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dos Reis JMC, Ribeiro FRCDM, Melo GDS, Reale HB, de Andrade MC. Lipectomy as an alternative for superficialization of autologous AVF in obese patients: experience of a referral center in Amazon. J Vasc Bras 2024; 23:e20230054. [PMID: 38562124 PMCID: PMC10984606 DOI: 10.1590/1677-5449.202300542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 01/06/2024] [Indexed: 04/04/2024] Open
Abstract
Background The preferred vascular access for hemodialysis is a native arteriovenous fistula (AVF) because it offers the best results in the short and long terms, lower morbidity and mortality, and has additional advantages in relation to central venous catheters or arteriovenous grafts. However, obesity can present an additional challenge because of the barrier of subcutaneous cellular tissue covering the surface of the vein to be punctured. Objectives The authors review their experience with excision of subcutaneous tissue (lipectomy) overlying upper arm cephalic vein arteriovenous fistulas in obese patients. Methods Consecutive vascular access patients undergoing lipectomy for cannulation with difficult access because of vein depth were reviewed. Cephalic vein depth was measured by ultrasound in all cases. Results Twenty-two patients were reviewed (15 men and 7 women), with a mean body mass index of 34.0 kg/m2 (range: 28-40 kg/m2). Mean age was 58.4 years. The mean preoperative vein depth of 7.9 mm (range: 7.0-10.0 mm) was reduced to 4.7 mm (range: 3.0-6.0 mm) (P 0.01). The mean follow-up period for patients was 13.2 months. Four patients were lost to follow-up and four died during the period due to causes unrelated to vascular access. Conclusions Obesity should not be a limiting factor to creation of a native AVF, since lipectomy is a relatively simple option for superficialization, enabling functioning native and deep arteriovenous fistulas in obese patients.
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Affiliation(s)
- José Maciel Caldas dos Reis
- Fundação Hospital de Clínicas Gaspar Vianna - FHCGV, Serviço de Cirurgia Vascular, Belém, PA, Brasil.
- Centro Universitário Metropolitano da Amazônia - UNIFAMAZ, Belém, PA, Brasil.
| | - Flávio Roberto Cavalleiro de Macêdo Ribeiro
- Fundação Hospital de Clínicas Gaspar Vianna - FHCGV, Serviço de Cirurgia Vascular, Belém, PA, Brasil.
- Centro Universitário Metropolitano da Amazônia - UNIFAMAZ, Belém, PA, Brasil.
| | - Glauco dos Santos Melo
- Fundação Hospital de Clínicas Gaspar Vianna - FHCGV, Serviço de Cirurgia Vascular, Belém, PA, Brasil.
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Ciudad P, Escandón JM, Duarte-Bateman D, Escandón L, Maruccia M, Forte AJ, Mayer HF, Manrique OJ. Surgical management of breast cancer-related lymphedema: a narrative review of contemporary practices. Ann Transl Med 2023; 11:418. [PMID: 38213809 PMCID: PMC10777216 DOI: 10.21037/atm-23-292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 09/22/2023] [Indexed: 01/13/2024]
Abstract
Background and Objective Breast cancer-related lymphedema (BCRL) represents a colossal burden in terms of health and patient-reported outcomes. Surgical management plays a prominent role in the psychological and physical well-being of women suffering from BCRL. Therefore, we performed a narrative review of the current surgical management of BCRL and analyzed the postoperative results. Methods A literature search was conducted across PubMed MEDLINE, Scopus, and Web of Science from database inception through January 2, 2023. We included English-written studies evaluating postoperative outcomes of lymphatic surgery for the management of BCRL. Key Content and Findings The surgical management of lymphedema can be classified into two approaches: (I) physiologic procedures and (II) debulking or ablative procedures. While ablative procedures are intended to lessen the symptomatic burden of lymphedema via the removal of pathological tissues, physiologic procedures are performed to restore the abnormal lymphatic flow by creating bypasses into the venous or lymphatic circulation, or by creating new lymphatic connections by means of lymphangiogenesis. Physiologic procedures generate better outcomes in the early stages of lymphedema as there is some residual physiologic flow and vessels are less fibrotic, while ablative procedures are regarded to be the best alternative in very advanced lymphedema stages. A combination of physiologic and ablative procedures provides more comprehensive surgical management to BCRL. Conclusions Lymphedema is a common complication of breast cancer treatment with an extensive incidence range. Postoperative outcomes of the surgical management of BCRL are heterogeneous despite most studies indicating favorable results after lymphatic surgery.
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Affiliation(s)
- Pedro Ciudad
- Department of Plastic, Reconstructive, and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru
| | - Joseph M. Escandón
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Lauren Escandón
- Los Cobos Medical Center, School of Medicine, Universidad El Bosque, Bogotá DC, Colombia
| | - Michele Maruccia
- Division of Plastic and Reconstructive Surgery, University of Bari, Bari, Italy
| | | | - Horacio F. Mayer
- Department of Plastic Surgery, Hospital Italiano de Buenos Aires, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
| | - Oscar J. Manrique
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA
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Duc NQ, Tien NP, Tu NT, Huynh HN, Linh LD. Lipectomy for madelung disease using tumescent technique: a cross-sectional study. Ann Med Surg (Lond) 2023; 85:2550-2558. [PMID: 37363562 PMCID: PMC10289536 DOI: 10.1097/ms9.0000000000000806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/30/2023] [Indexed: 06/28/2023] Open
Abstract
Madelung's disease is a rare disfiguring disorder that affects both function and esthetic appearance in the head and/or shoulder, neck, and arms regions. Lipectomy is typically necessary but such treatment can encounter difficulties due to the large sizes of the tumors, interspersed with important organs in the surrounding region. In this report, the authors evaluate the effectiveness of using tumescent solution in lipectomy to provide a dual treatment of tissue removal for Madelung disease in the head-and-neck region. Methods A prospective study and clinical descriptions were conducted on 17 patients undergoing 26 head-and-neck lipectomies. A tumescent solution was injected into the surgical region with a blunt-tip cannula 5-10 min before skin incision. The authors recorded systemic manifestations both during and after surgery; tumescent volume; surgical region; clarity of the operative field; weight of fat removed, and early complications. After surgery, the authors followed the patients from periods of 3 months to 4 years. Results All 17 male patients had a history of alcoholism. In total, 12 lipectomies for the removal of anterior neck fatty masses and 14 lipectomies for the removal of posterior neck fatty masses were performed. The average amount of tumescent injected was 260.1 ml (range 140-550 ml). Surgery was reported as totally bloodless in 10 (38.5%) operative fields, with minimum bleeding in 12 (46.1%) operative fields, acceptable bleeding in four (15.4%) operative fields. The average surgical time was 175.6 min (range 135-250 min). The removed fatty masses weighed between 250 and 2150 g, with an average of 582.9 g. Early complications were seen in four patients, accounting for 15.4% (2 hematoma, 1 skin necrosis, and 1 seroma). Conclusions Using tumescent solution in lipectomies to treat Madelung disease in the head and neck area is a simple, safe, and useful technique. The technique helps to create a clean operative field, reduces bleeding, and thereby assists surgeons during the operation.
