リンパ動態学からみたリンパ浮腫 Cervical nodes Sentinel node Subclavian vein R. lymph duct Thoracic duct Axillary nodes Cisterna chyli Abdominal nodes Inguinal nodes

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1 48 THE JOURNAL of JAPANESE COLLEGE of ANGIOLOGY Vol. 48,

2 リンパ動態学からみたリンパ浮腫 Cervical nodes Sentinel node Subclavian vein R. lymph duct Thoracic duct Axillary nodes Cisterna chyli Abdominal nodes Inguinal nodes Figure 1 The lymphatic system.1 Guyton: Circulatory Physiology 1975 Image used with the permission of Elsevier Inc. All rights reserved. んでいるが赤血球は含まず無色淡いクリーム色をリンパ浮腫の分類呈するまたタンパクの漏出量は75 195gでこの大部分は毛細リンパ管内に移行するとされている分類はTable 12 3 の通りであるが二次性が圧倒的にリンパ管系は基本的に体下部からのすべてのリンパ多く切除されるリンパ節の部位数病気の進行程液は左上肢左胸部や左頭部からリンパ液を合わせ胸度や術式放射線治療の有無などにより影響され個管に流れ込み次いで左内頸鎖骨下静脈への接合部人差も大きいに注ぎ込む右上肢右頸頭部肺の大部分からのリンパ液は右リンパ管に入り右鎖骨下と内頸静脈へリンパ浮腫の診断 4 5 の接合部で静脈に注ぎ込む Fig. 1 上肢または下肢の手術の既往と左右差のある患肢の色調の変化のないリンパ流が障害されると患肢の組織間隙内にタンパク無痛性腫脹から多くの場合診断は容易であるむくみが残り組織膠質浸透圧の上昇を来して水分を貯留さが急速に進んだ場合の皮膚の緊満感重圧感しびれせ浮腫を発生させることになるやむくみに起因する静脈うっ滞のために皮膚が青紫色になってくることもある浮腫の程度皮膚の硬さ弾力性伸展性湿潤度熱感角化シワ多毛や 160 脈管学 Vol. 48, 2008

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7 Lymphedema and the Lymphatic Dynamics Akio Hirota Hirota Internal Medicine Clinic, Tokyo, Japan Key words: lymphedema, CDP, elastic stocking, manual lymph drainage, cellulitis Lymphatic system acts as a safety valve in the connective tissue, as if an overflow drain prevents flooding in a bathtub. If for some reason this function is not fulfilled, edema develops. Lymphedema appears in most cases after surgery for breast cancer, uterine cancer and other cancers, manifesting as swelling of the upper or lower limbs. Conservative therapy of peripheral lymphedema is known as a complex decongestive physiotherapy (CDP), which involves a two-stage treatment program. The first phase consists of manual lymph drainage, range of motion exercise, skin care and compression typically applied with multi-layered bandage-wrapping. The CDP is performed exclusively on an inpatient basis in specialized hospitals. The second phase aims to conserve and optimize the results obtained in Phase 1. It consists of compression by a low-stretch elastic stocking or sleeve, skin care, exercise and repeated self lymphdrainage as needed. Important thing, however, is that these medical treatment can produce enough effects even if on an outpatient basis. (J Jpn Coll Angiol, 2008, 48: ) Online publication August 6,

The Journal of the Japan Academy of Nursing Administration and Policies Vol 7, No 2, pp 19 _ 30, 2004 Survey on Counseling Services Performed by Nursi

The Journal of the Japan Academy of Nursing Administration and Policies Vol 7, No 2, pp 19 _ 30, 2004 Survey on Counseling Services Performed by Nursing Professionals for Diabetic Outpatients Not Using