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Effect of a multidisciplinary program of weight reduction on endothelial functions in obese women.

Obesity is associated with an increased risk of developing atherosclerosis and atherosclerotic lesions are essentially an inflammatory response. The aim of this study was to evaluate the effect of a medically supervised, multidisciplinary weight loss program on endothelial functions and circulating levels of proinflammatory cytokines in obese women. Twenty healthy pre-menopausal obese women and 20 age-matched normal weight women were studied. Endothelial functions were assessed by evaluating the response of blood pressure and platelet aggregation to an intravenous bolus of L-arginine (3 g), the natural precursor of nitric oxide. In obese women, the vascular and rheological responses to L-arginine were significantly lower (p < 0.05) at baseline, as compared with non-obese women, indicating endothelial dysfunction; on the contrary, basal concentrations of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) were significantly higher (p < 0.01). After one year of a multidisciplinary program of weight reduction consisting of diet, exercise and liposuction surgery, all obese women lost at least 10% of their original weight (10.5 +/- 1.7 kg, range 7.9-13.9 kg). Compared with baseline, sustained weight loss was associated with reduction of cytokine (p < 0.01) concentrations and with improvement of vascular responses to L-arginine. In conclusion, a multidisciplinary approach aimed at inducing a sustained reduction of body weight in obese women is feasible and is associated with improvement of endothelial functions and reduction of circulating proinflammatory cytokine concentrations.

Adult↗

Endoscopic axillary lymphadenectomy without prior liposuction. Development of a technique and initial experience.

BACKGROUND: A new technique of endoscopic axillary lymphadenectomy without prior liposuction was developed by our group. METHOD: A total of 33 patients with early stage breast cancer were treated by breast-conserving therapy and endoscopic axillary lymphadenectomy. RESULTS: The median duration of the operation was 74.9 min (range, 30-130). Operation time was significantly shorter for the last 17 patients (p < 0.05) than for the first 16 patients. There were no intraoperative complications. The median number of removed lymph nodes was 14.5 (range, 2-28). Postoperatively three patients developed a seroma, one of which required evacuation. At postoperative day 5, arm mobility was unrestricted in 26 patients (78.7%); nine patients (27.2%) reported a loss of sensation in the outer side of the upper arm related to dermatome C5. One patient developed a temporary alar scapula, and one patient developed an axillary abscess 9 weeks after axillary lymphadenectomy during radiation therapy. After a median follow-up of 4.6 months seven patients reported persistent impairment of sensation, but all patients had regained full shoulder mobility. CONCLUSION: Endoscopic axillary lymphadenectomy can be done safely without prior liposuction.

Adult↗

[Esthetic facial surgery].

In the last few years, aesthetic facial surgery--especially soft-tissue surgery--has received increasing attention, not only from the medical profession but also particularly from the media. This is due, in part, to the growing level of general acceptance of the formerly stigmatized issue of aesthetic surgery, and in part to increasing patient expectations. Moreover, the introduction of less invasive procedures with outstanding long-term results have brought about a considerable change in aesthetic surgery. A comprehensive account of face lifting, forehead lifting, brow lifting, blepharoplasty, cervical liposuction and adjuvant techniques of skin rejuvenation will be given and discussed.

Adult↗

[Plastic reconstructive operations after weight loss through gastric banding].

The number of patients who desire reconstructive surgery after a huge weight loss through gastric banding is increasing. From 1999 to 2001, 40 reconstructive operations were performed on 25 patients after an average decrease in weight of 58 kg. Six months later, a follow-up examination was done. A questionnaire was handed out and the aesthetic results were judged by five independent plastic surgeons. The department of psychology judged the patient's attitude towards their body, the presentation of their body for attractiveness, satisfaction with life, anxiety and depression, and changes in experience and behavior. The results showed a discrepancy between the subjective satisfaction of the patients and the judgment of the plastic surgeons; the preference for long scars instead of remaining surplus tissue, the necessity of a strict indication for transplantation of one's own tissue, the importance of detailed preoperative information using pictures, advantages and disadvantages of simultaneous operations in different anatomical regions, the need for exact planning and postoperative care as well as the importance of interdisciplinary teamwork. These results will influence the indication for a reconstructive operation in the future.

Abdominal Wall↗

[No problem with liposuction?].