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Affiliation(s)
| | | | - Nguyen Thanh Tu
- The Anesthesiology Department, 108 Military Central Hospital
| | - Hoang Ngoc Huynh
- Department of Plastic and Reconstructive Surgery, Hanoi Medical University, Hanoi, Vietnam
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Le DT, McNulty L, Krakowski JC. The upper extremity regional anaesthesia trifecta: three upper extremity nerve blocks for awake upper-limb surgery in a patient with a history of contralateral pneumonectomy. Anaesth Rep 2023; 11:e12218. [PMID: 36936735 PMCID: PMC10020444 DOI: 10.1002/anr3.12218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 03/19/2023] Open
Abstract
While regional anaesthesia plays a pivotal role in the perioperative management of patients undergoing upper extremity surgery, its utility can be limited by the risk of hemi-diaphragmatic paresis. Furthermore, each approach to blocking the brachial plexus has associated limitations that may result in incomplete upper extremity anaesthesia. We describe the combination of three upper extremity nerve blocks to achieve surgical anaesthesia of the whole arm for a patient who had previously undergone a contralateral pneumonectomy. On this occasion, she required upper arm lipectomy and arteriovenous fistula formation. Adequate blockade was achieved with no significant perioperative complications. This case demonstrates the potential of this approach for patients with respiratory compromise undergoing upper limb procedures.
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Affiliation(s)
- D. T. Le
- Department of AnaesthesiologyUniversity of North Carolina School of MedicineChapel HillNCUSA
| | - L. McNulty
- Department of AnaesthesiologyUniversity of North Carolina School of MedicineChapel HillNCUSA
| | - J. C. Krakowski
- Department of AnaesthesiologyUniversity of North Carolina School of MedicineChapel HillNCUSA
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Melali H, Behjati-Najafabadi H, Tabesh F, Sayadishahraki M, Hasehmi-Jazi SM. Assessment of Endothelial Function in Iranian Healthy Obese Patients after Bariatric Surgery. Adv Biomed Res 2022; 11:118. [PMID: 36798922 PMCID: PMC9926030 DOI: 10.4103/abr.abr_250_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/29/2021] [Accepted: 10/18/2021] [Indexed: 12/27/2022] Open
Abstract
Background Endothelial function plays a critical role in cardiovascular homeostasis. Morbid obesity is associated with an enhanced risk of atherosclerosis and chronic inflammation. Bariatric surgery (BS) is a promising method used recently for weight loss; however, the number of studies that have examined the effect of BS on endothelial function is limited. This study aimed to investigate the association between endothelial function evaluated by flow-mediated dilation (FMD) and weight loss after BS. Materials and Methods This is a cross-sectional study conducted in Isfahan, Iran, and included 40 healthy obese individuals who underwent BS as an intervention group and 40 healthy obese patients who did not undergo BS as a control group in a 6-month follow-up duration period. FMD as an indicator of endothelial function was evaluated in these participants. FMD <7.1% is considered abnormal. Results There was no significant difference between control and BS groups in terms of age and body mass index (BMI) at baseline. The mean ± standard deviation (SD) of FMD in the BS group pre- and post-intervention were 12.95 ± 6.90 and 37.65 ± 13.52 respectively and the mean ± SD of FMD in the control group were 15.88 ± 6.85 and 15.85 ± 5.83. The association between significant weight loss after BS and FMD was strongly significant (P < 0.001). Conclusions According to the results of this study, it can be concluded that BS has been effective in terms of improving the FMD as an indicator of endothelial function.
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Affiliation(s)
- Hamid Melali
- Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Behjati-Najafabadi
- Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Dr. Hamid Behjati-Najafabadi, Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
| | - Faezeh Tabesh
- Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Sayadishahraki
- Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Kim RS, Yi CC, Lee JW, Yoon JA, Lee S, Kim JH. Outcomes of lipectomy in patients with advanced unilateral upper extremity lymphedema with regard to the difference in time required for indocyanine green to reach the axilla: A retrospective cohort study in a single center. Medicine (Baltimore) 2022; 101:e30742. [PMID: 36123869 PMCID: PMC9478229 DOI: 10.1097/md.0000000000030742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
This study aimed to compare and analyze the prognosis after lipectomy with respect to the difference in time required for indocyanine green (ICG) to reach the axilla in patients with advanced unilateral upper extremity lymphedema. The study population was divided into 2 groups, according to the time required by ICG to reach the axilla after injection, that is, <1 hour (<1 hour; n = 9) and over 1 hour (>1 hour; n = 8). The patient's arm volume was examined before surgery and up to 12 months after surgery. The volume difference between the 2 groups was compared using the excess volume ratio. Statistically significant differences were not observed before surgery (P = .847) and 1 month (P = .336), 3 months (P = .630), and 6 months after surgery (P = .124) between the excess volume ratio values of the < 1 hour and > 1 hour groups. A statistically significant difference was confirmed 12 months after surgery (P = .034). The difference in the time when ICG reached the axilla in patients with lymphedema was associated with prognosis after lipectomy. The difference in time could possibly be used as a variable to classify the progress of lymphedema in the future.
