selection: A search in PubMed, PEDro and Cinahl databases was conducted completing the process with a hand search. A total of 53 papers were identified and 14 randomized clinical trials which met the inclusion criteria were included. Methodology quality was evaluated with the Jadad scale, 10 randomized clinical trials being considered as was acceptable and 4 were deficient. Synthesis of results: Different therapeutic modalities were used in the treatment of lymphedema: Manual lymphatic drainage, exercises therapy, pneumatic compression, compression bandage, Kinesiotaping, hydrotherapy, low-frequency and low-intensity electrotherapy. Manual lymphatic drainage is the technique that had the greatest efficacy. This effectiveness increased when combined with others, for example, with pneumatic compression or compression bandage. The results on the kinesiotaping, hydrotherapy or low-frequency and low-intensity electrotherapy are not conclusive. Conclusion: Some physiotherapy techniques are effective in the treatment of lymphedema to reduce volume, decrease pain, improve health-related quality of life and functionality of patients

Emergency embolization after resection of a laryngeal Schwannoma / Embolizacao de urgencia apos resseccao de schwanoma de laringe

Schwannoma is a rare cause of benign tumors of the larynx. The first-choice treatment is surgical resection. The objective of this paper is to report on a rare case of a young female patient who suffered severe intraoperative hemorrhaging during surgical resection of a laryngeal Schwannoma and needed emergency embolization.

O schwanoma representa etiologia rara de tumor benigno de laringe, tendo como principal tratamento a ressecção cirúrgica. O objetivo deste trabalho é relatar um caso raro de paciente jovem submetido à ressecção cirúrgica de schwanoma laríngeo, evoluindo, no transperatório, para complicação hemorrágica grave e necessitando de embolização de urgência.

Early rehabilitation reduces the onset of complications in the upper limb following breast cancer surgery.

BACKGROUND: Breast cancer (BC) is currently the most frequent tumor in women. Through the years, BC management has evolved towards conservative surgery. However, even minimally invasive surgery can cause neuromotor and/or articular impairments which can lead to permanent damage, if not adequately treated. AIM: To clinically evaluate upper ipsilateral limb function and the impact of certain post-surgical consequences arising after invasive or breast-conserving surgery for early BC, by intervening, or not intervening, with an early rehabilitation program. To investigate physical morbidity after sentinel (SLND) or axillary lymph node dissection (ALND) and after reconstructive surgery in the treatment of early BC. DESIGN: Observational prospective trial. SETTING: Inpatient and outpatient treatment. POPULATION: Eighty-three females participated in the study: 25 patients did not begin physiotherapy during hospitalization (Group A), 58 patients received early rehabilitation treatment (Group B). METHODS: The patients of Groups A and B were compared with respect to the following criteria: shoulder-arm mobility, upper limb function, and presence of lymphedema. All patients were assessed at 15-30, 60 and 180 days after surgery. RESULTS: Statistically significant differences, in favor of Group B, were encountered at the 180-day follow-up visit, especially with respect to articular and functional limitation of the upper limb. CONCLUSION AND CLINICAL REHABILITATION IMPACT: The results of the present study show that early assisted mobilization (beginning on the first postoperative day) and home rehabilitation, in conjunction with written information on precautionary hygienic measures to observe, play a crucial role in reducing the occurrence of postoperative side-effects of the upper limb.

Risk factors for pelvic lymphoceles post-radical prostatectomy.

