Lipedema

Lipedema, also known as lipohyperplasia dolorosa (LiDo), is a painful condition affecting women, causing a disproportionate accumulation of subcutaneous adipose tissue in the extremities. It carries a lower risk of diabetes and cardio-metabolic dysfunctions compared to obesity, but coincident obesity can complicate diagnosis and treatment. This retrospective study included 607 female LiDo patients, ≥18years, stage 1-3, from Germany, the UK, and Spain. Data were collected as part of the standard initial assessment for LiDo patients. Based on waist-to-height-ratio (WHtR), 15.2% of patients were underweight, 45.5% normal weight, 22.1% overweight and 17.3% obese. There was a significant association between WHtR category and age group. Body mass index (BMI) is often overestimated, leading to misdiagnosis of obesity. The use of BMI also affects the recent decision of the German Federal Joint Committee on the reimbursement of liposuction costs by health insurance funds. Patients with BMI of more than 40kg/m2 are excluded from cost coverage, and those with BMI between 35kg/m2 and 40kg/m2 must first receive conservative obesity therapy. In conclusion, the sole use of BMI in lipedema is unreliable and, in contrast to WHtR, leads to inaccurate diagnoses overestimating overweight and obesity.

The purpose of this study was to examine the influence of motor coordination (MC), physical fitness (PF) and physical activity (PA) on the development of subcutaneous adiposity in a sample of children followed longitudinally from 6 to 10 years of age. Participants were 142 girls and 143 boys. Height, weight, and the triceps and subscapular skinfolds were measured annually between the ages of 6 and 10 years. PA was estimated with the Godin–Shephard questionnaire. MC was evaluated with the Körperkoordination Test für Kinder (KTK) test battery, and PF was assessed with four Fitnessgram tests: curl-ups (CU), push-ups (PU), trunk-lifts (TL) and one mile run/walk (MRW). Hierarchical linear modelling with MC, PF items and PA as predictors of the sum of two skinfolds (SKF) was used. The results showed that boys and girls differed significantly in SKF at baseline (girls: 19.7 mm; boys: 16.6 mm). Three PF items (CU, PU and MRW) and MC had a positive influence on SKF. For each unit improvement in CU, PU, MRW and MC, SKF was reduced by 0.06, 0.04, 0.06 and 0.12 mm, respectively. In conclusion, motor coordination, muscular strength and endurance, and aerobic endurance attenuated the accumulation of subcutaneous adipose tissue during childhood.

SummaryMultiple symmetric lipomatosis consists of localised excessive accumulation of subcutaneous adipose tissue, mainly seen in chronic alcoholics. Mediastinal locations with compression syndromes can occur. Neurologic complications are frequent. Multiple metabolic disturbances can be associated. The disease appears to be a triglyceride storage disease.

Backgrounds and aims: Morbid obesity is frequently associated with low grade systemic inflammation, increased macrophage accumulation in adipose tissue (AT), obstructive sleep apnea (OSA) and nonalcoholic fatty liver disease (NAFLD). It has been suggested that chronic intermittent hypoxia (CIH) resulting from OSA could be an independent factor for early stage of NAFLD in addition to other well-recognized factors (dyslipidemia, insulin resistance). Moreover, macrophage accumulation in AT is associated with local hypoxia in fat tissue. We hypothesized that the association between CIH and morbid obesity could exert additional specific deleterious effects both in liver and adipose tissues. Methods: 101 morbidly obese subjects were prospectively recruited and underwent bariatric surgery during which a liver biopsy as well as subcutaneous and omental AT biopsies were obtained. Oxygen desaturation index (ODI) quantified the severity of nocturnal CIH. Results: Liver biopsies analysis demonstrated that NAFLD lesions (ballooning of hepatocytes, lobular inflammation), NAFLD activity score (NAS) and fibrosis were more severe in patients with the highest ODI tertile (p values ≤0.001 for all hepatic lesions). In multivariate analysis, after adjustment for age, obesity and insulin resistance status, CIH remained independently associated with hepatic fibrosis, fibroinflammation and NAS. By contrast, no association was found between CIH, macrophage accumulation and adipocytes size in both subcutaneous and omental adipose tissue. Conclusions: In morbidly obese patients, CIH was strongly associated with more severe liver injuries but did not worsen obesity induced macrophage accumulation in adipose tissue depots.

Subcutaneous Adipose Tissue Accumulation is Associated With an Improved Prognosis in Patients With Hepatocellular Carcinoma.