Subcutaneous liposuction in tumescent technique is the most frequent aesthetic plastic procedure in the United States. In Germany, nearly 250,000 liposuctions are done per year by a variety of surgical and nonsurgical specialists including plastic surgeons, dermatologists, gynecologists, oral surgeons, and otolaryngologists in settings ranging from hospital operating rooms to physicians' offices. The method is applied and promoted as an easy-to-learn technique that is suited as an outpatient procedure. Although major complications seem to be rare, there are definite risks, including death at a rate of 1/5,000 procedures. Major risk factors are insufficient hygiene standards, multiliter wetting solution infiltration, megavolume aspiration, multiple cosmetic procedures in one setting, sedative and anesthetic drug hangover threatening ventilation, permissive postoperative discharge, and mistakes in patient selection. When major complications occur, office-based practitioners may refer patients to hospital emergency departments, where medical personnel unfamiliar with this procedure may underestimate the risk of major complications.

Adult↗

[Liposuction].

Explore the source record for details and available documents.

Anesthesia, General↗

[Liposuction curettage versus Botox for axillary hyperhidrosis. A prospective study of the quality of life].

BACKGROUND: Axillary hyperhidrosis is a dysfunction of the secretion of sweat glands. Conservative treatment modalities are mostly ineffective. Liposuction combined with subcutaneous curettage (TLC) destroys the sweat glands, while Botox injections inhibit the cholinergic transmission. MATERIAL AND METHOD: Of a total of 88 patients, TLC was carried out in 47 and 41 patients received intradermal Botox injections. The effect of both forms of treatment on the quality of life was assessed using a specific hyperhidrosis questionnaire and was correlated with sweat volumes measured by gravimetry. RESULTS: Follow-up after 6 months showed significantly changed sweat volumes of 52+/-41 mg/min of TLC patients versus 78+/-87 mg/min in the Botox group. In the TLC group 91% and in the Botox group 98% were satisfied with the result. CONCLUSION: The stress of a single surgical intervention is to be weighed against the necessary repetitive application of multiple Botox injections. Both methods are superior to other, more radical surgical methods in terms of efficacy and complication rates. Botox and TLC lead to a significant improvement of the quality of life.

Adolescent↗

[Peri-areolar approach in pronounced gynecomastia with focus-plasty and liposuction].

INTRODUCTION: The treatment of gigantic gynecomastia has usually been accompanied by ugly scars. METHODS: Because of our experiences in 38 patients with gynecomastia grade III, we suggest a surgical technique that not only involves a simple mastectomy and liposuction, but also a mere periareoler incision and, if necessary, repeated focusplasty and liposuction. Excessive skin can be repaired with a so-called focusplasty. RESULTS: In young patients this can successfully be achieved in one operation. CONCLUSIONS: Because skin has a minimized ability to retract in older patients, repeat operative sessions are necessary.

Adolescent↗

[Minimally invasive surgical therapy of gynecomastia: liposuction and exeresis technique].

INTRODUCTION: A number of techniques are available for the correction of gynecomastia. Nonscarring sparing methods are preferred, and the minimally invasive technique is to use liposuction for the gland and the fatty tissue exclusively. In this retrospective study we present our experience with a combination of liposuction and subsequent resection of the remaining gland. METHODS: Sixty-two patients (112 breasts) were surgically treated for gynecomastia from January 1996 and September 2000. From 1996 to 1997 all patients suffering from gynecomastia grade Simon I-II were treated by the method described by Rosenberg and Stark, which is exclusively suction of the fatty and glandular tissue. In a retrospective chart study a high recurrence rate was found in these patients. Subsequently we changed our technique to liposuction of the fatty tissue followed by sharp excision of the glandular tissue through the incision made for the liposuction cannula in the submammary fold. RESULTS: Suction alone was not sufficient to remove the glandular tissue; the rate of recurrence after suction was 35%. When sharp resection of the glandular tissue was carried out after the liposuction the recurrence rate dropped to under 10%. In total our complication rate was 50% including minor sequelae. The most frequent complication was unacceptable scarring of the nipple-areola complex. Hypesthesia of the nipple-areola occurred in 13.4% of the patients. CONCLUSION: The combination of liposuction and resection of the glandular tissue is a minimally invasive correction that can be used in all cases of gynecomastia grade Simon I-II.

Adult↗

[Autologous fat grafting].

Autologous fat grafting is a standard method for soft tissue augmentation. The method is commonly used for volume restoration of the ageing face. Furthermore, atrophic scars, lipodystrophy and scleroderma en coup de sabre can be treated. Following liposuction, the harvested fat can be reinjected immediately or stored at minus 28 degrees C for at least 2 years. In most cases, several injections at 3 to 4 months intervals are needed for good long-term effects. The procedure is used world-wide with good results and a minimum of side effects.

Adipose Tissue↗

[Liposuction].