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Affiliation(s)
- Ryuck Seong Kim
- Department of Plastic and Reconstructive Surgery, Pusan National University, School of Medicine, Busan, Korea
| | - Changryul Claud Yi
- Department of Plastic and Reconstructive Surgery, Pusan National University, School of Medicine, Busan, Korea
| | - Jae Woo Lee
- Department of Plastic and Reconstructive Surgery, Pusan National University, School of Medicine, Yangsan, Republic of Korea
| | - Jin A Yoon
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Rehabilitation Medicine, Pusan National University, School of Medicine, Busan, Republic of Korea
| | - Seungbeom Lee
- Department of Artificial Intelligence, Pohang University of Science and Technology, Pohang, Gyeongsangbuk-do, Korea
| | - Joo Hyoung Kim
- Department of Plastic and Reconstructive Surgery, Pusan National University, School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- * Correspondence: Joo Hyoung Kim, MD, PhD, Department of Plastic and Reconstructive Surgery, Pusan National University, School of Medicine, 179, Gudeok-ro, Seo-gu, Busan 49241, Republic of Korea (e-mail: )
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Yang CF, Liu WW, Wang HQ, Zhang JL, Li K, Diao ZY, Yue QL, Yan GJ, Li CJ, Sun HX. Gonadal white adipose tissue is important for gametogenesis in mice through maintenance of local metabolic and immune niches. J Biol Chem 2022; 298:101818. [PMID: 35278432 PMCID: PMC9052151 DOI: 10.1016/j.jbc.2022.101818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 11/18/2022] Open
Abstract
Gonadal white adipose tissue (gWAT) can regulate gametogenesis via modulation of neuroendocrine signaling. However, the effect of gWAT on the local microenvironment of the gonad was largely unknown. Herein, we ruled out that gWAT had a neuroendocrine effect on gonad function through a unilateral lipectomy strategy, in which cutting off epididymal white adipose tissue could reduce seminiferous tubule thickness and decrease sperm counts only in the adjacent testis and epididymis of the affected gonad. Consistent with the results in males, in females, ovary mass was similarly decreased by lipectomy. We determined that the defects in spermatogenesis were mainly caused by augmented apoptosis and decreased proliferation of germ cells. Transcriptome analysis suggested that lipectomy could disrupt immune privilege and activate immune responses in both the testis and ovary on the side of the lipectomy. In addition, lipidomics analysis in the testis showed that the levels of lipid metabolites such as free carnitine were elevated, whereas the levels of glycerophospholipids such as phosphatidylcholines and phosphatidylethanolamines were decreased, which indicated that the metabolic niche was also altered. Finally, we show that supplementation of phosphatidylcholine and phosphatidylethanolamine could partially rescue the observed phenotype. Collectively, our findings suggest that gWAT is important for gonad function by not only affecting whole-body homeostasis but also via maintaining local metabolic and immune niches.
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Affiliation(s)
- Chao-Fan Yang
- Ministry of Education Key Laboratory of Model Animal for Disease Study and Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing University, Nanjing, China
| | - Wen-Wen Liu
- Ministry of Education Key Laboratory of Model Animal for Disease Study and Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing University, Nanjing, China
| | - Hai-Quan Wang
- Ministry of Education Key Laboratory of Model Animal for Disease Study and Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing University, Nanjing, China
| | - Jia-Le Zhang
- State Key Laboratory of Reproductive Medicine and China International Joint Research Center on Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Kang Li
- Ministry of Education Key Laboratory of Model Animal for Disease Study and Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing University, Nanjing, China
| | - Zhen-Yu Diao
- Ministry of Education Key Laboratory of Model Animal for Disease Study and Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing University, Nanjing, China
| | - Qiu-Ling Yue
- Ministry of Education Key Laboratory of Model Animal for Disease Study and Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing University, Nanjing, China
| | - Gui-Jun Yan
- Ministry of Education Key Laboratory of Model Animal for Disease Study and Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing University, Nanjing, China.
| | - Chao-Jun Li
- State Key Laboratory of Reproductive Medicine and China International Joint Research Center on Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.
| | - Hai-Xiang Sun
- Ministry of Education Key Laboratory of Model Animal for Disease Study and Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing University, Nanjing, China.
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Tasopoulou KM, Argyriou C, Kakkos SK, Mourvati E, Georgakarakos EI, Thodis E, Lazarides MK, Georgiadis GS. Superficialization methods of arteriovenous fistula in obese patients: a review of the literature: Arteriovenous fistula in obese patients. Ann Vasc Surg 2021:S0890-5096(21)00967-5. [PMID: 34954375 DOI: 10.1016/j.avsg.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The creation of an arteriovenous fistula (AVF) in obese patients with end-stage-renal-disease, might not lead to a successful hemodialysis session, partly due to excess adipose tissue overlapping the enlarged vein. This review summarizes the available evidence on superficialization methods in studies dealing with obese patients. METHODS An English-language literature search was undertaken in the MEDLINE/SCOPUS databases looking for publications that described procedures of salvaging autologous arteriovenous access in upper extremities of obese patients. Perioperative outcomes including technical and clinical success, mean vein depth reduction, wound complications and patency rates were compared within all identified techniques. RESULTS We identified 12 prospective and 8 retrospective studies. A total of 1149 patients with a mean age 57.2 (range: 49-68) years and a mean BMI 35.8 (range: 28.2-40.8) kg/m2 underwent mainly radial-cephalic and brachial-cephalic AVF superficialization procedures [transposition, 54%; elevation, 11.1%; lipectomy, 26.1%; liposuction, 2.4%; implantation of a venous window needle guide device, 6.4%]. Technical success was similar between all methods (≥ 96%). However, successful cannulation was lower after liposuction and elevation (81.5 and 78.1% respectively). Transposition achieved lower mean vein depth reduction and clinical success when compared with lipectomy (4.9mm vs 8.8mm and 90% vs 92,7% respectively). Transposition and liposuction had the lowest and highest complication rate respectively (1.6% vs 40.8%). Primary and secondary patency rates were lower with liposuction (51.8 and 76.6% respectively), while lipectomy and elevation achieved the highest primary patency rates (68.3% and 71.6% respectively) at 12 months. CONCLUSIONS In obese patients, all superficialisation techniques report high technical success rates. Although limited by the design of individual published studies and lack of a standard for reporting outcomes, these results lead to satisfactory postoperative and early outcomes. In aggregate, lipectomy and transposition are more clinically effective and more durable procedures.
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Pokrowiecki R. Extended buccal lipectomy (bichectomy) for extreme cheek contouring. Int J Oral Maxillofac Surg 2021; 51:929-932. [PMID: 34598850 DOI: 10.1016/j.ijom.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 07/13/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022]
Abstract
The bichectomy, or buccal lipectomy, is a method for cheek contouring and midface tapering in cosmetic surgery. It is generally accepted that the long-term results of well-established conservative bichectomy approaches exhibit some limitations, and the surgery does not always deliver satisfactory results. The extended bichectomy approach includes the resection of the buccal extension of the fat pad along with the body and part of the temporal extension. When properly performed, this procedure provides the desired cheek contouring and slimming in patients who may not benefit from a conventional technique. Approaches for more defined cheek contouring are presented and discussed.
