Capitalising on the momentum through collaboration
<p>Lymphoedema (LE) is a dreaded condition. It is debilitating, chronic, and progressive, and is most commonly the result of cancer treatment (i.e. the surgical removal of lymph nodes or disruption to lymphatic pathways) in industrialised countries, or of filariasis in lesser developed countries. Lymphoedema is associated with significant medical, economic, and quality of life consequences, […]
Presentation of childhood lymphoedema
<p>Childhood lymphoedema is a relatively rare condition, uncommon outside of specialist clinics, but which has a significant effect on the affected individual and the family. As a lifelong condition with, at present, no cure, management of the condition by dedicated lymphoedema therapists is of paramount importance. Increasingly, the underlying molecular genetic cause of some forms […]
A general hospital’s multidisciplinary approach to BCRL
<p>The physical, psychological and financial burden of lymphoedema can be varied and complex. Approaching these problems in a thorough manner, involving the skills of many different providers of care offers the patient a more comprehensive plan of care than can be accomplished by a sole practitioner. The purpose of this article is to describe how […]
Society update Vol 5, No 1
<p>- National Lymphedema Network – The British Lymphology Society (BLS) – The Global Alliance to Eliminate Lymphatic Filariasis (GAELF) – The Austrian LymphLiga (ÖLL) – The Dutch Lymphedema Network (NLNet) – The Lymphoedema Association of Australia (LAA) – The Lymphoedema Support Network – The Leg Club</p>
A new way to assess superficial changes to lymphoedema
<p>Background: Appropriate management of lymphoedema requires an accurate diagnosis of the changes in fibrotic induration in order to target treatment. Tonometry is used to measure tissue’s resistance to compression and provide an objective assessment of the stage of lymphoedema, tissue changes and treatment efficacy. The mechanical tonometer that is commonly used has some shortcomings, as […]
Lymphoedema education needs of clinicians: a national study
<p>Background: Poor knowledge of lymphoedema among clinicians can delay its management, increasing the burden on affected individuals, carers, and services. Aims: To determine the nature of, and means to address, lymphoedema education needs of clinicians within the context of their working lives.</p>n<p>Methods: Electronic surveys of lymphoedema specialists and generalist clinicians in Scotland, followed by focus […]
Lymphoedema — primary or secondary, how does one tell?
<p>A recent editorial in Lymphatic Research and Biology suggests that many cases of apparent secondary lymphoedema may, in fact, have an underlying primary cause, even though the primary event cannot yet be identified (Rockson, 2008). A primary disease is usually defined as one arising spontaneously and not associated with, or caused by, a previous disease […]
USA-South African partnership for lymphoedema education
<p>Curricula for providing lymphoedema education varies internationally. The Lymphology Association of North America (LANA) has established curriculum criteria (135 hours), accepted as the standard model across the United States (US). This educational mode was successfully introduced in the Western Cape, South Africa (SA) in an inaugural course in 2008. This report outlines the necessary resources […]
Global Initiative for Wound and Lymphoedema Care (GIWLC)
<p>Over the past two decades the world has seen tremendous medical advances in modern wound care and lymphoedema management, principally due to new scientific knowledge, techniques and materials. These advances have occurred mainly in the developed countries. The diagnosis and treatment of chronic wounds and lymphoedema, both primary and secondary in aetiology, involves all medical […]
Selected abstracts from the BLS annual conference 2009
<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 Sheffield. We would like to encourage members and other healthcare professionals to submit abstracts for this year’s conference to be held in Manchester. Jacquelyne Todd, Chair […]
Anatomy and physiology in relation to compression of the upper limb and thorax
<p>An understanding of arterial, venous and lymphatic flow in the upper body in normal limbs and those at risk of, or with lymphoedema will greatly improve patient outcomes. However, there is much we do not know in this area, including the effects of compression upon lymphatic flow and drainage. Imaging and measuring capabilities are improving […]
Use of a tissue mobilising compression system
<p>The standard treatment for lymphoedema is complete or complex decongestive therapy (CDT) that combines manual lymphatic drainage (MLD), skin care, multilayer, multi-component bandaging, exercises and patient education (Cheville et al, 2003; International Lymphoedema Framework, 2006). Intermittent pneumatic compression (IPC) therapy can also be used in conjunction with CDT (Mayrovitz, 2007). Although CDT is well established […]
Yoga for women with breast cancer-related lymphoedema: a preliminary 6-month study