BACKGROUND: Lymphoceles (LC) represent a well-described rare complication post-radical prostatectomy (RP). Our aim was to determine risk factors and to develop possible prevention strategies for LC in a community-based study. METHODS: Data from 1163 RP-patients from 67 clinics between January 2002 and December 2004 were retrospectively evaluated. Patients underwent pelvic imaging procedures/LC-management during 3 weeks of rehabilitation post-RP. RESULTS: LC were identified in 304 patients (26%). Lymphadenectomy was carried out in 92% of patients (1001/1086 patients), from which 28% had LC (n = 277) versus 14% without lymphadenectomy (12/85, P = 0.007). Complications (lower limb edema, pain, thrombosis, infection and bladder compression) were observed in 9% of patients (28/304; 2.4% of total patients); necessitating therapy. LC therapy was carried out in 59 patients (5.9%) with pelvic lymph node dissection (PLND) and in no patients (0%) without PLND (P = 0.021). Risk factors included were patients' age, body mass index, prostate volume, TNM-classification, number of removed lymph nodes, previous surgery/therapy, heparin prophylaxis, surgical instruments and pelvic lymphadenectomy. Univariate analysis showed lymphadenectomy as the only significant risk factor for the development of LC post-RP (P = 0.007). When applying multivariate analyses using stepwise logistic regression, only lymphadenectomy was associated with a significant risk for lymphoceles (odds ratio = 2.6, 95% CI = 1.3-4.9, P = 0.004). Adjusting for other factors, no other factor came close to being significant (P < 0.05). All symptomatic LC were successfully treated without further sequelae. CONCLUSIONS: Subclinical LC post-RP are more common than thought, and rarely necessitate intervention. Pelvic lymphadenectomy represents the only significant factor contributing to LC-development. Because of this, prevention remains difficult.

[Quality of life after radical cystectomy - an overview and analysis of a contemporary series]. / Lebensqualität nach radikaler Zystektomie - Ubersicht und Analyse einer aktuellen Serie.

OBJECTIVE: Published evidence does not support a clear advantage in quality of life for continent versus incontinent urinary diversion or vice versa. PATIENTS AND METHODS: We retrospectively assessed 61 patients after radical cystectomy with the EORTC-QLQ-C30 and -BLM30 instruments. Analysis was performed in dependence of age, sex, technique of urinary diversion and time-course of therapy. RESULTS: 36 patients had an incontinent and 20 patients a continent urinary diversion. Younger patients (p = 0.001) and those with a continent urinary diversion (p = 0.03) were found to have a statistically significant higher incidence of financial problems. Also patients with continent urinary diversion had significantly (p = 0.032) more problems in social integration. Furthermore, there were significant differences in social integration (p = 0.03) and emotional ability (p = 0.008) in the age-dependent analysis. Patients with a continent diversion had significantly more meteoristic problems (p = 0.007). CONCLUSION: This study also could not demonstrate any clear differences in dependence on the technique of urinary diversion. A good postoperative quality of life seems possible independent of age.

Physical activity for the affected limb and arm lymphedema after breast cancer surgery. A prospective, randomized controlled trial with two years follow-up.

BACKGROUND. The influence of physical activity on the development of arm lymphedema (ALE) after breast cancer surgery with axillary node dissection has been debated. We evaluated the development of ALE in two different rehabilitation programs: a no activity restrictions (NAR) in daily living combined with a moderate resistance exercise program and an activity restrictions (AR) program combined with a usual care program. The risk factors associated with the development of ALE 2 years after surgery were also evaluated. MATERIAL AND METHODS. Women (n = 204) with a mean age of 55+/-10 years who had axillary node dissection were randomized into two different rehabilitation programs that lasted for 6 months: NAR (n = 104) or AR (n = 100). The primary outcomes were the difference in arm volume between the affected and control arms (Voldiff, in ml) and the development of ALE. Baseline (before surgery) and follow-up tests were performed 3 months, 6 months, and 2 years after surgery. Data were analyzed using ANCOVA and regression analysis. RESULTS. Voldiff did not differ significantly between the two treatment groups. Arm volume increased significantly over time in both the affected and the control arms. The development of ALE from baseline to 2 years increased significantly in both groups (p < 0.001). The only risk factor for ALE was BMI > 25 kg/m(2). CONCLUSION. Patients that undergo breast cancer surgery with axillary lymph node dissection should be encouraged to maintain physical activity in their daily lives without restrictions and without fear of developing ALE.

