ArticleLiterature Review

Lipedema, a hardly known disease: Diagnosis, associated illness and therapy

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Abstract

Lipedema is a common but rarely diagnosed disease or frequently confused with obesity. Patients are almost exclusively women. It is characterised by symmetrical, circumscribed, in advanced form deforming fat tissue accumulation on the legs that is associated with lymphedema. Spontaneous pain, pain to pressure and tendency to hematoma are characteristic. One of the possible causes of a fat leg, that is a very common complaint, is lipedema. Main differential diagnoses are obesity, lipohypertrophy and primary and secondary lymphedema. It is often associated with chronic venous and lymphatic insufficiency, early degenerative articular disease and obesity. The disease is rarely recognized and the treatment modalities are not widely known. Therefore patients feel very frustrated that leads to psychologic disorders. Until recently only conservative treatment was possible (combination of manual or intermittent pneumatic drainage, compression bandages and garments and physiotherapy). More recently surgical intervention (liposuction) is also included in the treatment options. The significance of lipedema is due not only to the disease itself, but also to the combination of lipedema and the group of associated and secondary diseases (articular and venous diseases, lymphedema, obesity, psychologic disorders). The more diseases coexist, the worse is the prognosis of lipedema itself. To prevent and delay this disease, it is indispensable to recognise it as early as possible and to treat it expertly and follow up patients suffering from lipedema.

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... Lipedema was first described by Allen and Hines in 1940. It is a disproportionate, bilateral, and symmetrical accumulation of subcutaneous fat of the lower and occasionally upper extremities [1][2][3]. In lipedema, fat pads extend to the ankles and wrists, with the feet and hands spared, resulting in the characteristic cuff sign [4] ( Fig. 1). ...
... Differentiation from other adipose tissue disorders can be challenging, and lipedema is frequently misdiagnosed as lifestyle-induced obesity or lymphedema [14]. In contrast to obesity, patients suffer from pain in the extremities, tenderness on palpation, and a tendency to bruise easily [2]. ...
Article
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Background Lipedema often remains undiagnosed in patients with obesity, leading to mismanagement of treatment. Because of this, despite remarkable weight loss after bariatric surgery and decreases in hip and abdomen circumference, some patients show only small decreases in circumference of the extremities, and report persistent limb pain. Objectives The goal of this work is to raise awareness of lipedema coincident with obesity, mistakenly diagnosed as obesity alone, in order to ensure the correct diagnosis of the condition and to achieve better treatment outcomes for people with lipedema and coincident obesity. Setting CG Lympha Clinic, Cologne and Ernst von Bergmann Clinic, Potsdam Methods From clinical records we identified 13 patients who were diagnosed with lipedema only after undergoing bariatric surgery. We describe the course of their pain before and after bariatric surgery focusing on the long-term progression of symptoms accompanying the disease. Results Lipedema cannot be cured by bariatric surgery and although the patients in the study lost an average of more than 50 kilograms of weight, they displayed no improvement in the pain symptoms typical of lipedema. Conclusions Due to the different etiology of lipedema and obesity, lipedema requires its own specific treatment. Patients suffering from obesity should always be assessed for pain and lipedema. If coincident lipedema is diagnosed, we suggest that bariatric surgery only be performed first if diet and exercise have failed, the patient’s BMI is over 40 kg/m², and the patient has been informed of the possible persistence of pain. This optimized treatment may help to better manage patient expectations after weight loss.
... A diferencia de la obesidad, los depósitos de grasa y el edema asociados al lipedema son resistentes a los cambios en la dieta, la restricción de la ingesta calórica, la actividad física o la cirugía bariátrica 3 . Los pacientes refieren, además, dolor en las extremidades inferiores que aumenta durante el día, con sensibilidad, facilidad de producción de equimosis e incluso, pudiendo llegar a linfedema progresivo 4 . ...
