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"Foeldi, Etelka"

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Lipedema

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Foeldi, E. (2008). Facts about lipoedema and lymph/lipoedema. Lymph-Lipoedema Treatment in Its Different Approaches, 36–40.

Knowledge of both the morphology/ pathomorphology and physiology/pathophysiology of adipose tissue is limited and the behaviour of fat tissue has not been widely researched. Changes in adipose tissue (hyperplasia, hyper trophy and atrophy) are defined differently and, as a consequence, diagnostic failures frequently occur. Figure 1 shows the complicated regulatory mechanisms which are responsible for lipolysis and lipogenesis. Even if body weight is normal, appearance depends on the distribution of subcutaneous adipose tissue (Figure 2). The amount of fat we carry and how we look are, in part, subject to fashion. What was still sexy several decades ago, a bigger waist and more on the hips, no longer corresponds to how we see perfection today. Figure 2 shows the different ideals of beauty — ‘Wonderwoman’, for example, where you can detect as little fat as possible. Recently, there has been a mania for slimness. In order to comply with the current trend in fashion, young girls starve or undergo surgical procedures to have the typical female fatty tissue removed.
Foeldi, E. (2009). Facts about lipoedema and lymph/lipoedema. Lymph/Lipoedema Treatment in Its Different Approaches. Jobst® Scientific Symposium 2008.

Knowledge of both the morphology/ pathomorphology and physiology/pathophysiology of adipose tissue is limited and the behaviour of fat tissue has not been widely researched. Changes in adipose tissue (hyperplasia, hypertrophy and atrophy) are defined differently and, as a consequence, diagnostic failures frequently occur. Figure 1 shows the complicated regulatory mechanisms which are responsible for lipolysis and lipogenesis. Even if body weight is normal, appearance depends on the distribution of subcutaneous adipose tissue (Figure 2) . The amount of fat we carry and how we look are, in part, subject to fashion. What was still sexy several decades ago, a bigger waist and more on the hips, no longer corresponds to how we see perfection today. Figure 2 shows the different ideals of beauty — ‘Wonderwoman’, for example, where you can detect as little fat as possible. Recently, there has been a mania for slimness. In order to comply with the current trend in fashion, young girls starve or undergo surgical procedures to have the typical female fatty tissue removed.
Foeldi, M., Foeldi, E., & Kubik, S. (Eds.). (2004). Textbook of lymphology: for physicians and lymphedema therapists. Klose Training & Consulting Llc.
Foeldi, E., & Foeldi, M. (2010). Local Diseases of the Subcutaneous Adipose Tissue. In M. Földi & P. D. Asmussen (Eds.), Lehrbuch Lymphologie für Ärzte, Physiotherapeuten und Masseure/med. Bademeister: mit dem Plus im Web ; Zugangscode im Buch (7., überarb. Aufl). Elsevier, Urban & Fischer.
Foeldi, E., & Foeldi, M. (2002). Das Lipödem. In M. Földi & P. D. Asmussen (Eds.), Lehrbuch der Lymphologie: für Mediziner, Masseure und Physiotherapeuten (5., völlig überarb. Aufl). Urban & Fischer.
Lohrmann, C., Foeldi, E., & Langer, M. (2009). MR imaging of the lymphatic system in patients with lipedema and lipo-lymphedema. Microvascular Research, 77(3), 335–339. https://doi.org/10.1016/j.mvr.2009.01.005

OBJECTIVE: To assess for the first time the morphology of the lymphatic system in patients with lipedema and lipo-lymphedema of the lower extremities by MR lymphangiography. MATERIALS AND METHODS: 26 lower extremities in 13 consecutive patients (5 lipedema, 8 lipo-lymphedema) were examined by MR lymphangiography. 18 mL of gadoteridol and 1 mL of mepivacainhydrochloride 1% were subdivided into 10 portions and injected intracutaneously in the forefoot. MR imaging was performed with a 1.5-T system equipped with high-performance gradients. For MR lymphangiography, a 3D-spoiled gradient-echo sequence was used. For evaluation of the lymphedema a heavily T2-weighted 3D-TSE sequence was performed. RESULTS: In all 16 lower extremities (100%) with lipo-lymphedema, high signal intensity areas in the epifascial region could be detected on the 3D-TSE sequence. In the 16 examined lower extremities with lipo-lymphedema, 8 lower legs and 3 upper legs demonstrated enlarged lymphatic vessels up to a diameter of 3 mm. In two lower legs with lipo-lymphedema, an area of dermal back-flow was seen, indicating lymphatic outflow obstruction. In the 10 examined lower extremities with clinically pure lipedema, 4 lower legs and 2 upper legs demonstrated enlarged lymphatic vessels up to a diameter of 2 mm, indicating a subclinical status of lymphedema. In all examined extremities, the inguinal lymph nodes demonstrated a contrast material enhancement in the first image acquisition 15 min after injection. CONCLUSION: MR lymphangiography is a safe and accurate minimal-invasive imaging modality for the evaluation of the lymphatic circulation in patients with lipedema and lipo-lymphedema of the lower extremities. If the extent of lymphatic involvement is unclear at the initial clinical examination or requires a better definition for optimal therapeutic planning, MR lymphangiography is able to identify the anatomic and physiological derangements and to establish an objective baseline.

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Brorson, H., Foeldi, E., Freccero, C., Schmeller, Wilfried, & Voesten, H. (2009). Appendix: Questions and Answers. Lymph/Lipoedema Treatment in Its Different Approaches. Jobst® Scientific Symposium 2008.

The challenges of providing effective treatment for patients with lymphoedema-related disorders have never been more prominent. Conservative management of lymphoedema remains of central importance, however, there is increasing evidence that other therapies, such as surgical approaches, may have an important part to play in the arena of treatment. The findings from these proceedings highlight the potential role that surgical approaches, including liposuction, can have in transforming the lives of patients. Conservative approaches, while effective in many patients, do not provide a solution for some of the complex issues patients face, nor do they always provide sustained results even after periods of expensive, intensive treatment. Relatively little attention has been placed on the impact that lymphatic conditions have on the lives of patients and their families. However, research is beginning to show that patients’ health-related quality of life is significantly affected and that previously dismissed symptoms, such as pain, are a feature of the condition. Lymphoedema and lipoedema are both likely to have a deleterious effect on the body image of patients who live day-to-day with distorted limbs. Treatments such as liposuction have the potential to reverse some of the crippling effects of these disorders on the psychosocial health of patients. The indications from these proceedings are that this is an important and encouraging area of practice that must be considered as part of the armoury of treatment. Liposuction has often been viewed negatively by the lymphoedema community, who have been sceptical about its value and concerned for its safety. This document shows that when it is used appropriately, by well trained surgeons, it can be very effective. In fact, the area of liposuction now has a growing evidence base that rivals many of the other conservative areas of lymphoedema management. Management of lymphatic conditions demands that the professional groups begin to work together in a more collaborative way in order to develop treatments that really address the growing number of patients with these types of conditions.
Wienert, V., Foeldi, E., Junger, M., Partsch, H., Rabe, E., Rapprich, S., Schmeller, W., Stenger, D., Stucker, M., & Waldermann, F. (2009). Lipodem Leitlinie der Deutschen Gesellschaft fur Phlebologie. Phlebologie, 38, 164–167.

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