Int Wound J. 2022 Jan;19(1):222-229. doi: 10.1111/iwj.13624. Epub 2021 Jun 15.

ABSTRACT

Grade 4 peripheral intravenous infiltration with skin tears has seldom been reported. On 4 August 2020, a 35-year-old female patient was admitted to the emergency department of our hospital because of postprandial abdominal pain for 2 hours. She was diagnosed with a severe acute pancreatitis with type II diabetes mellitus. On 7 August, a vein detained needle was inserted into the dorsal vein of her right foot to infuse drugs. On 9 August, a grade 4 infiltration, discoloured and bruised skin with a swollen area of 11 cm × 9 cm around the infusion part of her right foot, was discovered. The infusion was stopped immediately and the residual drug was aspirated at the infusion site. When removing the vein detained needle, the skin surrounding the infusion site on the right foot was torn by the adhesive dressing. The size of the skin tears was 6 cm × 3 cm (type 3). The patient was provided with appropriate dressing, manual lymphatic drainage, and surgical intervention. Two months later, she was fully recovered with no functional impairment of the affected foot. Timely local wound interventions could lead to a satisfactory outcome for severe peripheral intravenous infiltration with skin tears.

PMID:34129273 | PMC:PMC8684851 | DOI:10.1111/iwj.13624

J Orthop. 2021 May 15;25:237-243. doi: 10.1016/j.jor.2021.05.016. eCollection 2021 May-Jun.

ABSTRACT

CLINICAL TRIAL NUMBER: NCT04580069.

BACKGROUND: Total knee arthroplasty is associated with an elevated inflammatory response both at a local and systemic level. The main objective of this study is to demonstrate the effectiveness of lymphatic drainage and connective tissue techniques in modulating systemic inflammation. Another objective is to evaluate the existence, at baseline, of a correlation between the inflammation indices and the level of adherence to the Mediterranean diet.

METHODS: 34 patients were recruited, and divided into three groups. The control group followed the normal rehabilitation protocol. The other two groups were subjected, in addition to the standard treatment, to manual lymphatic drainage treatment or connective tissue techniques. The outcomes were recorded in three stages: upon entering the hospital, 1 week after entry and at follow-up 21 days after surgery.

RESULTS: The results of the study showed that both methods, compared with the standard treatment only, positively influenced the final outcomes. In regard to the systemic inflammation, lymphatic drainage and connective techniques showed equal efficacy and similar timing in modulating ESR, while they differ in how they affect CRP. With regard to the local inflammation, the effectiveness of both methods was confirmed with some differences in the location. Finally, analysis of the correlation between inflammatory T0 indices and adherence to the Mediterranean diet showed that patients with higher adhesion index have on average lower PCR, EDO and EDU values.

CONCLUSIONS: The post-surgical inflammatory pattern can be positively modified by the rehabilitation methods analyzed, albeit with different methodologies and timing.The influence of the diet on inflammatory parameters, although less evident, seems to show encouraging results worth of further studies.

PMID:34099953 | PMC:PMC8165292 | DOI:10.1016/j.jor.2021.05.016

Front Bioeng Biotechnol. 2021 Apr 1;9:656716. doi: 10.3389/fbioe.2021.656716. eCollection 2021.

ABSTRACT

Female patients suffer from the risk of upper limb lymphedema after breast cancer removal surgery. At present, the detection and the adjuvant treatment of this disease are not convenient enough, leading to delay of the disease and increase in the burden of patients. This paper presents a portable monitoring and treatment device for upper extremity lymphedema, enabling patients to monitor the symptoms of upper limb lymphedema and auxiliary rehabilitation. This design utilizes the arm circumference measurement and contrast method to realize symptom monitoring. The device realizes auxiliary rehabilitation using the regional pressure method to imitate traditional manual lymphatic drainage technology. According to the MRI images of volunteers’ upper limbs, the upper arm and forearm’s finite element models are reconstructed in ANSYS. The static simulation experiment is completed. The working mode and parameter design of each rehabilitation module of the device are obtained. The experimental results show that the integrated design principle of monitoring and treatment proposed in this paper has good feasibility, has auxiliary rehabilitation effect, and meets the principle of human comfort. The device can help patients find lymphedema in time and implement auxiliary treatment, which can effectively avoid the further deterioration of lymphedema.

