DÍA UNIVERSAL DE LOS DERECHOS DE LA INFANCIA 2023 - Declaración de los Derechos del Niño - Derecho a la Salud y a la Asistencia Sanitaria - Niños con Linfedema - Linfedema Pediátrico y Primario - Linfedema Secundario - Filariasis Linfática y Podoconiosis

El 20 de noviembre es un día importante: se celebra el Día Universal del Niño y se conmemoran los aniversarios de la adopción de la Declaración Universal de los Derechos del Niño (1959) y la aprobación de la Convención de los Derechos del Niño (1989).

El artículo 24 (Derecho a la salud y a los servicios sanitarios) de la Convención sobre los Derechos del Niño declara: “Los Estados Partes reconocen el derecho del niño al disfrute del más alto nivel posible de salud y a servicios para el tratamiento de las enfermedades y la rehabilitación de la salud. Los Estados Partes se esforzarán por asegurar que ningún niño sea privado de su derecho al disfrute de esos servicios sanitarios”.

Desde AGL queremos aprovechar este día para recordar que el linfedema no es sólo una enfermedad de personas adultas.

En la infancia, el linfedema puede aparecer por causas congénitas (Linfedema Primario) o bien causas adquiridas (Linfedema Secundario), como puede ser infecciones parasitarias (filariasis linfática).

El linfedema (Enfermedad Linfático Vascular Orgánica) es una enfermedad crónica y progresiva debida a una disfunción del sistema circulatorio linfático. Puede afectar brazos, piernas, dedos de manos y pies, cabeza, cuello, abdomen (vientre), genitales, órganos internos o todo el cuerpo, lo que provoca inflamación e hinchazón crónica en la zona afectada.

La filariasis linfática (Linfedema Secundario) es una enfermedad gravemente discapacitante en las personas adultas, y en general se piensa que sólo se da de forma esporádica en la infancia. Los nuevos avances en pruebas diagnósticas (detección de antígenos, ultrasonografía Doppler y examen linfocintigráfico) han ayudado a reconocer la patología subclínica causada por esta infección y han revelado que el linfedema a menudo se adquiere por primera vez durante la infancia, y que hasta un tercio de los/as niños/as se infectan antes de los 5 años. A lo largo de estos años se ha prestado muy poca atención a los signos y síntomas de la filariasis linfática en la infancia.

Estudios recientes indican que los fármacos para filariasis utilizados en los programas de administración masiva de medicamentos son capaces de revertir el daño linfático subclínico en la infancia y aportan otros beneficios además de la interrupción de la transmisión. Cuando hay un daño permanente e irreversible en el sistema linfático debido a la filariasis, éste también suele permanecer subclínico durante años o sólo da lugar a presentaciones inespecíficas de adenitis/adenopatía, que más tarde se desarrollarán y causarán linfedema en extremidades. Las manifestaciones clínicas de la enfermedad aparecen con mayor frecuencia durante la edad adulta temprana o más tarde, y sin un tratamiento adecuado, progresarán hasta su estadio grave tardío "la elefantiasis", hidrocele, y los consiguientes ataques agudos de dermatolinfangioadenitis. Lea más sobre los signos y síntomas de Linfedema AQUÍ.

Estudios científicos destacan la importancia y las implicaciones de la terapia de compresión en el control de la progresión del linfedema. Los resultados clínicos de las intervenciones para controlar el linfedema muestran que es necesario adoptar medidas higiene básicas sencillas, pero éstas no bastan por sí solas para controlar el volumen de las extremidades. El linfedema de las extremidades y los genitales deben tratarse siempre en sus primeros estadios, y no dejarse sin tratar hasta alcanzar la severidad del grado de la “elefantiasis”.

Durante décadas, la disfunción linfática que es tratable y se puede controlar su progresión, encarna los fracasos de los sistemas sanitarios y gobiernos a la hora de abordar las desigualdades e injusticias estructurales que permiten que prospere esta condición dura e ignorada.

