SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Explore the source record for details and available documents.
AIMS/HYPOTHESIS: Autotaxin is a lysophospholipase D that is secreted by adipocytes and whose expression is substantially up-regulated in obese, diabetic db/db mice. The aim of the present study was to depict the physiopathological and cellular mechanisms involved in regulation of adipocyte autotaxin expression. METHODS: Autotaxin mRNAs were quantified in adipose tissue from db/db mice (obese and highly diabetic type 2), gold-thioglucose-treated (GTG) mice (highly obese and moderately diabetic type 2), high-fat diet-fed (HFD) mice (obese and moderately diabetic type 2), streptozotocin-treated mice (thin and diabetic type 1), and massively obese humans with glucose intolerance. RESULTS: When compared to non-obese controls, autotaxin expression in db/db mice was significantly increased, but not in GTG, HFD, or streptozotocin-treated mice. During db/db mice development, up-regulation of autotaxin occurred only 3 weeks after the emergence of hyperinsulinaemia, and simultaneously with the emergence of hyperglycaaemia. Adipocytes from db/db mice exhibited a stronger impairment of insulin-stimulated glucose uptake than non-obese and HFD-induced obese mice. Autotaxin expression was up-regulated by treatment with TNFalpha (insulin resistance-promoting cytokine), and down-regulated by rosiglitazone treatment (insulin-sensitising compound) in 3T3F442A adipocytes. Finally, adipose tissue autotaxin expression was significantly up-regulated in patients exhibiting both insulin resistance and impaired glucose tolerance. CONCLUSIONS/INTERPRETATION: The present work demonstrates the existence of a db/db-specific up-regulation of adipocyte autotaxin expression, which could be related to the severe type 2 diabetes phenotype and adipocyte insulin resistance, rather than excess adiposity in itself. It also showed that type 2 diabetes in humans is also associated with up-regulation of adipocyte autotaxin expression.
Abdominoplasty is an electively undertaken aesthetic operation mostly performed on patients after massive weight reduction. Previous case reports have demonstrated an improvement of incontinence symptoms after abdominoplasty. We report a case where urinary dysfunction occurred after refashioning of an abdominoplasty. The stress urinary incontinence got worse but what was of greater concern to her was a noticeable change of her urinary stream in an upward direction. A urethrolysis combined with an insertion of a tension-free vaginal tape and an anterior colporrhaphy was performed. After the operation, stress urinary incontinence improved and she reported that her urine stream reverted towards a normal direction.
The study of the skin of medial area of the arm in cadavers made it possible to evaluate its regional characteristics. Sex or race were not reported, but the age group most appropriate to liposuction was considered. In this way, authors believed that, as per standards established at the time, results as to skin retraction in liposuction, will be able to be analyzed in a comparative way in the future.
A new concept of male chest reshaping has been developed. In a population of 12 patients, 10 had a male chest enhancement using only a new shaped silicon gel implant, and two had a combination of liposuction and pectoral implants. The very natural appearance of this new implant, with or without a liposuction, seems to dramatically improve the quality of the cosmetic results.
Breast surgery has evolved significantly since the increased demand for reduced scars led to the development of minimal incision techniques. Ultrasound-assisted lipoplasty (UAL) presents important advantages when compared to traditional liposuction, such as preservation of connective structures and significant skin retraction capability. Other factors such as a favorable side-effect profile, satisfactory aesthetic results, and virtually inconspicuous scars have led us to utilize UAL in virtually all of the different breast surgery modalities carried out in our practice. Important aspects of patient selection, markings, surgical technique, and postoperative care are outlined. Ultrasonic energy is applied through superficial tunnels that lie radial to the mammary cone, with preservation of elements such as the areola, mammary ducts, and the central part of the breast's base which contains the perforators that supply the gland. Deep treatment should be applied onto adipose tissue regions and should preferably be performed in the peripheral and subcutaneous layers of the breast, with conservation of the central glandular cone to ensure maintenance of anterior projection. In selected cases, UAL is a valuable adjunct to procedures such as symmetrization, reduction mammaplasty, and breast reconstruction, permitting both volume reduction and shaping through three-dimensional retraction of connective tissue and skin. The excellent preliminary results support new indications and future developments of the technique.
