ebook ebooks e-book e-books downloaden bei MyEbooks.ch downloaden

Lymphedema Diagnosis and Treatment

:	Lawrence L Tretbar, Cheryl L. Morgan, Byung-Boong Lee, Simon J. Simonian, Benoit Blondeau
:	Lymphedema Diagnosis and Treatment
:	Springer-Verlag
:	9781846287930
:	1
:	CHF 85.40
:

:	Klinische Fächer
:	English

:	74
:	Wasserzeichen/DRM
:	PC/MAC/eReader/Tablet
:	PDF

A comprehensive, evidence-based introduction to the area of lymphology, the book is directed mainly to the US audience and will appeal to an interdisciplinary field of health professionals. It describes the unique anatomy and physiology of the lymphatic system and the intimate relationship it shares with the venous system. It explores the differential diagnosis of the 'swollen leg/arm', which is often the presenting problem to the health care professional. The necessity of history taking, physical examination and laboratory studies are noted. Treatment methods are described as an introduction and psychosocial and quality of life issues are explored in depth.

"5 Medical Management of Lymphedema (S. 43-44)

Cheryl L. Morgan

Historical Review

While chapter 1 documents the early lymphatic discoveries, many of today’s interventions developed from investigations into the causes and management of lymphedema over the past 2 centuries. In the 1870s, Still, the founder of the American School of Osteopathy, created an approach to manual therapies acknowledging the lymphatics as a vital system and designed to correct anatomical deviations that interfered with the ? ow of lymph and blood.

Still proposed a relationship in which cerebrospinal ? uid is reabsorbed by the lymph, a relationship supported by recent research (1). In the 1890s, Winiwarter, an Austrian physician from Vienna, described a treatment for swollen limbs that seems surprisingly similar to that recommended today; the conservative treatment included elevation, compression, massage, and exercise. Unfortunately, Winiwarter’s suggestions were not advanced further for some time (2).

A few decades later, in the 1920s, Miller developed the Miller thoracic pump technique, which he described as effective in creating intrathoracic pressure changes on lymphatic ? ow. Many of the conditions that he treated successfully with this technique include forms of edema (3,4). In 1922, Millard published the ? rst osteopathic medical textbook examining only the lymphatic system, Applied Anatomy of the Lymphatics, and was the founder and president of the International Lymphatic Research Society in Kirksville, MO (5). In the 1930s, Vodder and his wife began working with manual techniques to affect lymph ?ow.

Although the Vodders were Danish, the majority of their work was performed and published in France, where they lived and worked from 1928 to 1939. Here they developed their technique, then called lymph drainage massage. They later coined the term manual lymph drainage. The Vodder technique of lymph drainage is the most widely taught component of conservative lymphedema treatment (6,7). In the 1960s, Asdonk, a German physician, scienti? cally tested the Vodder technique of manual lymph drainage in his clinic on 20 000 patients. From this research, he established the indications, contraindications, and effects of the techniques (8).

In the following decade, the Földis combined the Vodders’ manual lymph drainage with bandaging, exercise, and speci? c skin care into the treatment program termed complete decongestive physiotherapy (CDP), later renamed complete decongestive therapy (CDT) (9). The Földis’ many contributions to lymphology include their extensive research as well as directing the Földi Clinic in Germany. The ? rst North American lymphedema treat- ment centers opened in the 1980s, where specially trained therapists initiate the use of CDT to treat lymphedema patients. In the 1990s, an increase of scienti? c literature, patient awareness, and interested therapists and physicians stimulates an increase of treatment centers in the United States. In 1992, Medicare (KS) approves CDT treatment for lymphedema.

In 1999, a new CPT code describing manual therapies, including manual lymph drainage (97140), is approved by the American Medical Association. In recent years, continued use of CDT has encouraged controlled clinical studies and research to focus on quality of life, treatment outcomes, and cost effectiveness. The American Society of Lymphology (ASL) has initiated efforts to standardize educational requirements of health care professionals treating disorders of the lymphatics. Legislation has been introduced by the National Lymphedema Network (NLN) to improve reimbursement for medical supplies for lymphedema.

Research has moved to the forefront thanks to the Lymphatic Research Foundation (LRF). Among individuals, Australian physicians Casley-Smith devoted more than 40 years to research, treatment, and the education of therapists (10). Their abundant and diverse research using the electron microscope has received worldwide recognition. The signi? cant contributions through the Centers for Disease Control and Prevention led by Dreyer and Addiss in the treatment of ? larial lymphedema and vector control (11) have produced extraordinary developments that will bene? t millions suffering with dis? guring conse- quences of parasitic infection."

	Foreword	5
	Preface	6
	Table of Contents	8
	1 Structure and Function of the Lymphatic System	9
	Early Investigations	9
	Lymphatic Embryology	12
	Configuration of the Lymphatic System	13
	Prelymphatic Tissue Channels	13
	Lymph Capillaries	13
	Lymph Precollectors	13
	Lymph Collectors	14
	Peyer Patches	14
	Lymph Ducts	14
	Lymph Nodes	15
	Functions of the Lymphatic System	16
	Interstitial Fluid/Edema	16
	Fluid Exchanges	16
	Diffusion	16
	Osmosis	17
	Spontaneous Contractions	17
	Immune System	17
	Natural, Nonspecific Immunity	17
	Specific Immunity	18
	Antibodies	18
	Summary	18
	References	18
	2 Differential Diagnosis of Lymphedema	20
	Pathophysiology of Edema	20
	Lymphatic Causes of Edema	20
	Primary Lymphedema	20
	Secondary Lymphedema	20
	Infection	20
	Inflammation	21
	Cancer Treatment and Other Types of Trauma	21
	Other Causes of Edema	23
	Chronic Venous Insufficiency	23
	Hypoalbuminemia	23
	Drug-induced Edema	23
	Differential Diagnosis of Edema	23
	Duration and Distribution	23
	Dermatologic Changes	24
	Diagnostic Laboratory Tests for Systemic Disease	24
	Testing for Venous Disease	24
	Testing for Lymphedema	24
	Lipedema	26
	Summary	28
	References	28
	3 Classification and Staging of Lymphedema	29
	Introduction	29
	Condition	29
	Classification	29
	Primary Lymphedema	29
	Secondary Lymphedema	30
	Staging	31
	Current Staging Methods	31
	Földi Method of Staging	33
	Pitting Edema Scale	33
	Staging by Limb Size	33
	Staging by Clinical Symptoms	33
	Location, Volume, Fibrosis Scale	34
	Proposed Staging of Lymphedema	34
	Clinical Staging	34
	Laboratory Staging: Lymphangioscintigraphy	35
	Quality of Life	35
	Outcome Measurements	36
	Summary	37
	References	37
	4 Lymphatic Malformation	39
	Truncular Forms	39
	Primary Lymphedema	39
	Diagnosis	39
	Management	40
	Outcome Assessment	40
	Extratruncular Forms	41
	Diagnosis	41
	Management	41
	Sclerotherapy	42
	Excision	43
	Outcome Assessment	44
	Lymphangiosarcoma	44
	Lymphangioma Circumscriptum	44
	Lymphangiomatosis	45