Las organizaciones internacionales de salud, deben implementar programas de tratamiento adecuados y enfatizar la necesidad de realizar esfuerzos para aliviar la discapacidad tanto en la infancia como en la vida adulta. Los sistemas nacionales de salud deben implementar el control del manejo de la morbilidad con un tratamiento linfático y compresión adecuada para el linfedema crónico. Lea más sobre cuál es el mejor tratamiento para los niños con linfedema AQUÍ. 

Reconocer que la enfermedad de linfedema comienza su desarrollo en la infancia tiene implicaciones prácticas inmediatas, tanto para el manejo y la prevención de la enfermedad en pacientes individuales, como para los esfuerzos más amplios de salud pública necesarias para atender éstas enfermedades infantiles. De acuerdo con los derechos del niño, la infancia que sufre disfunción linfática (linfedema), sea cual sea su causa o contexto, también deben tener acceso a tratamiento linfático y compresión adecuada, para controlar esta enfermedad crónica y progresiva.

AVISO IMPORTANTE 

El Linfedema es una enfermedad crónica y progresiva debido a una discapacidad orgánica. El tratamiento clínico del linfedema no es ni un tratamiento cosmético ni estético. El tratamiento del linfedema es para controlar su avance y aliviar los síntomas relacionados con la disfunción del sistema circulatorio linfático. 

Para prevenir y evitar problemas graves asociados al tratamiento, como el posible desplazamiento del edema a zonas previamente no afectadas cuando se aplica la terapia de compresión para la reducción del volumen, los pacientes deben recurrir a terapeutas altamente especializados con experiencia. 

La cualificación profesional y la instrucción impartida a distancia en línea no son lo mismo que la instrucción práctica en directo en la formación clínica y la certificación de los terapeutas del linfedema, similar a todos los demás programas de formación en rehabilitación, medicina y cirugía, y especialmente para desarrollar las habilidades manuales necesarias para tratar una enfermedad tan compleja como el linfedema.

Los pacientes deben igualmente tener un especial cuidado a la hora de elegir un "Centro Multidisciplinar de Referencia de Linfedema", ya que no todos los países o centros de referencia proporcionan las mismas opciones de tratamiento. La mejor elección es un centro de referencia que aplica la Terapia Descongestiva Compleja (TDC), que está reconocida como el tratamiento "Estándar de Excelencia" para el linfedema.

• Lea más sobre la mejor opción de tratamiento para Linfedema AQUÍ.

• Lea sobre las principales funciones del Drenaje Linfático Manual AQUÍ.

• Lea sobre las diferencias entre los dos principales protocolos de tratamiento para Linfedema AQUÍ. 

• Lea sobre las estrategias para la aplicación de tratamientos de bajo coste para el linfedema AQUÍ.  

REFERENCIAS

(Pincha sobre los textos para leer los artículos científicos)

SOCIEDADES CIENTÍFICAS

• German Scientific Society Guideline: Diagnostics and Therapy of Lymphoedema.

LINFEDEMA PRIMARIO

• Artículo Científico: Linfedema Primario, definición, diagnóstico y tratamiento
• Convention on the Rights of the Child

LINFEDEMA PEDIÁTRICO

• NORD: Rare Disease Database - Lymphedema
• Medical management of lymphedema.
• Primary lymphedema in childhood.
• An approach to familiar lymphedema
• Pediatric Children Lymphedema
• Primary Lymphedema French National Diagnosis and Care Protocol (PNDS).
• Lymphatic filariasis: an infection of childhood.
• Lymphatic filariasis in children: clinical features, infection burdens and future prospects for elimination.

