Tratamiento rehabilitador en la cirugía del linfedema / Rehabilitation in lymphedema surgery

El tratamiento conservador de los pacientes con linfedema habitualmente comprende la terapia descongestiva compleja con objetivo de reducir el volumen y las prendas de compresión en fase de mantenimiento, realizando un seguimiento en los servicios de Rehabilitación. El tratamiento quirúrgico del linfedema es una opción terapéutica cuyo interés ha aumentado en los últimos años, aunque no existe evidencia actual de que pueda curar el linfedema y siempre se acompaña de tratamiento conservador. La mayoría de los estudios se centran en los resultados según el tipo de cirugía y no existe un protocolo estandarizado sobre el tratamiento conservador antes o después de la cirugía. Con este trabajo se pretende realizar un compendio sobre las cirugías de linfedema más frecuentes y sus indicaciones, centrándose en el tratamiento rehabilitador que implica cada cirugía.(AU)

Conservative treatment of lymphedema usually includes complex decongestive therapy in order to reduce the volume of the lymphedema, and compression garments in the maintenance phase. Follow-up is carried out in the Rehabilitation Services. Surgical treatment of lymphedema is a therapeutic option, the interest of which has increased in recent years, although there is no current evidence that it can cure lymphedema and it is always accompanied by conservative treatment. Most studies focus on results according to the type of surgery and there is no standardized protocol for conservative treatment before or after surgery. The objective of this work is to prepare a compendium about the most frequent lymphedema surgeries and their indications, focusing on the rehabilitation treatment for each surgery.(AU)

A comprehensive approach to risk factors for upper arm morbidities following breast cancer treatment: a prospective study.

BACKGROUND: Breast cancer surgery frequently causes deficiencies in shoulder functioning. The study pourpode is to identify risk factors for prolonged pain, reduction in function, and decrease in range of motion (ROM) in BC patients. METHODS: A prospective cohort study was designed in a private hospital; between October 2018 and April 2019 with a follow-up of 6 months. Patients following BC surgery, were divided by arm morbidities, and the different risk facrors were evaluated using univariate analysis and logistic regression. RESULTS: A total of 157 patients were included in the study. Risk factors for functional disabilities included; pain levels during hospitalization NPRS 1.2 (±0.8) compared to patients with no disabilities 0.5 ± 0.7 (p = .006), the size of tumors more than 1.4 ± 0.8 cm. compared with no morbidities 0.8 ± 0.9 cm. (p = .046), and breast reconstructions (p = .030). Risk factors for prolonged pain includes mastectomy (p = .006), breast reconstruction (p = .011), more than three dissected lymph nodes (p = .002), the presence of preoperative pain (p < .001), in-hospital pain (p < .001), axillary web syndrome (p < .001) and lymphedema (p < .001). Risk factors for decreased ROM were more than three dissected lymph nodes (p = .027), radiation (p = .018), and the size of dissected tissue (p = .035). Postoperative physical therapy appears to reduce the incidence of prolonged pain (p = .013) and regular physical activity may reduce long term functional disabilities (p = .021). CONCLUSIONS: Upper arm morbidity following BC treatments affect up to 70% of the patients. Identifying the different risk and beneficial factors may improve awareness among physicians to refer patients to early rehabilitation programs and thus avoid chronic morbidity and improve the course of recovery. TRIAL REGISTRATION: The study was registered in Clinical trial with the ID number: NCT03389204 .

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)

Early prevention of complex decongestive therapy and rehabilitation exercise for prevention of lower extremity lymphedema after operation of gynecologic cancer.