<p>Background: The lifelong nature of breast cancer-related lymphoedema (BCRL) requires an exploration of activities that may be of potential benefit. Exercise trials in BCRL are becoming more common. Aims: To determine if the continued practice of yoga for 6 months imparts measureable benefits in reduction of lymphoedema, self-reported symptoms, and quality of life (QOL).</p>n<p>Methods: Women […]
Factors precipitating an episode of lymphatic swelling
<p>Background: People with lymphoedema may be advised to avoid or take caution with certain activities, such as airline flights and wearing tight clothing in order to reduce the risk of an episode of lymphatic swelling. However, the association between these activities and the occurrence of lymphoedema has infrequently been evaluated. Aims: To document the patient-reported […]
Genital oedema
<p>Chronic oedema of the external genitalia has been classified as congenital or acquired (McDougal, 2003), and, as with other oedemas, is often referred to as ‘primary’ or ‘secondary’ lymphoedema.</p>
Cellulitis and lymphoedema: a vicious cycle
<p>Cellulitis is a relatively common infection of the skin and subcutaneous tissue associated with high morbidity and a burden on healthcare resources. Lymphoedema — the accumulation of fluid in interstitial spaces — can occur as a consequence of cellulitis. Similarly, the presence of chronic lymphoedema can predispose to recurrent episodes of cellulitis. This article explores […]
ILF is spreading the global lymphoedema message
<p>The International Lymphoedema Framework (ILF) was launched at the first International Lymphoedema Framework Conference at Royal Ascot in 2009 and has since grown into a fully-fledged global organisation. So far, it has given rise to national frameworks in Canada, the United States, Sweden, Japan and Australia.</p>
Selected abstracts from the BLS annual conference 2011
<p>The British Lymphology Society (BLS) Scientific Committee is pleased that the Journal of Lymphoedema has agreed to publish the following selected abstracts from this year’s conference in Nottingham We would like to encourage members and other healthcare professionals to submit abstracts for next year’s conference to be held in Cardiff. Jacquelyne Todd, Chair of the […]
Treating lymphoedema patients in Indian villages
<p>In 2004, the Institute of Applied Dermatology (IAD) developed an integrated treatment programme for lymphatic filariasis (LF) for rural communities. This included a combination of treatment elements from allopathy, Ayurveda and yoga therapy, to deliver low cost, home-based, self-care treatment with the support of a family member. Patients were treated at the outpatient department in […]
Lymphogenic cardiomyopathy
<p>The lymphatic system plays a major role in the maintenance of cardiac function. Dysfunction of the cardiac lymphatics can lead to the onset of new pathology, aggravation of existing pathology or worsening of the long-term prognosis. Obstruction or severance of the principal trunks of the cardiac lymphatics results in phenotypic lymphogenic cardiomyopathy, which can manifest […]
Imperatives for research to move the field forward
<p>Worldwide, more than a million women are newly diagnosed with breast cancer every year, accounting for one-tenth of all new cancers and nearly one-quarter (23%) of all female cancer cases (American Cancer Society [ACS], 2007).</p>
Pilot study of a handheld massage unit
<p>Background: Secondary arm lymphoedema is a chronic condition which affects a significant number of women and requires ongoing management. Aims: To pilot a new handheld massage unit which delivered vibration to the arm tissues and can be used in the home environment.</p>n<p>Methods: Women with established arm lymphoedema secondary to breast cancer treatment used the handheld […]
22nd International Congress of Lymphology
<p>It was a great pleasure to attend the 22nd International Congress of Lymphology in Sydney, Australia. This was an excellent meeting organised by Neil Piller and his team and was attended by many from across the globe. The different professional groups were well represented and the meeting was further enhanced by a public meeting for […]
Achieving independence through self-management
<p>Lymphoedema is a debilitating and chronic condition for which there is no curative treatment (Lymphoedema Framework, 2006).</p>
Acupuncture in lymphoedema management: a feasibility study
<p>Background: Acupuncture in lymphoedema management is controversial, with assumptions it will introduce infection or exacerbate swelling.</p>n<p>Aims: This three-step, patient-centred, mixed-methods study assessed acceptability, impact on quality of life, and adverse events of traditional acupuncture as an adjunct to maintenance care for people with lymphoedema secondary to breast and head and neck cancers.</p>n<p>Methods: Step 1: focus […]
Moving forward with the American Lymphedema Framework Project (ALFP)
<p>We are moving ahead in year two of the three-year National Library of Medicine G08 grant on Cyber Informatics Tools for Lymphoedema Stakeholders which enables us to develop and build the infrastructure for the American Lymphoedema Framework Projecct (ALFP) lymphoedema minimum data set (MDS). The ultimate goal is to create an operational cyber infrastructure that […]