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Affiliation(s)
- R Pokrowiecki
- Department of Craniomaxillofacial Surgery, Oral Surgery and Implantology, Warsaw Medical University, Warsaw, Poland; Aesthetic Facial Surgery, Private Practice, Warsaw, Poland.
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10
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Abstract
Background: Debulking via power-assisted liposuction has been established internationally as the gold standard for patients with chronic fat-dominant lymphedema. In this study we share our experience implementing a debulking surgery program in the United States. Methods and Results: A retrospective review was performed of patients who underwent debulking surgery using power-assisted liposuction at a single institution. Between December 2017 and January 2020, 39 patients with lymphedema underwent 41 extremity debulking procedures. In patients with lymphedema of the upper extremity, median excess volume reduction was 111% at 6 months and 116% at 12 months post-operatively. In patients with lymphedema of the lower extremity, excess volume reduction was 82% at 6 months and 115% at 12 months post-operatively. L-Dex and quality of life improved across all domains in upper and lower extremity patients as well. Conclusion: Debulking with power-assisted liposuction is an effective treatment for chronic lymphedema, supported by improvement in both objective and subjective metrics.
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Affiliation(s)
- Melisa D Granoff
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jaime Pardo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Dhruv Singhal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Varas V, Bertinelli P, Carrasco P, Souper N, Álvarez P, Danilla S, Egaña JI, Penna A, Sepúlveda S, Arancibia V, Álvarez MG, Vergara R. Intraoperative Ketamine and Magnesium Therapy to Control Postoperative Pain After Abdominoplasty and/or Liposuction: A Clinical Randomized Trial. J Pain Res 2020; 13:2937-2946. [PMID: 33235492 PMCID: PMC7678693 DOI: 10.2147/jpr.s276710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/02/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to compare the effects of ketamine and ketamine associated with magnesium on opioid consumption and pain scores in patients undergoing abdominoplasty and/or liposuction compared to standard treatment. Patients and Methods A total of 63 patients were included and randomized as follows: 21 patients in the Control group, 20 patients in the Ketamine group (Ket), and 22 patients in the Ketamine-magnesium group (KetMag). The KetMag group received an IV bolus of 0.3 mg/kg of ketamine and 50 mg/kg magnesium, followed by continuous infusion of ketamine (0.15 mg/kg/h) and magnesium (10 mg/kg/h) until extubation. The Ket group received the same bolus and infusion of ketamine, together with a bolus and continuous infusion of placebo instead of magnesium. The Control group received saline instead of ketamine and magnesium. The groups were compared in morphine consumption during the first 12h, body-postoperative pain and disability scale until the 90th day, the time until the first morphine request on the PCA pump, pain scores, and the adverse effects related to the use of study drugs. Results The KetMag group had a lower morphine consumption by almost 50% during the first 12h than the Control and the Ket groups. In addition, the KetMag group required the first dose of morphine later than the other two groups. There were no differences in the adverse effects of the proposed treatments. Finally, multiple linear regression and a nonlinear approach analysis indicated that the Control group experienced a higher degree of pain and increased morphine consumption per hour than Ket and KetMag groups. Conclusion Co-administration of intraoperative ketamine plus magnesium and ketamine alone are an effective and easy regime for reducing pain and opioid consumption in the postoperative period.
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Affiliation(s)
- Verónica Varas
- Department of Anesthesia and Perioperative Medicine, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Paz Bertinelli
- Department of Anesthesia and Perioperative Medicine, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Pablo Carrasco
- Department of Anesthesia and Perioperative Medicine, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Nicole Souper
- Department of Anesthesia and Perioperative Medicine, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Patricio Álvarez
- Department of Anesthesia and Perioperative Medicine, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Stefan Danilla
- Department of Surgery, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - José Ignacio Egaña
- Department of Anesthesia and Perioperative Medicine, Hospital Clínico de la Universidad de Chile, Santiago, Chile.,Biomedical Neuroscience Institute (BNI), Universidad de Chile, Santiago, Chile
| | - Antonello Penna
- Department of Anesthesia and Perioperative Medicine, Hospital Clínico de la Universidad de Chile, Santiago, Chile.,Centro de Investigación Clínica Avanzada (CICA), Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Sergio Sepúlveda
- Department of Surgery, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Virginia Arancibia
- Department of Anesthesia and Perioperative Medicine, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - María Gabriela Álvarez
- Department of Anesthesia and Perioperative Medicine, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Rodrigo Vergara
- Departamento de Kinesiología, Facultad de Artes y Educación Física, Universidad Metropolitana de Ciencias de la Educación, Santiago, Chile
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12
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Shrestha S, Shrestha R, Manandhar M. Lipectomy for Symptomatic Relief of Lymphangioma Circumscriptum. J Clin Aesthet Dermatol 2020; 13:45-48. [PMID: 33178382 PMCID: PMC7595359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We present two cases of lymphangioma circumscriptum (LC) that demonstrated characteristics of half-and-half lacunae or hypopyon sign in dermoscopy. The first case was that of a 19-year-old female patient with localized lymphangioma since childhood, presenting with continuous oozing of blood and fluid from the lesion. The second patient presented with extensive disease with verrucous growths and clear vesicles over the right chest wall. Both patients reported an impact on their quality of life due to constant oozing of the lesions. The magnetic resonance imaging showed depth and extent in localized versus extensive forms of the same condition. A lipectomy was performed on both patients to destroy subcutaneous connecting lymphatics, which caused significant symptomatic improvement in oozing of blood and fluid, which had been present since childhood in both patients. However, we observed a recurrence in the second patient after six months.
