Search PubMed⌕ Search

Biomedical subjects

H Brorson

Publications and source records attributed to H Brorson.

9 recordsLinked to original sources
PubMed2000

Liposuction gives complete reduction of chronic large arm lymphedema after breast cancer.

About one-third of all women treated for breast cancer develop arm lymphedema. In addition to the worry of the cancer itself, the swollen and heavy arm is both a physical and a psychosocial handicap for the patients. Previous surgical and conservative treatments have not always given satisfactory and permanent results, conceivably because lymphedema causes hypertrophy of the subcutaneous adipose tissue. From this point of view, liposuction (LS) combined with Controlled Compression Therapy (CCT) is an interesting approach, as the hypertrophied adipose tissue is effectively removed and the outcome sustained by wearing a compression garment. Pre- and postoperative arm edema volumes were measured using the water displacement technique. Skin blood flow was recorded using Laser Doppler imaging. Lymph transport in the arm was assessed by indirect lymphoscintigraphy. LS + CCT reduced the arm edema volume completely, compared with a 50% decrease following CCT alone. The use of a compression garment after liposuction is necessary in order to maintain the normalized arm volume. LS + CCT did not affect the already impaired lymph transport; it merely increased skin microcirculation. A reduced incidence of cellulitis was noted.

Adipose Tissue↗
PubMed1998

Liposuction in Dercum's disease: impact on haemostatic factors associated with cardiovascular disease and insulin sensitivity.

OBJECTIVE: To study the impact of adipose tissue removal by liposuction on factors associated with increased risk of cardiovascular atherosclerotic disease within the coagulation and fibrinolytic system and glucose metabolism. DESIGN, SETTING AND SUBJECTS: Liposuction was performed in 53 patients with Dercum's disease. The levels of fibrinogen, von Willebrand factor antigen (VWF:Ag) and plasminogen activator inhibitor type 1 activity (PAI-1) were measured preoperatively, and 2 weeks, 4 weeks and 3 months postoperatively. In a subsample of 10 patients, insulin sensitivity was determined before and 2-4 weeks after surgery using the 2-h euglycaemic hyperinsulinaemic clamp technique. The study was performed as a single-centre study. MAIN OUTCOME MEASURE: Fibrinogen, PAI-1 and VWF:Ag levels, and glucose uptake before and after removal of adipose tissue. RESULTS: Weight reduction was sustained throughout the follow-up period with a mean decrease from 90.7 to 86.6 kg (P < 0.0001). There was a slight increase in levels of coagulation factors 2 and 4 weeks postoperatively, probably in reaction to the surgical trauma. After 3 months the values had returned to preoperative levels except for PAI-1, which still showed a slight increase (P < 0.05). In the subsample of 10 patients, glucose uptake was improved (P < 0.05) from a short-term perspective after surgery. CONCLUSION: Surgical removal of adipose tissue, without change in lifestyle, does not seem to improve the levels of coagulation and fibrinolytic factors associated with cardiovascular atherosclerotic disease, whereas glucose takeup may be facilitated and insulin sensitivity increases from a short-term perspective.

Adiposis Dolorosa↗
PubMed1998

Liposuction combined with controlled compression therapy reduces arm lymphedema more effectively than controlled compression therapy alone.

Arm lymphedema after breast cancer therapy has been treated with various forms of conservative and surgical treatment during recent years. The clinical results usually have been modest or, in some instances, even disappointing. In a previous series of patients treated with the new liposuction technique combined with controlled compression therapy, we found, however, an overall edema reduction of 106 percent after 1 year. The purpose of this study was both to investigate how much the surgical procedure contributes to the outcome and to clarify the importance of controlled compression therapy. Twenty-eight patients were, therefore, prospectively matched into two groups. One group received liposuction combined with controlled compression therapy, and one group received the therapy alone. Additionally, the therapy group was compared with our complete group of patients treated thus far with liposuction combined with therapy (n = 30). The prospective study using matched pairs (n = 14) showed that liposuction combined with controlled compression therapy is significantly more effective than the therapy alone (p < 0.0001), with a mean difference of about 1000 ml during the entire 1-year observation period. The beneficial effect of liposuction was confirmed by the comparison between the controlled compression therapy group and our complete group of patients treated with liposuction combined with the therapy, as the edema reduction figures after 1 year were 47 percent and 104 percent, respectively (p < 0.0001). In six patients who had surgery and a complete reduction of the edema, the compression garments were removed for 1 week, 1 year postoperatively. A marked increase in the arm volume was observed, which was immediately remedied by reapplying the garments. We conclude that liposuction combined with controlled compression therapy reduces arm lymphedema more efficiently than the therapy alone. Continued use of compression garments is, however, important to maintain the primary surgical outcome.

