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IMPORTANCE OF PATIENT EDUCATION IN ERYSIPELAS CONTROL FOLLOWING BREAST CANCER RELATED L YMPHEDEMA
YESIM BAKAR, PT, PhD, Assoc. Prof.
Turkey
Introduction: Erysipelas is a common infection of the superficial layer of the skin, and is defined as an acute onset of local signs of inflammation associated with pain, swelling and also manifests with systemic symptoms such as fever, chills and malaise in patients with breast cancer-related lymphedema (BCRL).
Materials & Methods: This study evaluated whether education in combination with an educational booklet can reduce the risk of erysipelas in patients with BCRL. We analyzed 119 women with unilateral BCRL. The patients were divided into three groups: Group 1 (n=40), who received neither education nor education booklet; Group 2 (n=39), who received an education; and Group 3 (n=40), who received an education and educational booklet. The educational booklet give information about the lymphatic system, the symptoms and signs of lymphedema, and suggestions for preventing lymphedema, and avoiding infection or trauma of the upper limb.
Results: All patients were invited after 1 year for assesment. During the follow-up, 34 patients (28.6%) developed an erysipelas. The rates of erysipelas occurrence were 42.5% in Group 1 (n=17), 28.2% in Group 2 (n=11), and 15% in Group 3 (n=6) p=0.010.
Conclusions: The occurrence rate of erysipelas in BCRL patients was very high. The combination of education and educational booklet may reduce the risk of erysipelas. We conclude that patient education must begins directly after surgery to avoid lymphedema and erysipelas in patients after breast cancer.
NEW METHOD FOR DETECTION OF DORMANT BACTERIA IN LYMPHEDEMATOUS TISSUES
OLSZEWSKI W. L., ZALESKA M., DURLIK M., STELMACH E.
Central Clinical Hospital, Medical Research Center, Warsaw, Poland
Background: Lymphedema is complicated by recurrent dermato-lymphangio-adenitis attacks in around 50% of cases. To identify the causative bacteria classic bacteriological cultures are carried out frommaterial placed in differential media. This type of culture allows to detect fast proliferating microbes but not those remaining dormant. Lacking is tissue natural environment where bacteria are nourished by host tissue products. Culture of tissue fragments on blood containing plates for days or weeks may mimic the in vivo conditions.
Aim: To culture tissue fragments on bacteriological blood plates and follow bacteria migration from tissue, formation and competition between colonies, appearance of new strains in long-lasting cultures, and sensitivity to antibiotics supplementing medium.
Methods: Skin, subcutaneous tissue, muscle, vein and arterial fragments harvested during debulking operations from 10 patients with lower limb lymphedema were placed on Hemoline plates and observed daily for 3 weeks. Bacterial strains migrating from specimens were identified. They were in situ treated with antibiotics to check antibiotic sensitivity.
Results: Daily observations of culture plates showed formation of bacterial colonies attached to specimens, growing radially
(S. epidermidis), encroaching upon other of different color (S. aureus), some forming circular ”waves” (Proteus), spreading rapidly (Pseudomonas), some overgrown by Candida. Most strains formed colonies as late as 21 days. For comparison routine cultures revealed presence of one or two strains, whereas tissue culture on plates three to five and often fungi.
Conclusions: On –blood-plate bacteriological culture of tissue specimens gives more insight into rapidly growing and dormant microorganisms and efficiency of applied antibiotics.
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THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXVI - Nr. 72 - 2015