Understanding the differences between lipoedema and lymphoedema
<p>An incorrect diagnosis can be a significant event for the individual. Money will be wasted on wrong or poorly targeted treatment, relevant interventions will not be put in place, and there will be a detrimental impact on the person’s quality of life. This is my story of a misdiagnosis and what it meant for me […]
Haemodynamics of lymphoedema
<p>The Starling hypothesis and available data on the physiology of the microcirculation provide a clear model for understanding how arterial, capillary and venous haemodynamics may affect the production of lymphatic fluid. This review considers the studies that have focused on venous and arterial haemodynamics and calf muscle pump function. Although the evidence base available is […]
Field experience of Handicap International
<p>Even if around 180 million people suffer from lymphoedema worldwide (Casley-Smith et al, 1997), its impact as a public health problem is underestimated. The main reason for this being the lack of epidemiology. Both in developed and developing countries, the prevalence and incidence of lymphoedema is unknown. In developing countries, lymphatic filariasis (LF) is seen […]
Lymphologists, phlebologists, veins and lymphatics
<p>No matter who we are, clinician, allied healthcare professional, scientist, patient or carer, we often focus only on what we know, what we find comfortable and what we have learnt (or been told). In reality, that is not good, we stagnate, our chances for different and perhaps better outcomes are reduced, and strangely, we often […]
Using exercise classes to reduce arm lymphoedema
<p>Background: Arm lymphoedema is a chronic condition affecting multiple aspects of patients’ daily lives but quality of life can be improved with excess volume reduction. Treatment consists of infection prevention, lymphatic massage, compression therapy and special exercises. However, there is little evidence regarding the effect of exercise in a group framework. Aims: Using a series […]
Implementation of a BCRL management programme
<p>Background: Breast cancer-related lymphoedema (BCRL) is a growing concern with the increased survival rate following breast cancer (Smith et al, 2011). However, limited data is available on prospective management designed to reduce the morbidity of BCRL.</p>n<p>Aims: To evaluate the impact of the development of a BCRL programme on the management of women with breast cancer.</p>n<p>Methods: […]
Screening for morbidity following breast cancer
<p>Background: A screening tool was developed to identify morbidity emerging in the years after breast cancer treatment.</p>n<p>Aims: This project aimed to investigate patient responses to a newly developed screening tool for lymphoedema, reduced arm function, fatigue and pain.</p>n<p>Methods: Interviews were conducted following completion of the screening tool by 40 women attending review appointments post-treatment for […]
The skin as a barrier: What does it mean when it fails when lymphoedema is present?
<p>The skin is a barrier and a primitive immunosurveillance organ. When in good health at rest, the skin has no reason to undergo repair. Stretching, compression or stimuli such as stripping with tape or exposure to UVB switch on the repair mode (Ryan, 2004). After a short period, often measured in hours, mitoses appear and […]
Exercise for limb lymphoedema: evidence that it is beneficial
<p>Exercise has been shown to improve lymphatic propulsion, clearance and venous drainage from the limbs. However, awareness of the positive benefits of different exercise regimens for those with lymphoedema of the limb has been slow to emerge. Despite this, studies have demonstrated that various exercise regimens can have a positive impact on limb size, subjective […]
Lymphoedema in Japan: current issues
<p>Lymphoedema is a worldwide problem, and yet, until recently it has been considered a relatively unimportant health concern. In developed countries, it mainly occurs following surgical treatment for cancer. Recent studies have helped to raise awareness of this condition and have indicated that it can lead to a decrease in quality of life (McWayne and […]
Hosiery in lower limb lymphoedema
<p>As part of its work to establish a national provision of lymphoedema services in the UK, the Lymphoedema Framework project has developed guidelines for the use of compression hosiery in lower limb lymphoedema. The guidelines, to be presented in two parts, have drawn together existing hosiery classifications and linked a new classification with clinical descriptions […]
German Society of Lymphology
<p>The German Society of Lymphology (DGL) has existed since 1976, developing as an offshoot from the Society for Manual Lymph Drainage (Dr Vodder) and Related Therapies (GfMLV) that was founded in 1967. It is a membership organisation, recognised as a non-profit society. The goal of the society is to promote research and teaching in the […]
10 years of global efforts to eliminate LF: where are we?
