High-Frequency Generator in Wound Healing of Marjolin's Ulcer After Carcinoma Resection.

Marjolin's ulcers (MU) are skin malignancies that form over burn injuries. These very aggressive ulcers can result in functional and wound healing impairment, and require a well thought out treatment plan. Physiotherapy offers resources to help promote recovery of these patients, as described in this case report, in which the patient with a history of burn in the lower limbs evolved to malignancy 32 years later. This patient underwent tumor resection of the left foot, with recurrence and lymphadenectomy. Physical therapy included the application of high-frequency generator (HFG) for wound healing and exercises for functional recovery. The treatment lasted for many months and resulted in the improvement of the surgical wound areas, pain, swelling, sensitivity, strength muscle, and gait. It was observed that the use of HFG can be a tool in the tissue repair of surgical wound after the resection of MU; however, further studies need to be carried out to suit parameters and ensure safety of cancer patients.

Effect of high- and low- frequency transcutaneous electrical nerve stimulation (TENS) on angiogenesis and wound contraction in acute excisional wounds in rat skin / Efeito da estimulação elétrica nervosa transcutânea (TENS) de alta e de baixa frequências na angiogênese e na contração da ferida excisional aguda em pele de ratos

Abstract Introduction: Transcutaneous electrical nerve stimulation (TENS) can alter the local temperature, increase skin blood flow and induce the release of vasodilator neuropeptides and growth factors. These changes may be related to the effects of TENS on the tissue repair process. Objective: To assess the effect of high- and low-frequency TENS on angiogenesis and the contraction of acute excisional wounds in rat skin. Methods: Fifty-four young adult male EPM1-Wistar rats were used in the study. An excisional wound was performed on the back of each animal using an 8mm punch. The animals were randomly assigned to three groups: the High-frequency Group (HG: 80 Hz), Low-frequency Group (LG: 5 Hz), and Sham Group (SG: TENS turned off). TENS was delivered on three days consecutives. Pulse duration and current intensity were 200 µs and 15 mA. The length of each TENS session was 60 minutes. Microscopic and macroscopic assessments were performed on 3, 7 and 14 postoperative (PO) days. Hematoxylin-eosin staining was utilized to quantify the neoformed blood vessels. Photographs were taken to determine the percentage of wound contraction. After assessment, the animals were painlessly sacrificed. Results: There were increases in angiogenesis in the HG on the 3 PO day, and in the LG on the 14 PO day. No significant differences in wound contraction were found between the groups on the different PO days. Conclusion: High frequency TENS improved angiogenesis, and neither frequency of TENS had any influence on the contraction of acute excisional wounds in rat skin.

Resumo Introdução: A TENS pode promover alteração da temperatura local, aumento do fluxo sanguíneo cutâneo, liberação de neuropeptídeos vasodilatadores e de fatores de crescimento. Tais eventos podem estar relacionados aos efeitos da TENS no processo de reparo tecidual. Objetivo: Avaliar o efeito da TENS de alta e de baixa frequências na angiogênese e na contração da ferida excisional aguda em pele de ratos. Materiais e Métodos: Foram utilizados 54 ratos (Wistar-EPM1), machos e adultos jovens. Realizou-se uma ferida excisional na região dorsal do animal com um punch medindo 8 milímetros. Os animais foram randomizados em três grupos: Grupo Alta frequência (HG:80 Hz), Grupo Baixa frequência (LG:5 Hz) e Grupo Simulado (SG, TENS desligada). A TENS foi aplicada por 3 dias consecutivos. A duração do pulso e intensidade da corrente foram 200 µs e 15 mA. O tempo de cada aplicação foi de 60 minutos. As análises microscópicas e macroscópicas foram feitas nos POI, 3, 7 e 14 dias de pós-operatório (PO). Utilizou-se a hematoxilina-eosina para quantificação dos vasos neoformados. Foram feitas imagens fotográficas para determinação da porcentagem de contração da ferida. Após as avaliações, os animais foram sacrificados. Resultados: Observou-se aumento na quantidade de vasos sanguíneos no HG, aos 3 dias de PO; e no LG, aos 14 dias de PO. Não houve alterações na contração da ferida entre os grupos. Conclusão: A TENS de alta frequência estimulou a angiogênese e ambas as frequências não influenciaram na contração da ferida excisional aguda em pele de ratos.

Retrospective study of the physical therapy modalities applied in head and neck l ymphedema treatment.

