Lipedema is a common but rarely diagnosed disease or frequently confused with obesity. Patients are almost exclusively women. It is characterised by symmetrical, circumscribed, in advanced form deforming fat tissue accumulation on the legs that is associated with lymphedema. Spontaneous pain, pain to pressure and tendency to hematoma are characteristic. One of the possible causes of a fat leg, that is a very common complaint, is lipedema. Main differential diagnoses are obesity, lipohypertrophy and primary and secondary lymphedema. It is often associated with chronic venous and lymphatic insufficiency, early degenerative articular disease and obesity. The disease is rarely recognized and the treatment modalities are not widely known. Therefore patients feel very frustrated that leads to psychologic disorders. Until recently only conservative treatment was possible (combination of manual or intermittent pneumatic drainage, compression bandages and garments and physiotherapy). More recently surgical intervention (liposuction) is also included in the treatment options. The significance of lipedema is due not only to the disease itself, but also to the combination of lipedema and the group of associated and secondary diseases (articular and venous diseases, lymphedema, obesity, psychologic disorders). The more diseases coexist, the worse is the prognosis of lipedema itself. To prevent and delay this disease, it is indispensable to recognise it as early as possible and to treat it expertly and follow up patients suffering from lipedema.
Overweight and obesity is a public health problem in Hungary and in the Western world. It is important to underline that obesity is an illness and an important risk factor for several skin and other diseases. An overview of skin diseases caused or aggravated by obesity (acanthosis nigricans, acrochordons, keratosis pilaris, hyperandrogenism, stria, adiposis dolorosa, lymphoedema, chronic venous insufficiency, plantar hyperkeratosis, lipoedema, skin infections, acne inversa, psoriasis, tophi) helps us to look and see as well. Look for the possibility of skin infections as it helps the early diagnosis and to avoid complications. Draw patients' attention to the preventive importance of skin care. In case of an obese patient the usual dosage of most local and systemic drugs should be modified. It must be kept in mind that obesity directly or indirectly starts unfavorable processes in almost all organ systems. Therefore, only a multidisciplinary care may secure treatment and rehabilitation of obese patients. Dermatological and lymphological care is often part of the rehabilitation.
A daganatos betegek számának emelkedésével és az onkológiai kezelések hatékonyságának növekedésével egyre gyakrabban találkozunk másodlagosan kialakult nyiroködémával. Ezért a nyiroködéma kezelése az onkológiai betegek gondozásának része. A nyiroködéma kezelésének alapja daganatos betegekben a komplex ödémamentesítő kezelés, amelyet bele kell ágyazni a beteg átfogó orvosi ellátásába és mindig egyénre szabva kell meghatározni. A kezelés eredménye függ az orvos és a gyógytornász nyiroködéma-kezelésben való jártasságától, a betegcompliance-től, a daganat viselkedésétől és a kísérő betegségektől. A nyiroködéma krónikus betegség, élethosszig tartó gondozást, kezelést igényel. Az ellátás javítása érdekében fontos a betegek felvilágosítása a nyiroködéma kockázatát illetően és az erre vonatkozó helyes életmóddal kapcsolatosan (például testsúlykontroll); törekedni kellene a diagnózis korai felál-lítására. A palliatív ellátásba is lényeges lenne beépíteni a nyiroködéma-kezelést. Időben elkezdett terápiával elkerül-hetők a szövődmények, az egészségügyi kiadások csökkenthetők és a beteg számára jobb életminőség biztosítható. Orv. Hetil., 2016, 157(13), 488-494.Kulcsszavak: nyiroködéma, onkológia, malignus nyiroködéma, komplex ödémamentesítő kezelés, palliatív ellátás Management of secondary lymphedema in patients with cancerDue to the increased number of cancer patients and the progress in cancer treatment, there are more cases with cancer-related lymphedema. Lymphedema treatment became part of oncological patients' care. Basic therapy for lymphedema is the complex decongestive therapy, which should be embedded into the patient's comprehensive medical care and should always be determined individually. Results of therapy are influenced by the experience of the doctor and the physiotherapist in lymphedema care, patient's complience, tumor behavior and the accompanying diseases. Lymphedema is a chronic disease, requires lifelong follow-up and treatment. For prevention and better care, it would be important to inform patients about lymphedema risk and appropriate life-style (e.g. weight control) preoperatively and during oncological follow-up. Early diagnosis is important. Lymphedema treatment should be integrated into palliative programmes. If therapy is started in time, complications may be avoided, healthcare costs may be reduced and better quality of life may be achieved.Keywords: lymphedema, oncology, malignant lymphedema, complex decongestive therapy, palliative careWenczl, E. [Management of secondary lymphedema in patients with cancer]. Orv. Hetil., 2016, 157(13), 488-494. (Beérkezett: 2016 elfogadva: 2016. Ritkán ismerjük fel, vesszük komolyan és kezeljük szakszerűen a nyiroködémát, pedig a várható élettartam emelkedésével megnőtt a nyiroködémás betegek száma. Az életkor előrehaladtával ugyanis fokozatosan csökken a nyirokszállítás kapacitása és egyre gyakoribbak a nyiroködéma rizikófaktorai. A különféle daganatok előfordu-lása is emelkedik, és az onkológiai kezeléseknek köszön-hetően hosszabb a túlélés, gyakoribb a...
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