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 […]
The facts about liposuction as a treatment for lymphoedema
<p>There is some controversy regarding liposuction for late-stage lymphoedemas. While it is clear that conservative therapies such as complex decongestive therapy (CDT) and controlled compression therapy (CCT) should be tried in the first instance, options for the treatment of late-stage lymphoedema that is not responding to treatment is not so clear. Liposuction has been used […]
Lymphoedema and sexual relationships in mid/later life
<p>Background: Women with breast cancer-related lymphoedema (LE) can experience physical, psychological, and sexual problems as a result of both physical limitations and appearance associated with this condition. Aims: This study investigated the effect on quality of life of the sexual relationships with intimate partners for women with LE. Methods: Participants were 11 women with LE. […]
An overview of lower limb lymphoedema and diabetes
<p>The prevalence for individuals diagnosed with lower limb lymphoedema and coexisting diabetes is unknown. However, both conditions cause significant problems that can compromise the viability of the lower limbs. An extensive search of the literature including medical databases (MEDLINE, PubMed and CINAHL), plus hand searching through diabetes journals, podiatry journals and wound care journals, was […]
BCRL questionnaires: climate and indigenous groups
<p>Valid and reliable subjective questionnaires are essential to enable research regarding the effect of breast cancer-related lymphoedema (BCRL) on quality of life (QoL). This review was undertaken to determine the reliability and validity of four current subjective questionnaires for the evaluation of BCRL, particularly with respect to climate and ethnic or indigenous groups. Searches were […]
Audit of the use of kinesiology tape for breast oedema
<p>Background: Lymphoedema developing in the breast and truncal area after treatment for breast cancer can be challenging to manage and distressing for patients. Kinesiology tape has traditionally been used in sports injuries and is considered effective at improving lymph drainage (Kase et al, 2003). It offers potential as a self-care option for managing swelling in […]
A new treatment for soft tissue fibrosis in the breast
<p>Background: Soft tissue fibrosis is a common consequence of breast cancer treatment and chronic lymphoedema. It can compromise function and quality of life, but research regarding interventions is limited.</p>n<p>Aims: To assess the efficacy of using JoViPitPak® (JoviPak Corporation) to influence soft tissue fibrosis change by looking at tissue density, perceived cosmesis and perceived breast pain.</p>n<p>Methods: […]
Using honey in post-excision malignant melanoma ulcers
<p>Malignant melanomas are extremely difficult to treat conservatively at primary care level since the precise diagnosis requires a skin biopsy, which then undergoes dermatoscopy or epiluminescence microscopy. The treatment also varies according to the stage of melanoma and whether it is a superficial spreading melanoma or a melanoma in situ (Lorentzen et al, 1999). For […]
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 […]
Diagnostic investigations for oedema of the upper limb
<p>Oedema of the upper limb may be attributable to several factors, including malignancy, venous or lymphatic abnormality. This article illustrates the concept of differential diagnosis for lymphoedema, by critically reviewing the diagnostic tests and examinations performed to investigate unilateral arm swelling in a 51-year-old woman. It reveals the pitfalls of using non-standardised diagnostic tests and […]
Drugs that may exacerbate and those used to treat lymphoedema
<p>This article explores the potential for drugs which can cause oedema to exacerbate pre-existing lymphoedema. Guidance on the assessment and management of patients taking these drugs is given. Drugs which may be used to treat lymphoedema are also considered. Current evidence does not support the routine use of benzopyrones, selenium, or diuretics in the management […]
Understanding the impact on patients is crucial for practice
<p>A major theme emerging through this issue of the journal is the impact of lymphoedema on patients, and the failure of healthcare professionals to truly acknowledge this in many aspects of everyday life. Gerusa Dreyer portrays the horrifying experience of infestation with maggots (myiasis) and the humiliation and suffering this leads to. Few healthcare professionals […]
Pain and disability: are we ignoring parts of the picture?
<p>Clinical experience shows us that many of the patients that we see in our clinics present with comorbidities: pain, numbness, a range of motion limitations, reduced joint movement, functional problems, etc. I am part of a group that is conducting a multisite Canadian study, aiming to chart the incidence and course of three types of […]
Klippel-Trenaunay syndrome
<p>Klippel-Trenaunay syndrome (KTS) is a rare congenital disorder of blood and lymphatic vessels that is characterised by a combined vascular malformation of the capillaries, veins and lymphatics, congenital abnormalities, and associated limb hypertrophy. This review provides an overview of the disease with emphasis on the management and underlying aetiology of the syndrome. Management of this […]
Understanding lymphoedema in the new millenium
<p>We face three major issues in lymphoedema management: reducing the risk of secondary lymphoedema; early detection; and providing solid evidence for the management and treatment of patients. We have seen advancements in our understanding of lymphoedema at the genetic, molecular, cellular and tissue level, helping us to understand that more than just a damaged lymphatic […]
Multidisciplinary guidelines for early diagnosis and management
<p>In 1999, the Dutch Institute for Healthcare Improvement (CBO) organised a task force on lymphoedema to evaluate the current literature and to propose evidence- and expert-based recommendations suitable for the national implementation of guidelines for the treatment of lymphoedema. Representatives from national medical scientific organisations (e.g. surgery, gynaecology, radiotherapy, dermatology, and others), paramedical associations and […]
To measure or not to measure? What and when is the question
<p>Measuring limbs and noting patients reports tells us about the effects of a disrupted lymphatic system not about changes to lymphatic function. To know something of the latter, the only option is lymphoscintigraphy. Each measurement we make adds something to our knowledge and we must continue to measure as we think best, according to the […]
An unusual case of primary lymphoedema praecox
<p>Primary lymphoedema praecox is a condition that predominantly affects women and involves swelling in one or more limbs which may extend to the trunk (Browse, 2003). The swelling usually occurs before the age of 35 years and most commonly presents during puberty. There does not have to be a family history of the condition, but […]
Lymphoedema management in India
<p>This article focuses on the management of secondary lymphoedema caused by lymphatic filariasis (LF) in India. LF is a parasitic infection spread by mosquitoes. The infection, which is caused by thread-like parasitic worms (<em>Wuchereria bancrofti</em> or <em>Brugia malayi</em>) that damage the human lymphatic system, is usually contracted in childhood, often before the age of five […]
