Lipedema is a pathology of adipose tissue, still of unclear etiology and challenging to diagnose. For these reasons, a therapeutic approach is also complex and sometimes controversial. The inflammation state present in lipedema can be limited by controlling the glycemic peaks. Specifically, the ketogenic diet (KD) seems to have the right conditions to be effective. Herein, we reported a subject diagnosed with lipedema who, with only KD nutritional intervention, achieved a significant weight loss (−41 Kg), with a net decrease in body circumferences, and also reporting an improvement in pain, and therefore in the overall quality of life. She refused other types of intervention and kept KD for two years. This case could represent the first step to organize a KD nutritional protocol specifically applied to lipedema.

This narrative review portrays the lymphatic system, a poorly understood but important physiological system. While several reviews have been published that are related to the biology of the lymphatic system and lymphedema, the physiological alternations, which arise due to disturbances of this system, and during lymphedema therapy, are poorly understood and, consequently, not widely reported. We present an inclusive collection of evidence from the scientific literature reflecting important developments in lymphedema research over the last few decades. This review aims at advancing the knowledge on the area of lymphatic system function as well as how system dysfunction, as seen in lymphedema, affects physiological systems and how lymphedema therapy modulates these mechanisms. We propose that future studies should aim at investigating, in-detail, aspects that are related to fluid regulation, hemodynamic responses, and endothelial and/or vascular changes due to lymphedema and lymphedema therapy.

Lymphatic flow is necessary for maintenance of vital physiological functions in humans and animals. To carry out optimal lymphatic flow, adequate contractile activity of the lymphatic collectors is necessary. Like in all body systems, aging has also an effect on the lymphatic system. However, limited knowledge is available on how aging directly affects the lymphatic system anatomy, physiology and function. We investigated how senescence leads to alterations in morphology and function of the lymphatic vessels. We used the strategy of a review to summarize the scientific literature of studies that have been published in the area of lymphatic senescence. Searches were carried out on PubMed and Web of Science using predefined search queries. We obtained an initial set of 1060 publications. They were filtered to 114 publications based on strict inclusion and exclusion criteria. Finally, the most appropriate 57 studies that specifically addressed lymphatic senescence have been selected for the preparation of this review. Analysis of the literature showed that lymphatic senescence is associated with alterations in lymphatic muscles and nerve fibers, lymphatic glycocalyx function of lymphatic endothelial cells, effects of chronic ultraviolet light exposure and oxidative stress as well as changes in lymphatic pump, acute inflammation responses and immune function. The current review underscores the relevance of the understudied area of lymphatic senescence. Continued research on the impact of aging on the structure and function of the lymphatic vasculature is needed to provide further insights to develop innovative clinical diagnostic—and treatment—modalities as well as to reduce the morbidity associated with diseases related to the lymphatic system.

The report of the scientific conference held in Trieste on 5 and 6 April 2024, on topics relating to lymphedema and lipedema, is presented. Aspects relating to what is provided by the health services of 6 European countries were addressed. Various innovative diagnostic and therapeutic approaches were then presented. Finally, aspects relating to chronic diseases were discussed, with regard to new concepts and professional figures. Other particular topics completed the program.

Lower limb edema is a frequent occurrence in the geriatric age. Among the possible causes, the deterioration of lymphatic function caused by its senescence is usually overlooked. There is multiple evidence of aging of the lymphatic system, based on in vivo observations, both in humans and in animal models, and on cadavers. The alterations concern both the morphological and ultrastructural level, as well as functionality. On the basis of the available data, some clinical pictures can be better understood and new areas of investigation envisaged.

Aims and objectives: Chronic lymphoedema is associated with fibrosclerosis, lipid cell proliferation, angiogenesis as well as increase of tissue thickness and hardness. Here we quantitively assessed epifascial tissue elasticity in arm lymphoedema patients using the Acoustic Radiation Force Impulse Quantification (ARFI-Q) approach. Materials and methods: Thickness and elasticity of the epifascial tissues of both forearms (healthy and lymphoedematous) were measured, with and without tissue compression, using a Siemens Acuson 2000 - Virtual Touch ultrasound equipment. Differences in ARFI-Q values among epifascial tissue layers (superficial, intermediate and deep) of both forearms were assessed. Quantitative variables were evaluated using Spearman coefficient. ARFI values were evaluated using Kruskal Wallis non parametric test. Results: 41 patients (38 females, 3 males; age 63.3±11 years; weight 72.8±11 kg, height 162.5±7.8cm and BMI 27.6±4.8 kg/m2 with unilateral breast cancer related lymphoedema were enrolled into this study. The median elastographic values, in m/sec, without compression at the lymphoedematous limb were: superficial layer 1.70 m/s (0.78-2.82); intermediate layer 1.14 m/s (0.71-3.66) and deep layer 2.10 m/s (0.71-4.29). With tissue compression, values were 3.23 m/s (0.98-4.92), 3.16 m/s (1.29-7.92) and 3.65 m/s (1.72-5.70), respectively. In the lymphoedematous limb we found significant differences between intermediate and deep layers with no compression (p = 0.005), and between superficial and intermediate layers (p = 0.004) as well as intermediate and deep layers (p < 0.001) with compression. Conclusions: ARFI Quantification could demonstrate different stiffness values for the three layers in lymphoedematous limbs. The reduced elasticity of deep epifascial tissues could be an expression of fibrotic degeneration. Moreover, elastic compression, normally used as a treatment, could prevent or reduce fibrosis of the more superficial layers.