Juxta-articular adiposis dolorosa (Dercum's disease type IV): report of four cases and treatment by dermolipectomy.

Juxta-articular adiposis dolorosa is a rare subtype of Dercum's disease. It manifests mainly on the medial parts of the knees. Pain and impaired mobility are common symptoms. We report on four females (aged between 52 and 83 years) who suffered from juxta-articular adiposis dolorosa for more than 10 years. These patients were successfully treated by dermolipectomy resulting in dramatically improved pain and mobility. Adverse effects and complications were minor with a lymph fistula in a single patient which was treated by surgery.

Evaluation of measurement of fat mass reduction after liposuction in obese patients.

Body composition measurements are used to evaluate surgical treatment, such as bariatric surgery in overweight patients. Nowadays, there are many different methods to measure body composition available. However, none of them has been validated for use in patients after operation. The aim of the present study was to compare the amount of surgically removed fat with two different methods, bioelectrical impedance analysis (BIA) and total body potassium (TBK). Amount of removed fat during liposuction was measured 1, 2, 3, 4, 14 days, and 1 year postoperatively in 27 obese patients after liposuction. The results were compared with actual removed fat during the operation. The median fat mass removed was 4020 grams (range 1954-9655). Postoperatively there was a varying reduction in fat mass, as measured with BIA and with TBK. There was a clear difference between the range of amounts removed measured with BIA and the range of amount removed measured with TBK. This study indicates that BIA, but not TBK, is an appropriate method to measure fat mass in obese subjects in a surgical setting. BIA seems to underestimate the amount of fat removed, whereas TBK seems to overestimate it.

Quality-of-life in patients with Dercum's disease--before and after liposuction.

Dercum's disease is characterised by obesity, pronounced pain in the adipose tissue, and a number of associated symptoms. Liposuction has been suggested as a treatment. However, the effect on quality-of-life after liposuction in Dercum's disease has never been investigated. The objective of this study was to examine the quality-of-life in Dercum's disease before and after liposuction. A total of 114 women fulfilling the clinical criteria of Dercum's disease were included. Of the 114 women, 53 were operated on with liposuction and 61 were Dercum controls. In addition, 41 obese healthy women operated on with abdominoplasty were recruited as controls. Health-related quality-of-life (HRQoL) was measured with the Nottingham Health Profile (NHP) and the Psychological General Well-Being index (PGWB). The Dercum group had lower HRQoL than the abdominoplasty controls. After liposuction, a slight improvement could be seen in HRQoL in the operated patients compared with preoperatively, but it did not become as high as in the abdominoplasty patients. In conclusion, the findings could suggest that liposuction improves the quality-of-life slightly in Dercum's disease. Nonetheless, the causality is unclear and the improvement is not big enough to warrant operation.

Liposuction may reduce pain in Dercum's disease (adiposis dolorosa).

OBJECTIVE: The aim of this prospective study is to assess the effect of liposuction on the pain experienced by women with Dercum's disease (adiposis dolorosa). DESIGN: Pain was examined preoperatively and at 3 months, and 1, 2, 3, and 5 years after liposuction. The subjective pain sensation was evaluated with a visual analog scale and number of words chosen, and the objective pain sensation with the mechanical pressure pain threshold. SETTING: Dercum's disease is characterized by obesity and pronounced pain in the adipose tissue. The pain is chronic and often disabling and resistant to traditional analgesics and other pain treatment. However, five reports have been published on the encouraging effect of liposuction. PATIENTS: Pain was evaluated in 53 patients with Dercum's disease that had been operated on with liposuction. As controls, 58 nonoperated subjects with Dercum's disease and 41 obese abdominoplasty patients were followed for 5 years. RESULTS: Both subjective and objective pain measurements revealed a statistically significant decrease in the pain experienced by the Dercum patients after surgery as compared with preoperatively. However, the pain relief diminished over time. Furthermore, a significant postoperative difference could be seen between the Dercum operated group and the Dercum controls as regards measured pain. The difference decreased over time but still lingered 5 years postoperatively. CONCLUSION: The results suggest that liposuction might alleviate pain in patients with Dercum's disease. However, it is difficult to determine whether the effect is due to the actual surgery or to other factors.

Thermal and vibratory thresholds after liposuction in patients with Dercum's disease.

Dercum's disease is characterised by pronounced pain in the adipose tissue and a number of associated symptoms and is, in most patients, accompanied by obesity. Postoperative sensory change after liposuction is a well-known side effect, and probably caused by mechanical trauma to the nerves. The aim of this investigation was to find out whether the thermal and sensory sensation changed after liposuction in patients with Dercum's disease. The thermal and vibratory thresholds were examined preoperatively, and three and 12 months after, liposuction in 39 affected patients. There were only small differences in thermal and vibratory thresholds three and 12 months after liposuction compared with preoperatively, and none of these was statistically significant.

Painful fat syndrome in a male patient.

