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Anais Brasileiros de Dermatologia 2019
Topics: Adiposis Dolorosa; Aged; Female; Humans; Lipectomy; Lipoma; Lower Extremity
PubMed: 31090842
DOI: 10.1590/abd1806-4841.20198231 -
Dermatologic Surgery : Official... Dec 2019
Topics: Adiposis Dolorosa; Deoxycholic Acid; Humans; Injections, Intralesional; Male; Middle Aged; Off-Label Use; Treatment Outcome
PubMed: 30789509
DOI: 10.1097/DSS.0000000000001800 -
Arquivos Brasileiros de Cardiologia Nov 2018
Topics: 1-Alkyl-2-acetylglycerophosphocholine Esterase; Adiposis Dolorosa; C-Reactive Protein; Child; Cholesterol, HDL; Dyslipidemias; Female; Humans; Lipomatosis; Lipoproteins; Pain; Rare Diseases
PubMed: 30484519
DOI: 10.5935/abc.20180191 -
The British Journal of Dermatology May 2019Presentations of suspected lower-limb cellulitis are commonly misdiagnoses, resulting in avoidable antibiotic prescribing or hospital admissions. Understanding the...
BACKGROUND
Presentations of suspected lower-limb cellulitis are commonly misdiagnoses, resulting in avoidable antibiotic prescribing or hospital admissions. Understanding the challenges posed in diagnosing cellulitis may help enhance future care.
OBJECTIVES
To examine and map out the challenges and facilitators identified by patients and health professionals in diagnosing lower-limb cellulitis.
METHODS
A scoping systematic review was performed in MEDLINE and Embase in October 2017. Thematic analysis was used to identify key themes. Quantitative data were summarized by narrative synthesis.
RESULTS
Three themes were explored: (i) clinical case reports of misdiagnosis, (ii) service development and (iii) diagnostic aids. Forty-seven different pathologies were misdiagnosed, including seven malignancies. Two different services have been piloted to reduce the misdiagnosis rates of lower-limb cellulitis and save costs. Four studies have looked at biochemical markers, imaging and a scoring tool to aid diagnosis.
CONCLUSIONS
This review highlights the range of alternative pathologies that can be misdiagnosed as cellulitis, and emerging services and diagnostic aids developed to minimize misdiagnosis. Future work should focus on gaining a greater qualitative understanding of the diagnostic challenges from the perspective of patients and clinicians.
Topics: Adiposis Dolorosa; Cellulitis; Diabetic Foot; Diagnosis, Differential; Diagnostic Errors; Gout; Humans; Leg; Skin
PubMed: 30422315
DOI: 10.1111/bjd.17415 -
Pharmacotherapy Dec 2018This systematic review evaluates the safety and efficacy of intravenous (IV) lidocaine for the treatment of acute pain in adult patients. The PubMed database was...
This systematic review evaluates the safety and efficacy of intravenous (IV) lidocaine for the treatment of acute pain in adult patients. The PubMed database was searched for randomized controlled trials, retrospective cohort studies, case series, and case reports evaluating the use of IV lidocaine for the treatment of acute pain in adult patients, published between January 1970 and January 2018. The primary outcome was pain reduction via the Visual Analog Scale, Verbal Rating Scale, or Numeric Rating Scale among patients treated with IV lidocaine and placebo or active controls. Safety outcomes included both nonserious and serious adverse events. A total of 347 titles and abstracts were screened, and after full-text review, 13 studies met the inclusion criteria involving 512 patients. The four active controls studied were IV morphine, IV ketorolac, IV dihydroergotamine (DHE), and IV chlorpromazine (CPZ). The dosing of IV lidocaine varied among studies between a weight-based dose of a 1- to 2-mg/kg bolus, a fixed-bolus dose of 50-100 mg, and a 1-mg/kg/hour continuous infusion. Monitoring of serum lidocaine concentrations was not done routinely. Intravenous lidocaine had superior efficacy to morphine for renal colic and critical limb ischemia, superior efficacy to DHE for acute migraine, and equivalent efficacy to ketorolac for acute radicular lower back pain. However, lidocaine was less effective than CPZ for the treatment of acute migraine. The most common adverse event reported among all studies were neurologic effects such as altered mental status and slurred speech. Due to the inconsistency in dosing, length of administration, and lack of serum monitoring, the absolute safety of IV lidocaine for acute pain is unknown. Larger, prospective studies are needed before the routine use of IV lidocaine can be recommended for all types of acute pain.