Adult↗
PubMed1998

Liposuction reduces arm lymphedema without significantly altering the already impaired lymph transport.

In a prospective study, 20 patients with arm lymphedema after breast cancer treatment underwent liposuction combined with Controlled Compression Therapy (CCT) or CCT alone. Indirect lymphoscintigraphy (ILS) was used to study lymph kinetics before and after intervention. Lymphoscintigrams from the contralateral, non-edematous arm were characterized by prompt transit of the radiotracer (99mTc-albumin nanocolloid) to the axillary nodes, whereas tracer accumulation as dermal backflow characterized tracer transport in the lymphedematous arm. Neither liposuction with CCT nor CCT alone, changed this ILS profile. Liposuction combined with CCT reduced arm edema volume by (median) 115% (range 92-179%), whereas CCT alone decreased arm edema volume by only 54% (range 7-81%) (p = 0.008). Because liposuction in conjunction with CCT was not associated with further impairment to an already restricted lymph transport, we recommend this therapy (liposuction with external compression) for chronic arm lymphedema, as it reduces edema volume safely, rapidly, and more efficiently than external compression alone. Moreover, it does not worsen an already impaired lymph transport in the lymphedematous upper extremity.

Adult↗
PubMed1997

Complete reduction of lymphoedema of the arm by liposuction after breast cancer.

The incidence of lymphoedema of the arm after mastectomy ranges between 8% and 38%, and it is an appreciable problem from both functional and social aspects. Conservative and previous surgical regimens have not been completely successful. In the light of these experiences, liposuction clearly constitutes an interesting new surgical approach, which is potentially capable of effecting predictable and reliable improvements in patients with lymphoedema. Twenty eight women with lymphoedema of the arm after breast cancer were consecutively treated by liposuction. Limb compression with a compression garment was instituted immediately after operation. All patients had been given radiotherapy after the operation for breast cancer. Mean preoperative volume of oedema was 1845 ml (range 570-3915), and mean volume of aspirate was 2250 ml (range 1000-3850); volume of aspirate correlated linearly with the volume of preoperative oedema. There were no major surgical complications, but blood transfusion was necessary in eight patients whose volume of aspirate exceeded 2000 ml. After 12 months (n = 24), an average reduction in volume of oedema of 106% was found. Such a normalisation can be expected in patients with oedema that amounts to about 2500 ml. Although the oedema cannot be completely removed in more severe cases, substantial reduction is beneficial from both functional and cosmetic aspects. We conclude that liposuction is safe and effective for reducing lymphoedema of the arm after operations for breast cancer. In a one-stage procedure, oedematous and hypertrophic fat tissue can be removed with an excellent clinical outcome.

Aged↗
PubMed1997

Skin blood flow of the lymphedematous arm before and after liposuction.

Twelve women with arm lymphedema after breast cancer treatment underwent liposuction followed by external compression with a garment-sleeve. Arm volumes were measured using water displacement technique, and skin blood flow was recorded with laser Doppler imaging (LDI). Data was collected before and after (3 and 12 months) liposuction. Episodes of cellulitis were also recorded. Whereas previous investigations have indicated increased total blood flow in the lymphedematous arm, we found reduced superficial skin blood flow preoperatively. Liposuction produced a median edema reduction of 87% and 97% after 3 and 12 months respectively. Both in the forearm and in the upper arm, skin blood flow increased significantly after liposuction and values were similar to those of the non-edematous (control) arm. Along with increased skin blood flow, the frequency of cellulitis also decreased. Liposuction effectively reduces arm lymphedema after breast cancer treatment, and also lowers the incidence of arm cellulitis. Improved local skin blood flow may be an important contributing factor to the reduced episodes of arm infection.

Aged↗
PubMed1989

Normal pinch strength.

The normal pinch strength was determined with the Mannerfelt-Ulrich intrinsic meter in 90 men and women aged 21-65 years. The pinch strength decreased with increasing age. The ratio dominant/nondominant hand was 1.12, 0.13 (mean, SD) for both men and women. The ratio would be useful in evaluating pinch strength under pathologic conditions.

Adult↗