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The use of lymph drainage in patients with lymphedema
DĚKANOVÁ, Klára
For my bachelor thesis I chose the theme ?Utilisation of the lymph drainage at patients with lymphedema?. In the Czech Republic the lymph drainage is a relatively new method which is used in medical facilities only since the year 1992. Efforts to introduce this method in the area of the Czech Republic came already before, since the seventies of the 20th century this problems was dealt by MUDr. Miroslav Bechyně CSc. Thanks to him in 1992 the first course of manual lymph drainage was realised in the Czech Republic. In the same year MUDr. Bechyně contributed to the foundation of the League against swelling and he made a motion to the birth of the Czech society of lymphology. The aim of my thesis was to acquaint patients with the possibilities of the use of the lymph drainage in the health care, to find out to which extent it is possible to influence the lymphedema and above all how this method affects the global state of patients. In the theoretical part of the bachelor thesis I summarized the findings dealing with this problems. I engaged myself in the history of lymph drainage and in the research of the lymph system in the world and in our country. In my thesis I defined the notion of lymphedema and I sorted it according to its origin into primary and secondary. Next in the thesis I present the diagnosis of lymphedema and the possibilities of his conservative and chirurgical treatment. Among possibilities how to treat the lymphedema I chose in particular manual and instrumental lymph drainage. I present also indications and contraindications of the lymph drainages. In the thesis I dealt as well with the use of lymph taping. This method is more and more popular at patients with the chronical lymphedema. The application of the lymph tape has many advantages, for example it does not limit patients in move. In the last chapter of the theoretical part I dealt with possibilities of the spa treatment at patients with lymphedema. The practical part of my thesis was realised by the qualitative research strategy and the results were treated by the form of case interpretations. The research sample was constituted by four probands who had the diagnosis of lymphedema and whose therapy took place in the rehabilitation department of the health centre Poliklinika Jih MEDIPONT s.r.o. in České Budějovice. The sample was chosen from clients with various kinds of lymphedema who were willing to cooperate on my bachelor thesis. The chosen sample was constituted by one client with primary lymphedema and three clients with secondary lymphedema. Clients with the secondary lymphedema had diagnoses venous insufficiency, postoperative and post-traumatic lymphedema. All probands underwent 10 therapies of the manual and instrumental lymph drainage. At the beginning and at the end of the therapy the lower limb circumferences were measured. With the patient´s consent I have used their health documentation, I have elaborated their detailed anamnesis and I have realised a structured dialogue with all probands. The dialogue contained both closed-ended and open-ended questions in order to chart proband´s health state and the contribution of the implemented therapy. After the end of the therapy the probands had possibility to express their subjective opinions on the undergone treatment. All probands found out lymph drainage as a very pleasant procedure. Three of four probands have noticed improvement of their health state and a visible swelling reduction. At the fourth patient, who was treated with the lymphedema caused by the venous insufficiency the improvement did not take place yet. But this patient says that she did not observe regime measures. The doctor proposed to the patient to continue with the treatment. The results of my bachelor thesis may be used by other physiotherapists for the needs of education or for a further research.
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The risk of chronic lesions after radiation therapy in patients with breast cancer
KŘÍŽOVÁ, Jana
Breast carcinoma is the most common cancer in women. In 2009, 5,975 new cases were diagnosed in the Czech Republic. One of the main treatment modalities is radiotherapy, which, besides bringing treatment effects, may also cause post-radiation changes that significantly influence patients? quality of life. The work focuses on monitoring the occurrence of post-radiation changes following radiotherapy as part of breast carcinoma treatment ? chronic radiodermatitis, hypodermic fibrosis and lymphedema, all at Masaryk Memorial Cancer Institute Brno. After the end of radiotherapeutic treatment these changes are monitored by the physicians during regular checks and classified on the RTOG/EORTC scale. I used a set of 98 patients (97 women and 1 man) treated at the Masaryk Memorial Cancer Institute Brno between 1998 and 2009 who suffered from the mentioned post-radiation changes. The data was assessed upon the purpose, radiation equipment used for the radiotherapy, and the degree of the studied conditions. Occurrence of lymphedema prior to radiotherapy was statistically analysed as well. All the patients received the same dose of 50 Gy with a standard fractionation scheme of 25 fractions by 2 Gy, and therefore no evaluation of coincidence of the applied dose with the risk of chronic changes occurrence was possible. Consequent changes occurred in 74 % of the studied patients. Statistics shows that patients who received radiation treatment of mamma or chest and regional lymph nodes were at higher risk of suffering chronic changes to the skin and higher risk of lymphedema, but at lower risk of hypodermic fibrosis.
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The importance of lymphatic drainage in physiotherapy
VINKLEROVÁ, Miroslava
The theoretical part summarizes all the theoretical knowledge on the topic. I am presenting a brief history of the discovery of the lymphatic vessels and the lymphatic drainage, the lymphatic system anatomy and its functions in the human body. Next, I have defined the concept of lymphoedema and divided it by its origin to primary and secondary lymphedema. The work includes the diagnosis of lymphedema , both conservative and surgical treatment options, indications and contraindications of lymphatic drainage and the regime remedies to patients with lymphedema, where I have stated which activities patients should avoid. The conservative treatment consist of four pillars, i.e. a manual lymphatic drainage, an instrument lymphatic drainage, compression bandaging and decongestion exercise. One chapter covers the rehabilitation after a breast surgery with possible postoperative incidence of lymphedema, autolymphatic drainage and the metod of lymph ? taping, which has become popular with both lymphoterapists and even the patients themselves. The practical part has been conducted as a qualitative research strategy and its results were processed in a form of case studies. The research test group consisted of five patients with clinically proven lymphedema. Two patients had postoperative lymphedema and three of them posttraumatic one. The aim was to explore the benefits of lymphatic drainage in rehabilitation and its positive impact on improving the patient´s general state of health. The research conducted at the outpatient department of Polyclinic Jih MEDIPONT Ltd in České Budějovice using a structured interview, a retrospective analysis of data and observations. All patients agree on the benefits of lymphatic drainage therapy and after passing through the lymph drainage techniques their general states of health have improved.
