Biomechanical evaluation of scapular girdle in patients with chronic arm lymphedema.

The presence of arm lymphedema can induce alterations in motor functions and posture. Using an optoelectronic system (ELITE 2002), we evaluated these alterations during a set of tests involving walking, resting and fatigue. The results of our biomechanical analysis demonstrated a limited range of motion of the affected arm, particularly a reduction in swinging during walking tests, and in shoulder retroposition and abduction movements for all patients. After repeated cyclical movements, premature fatigue appeared in the pathological arm. Lymphedema does not appear to cause alterations to the posture of the spine in our study, but drooping of the shoulder homolateral to the lymphedema can occur. This kind of investigation, which is quick, easy, and comfortable for patients with lymphedema, can be a useful method to evaluate functional capacity, thus allowing a quantitative assessment of the loss of function and the optimizing of the rehabilitative protocol.

Ultrasonography of arm edema after axillary dissection for breast cancer: a preliminary study.

This work examined whether ultrasonography (US) provides detailed information about physical characteristics of lymphedema and whether there is agreement between imaging and clinical data. The study population included 46 women with chronic arm edema after axillary dissection for breast cancer. US showed in each patient an increase of subcutaneous tissue thickness compared with the contralateral arm. Fluid accumulation was seen in 16 patients (34.7%), fibrosis in 12 (26.0%), and a mixed picture (fibrosis and fluid) in 18 (39.1%). Correlation with clinical information ("soft," "medium," "hard, "and "pitting" edema) demonstrated that US documented interstitial fluid in 68.4% of soft edema, mixed fluid and fibrosis in 64.2% of medium edema, and fibrosis in 76.9% of hard edema. Ultrasonography also showed that in soft and medium edema, fibrosis may already have formed. US is useful to follow progression, composition, and management of arm lymphedema after axillary dissection.

Efficacy of homeopathic treatment of skin reactions during radiotherapy for breast cancer: a randomised, double-blind clinical trial.

The aim of this study was to assess the effects of Belladonna 7cH and X-ray 15cH associated in the treatment of acute radiodermatitis. A randomized double-blind placebo-controlled clinical trial involving 66 patients who had been operated on for breast cancer and were undergoing radiotherapy was conducted. The following parameters were assessed over ten weeks: breast skin colour, warmth, swelling and pigmentation. The efficacy of the treatment was assessed by the comparison of these parameters taken individually and by calculating an Index of Total Severity (sum of the scores of the four parameters) during radiotherapy, and during recovery, 15 and 30 d after the end of the radiotherapy. The differences of the scores of the Index of Total Severity during Radiotherapy were not statistically significant, but showed a trend towards a better activity of the homoeopathic medicine compared to placebo. Analysis of the data on Total Severity during recovery, showed a statistically significant benefit of the active medicines over placebo. The homeopathic medicines had particular effectiveness on the heat of the skin. The limited number of patients observed and the posology employed could have interfered with the significance of the results. Chemotherapy and hormonotherapy do not seem to affect the results.

A randomized, controlled clinical trial to evaluate the effects of zinc sulfate on cancer patients with taste alterations caused by head and neck irradiation.

BACKGROUND: In uncontrolled clinical trials, the administration of oral zinc sulfate has been reported both to prevent and correct taste abnormalities in cancer patients receiving external radiotherapy (ERT) to the head and neck region. METHODS: Eighteen patients were randomized to receive either zinc sulfate tablets (a dose of 45 mg) or placebo tablets three times a day at the onset of subjective perception of taste alterations during the course of ERT and up to 1 month after ERT termination. Taste acuity was determined by measuring detection and recognition thresholds for four taste qualities. Intolerance of zinc sulfate or placebo administration was investigated, and the oral cavity was examined. All the evaluations were studied prior to, at weekly intervals during, and 1 month after ERT administration. RESULTS: Taste acuity for one or more taste qualities was already impaired before ERT. During ERT treatment, taste alterations were experienced at least once for a minimum of 3 of the 8 measured thresholds by 100% of the patients, and 33.3% of the patients became aware of some alteration within the first week of treatment. The patients treated with placebo experienced a greater worsening of taste acuity during ERT treatment compared with those treated with zinc sulfate. One month after ERT was terminated, the patients receiving zinc sulfate had a quicker recovery of taste acuity than those receiving placebo. Statistically significant differences between the two groups emerged for urea detection and sodium chloride recognition thresholds during ERT treatment and for sodium chloride, saccharose, and hydrogen chloride recognition thresholds after the termination of ERT treatment. CONCLUSIONS: This pharmacologic therapy is effective and well tolerated; it could become a routine in clinical practice to improve the supportive care of patients with taste alterations resulting from head and neck cancer.

Megestrol acetate for anorexia in patients with far-advanced cancer: a double-blind controlled clinical trial.

The aim of this study was to evaluate a low-dose regimen of megestrol acetate (MA; 320 mg/day) on appetite in advanced cancer patients. Out-patients with far-advanced non-hormone responsive tumours and loss of appetite were randomised in a phase III trial, with two consecutive phases: a 14-day double-blind placebo controlled phase (phase A) and a 76-day open phase (phase B). During phase A, patients were treated with MA, two 160 mg tablets/day, or placebo. In phase B, the MA dose was titrated to clinical response in both groups. Appetite, food intake, body weight, performance status, mood and quality of life were evaluated with standardised measures; patients' global judgement about treatment efficacy was also requested. Of 42 patients entering the study, 33 (17 MA and 16 placebo) were evaluable for efficacy. The appetite score improved significantly with MA after 7 days (P = 0.0023), and this effect was still significant at 14 days (P = 0.0064). Patients judged the treatment with MA effective in 88.2% of cases (14th day), whilst placebo was considered effective by 25% (P = 0.0003). None of the other measures showed significant changes during treatment. The remarkable effect on appetite evident after 7 days, without serious side-effects, shows that MA can produce significant subjective effects at a low-dose even in patients with far-advanced disease.