FISIOPATOLOGÍA

• lymphedema.
• Biology of Lymphedema
• Lymph vessels: the forgotten second circulation in health and disease
• Lymphatic Vessel Network Structure and Physiology
• Lymphatic System Flows
• Organ-specific lymphatic vasculature: From development to pathophysiology.
• The lymphatic vascular system: much more than just a sewer.
• The unresolved pathophysiology of lymphedema.
• Lymphedema: A Practical Approach and Clinical Update.
• Coagulation in Lymphatic System.
• Regulation of immune function by the lymphatic system in lymphedema.
• Oxidative stress in chronic lymphoedema.
• Regulatory T Cells Mediate Local Immunosuppression in Lymphedema.
• Hemostatic properties of the lymph: relationships with occlusion and thrombosis.
• Secondary lymphedema: Pathogenesis
• Gastrointestinal Lymphatics in Health and Disease
• Intestinal lymphangiectasia in adults
• Role of the lymphatic vasculature in cardiovascular medicine
• The lymphatic vasculature in disease
• Lymphoscintigraphic abnormalities in the contralateral lower limbs of patients with unilateral lymphedema.
• The Prevalence of Lower Limb and Genital Lymphedema after Prostate Cancer Treatment: A Systematic Review
• Peripheral Edema

COMPLICACIONES CUTÁNEAS

• The lymphatic system and the skin. Classification, clinical aspects, and histology.
• Lymphedema and cutaneous diseases.
• Lymphedema and subclinical lymphostasis (microlymphedema) facilitate cutaneous infection, inflammatory dermatoses, and neoplasia: A locus minoris resistentiae.
• Serum Immune Proteins in Limb Lymphedema Reflecting Tissue Processes Caused by Lymph Stasis and Chronic Dermato-lymphangio-adenitis (Cellulitis).
• Lymphedema and subclinical lymphostasis (microlymphedema) facilitate cutaneous infection, inflammatory dermatoses, and neoplasia: A locus minoris resistentiae.

COMPLICACIONES INFECCIOSAS

• Lymphatic Flow: A Potential Target in Sepsis.
• Infectious complications of lymphedema.
• Acute inflammatory exacerbations in lymphoedema.
• Inflammatory Manifestations of lymphedema.

CELULITIS / DERMATOLINFANGIOADENITIS

• Cellulitis.
• Clinical features, microbiological epidemiology, and recommendations for the management of cellulitis in extremity lymphedema.
• Challenges of cellulitis in a lymphedematous extremity.
• Diagnosis and management of cellulitis.
• Cellulitis risk factors for patients with primary or secondary lymphedema.
• Oedema as a risk factor for multiple episodes of cellulitis/erysipelas of the lower leg.
• Prevention of dermatolymphangioadenitis by combined physiotherapy.
• Erysipelas: a common potentially dangerous infection.

TUMORES

• Malignant tumors as complications of lymphedema.
• Lymphedematous areas: Privileged sites for tumors, infections, and immune disorders.
• Lymphedema-related angiogenic tumors and other malignancies.
• Lymphedema: an immunologically vulnerable site for the development of neoplasms.
• Lymph stasis promotes tumor growth
• A retrospective analysis of Stewart-Treves syndrome in the context of chronic lymphedema.
• Stewart-Treves Syndrome

DOLOR

• Congenital lymphedema complicated by pain and psychological distress: case report
• Lymphatic Pain in Breast Cancer Survivors
• Does Manual Lymphatic Drainage Have Any Effect on Pain Threshold and Tolerance of Different Body Parts?
• Lymphedema therapy reduces the volume of edema and pain in patients with breast cancer
• Quality of life in patients with primary and secondary lymphedema in the community

