Lymphoedema prevalence in the West Midlands region
<p>A report was produced, focusing on the overall prevalence of lymphoedema in the West Midlands region with further analysis relating to diagnosis, caseload gender, average caseload, and staffing levels. The information was provided by 43% of British Lymphology Society members in the West Midlands between May and June 2012. However, the figures were affected by […]
A rare case of lymphoedema-distichiasis
<p>Lymphoedema-distichiasis is a rare autosomal-dominant condition characterised by a second row of eye lashes (distichiasis) and pubertal onset of lower limb lymphoedema. It was first described in 1964 by Falls and Kertesz, but it took almost 40 years for the gene that causes the condition to be located on chromosome 16 (Fang et al, 2000). […]
Society update Vol 3, No 2
<p>- British Lymphology Society – The Australasian Lymphology Association (ALA) – The International Society of Lymphology – Leg Club – The Japanese Society of Lymphology – The National Lymphedema Network (NLN) – The Lymphoedema Support Network – The Israel Lymphedema Association (ILA)</p>
Lymphoedema is part of who I am
<p>In 1999, when I was 19 years old and in my second year of university, I remember standing in the living room saying to my housemates, ‘Do my legs look swollen to you?’ They agreed they did look a little swollen but we did not know why, so left it there. A few months later […]
Use and response to treatment using low level laser therapy
<p>Laser therapy for lymphoedema treatment has been used internationally for many years but has been slow to be accepted in the UK. The science behind the technique and its effectiveness in reducing fluid viscosity and encouraging motoricity of the lymphatics has been reported (Lievens, 1987; Eliska and Eliskova, 1997). The evaluation reported in this paper […]
Klippel-Trenaunay-Weber syndrome — a case report
<p>Klippel-Trenaunay-Weber syndrome is a rare congenital syndrome involving enlarged veins and arteries, limb hypertrophy and capillary malformations. In 1900, French physicians, Klippel and Trenaunay, first described what became known as Klippel-Trenaunay syndrome after two patients presented with a triad of symptoms — port-wine stain, varicose veins, and bony and soft tissue hypertrophy involving an extremity […]
Role of GPs in breast cancer-related arm morbidity care
<p>Background: This paper addresses a gap in the literature on breast cancer-related arm morbidity care regarding clinician responsibility for the management of women’s treatment-related arm morbidity needs. Using a qualitative research method, the authors spoke to general practitioners (GPs) about their perceptions, knowledge and experiences of breast cancer-related arm morbidity, and what role, if any, […]
Human functioning in lymphoedema
<p>Background: The description and testing of the different levels of human functioning is essential prior to beginning the treatment of patients with lymphoedema.</p>n<p>Aims: The International Classification of Functioning, Disability and Health (ICF) offers an international framework for the classification of health and health-related domains. ICF Core Sets are lists of selected ICF categories concerning the […]
Clinical effectiveness and patient considerations in oedema management
<p>This article aims to strike a balance between compression bandaging to treat oedema and a positive patient experience. Compression therapy is well recognised as a key component in the management of venous and lymphatic conditions. Science indicates that intermittent pressures provided by inelastic bandage systems rhythmically stimulate venous and lymphatic flow to reduce and contain […]
Myiasis in a bancroftian filariasis endemic area
<p>Background: Human myiasis in bancroftian filariasis endemic areas, although rarely reported in the literature, might pose an important aggravating factor for patients with swollen limbs with wounds, such as varicose ulcers and mossy lesions (lymphangiomatosis).</p>n<p>Aims: To study the occurrence, clinical and parasitological characteristics of wound myiasis in individuals living in a filariasis endemic area in […]
Use of a Velcro® wrap system in the management of lower limb lymphoedema/chronic oedema
<p>Lymphoedema and chronic lower limb oedema are conventionally treated with multi-layer bandaging, followed by compression hosiery. Inevitably, this management system can be difficult to maintain in some patients, especially those with hand weakness, back problems, obesity, or those who are elderly, have abnormal limb shapes or are palliative patients. Farrow Wrap™, a Velcro® wrap system, […]
Mapping of lymphatic filariasis in Rwanda
<p>Background: Infections with Wuchereria bancrofti causing lymphatic filariasis (LF) still represent one of the major health problems in the tropics. In Rwanda, where LF has been considered endemic by the World Health Organization (WHO) and the Global Alliance to Eliminate Lymphatic Filariasis (GAELF), there are no reliable data on distribution and prevalence of the disease. […]
Is BIS ready for prime time as the gold standard measure?
