title: Decongestion improves cell-mediated immunity in postmastectomy arm lymphoedema: a pilot study.
abstract: BACKGROUND
  Chronic lymphoedematous limbs have an increased propensity for infections and primary or secondary malignant tumours. It has been attributed to suppressed delayed-type hypersensitivity measured in lymphoedemas related to Stewart-Treves syndrome, Kaposi's sarcoma or breast cancer treatment. Cell-mediated immunity is an effective defence mechanism against bacteria, fungi, viruses and tumour cells.
  
  
  OBJECTIVE
  We aimed to examine whether decongestive lymphoedema therapy could improve cell-mediated immunity in breast cancer treatment-related lymphoedema (BCRL).
  
  
  METHODS
  Eight women with unilateral BCRL were included in this study. At baseline, tuberculin skin test (TST) was performed on the volar surfaces of the forearms of the affected and non-affected sides using 0.5, 1 and 5 tuberculin units in the form of three consecutive injections with 3-cm spaces in-between, and arm volumes were measured using the Kuhnke's disc model. Decongestive lymphatic therapy was given to swollen arms in 10 consecutive working days. At the end of intensive decongestion, TST on affected side and bilateral volumetry were repeated.
  
  
  RESULTS
  Baseline test using undiluted (5 units) and fivefold diluted (1 unit) tuberculin solutions has shown significant differences (P < 0.05) between the mean sizes (11.81 ± 2.32 and 7.75 ± 1.92; 7.12 ± 1.12 and 5.12 ± 0.91 respectively) in favour to healthy arms. Post therapeutically, the mean sizes were significantly increased (P < 0.05) in the dilutions of 1 : 1 and 1 : 5 (7.75 ± 1.92 and 10.56 ± 1.23 mm, 5.12 ± 0.91 and 5.93 ± 1.74 mm respectively).
  
  
  CONCLUSIONS
  Significant increase in TST sizes suggests that decongestive lymphatic therapy is able to partially restore impaired cellular immune function in BCRL.
authors: Department of Dermatology and Allergology, Szeged University, Szeged, Hungary, and Dermatological Research Group, Hungarian Academy of Sciences, Szeged, Hungary.
authors: G
authors: G
authors: Szolnoky
authors: A
authors: A
authors: Dobozy
authors: L
authors: L
authors: Kemény
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007111:Immunity, Cellular; D008209:Lymphedema / Q000209:etiology / Q000276:immunology / Q000628:therapy*; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D010865:Pilot Projects; D011184:Postoperative Period