Article
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El lipedema es una enfermedad común, frecuentemente sub-diagnosticada, crónica y progresiva, que genera un gran deterioro en la calidad de vida. Consiste en el depósito anormal de tejido adiposo subcutáneo principalmente en las extremidades inferiores, afectando casi exclusivamente a mujeres. Sus síntomas principales son el dolor, la sensibilidad y la facilidad para producir equimosis. Desde el punto de vista fisiopatológico, existiría una susceptibilidad poligénica combinada con trastornos hormonales, microvasculares y linfáticos que pueden ser en parte responsables del desarrollo del lipedema. Se clasifica, según la distribución de la grasa en cinco tipos y, según la gravedad de la enferemdad, en cuatro etapas. El diagnóstico es eminentemente clínico y se debe diferenciar de otras patologías que producen aumento de volumen de las extremidades, especialmente el linfedema y obesidad. Es importante realizar un estudio funcional del sistema linfático cuando el diagnóstico es dudoso o para la etapificación del lipedema, por lo que la correcta interpretación de estos resultados es fundamental. El tratamiento está enfocado en disminuir la discapacidad y evitar la progresión, con el fin de mejorar la calidad de vida. Actualmente la liposucción es un tratamiento efectivo para el lipedema, sin embargo, las técnicas empleadas para la lipectomía en el lipedema son diferentes a las técnicas utilizadas para la liposucción con fines estéticos. Las técnicas selectivas que respetan los vasos linfáticos tienen mejor rendimiento para reducir el volumen de grasa, retrasar la progresión, reducir el dolor, reducir la alteración marcha y mejorar la calidad de vida en estos pacientes.
... MLD has been used as a way of treating several disorders, such as: cellulite (4)(5)(6)(7) , localized adiposity (5,7) , postoperative of cosmetic plastic surgeries (8) , postoperative of orthognathic surgery (9) , post-traumatic edema (10,11) , lymphedema (12,13) , chronic venous insufficiency (14)(15)(16) , lipedema (17) , premenstrual edema (18) , gestational edema (19,20) and fibromyalgia (21,22) . Especially, women in menacme, suffer the influences of the different phases of the menstrual cycle and, consequently, they are subject to changes caused by the difference in concentration of the female hormones participating in this process (23) . ...
Article
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Background: Manual lymphatic drainage (MLD) is a technique widely used in clinical practice to favor the absorption and transport ofinterstitial fluid and macromolecules through the lymphatic system. Usually, MLD is indicated as a way of treating edema andlymphedema of different etiologies. Objective: Analyze the immediate effects of manual lymphatic drainage on the volume andsensation of the lower limbs of healthy women. Methods: The sample consisted of 40 healthy women aged between 18 and 44 years,sedentary and with body mass index between 18,5 - 29,9 Kg/m2. They were bilaterally submitted to a single MLD session on the lowerlimbs. The evaluation of the volume of the lower limbs was made by perimetry and the sensation in the lower limbs was determinedthrough a questionnaire prepared by the authors of this study. Results: It was observed that there was no statistically significantdifference in the perimetry of the lower limbs (p ≥ 0.05), however a decrease was reported in the “sensation of weight” in the lower limbsand in the “tiredness to walk”. Conclusion: Manual lymphatic drainage did not decrease the volume, but it did improve the feeling ofheaviness and tiredness to walk providing a feeling of lightness in the lower limbs
... It is characterized by disproportional fat accumulation of the lower and also upper extremities that can result in considerable disability. 1 The hypertrophic fat pads normally extend from the hips to the ankles and/or from the shoulders to the wrists and are typically unresponsive to dietary regimens or physical activities. 2 In addition to the aesthetic deformity, women also describe pain in the lower extremities, which increases during the day, with tenderness, easy bruising, and progressive lymphedema. 3 In many cases, mothers, grandmothers, sisters, and aunts are affected in a comparable way. 4 However, the genetic background of the disease has not been fully discovered yet. 5 A study from 2010 showed that within six families of more than three generations with lipedema, a genetic autosomal-dominant hereditary pattern was found. ...
... Although not pathognomonic, and in spite of a lack of high-quality scientific data, microangiopathy has been considered a typical histological feature of lipedema by some researchers (7). This vascular alteration may be a consequence of the primary endothelial dysfunction through hypoxia mechanism with subsequent increased vascular fragility, similar to what was observed in patients with diabetic retinopathy (39). Angiogenesis has several stimulators, including VEGF. ...
