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- Berntorp, Erik, et al.
(författare)
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Liposuction in Dercum's disease: impact on haemostatic factors associated with cardiovascular disease and insulin sensitivity.
- 1998
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Ingår i: Journal of Internal Medicine. - 1365-2796. ; 243:3, s. 197-201
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study the impact of adipose tissue removal by liposuction on factors associated with increased risk of cardiovascular atherosclerotic disease within the coagulation and fibrinolytic system and glucose metabolism. DESIGN, SETTING AND SUBJECTS: Liposuction was performed in 53 patients with Dercum's disease. The levels of fibrinogen, von Willebrand factor antigen (VWF:Ag) and plasminogen activator inhibitor type 1 activity (PAI-1) were measured preoperatively, and 2 weeks, 4 weeks and 3 months postoperatively. In a subsample of 10 patients, insulin sensitivity was determined before and 2-4 weeks after surgery using the 2-h euglycaemic hyperinsulinaemic clamp technique. The study was performed as a single-centre study. MAIN OUTCOME MEASURE: Fibrinogen, PAI-1 and VWF:Ag levels, and glucose uptake before and after removal of adipose tissue. RESULTS: Weight reduction was sustained throughout the follow-up period with a mean decrease from 90.7 to 86.6 kg (P < 0.0001). There was a slight increase in levels of coagulation factors 2 and 4 weeks postoperatively, probably in reaction to the surgical trauma. After 3 months the values had returned to preoperative levels except for PAI-1, which still showed a slight increase (P < 0.05). In the subsample of 10 patients, glucose uptake was improved (P < 0.05) from a short-term perspective after surgery. CONCLUSION: Surgical removal of adipose tissue, without change in lifestyle, does not seem to improve the levels of coagulation and fibrinolytic factors associated with cardiovascular atherosclerotic disease, whereas glucose takeup may be facilitated and insulin sensitivity increases from a short-term perspective.
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| 2. |
- Brorson, Håkan, et al.
(författare)
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Complete reduction of lymphoedema of the arm by liposuction after breast cancer
- 1997
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Ingår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery. - 0284-4311. ; 31:2, s. 137-143
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Tidskriftsartikel (refereegranskat)abstract
- The incidence of lymphoedema of the arm after mastectomy ranges between 8% and 38%, and it is an appreciable problem from both functional and social aspects. Conservative and previous surgical regimens have not been completely successful. In the light of these experiences, liposuction clearly constitutes an interesting new surgical approach, which is potentially capable of effecting predictable and reliable improvements in patients with lymphoedema. Twenty eight women with lymphoedema of the arm after breast cancer were consecutively treated by liposuction. Limb compression with a compression garment was instituted immediately after operation. All patients had been given radiotherapy after the operation for breast cancer. Mean preoperative volume of oedema was 1845 ml (range 570-3915), and mean volume of aspirate was 2250 ml (range 1000-3850); volume of aspirate correlated linearly with the volume of preoperative oedema. There were no major surgical complications, but blood transfusion was necessary in eight patients whose volume of aspirate exceeded 2000 ml. After 12 months (n = 24), an average reduction in volume of oedema of 106% was found. Such a normalisation can be expected in patients with oedema that amounts to about 2500 ml. Although the oedema cannot be completely removed in more severe cases, substantial reduction is beneficial from both functional and cosmetic aspects. We conclude that liposuction is safe and effective for reducing lymphoedema of the arm after operations for breast cancer. In a one-stage procedure, oedematous and hypertrophic fat tissue can be removed with an excellent clinical outcome.
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| 3. |
- Brorson, Håkan, et al.
(författare)
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Dercum's disease. Fatty tissue rheumatism caused by immune defense reaction?
- 1996
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Ingår i: Läkartidningen. - 0023-7205. ; 93:10, s. 1433-1436
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Tidskriftsartikel (refereegranskat)abstract
- Dercums sjukdom, adiposis dolorosa eller, mera allmänt, fettvävsreumatism är en relativt okänd sjukdom trots att den beskrevs redan 1888 av den amerikanske neurologen Francis Xavier Dercum. Den drabbar företrädesvis 20–40-åriga kvinnor, men kan även debutera hos barn. Kännetecknande är en uttalad smärta i fettväven. Patienterna har liksom fibromyalgikerna ofta nonchalant avfärdats med att »alla feta har lite ont». Sjukdomen är dock klassificerad av WHO.
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| 4. |
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| 5. |
- Brorson, Håkan
(författare)
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Liposuction and Controlled Compression Therapy in the Treatment of Arm Lymphedema following Breast Cancer
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Liposuction and controlled compression therapy in the treatment of arm lymphedema following breast cancer About one-third of all women treated for breast cancer develop arm lymphedema. The cancer itself is a worry, but the swollen and heavy arm is an additional handicap for the patients, both physical and psychosocial. Previous surgical and conservative treatments have not always given satisfactory and permanent results, conceivably because lymphedema causes hypertrophy of the subcutaneous adipose tissue. From this point of view, liposuction (LS) combined with Controlled Compression Therapy (CCT) is an interesting approach as the hypertrophied adipose tissue is effectively removed and the outcome sustained by wearing a compression garment. Altogether 51 women participated in the present investigations. All, except one had received radiotherapy after the breast cancer operation which included the excision of axillary lymphnodes in all cases. Thirty-six patients were treated with LS and postoperative CCT, whereas 15 received CCT only. Pre- and postoperative arm edema volumes were measured using water displacement technique. Skin blood flow was recorded using laser Doppler imaging. Lymph transport in the arm was assessed with indirect lymphoscintigraphy. Rage of motion in the shoulder joint was measured using a protractor. Effects on quality of life were estimated using the Visual Analogue Scale, Nottingham Health Profile, Psychological General Well-Being index, and the Hospital Anxiety Depression scale. Results were monitored for up to one year after treatment. LS+CCT reduced the arm edema volume completely, compared with a 50% decrease following CCT alone. The use of a compression garment after liposuction is necessary to maintain the normalized arm volume. LS+CCT did not affect the already impaired lymph transport; it merely increased skin microcirculation. A reduced incidence of cellulitis was noted. The treatment improved range of motion in the shoulder joint and patients' quality of life, particularly qualities directly related to the volume reduction and thereby qualities associated with everyday activities. As could be expected from the volume measurements, the more favorable outcomes were recorded mostly in the LS+CCT group.
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