Proposed Framework for Research Case Definitions of Lipedema.

Background: Our aim is to propose a framework for the development of a research case definition of lipedema, based on current available literature and those observations that can be applied to future lipedema research with the intent to standardize and strengthen the scientific evidence base. Methods and Results: We conducted a narrative review of the literature, and identified consensus characteristics and disputed characteristics that could be included in a research case definition of lipedema. After considering the strength of the evidence and how each characteristic might be measured in a research study, we recommended an approach for the development of a research case definition of lipedema that would be based on consideration of five agreed-upon characteristics, and five disputed, or less substantiated, characteristics as additional evidence to enhance specificity. Conclusions: We present a case definition framework for lipedema drawn from the scientific literature that can be applied to future studies on lipedema. Utilizing this framework should help to increase the sensitivity and specificity of case definition and provide an opportunity for meta-analysis of clinical studies and facilitate future research intercomparisons.

Mecánica rotacional ventricular izquierda invertida en un paciente con lipedema (del estudio de MAGYAR-Path) / Left ventricular twist rotation mechanics in a patient with lipoedema (MAGYAR-Path Study)

Resumen El lipedema es un trastorno crónico que se caracteriza por una hiperplasia del tejido adiposo subcutáneo simétrico, deformante, asociado a hematomas y dolor, que afecta fundamentalmente a mujeres tras la pubertad, que suele ser familiar y tiene influencia hormonal. Sin tratamiento, el lipedema puede progresar a linfedema, y se ha asociado al aumento en la rigidez de la aorta. La mecánica rotacional del ventrículo izquierdo (VI) tiene un papel significativo en la circulación normal. En circunstancias normales, la base del VI rota en el sentido de las agujas del reloj, mientras que el ápex del VI rota en sentido contrario, provocando un movimiento como de retorcer una toalla llamado torsión del VI. En el presente caso, mediante ecocardiografía speckle-tracking tridimensional se reveló una torsión del VI demostrando un ápex VI en el sentido de las agujas del reloj y la rotación antihoraria de la base del VI en un paciente con características clínicas de lipedema.

Abstract Lipoedema is a chronic disorder that is characterised by a symmetric, deforming, hyperplasia of the subcutaneous adipose tissue, and is associated with haematomas and pain. It mainly affects women after puberty, is usually familial and is influence by hormones. Untreated, the lipoedema can progress to lymphoedema, and has been associated with the increase in aortic stiffness. The mechanical rotation of the left ventricle (LV) has an important role in normal circulation. In normal circumstances, the base of the LV rotates clockwise, while the LV apex rotates in the opposite direction, leading to a movement like wringing a towel, called LV twist. In the present case, using three-dimension speckle-tracking echocardiography, an LV twist is observed, showing an LV apex in the clockwise direction and the anti-clockwise rotation of the LV base in a patient with clinical characteristics of lipoedema.

Ground reaction force patterns during gait in patients with lower limb lymphedema / Forças de reação ao solo durante a marcha de pacientes com linfedema de membro inferior

Although gait problems have been reported in patients with lower limb lymphedema (LLL), the gait pattern (GP) changes have not been documented yet. However, it is possible that patients with LLL show abnormal GP that can be related to biomechanical complications related to osteoarthritis or falls affecting the quality of life. Ground reaction force analysis during gait allows objective assessment of the patients and it can be used to plan a rehabilitation approach. Objective: To analyze the GRF during gait in patients LLL. Methods: An experimental descriptive study was realized with twenty-three LLL patients, both unilateral and bilateral and classified as moderate and severe, participated in the experiments. The patients walked on a force plate while the three ground reaction force (GRF) components, vertical, mediolateral (M-L) and anteroposterior (A-P), under their feet were recorded and analyzed. Results: In the patients with unilateral lymphedema, either moderate or severe, the vertical GRF components of the affected limb were similar to the sound one and also resembling those found in healthy adults. The M-L GRF was smaller in the non-affected side. In patients with bilateral lymphedema gait speed was significantly slower. More interestingly, the vertical GRF pattern was flat, not showing the typical 2-peak shape. Finally, the large M-L forces found suggest gait stability problems. Conclusions: The patients showed abnormal GRF patterns, including compensation with the non-affected leg. The GRF variability was higher in the patients with severe unilateral lymphedema. Bilateral lymphedema results in lower A-P forces. Stance phase duration was longer in patients with bilateral and severe lymphedema

Síndrome de dolor posmastectomía en nuestro medio: características, tratamiento y experiencia con gabapentina / Postmastectomy pain syndrome in our region: characteristics, treatment, and experience with gabapentin

Introducción. El síndrome de dolor posmastectomía puede afectar a más de la mitad de pacientes intervenidas por cáncer de mama. Objetivos. Revisar las características clínicas de este síndrome y su evolución, y evaluar la respuesta al tratamiento farmacológico. Pacientes y métodos. Estudio retrospectivo de 65 pacientes con un seguimiento superior a cinco años. Resultados. El 88% de las pacientes estaba sin diagnosticar. Su edad media era de 56,49 años y permanecieron con dolor un promedio de 29,15 meses. En el 71%, las alteraciones neurológicas correspondieron al segundo nervio intercostobraquial. La media en la puntuación de dolor antes del tratamiento fue de 66,5 puntos en la escala analógica visual y de 13,14 en el índice de Lattinen. El tratamiento con gabapentina (dosis media: 1.135 mg/día; duración media: 14 semanas) disminuyó el dolor en el 80% de las pacientes (p < 0,0001). La mejoría se mantuvo a largo plazo. Un 10% continuó en tratamiento y el 10% debió suspenderlo por efectos secundarios. El número necesario de pacientes que hubo que tratar fue de 2,13. Recidivó el 35% y precisó cambiar de fármaco el 15,68% de las tratadas con gabapentina, frente al 50% de las tratadas con otros fármacos (p = 0,046). No se encontraron diferencias en la eficacia entre ambos grupos. Conclusiones. El dolor posmastectomía es una patología infradiagnosticada. El tratamiento (en especial con gabapentina) puede ser eficaz y bien tolerado hasta en el 90% de las pacientes de forma significativa (AU)

Introduction. Postmastectomy pain syndrome affects up to a half of the patients treated for breast cancer. Aims. Characterization of this syndrome and its evolution. Measure pharmaceutical treatment (specifically with gabapentin). Patients and methods. A retrospective study of 89 patients with more than five years monitoring was carried out. Results. Of the patients included in the study 88% had not been previously diagnosed. The mean age of the patients was 56.49 years old. The pain lasted on average 29.15 months. In 71% the neurological symptoms corresponded to the second intercostobrachial nerve. The average pain value for patients before treatment on the Visual Analog Scale was 66.5 and 13.14 on the Lattinen Index. The treatment with gabapentin at an average dose of 1,135 mg for 14 weeks reduced pain in 80% of the patients (p < 0.0001). In the majority of the patients the reduction was maintained in the long term. Ten percent continued the treatment whereas another 10% suspended treatment due to side effects. The average necessary number of patients to be treated was 2.13. Of those treated with gabapentin 35% relapsed while 15.68% changed medication compared to 50% of those treated with other indicated neuropathic drugs (p = 0.046). No difference in the effectiveness between both groups was found. Conclusions. Postmastectomy pain is an under-diagnosed pathology. Treatment (in particular with gabapentin) can be significantly effective and well tolerated in up to 90% of postmastectomy pain syndrome patients (AU)