We have undertaken the search for the publications of interest in the following databases: Scopus, Web of Science, MedLine, The Cochrane Library, CyberLeninka, and Russian science citation index. In addition, we evaluated the effectiveness of the physical agents and procedures having different mechanisms of action of the known factors responsible for the development of post-mastectomy lymphedema. Such agents and procedures include self-massage, manual lymphatic drainage, therapeutic physical exercises, compression bandaging, wearing elastic compression garments, Kinesio Tex taping, pneumatic compression, ultrasonic, electrostatic, extracorporeal shock wave therapy, electrical muscle stimulation, microcurrent and low-intensity laser therapy. These methods and products were used by the authors of selected publications either separately or in the combined modes taking into consideration the significant differences between effects of the application of individual techniques. The results of the treatment are presented for different time periods, either in absolute units (cm or ml) in the majority of the cases or in relative units (%) only in part of them without information concerning the statistical significance of the results obtained. There is thus far neither the universal classification of post-mastectomy lymphedema nor the generally accepted approaches to its diagnostics and treatment. Therefore, it is impossible to give an unambiguous answer as regards the effectiveness of one or another method for the diagnostics and treatment of this condition. The author of the present article observed 172 patients at the age of 56.8±9.7 years suffering from late grade I-IV lymphedema treated with the use of local low-intensity low-frequency electric and magnetic therapy in the combination with pneumatic compression applied during 15 days. The results of the treatment were evaluated using water and impedance plethysmography. Within 4 weeks after the onset of therapy, the volume of the upper limb decreased on the average for all stages of lymphedema by 37.7±9.3% under effect of pneumatic compression alone, by 49.5±10.7% under the influence of its combination with electrotherapy, by 59.9±5.4% under the action of the combination of pneumatic compression with magnetotherapy, and by 76.3±7.3% after the application of all the three techniques together (p<0.05). Electrical neurostimulation of the blood vessels and skeletal muscles proved especially effective for the treatment of I-II grade lymphedema while magnetic therapy was most efficient for the management of grade III-IV lymphedema. The proposed method of combined physiotherapy looks very encouraging for the treatment of late lymphedema but does not completely solve all problems pertaining to the management of this pathological condition.
Хирургическое вмешательство, лучевая, цито-статическая и гормональная терапия злокачествен-ных новообразований не только позволяют значи-тельно увеличить продолжительность жизни боль-ных, но и приводят к возникновению серьезных ос-ложнений, влияющих на снижение трудоспособно-сти и изменение социального статуса больных.На сегодняшний день отсутствует утвержденная методическая литература по порядку организации медицинской реабилитации онкологических боль-ных. Однако практический врач в своей каждоднев-ной деятельности сталкивается с необходимостью назначения онкологическим больным восстанови-тельного лечения. В связи с этим перед ним встают задачи не только по диагностированию и оценке Сведения об авторе:Грушина Татьяна Ивановна -д-р мед. наук, рук. отд. медицинской реабилитации онкологических больных МНПЦ МРВСМ ДЗМ,
ГАУЗ Москвы «Московский научно-практический центр медицинской реабилитации, восстановительной и спортивной медицины» Департамента здравоохранения Москвы, Москва, Россия Автором отобраны категории Международной классификации функционирования, ограничений жизнедеятельности и здоровья (МКФ) для больных раком молочной железы с основными поздними последствиями хирургического лечения: лимфедемой верхней конечности, болевым синдромом и ограничением подвижности в плечевом суставе на стороне операции. Описаны возникающие проблемы для каждой составляющей МКФ: функции организма-по 26 категориям, структуры организма-по 15, активность и участие-по 49, факторы окружающей среды-по 31 категории. Собственные классификации адаптированы для терминологии МКФ. Разработаны критерии оценки определителей для структуры спинномозговых нервов, лимфатических узлов и сосудов, вен молочной железы, верхней конечности, мышц туловища, кожи и относящихся к ней структур. Описаны все возникающие нарушения функций организма и предложены методы оценки определителей для умственных, сенсорных функций, функций сердечно-сосудистой, иммунной и дыхательной систем, нейромышечных, скелетных и связанных с движением функций, функций кожи и связанных с ней структур. Показаны принципы кодирования по составляющим активность и участие (общие задачи и требования, мобильность, самообслуживание, бытовая жизнь, межличностные взаимодействия и отношения, главные сферы жизни, жизнь в сообществах, общественная и гражданская жизнь) и факторы окружающей среды. Кодирование представлено в виде наглядных и подробных таблиц с пояснениями.