Análise sensitiva convencional no pós-cirúrgico de câncer de mama / Sensory analysis in the conventional post-surgery for breast cancer

Objetivo: Analisar a resposta sensitiva convencional no pós-cirúrgico de câncer de mama em mulheres submetidas à linfadenectomia axilar relativamente às diferentes técnicas de reeducação sensitiva no trajeto do nervo intercostobraquial (NICB) e verificar resultados após três meses. Métodos: Estudo clínico, prospectivo, randomizado, finalizado em 2006, em hospital de Santos, SP, composto por 120 mulheres submetidas à cirurgia de mama com linfadenectomia axilar pelo mesmo procedimento cirúrgico para a preservação do NICB. As pacientes foram subdivididas em quatro grupos iguais - o GI (estimulação sensitiva com bolas, sensiball, fisiobol e lisa), o GIl (drenagem linfática), o GIII (kit de diferentes texturas) e o GIV (controle) - e todas foram submetidas a dez intervenções fisioterápicas. A avaliação convencional utilizou dois tubos de ensaio com água quente e fria, pincel e agulha. As avaliações foram conduzidas em três momentos: o M1 (pré-intervenção), o M2 (pós-intervenção), após as dez sessões, e o M3 (washout), após três meses do M2. As regiões-alvo de avaliação e intervenção sensitiva foram dois pontos (P1 e P2) no dermátomo do NICB, localizado na face medial e súpero-posterior do braço. Resultados: Com tratamento estatístico de Goodman, observou-se melhora (p < 0,005) na sensibilidade térmica nos GIII (P1) e GIV (P1), sensibilidade tátil no GIl (P1), sensibilidade dolorosa apenas no GIl (P1) e piora (p> 0,005) nos GIII (P2) e GIV (P2), com a sensibilidade térmica, tátil e dolorosa. Conclusão: Apenas após a técnica de estimulação sensitiva com a drenagem linfática, houve resposta positiva quanto à alteração sensitiva (hipoestesia) no dermátomo do nervo ICB, permanecendo após três meses.

Objective: To analyze the response sensory conventional, post-surgery for breast cancer in women who underwent axillary lymph node dissection in the different techniques of rehabilitation in the sensory nerve pathway intercostobraquial (NICB) and check after three months. Methods: Clinical study, prospective, randomized, finalized in 2006, in hospital in Santos, Sao Paulo, composed 0f120 women who underwent surgery for breast cancer with axillary lymph node dissection by the same surgical procedure to preserve the NICB, subdivided into four equal groups. The GI (sensory stimulation with balls, sensiball, fisiobol and smooth), GIl (lymphatic drainage), GIII (kit of different textures) and GIV (control), all subject to ten physiotherapy interventions. The conventional assessment used two tubes for testing with hot and cold water, brush and needle. The evaluations were conducted on three occasions. The M1 (pre-intervention), the M2 (post-intervention) after the ten sessions and M3 (washout) after three months of M2. The region targeted for sensory evaluation and intervention were two points (P1 and P2) in the NICB dermatome, located on the medial side and back of the super-arm. Results: With statistical treatment of Goodman, was reported improvement (p < 0.005) in thermal sensitivity in GIII (P1) and GIV (P1), tactile sensitivity GIl (P1), painful sensitivity only in GIl (P1) and worse (p > 0.005) in GIII (P2) and GIV (P2) towards thermal sensitivity, tactile and painful. Conclusion: Only after the technique of sensory stimulation with lymphatic drainage, there was positive response to the amendment forward sensory (hypoesthesia) in dermatome nerve ICB, remaining after three months.

Patología postquirúrgica del cáncer de mama. Propuesta de subproceso y desarrollo de una unidad de tratamiento rehabilitador en el contexto sanitario andaluz / Post-surgical pathology of breast cancer. Proposal of subprocess and development of the rehabilitation treatment unit in the Andalusian health care context

En los últimos años, la Consejería de Salud de la Junta de Andalucía ha favorecido el desarrollo de procesos asistenciales encaminados a estructurar, mejorar e impulsar la asistencia al usuario/paciente en determinadas patologías que considera prioritarias por su incidencia, repercusiones y costes, tanto sociales como económicos. El papel del médico especialista en Medicina Física y Rehabilitación no siempre está bien definido dentro de los algoritmos asistenciales de estos procesos y puede quedar difuminado entre otros especialistas y fisioterapia. Dentro de estos procesos asistenciales se encuentra el cáncer de mama y como subproceso, el tratamiento del linfedema secundario a la cirugía. En este trabajo proponemos un modelo de desarrollo de subproceso asistencial que incluye tanto el tratamiento del linfedema como de otras lesiones asociadas a la cirugía del cáncer de mama, en el que queremos situar y definir el papel que cumple nuestra especialidad de forma que tomemos un papel activo en la creación de las bases de la futura asistencia sanitaria de calidad, tanto dentro como fuera de nuestra comunidad

