Hepathic, biochemical, hematological, and histological effects of the ultracavitation in rabbits livers.

PURPOSE: To collect data capable of pointing out the effects of the ultracavitation treatment on the liver of rabbits after adipose tissue application, by means of histological analyses of the liver and hematological and biochemical exams. METHODS: This is an experimental study with 12 albino rabbits as sample, which were divided into 3 groups and submitted to a hypercaloric diet for one month. Subsequently, subjects underwent UCV treatment: 3 minutes, 30 W, continuous mode at 100%, every 2 ERAS = 441.02 J/cm2, intensity of 10w/cm2. They were then euthanized and underwent biopsy after 24 hours. RESULTS: After 48 hours from the ultracavitation treatment, the animals' livers presented greater amount of fat infiltration if compared to the amount presented 96 hours after the treatment. However, laboratory tests showed no alterations. Values were maintained within normal parameters of cholesterol, triglycerides, liver enzymes, hemoglobin and hematocrit levels. CONCLUSIONS: This study has identified that infiltrates may appear on livers after the treatment, despite high hematological and biochemical tests results. The fat infiltrates reduction 96 h after treatment suggests lower risks to animal health, if the period between applications is respected.

Hepathic, biochemical, hematological, and histological effects of the ultracavitation in rabbits livers

Abstract Purpose To collect data capable of pointing out the effects of the ultracavitation treatment on the liver of rabbits after adipose tissue application, by means of histological analyses of the liver and hematological and biochemical exams. Methods This is an experimental study with 12 albino rabbits as sample, which were divided into 3 groups and submitted to a hypercaloric diet for one month. Subsequently, subjects underwent UCV treatment: 3 minutes, 30 W, continuous mode at 100%, every 2 ERAS = 441.02 J/cm2, intensity of 10w/cm2. They were then euthanized and underwent biopsy after 24 hours. Results After 48 hours from the ultracavitation treatment, the animals' livers presented greater amount of fat infiltration if compared to the amount presented 96 hours after the treatment. However, laboratory tests showed no alterations. Values were maintained within normal parameters of cholesterol, triglycerides, liver enzymes, hemoglobin and hematocrit levels. Conclusions This study has identified that infiltrates may appear on livers after the treatment, despite high hematological and biochemical tests results. The fat infiltrates reduction 96 h after treatment suggests lower risks to animal health, if the period between applications is respected.

Las tres generaciones de la UAL (lipoplastia asistida por ultrasonido) / The three generations of the UAL (ultrasound assisted lipoplasty)

La Lipoplastia asistida por ultrasonido (UAL) es una técnica empleada desde ya muchos años. Con el desarrollo de nuevas tecnologías, se replantea constantemente la terapéutica más eficaz con los nuevos recursos disponibles, por lo que se elaboran aparatos capaces de optimizar resultados llevando a un tratamiento más innovador y eficaz. Surgen nuevos conocimientos sobre las propiedades físico-mecánicas de los aparatos con ultrasonido, lo cual abre una ventana de oportunidades para su uso médico, particularmente para el uso en la liposucción en el tratamiento de los pacientes con lipodistrofia corporal, quienes podrían ser beneficiados por las ventajas de estas tecnologías en comparación con las que actualmente están en uso. Las características de los aparatos de ultrasonido en el campo de la cirugía plástica y su evolución con las décadas ha permitido obtener mayor eficacia en su acción y ademas ha disminuido las complicaciones. Se realiza una recopilación de datos sobre la Liposucción Asistida por Ultrasonido en el tratamiento de la lipodistrofia. Se exponen las cualidades del aparato ultrasónico en la lipodistrofia, su historia evolutiva, sus logros y mejores resultados, anteriormente no alcanzados con las técnicas hasta ahora empleadas