TRATAMIENTO

• Treatment of limbs lymphedema.
• Nonoperative treatment of lymphedema.
• Lymphedema: From diagnosis to treatment.
• Lymphedema-clinical picture and therapy.
• Physiotherapeutic rehabilitation of lymphedema: state-of-the-art.
• Diagnosis and management of lymphatic vascular disease
• Effective treatment of lymphedema of the extremities.
• Lymphoscintigraphic aspects of the effects of manual lymphatic drainage.
• Intensive Treatment of Lower-Limb Lymphedema and Variations in Volume.
• Effectiveness and safety of Complete Decongestive Therapy of Phase I.
• Therapeutic Efficacy of Complex Decongestive Therapy in the Treatment of Elephantiasis of the Lower Extremities.
• Effects of Phase I complex decongestive physiotherapy on physical functions and depression levels in breast cancer-related lymph edema.
• Does lymphoedema bandaging reduce the risk of toe ulceration?
• Study of 700 referrals to a Lymphedema Program.
• Worldwide assessment of healthcare personnel dealing with lymphoedema.
• Földi M, Földi E. Földi’s textbook of lymphology for physicians and Lymphoedema therapists.
• Fluid Shifts Induced by Physical Therapy in Lower Limb Lymphedema Patients
• Visualization of Accessory Lymphatic Pathways, before and after Manual Drainage, in Secondary Upper Limb Lymphedema Using Indocyanine Green Lymphography
• The risk of genital edema after external pump compression for lower limb lymphedema.
• The management of genital lymphoedema
• The management of deep vein thrombosis in lymphoedema: a review.
• Lymphedema-associated comorbidities and treatment gap.

PRENDAS DE COMPRESIÓN

• A study of the advantages of elastic stockings for leg lymphedema.
• Indications for medical compression stockings in venous and lymphatic disorders: An evidence-based consensus statement.
• Medical compression stockings for chronic venous diseases and lymphedema: Scientific evidence and results of a patient survey on quality of care.
• Impact of Compression Therapy on Cellulitis (ICTOC) in adults with chronic edema: a randomized controlled trial protocol.
• Compression Therapy Is Cost-Saving in the Prevention of Lower Limb Recurrent Cellulitis in Patients with Chronic Edema.
• Occupational leg edema-use of compression stockings.

DISCAPACIDAD

• Disability and lymphedema.
• Lymphedema and employability.
• Worse and worse off: the impact of lymphedema on work and career after breast cancer
• Functioning in lymphedema from the patient's perspective using the International Classification of Functioning, Disability and Health (ICF).
• Unilateral upper extremity lymphedema deteriorates the postural stability in breast cancer survivors
• Postural Stability in Patients with Lower Limb Lymphedema
• Disability, psychological distress and quality of life in breast cancer survivors with arm lymphedema

DISFIGURACIÓN

• Adjusting to disfigurement: processes involved in dealing with being visibly different
• Quality of Life in Cancer Patients with Disfigurement due to Cancer and its Treatments
• Quality-of-life and body image impairments in patients with lymphedema
• Association of lower extremity lymphedema with pelvic floor functions, sleep quality, kinesiophobia, body image in patients with gynecological cancers

CALIDAD DE VIDA

• The impact of lower limb chronic oedema on patients' quality of life
• Quality of life in patients with primary and secondary lymphedema in the community
• Evaluating the effect of upper-body morbidity on quality of life following breast cancer treatment.
• Functionality and quality of life of patients with unilateral lymphedema of a lower limb: a cross-sectional study
• The effect of complete decongestive therapy on the quality of life of patients with peripheral lymphedema

IMPACTO PSYCHOSOCIAL

• Psychosocial Impact of Lymphedema.
• Associations between chronic disease, age, and physical and mental health status
• A network analysis of psychological flexibility, coping, and stigma in dermatology patients
• 'Abandoned by medicine'? A qualitative study of women's experiences with lymphoedema secondary to cancer, and the implications for care
• People are neglected, not diseases.
• Chronic edema/lymphoedema: under-recognized and under‐treated.
• Lymphatic Medicine: Paradoxically and unnecessarily ignored.
• Medical education: a deficiency or a disgrace.

FILARIASIS / PODOCONIOSIS LINFÁTICA

• Podoconiosis: Clinical spectrum and microscopic presentations.
• Podoconiosis: A Possible Cause of Lymphedema in Micronesia.
• A cross-sectional study to evaluate depression and quality of life among patients with lymphoedema due to podoconiosis, lymphatic filariasis, and leprosy.
• The impact of acute adenolymphangitis in podoconiosis on caregivers.
• Neglected tropical diseases and disability-what is the link?
• Locomotor disability in bancroftian filarial lymphoedema patients.
• Neglected patients with a neglected disease?
• Neglected tropical diseases and mental health: a perspective on comorbidity.
• People are neglected, not diseases.
• Addressing Inequity: Neglected Tropical Diseases and Human Rights.
• Neglected Tropical Diseases, Conflict, and the Right To Health.