The complicated case of a 44-year-old white female following ultrasound-assisted liposuction of the entire abdomen is presented. In this case the postoperative course was complicated by hematoma, treated conservatively. During following weeks extensive cutaneous necrosis over the abdomen developed. After four weeks the patient presented to our institution with purulent discharge. After surgical revision, requiring excision of the abdominal wall necrosis, a significant residual abdominal wall defect remained. After three further revisions, removal of residual necrotic fat, irrigation, and temporary coverage with a synthetic dressing, infection cleared. At this point, split thickness skin grafting was possible. The healing in of the skin grafts was complete, eventually enabling wound closure and successful reconstruction of the abdominal wall.
The purpose of this study was to measure the changes in Intra-Abdominal Pressure (IAP) during abdominoplasty and the relevance of these changes to the immediate postoperative recovery period. Eighteen patients (17 females and one male) who underwent abdominoplasty for aesthetic reasons participated in the study. The data collected included measurements of height, weight, and measurements of the intra-urinary bladder pressure prior to surgery, immediately post operative, and 18-24 hours postoperative. Changes in tidal volume and ventilation pressures were also measured prior to surgery and immediately postoperative. The weight of the excised tissue ranged between 1150 g-6500 g with an average of 2700 g. Three patients had significant diasthesis recti repair during surgery. In these patients the measured intra-vesicular pressure was above 24 cm of H(2)O by the end of the operation and above 20 cm of H(2)O the day following surgery. Two out of the three patients were treated with anticoagulants and the symptoms subsided within a week. The third patient recovered spontaneously by the third day. In conclusion, patients with an intra-urinary bladder pressure above 20 cm of H(2)O following abdominoplasty were felt to be at significant risk for development of respiratory distress in the immediate postoperative period.
Ultrasound-assisted lipoplasty (UAL) was developed in Europe and South America. Its introduction into the mainstream of United States surgery in 1997 was initially received with great enthusiasm. Soon, however, anecdotal reports surfaced describing limitations and complications related to the emerging technology. Among the concerns expressed were burns and postoperative seroma formation. The etiology of these complications was speculated to be a result of prolonged ultrasonic energy time. Consequently, some authors recommended limiting the amount of ultrasonic energy time per site and even complete avoidance of UAL in certain body areas. Our review includes over 350 consecutive cases of internal UAL performed by two surgeons utilizing a similar technique. The basic rules of UAL as described by Zocchi were followed without regard to other limitations such as ultrasonic energy site times, body areas, and level of tissue planes. The mechanism of action of UAL and the surgical technique are described. The procedure is a two-stage technique, including tumescent infiltration followed by energy application and simultaneous hollow titanium cannula aspiration. Suction-assisted lipoplasty was not a component of the procedure. The results, including complications, are outlined. Complications were few and not severe. There was no correlation between length of ultrasonic energy time and rate of postoperative complications. The advantages and disadvantages of UAL are discussed. UAL alone is the authors' preferred technique for body contouring to all body areas, except in the female breast.
reproducible Some lipodystrophies can visually exaggerate the deviation from the axes of the legs. The objective of this work is to demonstrate how an aesthetic operation, such as liposuction, can be used not only to slenderize the leg, bearing in mind the proportions, but also to visually improve the deviations from the referred axis. In other words: aesthetic surgery can be used to pseudocorrect the axis of the legs. The median line of the leg is calculated preoperatively and postoperatively and these curved lines are compared with the axis of the leg. This way, the grade of visual correction can be quantified. This is an easy and reproducible method. Eighty-three cases have been studied with both deviated and lipodystrophic legs.
This experiment was designed to investigate whether addition of vitamin C to the solution used in tumescent technique of liposuction might increase lipolysis and whether increased fibrosis might improve skin retraction where liposuction did not work properly and the skin had poor retraction ability. Eighteen Sprague-Dawley rats were used in two groups. Both inguinal fat pads of rats with their vascular structures were elevated and the right inguinal fat pad was injected with 1 cc tumescent solution as a control and the left fat pad with a 1 cc vitamin C-tumescent solution. Histopathological examination showed that all fat pads injected with tumescent solution had normal adipocytes. Those injected with vitamin C-tumescent were shown to have extreme fibrosis and occasional adipocytes.
Challenges in suction-assisted lipoplasty (SAL) along with ultrasound-assisted lipoplasty (UAL) include physical effort by the surgeon, surface irregularities and undulations, risk of perforations (SAL), risk of burns (UAL), and lengthy operative time. In this study of 74 patients, vibro-assisted liposuction (VAL) was evaluated by rate of aspiration. In this group, variables included diameter of the cannula, number of openings, and pressure of compressed air. Our findings suggest that operative time is decreased with a greater number of openings into the cannula and a higher air pressure.
