Brazilian Society of Speech

Background: Emerging evidence suggests that lipedema may share hormonal, inflammatory, and genetic mechanisms with gynecologic diseases, particularly endometriosis. However, the extent and nature of these interrelationships remain poorly characterized, supporting the need for this scoping review. Objectives: To map and synthesize the available evidence on the clinical, pathophysiological, and epidemiological interrelationships between lipedema in women, endometriosis, and other gynecologic diseases. Methods: Searches were conducted in international and regional health databases, including MEDLINE (PubMed), CINAHL, Scopus, Embase, Web of Science, the Cochrane Library, LILACS/VHL, APA PsycInfo, SciELO, Epistemonikos, and La Referencia, as well as grey literature sources and relevant institutional websites. There were no language restrictions. The search period began in 1940, the year in which lipedema was first described by Allen and Hines. Study selection followed a two-stage process conducted independently by two reviewers, consisting of title and abstract screening followed by full-text review. Data extraction was performed using a pre-developed and peer-reviewed instrument covering participants, concept, context, study methods, and main findings. The review protocol was registered in the Open Science Framework. Results: Twenty-five studies from ten countries were included. Synthesized evidence supports the characterization of lipedema as a systemic condition with metabolic and hormonal dimensions. Key findings include symptom onset linked to reproductive milestones, a high frequency of gynecologic and endocrine comorbidities, and molecular features overlapping with steroid-dependent pathologies. These patterns reflect a recent shift from a predominantly lymphovascular paradigm toward a more integrated endocrinometabolic framework. Conclusions: The findings indicate that lipedema clusters with hormone-sensitive gynecologic and endocrine features across reproductive life stages.

Patients who travel more than 60 min to undergo hemodialysis may experience higher mortality and lower quality of life. The primary aim of this study was to calculate the travel distance between patient city areas and dialysis facility care locations in Brazil, to highlight barriers and need to optimize access to chronic dialysis. We conducted a retrospective cohort study using claims data from the Brazilian Public Health System's database, focusing on kidney replacement therapy (KRT) by hemodialysis. Our study population comprised all patients undergoing hemodialysis in Brazil between January 2023 and December 2023. For patients from different city areas, we calculated the Haversine distance between the patient city area and the dialysis facility. We evaluated 154,788 patients who received hemodialysis funded by the Brazilian Public Health System. Fifty-nine percent of the patients underwent dialysis in the same city area. Overall, patients traveled a median (IQR) distance of 35.9 [19.5 - 64.2] kilometers to the facilities, 48% traveled more than 40 km, with a maximum traveling distance of 353 km. Notably, the median distance traveled was shortest in the Southeast (27.6 km) and longest in the North (84.3 km). The number of patients that traveled more than 40 km was lower in the Southeast (32%) and higher in the North region (77%). The travel distance to the dialysis facility is an important inequity to KRT access in Brazil. In the South and Southeast, where there is a higher dialysis unit density, patients have greater regional availability of dialysis centers, and shorter traveling distances than in the North, Midwest, and Northeast regions.

Objective A novel technique is described for transpalatal hypophysectomy as an option for sellar region surgery using a microscope and/or endoscope. Technique A straight submucosal tunnel (approximately 20 mm in diameter; 40-50 mm long-half the length required by conventional transsphenoidal hypophysectomy) is dissected in favorable alignment with the main tumor axis, providing a direct view that allows the surgeon to operate on large suprasellar tumors, even in cases of extra-axial expansion. Results In a 25-year period, over 50 patients benefited from this surgery. Macroadenomas devoid of extra-axial expansions were totally excised (76.5%), otherwise, partially (23.5%). Forty-nine patients (98%) were extubated soon after surgery. Mean surgery duration was 3 hour 32 minute, with 2 days 6 hour before free feeding was restored. Postoperative hospitalization under neurosurgical care averaged 6 days 6 hour. Currently, patients undergoing the procedure do not require nasal tampons and can eat soft foods soon after recovery from anesthesia. Although two patients (3.9%) presented with oronasal fistulae postoperatively, no episodes of severe hemorrhage occurred during surgery and there were no cases of liquoric fistulae, visual impairment, panhypopituitarism, or severe syndrome of inappropriate antidiuretic hormone secretion. Conclusion The new surgical approach is safe, effective, and well accepted by patients, who reported low levels of discomfort. Postsurgical complications or sequela are currently rare, but further operations should be performed using more appropriate materials, instruments, and equipment to allow comparisons with other techniques.