SISTEMA VASCULAR SANGUÍNEO 

• Peripheral Edema
• Phlebolymphedema
• Understanding Chronic Venous Disease: A Critical Overview of Its Pathophysiology and Medical Management
• Role of the lymphatic vasculature in cardiovascular medicine
• Communication between lymphatic and venous systems
• Phlebopathies and occupation
• Phlebopathies and workers
• Evidence of health risks associated with prolonged standing at work and intervention effectiveness
• Leg edema formation and venous blood flow velocity during a simulated long-haul flight

UNIVERSAL CHILDREN´S DAY 2023 - Declaration of the Rights of the Child – The Right to Health and Healthcare – Children with Lymphedema - Pediatric and Primary Lymphedema – Secondary Lymphedema – Lymphatic Filariasis and Podoconiosis

November 20th is an important date, it is to promote the Declaration of the Rights of the Child. World Children's Day promotes and celebrates children's rights, and one of its main objectives is to improve children's health and welfare.  The Convention on the Rights of the Child was proclaimed and adopted by the United Nations General Assembly in 1989.

 ARTICLE 24 (health and healthcare) of the UN Convention on the Rights of the Child states: States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services.

On behalf of AGL, we want to celebrate World Children's Day to highlight that lymphoedema is not only a disease that affects adults.

Lymphedema (Organic Lymphatic Vascular Disease) is a chronic and progressive disease due to dysfunction of the lymphatic circulatory system. Lymphedema is a condition that may affect arms, legs, fingers, toes, head, neck, abdomen (belly), genitalia, internal organs, or the whole body, which causes chronic inflammation and swelling in the affected area. Regarding children, it may not only be due to congenital causes (Primary Lymphedema), but it can also appear in childhood due to secondary causes (Secondary Lymphedema), such as parasite infections (Lymphatic filariasis).

Lymphatic filariasis (Secondary Lymphedema) is a neglected disease. It is recognized as a common widespread, seriously handicapping disease of adults, and is generally thought to occur only sporadically in children. New advances in diagnostic tests (antigen detection, pulse-wave Doppler ultrasonography, and lymphoscintigraphy examination) have helped to recognize the subclinical pathology caused by this infection and have revealed that LF is often first acquired during childhood, with as many as one-third of children infected before age 5.

Recent studies indicate that medications used in mass drug administration programs are capable of reversing sub-clinical lymphatic damage in children. But when there is permanent irreversible damage to the lymphatic system due to filariasis, it also generally remains subclinical for years or gives rise only to non-specific presentations of adenitis/adenopathy, which will later develop and cause lymphedema of limbs.

 

Clinical manifestations of the disease appear most frequently during early adulthood or later, and without adequate treatment, will then progress to its late severe “elephantiasis Stage”, hydrocele, and consequent acute attacks of dermatolymphangioadenitis. Limb and genital Lymphedema should always be treated in their early stages, and not left undertreated till reaching its severe stages. Read more about the signs, symptoms, and complications of the disease HERE.

Studies have shown that simple hygiene-based measures are necessary and that community and family-based intervention has a positive effect on children who already have irreversible damage to their lymphatics, but these measures alone are not enough for edema control. Adequate lymphatic treatment and compression garments are recommended by international scientific societies for the control of long-term clinical manifestations and disease progression. The condition among school children, most of whom in developing countries never received proper medical attention, are found to develop anxiety and psychological concerns about the effect of the disease and their fate.

In consequence, very little attention, if any, has been given to the signs and symptoms of lymphatic filariasis in childhood. Lymphedema whatever the cause or setting, all need the same lymphatic treatment and compression garments to prevent the development of the elephantiasis stage and later complications and debulking surgeries. International health organizations must implement adequate treatment programs, and emphasize the need for disability-alleviation efforts among children as well as adults. Control of morbidity management with proper lymphatic and compression treatment for established lymphedema should be implemented by national health systems. Read more about what is the best treatment for children with lymphedema HERE.