OBJECTIVE: To investigate efficacy of early prevention of complex decongestive therapy and rehabilitation exercise for prevention of postoperative lower limb extremity lymphedema for patients with gynecologic cancer. METHODS: 109 female patients were randomly divided into two groups, the control group who only received routine treatment and the CDT group who received both CDT and rehabilitation exercise. For rehabilitation exercise, patients received additional rehabilitation exercise strategy including professional education and full range exercise of hip joint. The incidence of lower extremity lymphedema was recorded. A simple scale for patients' lower extremity lymphedema was designed. The diameter of low limbs (both thighs and calves) was also measured The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the Brief Fatigue Inventory (BFI) was used for measurement of quality of life. RESULTS: The incidence of lower extremity lymphedema was 15.09% cases of CDT group and 32.14% in the control group. K-M curve showed the lymphedema free time in CDT group was significantly longer. The subjective scores for heaviness of lower limbs, pain, numbness and dysfunction, as well as the diameters of both thighs and calves were lower in the CDT group. In both groups, the values of EORTC QLQ-C30-GHS and EORTC QLQ-C30-FS were significantly higher, and EORTC QLQ-C30-SS scores and BFI scores were remarkably lower. CONCLUSION: Early prevention of CDT combined with rehabilitation exercise reduced incidence of lower limb extremity lymphedema and improved patients' quality of life, as well as reduced the cancer-related fatigue.

Long-term functional outcomes upon application of split-thickness skin graft around major joints in HCC (Hung-Chi Chen)-modified Charles' procedure for advanced lymphedema.

OBJECTIVE: In the conventional Charles' procedure for lower-limb lymphedema, full-thickness skin grafts (FTSGs) or flaps are the preferred treatment for areas around the knee and ankle because of the belief that FTSGs or flaps result in slighter contracture relative to split-thickness skin grafts (STSGs). However, the use of FTSGs or flaps prolongs operation and increases the risk of partial graft loss; should partial graft loss occur, additional grafting is required for remnant defects to avoid significant scarring after secondary healing. The senior author (HCC) thus modified the Charles' procedure and used STSGs around the knee and ankle. The aim of this study was to elucidate the long-term outcomes of STSGs in HCC-modified Charles' procedure, including its attendant complications, such as joint contracture, range-of-motion limitations, and the presence of hypertrophic scars. METHODS: Participants were patients (n = 142) who underwent HCC-modified Charles' procedure and STSGs between 1990 and 2016 for advanced lymphedema; the follow-up was at least 3 years. We detail our modification for improving the take of STSGs in the first operation and the rehabilitation protocol. RESULTS: The active flexion of knee was >90° in 89.4% and 70°-90° in 10.6% of patients. The active plantar flexion of ankle was 30° in 90.8% and 20°-30° in 9.2% of patients. In Stiefel Grading System, 85.9% were "Excellent," 12.0% were "Good," 2.1% were "Fair," and 0 were "Poor." CONCLUSION: STSGs in HCC-modified Charles' procedure yield satisfactory outcomes without joint contracture. Early physiotherapy and the primary take of STSGs are crucial to good functional outcomes.

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

La pandemia de COVID-19 es un desafío para el manejo de las patologías no COVID como la enfermedad linfática y el lipedema. La telemedicina puede evitar la propagación del coronavirus. Se necesita un sistema que nos ayude a determinar la prioridad clínica y la selección de la asistencia presencial o telemática para cada paciente y la forma de realizarlas durante la pandemia. El Grupo Español de Linfología ha realizado un documento de consenso con recomendaciones basadas en la bibliografía y experiencia clínica, como guía de práctica clínica en el manejo de anomalías linfáticas y lipedema durante la pandemia de COVID-19. Estas recomendaciones deben adaptarse a las características del paciente, las condiciones locales de los centros y las decisiones de los profesionales de la salud. Es un documento de criterios mínimos, sujeto a modificaciones según evolucione la pandemia, los conocimientos científicos y las instrucciones de las autoridades sanitarias

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

A comprehensive approach to rehabilitation interventions following breast cancer treatment - a systematic review of systematic reviews.