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Affiliation(s)
- Smriti Shrestha
- Drs. Shrestha, Shrestha and Manandhar are with Dhulikhel Hospital at Kathmandu University in Dhulikhel, Kavrepalanchok, Nepal
| | - Riyaz Shrestha
- Drs. Shrestha, Shrestha and Manandhar are with Dhulikhel Hospital at Kathmandu University in Dhulikhel, Kavrepalanchok, Nepal
| | - Manindra Manandhar
- Drs. Shrestha, Shrestha and Manandhar are with Dhulikhel Hospital at Kathmandu University in Dhulikhel, Kavrepalanchok, Nepal
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13
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Cornide-Petronio ME, Jiménez-Castro MB, Gracia-Sancho J, Peralta C. New Insights into the Liver-Visceral Adipose Axis During Hepatic Resection and Liver Transplantation. Cells 2019; 8:E1100. [PMID: 31540413 DOI: 10.3390/cells8091100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/10/2019] [Accepted: 09/17/2019] [Indexed: 12/30/2022] Open
Abstract
In the last decade, adipose tissue has emerged as an endocrine organ with a key role in energy homeostasis. In addition, there is close crosstalk between the adipose tissue and the liver, since pro- and anti-inflammatory substances produced at the visceral adipose tissue level directly target the liver through the portal vein. During surgical procedures, including hepatic resection and liver transplantation, ischemia–reperfusion injury induces damage and regenerative failure. It has been suggested that adipose tissue is associated with both pathological or, on the contrary, with protective effects on damage and regenerative response after liver surgery. The present review aims to summarize the current knowledge on the crosstalk between the adipose tissue and the liver during liver surgery. Therapeutic strategies as well as the clinical and scientific controversies in this field are discussed. The different experimental models, such as lipectomy, to evaluate the role of adipose tissue in both steatotic and nonsteatotic livers undergoing surgery, are described. Such information may be useful for the establishment of protective strategies aimed at regulating the liver–visceral adipose tissue axis and improving the postoperative outcomes in clinical liver surgery.
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14
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Chen S, Gui XE, Cao Q, Routy JP. Clinical outcome after lipectomy in the management of patients with human immunodeficiency virus-associated dorsocervical fat accumulation: An observational cohort study. Medicine (Baltimore) 2019; 98:e16112. [PMID: 31232958 PMCID: PMC6636914 DOI: 10.1097/md.0000000000016112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Lipo-accumulation of the dorsocervical fat pad ("buffalo hump") is a complication observed in people living with human immunodeficiency virus (HIV). We described the clinical outcome of people living with HIV with "buffalo hump" treated by excisional lipectomy.From April 2013 to March 2018, medical records of people living with HIV, who received care in our hospital have been evaluated. Among them, patients with dorsocervical fat accumulation treated by excisional lipectomy have been retrospectively assessed.Nine patients with "buffalo hump" among 2886 people living with HIV (3.1‰, 9/2886) were included. Eight were women with a mean age of 47.9 ± 8.0 years old (range, 36-60). Most of them have been infected by blood transfusion (77%, 7/9) and the mean duration of HIV infection was 14.1 ± 5.5 years (range, 6-22). The mean duration for antiretroviral therapy was 8.8 ± 2.1 years (range, 6-11). The mean pre-ART CD4+ T cell count was 91.3 ± 76.5 cells/μL (range, 4-233) and 477.4 ± 271.8 cells/μL (range, 114-926) at the time of surgery. All 9 patients underwent excisional lipectomy of their hypertrophied dorsocervical fat pad. The mean size of the excised specimens was 14 × 11 × 6 cm. The median follow-up time was 24 months (range, 2-60), all 9 patients reported satisfaction with their results, with no recurrence has been observed.Corrective surgery used to treat localized fat accumulations in people living with HIV with "buffalo hump" showed a favorable effect and can therefore be considered when necessary. Whereas drugs such as integrase inhibitors may avoid lipo-accumulation related syndrome and should be given to people living with HIV in China.
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Affiliation(s)
- Song Chen
- Department of Urology
- Department of Biological Repositories
| | - Xi-en Gui
- Training Center of AIDS Prevention and Cure of Hubei Province
| | - Qian Cao
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jean-Pierre Routy
- Division of Hematology, and Chronic Viral Illness Service, Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
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15
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Abstract
The protective effects of lower body subcutaneous adiposity are linked to the depot functioning as a "metabolic sink" receiving and sequestering excess lipid. This postulate, however, is based on indirect evidence. Mechanisms that mediate this protection are unknown. Here we directly examined this with progressive subcutaneous adipose tissue removal. Ad libitum chow fed mice underwent sham surgery, unilateral or bilateral removal of inguinal adipose tissue or bilateral removal of both inguinal and dorsal adipose tissue. Subsequently mice were separated into 5 week chow or 5 or 13 week HFD groups (N = 10 per group). Primary outcome measures included adipocyte distribution, muscle and liver triglycerides, glucose tolerance, circulating adipocytokines and muscle insulin sensitivity. Subcutaneous adipose tissue removal caused lipid accumulation in femoral muscle proximal to excision, however, lipid accumulation was not proportionally inverse to adipose tissue quantity excised. Accumulative adipose removal was associated with an incremental reduction in systemic glucose tolerance in 13 week HFD mice. Although insulin-stimulated pAkt/Akt did not progressively decrease among surgery groups following 13 weeks of HFD, there was a suppressed pAkt/Akt response in the non-insulin stimulated (saline-injected) 13 week HFD mice. Hence, increases in lower body subcutaneous adipose removal resulted in incremental decreases in the effectiveness of basal insulin sensitivity of femoral muscle. The current data supports that the subcutaneous depot protects systemic glucose homeostasis while also protecting proximal muscle from metabolic dysregulation and lipid accumulation. Removal of the "metabolic sink" likely leads to glucose intolerance because of decreased storage space for glucose and/or lipids.
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Affiliation(s)
- A.D. Booth
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, USA
| | - A.M. Magnuson
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, USA
| | - J. Fouts
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, USA
| | - Y. Wei
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, USA
| | - D. Wang
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, USA
| | - M.J. Pagliassotti
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, USA
| | - M.T. Foster
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, USA
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16
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Sułkowski L, Matyja M, Pasternak A. Lipectomy Technique as a Second-stage Procedure for Primarily Matured, Deep Outflow Vein in Obese Individuals. Indian J Nephrol 2018; 28:320-322. [PMID: 30158755 PMCID: PMC6094833 DOI: 10.4103/ijn.ijn_42_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Prevalence of obesity is growing in the general population as well as among end-stage renal disease (ESRD) patients requiring dialysis. Obesity often leads to a situation when a mature outflow vein is located deeper than 6 mm and is difficult to cannulate. These obese patients usually require additional procedures to able to successfully cannulate the fistula. The available surgical options include: outflow vein elevation, liposuction, and lipectomy. We present a case of a 57-year-old obese female with ESRD and matured, deeply running, inadequate for cannulation arteriovenous fistula. We present a technique of lipectomy with wide resection of adipose tissue from superior and lateral surfaces of outflow vein. Postoperatively, the skin without the underlying adipose tissue collapses allowing easy cannulation of the long segment of outflow vein with two needles. Lipectomy of mature but deeply located outflow vein is a second-stage elective procedure. Wide resection of adipose tissue helps create easy to access cannulation zone in obese individuals.
