Primary Congenital Lymphedema with More Than 10 Years of Treatment Using the Godoy Method Through to Adolescence

Introduction: Lymphedema is a specific type of edema that affects regions of the body in a chronic, progressive manner. Aim: The aim of the present study was to describe the therapeutic evolution of more than ten years of treatment for primary congenital lymphedema using the Godoy and Godoy method. Method: Ten children with primary congenital lymphedema with more than ten years of treatment at the Godoy Clinic were evaluated. Children with a clinical diagnosis of primary congenital lymphedema in treatment for more than 10 years with the Godoy Method. Cervical stimulation is the first treatment option of the method and is performed as monotherapy. The patients were reevaluated with weekly, bi-weekly and monthly frequencies and then every three months or when the family was able to return to the clinic. Results: For cases in which cervical stimulation was not possible, grosgrain stockings as monotherapy was the second therapeutic option. Conclusion: The Godoy and Godoy Method is effective at reducing edema in cases of primary congenital lymphedema, with the maintenance of the results throughout the treatment period.

Sensory Stimulation of Oxytocin Release Is Associated With Stress Management and Maternal Care

It has been shown that various types of stress initiate different physiological and neuroendocrine disorders. Oxytocin (OT) is mainly produced in the supraoptic nucleus (SON) and paraventricular nucleus (PVN) of the hypothalamus. Hypothalamic OT has antistress effects and attenuates the hypothalamic–pituitary–adrenal (HPA) axis. One mechanism behind the antistress effects of OT is mediated through the inhibition from GABAA receptors on corticotropin-releasing factor (CRF) expression at the PVN. Various manual therapies such as acupuncture, transcutaneous electrical nerve stimulation (TENS), and massage initiate the stimulation of somatosensory neurons of the body. It is well-known that TENS simulates OT expression, while it inhibits CRF expression at the PVN following chronic stress loading in rodents. Upregulation of OT expression at the hypothalamus is activated by the somatosensory stimulation, which is mediated via the spinothalamic pathway (the connection between the spinal cord and hypothalamus). Thus, somatosensory stimulation is beneficial in treating stress-associated symptoms. Hypothalamic OT is associated with the social behaviors, including maternal care and affiliation. Childhood neglect and/or child abuse are severely responsible for deleterious long-term effects on the cognitive/social activity and behavioral development. At parturition, a profound amount of OT is released into the systemic circulation in response to vaginal and cervical stimulation caused by the body of fetus, which induces the onset of maternal behavior. Peridural anesthesia effectively impairs the sensitivity to vaginal and cervical stimulation at parturition. OT levels in cerebrospinal fluid is significantly reduced following peridural anesthesia. The vaginal delivery mothers had significantly more OT pulses than the caesarian section (CS) mothers. Due to low levels of endogenous OT, maternal behavior could be interrupted by epidural anesthesia and CS at parturition because of the reduction of the usual sensory input from the genitalia.

Recruitment of Upper-Limb Motoneurons with Epidural Electrical Stimulation of the Primate Cervical Spinal Cord

ABSTRACTEpidural electrical stimulation (EES) of lumbosacral sensorimotor circuits improves leg motor control in animals and humans with spinal cord injury (SCI). Upper-limb motor control involves similar circuits, located in the cervical spinal cord, suggesting that EES could also improve arm and hand movements after quadriplegia. However, the ability of cervical EES to selectively modulate specific upper-limb motor nuclei remains unclear. Here, we combined a realistic computational model of EES of the cervical spinal cord with experiments in macaque monkeys to explore the mechanisms of this modulation and characterize the recruitment selectivity of cervical stimulation interfaces. Our results indicate that interfaces with lateral electrodes can target individual posterior roots and achieve selective modulation of arm motoneurons via the direct recruitment of pre-synaptic pathways. Intraoperative recordings suggested similar properties in humans. These results provide a framework for the design of neuro-technologies to improve arm and hand control in humans with quadriplegia.

Immediate effects of cervical stimulation and diaphragmatic release on vocal production

Introduction: The voice is heavily influenced by breathing and abdominal muscles. Objective: To verify the immediate effects of cervical stimulation and diaphragmatic release on the respiratory and phonatory function of adult women with no vocal complaints. Method: Relaxation maneuvers and eccentric work of the diaphragm were performed together with articulatory maneuver of the third cervical vertebra. Twenty-four women without vocal complaints, aged between 18 and 35 years were part of the intervention. All volunteers were submitted to an evaluation of respiratory muscle strength, maximum phonation time of the vowel /a/, sound pressure level and acoustic vocal analysis, before and after physiotherapeutic intervention. Statistical analysis consisted of the Student's t-test for independent samples and Spearman's correlation. Significance level was set at 5%. Results: There was a significant increase in the maximum phonation time of the vowel /a/ and in the modal sound pressure level. Regarding the acoustic analysis, there was a reduction in the standard deviation values of the fundamental frequency; in the smoothed pitch disturbance quotient; and in the fundamental frequency and amplitude variations. Conclusion: Cervical stimulation and diaphragmatic release improved vocal quality regarding duration of emission, sound pressure, and stability and noise of the glottic signal.