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Improvement of manual lymph draining like method physical therapy in regeneration and therapeutic profession
OPATRNÁ, Alice
This thesis deals with usage of the technique of manual lymph drainage and verification of its influence in therapeutic, regeneration and cosmetic practise. This technique is very popular among non-professional and professional public. As for the regeneration practise it is used especially for cellulite treatment, whereas in medical practise it is used for healing numerous kinds of swelings, lymphedems in particular. In the introduction to the theoretical part my thesis aims for history of this technique in the Czech republic and abroad, emphasizes the importance of professional knowledge of the lymphatic system anatomy, physiology and pathophysiology, indication and contraindication and it introduces this manual heptic technique in detail. The practical part deals with verification of effectiveness of the manual lymph drainage technique in practise and it compares input and output data of the monitored set. The results of the practical examination confirm the effectiveness of this method in the therapeutic practise.
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Nuclear medicine techniques used in lymphatic system imaging
HLŮŽOVÁ, Lenka
Lymphoscintigraphy is a non-invasive examination technigue that can very easily contribute to the diagnosis of lymphoedema in patients suffering from swelling of the lower extremities. Thanks to the low radiation burden and minimum risk of allergic reactions, this technique can be used for repeated examinations as well as for monitoring the effects of the treatment. In this thesis, I am trying to familiarize readers with the principles of lymphoscintigraphy of the lower extremities and with various options for processing the images obtained. My objective was to compare the results of the semi-quantitative evaluation of the currently used static imaging techniques with whole body scintigraphy, thus contributing to the simplification of this examination. A group of 96 patients was formed for whom I always used two methods of data acquisition (currently used static images followed by whole body recording). Given the different possibilities of semi-quantitative evaluation, the patients were divided into two groups, according to the imaging methods for the site of application in the whole body records. In addition, I tried to evaluate the benefits of SPECT/low-dose CT on the area of the inguinal lymph nodes, especially in obese patients. Images were taken from a total of 5 patients. All data was imaged and subsequently processed at the Clinic of Nuclear Medicine, University Hospital Královské Vinohrady. It is evident from the processing of data from 96 patients that static data acquisition can be replaces with whole body imaging. Given the method of processing, imaging with shielding of the injection site seems to be a more suitable method. In 6,5% of these patients, the result was mildly underestimated. Unfortunately, the benefits of SPECT or SPECT/low-dose CT were not fully confirmed. I hope that this thesis will provide a comprehensive view of the performance of lymphoscintigraphy and will help to elucidate the influence of the imaging technique used on the results of semi-quantitative evaluation. Last but not least, it will help to facilitate the work of radiology assistants and doctors, and increase the comfort of examination for patients.
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Physiotherapy at people suffering from the oncology diagnosis focusing on the breast tumours
MALENINSKÁ, Zuzana
My Bachelor thesis Physiotherapy at people suffering from the oncology diagnosis focusing on the breast tumours, deals particularly with the most frequent malignant breast tumour which is breast carcinoma. The aim of the work in the theoretical part is to make a survey of the breast carcinoma issue with the intention to describe complications after the operation of the breast tumour which occur due to the removal of gravity lymph nodes and their therapy. In the practical part I watched the female patients after the surgery and the changes which occurred, as well as the issue whether the early therapy helped the patients to avoid the after-operation complications. I used the metod of the quality research which was carried out with two female patients who had the surgery major becouse of the diagnosed breast carcinoma. The patients were chosen according to the extent of the surgery major from the basic group of patients of The Hospital Surgical Ward in České Budějovice (Chirurgické oddělení Nemocnice České Budějovice a.s.). I used the following data collection techniques {--} interview, anamnesis, observation (kinesiology analysis), casuistry and personal medical documentations analysis. The results were processed by the form of casuistries. On the basic of patients observations I have proved the fact that the early therapy prevents the after-operation complications. It resulted in better ability to move with the shoulder joint, the relaxing of the soft tissues, regeneration of chest mobility and the correct breathing. Responsible attitude of the patient to self-therapy and preventive practices are an integral part of the therapy. The thesis can be used for needs of the clinical work of physiotherapists, different medical staff members and students who deal with this issue.
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The Subjective Evaluation of a Patient´s Overall Health State at the End of the Reduction Phase of Lymphedema Treatment
PLACATKOVÁ, Petra
The graduation thesis is focused on Lymphedema patientś problems. It addresses how the patient values his or her own health state. The differences between a patientś health state before therapy and after finishing its reduction phase have been compared. The following aspect have been valued: limited movement, pain and mental stress. All of them were improved after the reduction phase. Thus Hypothesis 1 has been confirmed: "At the end of the Reduction Phase of Lymphedema therapy the overal health state of the patient is improved." Out of above meditioned three aspect, the mental stress improved at a lowest rate. Differences between patients with and without good social background were demonstrated. Patients with bad social background valued mental stress caused by Lymphedema before and after the therapy as significantly higher then patients with good social background. Thus Hypothesis 2 was also confirmed: "Patients with good social background cope with their disease in a better way." In order to test the hypotheses the quantitative research was done. The technique was standardised integration.
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