Article
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Lipedema is a chronic progressive disease characterized by abnormal fat distribution resulting in disproportionate, painful limbs. It almost exclusively affects women, leading to considerable disability, daily functioning impairment, and psychosocial distress. Literature shows both scarce and conflicting data regarding its prevalence. Lipedema has been considered a rare entity by several authors, though it may be a far more frequent condition than thought. Despite the clinical impact on women's health, lipedema is in fact mostly unknown, underdiagnosed, and too often misdiagnosed with other similarly presenting diseases. Polygenic susceptibility combined with hormonal, microvascular, and lymphatic disorders may be partly responsible for its development. Furthermore, consistent information on lipedema pathophysiology is still lacking, and an etiological treatment is not yet available. Weight loss measures exhibit minimal effect on the abnormal body fat distribution, resulting in eating disorders, increased obesity risk, depression, and other psychological complaints. Surgical techniques, such as liposuction and excisional lipectomy, represent therapeutic options in selected cases. This review aims to outline current evidence regarding lipedema epidemiology, pathophysiology, clinical presentation, differential diagnosis, and management. Increased awareness and a better understanding of its clinical presentation and pathophysiology are warranted to enable clinicians to diagnose and treat affected patients at an earlier stage.
... Der Verlauf des Lipödems ist in aller Regel nicht schicksalhaft. Der Verlauf und die Schwere des Befundes hängen wesentlich von den Begleiterkrankungen wie beispielsweise peripherer arterieller Verschlusskrankheit, Lymphödem, Adipositas und psychologischen/psychiatrischen Störungen ab [32]. ...
... The course of lipedema is usually not predetermined. The course and the severity of fi ndings depend to a large extent on comorbidities such as peripheral arterial occlusive disease, lymphedema, obesity and psychological/ psychiatric disorders [32]. ...
Article
Due to its increased presence in the press and on television, the diagnosis of lipedema is on the way to becoming a trendy diagnosis for those with thick legs. Despite this, one must recognize that lipedema is a very rare disease. It is characterized by disproportional obesity of the extremities, especially in the region of the hip and the legs, hematoma development after minimal trauma, and increased pressure-induced or spontaneous pain. Aids for making the correct diagnosis are (duplex) sonography, the waist-hip index or the waist-height index and lymphoscintigraphy. Important differential diagnoses are constitutional variability of the legs, lipohypertrophy in obesity, edema in immobility, edema in chronic venous insufficiency and rheumatic diseases. The symptom-based therapy of lipedema consists of conservative (compression, manual lymphatic drainage, exercise) and surgical treatments (liposuction). Until now there is no curative therapy. Obesity is an important risk factor for the severity and prognosis of lipedema. Further studies for a better understanding of the pathogenesis of lipedema and in the end possible curative treatments are urgently needed.
... Painful SAT is a chronic problem in lipedema [111,114] . The excess tissue fluid weakens nearby structures leading to the development of joint pains; with progression of lipedema, arthritis develops [149] . Capillary fragility, ecchymosis, hematomas and venous varicosities are common [150] . ...
Article
Rare adipose disorders (RADs) including multiple symmetric lipomatosis (MSL), lipedema and Dercum's disease (DD) may be misdiagnosed as obesity. Lifestyle changes, such as reduced caloric intake and increased physical activity are standard care for obesity. Although lifestyle changes and bariatric surgery work effectively for the obesity component of RADs, these treatments do not routinely reduce the abnormal subcutaneous adipose tissue (SAT) of RADs. RAD SAT likely results from the growth of a brown stem cell population with secondary lymphatic dysfunction in MSL, or by primary vascular and lymphatic dysfunction in lipedema and DD. People with RADs do not lose SAT from caloric limitation and increased energy expenditure alone. In order to improve recognition of RADs apart from obesity, the diagnostic criteria, histology and pathophysiology of RADs are presented and contrasted to familial partial lipodystrophies, acquired partial lipodystrophies and obesity with which they may be confused. Treatment recommendations focus on evidence-based data and include lymphatic decongestive therapy, medications and supplements that support loss of RAD SAT. Associated RAD conditions including depression, anxiety and pain will improve as healthcare providers learn to identify and adopt alternative treatment regimens for the abnormal SAT component of RADs. Effective dietary and exercise regimens are needed in RAD populations to improve quality of life and construct advanced treatment regimens for future generations.