Ultrasound-assisted Lipoplasty (UAL) is a technique that has been used for many years. With the development of new technologies, the most effective therapy is constantly being rethought with the new resources available, so that devices are developed capable of optimizing results leading to a more innovative and effective treatment. New knowledge about the physico-mechanical properties of ultra sound devices emerges, which opens a window of opportunities for medical use, particularly for the use in liposuction the treatment of patients with body lipodystrophy, who could benefit from the advantages of these technologies compared to those currently in use. Due to the characteristics of ultrasound devices in the field of plastic surgery and its evolution over the decades, it has allowed greater effectiveness in its action, in addition to reducing complications. A collection of data on Ultrasound-Assisted Liposuction is performed in the treatment of lipodystrophy. The qualities of the ultrasonic apparatus in lipodystrophy, its evolutionary history, its achievements and better results, previously unreached with the techniques used until now, are exposed

Correção cirúrgica da lipodistrofia relacionada ao uso da terapia antirretroviral: uma análise sobre os procedimentos realizados e o impacto sobre os pacientes / Surgical lipodystrophy correction associated with the use of antiretroviral therapy: an analysis of procedures performed and impact on the patients

Introdução: O tratamento de pacientes portadores da síndrome da imunodeficiência adquirida deve ser integral e se basear no controle da doença e das complicações relacionadas ao uso de medicações antirretrovirais, como a lipodistrofia. Esse estudo tem como objetivo avaliar as principais queixas, os aspectos epidemiológicos e os procedimentos cirúrgicos realizados para corrigir a lipodistrofia em pacientes em uso crônico de antirretrovirais. Método: Estudo retrospectivo, no qual foram coletados dados dos prontuários de 27 pacientes submetidos a 36 procedimentos cirúrgicos relacionados à correção de lipodistrofia no período de março de 2010 a junho de 2014 no serviço de Cirurgia Plástica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. Resultados: A idade média dos pacientes foi 47,2 anos, 22,2% homens e 77,8% mulheres. O tempo médio de uso da terapia antirretroviral (TARV) foi de 12,1 anos. As queixas mais encontradas foram: giba dorsal (44,4%), lipodistrofia abdominal (44,4%) e lipoatrofia glútea (37,04%). Na maioria dos pacientes (70,4%), foi realizada uma cirurgia. Quanto às cirurgias, a lipoaspiração de giba foi realizada em 48,1% dos pacientes, seguida da lipoaspiração de abdome, dorso ou flancos (44,4%) e gluteoplastia (22,2%). Entre todos os 36 procedimentos realizados, apenas dois apresentaram complicações. O tempo médio de seguimento pós-operatório foi de 11,2 meses. Do total, 70,4% dos pacientes mostraram-se satisfeitos após os procedimentos. Conclusões: O sucesso do tratamento cirúrgico da lipodistrofia causada pelo uso da TARV baseia-se na seleção pré-operatória adequada e em seguimento constante e prolongado. A melhoria da autoestima facilita a adesão ao tratamento com antirretrovirais.

Introduction: Treatment of patients with acquired immunodeficiency syndrome should be complete and based on controlling the disease and the complications related to the use of antiretroviral medications, such as lipodystrophy. This study aimed to evaluate the main complaints, epidemiological aspects, and surgical procedures performed for lipodystrophy correction among patients receiving long-term antiretroviral therapy. Method: In this retrospective study, data were collected from the medical records of 27 patients who underwent 36 surgical procedures associated with lipodystrophy correction, from March 2010 to June 2014, at the Plastic Surgery Service of the Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto. Results: The average age of the patients was 47.2 years; 22.2% were men and 77.8% were women. The average duration of antiretroviral therapy (HAAR ) was 12.1 years. The most frequent complaints were dorsal hump (44.4%), abdominal lipodystrophy (44.4%), and gluteal lipoatrophy (37.04%). The majority of patients (70.4%) had undergone surgery . The most common type of surgery performed was hump liposuction (carried out in 48.1% of the patients), followed by abdominal, back, or flank liposuction (44.4%) and gluteoplasty (22.2%). Among all 36 procedures performed, only 2 resulted in complications. The average postoperative follow-up period was 11.2 months. In total, 70.4% of patients were satisfied with the results of their procedure. Conclusions: The success of surgical treatment of HAARinduced lipodystrophy is based on proper preoperative selection as well as constant and prolonged follow-up. Improved selfesteem facilitates the adherence to antiretroviral drug treatment.

