O uso da pneumopletismografia na quantificação do edema linfatico dos membros superiores apos tratamento do cancer de mama

AUTOR(ES)
DATA DE PUBLICAÇÃO

2001

RESUMO

Lymphedema of the upper limbs secondary to treatment for breast cancer affects a significant number of patients causing deformities, functionalclimitation, increase in the incidence of infectious disease, as well as emotional problems accompanied by reduced self-esteem. The development of edema may occur immediately after ar up to many years after surgery. The diagnosis and adoption of early treatment of this condition enables contrai of its course to fibreus edema. In the international literature, techniques used for quantifying intracellular and extracellular body fluids are mentioned, although they are based on principies different from those established in this research. Cirtometry and measurements of the perimeter and volume are methods reutinely employed to measure the difference between the normal limb and the limb affected by Iymphedema. Nevertheless, they are inadequate for differentiating the edema from tissue fibrosis secondary to Iymphatic stasis. The aim of the current paper is to ultimately establish a protocol for evaluating Iymphedema of the upper limb, secondary to treatment for breast cancer. Thus, it would be possible to quantify the fluid volume accumulated at a determined site. It could also be used to evaluate the efficacy of the treatment administered and establish the discharge criteria. This is a prospective study with 17 participants employing non invasive methods for the evaluation of edema, volumetry and pneumopletysmography. These are perfectly feasible methods and do not expose the patients to any risk, neither to the limb affected by the edema nor to the underlying disease. The current study also established pneumoplethysmographie parameters for the normal upper limbs, choosing 30 patients and applying the same criteria used for the Iymphadematous limbs. The clinical treatment employed was a sequential intermittent pneumatic compression and an inelastic contention, performed daily during 5 days a week. The device used was especially built for this research. It employed arm holders with 6 pressure cuffs and cycles lasting 6 seconds with pressures of 140 mmHg and a complete pause during 40 seconds. Reevaluations were performed at each cycle of 10 sessions, employing eirtometry and pneumoplethysmography. Method: Employing a cuff of 5 em in width by 29 em in length, applied to 7 em below the crook of the arm. A pressure of 70 mmHg of pressure was maintained to perform the exam.This cuff was connected to an electronic transducer which in tum was connected to a plethysmographer. Using the AQDADOS-4 software ali pressure variations were recorded and recovered in a common printer. The individual values found in the edematous and contralateral forearms along with values found in another group of 30 people without edema were presented and used to establish the superior limit of normality for the plethysmography. Ali the measures were compared to the cirtometry performed at the same site. Results: The value of the fluid volume considered within the normal range was 3.0 cm3 found in the group of 30 people without edema; this value was used as a diseharge criteria of patients treated and did not present a statistically significant difference from the values found in the contralateral limb of patients with edema (17 patients). During treatment, cirtometry values continued higher than in the control limb but there was no discharge criteria; with the new method and based on the value considered normal,treatment was interrupted or not, providing important secure information. Discussion: The new method, non invasiveand devoid of complications,was considered adequate. It was of great aid in controlling Iymphedema and diagnosing if there was fluid to be removed or not. Cirtometry detected an increase in the volume more indicative of fibrosis than of the fluid to be removed. Conclusion: The new method proved adequate for the proposed objectives of evaluating and quantifying the fluid volume to be removed at the beginning and end of treatment, as well as at further control values. It was also suitable to test the proposed method of treatment using external pneumatic compression.

ASSUNTO(S)

linfa mastectomia ganglios linfaticos - doenças elefantiase

ACESSO AO ARTIGO

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