Carotid sheath xanthoma: A rare manifestation of lipid disorders.

Xanthomas are visibly deformed cholesterol deposits that are commonly associated with lipid disorders, such as familial hypercholesterolemia (FH) or rare sitosterolemia. We present the first report of two cases of carotid sheath xanthomas in patients with lipid disorders. Case 1 involved a 26-year-old woman presenting with two heterogeneous mutations on the ABCG5 gene-as noted on genetic testing-who was finally diagnosed with sitosterolemia. Ultrasonography (US) revealed hypoechoic masses centered in the bilateral carotid sheath, which gradually reduced in size after diet control and the use of ezetimibe. Case 2 involved a 27-year-old man who was diagnosed with possible FH and had recurrent bilateral buttock xanthomas, as well as bilateral carotid sheath masses detected by US. Postoperative pathological examination of the resected right neck mass confirmed a xanthoma with proliferation of multinucleated giant cells and deposition of cholesterol clefts.

Síndrome de Barraquer-Simons: revisão da literatura e relato de caso / Barraquer-Simons syndrome: literature review and case report

A síndrome de Barraquer-Simons é uma lipodistrofia caracterizada por progressiva atrofia do tecido celular subcutâneo limitada à parte superior do corpo. Seu acometimento costuma ser simétrico e com evolução craniocaudal, podendo atingir até as coxas. Também é conhecida como lipodistrofia céfalo-torácica ou lipodistrofia parcial progressiva. É uma doença rara, de origem obscura, que geralmente se manifesta no começo da segunda década de vida e tem predominância no sexo feminino. O presente trabalho objetiva trazer uma revisão da literatura e relatar um caso desta rara patologia e sua condução terapêutica, comparando-a a outras modalidades de tratamento disponíveis atualmente. Durante o período de um ano e três meses de seguimento, foram realizadas quatro sessões de enxertia de gordura seguindo os princípios da lipoenxertia estruturada. Por meio desta modalidade terapêutica, foi possível obter uma melhora importante do contorno facial com desaparecimento quase completo das depressões e irregularidades características da doença e preservação do resultado durante o tempo de acompanhamento. Diversos tipos de tratamentos foram descritos como efetivos para as lipodistrofias: uso de materiais aloplásticos, enxertos autólogos, retalhos locais e microcirúrgicos. Cada um deles possui suas vantagem e desvantagens e a escolha dependerá da experiência do cirurgião e da disponibilidade de recursos e materiais específicos em cada centro. A lipoenxertia se mostrou uma forma de tratamento eficaz, simples, segura e de baixo custo para tratamento da síndrome de Barraquer-Simons.

Barraquer-Simons syndrome is a type of lipodystrophy characterized by progressive atrophy of the subcutaneous tissue limited to the upper body. Its involvement is usually symmetrical with craniocaudal evolution, reaching down to the thighs. This syndrome is also known as cephalo-thoracic lipodystrophy or progressive partial lipodystrophy. It is a rare disease of unknown origin that usually manifests at the beginning of the second decade of life and has predominance among women. We report a case and literature review of this rare disease, its therapeutic management, and a comparison with other treatment modalities currently available. During one year and three months follow-up, four sessions of facial fat grafting were performed following the principles of structural fat grafting. The use of this therapeutic modality, improved significantly facial contour, and almost complete disappearance of depressions and irregularities, and preservation were achieved during follow-up time. A number of treatments have been described as effective for lipodystrophy, such as: use of alloplastic materials, autologous grafts, local and microsurgical flaps. Each treatment has advantages and disadvantages. Decision depends on the surgeon's experience, availability of resources, specific materials in each center.

Glycemic and lipid metabolic disorders in diabetic and non-diabetic patients bmi < 35 or > 35 before gastric bypass.

