Funcionalidad y marcha en pacientes con linfedema de miembro inferior tratados mediante un programa de ejercicio terapéutico: serie de casos / Functionality and gait in patients with lower limb lymphoedema undergoing a therapeutic exercise programme: Case series

Introducción El ejercicio físico es un pilar en el tratamiento conservador del linfedema; sin embargo, normalmente no se realiza un programa de ejercicio terapéutico enfocado a mejorar la funcionalidad. Objetivo Analizar los cambios en la funcionalidad y la marcha de pacientes con linfedema de extremidad inferior aplicando un protocolo de ejercicio terapéutico progresivo supervisado. Materiales y método Pacientes adultos, portadores de linfedema de extremidad inferior, fueron tratados mediante un plan de ejercicios progresivo mixto, aeróbico y de resistencia, durante 8 semanas. Se registraron datos sociodemográficos, clínicos y antropométricos, funcionalidad de la extremidad inferior, marcha, fuerza isométrica de piernas y prensión de agarre, al inicio y final del programa. Para el análisis de datos se utilizó el t-test y Wilcoxon. Resultados Diecisiete mujeres y 5 hombres fueron reclutados, edad promedio 45,5 años (23-68), 12 participantes presentaron linfedema unilateral y 10 bilaterales, 20 estaban en etapas clínicas i o ii y 16 tenían linfedema secundario. Postintervención, la funcionalidad de miembros inferiores según el Lower Extremity Functional Scale mejoró 11 puntos promedio (p <0,005); la distancia recorrida promedio, aumentó de 474 m a 503 m, con p <0,005 solo para el grupo de mujeres. Hubo mejoras en la fuerza isométrica de piernas y fuerza de prensión de agarre sin significación estadística. Además, se observó reducción del peso corporal y del volumen de extremidad afectada (p <0,005). Conclusión El protocolo de ejercicio terapéutico progresivo aplicado mostró efectos positivos en todas las variables estudiadas, principalmente funcionalidad y marcha, y puede ser recomendable y seguro en esta población (AU)

Introduction Physical exercise is a fundamental part of the conservative treatment of lymphoedema. However exercise therapy programmes that focus on improving functionality are not usually undertaken. Objective To analyse changes in the functionality and gait of patients with lower limb lymphoedema through a supervised progressive therapeutic exercise programme. Materials and method adult patients with lower limb lymphedema underwent a progressive, aerobic and resistance exercise programme for 8 weeks. Sociodemographic, clinical and anthropometric data, lower limb functionality, gait, isometric leg strength and grip strength were recorded at the beginning and end of the programme. T-test and Wilcoxon were used for data analysis. Results 17 women and 5 men were recruited, the average age was 45.5 years old (23-68), 12 participants presented unilateral and 10 bilateral lymphoedema, 20 were in clinical stages i or ii, and 16 had secondary lymphoedema. Post intervention, lower limb functionality according to the Lower Extremity Functional Scale improved by an average of 11 points (P<.005), the average distance walked by the group increased from 474 meters to 503 meters, with P<.005 only in the women, the improvement in isometric leg strength and grip strength did not show statistical significance. A reduction of body weight and reduction of affected limb volume (P<.005) were also observed. Conclusion The protocol of progressive and supervised exercise therapy applied, showed positive effects in all the variables studied, mainly functionality of lower limb and gait, and may be recommended and safe in this population (AU)

Tratamiento transdisciplinario del linfedema mediante terapia físico-combinada compleja. Análisis de nuestra experiencia / Complex physical-combined decongestion therapy in lymphedema: Analysis of our experience

INTRODUCCIÓN: El tratamiento actual del linfedema se realiza por un equipo transdisciplinario y con terapia físico-combinada descongestiva compleja. OBJETIVO: Evaluar la respuesta a las primeras 10 sesiones continuas de terapia físico-combinada compleja, en pacientes con linfedema de las extremidades inferiores. MÉTODO: Se analizan 20 pacientes ingresados por linfedema con compromiso del miembro inferior. Se comparó el porcentaje de reducción del edema, en función de la perimetría realizando 9 mediciones en el miembro inferior tomadas al ingreso y al finalizar las 10 sesiones, más cálculos de volumetría. Los pacientes fueron tratados con terapia físico-combinada descongestiva compleja: drenaje linfático manual, vendaje multicapa y ejercicios miolinfokinéticos. RESULTADOS: Los pacientes varones que cumplieron terapia descongestiva compleja completa redujeron su perimetría en un 5,2% y las mujeres en un 6,2%, la volumetría disminuyó en un 8,7% para los hombres y en un 13,6% para las mujeres. CONCLUSIÓN: Para obtener un óptimo resultado en corto tiempo (10 sesiones), especialmente para pacientes que residen alejados de nuestro centro, se requiere hacer terapia descongestiva compleja completa

