[Management of patients with lymphatic diseases and lipoedema during the COVID-19 pandemic. Recommendations of the Spanish Group of Lymphology]. / La atención al paciente con patología linfática y lipedema en la pandemia COVID-19. Recomendaciones del Grupo Español de Linfología (GEL).

The COVID-19 pandemic poses a challenge to the management of non-COVID pathologies such as lymphatic diseases and lipoedema. The use of telemedicine can prevent the spread of the disease. A system is needed to help determine the clinical priority and selection of face-to-face or telemedicine options for each patient and how to carry them out during the pandemic. The Spanish Lymphology Group has drafted a consensus document with recommendations based on the literature and clinical experience, as clinical practice guidelines for the management of lymphatic abnormalities and lipoedema during the COVID-19 pandemic. These recommendations must be adapted to the characteristics of each patient, the local conditions of the centres, and the decisions of health care professionals. The document contains minimum criteria, subject to modifications according to the evolution of the pandemic, scientific knowledge and instructions from health authorities.

Validación de herramienta informática para el cálculo de linfedema en pacientes con afectación unilateral de extremidad superior / Validation of computer tool for the calculation of lymphedema in patients with unilateral involvement of upper limb

Introducción. El linfedema secundario a linfadenectomía axilar es una secuela grave que afecta a la calidad de vida de las pacientes con cáncer de mama. Hay diversas técnicas para la valoración del linfedema. Nuestro objetivo es presentar y validar una herramienta informática para el cálculo del volumen de linfedema a partir de la circometría y mostrar los resultados de su análisis de fiabilidad. El diseño de la herramienta se ha realizado en el seno de un ensayo clínico aleatorizado con grupo control. Material y métodos. Se seleccionó a 29 pacientes al azar, de la consulta de rehabilitación de dos centros de Madrid, con linfedema unilateral tras mastectomía. Dos rehabilitadores calcularon el volumen de los brazos de cada paciente mediante circometría tomando como referencia estructuras anatómicas y a partir de la fórmula de los conos truncados, utilizando una macro de Excel. Se obtuvo el tamaño medio de las cuatro determinaciones, su desviación estándar (DE) y su coeficiente de variación (CV). El grado de acuerdo intraobservador y entre observadores se cuantificó mediante la estimación del coeficiente de correlación intraclase (CCI) y su intervalo de confianza (IC). Resultados. La media±DE de los volúmenes del brazo afecto y el sano fue 3.155,82±877ml y 2.748,76±667,1ml, respectivamente (p=0,001). No hubo diferencias significativas en cuanto a la dispersión. El CCI intraobservador para el brazo afecto fue 0,991 y 0,979, y para el brazo sano, 0,967 y 0,961. El CCI interobservador del brazo afecto fue 0,952, y el brazo sano, 0,976. Conclusiones. La calculadora de linfedema es una herramienta fiable, reproducible, de manejo sencillo y bajo coste, que permite cuantificar el volumen del linfedema(AU)

Background. Lymphedema following breast cancer surgery is a serious sequel that affects the quality of life of breast cancer patients. There are several methods to evaluate lymphedema. We have aimed to present and validate a computer tool that calculates the lymphedema volume based on perimeter measurements and to show the results of its reliability analysis. This tool design was developed without a randomized clinical trial with a control group. Material and methods. A total of 29 patients were randomly selected from the Rehabilitation consultations of two centers in Madrid suffering unilateral lymphedema after mastectomy. Two rehabilitation doctors measured the arm perimeters of each patient using anatomic structures and with the frustum formula, using an Excel macro. Mean volume, standard deviation (SD) and variation coefficient (VC) were obtained for each measurement. Intra-and inter-rater reliability were calculated by estimation of the intra-class correlation coefficient (ICC) and its confidence interval (CI). Results. Mean volume of affected arm was 3155.82mL (877 SD) and for the healthy arm 2748.76mL (667.1 SD). There were no significant differences in the SD and CV dispersion. Intra-rater ICC for the affected arm was 0.991 and 0.979, and for healthy arm 0.967 and 0.961 for each observer. Inter-rater ICC for the affected arm was 0.952 and for the healthy arm 0.976. Conclusions. The «lymphedema calculator» is a reliable, reproducible, easy to use and low cost computer tool that helps the clinician to evaluate lymphedema volume as well as to objectify its distribution(AU)