<p>Assessment of lymphoedema can pose challenges to the clinician. There is no universally accepted standardised method for measurement. In this, the first of two articles, Leigh Ward, a pioneer in the application of bioelectrical impedance spectroscopy (BIS) for assessment of breast cancer-related lymphoedema, makes a strong case that BIS technology now warrants consideration as the […]
A quality of life measure for limb lymphoedema (LYMQOL)
<p>Background: This paper describes the validation of a ‘condition-specific’ quality of life (QoL) assessment tool for lymphoedema of the limbs (LYMQOL). Aims: To ascertain whether the tool could accurately assess QoL in this patient group. Methods: Face and content validity were assessed by patient questionnaires; criterion validity by comparison with European Organisation for Research and […]
Is there a role for contrast hydrotherapy?
<p>Contrast hydrotherapy involves the immersion or dousing of a limb in alternating hot and cold water. This ‘tweaks’ the peripheral autonomic nervous system, altering vascular tone and flow and improving nitric oxide production and vessel health. It has been shown (Elmstahl et al, 1995; Fiscus et al, 2005) to improve both short- and long-term distal […]
A shift to chronic disease care management
<p>Lymphoedema is a chronic medical condition which may reduce a person’s quality of life by negatively impacting on his or her medical, physical, psychosocial and functional status. This article argues that lymphoedema progression can be more effectively controlled by focusing clinical care delivery on client self-management, to better address the possible complications of this condition, […]
Relationship between pain, tightness, heaviness, perceived limb size, and objective limb size measurements in patients with chronic upper-limb lymphoedema
<p>Background: Lymphoedema has a significant effect on patient quality of life due to the daily experience of limb symptoms such as pain, tightness and heaviness. While treatment of lymphoedema often focuses on reduction in objective limb measures, there is minimal evidence to support that this reduces subjective limb symptoms.</p>n<p>Aims: This study aimed to investigate the […]
National Lymphedema Network
<p>In 1988 the National Lymphedema Network® (NLN®) was established by Saskia RJ Thiadens, in response to a growing need for awareness, education and, most importantly, an effective treatment for lymphoedema. Recognised both nationally and internationally, the NLN is a California-based 501(c)3 nonprofit organisation dedicated to diminishing the suffering of lymphoedema patients through education, service and […]
Holistic management of lymphoedema in Japan: two contrasting cases
<p>One of the roles of a nurse is to keep patients with secondary lymphoedema from breast cancer treatment motivated to self-care, as its symptoms are chronic and debilitating. Patients need an easy, quick, cheap, and effective self-care programme because they often cannot and do not adhere to complex, timeconsuming, and expensive treatments. The author’s clinic […]
Early detection — a strategy to reduce risk and severity?
<p>Despite changes in surgical techniques, radiotherapy targeting and the apparent earlier detection of cancers, secondary lymphoedema is still a significant problem for about 20–30% of those who receive treatment for cancer, although the incidence and prevalence does seem to be falling. The figures above generally relate to detection of an enlarged limb or other area, […]
ALFP: identifying issues in lymphoedema in the US
<p>The American Lymphedema Framework Project (ALFP) is a national initiative introduced in 2008 to improve the management of lymphoedema (LE) and related disorders in the United States. A National Stakeholders Conference was held in March 2009 to share perspectives on the current state of LE, establish priority issues, and recommend actions to move the field […]
I underwent liposuction to reduce the volume in my leg
<p>I first developed primary lymphoedema ten years ago. I woke up one morning to feel my right leg tight and slightly swollen. I could not recall being bitten or anything untoward and decided it would go away of its own accord. How wrong was I to be proved.</p>
Use of Juxta-Fit™ to reduce oedema and promote self-management
<p>This article looks at three case reports which show the clinical effects of the inelastic, adjustable device, Juxta-Fit™(medi UK). This device allows patients to be self-caring and independent. It is also effective in reducing the volume of the lymphoedematous limb and as maintenance therapy following decongestive lymphatic therapy (DLT). Juxta-Fit can be used as a […]
Lymphoedema associated with sirolimus treatment
<p>Background: Secondary lymphoedema is a chronic condition that has a financial, emotional and physical impact and causes a decrease in quality of life for affected patients. Twenty cases of lymphoedema presenting in patients undergoing sirolimus immunosuppresive therapy, for renal or hepatic transplantation, have been reported since 2004. Although some patients showed a marked improvement after […]
Introducing a skin cancer lymphoedema prevention and rehabilitation scheme