Lymphatic Drainage of Legs Reduces Edema of the Arms in Children with Lymphedema

Objective. The aim of the present study is to report on the reduction of edema of lymphedematous arms just by treating the lower limbs. Methods. A 16-year-old girl reported that she has started having right lower limb edema at the age of three. At age 13, she performed a lymphoscintigraphy that confirmed the diagnosis of primary lymphedema of the four limbs. Recently she sought treatment at the Clínica Godoy in São Jose do Rio Preto where she was submitted to intensive treatment for eight hours per day for five days using manual (Godoy & Godoy technique) and mechanical lymphatic therapy (RA Godoy®) of the lower limbs, cervical lymphatic therapy (cervical stimulation), and the continuous use of a grosgrain stocking. Results. At the end of treatment, reductions in the sizes of both arms and legs were noted even without the use of any specific therapy for the arms. After four years, the size of the arms was normal. Conclusion. Treatment of lymphedema of the legs has systemic repercussions that may lead to the reduction in swelling of other untreated regions of the body.

Evolution of Godoy & Godoy manual lymph drainage. Technique with linear movements

Manual lymph drainage has become the mainstay in the treatment of lymphedema for decades now. Five evolving variants have been described by Godoy & Godoy over the years: i) manual lymph drainage using rollers; ii) self-applied manual lymph drainage using rollers; iii) manual lymph drainage using the hands (manual lymphatic therapy); iv) mechanical lymphatic therapy using the RAGodoy® device; and v) lymphatic therapy using cervical stimulation in general lymphatic treatment. After breast cancer treatment using adapted technique with intermittent compression therapy. Lymphoscintigraphy, volumetry and bioimpedance were employed to analyze such treatment techniques applied to the upper and lower extremities. These treatment and evaluation topics are described in this brief report.

Considering the hypothesis of the pathophysiology of cellulite in its treatment

The aim of this study was to evaluate perimetric reductions in the clinical treatment of cellulite (aesthetics) using the Godoy method in a randomized retrospective clinical trial. The medical records of 150 patients treated for cellulite in the period from 2006 to 2011 in the Clinica Godoy were revisited. Treatment comprised manual and mechanical lymph drainage and cervical stimulation for one hour per day over 10 days. The paired t-test was used for statistical analysis, with an alpha error of 5% (P-value <0.05) being considered acceptable. This study was started after being approved by the Research Ethics Committee of the Medicine School in São José do Rio Preto (FAMERP - no. 395- 2010), Brazil and after being registered as a clinical trial. The mean reduction of the 150 patients was 3.81±2.76 g (P-value <0.0001; 95% confidence interval: 3.408-4.223). A significant reduction in size was seen with the clinical treatment of cellulite giving an improvement in the physical appearance. Pathophysiological mechanisms such as regional skin lymphostasis seem to be involved in the formation of cellulite.

Pattern of ovulation in an ancient, solitary mole-rat lineage: Heliophobius argenteocinereus emini from Tanzania

The genus Heliophobius Peters, 1846 is an ancient subterranean rodent lineage within the family Bathyergidae that displays seasonal breeding over a broad geographical range. In East Africa, reproduction in these solitary mole-rats has been shown to coincide with the long rains, but it is not clear whether the silvery mole-rat subspecies Heliophobius argenteocinereus emini Noack, 1894 from Tanzania is an induced or spontaneous ovulator. To address this, urinary progesterone was measured every second day over a period of 132 days in six wild-caught females subjected to three sequential experimental treatments. In the first, control (C) treatment, females were housed singly for a period of 44 days, following which nonphysical contact (NPC) with a vasectomised male and then physical contact (PC) with the same vasectomised male occurred in each of the subsequent 44-day treatments. Noninvasive monitoring of ovarian cyclicity confirmed that mean urinary progesterone concentration was higher during PC than during either NPC or C, despite the fact that the males were vasectomised and incapable of fertilising the females. Examination of penile morphology revealed that males possess epidermal projections on the glans penis, which probably bring about cervical stimulation during coitus. These findings together with the female progesterone profiles imply the species is an induced ovulator stimulated by penile intromission.

Intraoperative electrophysiological monitoring for C1–2 spinal cord stimulation

OBJECTIVE This study is a retrospective case series involving C1–2 spinal cord stimulation in patients with complex regional pain syndrome (CRPS) under general endotracheal anesthesia. Currently, C1–2 paddle lead placement is an accepted practice, which provides effective cervical stimulation to ameliorate upper-extremity and sometimes lower-extremity symptoms experienced by patients with CRPS. However, this technique must be performed under general endotracheal anesthesia rather than in an awake or semiconscious state due to intraoperative safety concerns and patient comfort. The authors aim to provide additional data to support the following novel technique: the use of somatosensory evoked potential (SSEP) diminution data to assist with proper midline placement of C1–2 leads under general anesthesia. METHODS SSEP median nerve (MN) and posterior tibial nerve (PTN) data were collected from 6 patients undergoing placement of C1–2 leads under general anesthesia. Fluoroscopy was used as an initial guide for proper anatomical midline placement. This was followed by the activation of the spinal cord stimulator and simultaneous collection of primarily MN SSEPs as well as PTN SSEPs for physiological midline placement. Unilateral and bilateral reductions in SSEPs assisted with the correct lateralization of the lead to ensure effective postoperative coverage according to the patient's individual preoperative symptoms. RESULTS Six patients were monitored using SSEPs and repeatable, reliable MN and PTN baseline responses were obtained from all. A reduction in amplitude ranging from 5% to 87% was observed, confirming inhibition of dorsal column conduction, and an average pain relief of 63% at short-term and 64% at long-term follow-up was recorded with 6 of 6 and 5 of 6 patients responding, respectively. CONCLUSIONS Intraoperative SSEP collision study testing appears to be a safe technique to monitor placement of C1–2 paddle leads intraoperatively under general anesthesia.