Longitudinal evaluation of manual lymphatic drainage for the treatment of gynoid lipodystrophy.

BACKGROUND: The gynoidlypodystrophy, known as cellulitis or cellulite, refers to a condition that gives the skin an undulating and uneven appearance, affecting 80-90% of women after puberty. OBJECTIVES: to investigate the efficacy and safety of manual lymphatic drainage for cellulite management. METHODS: this was an open, prospective, intervention study including 20 women aged from 20 to 40 years. Fourteen sessions of manual lymphatic drainage were performed once a week on lower limbs and buttocks. RESULTS: Fifteen women completed the study. A significant improvement on quality of life was observed (p=0.018). A significant reduction (p=0.023), estimated at 0.3 ± 0.8 cm, in hip circumference was found, but no difference was found in thighs circumference (p>0.05). A significant reduction elastic recuperation of skin on buttocks, which means skin elasticity worsening, was observed. All measures obtained by ultrasound images showed no changes (p>0.05). CONCLUSION: manual lymphatic drainage was safe but not effective as an isolated approach for cellulite management. Further randomized, controlled or comparative studies about manual lymphatic drainage for cellulite control, as unique or combined therapeutic modality, are necessary.

Longitudinal evaluation of manual lymphatic drainage for the treatment of gynoid lipodystrophy

BACKGROUND: The gynoidlypodystrophy, known as cellulitis or cellulite, refers to a condition that gives the skin an undulating and uneven appearance, affecting 80-90% of women after puberty. OBJECTIVES: to investigate the efficacy and safety of manual lymphatic drainage for cellulite management. METHODS: this was an open, prospective, intervention study including 20 women aged from 20 to 40 years. Fourteen sessions of manual lymphatic drainage were performed once a week on lower limbs and buttocks. RESULTS: Fifteen women completed the study. A significant improvement on quality of life was observed (p=0.018). A significant reduction (p=0.023), estimated at 0.3±0.8 cm, in hip circumference was found, but no difference was found in thighs circumference (p>0.05). A significant reduction elastic recuperation of skin on buttocks, which means skin elasticity worsening, was observed. All measures obtained by ultrasound images showed no changes (p>0.05). CONCLUSION: manual lymphatic drainage was safe but not effective as an isolated approach for cellulite management. Further randomized, controlled or comparative studies about manual lymphatic drainage for cellulite control, as unique or combined therapeutic modality, are necessary. .

Effect of ultrasound and hyaluronidase on gynoid lipodystrophy type II - an ultrasonography study.

INTRODUCTION: The objective of this study was to evaluate the effect of ultrasound and the technique of phonophoresis with hyaluronidase in patients with cellulite edematous type II in the gluteal region. METHODS: Forty-two individuals, all females, were selected and randomly divided into two groups with 21 patients in each. Group I was treated with ultrasound without hyaluronidase and Group II was treated with ultrasound with hyaluronidase. To evaluate individuals, inspection, palpation, photography data and diagnostic ultrasound were performed before and after the treatment. The gluteal region was divided into four areas of 2.5 cm(2); each area received an application of ultrasound. RESULTS: After 10 days of application, both treatments were effective in improving skin appearance and reducing its thickness (epidermis and dermis), as well as that of the hypodermis (p > 0.05). Ultrasound with hyaluronidase induced a larger reduction in skin thickness in the upper medial quadrant and in the lower lateral and medial quadrants, compared to treatment without hyaluronidase. Moreover, there was a significant reduction of the hypodermis in the upper lateral quadrant with hyaluronidase (p > 0.05). CONCLUSION: Both treatments effectively reduced the thickness of skin and the hypodermis; however, the group treated with hyaluronidase-associated ultrasound showed more significant results than that treated with ultrasound only.