<p>Lymphoedema is an incurable, progressive chronic condition and unfortunately it is a potential complication of the treatment for malignant melanoma following axillary node dissection and groin dissection. Referrals for this user group is ever-increasing to the Abertawe Bro Morgannwg University Health Board clinic presenting with established swelling, poor skin condition, and decreased range of movement. […]
Society update Vol 3, No 1
<p>Highlights from lymphology societies around the world.</p>
Selected abstracts from the BLS annual conference 2008
<p>The British Lymphology Society Research Advisory Board (BLS RAB) is pleased that the Journal of Lymphoedema has agreed to publish the following selected abstracts from last year’s conference in Belfast. We would like to encourage members and other healthcare professionals to submit abstracts for this year’s conference to be held in Sheffield. Details of the […]
Society update Vol 4, No 1
<p>- British Lymphology Society – The Lymphoedema Association of Australia (LAA) – The International Society of Lymphology – The Japanese Society of Lymphology – National Lymphedema Network – The Lymphoedema Support Network – The Dutch Lymphedema Network (NLNet) – The German Society of Lymphology – The Lymphology Association of North America (LANA) – Leg Club […]
Finding my ‘new normal’ by self-empowerment and self-care
<p>My personal journey with lymphoedema has been a rocky road, filled with misinformation from various healthcare professionals. I hope that no other patients have to go through the distress I went through in getting a diagnosis and finding an appropriately qualified lymphoedema therapist and treatment.</p>
Lymphoedema management in Spain
<p>In the 1980s, as a result of the work of a group of vascular surgeons, including Dr Azcona and Dr Jimenez-Cossio who founded the Club of Lymphology (a group of doctors interested in the study of lymphatics and lymphoedema) and Dr Samaniego, who was the first to perform venous-lymphatic anastomoses in Spain, lymphoedema began to […]
LE risks, what are they and how can they be reduced?
<p>Lymphoedema can a long-term complication of breast cancer treatment (Mak et al, 2008), which, once established, is difficult to cure. Therefore, it is essential to prevent or minimise this condition. Factors that contribute to the development of breast cancer-related lymphoedema (BCRL) are not as yet fully elucidated. The common procedures of venepuncture and blood pressure […]
Self-management in combating chronic skin disorders
<p>The lymphatic system plays an integral role within the body’s circulatory system. When this fails to work effectively, however, morbidity levels rise for the individual, as does the demand placed on healthcare services. Failure of the lymphatic system leaves individuals with long-term chronic conditions that require regular input from a range of health professionals.</p>
An optical fibre tape sensor for monitoring sub-bandage pressures: Progress towards an “ideal sensor”
<p>A fibre optic sensing array in the form of a thin, flexible tape is described and tested for the monitoring of sub-bandage pressures. The sensing array consists of 36 discrete sensing elements spaced at 1-cm intervals along the tape and provides real-time feedback of applied pressures. It has been used to assist an experienced wound […]
Early post-op swelling and its association with lymphoedema
<p>Background: Arm lymphoedema is a commonly recognised complication of breast cancer treatment and can cause major physical and psychological morbidity. Accurate assessment is important and it has been shown that early treatment can minimise the severity of chronic lymphoedema.</p>n<p>Aims: This study investigates the incidence of arm oedema in 133 women who had been treated for […]
30-month post-breast cancer treatment lymphoedema
<p>Background: Quantification of lymphoedema (LE) has been problematic, and the reported incidence of LE varies greatly among women treated with surgery and radiation for breast cancer. Aims: This study aims to describe LE occurrence over time among breast cancer survivors using four diagnostic criteria based on three measurement techniques. Methods: Limb volume and symptom assessment […]
Eliminating LF: a progress report from Tanzania
<p>Lymphatic filariasis (LF) is endemic throughout the United Republic of Tanzania. The figures for Tanzania mainland show that 34 million people are at risk of infection and it is estimated that 6 million people have debilitating manifestations of the disease. The endemicity varies from being highly endemic along the coast with antigenemia levels of 45–60%, […]
The case for intermittent pneumatic compression
<p>Intermittent pneumatic compression (IPC) is widely used to prevent deep vein thrombosis (DVT), yet IPC appears to have application to a broader base of lymphatic and venous disease. The intermittent nature of pulsatile external compression results in beneficial physiologic changes, including haematologic, haemodynamic, and endothelial effects. Application of IPC is a valuable adjunct to the […]
Managed clinical networks: future for LE service provision
<p>The Lymphoedema Network Northern Ireland (LNNI) was designed as a managed clinical network to ensure the best use of scarce resources across institutional boundaries. This facilitates work within and between the five regional trusts across Northern Ireland, including sharing of best practice and service improvement projects, working towards a modern, proactive and efficient service. The […]
Lipoedema: poor knowledge, neglect or disinterest?