Bandagem úmida empregada com baixa elasticidade no tratamento de úlcera em paciente com lipolinfedema / Damp low-stretch bandage employed in the treatment of an ulcer in patient with lipolymphedema

O lipedema é caracterizado pelo aumento bilateral e simétrico dosmembros inferiores, sem o acometimento dos pés, sinal de Stemmernegativo, podendo ocorrer hipotermia cutânea, alteração no suporteplantar e hiperalgesia. O objetivo do presente estudo é relatar umaforma incomum de lesão ulcerada em paciente com lipolinfedematratado com bandagem úmida empregada com baixa elasticidade.Paciente, do sexo feminino, de 50 anos, com história familiar delipedema refere vários episódios de erisipela em membro inferioresquerdo há cerca de 20 anos e com surgimento de úlceras de difícilcicatrização há mais de cinco anos. Foi tratada com bandagemúmida de baixa elasticidade e teve boa evolução com cicatrização da ferida. Lesões ulceradas são raras no lipolinfedema, porém a sua ocorrência esta associada com dificuldade na cicatrização.

The use of subatmospheric pressure dressing therapy to close lymphocutaneous fistulas of the groin.

Groin lymphorrhea is an uncommon but serious complication of vascular and cardiac surgery as well as interventional procedures that cannulate the femoral vessels. Treatment options are somewhat controversial. For lymphocutaneous fistulas, a commonly used current modality is early surgical ligation with the assistance of blue-dye staining of the lymphatic anatomy. The purpose of this case series is to give the first description of a new, less invasive, approach using subatmospheric pressure dressing therapy for the treatment of the challenging problem of lymphocutaneous fistulas of the groin.

[Staged surgical rehabilitation of patients with lymphovenous insufficiency of legs in village hospital]. / Etapnaia khirigicheskaia reabilitatsiia bol'nykh s limfovenoznoí nedostatochnost'iu nizhnikh konechnosteí v sel'skoí TsRB.

The organisation of screening of the patients with lympho-venous insufficiency is analysed. 1170 patients (5.4% of the adult population) with lympho-venous insufficiency have been detected. The staged surgical rehabilitation (village hospital- regional hospital- intraregional hospital) was used in 263 patients. Complete recovery was achieved in 84.5% of the patients.

Paracoccidioidomicose na criança / Paracoccidioidomycosis in children

No presente trabalho estuda-se a Paracoccidioidomicose na criança, que tem sido assunto frequente de estudo nomeio universitário, devido a sua incidência relativamente elevada, constituindo-se, mesmo numa patologia regional de destaque. O objetivo principal foi situar a real participação da criança segundo a concepção atual da história natural da doença. Para tanto fez-se uma abrangente revisão da literatura, comparando-se os aspectos epidemiológicos, clínicos e imunopatológicos com o estudo retrospectivo dos prontuários de 30 pacientes menores de 12 anos de idade, portadores de paracoccidioidomicose, confirmada pelo encontro do parasito em exames diretos e internados em 3 hospitais de referência de Goiânia, no período de janeiro de 1970 a julho de 1990. Os dados dos prontuários foram sintetizados em 17 tabelas. Dos resultados definiram-se 3 grupos de formas clínicas: Linfático abdominal; Linfático hepatoesplênica e Linfática; dos exames específicos: no hemograma a anemia e a eosinofilia foram achados marcantes, na eletroforese de proteínas séricas a hipoalbuminemia e hiperglobulinemia às custas de gama foram evidenciadas; as sorologias e as intradermorreações foram provas que denunciaram o envolvimento do sistema imune com elevação da imunidade humoral e depleção da imunidade celular; dos exames radiológicos (torax, trânsito e enema)e ultrossonográficos do abdomen verifica-se que o pulmão é raramente comprometido dos RX do torax realizados; o trânsito intestinal detecta lesões da mucosa, sugestivas do envolvimento dos linfáticos da parede; a USG é um recurso diagnóstico não invasivo as massas intrabdominais e pode sugerir fibrose hepática

