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Lipedema is a clinical entity frequently misdiagnosed or confound with primary lymphedema. Lipedema is a disorder of adipose tissue that occurs almost exclusively in obese women. It is characterized by bilateral enlargement from hip to ankle due to abnormal depositions of subcutaneous fat associated with often mild edema, usually sparing the feet. Disease onset is usually at or soon after puberty. Lipedema results in considerable frustration and distress resulting from the cosmetic appearance. Patients may complain of pain, tenderness, easy bruising of the affected areas with moderate to severe sensitivity to digital pressure or pinching. Imaging studies using computed tomography, magnetic resonance imaging, ultrasound, lymphoscintigraphy are not indicated, except if the diagnosis is atypic or doubtful. Long-term evolution may alter lymphatic system and lead to a lipo-lymphedema with specific complications such as cellulitis. Lipedema management is not codified and included weight loss (poorly improving leg appearance or discomfort), psychological counselling and compression therapy. Liposuction, especially using tumescent local anaesthesia, may reduce edema, spontaneous pain, sensitivity to pressure, bruising and improve appearance resulting in a important increase in quality of life.
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Lipedema is a clinical entity frequently misdiagnosed or confounded with primary lymphedema. Lipedema is an adipose tissue disorder, also pathological itself, that occurs almost exclusively in obese women. It is characterized by bilateral enlargement from hip to ankle due to abnormal deposits of subcutaneous fat, usually sparing the feet. This disease usually occurs at or just after puberty. Patients may complain of pain, easy bruising of the affected areas with moderate to severe sensitivity to digital pressure or pinching, and mild edema after orthostatism. Lipedema results in considerable frustration and distress resulting from the cosmetic appearance. Imaging studies using computed tomography, magnetic resonance imaging, and lymphoscintigraphy are not indicated, except if the diagnosis is atypical or doubtful or to confirm lipedema. Long-term evolution may alter lymphatic system and lead to a lipo-lymphedema, then involving the foot, with specific complications such as cellulitis. Lipedema management is not codified and includes weight loss (which poorly improves leg appearance or discomfort), psychological counselling, compression therapy often poorly tolerated and physical activity, particularly aquatic. Liposuction using tumescent local anesthesia, may reduce edema, spontaneous pain, sensitivity to pressure, bruising and may improve appearance resulting in a notable improvement of quality of life. Clinical and physiopathological studies are still required to enable improved management of women having lipedema.
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Lymphedema results from impaired lymphatic transport with increased limb volume. Primary and secondary forms can be distinguished. Secondary lymphedema of the upper limb is the most frequent in France. A 2-cm difference on any segment of the limb confirms the diagnosis of lymphedema. Calculated lymphedema volume using the formula for a truncated cone is required to assess the efficacy of treatment and to monitor follow-up. Primary lymphedema is sporadic but rarely familial. Lymphoscintigraphy is useful in the primary form to evaluate precisely lymphatic function of the two limbs. Erysipelas is the main complication,but psychological or functional discomfort may occur throughout the course of lymphedema. Lipedema is the main differential diagnosis, defined as an abnormal accumulation of fat from hip to ankle and occurs almost exclusively in obese women.
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