BACKGROUND: Secondary lymphedema after head and neck cancer treatment is a serious complication and its management can be a challenge. The purpose of this study was to verify which physical therapy modalities were applied in the treatment of head and neck lymphedema through a retrospective analysis. METHODS: A retrospective study was developed, based on the analysis of medical records of 32 patients treated in the physiotherapy outpatient department of the Brazilian Institute of Cancer Control (IBCC). RESULTS: The physiotherapy included manual lymphatic drainage, massage, exercises, patient education, and compression therapy with an average of 23.9 ± 14.8 sessions. Measurement results showed a significant reduction of face and neck lymphedema (p < .05) and pain (from 7.8 ± 2.2 to 3.6 ± 1.6; p < .001). CONCLUSION: The physical therapy modalities based on strategic manual lymphatic drainage, shoulder girdle massage, facial, tongue and neck exercises, compressive therapy at home, and patient education showed reduction of the lymphedema and pain, both of them secondary to head and neck cancer treatment.

Characterization of symptoms and edema distribution in premenstrual syndrome.

BACKGROUND: Premenstrual syndrome is a group of symptoms linked to the menstrual cycle, and edema is among these symptoms. Physiotherapy is often sought by many patients for the treatment of edema; however, for an adequate prescription of physiotherapeutic procedures, the distribution of edema throughout the body has yet to be characterized. OBJECTIVE: To determine the most frequent symptoms and body regions that present with edema in women during the premenstrual period. SUBJECTS AND METHODS: Sixty women with a mean age of 24.6±4.7 years were evaluated during their premenstrual (between days 21 and 28) and menstrual period (between days 1 and 3), and the collected data included body mass, height, biotype (body-fat distribution), face, breast, limb-circumference measurements, and limb-volume estimate, and an adapted version of the Premenstrual Symptoms Screening Tool was used. Statistical analysis was performed using Student's t-test and the test for equality of two proportions (P≤0.05). RESULTS: Premenstrual syndrome was identified in 91.7% of the women, and the most frequent symptoms were irritability (73.33%) and physical symptoms, including swelling (65%), and anxiety (58.3%). Edema was detected in the following areas: facial, epigastric, mammary, umbilical, and pubic, the mid-third of the arms, distal forearm, in both thighs and in the mid-third of the legs determined by circumference measurements, and in both upper and lower limbs, according to the estimated volume. CONCLUSION: In this study population, the most frequent symptoms were irritability, physical symptoms, and anxiety, with distribution of edema in the face, breast, abdomen, pubic area, distal upper limb, and proximal lower limb.

Perfil dos pacientes atendidos em fisioterapia dermatofuncional / Profile of patients treated in integumentary physical therapy

Por ser uma das áreas mais recentes da fisioterapia,muitos serviços públicos ainda não dispõem da especialidadedermatofuncional, dificultando traçar o seu perfil populacional.Objetivo: Identificar o perfil dos pacientes atendidos em fisioterapiadermatofuncional, no âmbito hospitalar e ambulatorial, emSão Paulo – SP, Brasil. Métodos: Estudo retrospectivo por análisede 421 prontuários dos pacientes atendidos no estágio do CentroUniversitário São Camilo. As variáveis foram analisadas pelo testede Igualdade de Duas Proporções ou Mann-Whitney. Resultados:O gênero feminino prevaleceu (73,1%), com idade de 51,1 ± 16anos, IMC de 27,5 ± 5,7 kg/m2 e escolaridade entre ensino médiocompleto e fundamental incompleto (p = 0,616). Neoplasiada mama (60,8%), tempo de evolução de 2 a 5 anos (20,2%) etratamento cirúrgico (80,1%) foram os mais encontrados. Assimcomo as queixas de dor (44%) e edema nos membros (39,1%)juntamente com diagnóstico fisioterapêutico de alteração vascular(75,1%). Conclusão: A população estudada foi caracterizada pelaprevalência de mulheres, por volta dos 50 anos, com sobrepeso,grau de escolaridade entre médio e fundamental, com diagnóstico decâncer de mama, tempo de evolução de 2 a 5 anos, com predomíniode tratamento cirúrgico, diagnóstico fisioterapêutico de alteraçõesvasculares e queixas de dor e edema...