Through the appropriate use of tumescent anesthesia and the use of modern instruments and techniques, liposuction surgery has become a low-risk procedure which produces predictable and aesthetically pleasing results. New indications for liposuction surgery include lipedema and cellulite. Vibration-assisted liposuction has proven to be especially gentle to the tissues. The induced tissue contraction helps to create better results in correction procedures after less-than-satisfactory liposuction. Autologous fat transfer is also firmly established as an augmentation procedure. In liporecycling, the fat obtained during reduction liposuction is used elsewhere for augmentation. New approaches in fat transfer include the microdroplet technique, flatter injection approaches and three-dimensional tissue augmentation.

Anesthesia, Local↗

[LipoRepair. Approach to correction of fat tissue deformities].

The increasing number of liposuction procedures has led to a growing number of iatrogenic fat tissue deformities, in addition to those of idiopathic, traumatic and disease-related nature. Correspondly the need for corrective procdures has incraesed. In recent years a number of methods have been developed with are minimally invasive and low-risk. LipoRepair is a treatment concept which combines several of these minimally invasive procedures in order to maximize results with maximum tissue sparing. LipoRepair is also suited to treat other fat tissue deformities. The following procedures can be employed alone or in combination: vibration-assisted liposuction, lipotransfer/liporecycling, liposhifting/ internal lipomobilization, repeated hydrodissection training subcutaneous tissue and subcision.

Adipose Tissue↗

[Tumescence local anesthesia. Improvement of local anesthesia methods for surgical dermatology].

The tumescent technique of local anesthesia was developed by J. Klein ten years ago to facilitate liposuction surgery. Tumescent anesthesia not only became the standard technique for liposuction, but proved to be of great value for other surgical problems in dermatology. Meanwhile, several noncosmetic uses for tumescent anesthesia were pioneered by dermatologic surgeons. This first review of the tumescent technique in German literature will focus on its specific advantages and disadvantages when applied in different fields of dermatologic surgery. Our own experience will be discussed, as well as future developments.

Anesthesia, Local↗

[Unspecified gain of weight?].

In the case of a 49 year old patient, a weight gain of 37 kg occurred during the first weeks of the year 2003, accompanied by a painless increase in the diameter of the upper arms and thighs. This process did spontaneously cease in the summer of 2003, but weight reduction could not be achieved. The diagnosis of multiple symmetrical lipomatosis, also known as Launois-Bensaude syndrome, the first authors to describe the condition in detail in 1898, could be established due to the unique appearance of the patient. Typical features of the disease are the accumulation of multiple lipomata in the shoulder girdle, upper arms, thorax and thighs, whereas the face, the forearms and the shanks are typically excluded. The etiology of the disease is obscure, dietetic intervention is futile, surgical approaches are liposuction or excision of the lipomata. Cessation of alcohol consumption may also be helpful, since the condition is typically associated with present or past alcohol abuse. The disease is usually reported to be rare, but there is reason enough to assume, that it is frequently misdiagnosed as simple truncal obesity.

Diagnosis, Differential↗

[Diagnosis and treatment of posttraumatic pseudolipomas. A retrospective analysis].

BACKGROUND: Both trauma and lipomas are frequently encountered in day-to-day clinical practice. Although lipomas are defined both clinically and pathologically as benign fatty tissue tumours, their aetiology is still not clear. METHODS: In this study 19 patients with 23 posttraumatic lipomas were analysed retrospectively with reference to ultrasound and MRI diagnosis, history, laboratory results and histopathological investigations. RESULTS: The mean age of the patients was 50.5 years (+/-15.5). The causative soft tissue trauma dated back an average of 2.6 years. When the histories were taken, 16 of the 19 patients reported vast, slow-resorbing posttraumatic haematomas. Nine of the 23 lipomas were sited in the upper extremity, 3 in the lower extremity, 9 in the trunk and 2 in the face. All were located epifascially. In 22 cases the lipomas were excised, and in 1 case the lipoma was removed by liposuction. Histological examination demonstrated capsulated benign fatty tissue tumours in 19 cases and uncapsulated benign fatty tissue tumours in 4. The average body mass index (BMI) was 29 kg/m(2). Removal of the tumour resulted in a good aesthetic result in all patients. CONCLUSIONS: The link between a blunt soft tissue injury and the development of a posttraumatic lipoma is still the subject of controversy; there are two mechanisms that seem more likely than any others proposed: (1) the "pseudolipoma" as the result of a prolapse of fatty tissue as an immediate result of trauma and (2) the development of a lipoma by way of differentiation of pre-adipocytes mediated by cytokines released by a posttraumatic haematoma. There appears to be a correlation between an increased partial thromboplastin time (PTT) and the development of posttraumatic lipomas. The generalised increase in the volume of body fat documented by the elevated BMI supports the idea that lipomas arise from the prolapse of adipose tissue. However, there is no single mechanistic explanation for the development of posttraumatic lipomas. They are probably caused by multiple factors and not by isolated pathological mechanisms.

Adolescent↗