BACKGROUND: Breast cancer (BC) is the most common type of cancer in women worldwide. Post-treatment, patients suffer from side effects and have various rehabilitation needs, which means that individualization is fundamental for optimal rehabilitation. This systematic review (SR) of SRs aims to evaluate the current evidence on rehabilitation interventions in female patients following BC treatment. METHODS: Full-text SRs published in English from 2009 were searched in Embase, PubMed, Cinahl Complete, PsycINFO, AMED, SCOPUS, and Cochrane Library. INCLUSION CRITERIA: SRs of randomized or non-randomized controlled trials investigating the effects of rehabilitation interventions in women following BC treatment. All outcomes were considered. Methodological quality was evaluated using the AMSTAR 2 tool and interrater agreement was evaluated. Out of 1269 citations retrieved, 37 SRs were included. RESULTS: Five rehabilitation areas were identified: exercise and physical activity (PA), complementary and alternative medicine (CAM), yoga, lymphoedema treatment, and psychosocial interventions. The most solid evidence was found in exercise/PA and yoga. Exercise interventions improved outcomes such as shoulder mobility, lymphoedema, pain, fatigue and quality of life (QoL). Effects of yoga were shown on QoL, anxiety, depression, sleep disturbance, fatigue and gastrointestinal symptoms. The effect of CAM was shown on nausea, pain, fatigue, anger and anxiety but these results need to be interpreted with caution because of low methodological quality in included studies in the SRs. Among the lymphoedema treatments, positive effects were seen for resistance training on volume reduction and muscle strength and psychosocial interventions such as cognitive behavioural therapy had positive effects on QoL, anxiety, depression and mood disturbance. CONCLUSIONS: This SR of SRs show solid positive effects of exercise/PA and yoga for women following BC treatment, and provides extended knowledge of the effects of CAM, yoga, lymphoedema treatment and psychosocial interventions. It is evident that more than one intervention could have positive effects on a specific symptom and that the effects depend not only on intervention type but also on how and when the intervention is provided. The results can be used as a foundation for individualized rehabilitation and aid health care professionals in meeting patients' individual needs and preferences. TRIAL REGISTRATION: PROSPERO ( CRD42017060912 ).

Preliminary evidence of effectiveness of TECAR in lymphedema.

Lymphedema of the lower limbs often contributes to the mobility impairment of morbidly obese patients. Defining novel costeffective protocols is important for reducing treatment costs. The study aimed to assess if Capacitive and Resistive Energy Transfer (TECAR) can reduce edema and the minimum number of sessions needed to observe volume reduction. Forty-eight severely obese subjects (age range: 46-78 years; BMI >40 kg/m2) with bilateral lower limb lymphedema were divided into three groups undergoing either manual lymphatic drainage, pressure therapy, or TECAR, in addition to a multidisciplinary rehabilitation program. They were compared to a control group composed by 12 women (age: 67.4 ± 8.9 years, BMI: 44.6 ± 4.1 Kg/m2) undergoing only the rehabilitation program. A handheld laser scanner 3D system was used for volume measurements. In addition, patients were evaluated with a Timed Up and Go (TUG) test and pain/heaviness of the lower limbs with a Visual Analog Scale (VAS). A significant volume reduction was observed after 6 sessions of TECAR: specifically, in the whole limb (PRE: 9.7+2.8 dm3; POST: 9.4+2.8 dm3; p<0.05) and in the thigh (PRE: 3.5+1.3 dm3; POST: 3.3+1.2 dm3; p<0.05). The TUG and VAS for pain showed a significant improvement in all groups. Our preliminary results suggest that TECAR can provide a relatively early reduction of lower limb edema with improvement of patients' function and pain.

Progressive resistance training to prevent arm lymphedema in the first year after breast cancer surgery: Results of a randomized controlled trial.