INTRODUCTION: Lymphedema treatment is being currently being performed by a multi-disciplinary health team using a complex physical-combined decongestion therapy. OBJECTIVE: To evaluate patient response to the first 10 sessions of a complex physical-combined decongestion therapy to treat lower-limb lymphedema. METHOD: Twenty patients with lower-limb lymphedema were evaluated and treated with 10 sessions of a complex physical-combined decongestion therapy, which includes: manual lymphatic drainage, multi-layer bandage and mio- lymphatic kinetic exercises. The edema reduction percentage was compared, based on the lower limb perimeter by evaluating 9 measurements s taken at the beginning and at the end of the sessions cycle, along with volumetric calculations. RESULTS: Male patients that completed the therapy showed a 5.2% decrease in their lower limb perimeter, while female patients showed a 6.2% decrease. Volumetric measurements decreased by 8.7% in males and 13.6% in females. CONCLUSION: To achieve an optimal result in a short period of time (10 sessions), a complex physical-combined decongestion therapy is required

Linfedema: olvidado, evadido, ignorado, pero aún no derrotado / Lymphoedema: Forgotten, avoided, ignored, but still not defeated

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Volumetry of human taste buds using laser scanning microscopy.

OBJECTIVE: In vivo laser scanning confocal microscopy is a relatively new, non-invasive method for assessment of oral cavity epithelia. The penetration depth of approximately 200-400 microm allows visualisation of fungiform papillae and their taste buds. MATERIALS AND METHODS: This paper describes the technique of in vivo volumetry of human taste buds. Confocal laser scanning microscopy used a diode laser at 670 nm for illumination. Digital laser scanning confocal microscopy equipment consisted of the Heidelberg Retina Tomograph HRTII and the Rostock Cornea Module. Volume scans of fungiform papillae were used for three-dimensional reconstruction of the taste bud. RESULTS: This technique supplied information on taste bud structure and enabled measurement and calculation of taste bud volume. Volumetric data from a 23-year-old man over a nine-day period showed only a small deviation in values. After three to four weeks, phenomenological changes in taste bud structures were found (i.e. a significant increase in volume, followed by disappearance of the taste bud and appearance of a new taste bud). CONCLUSIONS: The data obtained indicate the potential application of this non-invasive imaging modality: to evaluate variation of taste bud volume in human fungiform papillae with ageing; to study the effects of chorda tympani nerve transection on taste bud volume; and to demonstrate recovery of taste buds in patients with a severed chorda tympani nerve who show recovery of gustatory sensibility after surgery.

[Extra meningeal cryptococcosis in a patient with AIDS]. / Cryptococosis extra meníngea en un paciente con SIDA.

We report a young homosexual male with AIDS that presented a systemic Cryptococcus neoformans infection. He had skin, lymph node and colonic involvement but the central nervous system was spared. Treatment was started with amphotericin B, achieving a good remission of skin lesions. However, malaise and digestive symptoms did not abate and the patient died.

[Etiologic diagnosis of pneumonia in HIV-AIDS patients. Usefulness of fibrobronchoscopy]. / Diagnóstico etiológico de neumonía en pacientes VIH-SIDA. Utilidad de la fibrobroncoscopía.

AIM: to assess the usefulness of fiberoptic bronchoscopy in the etiologic diagnosis of pulmonary infiltrates in patients with AIDS. PATIENTS AND METHODS: in 25 patients with AIDS and pneumonia, 31 fiberoptic bronchoscopies with bronchoalveolar lavage were performed; in 11 occasions, a transbronchial biopsy was also performed. RESULTS: in 24 of the 31 procedures (77%) an etiologic diagnosis was made. There were 7 false negative results; in two of these patients, a repeated examination allowed an etiologic diagnosis. The etiologies of the infiltrates were pyogenic bacteria in 14 cases. Pneumocystis carinii in 9, mycobacteria in 3, cytomegalovirus in one and a lymphocytic interstitial pneumonia in one. In 5 patients, the association of two or more etiological agents was observed. Except one case, all patients had a good response to specific treatments. There were no complications attributed to the bronchoscopic procedure. CONCLUSIONS: fiberoptic bronchoscopy and bronchoalveolar lavage are safe and effective procedures for the etiologic diagnosis of pulmonary infiltrates in patients with AIDS.