INTRODUCTION: Obesity and diabetes are diseases with high prevalence worldwide. There is currently no effective medical treatment for combat the weight gain. It is precursor of diseases such as diabetes or metabolic syndrome. It is necessary to know if weight gain has cumulative effects on the glycemic and lipid metabolism as precursors of complications or comorbidities. PATIENTS AND METHODS: We studied 131 patients (78 nondiabetic and 53 diabetic), 37 BMI ≤35 (3 BMI < 25, 18 BMI 25-29.9, 16 BMI 30-34.9) and 94 BMI ≥35 (81 BMI 35-49.9 and 13 BMI ≥50).We analyzed BMI, gender, diabetes and the time of evolution. Lipid profile, glucose, HbA1c and C-peptide evaluated after 12-hour fasting. RESULTS: Diabetic and diabese patients showed high triglycerides. Non-diabetics have impaired glucose (58% BMI < 35 and 36% BMI > 35). The 20% of non-diabetics BMI < 35 had high C-peptide, and 19% of BMI > 35 had high levels. The 5% of diabetics BMI < 35 had low Cpeptide and 36% of BMI > 35 had high levels. HbA1c was higher in 40% of non-diabetic patients BMI < 35 compared to 13% BMI > 35. CONCLUSIONS: Glucose and triglycerides increase with age and years of development of T2DM. Age of 51 and more, and men are more affected. The weight increase has cumulative effect by altering the metabolism favoring the onset of diabetes and comorbidities. Despite having intensive control treatment of diabetes, it continues its deleterious effects on patients through the years.

Introducción: La obesidad y la diabetes son enfermedades de alta prevalencia a nivel mundial. Actualmente no existe un tratamiento médico eficaz para combatir el aumento de peso. La obesidad es precursora de enfermedades tales como la diabetes o el síndrome metabólico. Es necesario saber si el aumento de peso tiene efectos acumulativos sobre el metabolismo de la glucemia y los lípidos como precursores de complicaciones o comorbilidades. Pacientes y métodos: Se estudiaron 131 pacientes (78 no diabéticos y 53 diabéticos), 37 IMC ≤35 (3 IMC < 25, 18 IMC 25-29,9, 16 IMC 30-34,9) y 94 IMC ≥35 (81 IMC 35- 49,9 y 13 de IMC ≥50). Se analizó el IMC, el género, la diabetes y su tiempo de evolución. El perfil lipídico, glucosa, HbA1c y el péptido C fueron evaluados después de un ayuno de 12 horas. Resultados: Los pacientes diabéticos y diabesos mostraron niveles altos de triglicéridos. Los pacientes no diabéticos tienen alteración de la glucosa (58% IMC 35). El 20% de los no diabéticos IMC 35 tenían niveles altos. El 5% de los diabéticos IMC < 35 tenía bajos niveles de péptido C y 36% de IMC > 35 tenían niveles altos. HbA1c fue mayor en 40% de pacientes no diabéticos IMC < 35 frente al 13% de IMC > 35. Conclusiones: La glucosa y los triglicéridos aumentan con la edad y los años de evolución de la DMT2. La edad de ≥51 años y los hombres son los más afectados. El aumento de peso tiene efecto acumulativo alterando el metabolismo favoreciendo la aparición de la diabetes y sus comorbilidades. A pesar de tener un tratamiento de control intensivo de la diabetes, esta continúa con sus efectos nocivos sobre los pacientes a través de los años.

Water jet-assisted liposuction for patients with lipoedema: histologic and immunohistologic analysis of the aspirates of 30 lipoedema patients.

Lipoedema is a fat distribution disorder causing massive, bilaterally symmetrical enlargement of the lower and in some cases the upper extremities in women. The atraumatic, anatomically appropriate procedure of water jet-assisted liposuction available today represents a promising treatment for these patients who generally suffer from severe subjective and objective impairment. Liposuction treatment can bring long-term improvement if the operative technique focuses on lymph vessel preservation. Immunohistologic analyses show minimal evidence of lymph vessel structures in lipoaspirates. The histologic analysis of the aspirates documents a relatively specific removal ("apheresis") of primarily intact lipocytes with low vascular amount.

Electrolysis-needle cauterization of corneal vessels in patients with lipid keratopathy.

PURPOSE: To describe a technique of corneal vessel occlusion by using electrolysis-needle cautery. METHODS: A prospective case series of three patients. RESULTS: Corneal vessels were successfully occluded in all patients. Vessels remained occluded during the first 8 months post-cautery follow up. Two patients needed repeat cautery at 9 and 10 months respectively. Patients found the procedure comfortable. There was no post-operative induced astigmatism. CONCLUSION: The technique of ENC is simple, effective and controlled. This technique compares favorably and may prove to be more versatile than Fine Needle Diathermy in the occlusion of corneal vessels that lead to lipid keratopathy.