Article
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Background Lipedema is a loose connective tissue disease predominantly in women identified by increased nodular and fibrotic adipose tissue on the buttocks, hips and limbs that develops at times of hormone, weight and shape change including puberty, pregnancy, and menopause. Lipedema tissue may be very painful and can severely impair mobility. Non-lipedema obesity, lymphedema, venous disease, and hypermobile joints are comorbidities. Lipedema tissue is difficult to reduce by diet, exercise, or bariatric surgery. Methods This paper is a consensus guideline on lipedema written by a US committee following the Delphi Method. Consensus statements are rated for strength using the GRADE system. Results Eighty-five consensus statements outline lipedema pathophysiology, and medical, surgical, vascular, and other therapeutic recommendations. Future research topics are suggested. Conclusion These guidelines improve the understanding of the loose connective tissue disease, lipedema, to advance our understanding towards early diagnosis, treatments, and ultimately a cure for affected individuals.
Article
Background : Lipedema is a condition of painful increase of subcutaneous fat affecting almost exclusively women. Several studies have examined the effectiveness of liposuction in the treatment of lipedema but none has focused on water-jet assisted liposuction technique. Methods : A standardized treatment protocol for liposuction in lipedema, which was established over the course of 15 years, is presented. Patients received questionnaires preoperatively and after operative treatment assessing characteristics and symptom severity on visual analog scales in a prospective manner. Results : Pre- and postoperative questionnaires were available for 63 patients. Median age was 35 years and mean BMI 28.4±0.6, all patients had stage I or stage II lipedema diagnosed by two separate specialists. After a mean follow-up of 22 months after operative treatment, all assessed symptoms had decreased significantly in severity. All patients wore compression garments and/or received manual lymphatic drainage preoperatively; this could be reduced to only 44% of patients needing any conservative treatment postoperatively. Conclusion : Liposuction in water-jet assisted technique using the presented treatment protocol is an efficient method of operative treatment of early-stage lipedema patients leading to a marked decrease of symptom severity and need for conservative treatment.
Article
Background: Lipedema is characterized by localized accumulation of fat in the extremities, which is typically unresponsive to dietary regimes or physical activity. Although the disease is well described and has a high incidence, little is known regarding the molecular and cellular mechanisms underlying its pathogenesis. The aim of this study was to investigate the pathophysiology of lipedema adipose cells in vitro. Methods: Adipose stem cells (ADSCs) were isolated from lipoaspirates derived from lipedema and non-lipedema patients undergoing tumescent liposuction. In vitro differentiation studies were performed for up to 14 days using adipogenic or regular culture medium. Supernatants and cell lysates were tested for adiponectin, leptin, insulin-like growth factor-1 (IGF-1), aromatase (CYP19A1), and interleukin-8 (IL-8) contents at days 7 and 14, using enzyme-linked immunosorbent assays (ELISAs). Adipogenesis was evaluated by visualizing and measuring cytoplasmic lipid accumulation. Results: Lipedema ADSCs showed impeded adipogenesis already at early stages of in vitro differentiation. Concomitantly with a strongly reduced cytoplasmic lipid accumulation, significantly lower amounts of adiponectin and leptin were detectable in supernatants from lipedema ADSCs and adipocytes compared to control cells. Additionally, lipedema and non-lipedema cells differed in their expression of IGF-1, aromatase (CYP19A1), IL-8 and in their proliferative activity. Conclusion: Our findings indicate that in vitro adipogenesis of lipedema ADSCs is severely hampered in comparison to non-lipedema ADSCs. Lipedema adipose cells not only differ in their lipid storage capacity but also in their adipokine expression pattern. This might serve as a valuable marker for diagnosis of lipedema, probably from an early stage on.
