The development of a 'wet leg' pathway for chronic oedema.

Chronic oedema and leaking lymphorrhoea can be distressing and challenging for patients to live with. This article introduces the Chronic Oedema 'Wet Leg' Pathway, which became an output from the Lymphoedema Network Wales 'On the Ground Education Project' ( Thomas et al, 2017 ). The evidence-based pathway provides nurses and therapists with clear guidelines to support prompt, efficient and effective management of all patients with chronic oedema and wet legs. This article presents the evidence and demonstrates the benefits of timely active treatment for all patients with leaking lymphorrhoea, which includes decreasing pain and improving mobility and daily activities. Other benefits include reducing the risk of cellulitis and the development of chronic wounds. The pathway also demonstrates opportunities for the NHS by decreasing both the number of community nursing visits and the number of wound dressings used. By actively treating symptoms-rather than simply mopping up the leaking lymphorrhoea-this pathway demonstrates value-based health care by reducing waste, harm and variation within the NHS.

Extrapleural paravertebral CT guided fine needle biopsy of subcarinal lymph nodes.

PURPOSE: To report our experience in CT guided extrapleural paravertebral subcarinal lymph biopsy using a thin 25 gauge (25 G) thin needle without the need of injection of saline to widen the mediastinum. MATERIALS AND METHODS: Biopsy was performed using a 25 G needle which was advanced lateral to the vertebral body between the endothoracic fascia and the parietal pleura to gain access to subcarinal lymph nodes. One hundred and forty one patients were included in the study (74 females, 57 males). No artificial widening of the mediastinum using saline injection was required. The study was performed in the presence of a cytopathologist; sensitivity and specificity rates were calculated. Complications were documented for each case especially for pneumothorax and haemorrhage. RESULTS: Cytopathological diagnosis was reached in all cases. All re-aspirations were done in the same session to reach a primary diagnosis at the time of the biopsy. Imunophenotyping study was done in 94 cases to confirm the primary diagnosis and to classify the malignant lesions. No pneumothorax was encountered. Small haematomas were noted in 5 cases (3.5%). Cytopathology showed a sensitivity of 97.2% and specificity of 100%. By adding immunophenotyping a 100% sensitivity and specificity was achieved. CONCLUSION: Fine needle aspiration cytology (FNAC) using a 25 gauge needle for subcarinal lymph nodes via a percutaneous extrapleural paravertebral CT guided approach is a safe, minimally invasive, and tolerable procedure yielding a high sensitivity and specificity rates without the need of artificial widening.

Symptoms before, during, and 14 months after the beginning of treatment as perceived by patients with lymphoma.

PURPOSE/OBJECTIVES: To explore occurrence of symptoms and relationships between them as perceived by patients with lymphoma before, during, and 14 months after the beginning of treatment. RESEARCH APPROACH: Qualitative and longitudinal. SETTING: A major oncology center in the United Kingdom. PARTICIPANTS: 10 adult patients with lymphoma (3 women and 7 men) were recruited at treatment initiation. METHODOLOGIC APPROACH: Semistructured audiotaped interviews were conducted with participants in median 15 days, 4 months, and 14 months after diagnosis. Analysis of the verbatim transcripts was inspired by interpretive description, which is a grounded approach articulating patterns emerging in relation to clinical phenomena. MAIN RESEARCH VARIABLES: Symptoms. FINDINGS: Symptoms commonly reported by patients in this sample were lack of energy, lymphadenopathy, weight loss, itching, pain, sadness, night sweats, sleeping difficulties, and hair loss. Co-occurring prediagnosis symptoms seem to have led patients to seek medical attention; co-occurring symptoms during treatment seem to have a cumulatively distressing effect. Several of the symptoms were described as interrelated, with one symptom leading to one or more other symptoms. CONCLUSIONS: The data confirm a complex symptomatology in patients with lymphoma. In addition, the findings support that co-occurring symptoms may have a synergistic effect on patients' health outcomes and add new knowledge about relationships between symptoms from patients' perspectives. INTERPRETATION: Illustrating symptoms and interrelationships between symptoms using diagrams may be useful to support communication as well as in identifying targets for symptom management.

The community management of chylous fistula using a pancreatic lipase inhibitor (orlistat).

We describe two innovative ideas in the treatment of iatrogenic chyle leak. The first is the early use of a pancreatic lipase inhibitor (Orlistat) to reduce fat absorption and chyle production, with consequent faster fistula healing. The second is the treatment of these patients at home in the community by district nurses backed by the hospital staff. This domiciliary approach has a positive psychological effect on the patient, permits the patient to take responsibility for their treatment, and reduces hospital length of stay minimising patient exposure to nosocomial infections.

Does your home healthcare client have lymphadenopathy?

The routine head-to-toe home care assessment should include screening for abnormal lymph nodes. This can provide critical information about existing disease states or underlying problems that may have been overlooked. This article details the lymph node examination for the home care client that is easily incorporated into the initial examination, allows for fast documentation of findings, and provides helpful assessment information for disease detection in adults and children.