The Chronically Swollen Painful Extremity

Stallworth, J. Manly

doi:10.1001/jama.1974.03230380024015

Cited by 24 publications

(14 citation statements)

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“…All this happened without any organic alterations of the big veins. 19 We need to determine whether the lymphatic alterations are primary or secondary. F61di thinks that the pathologic accumulation of fat alters the functions of collagen fibers that open the endothelial junctions of the initial lymphatics, causing a lymphostasis.20 On the other hand, Jagtman's data regarding skin elasticity would make us think of a secondary disturbance of the lymphatic system.…”

Section: Discussionmentioning

confidence: 99%

Functional Lymphatic Alterations in Patients Suffering from Lipedema

Bilancini¹,

Lucchi²,

Tucci³

et al. 1995

Angiology

100

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Lipedema is a chronic vascular disease almost exclusively of female sex, characterized by the deposit of fat on the legs, with an "Egyptian column" shape, orthostatic edema, hypothermia of the skin, alteration of the plantar support, and negativity of Stemmer's sign. The etiology and pathogenesis of this disease are still the object of study, and therapy is very difficult. Various authors have described morphologic and functional alterations of prelymphatic structures and of lymphatic vessels. The big veins remain untouched in the phlebograms and an alteration of the skin elasticity is demonstrated. The present authors have studied by dynamic lymphoscintigraphy 12 women patients suffering from lipedema, and compared the results with those of 5 normal subjects and 5 patients suffering from idiopathic lymphedema who were sex and age matched with the patients suffering from lipedema. The patients suffering from lipedema showed an abnormal lymphoscintigraphic pattern with a slowing of the lymphatic flow that presented some analogies to the alterations found in the patients suffering from lymphedema. A frequent asymmetry was also noticed in the lymphoscintigraphic findings that is in contrast to the symmetry of the clinical profile.

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Section: Discussionmentioning

confidence: 99%

Functional Lymphatic Alterations in Patients Suffering from Lipedema

Bilancini¹,

Lucchi²,

Tucci³

et al. 1995

Angiology

100

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“…A number of investigations have been undertaken in patients with lipedema, including histological studies [Stallworth et al, 1974], lymphoscintigrams, venograms, arteriograms, and magnetic resonance lymphangiography, all failing to demonstrate specific abnormalities, but suggesting a subclinical reduction in lymphatic function [Beninson and Edelglass, 1984; Amman‐Vesti et al, 2001; Boursier et al, 2004; Lohrmann et al, 2009]. Lipedema can be complicated by secondary lymphedema, resulting in the clinical picture of lipo‐lymphedema.…”

Section: Introductionmentioning

confidence: 99%

Lipedema: An inherited condition

Child

Gordon

Sharpe

et al. 2010

American J of Med Genetics Pt A

199

215

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Lipedema is a condition characterized by swelling and enlargement of the lower limbs due to abnormal deposition of subcutaneous fat. Lipedema is an under-recognized condition, often misdiagnosed as lymphedema or dismissed as simple obesity. We present a series of pedigrees and propose that lipedema is a genetic condition with either X-linked dominant inheritance or more likely, autosomal dominant inheritance with sex limitation. Lipedema appears to be a condition almost exclusively affecting females, presumably estrogen-requiring as it usually manifests at puberty. Lipedema is an entity distinct from obesity, but may be wrongly diagnosed as primary obesity, due to clinical overlap. The phenotype suggests a condition distinct from obesity and associated with pain, tenderness, and easy bruising in affected areas.

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“…They found elastic stockings were often not tolerated. Forty additional patients with 'lipoedema' were studied (Stallworth et al, 1974). Normal fat was found on biopsy.…”

Section: Discussionmentioning

confidence: 99%

Juxta-articular adiposis dolorosa: what is it? Report of 2 cases.

Eisman¹,

Swezey²

1979

Annals of the Rheumatic Diseases

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suMMARY Juxta-articular adiposis dolorosa may be defined as the localised accumulation of painful fat near joints, most commonly the knee. It exists as a separate entity that must be distinguished from other causes of knee pain. We present 2 patients with this condition and review the literature. Various approaches to therapy are discussed. A classification of painful fat near joints is proposed.Juxta-articular adiposis dolorosa (JAD)-does it exist? What is it? Literally it means painful fat near a joint. We believe the condition does exist as a separate entity and that it may coexist with other disorders affecting joints. We describe 2 patients with this disorder and review the available literature. It is important to recognise the condition as a not so rare cause of knee pain. Nevertheless we have been unable to find a single publication about this disorder in the rheumatology journals and reviews. A classification of painful fat in and around joints is proposed, and various pharmacological and physiotherapeutic measures are discussed. effusion. Just medial to each knee was a fist-sized mass of rather tense and extremely tender fatty tissue. There was also tenderness of both pes anserine bursae.Investigations revealed a normal complete blood count, differential white cell count, and erythrocyte sedimentation rate. Biochemical tests were normal except for a serum calcium of 11 2 mg/dl, serum phosphorus of 2 * 3 mg/dl, and a serum parathyroid hormone level of 109 ,tlEq/ml (normal 90-100) (at the time of writing no disposition of her hyperparathyroidism has been made). Thyroid function tests, glucose tolerance test, RA latex, ANA, serum uric acid, and an electromyogram of both lower limits were normal or negative. Roentgenograms (including weight-bearing views) of both knees were also normal. A fat biopsy from the mass on the left knee was also normal.A diagnosis of JAD was made. She was treated with aspirin, naproxen, indomethacin, and ibuprofen in full anti-inflammatory doses. None of the nonsteroidal agents relieved her pain. A course of carbamazepine (given elsewhere) was also without benefit. Local injection (of the painful fat) with lignocaine exacerbated her symptoms. Injection of the left anserine bursa with triamcinolone acetonide suspension and lignocaine was ineffective, and attempts at weight reduction were also unsuccessful. A trial of corrective shoes with medially wedged soles and heels in an effort to minimise valgus angulation and medial knee contact gave no relief. Finally, intermittent pneumatic compression (Jobst) was used in an attempt to compress the fat and possibly mobilise suspected local oedematous accumulations in fatty tissue. The patient was able to tolerate 65 mmHg of pressure for 1 hour twice daily, but when the pressure was increased to 70 mmHg 479 on 11 May 2018 by guest. Protected by copyright.

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The Chronically Swollen Painful Extremity

Cited by 24 publications

References 0 publications

Functional Lymphatic Alterations in Patients Suffering from Lipedema

Functional Lymphatic Alterations in Patients Suffering from Lipedema

Lipedema: An inherited condition

Juxta-articular adiposis dolorosa: what is it? Report of 2 cases.

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