PubMed · 999508
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R P Saik. 1976. An improved rectal pack.. https://doi.org/10.1001/archsurg.1976.01360300096017
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An important sequela of cancer treatment is lymphedema. Management of this condition must be based on the physiologic functioning of the lymphatic system and tailored to the individual patient's presentation of the disease. Early diagnosis and treatment are essential to prevent worsening of the condition and to help assuage the psychologic impact of the disease. A review of the normal and impaired lymphatic system is presented in this article. Current assessment and treatment options are described, including education of patients in precautions, positioning, exercise, compression garments and bandages, pneumatic pumps, and lymphatic massage. Also included is a discussion of the psychologic impact of the disease as well as management of psychologic symptoms. Various strategies for management of the physical aspects of lymphedema are available. Studies have shown that use of physical treatments such as exercise, compression, and lymphatic massage are effective in reducing the amount of swelling in affected limbs. The specific type, amount, and combination of these treatments continues to be debated. The development of lymphedema is commonly associated with significant psychologic distress that can impact on compliance with physical treatments. Because there is no consensus as to the optimal treatment approach for management of lymphedema, additional research must ensue to determine the efficacy of existing treatments and to develop new management techniques. Clinicians must be attuned to the signs and symptoms of lymphedema in order to make prompt referrals for treatment.
BACKGROUND: Stockings for thrombosis prophylaxis (MTS) are generally advised for all immobilized patients by the German Societies of Surgery, Orthopedics, and Phlebology. In critical care patients, the indication is unclear and many questions are left unanswered, especially if combined with heparins for prophylaxis of thromboembolism. We evaluated the customary use of MTS in critical care patients. METHODS: A multiple choice questionnaire was sent to the nursing staff of 324 randomly selected German non-surgical ICUs. The answers of 144 units (44.4%) could be evaluated, 15 of which were special neurology, 88 special internal medicine, 41 mixed. RESULTS: Each 8th ICU principally avoids MTS, each 19th ICU principally provides all patients with MTS. Of those who use special indications, the degree of immobilisation plays an indecisive role with 50% for and 50% against MTS. In particular, coma serves as a contraindication. Effective anticoagulation excludes the need for MTS in half of the ICUs. Polyneuropathies and dysesthesias are the far most noticed arguments against MTS. CONCLUSIONS: There seems to be an uncertainty about the indication of MTS for non-surgical critical ill patients. With respect to available guidelines, a decision in principle for MTS should be made. However, in the individual patient with relative contraindications and progressively effective anticoagulation, MTS may be dispended relatively liberally.