Abdominal adipose tissue consists of visceral and subcutaneous fat deposits, each with unique metabolic and functional properties. Identifying the characteristics that influence different obesity phenotypes can support targeted prevention and intervention strategies. To identify predictive factors associated with visceral and subcutaneous adipose tissue accumulation. This is a cross-sectional study including adults of both sexes aged ≥20 years under outpatient care in a public healthcare service in Northeast Brazil. Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were measured via ultrasound. Anthropometric, clinical, sociodemographic, and behavioral variables were incorporated into the predictive model. A total of 347 individuals were included. They were median age of 47.0 years (interquartile range: 39.0 to 56.0). Visceral obesity was found in 79.3% of the sample. Adjusted analysis demonstrated that physical inactivity (OR 2.3; 95% CI 1.1-4.7; p = 0.023) and elevated waist circumference (WC) (OR 6.4; 95% CI 2.6-15.8 p < 0.001) were associated with VAT accumulation. Alcohol consumption increased the likelihood of SAT accumulation by 2.2 times (95% CI 1.3-3.7; p = 0.005), while elevated WC raised this likelihood by 4.5 times (95% CI 2.1-9.8; p < 0.001). The VAT/SAT ratio was significantly higher in older adults (OR 5.5; 95%CI 2.0-14.8; p = 0.001), among individuals of Mixed Race and Black, those with lower educational levels (OR 2.4; 95%CI 1.1-5.2; p = 0.028), and in diabetics (OR 2.4; 95%CI 1.2-4.9; p = 0.017). Distinct factors influence visceral and subcutaneous obesity. Sedentary behavior emerged as an independent predictor of visceral obesity, while alcohol consumption was associated with a subcutaneous obesity pattern. Diabetes and sociodemographic factors (older age, non-White race, and lower education) were predictive of an elevated VAT/SAT ratio.

With the goal of evaluating the available literature on the course of Tourette's disorder, we conducted a systematic literature search through electronic databases for pertinent scientific articles in English with a minimum of 20 subjects. We also examined bibliographies of papers identified in this manner for additional sources. We found only 16 articles; most consisted of retrospective reports on treated samples. Overall, the available literature suggests that Tourette's disorder follows a remitting course in a sizeable number of individuals. Little has been published regarding predictors of remission or persistence. More work is needed using longitudinal prospective studies to better define the course and outcome of Tourette's disorder.

Bowel obstruction is a common complication that can affect patients due to different factors, including after a history of gastric bypass surgery. This review was conducted by searching the literature using both PubMed and Google Scholar for articles relating to bowel obstructions. Fifty-six articles were found after applying inclusion and exclusion criteria. Based on the literature search, there are many causes of bowel obstruction, the most common of which include internal hernias, adhesions, and intussusception. Regarding management strategies, surgery is usually the definitive treatment method, but other studies favor a non-surgical approach depending on the specific case. Bowel obstruction is a significant complication that can occur post gastric bypass surgery. This review sheds light on various causes of bowel obstruction, including the possible treatment options, prevention of bowel obstruction that could be achieved by implementing different surgical techniques, the importance of postoperative monitoring, and timely intervention.

Chapter 15 - Fat deposition in birds

Ectopic Adipose Tissue Storage in the Left and the Right Renal Sinus is Asymmetric and Associated With Serum Kidney Injury Molecule-1 and Fibroblast Growth Factor-21 Levels Increase

Orexin modulation of adipose tissue

Guiding Principles for the Care of Older Adults with Multimorbidity: An Approach for Clinicians

Lipedema is secondary to local fat deposition, a disease characterized by the symmetric thickening of lower limbs, mostly occurs in women, especially in adolescence and pregnancy. In its early stage, it could be easily confused with lymphedema. Extensive literature review on primary fat edema in recent years, as well as a summary of the clinical symptoms and signs and diagnosis and treatment of lipedema were conducted, so as to provide a useful reference for clinicians. Key words: Lipedema; Lipidosis

Spinal epidural hematoma (SEH) represents the most frequent entity of acute or chronic spinal bleeding. Based upon pathogenesis, SEH can be classified as idiopathic, spontaneous, and secondary. The idiopathic forms are considered not to be attributed to any specific risk factors. Spontaneous SEH, accounting for 0.3–0.9% of all spinal epidural space occupying lesions, instead is associated with risk factors (such as substantial soft trauma or coagulation abnormalities). The chronic form, as our literature review revealed, is the rarest and its most frequent location is the lumbar spine. The pathophysiology of spontaneous and idiopathic SEH is still under debate: There are only a few reports in literature of chronically evolving SEH with progressively increasing pain and neurological impairment. Magnetic resonance imaging may be inconclusive for differential diagnosis. Here, we present two cases of lumbar chronic SEH with slow, progressive, and persistent lumbar radicular impairment. The first patient reported a minor trauma with slight back contusion and thus was classified as spontaneous SEH. In the second case not even a minor trauma was involved, so we considered it to be idiopathic SEH. In both cases preoperative blood and coagulation tests were normal and we did not find any other or co-factors in the patients’ clinical histories. MR imaging showed uncertain spinal canal obstructing lesions at L3 and L4 level in both cases. Surgical treatment allowed a correct diagnosis and resulted in full clinical and neuroradiological recovery after 1 year follow-up. Our aim is to discuss pathogenesis, clinical and radiological features, differential diagnosis and treatment options, on the background of relevant literature review.

The Subcutaneous Rheumatoid Nodule