[Morpho-functional status of the lymph nodes of rats during rehabilitation after exposure to vapors of dimethyl sulfate]. / Morfofunktsional'noe sostoianie limfaticheskikh uzlov krys v periody reabilitatsii posle vozdeistviia parov dimetilsul'fata.

By means of histological methods inferior tracheobronchial lymph nodes have been investigated in 48 Wistar rats in 2 weeks and 3 months after cessation of inhalation of DNSV at maximum possible dose (0.1 mg/m3) for 2 and 14 days. Cell composition of the lymph nodes and cross sections of structural components have been compared. The cross section of the cortex decreases, while that of the medulla increases in comparison with corresponding parameters of the acute experiment. In 2 weeks and 3 months after DMSV effect for 2 days the part (%) of poorly differentiated cells and middle lymphocytes increases, while content of plasma cells in the medullary cords decreases. During rehabilitation after DMSV effect for 14 days a low level plateau is noted (as in the acute experiment). However, in lymphoid nodules++ within content of the poorly differentiated cells and middle lymphocytes in the cortical germinative centers in 2 weeks and 3 months the number of the poorly differentiated and reticular cells increases essentially, as well as mitotically dividing cells (in comparison to the acute experiment). In the medullary cords of the lymph nodes after 3 months of rehabilitation content of immature plasma cells is essentially higher than in 2 weeks of rehabilitation and than in the acute experiment. During rehabilitation the level of cells destruction in the lymph nodes noticeably decreases in comparison to the acute experiment.

Legging orthosis for venous and lymphatic insufficiency.

Presented are the description and advantages of a unique compression device in the form of a legging for the treatment of venous and lymphatic insufficiency. It consists of a number of pliable, unyielding, adjustable compression bands, from the knee to the instep. The bands are easily closed, tightened, and opened, which is particularly useful for the physically handicapped patient for whom the commonly prescribed elastic stocking is inappropriate because of the difficulty in putting it on and removing it. The effectiveness of the legging is enhanced by its nonelasticity, as has been long proven by the Unna boot, and its ability to maintain an unreduced compression level throughout its lifetime, regardless of edema changes.

Estudio de las Linfadenopatias en el Instituto de Anatomia Patologica Sucre (1.966-1.970)

1.-Se analizan 122 casos de linfadenopatias con estudioo histopatologico en el servicio de Anatomia Patologica del Hospital Universitario "Santa Barbara" durante este último quinquenio 1966-1970, 2-Del total de linfadenopatias en estudio se obsrva la siguiente incidencia metastasis de calcinomas 27,049 por ciento, linfadenitis hisperplasica regional cronica 19,671 por ciento, linfadenitis hiperplastica regional aguda 18,852 por ciento adenitis tuberculosa 13,114 por ciento enfermedad de Hodjkin 10,655 por ciento linfosarcoma 9,016 por ciento metastasis de melanoma maligno 0.819 por ciento metastasis de retinoblastoma 0,819 por ciento, 3.-Se plantea en forma general la diferenciación morfologica de cada una de stas linfodenopatias y la incidencia mayor con respecto a la edad y el sexo, 4.-El alto porcentaje de carcinomas linfadenitis hiperpásticas aguda y crónica adenitis tuberculosa enfermedad de Hodjkin y linfosarcoma llama la atención y nos estimula a plantear