Body lifts are surgical procedures that are infrequently performed because the length of operating time increases the risk to the patient as well as the likelihood of surgeon fatigue. The other drawback of body lifts is the long incision line. However in our experience, these incisions are well accepted if they are well placed and if the results of body change is significant. The goal of this paper is to show how operating time can be shortened and the scar be correctly positioned by using precise preoperative markings. In addition to high superior tension abdominoplasty, the two innovations of this type of body lift are the dermal fat flap and the suspension of tissue in the trochanteric and buttock regions. Meticulous hemostasis limited undermining, and the closure of dead space are factors that produce a more reliable procedure, both in terms of postoperative problems and the final results.
Solitary lipomas and familial multiple lipomatosis are the most common benign tumors and are very well encapsulated. They are very slow growing and have the potential for recurrence if incompletely excised and a very remote chance for malignant changes. These can be freed from surrounding tissue without difficulty, but because of the fibrous nature of the capsule, its violation is more likely with suction technique and may result in an inadequate resection, possibly leading to recurrence. Furthermore, liposuction alone will not allow histopathological study of the swellings. Therefore, we report here the treatment of moderate (>4-10 cm) and large (>10 cm) lipomas with liposuction-assisted surgical extraction of the capsule via the same wound (1 cm in length). This capsule extraction is aimed at avoiding recurrence and evaluating the histopathological nature of these swellings. 16 patients (nine men and seven women) presented with solitary lipomas (in 11 patients) and multiple lipomas (in five patients) have been successfully treated. Methods involved 1-cm incision for both liposuction and surgical removal of the capsule. Another 1-cm counter-incision may be needed in case of large size lipomas. High patient satisfaction was achieved because of the good cosmetic results due to the small postoperative residual scar and the smooth postoperative course. There has been no recorded recurrence in six years postoperative followup.
Successful surgical treatment of medium degree obesity by subcutaneous liposuction has been reported in the literature. In obesity, most adipose tissue is visceral, mainly omental, and the resection of omentum is a mutilating procedure for the intestinal tract. Because of this, we planned to reduce omental adipose tissue by an apparently conservative approach: ultrasound-assisted lipolysis. The purpose of this study was to assess the feasibility and safety of this procedure in an animal experimental model, drawing clinical and autoptic patterns. We chose pigs because they are functionally analogous to humans, although they store less fat in the omentum, whose structure looks like a veil. Four male dwarf pigs were fed, since weaning, with hyperlipidic fodder. When they were eight months old, they were operated on under general anesthesia in our laboratory for experimental surgery. After laparotomy, the omentum was delivered and treated with ultrasound for 1 hour. Before and just after the sonication, biopsies were drawn from omentum and processed for histologic findings. After 50 days, the surviving animals were sacrificed and autopsied; specimens from omentum, liver, and spleen were histologically processed. Two animals died during the operation, while the two surviving animals were in good general condition. Macro and microscopic observations demonstrated that the ultrasound can liquefy omental fat, sparing its fibrous network in the immediate time; during the postoperative period, an intense inflammatory reaction developed; macroscopic observation evidenced fibrous adhesions of the omentum to the surrounding organs; the connective tissue network was thickened and the whole omentum was twisted on itself. The high mortality rate could be due either to the surgical learning curve or to casualty or to lethal effects of ultrasound on the cardiac conductive system; the inflammatory peritoneal reaction could be specifically due to ultrasound or to surgical handling.
Explore the source record for details and available documents.
An innovative liposuction technique using a laser device is presented. It is a precise method, less traumatic than the conventional one. The interaction between the laser and the adipocyte causes lipolysis with reduced bleeding and its effect on collagen tone promotes collagen retraction and skin shrinkage. The results of the use of laser lipolysis on flaccid areas or in areas with the potential for flaccidity are shown. The resulting skin retraction and the pathologic anatomy confirm these claims.
The early experiences using ultrasound-assisted liposuction in treating difficult fibrous cases, such as gynecomastia, have led to the evolution and improvement of ultrasound-assisted liposuction techniques. This prospective study examined 348 consecutive patients treated with ultrasound-assisted liposuction over two and a half years, from October of 1998 to July of 2001. We use a three-stage technique consisting of infiltration, ultrasound-assisted sculpturing, and suction-assisted liposuction. This technique has improved our final outcome, with better skin contraction, shorter operative time, and minimization of complications, resulting in the optimization of liposuction as a safe procedure.