Ultrasound therapy of chronic arm lymphedema after surgical treatment of breast cancer.

The treatment of chronic arm lymphedema following axillary dissection for breast cancer is still a therapeutic challenge. To examine other treatment options, we undertook a pilot study on the efficacy of ultrasound therapy (UST) in management of these patients. Fifty patients with post-surgical arm lymphedema and without regional irradiation underwent ultrasound treatment (2 cycles at 4 month intervals) and the results were compared up to 1 year with 100 other patients treated by standardized mechanical pressure therapy (MPT) using a pneumatic pump. In this report we evaluate 96 patients who have been followed after 1 year, 31 of whom belong to UST group and 65 to the MPT group. UST did not show a statistically significant difference in whole arm reduction of lymphedema although there was initially a greater reduction in size after the first 4 months of treatment. The addition of an elastic sleeve did not improve lymphedema in either group. Advantages of UST were an overall shorter length of treatment, a tendency to greater softening of the arm, patient satisfaction by avoidance of an uncomfortable and constrictive device and better relief of osteomyofascial pain, greater scapulohumeral motion, and less intercostobrachial pain-dysesthesia.

Peripheral neurotoxicity following high-dose cisplatin with glutathione: clinical and neurophysiological assessment.

The use of high-dose cisplatin is limited by development of severe peripheral neurotoxicity and gradual worsening of renal function. In an ongoing study of high-dose cisplatin glutathione has been employed with the aim of preventing major cisplatin-induced toxicities. Neurotoxicity was examined in detail in 32 patients with ovarian cancer treated with cisplatin (160 mg/m2) and cyclophosphamide (600 mg/m2) every 3-4 weeks for five courses. In addition to serial complete neurological examination, sensory action potentials (SAPs) and motor conduction velocities (MCVs) were also assessed. We confirmed the development of a predominant sensory involvement, characterized by mild distal paresthesias and decrease in vibratory sensibility and in deep tendon reflexes, with a slight reduction of SAPs, observed after three courses of treatment. After five courses, distal paresthesias and disesthesias, decreased proprioception and loss of vibratory sensibility with ataxic signs, absence of deep tendon reflexes, unobtainable SAPs and only moderately reduced MCVs were seen. We did not observe any case of disabling neuropathy. There was a tendency to a more severe involvement of peripheral nerves in patients aged more than fifty. The 3 patients presenting the most serious neuropathy were the oldest in the whole group. Low degree of neurotoxicity observed in this study supports a glutathione protection against cisplatin-induced neurotoxicity. As the urinary excretion of platinum indicated no changes in the renal clearance of cisplatin following repeated courses, the lack of drug accumulation and high plasma peak due to preserved renal function might explain the reduced neurotoxicity observed.

The preservation of minor pectoralis muscle in axillary dissection for breast cancer: functional and cosmetic evaluation.

We have evaluated, in two groups of 50 patients each submitted to axillary dissection for breast cancer (10 mastectomies and 90 conservative procedures), the advantage of the preservation of the minor pectoralis muscle. This muscle was preserved in one group and removed in the other. Whereas in the immediate postoperative period complications (shoulder pain, functional impairment, quantity or duration of serum drainage from the axilla) were the same in the two groups, at longer follow-up (more than 6 months after surgery) the patients whose pectoralis minor muscle was preserved showed a reduction in the incidence of partial atrophy and fibrosis of the pectoralis major muscle. Patients treated with conservation of the pectoralis minor muscle showed this atrophy in 6% of cases vs 54% observed in the other patients. This fact may be related to disruption of the pectoral nerves, which are in close contact with the pectoralis minor during their course from the brachial plexus to the pectoralis major muscle.

Bladder and urethral dysfunction after radical abdominal hysterectomy: rehabilitative treatment.

We studied bladder and urethral function prospectively in 64 patients before and after Wertheim's radical hysterectomy. Immediately after surgery, neurogenic bladder dysfunction of various degrees was found in 70% of all patients who presented difficulty of voiding, with high residual urine and/or stress incontinence. All the patients have received an early rehabilitative treatment with kinesitherapy and/or pharmacological therapy after the bladder catheter removal and the urodynamics' results. We have obtained a satisfactory functional recovery of the bladder activity in 91% of the symptomatic patients.

Evaluation of the results of three different methods of postmastectomy lymphedema treatment.

The aim of this study was to evaluate the following methods of postmastectomy lymphedema treatment: pneumatic massage with uniform pressure, pneumatic massage with differentiated pressure, and manual lymphatic massage. The study concerned three groups of 20 mastectomized patients with secondary early developed arm lymphedema. The measurement of circumference on seven points of both arms, the self-scoring mood questionnaire, and the visual analogue scale (VAS) were evaluated before, at the end, and 3 months after the treatment. We observed a permanent edema reduction, which was statistically significant, with uniform pressure pneumatic massage and with manual lymphatic massage, but not with differentiated pneumatic massage. The VAS and the self-scoring mood questionnaire made from measuring the subjective ratings of the patients confirmed the objective evaluations.