Upper limb lympedema is a frequent consequence of breast cancer treatment. The International Society of Lymphology recommends physical therapy for lymphedema management. This treatment includes a combination of
manual lymphatic drainage and high-compression bandaging. Actually, the effectiveness of manual lymphatic
drainage remains an area of controversy, especially because of the many different techniques called “manual lymphatic drainage” since 1930. The purpose of this review was to emphasise the efficacy of these different techniques according to physiological data and evidence-based practice. To improve the manual lymphatic drainage
efficiency, the pressure, sometimes important, should be tailored to each edema and the techniques had to consider altered lymphatic drainage patterns. The methods used by physical therapist in the studies should be specified for higher lightness.
Résumé
Le lymphœdème du membre supérieur est une séquelle du traitement des cancers du sein. Le traitement physique
des lymphœdèmes est recommandé par la Société internationale de lymphologie. Il associe drainage lymphatique
manuel et bandages de décongestion. Le drainage lymphatique manuel a fait l’objet de critiques quant à son effi-
cacité. Or depuis son invention dans les années 1930, de très nombreuses techniques s’intitulent « drainage lymphatique manuel ». Les auteurs distinguent l’efficacité de ces différentes techniques en fonction des données de la
physiologie lymphatique et de la démonstration de ses effets basée sur les faits. Pour améliorer son efficacité, le
drainage lymphatique manuel doit être appliqué sur l’œdème avec une pression adaptée à la consistance de
l’œdème, parfois élevée. Les manœuvres doivent prendre en considération les trajets remaniés des collecteurs lymphatiques. Les études qui l’utilisent doivent décrire la technique utilisée. 相似文献
Upfront resection is becoming a rarer indication for pancreatic ductal adenocarcinoma, as biologic behavior and natural history of the disease has boosted indications for neoadjuvant treatments. Jaundice, gastric outlet obstruction and acute cholecystitis can frequently complicate this window of opportunity, resulting in potentially deleterious chemotherapy discontinuation, whose resumption relies on effective, prompt and long-lasting management of these complications. Although therapeutic endoscopic ultrasound (t-EUS) can potentially offer some advantages over comparators, its use in potentially resectable patients is primal and has unfairly been restricted for fear of potential technical difficulties during subsequent surgery. This is a narrative review of available evidence regarding EUS-guided choledochoduodenostomy, gastrojejunostomy and gallbladder drainage in the bridge-to-surgery scenario. Proof-of-concept evidence suggests no influence of t-EUS procedures on outcomes of eventual subsequent surgery. Moreover, the very high efficacy-invasiveness ratio over comparators in managing pancreatic cancer-related symptoms or complications can provide a powerful weapon against chemotherapy discontinuation, potentially resulting in higher subsequent resectability. Available evidence is discussed in this short paper, together with technical notes that might be useful for endoscopists and surgeons operating in this scenario. No published evidence supports restricting t-EUS in potential surgical candidates, especially in the setting of pancreatic cancer patients undergoing neoadjuvant chemotherapy. Bridge-to-surgery t-EUS deserves further prospective evaluation. 相似文献
BACKGROUNDThe management of vascular graft infections continues to be a significant challenge in a clinical situation. The aim of this report is to illustrate the novel vacuum sealing drainage (VSD) technique and rectus femoris muscle flap transposition for vascular graft infections, and to evaluate the prospective of future testing of this surgical procedure.CASE SUMMARYWe report the case of a 32-year-old male patient, who presented a severe infected groin wound with biological vascular graft Acinetobacter baumannii infection resulting in extensive graft exposure. Using the VSD and muscle flap trans-position, the groin wound and vascular graft infection were finally treated successfully.CONCLUSIONOur case report highlights that VSD technique and rectus femoris muscle flap transposition could be considered in patients presenting with a severe infected groin wound with biological vascular graft Acinetobacter baumannii infection resulting in extensive graft exposure, especially in consideration of treatable conditions. 相似文献