Painful fat syndrome or lipoedema is a distinct clinical condition, characterised by bilateral and symmetrical enlargement of the upper and lower leg with tenderness, but excluding the feet. Lipoedema occurs almost exclusively in females, and no male patient has been reported in the literature published in English. We report on an extremely rare presentation of lipoedema in a male patient. A thorough study based on the case history, physical manifestations, and magnetic resonance imaging (MRI) provided valuable clues for a differential diagnosis. Conservative treatment using weight reduction, compression-stocking application, and diuretic therapy was not effective. Tumescent liposuction with postoperative pressure garments provided a satisfactory treatment.

Dercum's disease (adiposis dolorosa): a new case-report.

UNLABELLED: Dercum's disease, or adiposa dolorosa, is a rare condition characterized by the development of multiple painful subcutaneous lipomas. Postmenopausal women are selectively affected. The ankle area is an uncommon site of involvement. We report a case with lipomas about the ankle, and we review the relevant literature. CASE-REPORT: This 46-year-old perimenopausal woman receiving follow-up for depression presented in December 1997 for swelling and mechanical pain in the right ankle. Lumps behind and under the malleoli were removed surgically and found to have the typical histological features of lipomas. In January 2000, a lump developed behind and under the malleoli of the left ankle, and the lumps on the right recurred. The physical examination showed obesity, with a body mass index of 32.04 kg/m(2). Firm, mobile, painless lumps were felt under and behind the malleoli on both sides. The ankles were painful, although range of motion was normal. Examination of the back found two similar lumps. The erythrocyte sedimentation rate was 10 mm/h and the C-reactive protein level was 6 mg/l. Serum lipid levels were normal. Findings were normal from plain radiographs of the ankles. Ultrasound scanning of the ankles confirmed that the lumps were composed of adipose tissue. Magnetic resonance imaging visualized an arc-shaped lipomatous mass on the left. Whole-body bone density measurement found an increase in fat mass of the lower limbs with normal bone mass. The ankle lipomas were removed surgically. At last follow-up 18 months later, she was free of recurrence. DISCUSSION: Dercum's disease is a rare condition of unknown etiology characterized by multiple, often painful lipomas. Paresthesia in the overlying skin is common. Lipomas about the joints cause mechanical arthralgia. The diagnosis, which is often delayed, rests on ultrasonography and, above all, magnetic resonance imaging. A combination of medications, surgery, and psychiatric care is usually needed. The treatment aims at relieving the pain and restoring a normal appearance.

Dysarthria, progressive parkinsonian features and symmetric necrosis of putamen in a family with painful lipomas (Dercum disease variant).

We describe painful subcutaneous lipomatosis in four members of a two-generation family. Lipomas appeared in adulthood, were circumscribed, painful on touch and mainly localized to the trunk and proximal parts of the extremities. The disorder was associated with dysarthria, visual pursuit defect and progressive dystonia. MRI showed bilateral increasing cystic lesions in the basal parts of the putamen. No other abnormalities were detected. The lesions corresponded well with the clinical presentation in the patients. Investigation for mitochondrial disease with muscle biopsy and mitochondrial DNA gave normal results. No consistent biochemical changes were found. The disorder in this family was considered to differ from MERRF with lipomatous lesions and multiple symmetric lipomatosis but compatible with a Dercum disease variant.

[Painful lipoma?]. / Schmerzhafte Lipome?!

The adiposis dolorosa (Dercum's disease) was described already in 1892. Many questions about its physiopathological mechanism are still unresolved. Presentation of a patient with this disease is reported, followed by a brief review of the literature, where the pathogenesis, the differential diagnosis and the therapeutical approaches of this syndrome are especially pointed out.

Dercum's disease (adiposis dolorosa).

Dercum's disease (adiposis dolorosa) is a rare condition characterized by progressively painful fatty deposits, usually, in menopausal women with obesity, asthenia and mental phenomena. We report a case of a 48-year-old woman with recurrent neck swelling and pain in the neck and parotid region, and a review of management of this uncommon problem.

[Liposuction]. / Liposuctie.

Liposuction is a frequently applied technique in aesthetic plastic surgery, with which subcutaneous adipose tissue can be removed. In recent decades new techniques of liposuction were developed. This led to better results and fewer complications. Liposuction is indicated as symptomatic treatment of obesity and (or) lipomas. Liposuction is not without risks; patients have to be informed of practical consequences and possible complications of the technique.

Liposuction in Dercum's disease: impact on haemostatic factors associated with cardiovascular disease and insulin sensitivity.

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.

Liposuction in the treatment of juxta-articular adiposis dolorosa.

Two patients are presented who had symptomatic relief of juxta-articular adiposis dolorosa of the knees after liposuction. Liposuction is recommended for the treatment of this condition.

Adiposis dolorosa (Dercum's disease): liposuction as an effective form of treatment.

The clinical picture of adiposis dolorosa makes a lasting impression on the examining physician. The patient is typically an obese, asthenic woman who appears to have a low pain threshold. She has an unusual distribution of fatty tumors, and her complaint of pain in these tumors seems out of proportion to the physical findings. Alcoholism, emotional instability, and depression are common, and narcotic pain medicine is frequently requested. The patient is easily dismissed as a malingerer after a brief examination. However, liposuctioning of the painful fatty tumors appears to be both practical and effective. While adiposis dolorosa is an unusual disease, it is one that plastic surgeons can recognize and treat.