As one of the newest areas of physical therapy,many public services do not yet have the integumentary specialty,making it difficult to trace their population profile. Objective: Toidentify the profile of patients treated in integumentary physicaltherapy at the Hospital and outpatient units, in Sao Paulo/SP.Methods: Retrospective study through the analysis of 421 medicalrecords of patients treated at São Camilo University Centre. Thevariables were analyzed using the Test for Equality of Two proportionsor Mann-Whitney. Results: Female gender was the mostprevalent (73.1%), mean age 51.1 ± 16 years, BMI 27.5 ± 5.7 kg/m2 and schooling level between complete high school and incompleteelementary school (p = 0.616). Breast cancer (60.8%), time ofdisease progression from 2-5 years (20.2%) and surgical treatment(80.1%) were the most prevalent information, as complaint ofpain (44%), swelling in the limbs (39.1%) and physiotherapeuticdiagnosis of vascular dysfunction (75.1%). Conclusion: The studypopulation was characterized by the prevalence of women aged ≥50, overweighted, with elementary and high school schooling levels,with a diagnosis of breast cancer, time of disease progression 2-5years, prevalence of surgical treatment, physiotherapeutic diagnosisassociated with vascular dysfunction and complaints of pain andswelling in the limbs...

Fisioterapia aquática e de solo em grupo na postura de mulheres mastectomizadas / Aquatic and land physiotherapy group in the posture of women with mastectomy

Verificar a efetividade da fisioterapia aquática e de solo na postura de mulheres mastectomizadas. Métodos - A amostra foi de15 pacientes submetidas à mastectomia unilateral ou bilateral, parcial ou total. Distribuídas em 2 grupos, um controle (GC) que realizou fisioterapia em solo e um grupo de estudo (GE) que realizou fisioterapia aquática, entre 2009 e 2010, no Centro de Reabilitação Promove -São Camilo. Para avaliação da postura das participantes utilizou-se o Software de Avaliação Postural (SAPO), pré e pós-tratamento. Para análise estatística foram utilizados os testes Mann-Whitney e Wilcoxon, Intervalo de Confiança para Média e p-valor que foi fixado em p<0,05 (5%). Resultados - Observaram-se diferenças estatisticamente significantes nas seguintes alterações posturais: alinhamento horizontal de pélvis (p=0,007), ângulo do tornozelo (p=0,007), assimetria no plano frontal (p=0,007) e sagital (p=0,014), centro de gravidade relativo à posição média dos maléolos no plano lateral (p= 0,003). Conclusão - A fisioterapia aquática e de solo mostraram-se eficientes para apostura corporal de mulheres mastectomizadas...

To verify the effectiveness of aquatic and land physiotherapy in the posture of women with mastectomy. Methods - The sample consisted of 15 patients with unilateral or bilateral, partial or total mastectomy. Distributed into two groups, a control group (CG) that did land physiotherapy, and a study group (SG) that did aquatic physiotherapy, between 2009 and 2010, in Centro de Reabilitação Promove -São Camilo. To evaluate the posture of the participants it was used Postural Assessment Software (SAPO), pre-and post-treatment. To statistical analysis were used Mann-Whitney and Wilcoxon test, Confidence Interval for mean and p-value was set at p<0.05 (5%). Results - It were observed statistically significant differences in the following postural changes: horizontal alignment of the pelvis (p=0.007), ankle angle(p=0.007), asymmetry in the frontal (p=0.007) and sagittal (p=0.014) plane, center of gravity on the average position of the malleolus in the lateral (p=0.003) plane. Conclusion - The aquatic and land physiotherapy were effective for the posture of women with mastectomy...

Prevalência de dor nos nadadores de São Vaetano do Sul / Pain prevalence in swimming athletes of São Caetano do Sul

OBJECTIVE: A natação é um esporte que vem se destacando nos últimos anos, sendo reconhecido que requer um elevado nível de treinamento e que gera sobrecarga musculoesquelética, a qual predispõe os nadadores a lesões. OBJETIVO: Verificar a prevalência e as regiões corporais com dor, correlacionando com o estilo principal e o tempo de prática nos nadadores do SERC em São Caetano do Sul. Método: Aplicação de um questionário com 19 perguntas em 71 atletas, sendo 30 do sexo feminino e 41 do masculino, nas categorias petiz (10 a 12 anos), infantil (12 a 14 anos), juvenil (14 a 16 anos), júnior (16 a 18 anos) e sênior (a partir dos 18 anos). As variáveis foram analisadas pelo teste de igualdade de duas proporções e Mann-Whitney. RESULTADOS: A prevalência de dor foi de 74,6% (n = 53; p < 0,001), sendo 39,6% (n = 21) no ombro e 22,6% (n = 12; p = 0,059) na coxa e o nado costas foi o único estilo que não apresentou correlação com a dor (p = 1,000), bem como com o tempo de prática (p = 0,075). CONCLUSION: Na população estudada houve alta prevalência de dor, sendo as regiões do ombro e da coxa as mais acometidas, não tendo correlação nem com o nado costas e tampouco com o tempo de prática esportiva.