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Affiliation(s)
- L Sułkowski
- Department of General and Vascular Surgery, Regional Specialist Hospital, Częstochowa, Poland
| | - M Matyja
- 2nd Department of General, Endsocopic, Metabolic and Soft Tissue Tumors Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - A Pasternak
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
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17
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Wang MS, Wang S. Efficacy and comparison of elevation transposition and lipectomy for superficialization of cephalic arteriovenous fistula veins. J Vasc Access 2018; 19:350-357. [PMID: 29926786 DOI: 10.1177/1129729818757709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Substantial percentages of cephalic arteriovenous fistulas are situated too deep and require superficialization before use for hemodialysis. The superficialization techniques are diverse: tunnel transposition, elevation, elevation transposition, and lipectomy. Since the fistula veins are not mobilized during lipectomy, it is believed that lipectomy produces better outcomes than other techniques. However, no available report directly compares lipectomy with other techniques. The objective of this report is to compare the outcomes of cephalic elevation transposition with lipectomy. METHODS The clinical data of patients who underwent second-stage cephalic elevation transposition or lipectomy at an ambulatory surgery center from 2009 to 2017 were analyzed ( n = 153). RESULTS Comparing the cephalic elevation transposition group ( n = 125) with the lipectomy group ( n = 28), the mean body mass index was 36.8 ± 7.6 versus 38.1 ± 7.2 ( p = 0.41); the percentage of upper arm fistulas was 84% versus 61% ( p < 0.01); the mean follow-up was 20.1 ± 17.5 versus 38.6 ± 24.4 months ( p < 0.01); the primary patency rates of the whole fistula conduits were 42% versus 50% at 1 year ( p = 0.08); the secondary patency rates were 99% versus 100% at 1 year ( p = 0.22); the primary patency rates of the superficialized vein segments were 73% versus 68% at 1 year ( p = 0.72); and the mean number of percutaneous interventions required for the superficialized vein segments was 0.49 ± 1.10 versus 0.43 ± 0.71 per access-year ( p = 0.74). CONCLUSION Cephalic elevation transposition and lipectomy are both reliable techniques for superficialization of cephalic fistula veins and their outcomes are comparable.
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Affiliation(s)
- Michele S Wang
- AKDHC Ambulatory Surgery Center, Arizona Kidney Disease and Hypertension Center, Phoenix, AZ, USA
| | - Shouwen Wang
- AKDHC Ambulatory Surgery Center, Arizona Kidney Disease and Hypertension Center, Phoenix, AZ, USA
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18
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Wollina U, Heinig B. Madelung's Disease - Case Series and Treatment by Tumescent Liposuction or Lipectomy. Open Access Maced J Med Sci 2017; 5:427-431. [PMID: 28785324 PMCID: PMC5535649 DOI: 10.3889/oamjms.2017.114] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 04/22/2017] [Accepted: 04/23/2017] [Indexed: 12/11/2022] Open
Abstract
Madelung disease is a disfiguring disorder belonging to the heterogeneous group of lipomatosis. The aetiology is not well understood, but alcohol consumption has been regarded as of importance. The reported incidence is about 1 in 25,000 inhabitants. We reviewed our files of the last ten years and identified eight adult patients with an equal gender distribution. Their age was between 60 and 85 years of life. Comorbidities are frequent. Clinical presentation may vary. Surgical treatment is reported and discussed. Both cold steel surgery and tumescent liposuction have their place in treatment.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt in Dresden, Dresden, Germany
| | - Birgit Heinig
- Center for Physical and Rehabilitative Medicine, Hospital Dresden-Friedrichstadt, Academic Teaching Hospital, Friedrichstrasse 41, 01067, Dresden, Germany
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19
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Cox-York K, Wei Y, Wang D, Pagliassotti MJ, Foster MT. Lower body adipose tissue removal decreases glucose tolerance and insulin sensitivity in mice with exposure to high fat diet. Adipocyte 2015; 4:32-43. [PMID: 26167400 DOI: 10.4161/21623945.2014.957988] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 08/13/2014] [Accepted: 08/20/2014] [Indexed: 11/19/2022] Open
Abstract
It has been postulated that the protective effects of lower body subcutaneous adipose tissue (LBSAT) occur via its ability to sequester surplus lipid and thus serve as a "metabolic sink." However, the mechanisms that mediate this protective function are unknown thus this study addresses this postulate. Ad libitum, chow-fed mice underwent Sham-surgery or LBSAT removal (IngX, inguinal depot removal) and were subsequently provided chow (Chow; typical adipocyte expansion) or high fat diet (HFD; enhanced adipocyte expansion) for 5 weeks. Primary outcome measures included glucose tolerance and subsequent insulin response, muscle insulin sensitivity, liver and muscle triglycerides, adipose tissue gene expression, and circulating lipids and adipokines. In a follow up study the consequences of extended experiment length post-surgery (13 wks) or pre-existing glucose intolerance were examined. At 5 wks post-surgery IngX in HFD-fed mice reduced glucose tolerance and muscle insulin sensitivity and increased circulating insulin compared with HFD Sham. In Chow-fed mice, muscle insulin sensitivity was the only measurement reduced following IngX. At 13 wks circulating insulin concentration of HFD IngX mice continued to be higher than HFD Sham. Surgery did not induce changes in mice with pre-existing glucose intolerance. IngX also increased muscle, but not liver, triglyceride concentration in Chow- and HFD-fed mice 5 wks post-surgery, but chow group only at 13 wks. These data suggest that the presence of LBSAT protects against triglyceride accumulation in the muscle and HFD-induced glucose intolerance and muscle insulin resistance. These data suggest that lower body subcutaneous adipose tissue can function as a "metabolic sink."