BACKGROUND: Existing research suggests that progressive resistance training (PRT) after breast cancer (BC) surgery is safe, but the preventive effect on arm lymphedema has yet to be determined. METHODS: Women aged 18 to 75 years who were undergoing BC surgery with axillary lymph node dissection were eligible for the study. Recruited on the day of surgery, participants were allocated to intervention or usual care by computer randomization. The intervention consisted of PRT 3 times per week: in the first 20 weeks as a supervised group exercise and in the last 30 weeks as a self-administered exercise. The primary outcome was arm lymphedema, which was defined as a >3% increase in the interlimb volume difference by water displacement. Measurements were made at the baseline and at a 12-month follow-up by physiotherapists blinded to group allocation. Analyses of effects included t tests and regression models; missing data were addressed by multiple imputation. RESULTS: Among the 158 randomized women, no mean group difference was found in arm volume (0.3%; 95% confidence interval, -1.7% to 2.3%) or lymphedema incidence (adjusted odds ratio, 1.2; 95% confidence interval, 0.5-2.8). None of the participants exited the program because of adverse events. CONCLUSIONS: This study provides no evidence that PRT can prevent arm lymphedema in the first year after BC, but the results corroborate the importance and safety of resistance training for patients, including women at high risk for lymphedema.

Gynecologic Cancer Survivorship.

Survivorship care includes surveillance and prevention of cancer recurrence, addressing side effects of cancer and cancer treatment and coordination of follow-up care. This article reviews guidelines for surveillance of women with ovarian, endometrial, cervical, and vulvar cancer. It also reviews many of the long-term physical side effects of gynecologic cancer treatment including fatigue, neuropathy, lymphedema, cognitive dysfunction, sexual health concerns, menopausal symptoms, infertility, and economic stressors. Finally, survivorship care plans are reviewed as a tool for coordinating care for women with a history of gynecologic cancer.

[CERVICAL CANCER REHABILITATION: A PROSPECTIVE STUDY].

Aim - to evaluate the rehabilitation program impact on the quality of life of оncogynecological patients and to introduce this approach in clinical practice. The study included93 reproductive-aged women, who underwent the cervical cancer treatment. Patients were divided into two groups: the experimental group, which received rehabilitation, and the control group. The thrombotic complications risk, lymphatic system condition, cognitive functions and anxiety level were assessed in all patients using special questionnaires, physical examination, and laboratory assessment. The lower limbs lymphedema was observed in 19.1% of cases in the control group and in 2.1% in the experimental group (p <0.05). According to the Moka test data, cognitive impairment level at the end of the study was 24.02 (17-30, CI: = 22.5-25.54) in the control group and 26.85 (19-30, CI: = 26.0 - 27.64) in the experimental group (p <0.05). The cognitive impairment subjective signs were significantly higher in the control group (p <0.05) as well. The anxiety level at the end of the study was 7.022 (1-19, CI: = 5.91-8.13) in the experimental group and 11.02 (4-22, CI: = 9.83-12.22) in the control group (p <0.05). At the end of the study, the following depression levels were obtained: 12.43 (5 - 21; CI: = 11.23 - 13.64) and 7.69 (1 -14; CI: = 6.77 - 8.62) in the control and the experimental group respectively (p <0.05). At the end of the study, deep vein thrombosis was observed in 21 patients in the control group (44.7%) and 7 patients in the experimental group (15.22%) (p <0.05). One patient from the control group had PATE. According to EORTC QLQ-C30, the quality of life and socialization level was significantly higher in the experimental group, while fatigue level was lower. At the end of the study, 36.2% and 76.0% of patients in the control and the experimental group respectively were employed. The rehabilitation program improves the emotional and cognitive functioning, induced menopause associated somatic disorders, quality of life, and work capacity.

Comparison of the effectiveness of complex decongestive therapy and compression bandaging as a method of treatment of lymphedema in the elderly.

