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Lipedema is a disease with unknown etiology presenting as bilateral and symmetric enlargement of the lower extremities due to subcutaneous deposition of the adipose tissue. Here we describe the histopathological features of the lipedema tissue and nonaffected adipose tissue obtained from a typical patient with severe lipedema. Immunohistochemical analyses indicated degenerative and regenerative changes of the lipedema tissue, characterized by crown-like structures (necrotizing adipocytes surrounded by infiltrating CD68+ macrophages; a feature commonly seen in obese adipose tissue) and proliferation of adipose-derived stem/progenitor/stromal cells (Ki67+CD34+ cells), respectively. These findings suggested increased adipogenesis in the lipedema tissue, which may further lead to hypoxia similar to that seen in obesity, resulting in adipocyte necrosis and macrophage recruitment. The confinement to the lower extremities and the difference from systemic obesity warrants further elucidation in future studies.

Lipoedema is an infrequently recognized disorder in women. Lipoedema is characterized by bilateral enlargement of the legs due to abnormal depositions of subcutaneous fat associated with often mild oedema. There is substantial variability in disease severity. The diagnosis should be made as early as possible to prevent complications of the disorder, which is associated with increasing functional and cosmetic morbidity. This review describes clinical manifestations, pathogenesis, technical investigations, management and therapies of lipoedema, with the aim of optimizing management and care of patients with lipoedema.

Lipoedema is an infrequently recognized disorder in women. Lipoedema is characterized by bilateral enlargement of the legs due to abnormal depositions of subcutaneous fat associated with often mild oedema. There is substantial variability in disease severity. The diagnosis should be made as early as possible to prevent complications of the disorder, which is associated with increasing functional and cosmetic morbidity. This review describes clinical manifestations, pathogenesis, technical investigations, management and therapies of lipoedema, with the aim of optimizing management and care of patients with lipoedema.

Lymphedema results from impaired lymphatic transport with increased limb volume. Primary and secondary forms can be distinguished. Secondary lymphedema of the upper limb is the most frequent in France. A 2-cm difference on any segment of the limb confirms the diagnosis of lymphedema. Calculated lymphedema volume using the formula for a truncated cone is required to assess the efficacy of treatment and to monitor follow-up. Primary lymphedema is sporadic but rarely familial. Lymphoscintigraphy is useful in the primary form to evaluate precisely lymphatic function of the two limbs. Erysipelas is the main complication,but psychological or functional discomfort may occur throughout the course of lymphedema. Lipedema is the main differential diagnosis, defined as an abnormal accumulation of fat from hip to ankle and occurs almost exclusively in obese women.

We report a familial Sotos syndrome in two children, boy and girl, aged 17 and 8 years, and in their 44 year old mother, who displayed normal intelligence at adult age, but suffered from insulin dependent diabetes mellitus, bronchial asthma, and severe lipedema. The underlying missense mutation, C2175S, occurred in a conserved segment of the NSD1 gene. Our findings confirm that familial cases of SS are more likely to carry missense mutations. This case report may prove useful to avoid underestimation of the recurrence rate of SS, and to demonstrate that the developmental delay may normalize, enabling an independent life and having an own family.

Einleitung: Bei einem Lipödem liegt eine anlagebedingte Fettgewebsvermehrung vor, bei der es zu einer symmetrischen Verdickung der Extremitäten kommt. Klinisch ist für das Lipödem eine Druckschmerzhaftigkeit charakteristisch. Bei länger bestehendem Lipödem kann man beobachten, dass bei einem Teil der Patientinnen zusätzliche Beschwerden auftreten. Die betroffenen Frauen erleben auf Grund der massiven Schwellungen dann, neben einem ausgeprägten Spannungs- und Schweregefühl der Beine, physische und psychische Belastungen, wodurch Sportangebote häufig nicht wahrgenommen werden und die soziale Interaktionen eingeschränkt ist. Studiendesign: Die vorliegende prospektive randomisierte Studie wurde zur Evaluation der Wirksamkeit eines vibrationsgestützten Krafttrainings mit dem Galileo-System im Vergleich zu einem herkömmlichen Training zur Aktivierung der Beinmuskelpumpe bei Patientinnen mit Lipödem durchgeführt. Die Probanden beider Gruppen erhielten 12 Anwendungen in einem Zeitraum von sechs Wochen. Zur Beurteilung des Therapieverlaufs wurde die Druckschmerzschwelle im Beinbereich mithilfe der visuellen Analogskala (VAS) und der Dolorimetrie an definierten Messpunkten erfasst. Nebenzielkriterien waren die Volumenreduktion und die Verbesserung funktioneller Parameter sowie der Lebensqualität. Die Erhebung der Outcomeparameter erfolgte vor der Intervention (U1), vor der letzen Trainingseinheit (U2) und 6 Wochen nach Therapieende (U3). Ergebnisse: Das Vibrationstraining (n=27) und die Venengymnastik (n=17) zeigten bezüglich der Schmerzlinderung signifikante Verbesserungen im Therapieverlauf. Die Druckschmerzschwelle konnte erhöht werden. Die Auswertung der Fragebögen zu Hämatomneigung und Schmerzempfinden ergab in der Interventionsgruppe eine signifikante Beschwerdelinderung im Therapieverlauf. In beiden Gruppen konnte eine subjektive Verbesserung der Mobilität und ein positiver Einfluss auf die Lebensstiländerung verzeichnet werden. Die im Gehtest beurteilte Ausdauerleistung verbesserte sich ebenfalls. Diskussion: Es konnte gezeigt werden, dass sowohl mit herkömmlicher Krankengymnastik als auch durch ein gerätegestütztes Vibrationstraining zwei wesentliche Symptome des Lipödems, nämlich Druckschmerzhaftigkeit und Hämatomneigung, positiv beeinflusst werden können. Somit lässt sich die Notwendigkeit unterstreichen, dass eine Therapie des Lipödems durch eine Bewegungstherapie ergänzt werden sollte.