In recent years, the Public Health Care Administration of Andalusia has developed health care programs to improve care programs aimed at structuring, improving and encouraging user care/patient care in specific diseases due to their social and economic incidence, repercussions and costs. The role of the specialist in Physical Medicine and Rehabilitation is not always well defined within the care algorithms of these processes and can become blurred among other specialists and physical therapy. Within these care processes are breast cancer and the treatment of secondary lymphedema to surgery as a subprocess. We propose a development model of health subprocess that also included treatment of lymphedema and other breast cancer surgery associated injuries in which we want to define the active role we take in our speciality in the creation of the bases of future health care of quality within and outside of our community

Barriers to rehabilitation following surgery for primary breast cancer.

Surgery is a mainstay of primary breast cancer therapy. Alterations in surgical technique have reduced normal tissue injury, yet pain and functional compromise continue to occur following treatment. A tenuous evidence base bolstered by considerable expert opinion suggests that early intervention with conventional rehabilitative modalities can reduce surgery-associated pain and dysfunction. Barriers to the timely rehabilitation of functionally morbid sequelae are discussed at length in this article. Barriers arise from a wide range of academic, human, logistic, and financial sources. Despite obstacles, expeditious and effective post-surgical rehabilitation is being regularly delivered to breast cancer patients at many institutions. This experience has given rise to anecdotal information on the management of common sequelae that may undermine function. The epidemiology, pathophysiology, and management of these sequelae are outlined in this article with an emphasis on the caliber of supporting evidence. Myofascial dysfunction, axillary web syndrome, frozen shoulder, lymphostasis, post-mastectomy syndrome, and donor site morbidity following breast reconstruction are addressed. A critical need for more definitive evidence to guide patient management characterizes the current treatment algorithms for surgical sequelae.

Movimentação precoce do braço no controle do seroma pós-linfadenectomia axilar / Early arm movement to control seroma formation after axillary lymphadenectomy

Este estudo teve o objetivo de avaliar a eficácia da movimentação precoce do braço, no controle da formação de seroma, em mulheres com câncer de mama submetidas a linfadenectomia axilar (LA). Foi realizado um estudo comparativo com a participação de 39 mulheres, com diagnóstico de câncer de mama, unilateral de qualquer extensão, submetidas à cirurgia com LA. A coleta dos dados foi realizada de julho de 2004 à janeiro de 2005, Setor de Onco-ginecologia e Mastologia do Departamento de Ginecologia e Obstetrícia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP). As mulheres foram divididas, aleatoriamente, em dois grupos: Grupo Movimento (GM) e Grupo Controle (GC). No GC, as 20 mulheres receberam as orientações rotineiras da unidade e no GM, as 19 mulheres foram orientadas à movimentação precoce e sistemática do braço, com um programa específico de movimentos iniciados antes da alta hospitalar e continuando no domicílio. Todas as participantes foram avaliadas antes da cirurgia, no primeiro dia pós operatório, de 5 a 10 dias e de 30 a 40 dia depois da cirurgia. Através do teste estatístico de Mann-Whitney observou-se que os grupos foram homogêneos para as variáveis idade e índice de massa corpórea, apesar de o número de sujeitos não ter sido estatisticamente significante. O tempo de permanência do dreno e o volume drenado, foram menores no GM. A incidência de seroma foi igual para os dois grupos, mas a resolução foi mais rápida e menos invasiva no GM. Pode-se assim concluir que apesar de a amostra não ter sido estatisticamente significante, a movimentação precoce e sistematizada favoreceu uma melhor absorção do seroma e não esteve associada a outras complicações cirúrgicas.