Proteolytic enzymes in lymphedema therapy

Slovenský Lekár 2000, číslo 9-10, str. 355-360 - ISSN 1335-0234

(17-14-2)

Czech summary, summary in German 

The goal of this study was to establish the effect of Wobenzym as an additional medical therapy to the standard treatment of lymphedema. Methods: Clinical examination, duplex sonography, radionuclide lymphoscintigraphy, CT and MRI established the diagnosis of lymphedema in 52 patients. Patients were divided into three groups: 1. - Primary lymphedema of the lower extremity - twelve patients, II. - Secondary lymphedema of upper extremity following breast cancer surgery - twenty patients, III. - Secondary lymphedema of low extremity following erysipelas - twenty patients. As standard treatment of lymphedema is nowadays considered complex decongestive therapy (CDT). It is a combination of manual lymph drainage, sequential gradient pneumatic therapy, special excercises including aquatherapy and bandaging. After four weeks of CDT randomly selected half of the patients in all groups (I.B, II.B, III.B) received 9 Wobenzym tablets daily with standard CDT for following 6 weeks and the remaining patients in all groups (I.A, II.A, III.A) continued in the standard CDT only. Subjective symptoms by questionnaire method, extremity volume differences measurement, centripetal fraction of venous flow by duplex sonography and serum levels of liver enzymes, creatinine and minerals were monitored.
Results:
Subjective symptoms: Group I. After 4 weeks therapy 42,6 percent, group I.B 10,4 percent (p<0,00043) Group II. After 4 weeks therapy 56,3 percent, group II.B 11,2 percent (p<0,0004) Group III. After 4 weeks therapy 42,5 percent, group III.B 5 percent (p<0,0002)
Extremity volume in cm³: Group I. After 4 weeks therapy 10,08±0,35, group I.B 9,3±0,3 (p<0,005) Group II. After 4 weeks therapy 2,9±0,2, group II.B 2,3±0,16 (p<0,004) Group III. After 4 weeks therapy 9,95±10,23, group III.B 6,8±0,2 (p<0,003)
Centripetal fraction of venous flow in ml/min: Group 1. After 4 weeks therapy 50,1±0,62, group I.B 69,5±0,68 (p<0,005) Group II. After 4 weeks therapy 11,4±0,5, group II.B 19,5±0,6 (p<0,004) Group III. After 4 weeks therapy 72,2±0,8, group III.B 92,3±0,92 (p<0,003)
No adverse effect or significant changes in laboratory data, serum levels of creatinin, liver enzymes or minerals were observed. Conclusion: Adding Wobenzym to complete standard therapy significantly improves subjective and objective parameters of lymphedema.
Key words: protheolytic enzymes, Wobenzym, lymphedema therapy