BACKGROUND: Lymphedema is a chronic condition which significantly lowers the quality of patient life, particularly among elderly populations, whose mobility and physical function are often reduced. OBJECTIVES: The aim of the study was to compare the effectiveness of multi-layer compression bandaging (MCB) and complex decongestive therapy (CDT), and to show that MCB is a cheaper, more accessible and less labor intensive method of treating lymphedema in elderly patients. PATIENTS AND METHODS: The study included 103 patients (85 women and 18 men) aged ≥60 years, with unilateral lower limb lymphedema. The subjects were divided into two groups: 50 treated with CDT and 53 with MCB. Pre- and post-treatment BMI, and average and maximum circumference of the edematous extremities were analyzed. RESULTS: Reduction in swelling in both groups was achieved after 15 interventions. Both therapies demonstrated similar efficacy in reducing limb volume and circumference, but MCB showed greater efficacy in reducing the maximum circumference. CONCLUSION: Compression bandaging is a vital component of CDT. Maximum lymphedema reduction during therapy and maintaining its effect cannot be achieved without it. It also demonstrates its effectiveness as an independent method, which can reduce therapy cost and accessibility.

Lymphedema in ovarian cancer survivors: Assessing diagnostic methods and the effects of physical activity.

BACKGROUND: Lymphedema is a poorly understood side effect of gynecologic cancer treatment. This study was designed to determine the prevalence of lower limb lymphedema (LLL) in a sample of ovarian cancer survivors via 3 different diagnostic methods and to assess the effect of a randomized exercise intervention. METHODS: Physically inactive ovarian cancer survivors (n = 95) were enrolled in a 6-month randomized trial of exercise (primarily brisk walking) versus attention control. LLL was measured at baseline and 6-month visits via a self-report questionnaire, optoelectronic perometry, and an evaluation by a certified lymphedema specialist. RESULTS: LLL prevalence ranged from 21% to 38% according to the diagnostic method, and there was substantial agreement between the self-report questionnaire and the lymphedema specialist evaluation (κ = 0.61). There was no agreement between the evaluation with optoelectronic perometry and the specialist evaluation. With LLL defined by any method, the baseline prevalence was 38% in both groups. At 6 months, both groups experienced a decreased LLL prevalence: 28% in the exercise group and 35% in the control group. There was no difference in the change in lymphedema prevalence between the 2 groups (P = .64). Body mass index was a significant predictor of LLL. CONCLUSIONS: With a potential prevalence of LLL as high as 40%, further evaluation of diagnostic methods is required to better characterize this side effect of ovarian cancer treatment. No adverse effect of exercise on LLL was found. Further research is strongly needed to evaluate predictors of LLL and the effects of exercise on LLL in order to develop effective physical activity recommendations for women with ovarian cancer. Cancer 2018;124:1929-37. © 2018 American Cancer Society.

Anatomy education in occupational therapy curricula: Perspectives of practitioners in the United States.

The study of human anatomy is an integral component in the education of future occupational therapists, yet there is a paucity of research that explores the anatomy needs of students and new practitioners. As a follow up from a pilot study that surveyed a small cohort of practicing therapists, this article aimed to determine occupational therapy (OT) practitioners' views on anatomy course structure and content deemed important to include in OT curricula, entry level practitioners' anatomy knowledge, and application of anatomy in current practice. A Likert scale and free text questionnaire was distributed to practicing occupational therapists across the United States. Fifty-four percent of the participants in this cohort favored a standalone course, as compared to 94% in the pilot study group. Anatomy course content areas were comparable across groups. Systems identified as essential to cover in an OT anatomy course included skeletal, muscular, and nervous. Regions included the upper limb, thorax/trunk, head and neck, and lower limb. Seventy percent of participants in both groups felt that entry-level practitioners had adequate anatomy knowledge; 30% did not. Practice areas requiring anatomy knowledge included assessment of joint movement, muscle strength, pain, and functional mobility. Qualitative analysis of free text response data revealed the importance of anatomy knowledge in OT assessment and intervention strategies, determining the impact of injury or disease on occupational performance, client safety, and communication with other health care professionals and families. Anat Sci Educ 11: 243-253. © 2017 American Association of Anatomists.

Construct validity of functional status scores of patients with lymphedema.

