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The "Lipedema" or "Fatedema" is conditioned by a slight mechanical obstruction of the small lymphatic vessels by the increasing pressure of the growing fat tissue. This lymphostasis in a normal lymphatic vessel system arises only with women and always symmetrically and conducts to typical complaints. Therapeutically, apart from loss in weight, only lymph drainage therapy is in a position to remove the complaints of edema.
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Venous oedema, which occurs almost exclusively in the legs, develops due to increased venous pressure following valvular insufficiency, and is marked by blue discolouration, varicosities and, in chronic forms, by brown discolouration of the skin resulting from the deposition of haemosiderin. It is possible to confirm the condition by phlebological instrumental diagnosis. Primary lymphoedema also almost always occurs in the legs. It is caused by underdevelopment of lymphatic vessels, but the skin colour remains normal. It is recognisable by Stemmer’s sign and characteristic thickening of the skin over the toes resulting from subcutaneous protein fibrosis. Lymphoscintigraphy may be required for diagnosis in rare cases. Venous oedema and lymphoedema are found in both sexes, uni- or bilaterally. If bilaterally then usually asymmetrical. In contrast, lipoedema occurs in women only, thickening is always symmetrical, and the skin has a normal colour as in lymphoedema. The predisposing condition for lipoedema is lipohypertrophy of the extremities, a congenital accumulation of adipose tissue in the extremities that results in a disproportionate physical form with a relatively slim trunk. In one third of cases lipoedema is also observed in the arms. In contrast to lymphoedema, the hands and feet characteristically remain free of thickening and oedema.
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15% of the patients of a special clinic for lymphological diseases had a lipedema. In 97% it was located in the legs and in 31% also in the arms. In 66% it was located only in the legs and in 3% only in the arms. Combinations of lipedema of the leg with phlebedemas have been seen in 2% and with a lymphedema in 1%. The differential diagnosis to lipohypertrophy, adiposis and lymphedema is given. The therapy with liposuction and physical therapy of edema, combination of manual lymphatic drainage and compression, will be discussed.
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Tissue proliferation can appear with or without gigantism and can be generalized or localized. It is not unusual for tissue proliferation to be mistaken for lymphedema.
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Early terms of lymphostasis in lipedema can be detected with lymphoscintigraphy. A normal examination almost certainly excludes a lymphatic component. Indirect lymphography is only used to rule out morphological abnormalities of lymph vessels. If a lymphoscintigraphic study is normal indirect lymphography is not indicated.
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- Lipedema (7)
- Original studies and data (2)
- Review (6)
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- Journal Article (7)