Topics: Acute Pain; Anesthetics, Local; Gastrointestinal Diseases; Humans; Infusions, Intravenous; Lidocaine; Pain Measurement; Randomized Controlled Trials as Topic; Retrospective Studies
PubMed: 30303542
DOI: 10.1002/phar.2189 -
Clinical Obesity Dec 2018Lipoedema is painful nodular subcutaneous adipose tissue (SAT) on legs and arms of women sparing the trunk. People with Dercum disease (DD) have painful SAT masses....
Lipoedema is painful nodular subcutaneous adipose tissue (SAT) on legs and arms of women sparing the trunk. People with Dercum disease (DD) have painful SAT masses. Lipoedema and DD fat resists loss by diet and exercise. Treatments other than surgery are needed. Six women with lipoedema and one with DD underwent twelve 90-min sessions over 4 weeks. Body composition by dual X-ray absorptiometry scan, leg volume, weight, pain, bioimpedance, tissue size by caliper and ultrasound were analysed before and after SAT therapy by paired t-tests. There was a significant decrease from baseline to end of treatment in weight, 87.6 ± 21 to 86.1 ± 20.5 kg (P = 0.03), leg fat mass 17.8 ± 7.7 to 17.4 ± 7.6 kg (P = 0.008), total leg volume 12.9 ± 4 to 12 ± 3.5 L (P = 0.007), six of 20 calliper sites and tissue oedema. Pain scores did not change significantly. By ultrasound, six women had 22 hyperechoic masses in leg fat that resolved after treatment; five women developed seven new masses. Fascia improved by ultrasound after treatment. SAT therapy reduced amount and structure of fat in women with lipoedema and Dercum disease; studies are needed to compare SAT therapy to other therapies.
Topics: Absorptiometry, Photon; Adiposis Dolorosa; Adult; Body Composition; Body Weight; Female; Humans; Lipedema; Middle Aged; Pain; Prospective Studies; Subcutaneous Fat; Ultrasonography
PubMed: 30248251
DOI: 10.1111/cob.12281 -
BMJ Case Reports Mar 2018We present a case of a 39-year-old man who presented with chronic bilateral upper extremity pain associated with innumerable angiomyolipomas that developed 5 years...
We present a case of a 39-year-old man who presented with chronic bilateral upper extremity pain associated with innumerable angiomyolipomas that developed 5 years after a motor vehicle accident involving his upper extremities. Our case notes the rare nature of painful adipose tissue deposits and the diagnostic challenges.
