Page 3 - III-Congresso Nazionale ITALF

LA MATRICE SERBATOIO O NETWORK
S. Michelini (Roma)
1) LYMPHODEMA, CONSIDERED BY THE WORLD HEALTH ORGANIZATION AS AN ILLNESS WELL DEFINED BY OFFICIAL IDENTIFICATION CODES, CONSTITUTES, FOR BOTH PRIMARY AND SECONDARY FORMS, A CLINICAL STATE TO BE CHRONICALLY ADMINISTERED
2) IN SOME CASES THE DISEASE IS ALREADY IDENTIFIABLE AT THE FETAL LEVEL WITH APPROPRIATE ULTRASOUND EXAMINATIONS. IT MUST BE FOLLOWED OVER TIME, AND IN THE COURSE OF PROGRESSIVE AND DEGENERATIVE CHRONIC DISEASES, NEONATAL FORMS ALSO AFFECT PSYCHOLOGICALLY BY ACCOMPANYING THE PATIENT FOR THE REST OF HIS LIFE FROM THE VERY FIRST MOMENTS.
3) THE MONITORING OF LYMPHEDEMA REPRESENTS A VERY DIFFICULT PRACTICE FOR ALL THE REHABILITATIVE TEAM, AS FOR THE POSSIBLE CLINICAL COMPLICATIONS AND FOR THE OEDEMA IMPROUVEMENT CONTROL.
4) INFORMATION IS CRUCIAL AND MUST INVOLVE, ABOVE ALL IN THE ADOLESCENT AND SENILE AGES, AT LEAST THE LEADER OF THE FAMILY FOR A CORRECT THERAPEUTIC DIAGNOSTIC APPROACH.
5) AMONG THE SECONDARY FORMS OF LYMPHEDEMA THOSE RELATING TO THE OUTCOMES OF CANCER TREATMENTS ARE THE MOST FREQUENT AND YOU SEE FROM THE NUMBERS THAT TUMOR DISEASE HAS BECOME A WIDESPREAD ILLNESS.
6) BUT, THANKS TO THE NEW THERAPIES, THE AVERAGE SURVIVAL OF THE SICK IS INCREASING AND THIS ENTAILS A GREATER INCIDENCE OF SOME COMPLICATIONS THAT ARISE OVER TIME: AMONG THEM THE SECONDARY LYMPHOEDEMA.
7) FOR EXAMPLE, AT LEAST ONE-QUARTER OF WOMEN WHO HAVE UNDERGONE BREAST CANCER TREATMENT ARE FACING THE COMPLICATION OF SECONDARY LYMPHOEDEMA THAT ALWAYS REMINDS HER OF THE DISEASE THAT CAUSED IT. THIS AMERICAN WRITER, DANIEL STEAL, HAS WELL DESCRIBED THE PSYCHOLOGICAL, RELATIONAL AND SOCIAL CONSEQUENCES OF THESE CLINICAL ASPECTS.
8) THE MANAGEMENT PROJECT HAVE AT LEAST THREE GOALS. FIRST OF ALL THE REDUCTION OF VOLUME AND CONSISTENCY, SECOND ONE TO OBTEIN A PHYSICAL AND PSYCHOLOGICAL BALANCE COMPATIBLE WITH ADEQUATE REPORT LIFE; THE TIRD END POINT CONSISTS IN AN ADEQUATE CONTROL OF PATHOLOGY IN TIME AND SECONDARY PREVENTION.
9) THE MANAGEMENT PROJECT MUST INCLUDE THE COMBINED PHYSICAL TREATMENT, WHEN INDICATED THE SURGICAL TREATMENT, DRUGS AND THE DAILY USE OF THE TAILORED ELASTIC GARMENT.
10) SURGICAL TREATMENT INCLUDE SOME OF TECHINQUES: MICROSURGERY, SUPRAMICROSURGERY, LYMPHNODES TRANSPLANTATION AND OTHER PLASTIC SURGERY APPLICATIONS; ACTUALLY PERFORMED IN VERY FEW CENTRES AT WORLD LEVEL.
11) IN HTE CASES OF MORE INCIDENT SECONDARY LIPOEDEMA SOME SCHOOLS PROPOSE THE LIPOSUCTION TREATMENT, FOLLOWED BY THE PHYSICAL TREATMENT.
12) IN OTHER CASES THE REDUCTIVE PLASTIC SURGERY CAN HELP US TO PRESCRIBE THE PROPER TAILORE ELASTIC GARMENT TO THE PATIENT.
13) PHYSICAL TREATMENT MUST INCLUDE ALL THE MANUAL AND MECHANICAL THERAPIES, PERFOMED BY SANITARY OPERATOR WITH ADEQUATE SPECIFIC CULTURAL BACKGROUND.
14) BUT BEST RESULTS WE OBTEIN WHEN THE REHABILITATIVE TIME (I REMEMBER YOU THE MEANING OF THE TERM ‘TIME’: TOGHETER EVERIBODY ACHIEVES MORE) INCLUDE ALL THE POSSIBLE PROTAGONINSTS OF THE CURE, FIRST OF ALL THE SAME PATIENT, VERY WELL INFORMED ABOUT ITS ILLNESS.
15) THE REHABILITATIVE PROTOCOL, WHICH MAKES TO AVOID THE MONOTHERAPIES, MUST BE PERSONALIZED IN ANY SINGLE CLINICAL CASE.
16) AND MUST INCLUDE, ABOVE ALL IN SECONDARY LYMPHOEDEMA, THE OCCUPATIONAL THERAPY.