INTRODUCTION: Swimming is a sport that has been on the high in the last years and requires high levels of training and performance, which can cause overuse on muscular skeletal system, causing injuries to swimmers. Objective: To verify the pain prevalence and the body areas with pain, correlating with main style and practice time in swimming athletes from SERC Club in São Caetano do Sul. METHOD: A survey with 19 questions was applied to 71 athletes (30 female and 41 male) in child I (10-12 years old), child II (12-14 years old), juvenile (14-16 years old), junior (16-18 years old) and senior (From 18 years old) categories. The variables were analyzed by Two-Proportional Equality Test and Mann-Whitney Test. RESULTS: Pain prevalence was of 74.6% (n = 53; p < 0.001),namely: 39.6% (n = 21) in shoulder and 22.6% (n = 12; p = 0.059) in thighs and the back stroke swim was the only style that had no correlation with pain (p = 1.000) or time of practice (p = 0.075). CONCLUSION: In the studied subjects, there was high pain prevalence, with the shoulder and thigh being the most affected areas, not presenting correlation with the back stroke style neither in sports time of practice.

Abordagem fisioterapêutica do linfedema bilateral de membros inferiores / Physiotherapeutic approach of bilateral lower limb lymphedema

INTRODUÇÃO: O linfedema é um acúmulo de proteína no interstício em virtude de deficiência do sistema linfático, sendo recomendada a utilização da Terapia Física Complexa como forma de tratamento. OBJETIVO: Verificar os efeitos da Terapia Física Complexa no tratamento e na manutenção do linfedema bilateral de membros inferiores. MÉTODOS: Participaram deste estudo sete pacientes com linfedema bilateral nos membros inferiores, de faixa etária entre 59 e 85 anos, os quais foram submetidos a: 1ª avaliação fisioterapêutica, quando permaneceram sem tratamento (período controle); 2ª avaliação, quando receberam o tratamento fisioterapêutico (período tratamento - terapia física complexa - fase de redução); 3ª avaliação, quando receberam alta (período manutenção - terapia física complexa - fase de manutenção); e 4ª avaliação, para acompanhamento desse último período. O intervalo entre cada avaliação foi de 10 a 12 semanas. Os dados da perimetria foram transformados em volume do membro, por meio da fórmula do cone truncado, e a região do tornozelo foi avaliada pelo método da Figura Oito. RESULTADOS: A média da Figura Oito e do volume dos membros foi de 62,32 cm e 6233 ml, 62,57 cm e 6308 ml, 56,75 cm e 5505 ml, 57 cm e 5566 ml, respectivamente para 1ª, 2ª, 3ª e 4ª avaliações. Pelos testes de Friedman e Wilcoxon, observou-se diferença significativa entre a 3ª e a 4ª avaliações, quando comparadas à 1ª e à 2ª (p < 0,001), para ambas as variáveis, mostrando redução significante do linfedema e sua estabilização durante o período de manutenção. CONCLUSÃO: A terapia física complexa foi eficaz no tratamento e na manutenção do linfedema bilateral de membros inferiores.

INTRODUCTION: Lymphedema is the accumulation of protein interstitial fluid as a result of impaired lymphatic function, recommended the use of Complex Physical Therapy as a treatment. OBJECTIVE: To determine the effects of Complex Physical Therapy on the treatment and maintenance of bilateral lower limb lymphedema. METHODS: Seven patients, aged between 59 and 85 years, with bilateral lower limb lymphedema participated in this study. The study consisted of four periods: (1) Control period - first physiotherapeutic evaluation (the patients did not receive any treatment at this stage); (2) Treatment period (reduction stage) - second evaluation and physiotherapeutic treatment (complex physical therapy); (3) Maintenance period - third evaluation, patient discharge, and complex physical therapy; and (4) follow-up period - evaluation of the last stage. The time interval bewteen evaluations was 10-12 weeks. The leg volume was calculated using leg perimeter data and the formula for the volume of a truncated cone, and ankle swelling was measured using the figure-of-eight method. RESULTS: The mean ankle measurement and leg volume at the first, second, third and fourth evaluations were 62.32 cm and 6233 ml, 62.57 cm and 6308 ml, 56.75 cm and 5505 ml, and 57 cm and 5566 ml, respectively. Figure Eight measurements and leg volumes were significantly lower at the third and fourth evaluations than at the first and second evaluations (p < 0.001), showing a significant reduction in volume and stabilization of the lymphedema during the maintenace period. CONCLUSION: The complex physical therapy was efficient in the treatment and maintenance of bilateral lower limb lymphedema.