Recognizing that LF disease starts its development in childhood has immediate practical implications both for the management and prevention of the progression of the disease in individual patients and for the broader public health efforts to overcome all childhood illnesses. For decades, this disease (lymphatic dysfunction) which is treatable, embodies the failures of health systems, governments, and societies to tackle the structural inequalities and injustices that allow this cruel and ignored condition to thrive. Under children's and human rights, all children suffering from lymphatic dysfunction (lymphedema), whatever its cause or setting, should have access to the correct treatment to manage this chronic and progressive disease.

I

MPORTANT NOTICE 

Lymphedema is a serious chronic and progressive disease due to an organic disability. The clinical treatment of lymphedema is neither a cosmetic nor an aesthetic treatment. The treatment of lymphedema is to control its progression and alleviate the symptoms related to dysfunction of the lymphatic circulatory system. 

To prevent and avoid serious complications associated with treatment, such as the possible displacement of edema to previously unaffected areas when compression therapy is applied for volume reduction, patients should use highly specialized and experienced therapists. 

Professional qualification and instruction delivered remotely online are not the same as live hands-on practical instruction in the clinical training and certification of lymphedema therapists, similar to all other rehabilitation, medical, and surgical training programs, and especially for developing the necessary manual skills to treat a disease as complex as lymphedema. 

Patients should also take special care when choosing a "Multidisciplinary Center of Reference for Lymphedema", as not all countries and centers provide the same treatment options. The best choice is a center of reference that provides “Complete Decongestive Therapy (CDT)”, which is recognized as the “Gold Standard” treatment for lymphedema.

• Read about the best treatment option for Lymphedema HERE.

• Read about the principal functions of Manual Lymphatic Drainage HERE.

• Read about the differences between the two principal lymphedema treatment protocols HERE. 

• Read about the strategies for the implementation of low-cost treatment options for Lymphedema HERE.

REFERENCES

(Click on the texts to read the research articles)

SCIENTIFIC SOCIETIES

• German Scientific Society Guideline: Diagnostics and Therapy of Lymphoedema.

PRIMARY LYMPHEDEMA

• Scientific Article: Primary Lymphedema, definition, diagnose, and treatment
• Convention on the Rights of the Child

PEDIATRIC LYMPHEDEMA

• NORD: Rare Disease Database - Lymphedema
• Medical management of lymphedema.
• Primary lymphedema in childhood.
• An approach to familiar lymphedema
• Pediatric Children Lymphedema
• Primary Lymphedema French National Diagnosis and Care Protocol (PNDS).
• Lymphatic filariasis: an infection of childhood.
• Lymphatic filariasis in children: clinical features, infection burdens and future prospects for elimination.

PATHOPHYSIOLOGY

• lymphedema.
• Biology of Lymphedema
• Lymph vessels: the forgotten second circulation in health and disease
• Lymphatic Vessel Network Structure and Physiology
• Lymphatic System Flows
• Organ-specific lymphatic vasculature: From development to pathophysiology.
• The lymphatic vascular system: much more than just a sewer.
• The unresolved pathophysiology of lymphedema.
• Lymphedema: A Practical Approach and Clinical Update.
• Coagulation in Lymphatic System.
• Regulation of immune function by the lymphatic system in lymphedema.
• Oxidative stress in chronic lymphoedema.
• Regulatory T Cells Mediate Local Immunosuppression in Lymphedema.
• Hemostatic properties of the lymph: relationships with occlusion and thrombosis.
• Secondary lymphedema: Pathogenesis
• Gastrointestinal Lymphatics in Health and Disease
• Intestinal lymphangiectasia in adults
• Role of the lymphatic vasculature in cardiovascular medicine
• The lymphatic vasculature in disease
• Lymphoscintigraphic abnormalities in the contralateral lower limbs of patients with unilateral lymphedema.
• The Prevalence of Lower Limb and Genital Lymphedema after Prostate Cancer Treatment: A Systematic Review
• Peripheral Edema

