Page 22 - VOL 26 N. 72 - 2015

June 4, 2015 - Auditoire A. Yersin
FREE COMMUNICATIONS 2
A NEW METHOD FOR MEASURING DEEP TISSUES TONOMETRY IN LYMPHEDEMA
ZALESKA M. 1, OLSZEWSKI W. L. 1, KACZMAREK M. 2
1 Central Clinical Hospital, Medical Research Center, Warsaw (PL); 2 Kazimierz Wielki University, Bydgpszcz (PL)
Introduction: Edematous tissue has viscoelastic properties of a sponge. Measuring elasticity using tonometers may provide useful data not only for setting intermittent pneumatic compression at levels allowing initiation of edema fluid flow but also assessment of therapeutic compression results. The so far used tonometers with indentation of 3 mm measure elasticity of skin but not of the subcutaneous tissue, where the bulk of edema fluid is located. Moreover, no information is obtained how high pressure is generated during tonometry in the tissue. We designed a tonometer with a 10mm long, plunger reaching subcutis, so that the force necessary for moving deep located fluid could be measured and an intra-tissue pressure sensor to assess the effect of external force on fluid pressure.
Aim: To measure simultaneously tissue tonicity and tissue edema fluid pressure underneath the tonometer. The obtained data would provide information how high compression (bandage, stockings, intermittent pneumatic compression) pressures should be applied to move edema fluid.
Material and methods: Forty patients with lymphedema of lower limbs stage II-IV were studied. Tonometer plunger 10 mm long, pressing area 1sq.cm, time of pressing to reach 10 mm deep in 5 sec was used. Force was read off on the scale. Pressure sensor was placed in the subcutaneous tissue under the tonometer . Measurements were taken above ankle, mid-calf, below and above knee and mid-thigh. Applied force was plotted against tissue fluid pressure.
Results: Tonometer force of 500g/sq.cm generated edema fluid pressures around 30mmHg. Those of 1000g/sq.cm 50 mmHg. However, in cases with hard skin force of 2500 g/sq.cm produced only 40-70 mmHg. This means in order to obtain the minimum 30 mmHg to move fluid in the tissue higher external forces should be applied: tonometry up to 1.0 – calf compression pressure 50 to 60 mmHg, 1.1 to 2.0 - 60 to 90 mmHg, above 2.1 - 90-120 mmHg. Elasticity of lower limbs tissue was lower in the calf with more hard skin than in the thigh.
Conclusions: Deep tonometry is indispensable for: 1. setting pneumatic device at effective level to move tissue fluid, 2. evaluating effect of IPC by pre- and post treatment measurements (increase of elasticity), 3. evaluating the postoperative effects of lympho- venous shunts (increase of elasticity).
EVALUATION OF THE AXILLRY WEB SYNDROMES (AWS) BY LYMPHOSCINTIGRAPHIS IMAGINGS
LEDUCO.1-3,LEMOINEM.2,GOBILLARDA.2,HARDYM.2,MAIRES.1,HIGUETM.1, DEWILDEJ.2,BERNARDF.2,VAESH.2,BADIIN.2, ADRIAENSSENS N. 4, LEDUC A. 1, BOURGEOIS P . 3
1 Lympho-phlebology Unit, Department of occupational and environmental physiology, Haute Ecole P. H. Spaak, Brussels (BE); 2 Departement of Physical Therapy, Institut Jules Bordet, Université Libre de Bruxelles (BE); 3 Department of Nuclear Medecine and Clinic of Lymphology, Institut Jules Bordet, Université Libre de Bruxelles (BE); 4 Department of Physical therapy Vrije universiteit Brussel and Oncology department UZ Brussel (BE)
Introduction: The Axillary Web Syndrome (AWS) follows surgery for breast neoplasia and consists in the appearance of one or more frequently two or three cords of subcutaneous tissue. Strings originate from the axilla, spread to the antero-medial surface of the arm down to the elbow and then move into the antero-medial aspect of the forearm and sometimes into the root of the thumb. The purpose of this study was to analyse these cords by lymphoscintigraphy before (and after) physical treatment.
Material and methods: The two upper limbs of 21 women with clinically (either obvious, or suspected) unilateralized AWS were investigated using one simplified lymphoscintigraphic protocol as developed by PB.
Results: Lymphoscintigraphy was analyzed as normal in a single case. Another presented only points of colloidal attachment on the lymphatic vessels with a normal function when compared to the normal limb. In all other patients, a decreased lymphatic function was observed. Among these 19 patients, 7 showed, either localized, or extensive lymphatic colloidal “stasis” (pattern A). In six patients, one complete stop on the lymphatic pathway was found (sometimes with first signs of developing collaterals) (pattern B) and in six additional cases, lymph stasis with localized colloidal attachment on the lymphatic pathway with obvious collateralisation(s) (pattern C) (and in two cases dermal bacflow).
Conclusion: Our lymphoscintigraphic evaluations of these situations suggest that the AWS begins with one “inflammation” of the lymphatic vessel (pattern A), evolves toward lymphatic thrombosis pattern B) with the final development of lymphatic collaterals (pattern C).
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXVI - Nr. 72 - 2015
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