Article
Lipedema is a common, but often underdiagnosed masquerading disease of obesity, which almost exclusively affects females. There are many debates regarding the diagnosis as well as the treatment strategies of the disease. The clinical diagnosis is relatively simple, however knowledge regarding the pathomechanism is less than limited and curative therapy does not exist at all demanding an urgent need for extensive research. According to our hypothesis, lipedema is an estrogen-regulated polygenetic disease, which manifests in parallel with feminine hormonal changes and leads to vasculo- and lymphangiopathy. Inflammation of the peripheral nerves and sympathetic innervation abnormalities of the subcutaneous adipose tissue also involving estrogen may be responsible for neuropathy. Adipocyte hyperproliferation is likely to be a secondary phenomenon maintaining a vicious cycle. Herein, the relevant articles are reviewed from 1913 until now and discussed in context of the most likely mechanisms leading to the disease, which could serve as a starting point for further research.
Article
Overweight and obesity is a public health problem in Hungary and in the Western world. It is important to underline that obesity is an illness and an important risk factor for several skin and other diseases. An overview of skin diseases caused or aggravated by obesity (acanthosis nigricans, acrochordons, keratosis pilaris, hyperandrogenism, stria, adiposis dolorosa, lymphoedema, chronic venous insufficiency, plantar hyperkeratosis, lipoedema, skin infections, acne inversa, psoriasis, tophi) helps us to look and see as well. Look for the possibility of skin infections as it helps the early diagnosis and to avoid complications. Draw patients' attention to the preventive importance of skin care. In case of an obese patient the usual dosage of most local and systemic drugs should be modified. It must be kept in mind that obesity directly or indirectly starts unfavorable processes in almost all organ systems. Therefore, only a multidisciplinary care may secure treatment and rehabilitation of obese patients. Dermatological and lymphological care is often part of the rehabilitation.
Article
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To evaluate the accuracy of computed tomography (CT) scan imaging in distinguishing lymphedema from deep venous thrombosis (DVT) and lipodystrophy (lipedema) in patients with swollen legs. CT scans of the lower limbs were performed in 55 patients with 76 swollen legs (44 lymphedemas, 12 DVT and 20 lipedemas). Thirty-four normal contralateral legs were also similarly evaluated. Primary lymphedema was verified by lymphography or lymphoscintigraphy, whereas secondary lymphedema was documented by a typical clinical history. DVT was established by ultrasound Doppler imaging. The diagnosis of lipedema was made with bilateral swollen legs where lymphoscintigraphy and Doppler examination were both unremarkable. Qualitative CT analysis was based on skin thickening, subcutaneous edema accumulation with a honeycombed pattern, and muscle compartment enlargement. Sensitivity and specificity of CT scan for the diagnosis of lymphedema was 93 and 100%, respectively; for lipedema it was 95 and 100%, respectively; andfor DVT it was 91 and 99%, respectively. Skin thickening was found in 42 lymphedemas (95%), in 9 DVT (75%), and in 2 lipedemas (16%). Subcutaneous edema accumulation was demonstrated in 42 legs (95%) with lymphedema and in 5 (42%) with DVT but in none with lipedema. A honeycombed pattern was present only in lymphedema (18 legs or 41%); muscle enlargement was present in all patients with DVT, in no patient with lipedema, and in 4 (9%) with lymphedema. Edema accumulation is readily demonstrated with plain CT scan and is not present in lipedema. Specific CT features of the subcutaneous fat and muscle compartments allow accurate differentiation between lymphedema and DVT.
Article
Zusammenfassung Fragestellung: Die Lymphszintigraphie wird fast ausschließlich als qualitative Untersuchung durchgeführt. Diese Tatsache erfüllt nicht die lymphologische Forderung nach einer Funktionsdiagnostik zur Abklärung lymphostatischer Ödeme der Extremitäten. Eine zusätzliche quantitative Untersuchung ist deshalb unbedingt erforderlich. In diesem Zusammenhang wurde die Notwendigkeit einer Schwächungskorrektur und Methoden der Lymphknotentiefenbestimmung sowie die Verbesserung der körperlichen Belastung während der Untersuchung bestimmt und ein standardisiertes Untersuchungsprotokoll erarbeitet. Methoden: Subkutane Injektion (in Fuß oder Hand) von 37 MBq 99mTc-Nanokolloid bei 924 Patienten. Kontinuierliche Erfassung des Uptakes in den regionalen Lymphknoten während körperlicher Belastung (1 h) mit unterschiedlichen Belastungsverfahren. Bei der Uptakeberechnung wird eine Schwächungskorrektur durchgeführt; die Ergebnisse nach Lymphknotentiefenbestimmung mit SPECT (Single Photon Emission Computed Tomography) werden im Vergleich mit der sonographischen Tiefenbestimmung sowie mit Uptakeberechnung ohne Schwächungskorrektur diskutiert. Ergebnisse: Der Vergleich der Belastungsformen zeigt, dass nur das kontrollierte Gehen eine zuverlässige Belastung gewährleistet. Ein Vergleich der Uptakewerte nach sonographischer Lymphknotentiefenbestimmung gegenüber der SPECT ergibt beträchtliche Fehler bei der sonographischen Methode. Der Verzicht auf eine Schwächungskorrektur schließt eine quantitative Untersuchung aus. Die genaueren Messverfahren eröffnen neue pathophysiologische Aspekte beim Lipödem und Lipolymphödem. Schlussfolgerungen: Kontrolliertes Gehen und tiefenkorrigierte Lymphknotenuptakewerte sind unverzichtbare Voraussetzungen für zuverlässige Ergebnisse bei der Funktionslymphszintigraphie.