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20
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Masson IFB, de Oliveira BDA, Machado AFP, Farcic TS, Júnior IE, Baldan CS. Manual lymphatic drainage and therapeutic ultrasound in liposuction and lipoabdominoplasty post-operative period. Indian J Plast Surg 2014; 47:70-6. [PMID: 24987208 PMCID: PMC4075221 DOI: 10.4103/0970-0358.129627] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Physiotherapy in the plastic surgery post-operative (PO) is essential to provide means for an adequate and fast recovery as it restores function through the use of physiotherapeutic procedures. AIM The aim of the following study is to verify the effects of the association between the manual lymphatic drainage and the therapeutic ultrasound on pain, oedema and the tissue fibrosis in liposuction and lipoabdominoplasty PO. DESIGN This is a clinical trial prospective. MATERIALS AND METHODS Eighteen women aged between 18 and 60 years participated in this study, in the late PO period following lipoabdominoplasty or liposuction in the abdomen, flanks and lower trunk, which showed tissue fibrosis of the flanks and abdomen regions. They were divided into two groups: Liposuction group and lipoabdominoplasty group. A total of twelve sessions of therapeutic ultrasound followed by the manual lymphatic drainage were performed. The patients were assessed with regard to pain, oedema and tissue fibrosis in different moments: Initial assessment, during assessment and final assessment through the application of the protocol of evaluation of cysts fibrosis levels. STATISTICAL ANALYSIS The test of equality for two proportions and the confidence interval test for mean to evaluate the distribution of variables. The significance level adopted for statistical tests was 5% (P < 0.05). RESULTS There was a statistically significant reduction of pain, swelling and tissue fibrosis in both groups. CONCLUSION the association between manual lymphatic drainage and the therapeutic ultrasound reduced the swelling and the tissue fibrosis and made pain disappear in liposuction and lipoabdominoplasty PO period.
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Affiliation(s)
- Igor F B Masson
- Department of Physical Therapy, Universidade Paulista, São Paulo, Brazil
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21
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Abstract
A 48-year-old male patient with chronic alcoholism presented with a soft, bulky, asymptomatic, and slow-growing mass in the posterior region of the neck, as well as nodules in the deltoid region and posterior triangle of the sternocleidomastoid muscle. Needle aspiration confirmed the diagnosis of lipoma. Multiple symmetric lipomatosis (Madelung's disease) is a rare proliferation of adipocytes, of unknown etiology, most common in middle-aged men and mainly associated with alcoholism. It predominantly affects the neck and upper trunk, causing compressive symptoms or a imparting a pseudoathletic appearance. Surgical resection or liposuction is the most effective treatment, despite frequent recurrence.
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Affiliation(s)
- Cínthia Rosane Orasmo
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp) - Botucatu
(SP), Brazil
| | - Juliana Polizel Ocanha
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp) - Botucatu
(SP), Brazil
| | | | - Hélio Amante Miot
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp) - Botucatu
(SP), Brazil
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22
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Wollina U. Photoletter to the editor - Nevus lipomatosus superficialis (Hoffmann-Zurhelle). Three new cases including one with ulceration and one with ipsilateral gluteal hypertrophy. J Dermatol Case Rep 2013; 7:71-3. [PMID: 23858347 DOI: 10.3315/jdcr.2013.1143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 03/27/2013] [Indexed: 11/11/2022]
Abstract
Nevus lipomatosis superficialis is a rare, asymptomatic hamartoma of skin. We report 3 adult patients with NLS of Hoffmann - Zurhelle type, 2 males and a female. Two cases showed clinical peculiarities - ulceration or association with ipsilateral gluteal hypertrophy. Reduction buttock lift was performed to improve body contour. In conclusion, nevus lipomatosis superficialis can become symptomatic. Although simple surgical excision leads to a complete cure in the majority of cases, sometimes more complex procedures become necessary.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, 01067 Dresden, Germany
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23
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Abstract
Increased visceral adiposity is a risk factor for metabolic disorders such as dyslipidemia, hypertension, insulin resistance and type 2 diabetes, whereas peripheral (subcutaneous) obesity is not. Though the specific mechanisms which contribute to these adipose depot differences are unknown, visceral fat accumulation is proposed to result in metabolic dysregulation because of increased effluent, e.g., fatty acids and/or adipokines/cytokines, to the liver via the hepatic portal vein. Pathological significance of visceral fat accumulation is also attributed to adipose depot/adipocyte-specific characteristics, specifically differences in structural, physiologic and metabolic characteristics compared with subcutaneous fat. Fat manipulations, such as removal or transplantation, have been utilized to identify location dependent or independent factors that play a role in metabolic dysregulation. Obesity-induced alterations in adipose tissue function/intrinsic characteristics, but not mass, appear to be responsible for obesity-induced metabolic dysregulation, thus “quality” is more important than “quantity.” This review summarizes the implications of obesity-induced metabolic dysfunction as it relates to anatomic site and inherent adipocyte characteristics.
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24
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Foster MT, Shi H, Softic S, Kohli R, Seeley RJ, Woods SC. Transplantation of non-visceral fat to the visceral cavity improves glucose tolerance in mice: investigation of hepatic lipids and insulin sensitivity. Diabetologia 2011; 54:2890-9. [PMID: 21805228 PMCID: PMC5451325 DOI: 10.1007/s00125-011-2259-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 06/29/2011] [Indexed: 01/29/2023]
Abstract
AIMS/HYPOTHESIS Intra-abdominal transplantation of non-visceral adipose tissue in rodents, simulating increased abdominal fat in obesity, paradoxically improves glucose tolerance and insulin sensitivity. We hypothesised that this improvement is due to transplant-induced enhanced uptake of fatty acids by adipose tissue, thus reducing fatty acid flux into, and triacylglycerol storage in, the liver. METHODS In Experiment 1, mice were sham-operated or received heterologous epididymal white adipose tissue (WAT; EWAT) or visceral WAT (VWAT) transplantation to the portal and splanchnic circulation regions in the visceral cavity. In Experiment 2, inguinal WAT (IWAT) or EWAT was removed and subsequently transplanted to the visceral cavity of the same mouse (autotransplant). IWAT and EWAT autotransplants were repeated in Experiment 3 and compared with heterotransplants. RESULTS Heterotransplantation of VWAT did not alter glucose tolerance, whereas auto- or hetero-transplantation of EWAT or IWAT significantly improved glucose tolerance. Transplantation-induced improvements in glucose tolerance 4 weeks after surgery coincided with decreased liver triacylglycerol, decreased portal plasma lipids and increased hepatic insulin sensitivity. By 8 weeks, these changes were apparent only in mice with autotransplantation. Heterologous EWAT transplantation-induced glucose improvement persisted without altered liver metabolism. CONCLUSIONS/INTERPRETATION Increases in visceral fat, via transplantation of visceral or non-visceral adipose tissue, is not a major risk factor for glucose intolerance. In fact, there are dynamic metabolic improvements following transplantation that include decreased portal lipids and improved liver metabolism, but these improvements are transient under certain circumstances.