The effect of a cryotherapy gel in localized adiposity in young women / O efeito do gel crioterápico na adiposidade localizada em mulheres jovens

Objective - The aim of this study was to verify the effects of cryotherapy with a camphor and menthol gel, used isolatedly, on the body composition, fat percentage and body self-image in young women. Methods - Third six women, with mean age: 21 years old, with mean body mass index: 22,92 kg/m2 and having localized android and/or gynecoid adiposities, were selected. Volunteers were randomly divided into two groups: the one which went through treatment (Treatment Group = 20) and the one that did not (Control Group = 16). Several procedures, such as anamnesis, physical exam and body composition evaluation through the tetrapolar bioelectric impedance and the anthropometric technique, body self-image scale applied. Results - According to the results achieved, cryotherapy was ineffective, as the body mass and the body mass index kept unchanged and the body perimeter measures (except the arm measure) and the cutaneous folds (except the axillary fold) did not decrease. Conclusions - This study conclusion was that cryotherapy with a camphor and menthol gel, used isolatedly, decreased medial axillary, pectoral and abdominal skinfold and arm body perimeter measure, but did not change significantly the others body perimeter measures, fat percentage and body self-image in young women.

Objetivo - Verificar o efeito da crioterapia com gel à base de cânfora e mentol, usada isoladamente, na composição corporal, porcentagem de gordura e autoimagem corporal em mulheres jovens. Métodos - Foram selecionadas 36 mulheres, com média de idade de 21 anos, média do índice de massa corporal de 22,92 kg/m2, portadoras de adiposidades localizadas de características andróide e/ou ginóide. As voluntárias foram divididas randomicamente entre dois grupos: o que realizou o tratamento (Grupo Tratamento = 20) e o que não realizou o tratamento (Grupo Controle = 16). Foram realizados anamnese, exame físico e avaliação da composição corporal por meio da impedância bioelétrica tetrapolar e da técnica antropométrica, e assim pode-se obter a porcentagem de gordura e foi aplicada uma escala de autoimagem corporal. Resultados - De acordo com os resultados obtidos, observou-se que a aplicação de gel crioterápico foi ineficaz na modificação da massa e índice de massa corporal, na diminuição das perimetrias (exceto a de braço); e na redução das dobras cutâneas (exceto a dobra cutânea axilar). Conclusões - Conclui-se que a crioterapia à base de cânfora e mentol, utilizada isoladamente, diminuiu as dobras cutâneas axilar média, peitoral e abdominal e a perimetria de braço, porém não modificou os valores das outras perimetrias, porcentagem de gordura e escala de autoimagem corporal.

The effects of transcutaneous electrical nerve stimulation on tissue repair: A literature review.

BACKGROUND: Transcutaneous electrical nerve stimulation (TENS) consists of a generic application of low-frequency, pulsed electrical currents transmitted by electrodes through the skin surface. It is a therapeutic modality that is nonpharmacological, noninvasive, inexpensive, easy to use and widely applied in clinical practice. OBJECTIVE: To narratively review the scientific evidence of the effects of TENS on tissue repair with respect to wound healing, skin flap viability and tendinous repair. METHODS: The study was conducted using the MEDLINE, Lilacs and Scielo databases, without limit to the period of publication, and was completed in November 2011. Inclusion criteria were randomized or nonrandomized, controlled or noncontrolled clinical trials, and experimental trials involving rats subjected to TENS for tissue repair. RESULTS: Thirty articles on tissue repair were found and, among these, 14 reported on wound healing, 14 reported on skin flaps and two analyzed tedinous repair. DISCUSSION: It was suggested that TENS stimulates skin wound healing and tendon repair, as well as the viability of random skin flaps. Such effects may be due to the release of substance P and calcitonin gene-related peptide, which would increase blood flow and, consequently, hasten the events leading to tissue repair. CONCLUSIONS: Based on the scientific evidence regarding the effects of TENS on tissue repair, the findings of the present literature review were inconclusive because data from the randomized controlled clinical trials were insufficient to confirm such effects.

