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Saturday, May 27th, 2017
PARALLEL SESSION
Chairmen: E. Földi, J.P. Belgrado, G. Manokaran
EFFECTIVENESS OF CONSERVATIVE COMBINED TREATMENT IN LIPEDEMA PATIENTS AND CLINICAL MONITORING
MICHELINI S.1, CARDONE M.1, CAPPELLINO F.1, FIORENTINO A.1, FAILLA ALESSANDRO1, MONETA GIOVANNI1, ZINGARETTI CRISTINA2,
SA VERIO CINTI 2
1 San Giovanni Battista Hospital – ACISMOM –Via L.E. Morselli, 8, 00148 Rome, Italy
2 Dip. Medicina Sperimentale e Clinica - Anatomia - Facoltà di Medicina, Università Politecnica delle Marche, Ancona, Italy
Introduction: Lipedema is painful and causes an impairment of daily activities. Traditional conservative treatments combine compression therapy, lymphatic manual drainage, and diet modification, mainly addressed to reduction of pain.
Aims of study: Aim of the study was to evaluate effectiveness in adding to these treatments low frequency ultrasound therapy, through 40 KHz cavitation, extracorporeal shock wave therapy (2 atm., 300 blows/min, 4.000 blows/ session), manual lymphatic drainage and inelastic bandaging, in reducing leg measurements after treatment.
Methods: The study was conduced on 30 affected patients, in II clinical stage. The subjects underwent 10 sessions of treatment addressed to the fatty tissue of the legs, twice a week. Leg measurements, VAS pain scale and ultrasound measurements of supra- fascial thickness were performed before and after treatment protocol.
Results: The results showed a significant reduction of leg measurements and of supra-fascial thickness (14%) , showing better results in combining all the performed conservative treatments, compared to limited protocols observed in literature. Average values of VAS pain scale showed significant reduction after treatment (average 3.7 points). Lymphoscintigraphy performed in 16 cases demonstrated a decrease of dermal back flow (with normal picking up of tracer at root of limbs in all cases) at the end of treatment. BMI was substantially unchanged before and after the treatment in all patients. We also started electronic microscopy examination of histological samples in familial cases in order to evaluate common morphological and functional features in inherited lipedema.
ITALIAN GUIDELINES ON LYMPHEDEMA: NEW PUBLIC RULES 2017
MICHELINI S.1, CESTARI M.2, RICCI M.3, LEONE A.4, GALLUCCIO A.1, CARDONE M.1
1 San Giovanni Battista Hospital – Rome – Italy
2 Vascular Public Consulting Room – Terni – Italy
3 Rehabilitative Department Torrette Hospital – Ancona – Italy 4 Carmide Hospital .- Catania - Italy
Lymphedema is a social and disabling illness that effects the patient globally, as for the primary and for the secondary kind.
In 2006 the Italian Ministry of the Health appointed a Commission of national experts to draft the ‘National Guidelines’ on the illness. On 15th September 2016 the Italian Ministry of Health issued regulations that govern the care for patients with lymphedema and related disorders.
Lymphedema is a complex pathology now considered under ICF standards applying a bio-psycho-social approach in the evaluation of rehabilitation needs of the patient.
Diagnosis procedure includes a three level examination. The first consists of lymphoscintigraphy, high resolution ultrasound and colour Doppler ultrasounds. The second, the Computering tomography, the MRI and a Lymphography; the third, other particular exams tailored for each clinical case.
Early combined therapy is recommended. The type of treatment depends on clinical stage and patients compliance.
Surgical intervention includes microsurgical treatment by means derivative or reconstructive anastomosis or super-microsurgery.
Very important is to avoid monotherapy (only manual lymphatic drainage, only bandaging etc.). Regarding the garments two/yearly in adult and three in paediatric patients are assured by the Health System. It is recommended genetic testing in primary lymphedema. Every Italian Region must organize at least a ‘Reference Centre’, in order to transmit data, for the Epidemiological Monitoring, perform diagnosis, care and training, for patients and health care professionals, under the aegis of scientific societies. With regards to treatment guaranteed public rehabilitation centres for periodic therapy cycles, according to clinical indication are provided.
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXIX - Nr. 76 - 2017
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