An index for staging facial lipoatrophy and evaluation of the efficacy of the treatment with polymethylmethacrylate in HIV/AIDS patients: a pilot study.

BACKGROUND: Treatment of facial lipoatrophy of HIV/AIDS patients is mandatory by law in Brazil due to its negative impact on their quality of life. The index for facial lipoatrophy (ILA) is used as one of the inclusion criteria for patient treatment. OBJECTIVES: To define a correct diagnosis and staging of facial lipoatrophy, by employing the ILA. PATIENTS AND METHODS: This is an observational study of a series of case reports from patients submitted to facial lipoatrophy evaluation through ILA and treated with polymethylmethacrylate (PMMA) fillers. Facial lipoatrophy was classified in grades from I to IV, corresponding to mild, moderate, severe and very severe stage, according to ILA. Response to the treatment was defined as excellent (≥ 91%), good (71-90%), moderate (51-70%) and insufficient (≤ 50%). RESULTS: A total of 20 patients were included in this study: 18 men and two women. Median age was 49 years (35-61) and average ILA was 9.9 (7.2-16.8). Ten patients presented facial lipoatrophy grade II (moderate), 5 grade III (severe) and 5 grade IV (very severe). The average volume of PMMA used was 13 mL (5.5-22 mL). All patients showed good or excellent response, with a median of 86% (74-100%). The most typical adverse effect was local oedema but there were no late adverse effects. CONCLUSION: The ILA is an excellent method for evaluation of facial lipoatrophy and also for the assessment of the response to therapy. Facial filling with PMMA showed efficacy and safety in the treatment of facial lipoatrophy in HIV/AIDS patients.

Liposuction in body-shaping treatment for Kobberling-Dunnigan syndrome / Lipoaspiração no tratamento do contorno corporal na síndrome de Kobberling-Dunnigan

INTRODUCTION: Kobberling-Dunnigan syndrome is characterized by a series of alterations in metabolism and body fat distribution. Body dysmorphism and the Cushingoid appearance may have negative social and psychological impacts on the patient, including difficulty with social adaptation. In such cases, liposuction is used with the aim of improving body contour, with consequent improvements in self-esteem. The results are long lasting when body weight is maintained. CASE REPORT: Liposuction of the back, abdomen, and cervical regions in a woman with Kobberling-Dunnigan syndrome led to significant improvement in her body shape, and the results were maintained nine months postoperatively.

INTRODUÇÃO: A síndrome de Kobberling-Dunnigan caracteriza-se por um conjunto de alterações metabólicas e de distribuição da gordura corporal. O dismorfismo corporal e o aspecto cushingoide trazem repercussões psicológicas e sociais, com dificuldade de ajuste social. Nesses casos, a lipoaspiração é empregada com o objetivo de melhorar o contorno corporal e, consecutivamente, as alterações de autoestima. Os resultados apresentam-se duradouros quando há manutenção do peso. RELATO DO CASO: Paciente do sexo feminino, portadora de síndrome de Kobberling-Dunnigan, submetida a lipoaspiração de dorso, abdome e região cervical, com melhora significativa do contorno corporal e manutenção dos resultados nove meses após a operação.

Exercise training in HIV-1-infected individuals with dyslipidemia and lipodystrophy.