CUTANEOUS COMPLICATIONS

• The lymphatic system and the skin. Classification, clinical aspects, and histology.
• Lymphedema and cutaneous diseases.
• Lymphedema and subclinical lymphostasis (microlymphedema) facilitate cutaneous infection, inflammatory dermatoses, and neoplasia: A locus minoris resistentiae.
• Serum Immune Proteins in Limb Lymphedema Reflecting Tissue Processes Caused by Lymph Stasis and Chronic Dermato-lymphangio-adenitis (Cellulitis).
• Lymphedema and subclinical lymphostasis (microlymphedema) facilitate cutaneous infection, inflammatory dermatoses, and neoplasia: A locus minoris resistentiae.

INFECTIOUS COMPLICATIONS

• Lymphatic Flow: A Potential Target in Sepsis.
• Infectious complications of lymphedema.
• Acute inflammatory exacerbations in lymphoedema.
• Inflammatory Manifestations of lymphedema.

CELLULITIS / DERMATOLYMPHANGIOADENITIS

• Cellulitis.
• Clinical features, microbiological epidemiology, and recommendations for the management of cellulitis in extremity lymphedema.
• Challenges of cellulitis in a lymphedematous extremity.
• Diagnosis and management of cellulitis.
• Cellulitis risk factors for patients with primary or secondary lymphedema.
• Oedema as a risk factor for multiple episodes of cellulitis/erysipelas of the lower leg.
• Prevention of dermatolymphangioadenitis by combined physiotherapy.
• Erysipelas: a common potentially dangerous infection.

TUMOURS

• Malignant tumors as complications of lymphedema.
• Lymphedematous areas: Privileged sites for tumors, infections, and immune disorders.
• Lymphedema-related angiogenic tumors and other malignancies.
• Lymphedema: an immunologically vulnerable site for the development of neoplasms.
• Lymph stasis promotes tumor growth
• A retrospective analysis of Stewart-Treves syndrome in the context of chronic lymphedema.
• Stewart-Treves Syndrome

PAIN

• Congenital lymphedema complicated by pain and psychological distress: case report
• Lymphatic Pain in Breast Cancer Survivors
• Does Manual Lymphatic Drainage Have Any Effect on Pain Threshold and Tolerance of Different Body Parts?
• Lymphedema therapy reduces the volume of edema and pain in patients with breast cancer
• Quality of life in patients with primary and secondary lymphedema in the community

TREATMENT

• Treatment of limbs lymphedema.
• Nonoperative treatment of lymphedema.
• Lymphedema: From diagnosis to treatment.
• Lymphedema-clinical picture and therapy.
• Physiotherapeutic rehabilitation of lymphedema: state-of-the-art.
• Diagnosis and management of lymphatic vascular disease
• Effective treatment of lymphedema of the extremities.
• Lymphoscintigraphic aspects of the effects of manual lymphatic drainage.
• Intensive Treatment of Lower-Limb Lymphedema and Variations in Volume.
• Effectiveness and safety of Complete Decongestive Therapy of Phase I.
• Therapeutic Efficacy of Complex Decongestive Therapy in the Treatment of Elephantiasis of the Lower Extremities.
• Effects of Phase I complex decongestive physiotherapy on physical functions and depression levels in breast cancer-related lymph edema.
• Does lymphoedema bandaging reduce the risk of toe ulceration?
• Study of 700 referrals to a Lymphedema Program.
• Worldwide assessment of healthcare personnel dealing with lymphoedema.
• Földi M, Földi E. Földi’s textbook of lymphology for physicians and Lymphoedema therapists.
• Fluid Shifts Induced by Physical Therapy in Lower Limb Lymphedema Patients
• Visualization of Accessory Lymphatic Pathways, before and after Manual Drainage, in Secondary Upper Limb Lymphedema Using Indocyanine Green Lymphography
• The risk of genital edema after external pump compression for lower limb lymphedema.
• The management of genital lymphoedema
• The management of deep vein thrombosis in lymphoedema: a review.
• Lymphedema-associated comorbidities and treatment gap.