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MESH Headings
- Adipose Tissue, White/metabolism
- Adipose Tissue, White/pathology
- Adipose Tissue, White/transplantation
- Animals
- Disease Models, Animal
- Epididymis
- Glucose Intolerance/etiology
- Glucose Intolerance/prevention & control
- Green Fluorescent Proteins/genetics
- Green Fluorescent Proteins/metabolism
- Insulin Resistance
- Intra-Abdominal Fat/metabolism
- Intra-Abdominal Fat/pathology
- Intra-Abdominal Fat/transplantation
- Lipid Metabolism
- Lipids/blood
- Liver/metabolism
- Liver/pathology
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Transgenic
- Obesity, Abdominal/blood
- Obesity, Abdominal/metabolism
- Obesity, Abdominal/pathology
- Obesity, Abdominal/physiopathology
- Peritoneum/surgery
- Recombinant Proteins/metabolism
- Transplantation, Autologous
- Transplantation, Homologous
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Affiliation(s)
- M T Foster
- Obesity Research Center, Department of Psychiatry, University of Cincinnati, 2170 E. Galbraith Road, Cincinnati, OH 45237, USA.
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25
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Boucher J, Quilliot D, Pradère JP, Simon MF, Grès S, Guigné C, Prévot D, Ferry G, Boutin JA, Carpéné C, Valet P, Saulnier-Blache JS. Potential involvement of adipocyte insulin resistance in obesity-associated up-regulation of adipocyte lysophospholipase D/autotaxin expression. Diabetologia 2005; 48:569-77. [PMID: 15700135 PMCID: PMC1885462 DOI: 10.1007/s00125-004-1660-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2004] [Accepted: 10/04/2004] [Indexed: 10/25/2022]
Abstract
AIMS/HYPOTHESIS Autotaxin is a lysophospholipase D that is secreted by adipocytes and whose expression is substantially up-regulated in obese, diabetic db/db mice. The aim of the present study was to depict the physiopathological and cellular mechanisms involved in regulation of adipocyte autotaxin expression. METHODS Autotaxin mRNAs were quantified in adipose tissue from db/db mice (obese and highly diabetic type 2), gold-thioglucose-treated (GTG) mice (highly obese and moderately diabetic type 2), high-fat diet-fed (HFD) mice (obese and moderately diabetic type 2), streptozotocin-treated mice (thin and diabetic type 1), and massively obese humans with glucose intolerance. RESULTS When compared to non-obese controls, autotaxin expression in db/db mice was significantly increased, but not in GTG, HFD, or streptozotocin-treated mice. During db/db mice development, up-regulation of autotaxin occurred only 3 weeks after the emergence of hyperinsulinaemia, and simultaneously with the emergence of hyperglycaaemia. Adipocytes from db/db mice exhibited a stronger impairment of insulin-stimulated glucose uptake than non-obese and HFD-induced obese mice. Autotaxin expression was up-regulated by treatment with TNFalpha (insulin resistance-promoting cytokine), and down-regulated by rosiglitazone treatment (insulin-sensitising compound) in 3T3F442A adipocytes. Finally, adipose tissue autotaxin expression was significantly up-regulated in patients exhibiting both insulin resistance and impaired glucose tolerance. CONCLUSIONS/INTERPRETATION The present work demonstrates the existence of a db/db-specific up-regulation of adipocyte autotaxin expression, which could be related to the severe type 2 diabetes phenotype and adipocyte insulin resistance, rather than excess adiposity in itself. It also showed that type 2 diabetes in humans is also associated with up-regulation of adipocyte autotaxin expression.
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Affiliation(s)
- Jérémie Boucher
- Unité de recherche sur les obésités
INSERM : U586 IFR31Université Paul Sabatier - Toulouse IIIInstitut Louis Bugnard
1, Avenue Jean Poulhes
31432 TOULOUSE CEDEX 4,FR
| | - Didier Quilliot
- Diabétologie-Nutrition-Métabolismes
CHU Nancy Hôpital Jeanne d'ArcNancy,FR
| | - Jean-Philippe Pradère
- Unité de recherche sur les obésités
INSERM : U586 IFR31Université Paul Sabatier - Toulouse IIIInstitut Louis Bugnard
1, Avenue Jean Poulhes
31432 TOULOUSE CEDEX 4,FR
| | - Marie-Françoise Simon
- Unité de recherche sur les obésités
INSERM : U586 IFR31Université Paul Sabatier - Toulouse IIIInstitut Louis Bugnard
1, Avenue Jean Poulhes
31432 TOULOUSE CEDEX 4,FR
| | - Sandra Grès
- Unité de recherche sur les obésités
INSERM : U586 IFR31Université Paul Sabatier - Toulouse IIIInstitut Louis Bugnard
1, Avenue Jean Poulhes
31432 TOULOUSE CEDEX 4,FR
| | - Charlotte Guigné
- Unité de recherche sur les obésités
INSERM : U586 IFR31Université Paul Sabatier - Toulouse IIIInstitut Louis Bugnard
1, Avenue Jean Poulhes
31432 TOULOUSE CEDEX 4,FR
| | - Danielle Prévot
- Unité de recherche sur les obésités
INSERM : U586 IFR31Université Paul Sabatier - Toulouse IIIInstitut Louis Bugnard
1, Avenue Jean Poulhes
31432 TOULOUSE CEDEX 4,FR
| | - Gilles Ferry
- Centre de Recherche de Croissy
Institut de Recherche Servier78290 Croissy-sur-Seine,FR
| | - Jean A. Boutin
- Centre de Recherche de Croissy
Institut de Recherche Servier78290 Croissy-sur-Seine,FR
| | - Christian Carpéné
- Unité de recherche sur les obésités
INSERM : U586 IFR31Université Paul Sabatier - Toulouse IIIInstitut Louis Bugnard
1, Avenue Jean Poulhes
31432 TOULOUSE CEDEX 4,FR
| | - Philippe Valet
- Unité de recherche sur les obésités
INSERM : U586 IFR31Université Paul Sabatier - Toulouse IIIInstitut Louis Bugnard
1, Avenue Jean Poulhes
31432 TOULOUSE CEDEX 4,FR
| | - Jean Sébastien Saulnier-Blache
- Unité de recherche sur les obésités
INSERM : U586 IFR31Université Paul Sabatier - Toulouse IIIInstitut Louis Bugnard
1, Avenue Jean Poulhes
31432 TOULOUSE CEDEX 4,FR
- * Correspondence should be adressed to: Jean Sébastien Saulnier-Blache
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