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Volumetry by communicant chambers in lymphedematous upper limbs: reliability of the intra and intertesters measurements and its accuracy compared with the current gold standard

Grant number: 10/11552-6
Support type:Regular Research Grants
Duration: August 01, 2011 - July 31, 2014
Field of knowledge:Health Sciences - Medicine
Principal Investigator:Fausto Miranda Júnior
Grantee:Fausto Miranda Júnior
Home Institution: Escola Paulista de Medicina (EPM). Universidade Federal de São Paulo (UNIFESP). Campus São Paulo. São Paulo , SP, Brazil
Assoc. researchers: Rogério Mendonça de Carvalho

Abstract

The evaluation of limb's volume is essential for the follow up of the appendicular edema's evolution from any aetiology. That evaluation constitutes an objective datum that will serve as diagnostic, prognostic and guiding basis for the resolvability of the adopted therapeutic strategy (Carvalho, 2007). According to Deltombe et al. (2007), the precise determination of the lymphedematous upper limb's volume has three important goals, being: (1º) the early diagnosis of lymphedema enabling appropriate treatment before clinically significant lymphedema develops, as known that delayed intervention in reducing lymphedema may result in poor functional outcomes; (2º) to follow the volumetric evolution of the lymphedema and monitor the effects of treatment. Many therapeutic modalities such as manual lymphatic drainage, pneumatic compression or bandaging are effective in reducing the volume of upper limb lymphedema but individual responses to these different treatments are often variable and largely unpredictable. Precise knowledge of the volume decrease subsequent to a given treatment (lymphatic drainage or compression for instance) may help to determine the most effective treatment for each patient in order to propose individual programs based on the objective results obtained by previous treatments; (3º) to facilitate comparison of different treatments and methods applied to a large population of patients in order to objectively compare them.The present draft gives sequence to a successful study funded by FAPESP from 2005 to 2007 (process 05/55240-0) about a new device developed for the objective assessment of limbs' volumes, the communicant chambers volumeter, equipment already patented (PI 0502899-0 A) in partnership with the Federal University of São Paulo.Unlike the traditional technique that uses the overflow as the only mechanism for fluid displacement, the volumetry by communicant chambers unites the Archimede's Law for submerged bodies to the Pascal's Principle of the hydraulic presses. Composed by three interconnecting chambers, being an immersion vat for the upper limb, a graduated volumetric column and a balloon for suction of residual air, all forming a hermetic system during the segment evaluation, the concept of the device allows the systematic elimination of several disadvantages related to overflow, such as the delay of the exam, the contraindication in cases of open or dressed wounds, the necessity of the transfer and weighing the displaced liquid (indirect measurement) and the patient's embarrassment about having to wet his (her) upper limb.The study will be of quantitative type, with prospective clinical trial and sample consisting by 30 (thirty) female volunteer patients, with ages ranging from 18 to 60 years, carriers of uni or bilateral upper limb's lymphedema. Shall be excluded patients who are undergoing corticotherapy treatment, the carriers of decompensated circulatory disorders, rheumatic diseases that affect peripheral joints, those in vigency of infection and persons allergic to the material of glove used for the introduction of the upper limb into the immersion vat.The population to be invited will be selected among the patients seen routinely by Mastology Clinic of Federal University of São Paulo.A total of 540 tests will be made in 6 days, being 270 by the communicant chambers volumetry and 270 by the overflow volumetry, with distribution of 5 lymphedematous limbs evaluated per day, until completed 30 segments measured by both techniques. Each lymphedematous upper limb will be measured 3 times for each one of 3 independent evaluators, using each one of the 2 volumetric methods, totalizing 18 measurements per affected limb. (AU)

Scientific publications
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
DE CARVALHO, ROGERIO MENDONCA; MIRANDA JR, FAUSTO. Communicating vessels volumeter to measure upper extremity lymphedema after breast cancer: reliability and criterion validity compared to the gold standard. BRAZILIAN JOURNAL OF PHYSICAL THERAPY, v. 23, n. 6, p. 532-540, NOV-DEC 2019. Web of Science Citations: 0.

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