Background Lymphedema is a clinical condition resulting from the accumulation of macromolecules in the interstitial space with a consequent buildup of fluids. Aim The objective of this study was to compare the therapeutic response to treatment that mobilizes fluids between primary and secondary lymphedemas. Method Thirty-three patients with severe leg lymphedema who underwent intensive treatment for five consecutive days in 2013 and 2014 at the Clínica Godoy were evaluated in a prospective clinical trial. Diagnosis was based on the patient's history and physical examination. Treatment consisted of eight hours/day of Mechanical Lymphatic Therapy using an electromechanical device (RAGodoy®) that performs plantar flexion and extension associated with 15 minutes of Cervical Lymphatic Therapy, a technique developed by Godoy and Godoy that involves stimulation in the cervical region and a grosgrain compression stocking alternated with elastic bandages. The unpaired t-test and Fisher's exact test were used for statistical analysis with an alpha error of 5% (p value < 0.05) being considering acceptable. Secondary lymphedema was more prevalent in women (Fisher exact test p value < 0.01). Results The age of patients with secondary lymphedema was greater than those with primary lymphedema (unpaired t-test: p value < 0.03). The mean volume losses were 64.62% and 48.35% for the patients with secondary and primary lymphedema, respectively (p value < 0.03). Conclusion Women are more prevalent and older in the secondary lymphedema group. Volumetric reductions below the knee are faster with intensive treatment for secondary rather than for primary lymphedema.
Background: The differential diagnosis of gallbladder adenomyomatosis is not always easy and, many times, the option is surgical. The aim of the present study was to report the diagnostic strategy for gallbladder adenomyomatosis in an asymptomatic older patient. Case presentation: A 76-year-old female patient was sent to the digestive tract surgery service of the Cuiabá Santa Casa Hospital in Brazil due to evidence of polyps in the gallbladder diagnosed by tomography during the follow-up of repeated urinary infections. The tomogram revealed irregular thickness with the densification of adipose planes of the fundus of the gallbladder without dilation of the bile ducts. Magnetic resonance cholangiopancreatography was performed for a better assessment of the gallbladder and biliary tree. The exam revealed heterogenous intraluminal structures in the fundus region of the gallbladder, with focal points of hypersignals in T2 and an area highlighted by the para-magnetic contrast medium measuring 2.0 cm along the longest axis and colonic diverticulosis with no signs of infection. Surgery was performed and the histopathological analysis revealed gallbladder adenomyomatosis. Conclusion: In cases of diagnostic doubt and considering the possibility of malignancy, the option should be surgery.
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