PURPOSE: Highly active antiretroviral therapy has improved the prognosis of human immuno deficiency virus type 1 (HIV-1)-infected individuals, but it has been associated with the development of metabolic and fat distribution abnormalities known as the lipodystrophy syndrome. This study tested the hypothesis that aerobic exercise training added to a low-lipid diet may have favorable effects in HIV-1-infected individuals with dyslipidemia and lipodystrophy. METHODS: Thirty healthy subjects, carriers of HIV-1, with dyslipidemia and lipodystrophy, all of whom were using protease inhibitors and/or non-nucleoside reverse transcriptase inhibitors, were randomly assigned to participate in either a 12-wk program of aerobic exercise or a 12-wk stretching and relaxation program. All subjects received recommendations for a low-lipid diet. Before and after intervention, peak oxygen uptake, body composition, CD4, viral load, lipid profile, and plasma endothelin-1 levels were measured. RESULTS: Peak oxygen uptake increased significantly in the diet and exercise group (mean +/- SD: 32 +/- 5 mL x kg(-1) x min(-1) before; 40 +/- 8 mL x kg(-1) x min(-1) after) but not in the diet only group (34 +/- 7 mL x kg(-1) x min(-1) before; 35 +/- 8 mL x kg(-1) x min(-1) after). Body weight, body fat, and waist-to-hip ratio decreased significantly and similarly in the two groups. There were no significant changes in immunologic variables in either group. Likewise, plasma triglycerides, total cholesterol, and HDL cholesterol levels did not change significantly in either group. Plasma endothelin-1 levels were elevated in both groups and presented no significant changes during the study. CONCLUSION: HIV-seropositive individuals with lipodystrophy and dyslipidemia submitted to a short-term intervention of low-lipid diet and aerobic exercise training are able to increase their functional capacity without any consistent changes in plasma lipid levels.

Sindrome de lipodistrofia secundaria a inhibidores de las proteasas en pacientes hiv positivos (HALS) / Syndrome of perpheral lipodystrophy a proteasa inhibitor in positive HIV patients

Sobre la base de la bibliografía encontrada sobre sindrome de lipodistrofia HIV (associated lipodystrofy sindrome) (HALS) se estuduó una población de 30 pacientes (18 hombres y 12 mujeres) con serología positiva para HIV, en tratamiento con inhibidores de la proteasa; con la finalidad de observar la detección de la distribución de la grasa corporal y el comportamiento de lípidos e hidratos de carbono. Encontramos que a partir del tercer mes de tratamiento se producían modificaciones humorales caracterizadas por el aumento en sangre de colesterol, triglicéridos, transaminasas hepáticas y glucemia. La distribución de la ghrasa corporal mostro patrón de obesidad central: aumento en abdomen, tronco y cuello con atrofia muscular en miembros y cara. Todos los pacientes presentaron disminución de peso, no tan marcada como la descripta en los estudios publicados. Los inhibidores de la proteasa son drogas que alteran el metabolismo de los lípidos produciendo sindrome de lipodistrofia (HALS). Además comentamos nuevas teorías sobre patogenia y tratamiento. (AU)

Nutrición y SIDA: alteraciones metabólicas nutricionales en el Síndrome de Inmunodeficiencia Adquirida / Nutrition and aids: nutritional metabolic alterations in the acquired inmunodeficiencia syndrome

El diagnóstico de posibles carencias calórico-proteicas, de vitaminas y/o minerales, en este tipo de pacientes, puede ayudar a prevenir riesgos nutricionales de distinta gravedad. La valoración nutricional debe incluir esencialmente anamnesis alimentaria, examen físico y de los tiempos de la nutrición, estudio de la composición corporal, y análisis bioquímicos. También se analiza el cuadro de lipodistrofia, la conducta terapéutica, parámetos a tener en cuenta en la valoración nutricional, efectos de nutrientes específicos sobre la función inmune, suplementos vitamínicos, terapia hormonal, y alimentación enteral y parenteral

Síndrome de Madelung - relato de um caso e revisäo de literatura / Madlung's syndrome - case report and literatura review