HISTORIQUE: La stimulation nerveuse électrique transcutanée (SNET) désigne l'application générique de courants électriques pulsés à faible fréquence transmis à travers la surface de la peau par des électrodes. C'est une modalité thérapeutique non pharmacologique, non effractive, peu coûteuse, facile à utiliser et largement appliquée en pratique clinique. OBJECTIF: Procéder à l'analyse narrative des données scientifiques probantes sur les effets de la SNET sur la réparation tissulaire en matière de guérison des plaies, de viabilité du lambeau cutané et de réparation tendineuse. MÉTHODOLOGIE: L'étude a été conçue à l'aide des bases de données MEDLINE, Lilacs et Scielo, sans limite pour la période de publication, et a pris fin en novembre 2011. Les critères d'inclusion étaient des essais cliniques aléatoires ou non et contrôlés ou non et des essais expérimentaux touchant des rats soumis à la SNET pour réparer les tissus. RÉSULTATS: Les chercheurs ont trouvé 30 articles sur la réparation tissulaire et, de ce nombre, 14 traitaient de la guérison des plaies, 14 des lambeaux cutanés et deux des réparations tendineuses. EXPOSÉ: Il a été postulé que la SNET stimule la guérison des plaies cutanées et la réparation des tendons, de même que la viabilité des lambeaux cutanés pris au hasard. Cet effet serait causé par la libération de la substance P et du peptide lié au gène calcitonine, qui accroîtrait le débit sanguin et, par conséquent, accélérerait les événements responsables de la réparation tissulaire. CONCLUSIONS: D'après les données scientifiques probantes sur les effets de la SNET sur la réparation tissulaire, les résultats de la présente analyse bibliographique n'étaient pas concluants puisque les données des essais cliniques aléatoires et contrôlés n'étaient pas suffisantes pour confirmer ces effets.

Intervenção fisioterapêutica nas sequelas de drenagem linfática manual iatrogênica: relato de caso / Physical therapy in sequelae of iatrogenic manual lymphatic drainage: a case report

Atualmente, a drenagem linfática manual (DLM) é um dos recursos de grande destaque no tratamento de edemas, linfedemas e condições inestéticas, porém, na prática clínica têm-se observado sua aplicação de forma iatrogênica. Os objetivos deste relato de caso foram apontar as sequelas da aplicação iatrogênica da DLM, em uma jovem caucasiana, e verificar os efeitos da intervenção fisioterapêutica no tratamento dessas. Voluntária de 27 anos, apresentava-se com uma equimose importante na região lateral da coxa esquerda (28 x 9,5 cm), telangiectasias, microvaricosidades e petéquias em ambas as coxas e pernas, dor de forte intensidade e edema, após ter se submetido a um procedimento manual iatrogênico com finalidade estética há dois dias. As condutas fisioterapêuticas adotadas foram: Ultrassom 3 MHz, pulsado (2 ms on, 8 ms off), 0,4 W/cm2 SATP na região da equimose e DLM (Método Leduc) durante 20 minutos, na coxa esquerda. Foram realizadas nove sessões até a alta no 16º dia pós-lesão, observando-se apenas a redução gradativa da dor e da equimose. Verificou-se a efetividade da intervenção fisioterapêutica em apenas algumas das sequelas provocadas pela iatrogenia, sem desconsiderar que a remissão espontânea dos sinais e sintomas também pode ter contribuído para tal. Destaca-se a importância de conscientizar os fisioterapeutas que atuam com este procedimento para que o aplique de forma adequada, evitando tais iatrogenias.

Recently, the manual lymphatic drainage (MLD) is an important resource in the treatment of edemas, lymphedemas, and other unaesthetic conditions. However, problems caused by the incorrect application of this therapy have been observed in the clinical practice. The aims of this case report were to describe sequelae resulting from the negligent application of MLD on a young patient, and to determine the effects of physical therapy on the treatment of sequelae. A 27-year-old Caucasian woman presented with a large ecchymosis (28 x 9.5 cm) on the outer side of the left thigh, telangiectasias, micro varicose veins, and petechiae on the legs and thighs, intense pain, and edema, after undergoing an incorrect manual procedure for aesthetic purposes two days earlier. Physical therapy consisted of ultrasound application (3 MHz, pulsed mode, 20% duty cycle, SATP intensity of 0.4 W/cm²) to the ecchymosis site and MLD (Leduc method) for 20 minutes on the left thigh. The patient underwent nine physical therapy sessions until discharge from the hospital 16 days after injury. The effectiveness of physiotherapy intervention was verified in only some of the consequences caused by iatrogenic, without disregarding that the spontaneous remission of signs symptoms can have contributed to such fact. The study emphasizes the importance of awareness among physical therapists who work with this procedure to apply it appropriately in order to avoid such conditions.

