Die manuelle Lymphdrainage ist eine Sonderform der Massage, die bei Lymphabflussstörungen indiziert ist. Sie muss flankiert sein von Hautpflege, Kompressionsbehandlung, Bewegungstherapie und bestimmten Verhaltensmaßnahmen. Eine solche komplexe physikalische Entstauungstherapie (der Ausdruck wurde von Földi geprägt) versucht den anatomischen und physiologischen Gegebenheiten bei Lymphabflussstörungen gerecht zu werden. Eine diuretische Behandlung von Lymphödemen ist nicht indiziert; eine medikamentöse Therapie (z. B. mit Benzopyronen) hat sich nicht durchgesetzt. Wesentlichster Bestandteil der entstauenden physikalischen Maßnahmen ist die Kompression. Klassische Indikationen für entstauende physikalische Maßnahmen sind primäre und sekundäre Lymphödeme; unterstützend werden sie bei phlebolymphostatischen Ödemen sowie beim Lipödem eingesetzt. Kontraindikationen sind Ödeme anderer Genese (kardiale, renale Ödeme), frische Thrombosen sowie entzündliche Prozesse der Haut (Erysipel). Von den chirurgischen Behandlungsmethoden sind allein Rekonstruktionsverfahren (Replantation körpereigener Lymphgefäße) sinnvoll und haben sich bei bestimmten Indikationen bewährt.

Effects of a series of classical massage upon different parameters of the immune system: In an experimental study, the effects of classical massage upon different parameters of the immune system were tested. In 15 healthy persons (average age 23 years), cellular components of the blood, immune globulins, factors of the complement system, cytokines, gamma-interferon, alpha-tumour-necrosis-factor and tests of function of B-lymphocytes and macrophages were investigated before and after a series of six massages. A slight increase of leucocytes and monocytes was found: the number of thrombocytes increased significantly. The regulatory balance of 1-lymphocytes changed: the number of CD3/CD4-cells increased; there was a reduction of activated CD3/CD4-cells. The interleukins 4 and 6 as well as gamma-interferone showed a marked reduction, interleukin 10 rose significantly. Classical massage clearly influences the immune system; the results of this study may explain its stabilizing and calming effects.

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Immunity against tetanus in an urban population: gaps of immunity among elderly persons. In a sero-epidemiological survey we investigated the immunity against tetanustoxoid in an urban population. Children and adolescents born in Germany (n = 193) showed an excellent immunity, negative findings being the exception. Among soldiers of the army (n = 136), negative findings were rare too. In these both groups the antibody titiers averaged 4,5 IU/ml. It is generally agreed that an antibody titer of 0,01 IU/ml protects against tetanus. Adults born in Germany (n = 295) had a good immunity: 84% showed antibody - titers against tetanus. Among elderly persons, however, above 60 years of age (n = 1576) there was a striking incidence of negative findings: in 1043 persons (65%) no antibodies could be detected. The remaining 533 persons with positive findings (35%) had antibody-titers in the lower range (average 0,482 IU/ml). Also among foreigners and immigrant labourers from mediterrean countries (Greece, Turkey, Yugoslavia) the frequency of negative findings was high: 183 persons were examined, 70 (39%) were negative 113 (61%) were positive. The incidence of negative findings was highest among women from the mediterrean countries. Several small studies published in Switzerland show a similar tendency. Our paper will encourage further seroepidemiological studies.

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