A Síndrome de Madelung é um tipo raro de lipodistrofia descrita pela primeira vez em 1888 por Otto Madelung. Deste entäo, apenas 200 casos foram relatados na literatura. A condiçäo, de etiologia ainda desconhecida, caracteriza-se por uma deposiçäo de tecido adiposo simetricamente em: pescoço, ombros, regiöes supraclaviculares, suboccipital, tronco e regiäo proxima dos membros superiores, determinando um desfiguramento progressivo do doente. Embora usualmente assintomática, a doença pode causar complicaçöes severas, tais como: compressäo traqueal, laríngea ou mediastinal. O diagnóstico diferencial deve incluir outras lesöes do tecido celular cutâneo, a saber: lipomas, angiolipomas, neurofibromas, sarcomas, bem como outras lipomatoses. A excisäo cirúrgica é o único método efetivo de tratamento, sendo a operaçäo em geral trabalhosa devido à natureza hipervascularizada e fibrosa do tecido lipomatoso. Relata-se um caso de Síndrome de Madelung que está sendo acompanhado pelo serviço de Cirurgia Geral do HC-UFPR. O paciente, alvo de olhares curiosos pelo seu aspecto, vem sendo submetido a dermolipectomias e lipoaspiraçöes periódicas

Sindrome de Lipodistrofia Congénita Generalizada / Congenital generalized lipodystrophy syndrome

El actual estudio trata sobre la forma de presentación y evolución de los pacientes con lipodistrofia congénita generalizada o el Síndrome de Seip-Berardinelli. Se caracteriza por la ausencia de tejido graso subcutáneo, cirrosis hepática, desarrollo de diabetes resistente a la insulina, hiperlipemia, y crecimiento corporal rápido con edad ósea avanzada en la infancia, coexistiendo alteraciones cutáneas, desarrollo muscular exagerado y compromiso de otros órganos. Se presentan 3 casos de esta patología diagnosticados entre 9 y 19 meses de edad. Las 3 pacientes presentaban varias características en común: aparentaban una edad mayor a la cronlógica, cara triangular, abundante cabello, lesiones hiperpigmentadas a predominio de pliegues, marcada disminución de tejido celular subcutáneo, prominencia muscular y hepatomegalia. Otros hallazgos clínicos sólo se demostraron en una u otra de las pacientes. La evaluación de laboratorio muestra alteración precoz de lípidos a predominio de triglicéridos, conservando la glicemia y la curva de tolerancia a la glucosa dentro de límites normales. Edad ósea avanzada en 1 de los 3 casos. Analizando los datos de las pacientes y de la literatura respecto a la fisiopatología y posibles efectos beneficiosos de los neurolépticos, se sugiere existencia de alguna anomalía a nivel del hipotálamo y/o hipófisis responsable de la presentacióm del cuadro clínico.

Una enfermedad de base genética: lipodistrofia congénita generalizada; presentación de un caso / A genetical based disease: congenital generalized lipodystrophy; report of a case

Se presenta el caso de un niño de 13 meses de edad con antecedentes de sepsis urinaria, anorexia severa y pérdida de peso desde los 4 meses de edad. Al examen físico se observa una facie simiesca con pérdida del panículo adiposo, hipertricosis generalizada, relieve muscular visible, ausencia del tejido celular subcutáneo, prominencia de la red venosa en miembros superiores e inferiores, manos y pies grandes, así como hipertrofia del pene. Se comprueba implantación baja de las orejas. Con estos elementos clínicos se sospecha que padezca de una lipodistrofia congénita generalizada, se le realiza biopsia muscular y se encuentra ausencia total de tejido adiposo, lo cual ayuda a confirmar el diagnóstico. Se detectan, también, alteraciones de los niveles lipídicos en sangre, no así en la glicemia. Se presenta este caso como una entidad de base genética, que se trasmite con carácter autosómico recesivo, pero de causa no totalmente esclarecida todavía. Se discuten algunos posibles mecanismos etiológicos así como terapéuticos. Consideramos que se debe profundizar más en estos aspectos para evitar complicaciones habituales, como la diabetes mellitus y los trastornos hepáticos