Efeito da massagem clássica estética em adiposidades localizadas: estudo piloto / Effects of classic aesthetic massage on localized adiposity: a pilot study

Devido ao padrão de beleza imposto atualmente, tem aumentado a procura por tratamentos estéticos como a massagem clássica, porém sua suposta ação lipolítica ainda é uma questão controversa na literatura. O objetivo deste estudo foi verificar o efeito da massagem clássica estética nas adiposidades localizadas, por meio de perimetria do abdome, quadril e coxas e pela estimativa da espessura da tela subcutânea da parede abdominal (ETS) por ultrassonografia. Oito voluntárias (idade 33,9±8,9 anos, peso 65,1±8,4 kg) foram avaliadas quanto a MC, IMC e ETS 30 dias antes, logo antes do início da intervenção e após esta. Foram efetuadas 12 sessões de massagem clássica estética em coxas, glúteos e abdome por 30 minutos, três vezes por semana. Foi encontrada redução significativa apenas da perimetria na região do quadril (p=0,012), mas não da ETS (p=0,301). A massagem clássica estética contribuiu apenas para a redução da perimetria do quadril, e não modificou outras medidas nem a espessura da tela subcutânea da região abdominal.

Due to current beauty standards, the search for aesthetic treatments, including classical massage, has increased; however, its presumed lipolytic action is still controversial in literature. The purpose of this study was to assess the effect of classical massage on localized adiposity, by means of abdomen, hip and thigh perimeter measuring, nd by estimating thickness of abdominal wall fat by ultrasonography. Eight volunteers (33.9±8.9 years old, 65.1±8.4 kg) were assessed as to weight, body mass index, body perimeter measures and by abdomen ultrasonography at three moments: control (30 days before treatment), just before, and after treatment. The latter consisted of 12 thrice-weekly, 30-minute massage sessions on thighs, buttocks, and abdomen. Results showed a significant reduction at hip perimeter (p=0.012), but none of subcutaneous fat tissue thickness (p=0.301). Classical aesthetic massage hence did not modify abdominal wall fat, but did reduce hip perimeter.

Mechanical stimulation improves survival in random-pattern skin flaps in rats.

This was a study on the effects of 3-MHz ultrasound at 16- and 100-Hz pulse repetition frequencies on angiogenesis and viability of random-pattern skin flaps in rats. A cranially-based dorsal skin flap was raised in 60 EPM-Wistar rats, which were randomly divided into four groups: control, sham, 16-Hz and 100-Hz groups. The mean percentage of necrosis was as follows: control, 42% ± 13%; sham, 18% ± 13%; 16-Hz group, 13% ± 10%; and 100-Hz group, 15% ± 7%, with significant differences between the control and the other groups (p < 0.001). The mean vascular density was as follows: control, 5% ± 2%; sham, 7% ± 2%; 16-Hz group, 21% ± 4%; and 100-Hz group, 24% ± 10%, with significant differences between control and ultrasound groups, and between the sham and ultrasound groups (p < 0.001). Both ultrasound treatments (16- and 100-Hz PRFs) induced angiogenesis, and sham and ultrasound treatments improved viability of random-pattern skin flaps in rats.

Protocolo de avaliação de linfedema de cabeça e pescoço / Protocol of assessment of head and neck lymphedema

Introdução: No Brasil, são esperados 14.160 novos casos de câncer de cavidade oral em 2009 e os principais tratamentos, cirurgia e radioterapia, favorecem o desenvolvimento do linfedema de cabeça e pescoço, sendo a sua mensuração dificultada pela falta de padronização e reprodutibilidade das medidas realizadas. Objetivo: Propor um protocolo de avaliação do linfedema de cabeça e pescoço e testar sua reprodutibilidade intra e interavaliadores. Método: O protocolo consistiu de 11 medidas da cabeça e do pescoço, as quais foram realizadas por 2 avaliadores separadamente com intervalo de 2 minutos entre as avaliações, e após 15 minutos foi realizada uma nova avaliação por um dos avaliadores, selecionado aleatoriamente. O teste de correlação de Pearson foi utilizado para comparação intravaliadores e o T-Student para interavaliadores. Resultados: Foram incluídos 21 pacientes no pós-operatório de câncer de cabeça e pescoço com ou sem esvaziamento cervical. Houve correlação entre as medidas intravaliadores (p < 0,05), exceto na medida 2, do ângulo da mandíbula ao canto interno do olho à esquerda (p = 0,27) e não houve diferença significante entre as medidas interavaliadores (p > 0,05). Conclusão: O protocolo proposto mostrou maior abrangência da cabeça e pescoço, praticidade, baixo custo e reprodutibilidade tanto intra quanto interavaliadores.

