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Lipoedema is a form of lipodistrophy, which consists of abnormal accumulation of fat in subcutaneous tissue of the lower limbs. It does not cause any disease and it has not been reported association with malignity. We describe a 63-year-old woman occurring of Kaposi sarcoma on the lipoedema base.
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Purpose: Assessment of the relation between age and lymph transport in lipedema patients using lymphoscintigraphic function test. Material and methods: 99mTc human serum nanocolloid (37 MBq) was injected subcutaneously into the dorsum of foot (n = 290 feet) in female patients suffering of lipedema, lipolipedema or patients with normal lymph transport. Patients were enrolled in standardized exercise tasks. For the radioisotope uptake calculation regional lymph nodes depth was determined by SPECT (single photon computed tomography). Results: The lymph node uptake of young patients (until 35 years) reaches higher values than the normal collective and decreases significantly with age until it drop's below the normal collective. Conclusions: The lymphoscintigraphic function test of the legs showed an increased transport function of the epifascial lymphatic system by younger and a decreased transport function by elder patients with lipedema compared to the normal population, the high transport values suggest a high lymphatic volume with compensatory capacity increase of the lymphatic system in young patients. According to these results of the lymphatic transport function the age of the patients has to be regarded.
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The primary lymphedema is a pathological interstitial accumulation of lymphatic fluid. Lower limbs are mainly affected by primary lymphedema. It is caused by a hereditary lack or complete absence of lymphatic vessel systeme. Final complications of chronic limb lymphedema include »elephantiasis«, lymphatic ulceration and malignant degeneration. Secondary lymphedema, obesity, phlebedema and lipedema are most important differential diagnoses.Treatment of primary lymphedema includes early manual lymph drainages, decrease in weight, exercise, prevention or therapy of skin infections. Up to the present primary lymhedema cannot be cured in causality.
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Lipoedema: Improved Quality of Life by Combination of Therapies Lipoedema is a chronic progressive disease with increased fat volumes mainly of the legs, causing body disproportion together with orthostatic oedema, pain and bruising. Early diagnosis can be achieved by clinical symptoms. Complex physical therapy with manual lymphatic drainage, compression and physiotherapy reduces oedema and complaints. Surgical therapy with liposuction reduces circumscribed fat volumes, improves body proportions and diminishes oedema and bruising. Following surgery physical therapy can be diminished in intensity and number. Nowadays the combination of physiotherapy and liposuction is considered the optimal treatment regime which can tremendously improve the patient's quality of life.
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Modern aspects of pathophysiology, epidemiology, symptoms, diagnosis and therapy in lipedema are presented. Within recent years the development of new techniques in local anaesthesia and surgery has revolutionized therapy. By using surgical and conservative methods (tumescent liposuction and combined decongestive therapy) a normalization of body proportions and a reduction of subjective and objective symptoms with a distinct improvement in the quality of life can be achieved.
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In vivo measurements in 26 female patients with lipedema and cellulite parameters were carried out before and after therapy by means of complex physical decongestive therapy (CPDT) including manual lymph drainage and compression as main components and/or shock wave therapy (SWT). Oxidative stress parameters of blood serum and biomechanic skin properties/smoothening of dermis and hypodermis surface were evaluated. Oxidative stress in lipedema and cellulite was demonstrated by increased serum concentrations of malondialdehyde (MDA) and plasma protein carbonyls compared with healthy control persons. Both MDA and protein carbonyls in blood plasma decreased after serial shock wave application and CPDT. The SWT itself and CPDT itself lead to MDA release from edematous tissue into the plasma. Obviously both therapy types, SWT and CPDT, mitigate oxidative stress in lipedema and cellulite. In parallel SWT improved significantly the biomechanic skin properties leading to smoothening of dermis and hypodermis surface. Significant correlation between MDA depletion of edematous and lipid enriched dermis and improvement of mechanic skin properties was demonstrated. From these findings it is concluded, that a release of lipid peroxidation (LPO) products from edematous dermis is an important sclerosis-preventing effect of SWT and/or CPDT in lipedema and cellulite. Expression of factors stimulating angiogenesis and lymphangiogenesis such as VEGF was not induced by SWT and/or CPDT and, therefore, not involved in beneficial effects by SWT and/or CPDT.
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