<p>Lymphatic filariasis (LF) is a mosquito-borne parasitic infection responsible for long-term chronic morbidity in the form of lymphoedema, genital pathology (especially hydroceles), recurrent disabling fevers (lymphangitis) and elephantiasis in over 40 million people around the world (Ottesen et al, 2008). Currently, over one billion people are exposed to infection in 81 endemic countries in Asia, […]
Imaging of lymphatics, LE and lymphatic function
<p>Despite our best imaging techniques and technologies, many are still far from perfect. However, they can give us valuable information about the structural and functional status of the tissues and systems, and specifically about the lymphatic system and the diagnosis of lymphoedema.</p>
We need to help patients to help themselves
<p>Performing the same task day after day, week after week is not only predictably routine, there is also a danger that we may avoid doing it altogether. Perhaps worse, fear of losing face may result in us telling people we have been performing the task when, in fact, we haven’t.</p>
Historical review of lymphatic studies in the head and neck
<p>The discovery of the lymphatic system occurred later than the other vascular systems. Early studies only observed lymphatics of the viscera in mammals. Lymphatics of the head and neck were not revealed until the mercury injection technique was introduced, which detailed in books of Mascagni (1787) and Sappey (1874) that were largely referred by later […]
So, this is lipoedema
<p>I find it hard to remember when I first began to realise that my legs looked different to others. Being obese from the age of six hid the fact that my body was showing signs of other problems. I have always been singled out as being different, and when my knee-high nylon school socks only […]
Lymphoedema and delusional parasitosis
<p>The false and fixed belief of being infected/infested by one or many different living organisms, such as insects or parasites, is not a common condition. Although several cases have been recorded since the end of the nineteenth century, it was the Swedish psychiatrist Karl-Axel Ekbom who first systematically studied the presenile syndrome of delusional dermatozoid […]
Use of laser therapy in the management of lymphoedema
<p>The use of laser therapy has been slow to develop and not without controversy along the way. Forty years have passed since initial research reported positive biological effects from laser light (Carney et al, 1967). Despite the publication of over 2,500 titles relating to therapeutic light, there is still debate over its clinical use particularly […]
Learning from traditional healers in South Africa
<p>In 1999 the South African Ministry of Health (1999) reported that breast cancer was the leading cancer diagnosis among South African women in 1999. More recently, Mqoqi et al (2004) found one in 12 white women and one in 18 ethnically-diverse women were at risk of being diagnosed with breast cancer in South Africa. The […]
Haddenham Healthcare: children with lymphoedema
<p>The treatment of lymphoedema in the UK is predominantly based on the needs of adults with cancer-related lymphoedema (Robertson Squire, 2000). This paper aims to look at the different treatment options available from Haddenham Healthcare and their suitability for children with lymphoedema. Factors such as age, parents’ attitude and severity of oedema all need to […]
Being true to your specialism, is being true to your patient
<p>As we are at the infancy of 2012, we too are at the infancy of the plethora of change within the NHS in the UK. Although the idealism was set out in 2011, it is this year where we will experience the impact of what the reforms truly mean to both patients and those involved […]
Non-compliance? It’s easy for you to say…
<p>Recently, I was delighted to receive an invitation to attend the 20th birthday celebration of the Lymphoedema Practitioners Education Group of Victoria (LPEGV), which I gladly accepted, looking forward to catching up with some old friends from my time with the Lymphoedema Association of Victoria (LAV). I was not disappointed. It was a great evening, […]
Lipoedema management: Gaps in our knowledge
<p>Lipoedema is a condition characterised by abnormal, symmetrical fat deposits in the legs, resulting in a disproportion between a smaller upper body and a larger lower body. Since its first use, the term “lipoedema” devised by Allen and Hines (1940) has been broadened to incorporate patterns of limb adiposity differing from the original pattern, which […]