<p>At the 3rd International Lymphoedema Framework (ILF) conference in Toronto, an attempt was made to begin to try to address this issue. Over thirty people attended a lipoedema workshop run by the author. In this workshop, I had the opportunity to talk to this international group (Canada, USA, Netherlands, Australia, UK, Germany) who shared their […]
Using yoga in breast cancer-related lymphoedema
<p>The aim of this article is to explore the research findings that can inform the use of yoga for women with breast cancer-related lymphoedema (BCRL). Women with this condition may need lifelong treatment and have to self-manage the affected area. A growing body of research has led to the development of guidelines for the inclusion […]
The use of low level light therapy in the treatment of head and neck oedema
<p>The focus of this article is to present evidence supporting the use of low level laser therapy (LLLT) as a specialist treatment for patients with head and neck oedema. Information obtained from a critique of relevant literature will be utilised to discuss the treatments available for those with head and neck oedema, highlighting how outcomes […]
Lymphoedema Association of Australia
<p>The Lymphoedema Association of Australia (LAA) was founded in 1982 by Drs John and Judith Casley-Smith. The society includes patients, practitioners, allied healthcare professionals, carers and partners. The stated philosophy has been that this association was ‘formed to help each and every one of you’. The LAA previously ran lymphoedema treatment training sessions for both […]
A case for specialist practice
<p>The International Society of Lymphology (ISL) consensus document (2003) and the Lymphoedema Framework (LF) consensus document (2006) provide guidelines to support Best Practice for lymphoedema management. In extreme cases, such guidelines may require creativity and modification to suit patients’ needs. This case report shows the treatment and support needed to assist a patient with gross […]
Case for investment in neglected tropical diseases
<p>Over the last year, we have witnessed a plummeting global economy, one so distressed that it is hard to point at any one thing — real estate, a company, a commodity — that can hold real value and pay dividends. That sort of instability makes it a great time to be in global public health. […]
Society update Vol 4, No 2
<p>- The Lymphoedema Association of Australia (LAA) – The Australasian Lymphology Association (ALA) – The Lymphology Association of North America (LANA) – The Israel Lymphedema Association – Scandinavian Forum of Lymphedema – British Lymphology Society – Lymphoedema Support Network – The Leg Club – MLD UK – The Global Alliance to Eliminate Lymphatic Filariasis (GAELF) […]
Care of palliative patients with cancer-related lymphoedema
<p>Care of the lymphoedema patient with advanced malignant disease requires specific attitudes, modified treatment approaches and a redefinition of the goals of care. This article reviews the factors that can produce oedema in advanced cancer, outlines some key medical and psychosocial issues that can impact lymphoedema treatment in the palliative population, and suggests how standard […]
Managing oedema and fibrosis with coordinated movement
<p>It is generally accepted that lymphoedema and fibrosis can lead to impaired mobility. This will generally lead to a process of adaptation and changes in the neuro-motor system and motor activity. These changes can lead to degenerative processes in the articular and muscular structures, resulting in reduced mobility, inactivity, pain, loss of function, all of […]
Using indocyanine green fluorescent lymphography to demonstrate lymphatic architecture
<p>Background: Visualisation of the lymphatic system is a challenging task. Recently, an indocyanine green (ICG) fluorescent lymphography system was developed for visualising the lymphatic vessels. ICG emits energy in the near-infrared region between 840 and 850 nm when it is bound to protein in the tissue.</p>n<p>Aim: To use ICG fluorescent lymphography to identify locations of […]
Breast cancer treatment, BMI, post-op swelling/lymphoedema
<p>Background: Diagnosis of post-breast cancer lymphoedema is difficult because of inconsistent measurement approaches, measurement reliability and validity, and lymphoedema definition and criterion. Aims: To examine lymphoedema occurrence using a body mass index (BMI)-adjusted limb volume change (LVC) as a potentially sensitive alternative criterion for assessment and diagnosis of lymphoedema. Secondary aims were to examine the […]
Cutaneous infections in lymphoedema
<p>The typical diagnosis of skin infection in patients with lymphoedema includes erysipelas and cellulitis, but the true picture is more complex with the possibility of secondary complications such as lymphadenitis (adeno-lymphangitis) and lymphangitis. The recent description of acute inflammatory episodes (or AIEs) has gone some way to explaining how a patient may be prone to […]