Introduction: In Brazil, 14160 new cases of oral cavity cancers are expected to be diagnosed in 2009. The main treatments for this type of cancer, surgery and radiotherapy, may lead to the development of lymphedema of the head and neck, which is a condition difficult to assess because of a lack of standardization and reproducibility of measurements. Objective: To devise a protocol for the assessment of head and neck lymphedema, and test inter- and intraobserver reproducibility. Method: The protocol consisted of 11 measurements of the head and neck. Patients were assessed independently by two observers, with an interval of two minutes between assessments; 15 minutes after the second assessment, a third assessment was performed by one of the observers who was selected at random. Intraobserver comparisons were made using the Pearson?s correlation coefficient, and the Student?s t-test was used for interobserver comparisons. Results: Twenty-one patients who underwent head and neck surgery with or without neck dissection participated in this study. There was a good intraobserver correlation between measurements (p < 0.05), except for the measurement of the angle between the mandible and the inner corner of the left eye (measurement 2, p = 0.27). There were no significant differences between the interobserver measurements (p > 0.05). Conclusion: The protocol devised in this study allowed a better assessment of the head and neck at low costs, was practical, and showed inter- and intraobserver reproducibility.

Drenagem linfática manual nos sintomas da síndrome pré-menstrual: estudo piloto / Manual lymphatic drainage for premenstrual syndrome symptoms: a pilot study

A síndrome pré-menstrual é um complexo de sintomas – dentre os quais o edema pré-menstrual – entre o 10º e o 14º dias que antecedem a menstruação e cessam no início do fluxo menstrual. A técnica de drenagem linfática manual (DLM) drena o excesso de líquido acumulado, atua no edema e poderia aliviar esses sintomas. O objetivo deste estudo piloto foi verificar o efeito da DLM no alívio dos sintomas da síndrome pré-menstrual e a qualidade de vida relacionada à saúde em quatro mulheres jovens. O estudo foi realizado ao longo de dois ciclos menstruais, ciclo 1 sem intervenção terapêutica, e o segundo ciclo, com aplicação da técnica de DLM. As participantes foram avaliadas, no início do ciclo 1 e final do ciclo 2, por anamnese, mensuração de estatura e massa, estimativa da composição corporal, diário de sintomas e quanto à qualidade de vida relacionada à saúde, pelo WHOQoL-bref. Os resultados mostraram redução significativa apenas do diâmetro de abdome superior nos níveis xifóide e umbilical; as médias total e individual dos sintomas do diário reduziram-se, porém sem significância, tal como ocorreu no aumento dos escores no WHOQoL-bref. A drenagem linfática manual foi eficaz na diminuição de um sintoma da síndrome pré-menstrual, o edema em região superior abdominal, e não alterou a qualidade de vida dessas jovens...

Premenstrual syndrome is a symptomatology – including premenstrual edema – that affects women between the 10th and 14th days prior to menstruation and ends at the onset of menstrual flux. The technique of manual lymphatic drainage (MLD) draws off accumulated fluid excess, acts on edema and might help relieve such symptoms. The purpose of this pilot study was to assess the effect of MLD on premenstrual symptoms and on health-related quality of life of four young women. The study was carried out along two menstrual cycles, the first with no intervention; MLD was applied along the second cycle. Participants were assessed, at the beginning of the first cycle and after treatment, as to height and weight, body composition estimate, daily symptoms by means of a diary, and quality of life by the WHOQoL-bref. After treatment results showed the sole significant decreases in abdomen xyphoid and navel level diameters; mean total and individual symptom scores decreased, but with no significant differences, the same happening to the higher WHOQoL-bref mean scores. Manual lymphatic drainage was thus able to reduce one premenstrual symptom, namely the upper abdomen edema, and didn’t affect these young women's quality of life...