During treatment of lymphedema, routine use of patient-reported outcomes measures (PROMs) is recommended to monitor patient progress; however, the validity functional status (FS) PROMs in these patients is unknown. Our aims were to examine construct validity of the shoulder computerized adaptive testing (CAT) and the foot-and-ankle CAT, as a measure of FS for patients selecting the shoulder or the foot-and-ankle as their main body part affected by their lymphedema. We assessed the ability of the FS scores to distinguish between patient groups in clinically expected ways at admission and discharge from physical therapy. At admission (n=1600), patients who were younger and had more acute symptoms, less severe lymphedema, less co-morbidities, no relevant surgical history, did not use medications for chronic conditions, and exercised regularly, had higher FS. At discharge (n=611), patients who were younger and had less advanced lymphedema, fewer co-morbidities, no relevant surgical history, did not use medications for chronic conditions, exercised regularly, and had more acute symptoms had higher FS change, after controlling for their baseline FS score. Low participation rates in FS outcomes data collection could have biased results. Overall, the CAT-based FS PROMs used in this study discriminated between patient groups in clinically logical ways both at intake and at discharge from lymphedema treatment.

Linfogammagrafía de miembros inferiores: tres posibles patrones / Lower-limb lymphoscintigraphy: three possible patterns

Una de las múltiples causas del edema de miembros inferiores es el linfedema cuyo diagnóstico correcto es crucial para la precoz instauración de un tratamiento efectivo y evitar así la morbilidad que este ocasiona a los pacientes. Desde la perspectiva del médico nuclear presentamos tres casos de edema de miembros inferiores. Tras una breve descripción de la técnica empleada y del mecanismo de actuación del radioisótopo (nanocoloides de albúmina humana marcados con Tc-99m) describimos el patrón de captación de la linfogammagrafía de miembros inferiores en pacientes seleccionados, por ser cada uno de ellos representativos de lo que en diagnóstico de imagen nuclear se considera normal, linfedema primario y linfedema secundario (AU)

One of many causes of lower-limb oedema is lymphedema. Correct diagnosis of this entity is crucial for the early establishment of an effective treatment to avoid the morbidity caused to the patient. From the perspective of nuclear medicine physicians, we present three cases of lower-limb oedema. After providing a brief description of the technique used and the mechanism of action of radioisotope (Tc-99m-labelled human albumin nanocolloid), we describe the uptake pattern of lower-limb lymphoscintigraphy in three representative cases of what is considered normal, primary lymphedema and secondary lymphedema (AU)

Effects of a complex rehabilitation program on edema status, physical function, and quality of life in lower-limb lymphedema after gynecological cancer surgery.

OBJECTIVE: The purpose of this study was to investigate the effects of a complex rehabilitation (CR) program and complex decongestive therapy (CDT) on edema status, physical function, and quality of life in patients with unilateral lower-limb lymphedema after gynecologic cancer surgery. METHODS: In this randomized pilot study, 40 patients with secondary unilateral lymphedema, after gynecologic surgery for cervical, endometrial, or ovarian cancer, that had been diagnosed based on clinical assessment and 10% volume differences between the legs were randomly assigned to the CDT (n=20) and CDT combined with CR (CRCDT; n=20) groups. CR comprised stretching, strengthening, and aerobic exercises performed for 40min, five times a week for 4weeks. Intensive CDT was administered by a physical therapist during weeks 0-2 and by the patients themselves during weeks 2-4. Limb volume, bioimpedance, muscular strength, EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30) score, 30-s chair stand test, muscular strength, and GCLQ-K (Korean version of the Gynecological Cancer Lymphedema Questionnaire) score were assessed at baseline and after 4weeks of treatment. RESULTS: The edema status, fatigue, pain, and GCLQ-K scores were significantly improved in both groups after the 4-week intervention (P<0.05). Physical function and fatigue in EORTC QLQ-C30 and the 30-s chair stand test and quadriceps muscle strength were significantly improved in the CRCDT group compared with the CDT group (P<0.05). CONCLUSIONS: CR improves physical function, fatigue, and muscular strength without increasing edema status in patients with unilateral lower-limb lymphedema after gynecologic cancer surgery.