PMID:33869161 | PMC:PMC8047204 | DOI:10.3389/fbioe.2021.656716

Biology (Basel). 2021 Mar 25;10(4):261. doi: 10.3390/biology10040261.

ABSTRACT

This narrative review portrays the lymphatic system, a poorly understood but important physiological system. While several reviews have been published that are related to the biology of the lymphatic system and lymphedema, the physiological alternations, which arise due to disturbances of this system, and during lymphedema therapy, are poorly understood and, consequently, not widely reported. We present an inclusive collection of evidence from the scientific literature reflecting important developments in lymphedema research over the last few decades. This review aims at advancing the knowledge on the area of lymphatic system function as well as how system dysfunction, as seen in lymphedema, affects physiological systems and how lymphedema therapy modulates these mechanisms. We propose that future studies should aim at investigating, in-detail, aspects that are related to fluid regulation, hemodynamic responses, and endothelial and/or vascular changes due to lymphedema and lymphedema therapy.

PMID:33806183 | PMC:PMC8065876 | DOI:10.3390/biology10040261

Arch Plast Surg. 2021 Mar;48(2):239-240. doi: 10.5999/aps.2020.01823. Epub 2021 Mar 15.

NO ABSTRACT

PMID:33765744 | PMC:PMC8007464 | DOI:10.5999/aps.2020.01823

Front Oncol. 2021 Mar 4;11:638948. doi: 10.3389/fonc.2021.638948. eCollection 2021.

ABSTRACT

The axillary lymph nodes are the primary group responsible for lymphatic drainage in the breast and, consequently, are the most common location for breast cancer metastasis. However, lymphatic pathways running from the breast, via intercostal spaces, to parasternal lymph vessels have also been identified. According to the American Joint Committee on Cancer eighth edition manual, regional lymph node metastasis normally travels to the ipsilateral axillary, supraclavicular, subclavicular, and internal mammary lymph nodes. The presence of intercostal metastasis is out the range of these regional lymph nodes. It is very rare for intercostal lymph nodes to be the extra-axillary site of metastasis in breast cancer, and it has been little reported on in the literature. Despite its rarity, it has the capacity to adversely affect the prognosis of breast cancer and drastically influence treatment choice. Here, we analyze such a case, with a patient receiving a radical mastectomy and metastatic intercostal lymph node dissection due to the presence of intercostal lymph node metastasis indicated via MRI. Furthermore, the potential application of preoperative 3-dimensional (3D) visualization and surgical planning is also discussed.

PMID:33747962 | PMC:PMC7969973 | DOI:10.3389/fonc.2021.638948

Sci Prog. 2021 Jan-Mar;104(1):36850421998485. doi: 10.1177/0036850421998485.

ABSTRACT

Lymphedema is manifested as a chronic swelling arising due to stasis in the lymphatic flow. No cure is currently available. A non-invasive treatment is a 3 week complete decongestive therapy (CDT), including manual lymphatic drainage and compression bandaging to control swelling. As CDT leads to mobilization of several liters of fluid, effects of CDT on hyaluronan clearance (maker for lymphatic outflow), volume regulating hormones, total plasma protein as well as plasma density, osmolality and selected electrolytes were investigated. In this pilot study, we assessed hyaluronan and volume regulating hormone responses from plasma samples of nine patients (three males, six females, aged 55 ± 13 years) with lower limb lymphedema stage II-III, before – and after – CDT. A paired non-parametric test (Wilcoxon) was used to assess hormonal and plasma volume changes. Correlation was tested using Spearman’s correlation. The main findings of this novel study are that lymphedema patients lost volume and weight after therapy. Hyaluronic acid did not significantly change pre- compared to post-CDT. Aldosterone increased significantly after therapy, while plasma renin activity increased, but not significantly. Plasma total protein, density, osmolality and sodium and chloride did not show differences after CDT. To our knowledge, no study has previously investigated the effects of CDT on volume regulating hormones or electrolytes. To identify the time-course of volume regulating hormones and lymphatic flow changes induced by CDT, future studies should assess these parameters serially over 3 weeks of therapy.

PMID:33733941 | PMC:PMC10358536 | DOI:10.1177/0036850421998485

SAGE Open Med Case Rep. 2021 Jan 21;9:2050313X20952224. doi: 10.1177/2050313X20952224. eCollection 2021.

