Savinov V. A. «UPPER EXTREMITY ELEPHANTIASIS
AFTER RADICAL MAMMECTOMYLEECH THERAPY »
Background.
There was a problem to find out the possibility for upper extremity elephantiasis treatment in woman, who underwent the operatiation in case of breast cancer. This method is based on leech secret characteristics- lymphotropic and hialuronidaza activity /M. V. Dorogova, 1935; G. I. Nikonov, 1992/ and experimential and clinical efficacy of hirudotherapy in the treatment of malignant tumours. /V. A. Savinov, 1994, Khomyakov Yu. N., a.o 1995, 1998/
Materials and methods.
24 patients had the course of leech treatment for the period of 5 years /1994 — 1999/. The patients had upper extremity elephantiasis after the operation on breast tumour and regional affected lymphnodes. The age of patients was 39-56, period after the operation was from 2 to 15 years. Leeches were applied on postoperative scars, hepatic zone, on the zone of processus xiphoideus, the zone above clavicular and on the biological active points. The seanses of hirudotherapy were 2 times a week, the course of treatment included 7-11 seanses. Every course was accompanied by injections of heparinum (1250 ED) subcutaneously in hepatic zone 4 times a day during 5 days. 3 patients underwent 1 course of treatment /the 1st group/, with interval of 3 months.
Results.
Results were evaluated for 2 years. After the first 3-4 seanses the discomfort (heaviness) in affected extremity abated, the skin became warm on palpation in every patient. The 1st group: circumference of the shoulder in the middle 1/3 reduced in 3-4sm, the volume of movements in shoulder joint and the elbow joint increased slightly. The 2nd group: circumference of the shoulder in the middle. 1/3 reduced in 3-4sm, the volume of movements in shoulder joint and the elbow joint increased slightly. The 2nd group: 4 patients — circumference of the shoulder reduced in 8-9 sm, the movements in joints repaired completely; 7 — circumference of the shoulder reduced in 7-8 sm, the volume of motive activity increased considerably; 4 — circumference of the shoulder reduced in 7-8 sm, the volume of activity increased slightly. The 3rd gruop: 2 patients — the volume of motive activity in joints repaired completely, the affected extremity became normal size as contralateral one; 3 — the movementin joints without any limitation, the patients could make a first, the oedema became insignificant in comparison with contralateral extremity.; 1 — circumference of the shoulder reduced 5-6 sm, the volume of motive activity in joints increased considerably.
Conclusions.
1. Hirudotherapy is the effective method in the treatment of upper extremity elephantiasis in women who had the operation on breast cancer with metastases.
2. Mechanism of hirudotherapy in patients with elephantiasis could be probably explained by lymphotropic property of leech secret, and also activity of hialuronidaza, which can restore the penetrability of histohematic barriers.