Report from Grado 2023

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With a sober style, as always befits Alberto Onorato, but dense with content on March 23, 2023 a day was held in Grado dedicated to ‘Lymphedema and Lipedema: Today and Tomorrow. State of the art and future perspectives’. Dr. Onorato himself and the President of the ‘Lotta al Linfedema’ Association, Dr. Nerina Fabbro, a strong supporter of the initiative, opened the proceedings. The scientific proceedings then began with a presentation by Bianca Steuber, from Graz, who emphasized the preeminent aspects of the anatomy and functions of the lymphatic system. Alberto Macciò then outlined the diagnostic protocols in use for lymphatic diseases while also highlighting the emerging value of videofluoroscopy, which, however, takes nothing away from traditional lymphoscintigraphy. Dr. Federica Lipanje, from Udine, then recalled some aspects of Primary Lymphedema, finally recognized (although only recently) among rare diseases. It was then the turn of Fabio Puglisi of the Treatment Center for Oncologic Diseases, who dwelt on some aspects of secondary forms of Lymphedema, which, despite the partial downsizing brought about by the use of the sentinel lymph node and increasingly conservative treatment protocols, continues to have a marked incidence in the population of all age groups. It was then the turn of the writer’s Lecture on ‘Diagnosis and Treatment of Lymphedema in Italy: current situation and future prospects, during which the slow steps forward from the point of view of Referral Centers on the national territory and the care aspects that still require regulatory and organizational insights, especially in some regions, were described.

                                                                      
Albino Visentin, of Gorizia, then described the role of the general practitioner in the management of the patient with lymphedema, pointing out that the national federation of physicians also cyclically tries to conduct studies from an epidemiological point of view in an attempt to understand the approach from a diagnostic-therapeutic point of view, already from the territory.
                                                     

With the experience of his Facility, it was then the turn of Christian Ure, of Wolsfberg, who described the individual and personalized courses of conservative treatments in patients with Lymphedema, reserving in individual cases the most appropriate targeted therapies. Alessandro Busetto from Venice then illustrated the indications for surgical treatment, emphasizing that even modest clinical improvements justify its use.
It was then the turn of Elisa Dorigo, from Grado, who described the experience of taking care of patients with lymphedema at the Hospizio Marino in Grado, an ex-Article 26 Center that allows Onorato’s team to follow and treat the most complex patients thanks to this rehabilitative care setting, which she explained is one of the institutional agreed weapons in the possession of operators to assist patients, among the various types of care available today after the ministerial document of guidelines was made official.
The afternoon session was opened by Plastic Surgeon Matthias Sandhofer, from Linz, who described the results on Lipedema achieved with his extensive professional experience; satisfactory and lasting results that require a particular ‘personalization of the intervention towards the individual clinical case.

                                                         
Christian Ure then presented his conservative rehabilitation protocols toward the patient with lipedema, which include all aspects of care: from adherence to the individualized diet, physical treatments, exercise, and lifestyle hygiene rules to be observed, to possible psychological support.
                                                                                       
Agostino Bruno, from Rome, then presented some therapeutic options for the treatment of Lipedema, including markedly reductive and demolitive interventions in subjects with morbid obesity as a comorbidity.
This was followed by the Reading of Manuel Cornely, from Cologne, who highlighted how surgical treatment represents, in the state of our current knowledge, the most effective and diriment therapeutic remedy towards the pathology
                                                                  
The entire afternoon, dedicated to Lipedema continued with a presentation by Roberto Cannataro, who explained how the nutritional approach, even in Lipedema, must be personalized, also taking into account the possible co-morbidities present in individual cases, from autoimmune thyroiditis to insulin resistance. The ketogenic diet itself (the one to which affected areas would respond most) must be considered within the context of an overall balance of the individual organism.
Nerina Fabbro, from Udine, then illustrated the possibilities of psychological intervention on patients who, frequently present problems of discouragement or depression, not only because of the pathology per se, but also because of the futility of the many ’empirical’ treatments to which the pazinete has been subjected, often in vain from the point of view of clinical results.
The writer then presented the new international association that has arisen for the study of Lipedema: the World Lipeda Alliance (WLA), currently chaired by the undersigned (vice-president the US-based Karen Herbs), which has more than 90 founding members (from 24 countries), 12 iternazional patient associations and 5 specific cultural associations (including two American ones).
Valeria Giordano, the president of the patient association LIO (Lipedema Italia Onlus)  rappresented by vice-president Marcella Oggiano. Dr Giordano then took the floor, via a link from Rome (the entire event was streamed), and outlined all the main issues presented by patients and the various battles carried out by the association in favor of the thousands of patients affected by the condition in Italy.
Busetto and Onorato (co-organizers of the event) closed the proceedings by pointing out how the various study groups (including the Italian ones) are proceeding, at a steady pace, acquiring more and more new knowledge that will soon allow further improvements in the lives of patients with Lymphedema and with Lipedema.