Article
The lipedema lacks adequate attention in the medical profession. It is a disproportional disturbance of the topography of the hypodermic fat tissue, which is sonomorphically altered. Lipedema concerns nearly exclusively women with manifestation soon after puberty. The symptoms are typically symmetric at the extremities (ankle fat pads), with shin feet (and hands), The early stage is painless (extremities' lipohypertrophy) and shows a hyperdynamic lymph transport. In the late stage the lymph transport decreases; the hypodermis is scarcely compressible with distinct pressure pain. In this stage «complex physical antistasis therapy» is indicated. The diagnostic should always include a high resolution (duplex-) sonography.
Article
Aim: Lymphoscintigraphy is commonly performed as a qualitative diagnotic study with visual interpretation of images. However, quantitative lymphoscintigraphy is the only functional test of the lymphatic system to obtain accurate information about lymph transport in lymphedema patients. Since attenuation correction and type of exercise may vary, heterogeneous data are the result. Here we compare different methods and derive a standardized protocol resulting in highly reproducible data. Patients and methods: Tc-99m-marked human serum nanocolloid (37 MBq) was injected subcutaneously into the back of foot or hand (924 patients). Patients were enrolled in standardized exercise tasks and radioisotope uptake into regional lymph nodes was determined. Using ultrasound or SPECT to localize the lymph node, we determined best attenuation correction. Results: Reliable and comparable results were achieved by using a treadmill ergometer to standardize exercise. SPECT was superior compared to ultrasound in detemining the correct depth of lymph nodes and in deriving the correct attenuation correction, which is essential in quantitating lymphatic function accurately. Conclusions: Standardization of exercise and attenuation correction are essential in performing functional lymphoscintigraphy. We show that systematic errors are reduced to a great extent by using the developed optimized protocol.
Article
A 22 yr old woman with bilateral symmetrical enlargement of her lower extremities since the age of 11 is reported. A diagnosis of lipedema of the legs was made on the basis of history, physical examination, biopsy and phlebography. Lipedema of the legs should be included in the differential diagnosis of symmetrical nonpitting edematous lower extremities. According to Allen and Hines, the characteristic points to be made for a diagnosis of lipedema of the legs included the following: almost exclusively seen in women; always bilateral and symmetrical with minimal involvement of the feet; minimal to absent pitting edems; all parts of the limbs are involved simultaneously; persistent enlargement despite elevation of the extremities. 16% of their patients gave a family history of the disorder; 40% complained of pain in the lower extremities; and approximately half of the patients were obese. The age of onset was variable, from childhood to the sixth or seventh decade. There was no racial preponderance. No patient gave a history compatible with progressive lipodystrophy. Treatment included diet, diuretics, tight stockings, rest and elevation, and massage, but was unsatisfactory in most cases.
