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 […]
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 […]
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 […]
Patients will benefit from stronger interdisciplinary links
<p>For the majority of healthcare specialists in the UK, life is often hectic and working through lengthy to-do lists more than fills the hours in each day. As a result of this we can sometimes become immersed in our own worlds, focused on meeting the clinical challenges directly in front of us and becoming detached […]
Prophylactic antibiotics for the prevention of cellulitis
<p>Background: Cellulitis of the lower leg accounts for 2–3% of hospital admissions (Cox et al, 1998), with an average length of in-patient stay of nine days. Studies have reported that up to half of these patients suffer further episodes (Cox et al, 1998; Dupuy et al, 1999). Reducing the recurrence of cellulitis could therefore have […]
Global teamwork is key for treating complex disorders
<p>There appears to be a growing acknowledgement that lymphoedema is an important healthcare issue in all countries of the world. In the UK, the work of the Lymphoedema Framework Project (LFP) with its partnership approach, has led to increasing awareness of the size and complexity of the problem and has attracted interest from the Department […]
Achieving consensus in lymphoedema care
<p>The Lymphoedema Framework Project is a national initiative aimed at developing and evaluating integrated, primary care-based, specialist-led lymphoedema services in a number of participating primary care trusts around the country. The aims of the project are to make available appropriate care to patients no matter what the cause of their lymphoedema, and to raise the […]
Global collaboration is crucial for lymphology and filariology
<p>‘New trial with antibiotics brings hope to elephantiasis sufferers’ declared a recent press release from a prominent university in the UK. Researchers reported that lymphoedema stage (but not limb circumference or the incidence of acute inflammatory episodes) had been significantly reduced in eight patients from a filariasis-endemic area of Ghana one year after a six-week […]