ABSTRACT

This case report illustrates the treatment outcomes of a collegiate athlete presenting with an 18-month history of post-concussion syndrome who received a series of mixed manual therapies in isolation of other therapy. Persistent symptoms were self-reported as debilitating, contributing to self-removal from participation in school, work, and leisure activities. Patient and parent interviews captured the history of multiple concussions and other sports-related injuries. Neurological screening and activities of daily living were baseline measured. Post-Concussion Symptom Checklist and Headache Impact Test-6™ were utilized to track symptom severity. Treatments applied included craniosacral therapy, manual lymphatic drainage, and glymphatic techniques. Eleven treatment sessions were administered over 3 months. Results indicated restoration of oxygen saturation, normalized pupil reactivity, and satisfactory sleep. Post-concussion syndrome symptom severity was reduced by 87% as reflected by accumulative Post-Concussion Symptom Checklist scores. Relief from chronic headaches was achieved, reflected by Headache Impact Test-6 scores. Restoration of mood and quality of life were reported. A 6-month follow-up revealed symptoms remained abated with full re-engagement of daily activities. The author hypothesized that post-concussion syndrome symptoms were related to compression of craniosacral system structures and lymphatic fluid stagnation that contributed to head pressure pain, severe sleep deprivation, and multiple neurological and psychological symptoms. Positive outcomes over a relatively short period of time without adverse effects suggest these therapies may offer viable options for the treatment of post-concussion syndrome.

PMID:33628444 | PMC:PMC7829464 | DOI:10.1177/2050313X20952224

Indian J Palliat Care. 2020 Oct-Dec;26(4):537-539. doi: 10.4103/IJPC.IJPC_36_20. Epub 2020 Nov 19.

ABSTRACT

Breast cancer-related lymphedema (BCRL) is an increasingly common complication seen in the palliative care setting due to increased life expectancy of breast cancer survivors. It is an important determinant of the quality of life of breast cancer survivors, due to the functional impact that it has, apart from the pain and deformity associated with it. Conservative management of lymphedema with the help of physiotherapy, positioning, manual lymphatic drainage, and intermittent pneumatic compression is well known. Even then, there remains a subset of patients that fail to respond to conservative management. T2 sympathectomy is a technique which ablates the thoracic sympathetic chain and helps in improving the lymphatic drainage. We report a series of four cases of BCRL, which showed a significant reduction in the mid-arm circumference as well as pain scores after a T2 sympathectomy. We believe that T2 sympathectomy can be used as the second line of management in lymphedema patients in whom conservative treatment has failed.

PMID:33623320 | PMC:PMC7888422 | DOI:10.4103/IJPC.IJPC_36_20

J Clin Med. 2020 Dec 16;9(12):4062. doi: 10.3390/jcm9124062.

ABSTRACT

The aim of this study is to describe the short-term effects of manual lymph drainage (MLD) isolated in supraclavicular area in healthy subjects. A 4-week cross-sectional, double-blinded randomized clinical trial was conducted. Participants: 24 healthy participants between 18 and 30 years old were recruited from Universidad Europea de Madrid from December 2018 to September 2019. A total of four groups were studied: control, placebo, Vodder, and Godoy. The order of the interventions was randomized. Resting Heart Rate and Oxygen Saturation, blood pressure, pressure pain threshold of trapezius muscle, respiratory rate, range of active cervical movements were measured before and after every intervention. All the participants fulfilled four different interventions with a one-week-wash-out period. No statistically significant differences were found between groups in descriptive data; neither in saturation of oxygen, diastolic blood pressure and cervical range of motion. Significant differences were found in favor of Vodder (p = 0.026) in heart rate diminution and in cardiac-rate-reduction. A significant difference in respiratory rate diminution is found in favor of the Godoy group in comparison with the control group (p = 0.020). A significant difference is found in favor of the Godoy group in systolic blood pressure decrease (p = 0.015) even in pressure pain threshold (p < 0.05). MLD decreases systolic blood pressure in healthy participants. However, it does not produce any changes in other physiologic outcomes maintaining physiologic values, which may suggest the safety of the technique in patients suffering from other pathologies.

PMID:33339196 | PMC:PMC7765613 | DOI:10.3390/jcm9124062