Article
Im vorliegenden ersten Teil der Arbeit: “Histologie und Histopathologie cutaner Lymphgefäße der unteren Extremitäten” wird im Anschluß an einen kurzen historischen Überblick über die Entdeckung und Darstellung des LG-Systems der histologische Aufbau der cutanen LG ausführlich besprochen. Das cutane LG-System besteht aus den Lymphcapillaren, den postcapillaren LG und den eigentlichen LG, die sich voneinander durch ihre Wandstruktur unterscheiden. Die Lymphcapillaren sind durch einen einschichtigen zusammenhängenden Endothelbelag begrenzte Gefäße. Infolge der resorptiven Funktion der Endothelien bilden sie aus der interstitiellen Flüssigkeit die Lymphe. Als postcapillare LG bezeichnen wir die Abschnitte, die zwischen den Lymphcapillaren und den LG eingeschaltet sind und die außerhalb des Endothelbelages eine einschichtige Bindegewebshülle aufweisen in welche einzelne Muskelfasern eingelagert sind. Sie stellen den Beginn der Abflußbahnen dar. Die LG der Haut an den unteren Extremitäten haben eine dreischichtige Wand. Sie bestehen aus der bindegewebigen Intima, einer muskelreichen Media und der Adventitia, die ebenfalls aus Bindegewebe gebildet ist und in welcher die das LG versorgenden Blutgefäße verlaufen. Die Media wird von der Intima durch ein Rete elasticum internum und von der Adventitia durch ein Rete elasticum externum abgegrenzt. Diese LG liegen an der Corium-Subcutisgrenze, mitunter auch in den tieferen Coriumschichten. Sie dienen dem Abtransport der Lymphflüssigkeit und sind histologisch oft schwer von Blutgefäßen zu unterscheiden. Als differentialdiagnostische Kriterien gegenüber den Blutgefäßen sind vor allem die Anordnung der Elastica und die geflechtartige Struktur der Muskelbündel der Media anzusehen.
Article
Plugging of skin capillaries by activated white blood cells is one of the proposed mechanisms by which skin damage may be initiated in chronic venous insuffi ciency . The aim of this study was to determine whether a microcirculatory deficit was induced in the skin by raising the venous pressure proximally for thirty minutes. Seventeen subjects with no evidence of venous or arterial disease had laser Doppler velocimetry performed in the gaiter region of the leg; 8 different subjects had the measurement done on the dorsum of the hand. Peak hyperemic response following three minutes of ischemia was measured before and after a thirty-min ute period of sustained venous hypertension applied by a proximal tourniquet inflated to 80 mm Hg. A decrease in the peak flow: baseline flow ratio (median ratio 2.25 before, 1.70 after, p <0.02) and an increase in the time taken to reach maximal hyperemia (median time ten seconds before, twenty seconds after, p<0.01) were observed after the period of venous hypertension in the lower limb . The second parameter, but not the first, was significantly affected in the upper limb . The authors conclude that a microvascular deficit in the skin is demonstrable after a short period of venous hypertension . This is consistent with the white-cell- trapping theory, but other possible explanations are discussed.
Article
The relevant role played by the microcirculation on several pathologies and on the genetic evolution of rarely known diseases as the panniculopathy with venous stasis have been explained. It represent a support on the concept for new research of microcirculation's injuries as a primary factor on macrophlebopathies.
Article
Patients with lipoedema of the typus rusticanus Moncorps show a skin elasticity deficit of the skin of the calf. This is partly due to the derma oedema in the skin of these patients and seems partly to be due to an intrinsic connective tissue defect in the skin of such patients. The auteurs put forward the hypothesis that also present calf muscle pump dysfunction in these patients is the result of a connective tissue defect of the fascia of the muscular compartment, as an expression of a more generalized connective tissue defect.
Article
Lipedema is a chronic vascular disease almost exclusively of female sex, characterized by the deposit of fat on the legs, with an "Egyptian column" shape, orthostatic edema, hypothermia of the skin, alteration of the plantar support, and negativity of Stemmer's sign. The etiology and pathogenesis of this disease are still the object of study, and therapy is very difficult. Various authors have described morphologic and functional alterations of prelym phatic structures and of lymphatic vessels. The big veins remain untouched in the phlebograms and an alteration of the skin elasticity is demonstrated. The present authors have studied by dynamic lymphoscintigraphy 12 women patients suffering from lipedema, and compared the results with those of 5 normal subjects and 5 patients suffering from idiopathic lymphedema who were sex and age matched with the patients suffering from lipedema. The patients suffering from lipedema showed an abnormal lymphoscintigraphic pattern with a slowing of the lymphatic flow that presented some analogies to the alter ations found in the patients suffering from lymphedema. A frequent asymmetry was also noticed in the lymphoscintigraphic findings that is in contrast to the symmetry of the clinical profile.