Introduction. Thyroid cancer has a favorable prognosis but in long term patients are observed to be in psychological distress manifesting through elevated anxiety and depression which disrupt social adaptation. Studies have shown that 2–4 years after diagnosis and treatment of this malignant tumor, the majority of patients report dissatisfaction with family relationships and difficulties in performing everyday activities. These data demonstrate the necessity of rehabilitation aimed at patient adaptation to everyday life after therapy completion. Psychological help is an important aspect of rehabilitation.Aim. To evaluate the effectiveness of psychological help in patients with thyroid cancer.Materials and methods. The study included 42 women with thyroid cancer, stages I–III, Т1–3N0–1М0. Mean patient age was 44.5 ± 1.1 years. The patients were randomly divided into 2 groups matched by age, disease stage and type of surgical intervention: treatment and control groups. The treatment group (n = 24) included patients who underwent psychological training in the postoperative period, the control group (n = 18) included patients who did not receive psychological help. Mental state was evaluated using the Hospital Anxiety and Depression Scale (HADS). The patients’ mental state was evaluated dynamically: 1st testing was performed after surgery, 2nd testing 12 months after surgery. Psychological training was performed in the postoperative period and included 5 individual classes teaching self-regulation skills.Results. After the surgery, HADS scale showed insignificant increase in anxiety in both groups. Analysis of repeat testing showed decreased anxiety levels in patients in the treatment group from 7.7 ± 0.2 to 6.3 ± 0.2, i. e. to normal level. In the control group, anxiety significantly increased from 7.8 ± 0.2 to 9.2 ± 0.2 (Student’s t-test = 5.17; p = 0.000168). Additionally, 12 months after surgical treatment statistically significant differences in anxiety levels between groups were observed: 6.3 ± 0.2 and 9.0 ± 0.2, respectively (Student’s t-test = 9.55; р <0.05). Primary examination showed subthreshold depression in patients of both groups: 7.9 ± 0.1 and 8.1 ± 0.2, respectively. No statistically significant differences between the groups were observed (Student’s t-test = 0.89; р >0.05). Repeat examination showed decreased depression level (in treatment group from 7.9 ± 0.1 to 7.4 ± 0.2, in the control group from 8.1 ± 0.2 to 7.7 ± 0.1), however it remained in the range of mean values. No statistically significant differences between the groups were observed (Student’s t-test = 1.34; р >0.05).Conclusion. Psychological training using self-regulation techniques performed in the early postoperative period normalizes anxiety level and prevents its elevation in long term in patients with thyroid cancer.
BACKGROUND: In the arsenal of a physiotherapist, there are many methods of non-drug rehabilitation. As contraindications to their use, spinal neoplasms, benign formations with a tendency to growth are indicated, among other things. At the same time, there is no data in the literature on contraindications to physiotherapy in the presence of non-aggressive vertebral hemangioma. As well as there are no scientific studies with a proven absence of a negative effect on the course of this tumor. AIMS: scientific substantiation of the use of physical methods of treatment of patients with degenerative-dystrophic diseases of the spine in the presence of non-aggressive vertebral hemangioma. MATERIAL AND METHODS: The study involved 154 patients with degenerative-dystrophic diseases of the spine and non-aggressive vertebral hemangioma. 94 patients were analyzed retrospectively, 60 took part in a prospective study. The following methods of physical therapy were used in the treatment of all patients: magnetotherapy, electrotherapy, physical therapy and massage. All patients underwent computer or magnetic resonance imaging of the spine before the start of treatment and 1 year after the end of treatment with an assessment of the presence or absence of hemangioma growth in dynamics. RESULTS: In 94 patients with degenerative-dystrophic diseases of the spine in combination with non-aggressive vertebral hemangioma, who received various methods of physiotherapy, a different proportion of cases of increase in the size of vertebral hemangioma was noted upon repeated examination after 1 year. At the same time, in no case did the vertebral hemangioma acquire signs of aggressiveness. The minimum frequency of increasing the size of vertebral hemangioma was noted in patients after magnetic therapy, therapeutic gymnastics and massage. As a result of the use of magnetotherapy, electrotherapy, therapeutic gymnastics and massage in 60 patients, the growth of vertebral hemangioma was detected only in 1 case. CONCLUSION: In patients with degenerative-dystrophic diseases of the spine, local low-frequency electrotherapy, magnetic therapy, physical therapy and therapeutic back massage did not significantly affect the frequency of cases of increase in the size of vertebral hemangioma. The possibility of using other methods of physiotherapy in the treatment of patients with degenerative-dystrophic processes of the spine in the presence of non-aggressive vertebral hemangioma requires further research.
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