Autor/en: Benoit Blondeau, Byung-Boong Lee, CherylL. Morgan, SimonJ. Simonian, LawrenceL. Tretbar
Dateigröße in MByte: 21.
6. Mai 2010 - pdf eBook
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.
Anatomy and physiology of the lymphatic system.
Differential diagnosis of the swollen leg/arm.
Treatment of lymphedema.
Evaluation and treatment of lympho/venous disease.
Quality of life and other human concerns.
"5 Medical Management of Lymphedema (S. 43-44)
Cheryl L. Morgan
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 th
e 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."
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