Article
Lipoedema is a common but infrequently recognized condition causing bilateral enlargement of the legs in women. Although generally considered to be the result of an abnormal deposition of subcutaneous fat with associated oedema, the precise mechanisms responsible for oedema formation have yet to be fully established. In order to evaluate the possible role of lymphatic or venous dysfunction in the pathogenesis of lipoedema, 10 patients were investigated by photoplethysmography (venous function) and quantitative lymphoscintigraphy (lymphatic function). The results were compared with those from patients with primary lymphoedema and those from healthy volunteers. The results demonstrated minor abnormalities of venous function in only two patients. One patient had moderately impaired lymphatic function in both legs and seven patients had a marginal degree of impairment in one or both legs. However, in none of these cases did the impairment attain the low levels seen in true lymphoedema. Lipoedema appears to be a distinct clinical entity best classified as a lipodystrophy rather than a direct consequence of any primary venous or lymphatic insufficiency.
Article
Twenty-four healthy subjects and 16 patients with lymphedema and lipedema were studied with MRI and ultratomography. In chronic lymphedema, ultrasonography revealed a statistically significant increase of the subcutaneous fat without difference in skin thickness as compared to the healthy subjects. MRI revealed in lymphedema a statistically significant increase of skin thickness + subcutaneous tissue + muscular mass (p = 0.048); in lipedema, a statistically significant increase of skin thickness and subcutaneous tissue (p < 0.0001) as compared to the healthy controls. MRI offers strong qualitative and quantitative parameters in the diagnosis of lymphedema and lipolymphedema, while ultrasonography is expected to improve its diagnostic efficiency with the aid of high frequency echo with more sophisticated resolution apparatus. Age, weight and height of the patient as well as duration of the disease do not seem to affect the above-mentioned parameters.
Article
"Lipedema," a special form of obesity syndrome, represents swelling of the legs due to an increase of subcutaneous adipose tissue. In 12 patients with lipedema of the legs and in 12 healthy subjects (controls), fluorescence microlymphography was performed to visualize the lymphatic capillary network at the dorsum of the foot, at the medial ankle, and at the thigh. Microaneurysm of a lymphatic capillary was defined as a segment exceeding at least twice the minimal individual diameter of the lymphatic vessel. In patients with lipedema, the propagation of the fluorescent dye into the superficial lymphatic network of the skin was not different from the control group (p > 0.05). In all 8 patients with lipedema of the thigh, microaneurysms were found at this site (7.9 +/- 4.7 aneurysms per depicted network) and in 10 of the 11 patients with excessive fat involvement of the lower leg, multiple microlymphatic aneurysms were found at the ankle region. Two obese patients showed lymphatic microaneurysms in the unaffected thigh and in only 4 patients were microaneurysms found at the foot. None of the healthy controls exhibited microlymphatic aneurysms at the foot and ankle, but in one control subject a single microaneurysm was detected in the thigh. Multiple microlymphatic aneurysms of lymphatic capillaries are a consistent finding in the affected skin regions of patients with lipedema. Its significance remains to be elucidated although its occurrence appears to be unique to these patients.
Article
Lipedema is a rare and painful disease in women. Until recently, it could be treated only by conservative methods (combined physical therapy). To determine the efficacy and safety of surgery (liposuction) concerning appearance and associated complaints. Twenty-eight patients, who had undergone conservative therapy over a period of years, were treated by liposuction under tumescent local anesthesia with vibrating microcannulas. Twenty-one could be reevaluated after an average of 12.2 (1-26) months. All showed great improvement, with normalization of body proportions. Additionally, spontaneous pain, sensitivity to pressure, and bruising either disappeared completely or improved markedly. Other than minor swelling for a few days, no complications could be observed following surgery. All patients reported a tremendous increase in their quality of life. Physical therapy had to be continued to a much lower degree. Tumescent liposuction has proved to be a safe and effective treatment for lipedema.