COMPRESSION GARMENTS

• A study of the advantages of elastic stockings for leg lymphedema.
• Indications for medical compression stockings in venous and lymphatic disorders: An evidence-based consensus statement.
• Medical compression stockings for chronic venous diseases and lymphedema: Scientific evidence and results of a patient survey on quality of care.
• Impact of Compression Therapy on Cellulitis (ICTOC) in adults with chronic edema: a randomized controlled trial protocol.
• Compression Therapy Is Cost-Saving in the Prevention of Lower Limb Recurrent Cellulitis in Patients with Chronic Edema.
• Occupational leg edema-use of compression stockings.

DISABILITY

• Disability and lymphedema.
• Lymphedema and employability.
• Worse and worse off: the impact of lymphedema on work and career after breast cancer
• Functioning in lymphedema from the patient's perspective using the International Classification of Functioning, Disability and Health (ICF).
• Unilateral upper extremity lymphedema deteriorates the postural stability in breast cancer survivors
• Postural Stability in Patients with Lower Limb Lymphedema
• Disability, psychological distress and quality of life in breast cancer survivors with arm lymphedema

DISFIGUREMENT

• Adjusting to disfigurement: processes involved in dealing with being visibly different
• Quality of Life in Cancer Patients with Disfigurement due to Cancer and its Treatments
• Quality-of-life and body image impairments in patients with lymphedema
• Association of lower extremity lymphedema with pelvic floor functions, sleep quality, kinesiophobia, body image in patients with gynecological cancers

QUALITY OF LIFE

• The impact of lower limb chronic oedema on patients' quality of life
• Quality of life in patients with primary and secondary lymphedema in the community
• Evaluating the effect of upper-body morbidity on quality of life following breast cancer treatment.
• Functionality and quality of life of patients with unilateral lymphedema of a lower limb: a cross-sectional study
• The effect of complete decongestive therapy on the quality of life of patients with peripheral lymphedema

PSYCHOSOCIAL IMPACT

• Psychosocial Impact of Lymphedema.
• Associations between chronic disease, age and physical and mental health status
• A network analysis of psychological flexibility, coping, and stigma in dermatology patients
• 'Abandoned by medicine'? A qualitative study of women's experiences with lymphoedema secondary to cancer, and the implications for care
• People are neglected, not diseases.
• Chronic edema/lymphoedema: under-recognized and under‐treated.
• Lymphatic Medicine: Paradoxically and unnecessarily ignored.
• Medical education: a deficiency or a disgrace.

LYMPHATIC FILARIASIS / PODOCONIOSIS

• Podoconiosis: Clinical spectrum and microscopic presentations.
• Podoconiosis: A Possible Cause of Lymphedema in Micronesia.
• A cross-sectional study to evaluate depression and quality of life among patients with lymphoedema due to podoconiosis, lymphatic filariasis, and leprosy.
• The impact of acute adenolymphangitis in podoconiosis on caregivers.
• Neglected tropical diseases and disability-what is the link?
• Locomotor disability in bancroftian filarial lymphoedema patients.
• Neglected patients with a neglected disease?
• Neglected tropical diseases and mental health: a perspective on comorbidity.
• People are neglected, not diseases.
• Addressing Inequity: Neglected Tropical Diseases and Human Rights.
• Neglected Tropical Diseases, Conflict, and the Right To Health.

BLOOD VASCULAR SYSTEM 

• Peripheral Edema
• Phlebolymphedema
• Understanding Chronic Venous Disease: A Critical Overview of Its Pathophysiology and Medical Management
• Role of the lymphatic vasculature in cardiovascular medicine
• Communication between lymphatic and venous systems
• Phlebopathies and occupation
• Phlebopathies and workers
• Evidence of health risks associated with prolonged standing at work and intervention effectiveness
• Leg edema formation and venous blood flow velocity during a simulated long-haul flight