Topics: Accidents, Traffic; Adipose Tissue; Adiposis Dolorosa; Adult; Amitriptyline; Analgesics, Non-Narcotic; Angiomyolipoma; Baclofen; Chronic Pain; Clonidine; Diagnosis, Differential; Humans; Ibuprofen; Male; Muscle Relaxants, Central; Tomography, X-Ray Computed; Upper Extremity
PubMed: 29592996
DOI: 10.1136/bcr-2017-223869 -
Journal Der Deutschen Dermatologischen... Mar 2018Lipomatoses are benign proliferations of adipose tissue, often with typical distribution patterns, which usually occur without clear causes. In contrast to circumscribed... (Review)
Review
Lipomatoses are benign proliferations of adipose tissue, often with typical distribution patterns, which usually occur without clear causes. In contrast to circumscribed lipomas, they develop diffusely and symmetrically and are not surrounded by a fibrous pseudocapsule. The most common form is benign symmetric lipomatosis (BSL; Launois-Bensaude syndrome), of which four types are distinguished based on the distribution pattern of hyperplastic adipose tissue. The etiology and pathogenesis of the disease are still largely unknown, although some forms appear to have a hereditary basis or to be associated with increased alcohol consumption. In some cases, mitochondrial dysfunctions have been detected. Lipomatoses may be solitary, but may also be associated with other symptoms or illnesses (comorbidity). Effective drug therapies are not known, but surgical procedures can alleviate the symptoms. Lipomatosis dolorosa, which can be distinguished from BSL, occurs predominantly in middle-aged women and is characterized by proliferation of adipose tissue and severe pain in the affected areas. Various differential diagnoses and concomitant illnesses need to be considered, in particular depression. There are no evidence-based recommendations for therapy. Repetitive lidocaine infusions can achieve temporary improvement. Recurrence after surgical intervention is not uncommon, but long-term success is also possible.
Topics: Adipose Tissue; Adiposis Dolorosa; Diagnosis, Differential; Female; Humans; Lidocaine; Lipectomy; Lipomatosis; Male; Middle Aged
PubMed: 29431910
DOI: 10.1111/ddg.13460 -
The American Journal of Medicine Jun 2018Dercum disease is a rare disorder of painful subcutaneous adipose tissue masses typically presenting as a constellation of signs and symptoms affecting most organs,...
BACKGROUND
Dercum disease is a rare disorder of painful subcutaneous adipose tissue masses typically presenting as a constellation of signs and symptoms affecting most organs, including slow lymphatic flow and fatty liver.
METHOD
The University of Arizona Institutional Review Board considered this report exempt after patient consent. Multislice, multisequence magnetic resonance imaging (MRI) of the abdomen and pelvis was performed prior to and after d-amphetamine, with and without intravenous gadolinium.
RESULTS
Initial MRI demonstrated hepatic steatosis in Case 1; Case 2 had 2-subcentimeter lipid foci within the liver. Initiation of 10-20 mg d-amphetamine decreased liver lipid deposition from 16% to 4% in Case 1 and resolved fat deposits in Case 2 after ~1 year.
CONCLUSION
There is a dire need for novel treatment options for nonalcoholic fatty liver disease to prevent progression to cirrhosis. Reduction of liver fat by d-amphetamine suggests a potential therapeutic role in nonalcoholic fatty liver disease.
Topics: Adiposis Dolorosa; Amphetamine; Dose-Response Relationship, Drug; Drug Administration Schedule; Fatty Liver; Female; Humans; Liver; Male; Middle Aged
PubMed: 29355511
DOI: 10.1016/j.amjmed.2017.12.026 -
Clinics in Dermatology 2018The cutaneous manifestations of obesity and the associated metabolic syndrome (MetS) may present with a wide variety of cutaneous findings, including acanthosis... (Review)
Review
The cutaneous manifestations of obesity and the associated metabolic syndrome (MetS) may present with a wide variety of cutaneous findings, including acanthosis nigricans, acrochordon, cellulitis, psoriasis, hidradenitis suppurativa, acne, and hirsutism. Being aware of such clinical signs and the underlying systemic disorders may facilitate earlier diagnoses, thereby permitting earlier of therapy initiation and prevention of long-term sequelae. In this process, dermatologists are key figures in the early detection of MetS and its clinical manifestations.
Topics: Acanthosis Nigricans; Adiposis Dolorosa; Cellulite; Dermatitis, Seborrheic; Gout; Hidradenitis Suppurativa; Hirsutism; Humans; Hyperandrogenism; Lichen Planus; Metabolic Syndrome; Obesity; Psoriasis; Skin Diseases; Xanthomatosis
PubMed: 29241757
DOI: 10.1016/j.clindermatol.2017.09.014