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 […]
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 […]
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 […]
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 […]
Learning from the past while looking to the future
<p>Many milestones have been passed since the mid-1990s in the quest to improve the worldwide management of lymphoedema. For example, there have been huge advances in our understanding of the way genes determine lymphatic vessel behaviour. Karkkainen et al (2001) demonstrated how a specific gene helps the development of a mature lymphatic system in mice, […]
Think global and act local to treat lymphatic disease
<p>A recent trip to India has raised my awareness of how important it is that we as a specialty address the issues of lymphoedema and lymphatic filariasis (LF) by working together on a global scale.</p>
The Microfine glove and its use in the management of hand oedema
<p>A recent study has shown that in the UK, 90% of people with lymphoedema wear some form of compression garment (Lam et al, 2006). The use of compression is a recognised cornerstone of lymphoedema management as defined by the British Lymphology Society (BLS) (1997). All compression garments have an elastic element to them, which is […]
Experiences of patients with lymphoedema
<p>Background: The LSN and CRICP are working with the Lymphoedema Framework Project to develop a rational system for the delivery of lymphoedema care.</p>n<p>Aims: To obtain an overview of patients’ experiences and views throughout the UK. Methods: A questionnaire was sent to all members of the LSN.</p>n<p>Results: A total of 1,449 responses were given, this being […]
The focus on oedema therapies may blind us to innovation
<p>Since Emil Vodder described his technique of lymphatic drainage in 1936 there have been many developments in conservative treatment for lymphoedema. Compression, remedial exercises and skin care superseded the surgical approaches that were popular in the 1970s and 1980s, and the cornerstone of current therapy is the Földi method of manual lymphatic drainage (MLD) (Földi […]
