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 […]
Cellulitis treatment for people with lymphoedema: UK audit
<p>Background: A group of UK clinicians (under the auspices of the British Lymphology Society [BLS] and the Lymphoedema Support Network [LSN]) drew up consensus guidelines on the management of cellulitis in patients with lymphoedema in 2005 (available at: <a href="http://www.thebls.com" target="_blank">www.thebls.com</a>). Aims: To determine whether the guidelines were being followed and to assess the effectiveness […]
ALFP to update the Best Practice document
<p>The Best Practice for the Management of Lymphoedema document (Lymphoedema Framework, 2006) has made a significant impact on the quality of lymphoedema care in the United Kingdom and worldwide. The International Lymphoedema Framework (ILF) has partnered with the American Lymphedema Framework Project (ALFP) to update and expand the 2006 edition to incorporate recent advancements and […]
Placebo controlled trial of mild electrical stimulation
<p>Background: To find ways to improve lymph flow especially when it is hot and or dry/humid when lymph loads are higher than normal. Aims: To determine if mild electrical stimulation of the epifascial compartment of lymphoedema limbs can improve lymphatic drainage when used in conjunction with garments. Methods: Patients were entered into a self-maintenance group […]
A practice guideline for the management of lymphoedema
<p>Management and treatment options for lymphoedema in Japan have traditionally varied between different healthcare institutions. The authors of this article have developed guidelines to standardise treatment of lymphoedema patients, based on scientific evidence. Consensus methods based on the Delphi technique were used when formulating the guidelines. A literature search was conducted and a clinical guideline […]
Unproven concepts needing correlation and further study in lymphoedema
<p>Lymphoedema is a chronic medical condition and a range of questions remain regarding its aetiology, pathophysiology, and management. In this article, the author discusses a range of unproven concepts in lymphoedema and draws attention to some possible mechanisms. The author also produces some hypotheses on which to base some experiments.</p>
Arm symptoms and QoL in Japanese breast cancer patients
<p>Background: Post-operative arm complications among breast cancer patients are relatively underestimated in clinical settings, but the symptoms may affect quality of life (QoL). Aims: To assess the relationships between lymphoedema symptom-related variables and QoL among Japanese women with breast cancer who had undergone surgery. Methods: A cross-sectional postal survey investigated the = relationships between post-operative […]
A time for international collaboration
<p>This is an important time in the work of the International Lymphoedema Framework (ILF) as the conference at Ascot comes to fruition. This event will bring together many of the international groups who are working to improve the lives of patients with lymphatic disorders. Delegates at the conference are coming from around the world. This […]
Lymphoedema in bariatric patients
<p>Obesity continues to rise in Western and developing countries and the prevalence of morbid obesity in the US has reached 5% (Arterburn et al, 2005). Obesity is linked to leg oedema, and morbid obesity certainly appears to be a factor in the development of chronic venous insufficiency (CVI), a condition seen in many patients with […]
Australasian Lymphology Association
<p>The Australasian Lymphology Association (ALA) strives to promote excellence in all aspects of lymphoedema and other oedemas across Australasia. From primary to secondary lymphoedema, paediatrics to geriatrics, from the genetic development of the lymph system, to clinical-based assessment and treatment, the ALA has been instrumental in the recognition of this condition. Areas including education, committees […]
Helping patients self-manage their lymphoedema
<p>This paper describes a matrix of service delivery for patients. The aim at each level is empowerment. The matrix describes five groups of patients with differing levels of lymphoedema complexity. The final group includes two groups of patients; those whose lymphoedema requires surgical intervention and children with lymphoedema. Treatment is used to facilitate the development […]
Star of track and field remains undefeated by lymphoedema
<p>Deborah Cordner was a college track and field star, with a promising athletics career ahead of her when, in her third year at college, after a lump in her groin was removed she developed lymphoedema. She was told she should give up her training altogether but, despite this, she decided that lymphoedema would not get […]
Getting the pressure right: how do we know?
<p>The lymphatic system is a low-flow, low-pressure system, with the latter generally remaining in single figures, but occasionally rising to 40–50 mmHg when blocked. These low pressures – coupled with the delicate nature of even the collecting lymphatics, their location, and the relatively few muscular and structural elements in their walls – mean that the […]
An opportunity to learn, discuss and share experiences
<p>Welcome to the autumn edition of the journal. It gives me great pleasure to introduce the first International Lymphoedema Framework (ILF) Conference that will be taking place at the Ascot conference centre, near London, from the 21st to the 23rd April, 2009. This is an important event in the calendar of the ILF project, as […]
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 […]