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.

A lipedema is characterized by the bilateral and symmetrical en-largement of the lower limbs without the involvement of the feet and a negative Stemmer’s sign; it may cause skin hypothermia, alteration in the plantar support, and hyperalgesia. The current study aims to report a rare type of ulcerative lesion in a patient with lipolymphedema treated with a damp low-stretch bandage. The patient is a female, age 50, with a family history of lipedema, and who has suffered many episodes of erysipelas in the lower left limb for approximately 20 years. For over five years ulcers which are difficult to heal have appeared. She was treated with a damp low-stretch bandage and the healing of the wound has shown significant improvement. Ulcerative lesions are rare in lipolymphedema; however, their occurrence is associated with difficulties in healing.

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.

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.

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.

Tissue proliferation can appear with or without gigantism and can be generalized or localized. It is not unusual for tissue proliferation to be mistaken for lymphedema.

Lipoedema is a disease characterised by an abnormal, circumscribed accumulation of subcutaneous fat, mainly in the lower extremities, in combination with oedema. This results in an obvious disproportion between the upper and lower half of the body, as well as pain (Figure 1). Although lipoedema was first described in 1940 by Allen and Hines in the United States of America, the discussion still continues today as to whether this disease really is an entity, with some clinicians even doubting that it exists. In the 1940s it was described as a symmetrical subcutaneous deposition of fat in the buttocks and lower legs, together with an accumulation of fluid that begins almost imperceptibly, progressing gradually. Lipoedema was often associated with weight gain and accentuated by orthostatic activity.

Dear Patient, although much has been published about lipoedema during the past decade, this disease continues to be relatively unknown; it is still overlooked and/or mistaken for obesity (overweight) or lymphoedema by many doctors. As a result, the information and therapy instructions given to afflicted individuals is often either incorrect or only partially covers the aspects of this disease. This brochure was designed to help you learn more about lipoedema and to enable you to evaluate and get the most benefit from available therapeutic options. All important information is presented concisely in the form of questions and answers. Please keep in mind that many aspects of this disease remain unclear to date. As with most other diseases (e.g. diabetes, high blood pressure, varicosis, rheumatism, etc.), the symptoms and discomforts are fairly well known, but the underlying causes are not. However, our insights have become much more extensive in the past few years. Since crucial progress has been made in recent years especially with regard to the treatment of lipoedema, there are some very effective measures now available that have a positive impact on all aspects of this chronic disease. This allows you to live a largely „normal“ life without major limitations, at a quality level that until recently was unthinkable. Meanwhile, a wealth of information has become accessible through the internet, where you can get help from specialised doctors, physiotherapists, and other patients afflicted by this disease. There is no longer reason for despair. With the compliments of BSN-JOBST® GmbH

Lipoedema is a disease of women, characterised by a circumscribed accumulation of subcutaneous fat, mainly in the legs, with oedema, hematomas, and pain from tension and pressure. Up to now, only conservative treatment with manual lymphatic drainage and compression was possible. Nowadays surgical therapy with liposuction under tumescent local anaesthesia can not only improve morphology but can also reduce complaints. When performed with modern techniques by experienced surgeons, liposuction is very safe and highly effective. The combination of conservative and surgical methods can considerably improve quality of life.

Lymphoedema is a debilitating, progressive and incurable pathological condition caused by a chronic imbalance between the production and transport of lymph within the lymphatic system. There are many reasons for this damage or disruption to the lymphatic system. Lymphoedema results in significant physical and psychological morbidity. Approximately 140–250 million people worldwide are affected by this condition, mostly in developing countries as a result of lymphatic filariasis, a parasitic infection transmitted by mosquitoes. In the majority of cases, treatment is non-curative, complex and requires a multidisciplinary clinical approach. Surgery takes place as a last resort when conservative treatment has proven ineffective to restore function, reduce comorbidity or the frequency of erysipelas attacks.