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[An uncommon cause of recurrent abdominal pain in a 63-year-old obese woman].

HISTORY AND CLINICAL FINDINGS: A 63-year-old woman was admitted because of abdominal pain for 12 months, associated with an increasing abdominal distension. One month before a gastroscopy had revealed mild gastritis. The taking of proton pump inhibitors did not improve her symptoms. There was no relevant neurological or psychiatric past history. INVESTIGATIONS: Ultrasound and laboratory tests demonstrated a fatty liver and increased serum levels of lipoproteins. Magnetic resonance imaging revealed an increase in subcutaneous and intraperitoneal adipose tissue. Endoscopy did not show any additional significant findings. DIAGNOSIS AND TREATMENT: The patient had adiposis dolorosa. Initially she was given daily a combination of mexiletine 400 mg and 75 mg Amitriptyline. After a few days the ailment decreased and had disappeared completely after one week. Three months later the dosage was reduced to 100 mg mexiletine and 25 mg Amitriptyline daily. After another two months all medication was discontinued. At follow-up after 12 months the symptoms had not recurred. CONCLUSION: This case demonstrates that abdominal pain is not always caused by diseases of the visceral hollow organs. It must also be borne in mind that abdominal pain may be associated with adipose tissue, as is the case in adiposis dolorosa. The disease can be successfully treated, as in this case, using a combination of mexiletine and Amitriptyline.

Abdominal Pain↗

[Painful lipoma?].

The adiposis dolorosa (Dercum's disease) was described already in 1892. Many questions about its physiopathological mechanism are still unresolved. Presentation of a patient with this disease is reported, followed by a brief review of the literature, where the pathogenesis, the differential diagnosis and the therapeutical approaches of this syndrome are especially pointed out.

Adiposis Dolorosa↗

Surgical amelioration of Dercum's disease: a report and review.

Dercum's disease, or adiposis dolorosa, is a rare condition characterized by painful lipomas, usually on the extremities of obese postmenopausal women. At present, there are no treatments known to alter the progressive course of this often incapacitating disease. Surgical intervention, while not preventive, is useful in ameliorating local symptoms of pain. We report a characteristic 15-year course of Dercum's disease.

Adiposis Dolorosa↗

Dercum's disease.

Dercum's disease (adiposis dolorosa, lipomatosis dolorosa morbus Dercum), is a rare disorder resulting in painful fatty deposits around the upper legs, trunk, and upper arms. The portrait painted of Dercum's disease is very complicated, with many other disorders seen associated with the disease. There are no clear pathological mechanisms known, although it is suspected that there is either a metabolic or autoimmune component involved. Here, the authors review the literature to date, including some information from their own studies. In particular, the authors will look at the different strands of evidence pointing to the pathological mechanism of the disorder.

Adiposis Dolorosa↗

The regulation of subcutaneous blood flow in patient with Dercum's disease.

Dercum's disease or adiposis dolorosa is a poorly understood disorder with painful fatty deposits in the skin localized to the lower extremities. The etiology is unknown. In such a patient the mechanisms of local regulation of blood flow in subcutaneous tissue was investigated by the local 133Xenon washout technique. The patient was reinvestigated one week after treatment with intravenous lidocaine. The local vasoconstrictor response to increase in venous transmural pressure was not present in this patient, but reappeared after lidocaine treatment. Autoregulation of blood flow in subcutaneous tissue was present before as well as after lidocaine treatment. It seems likely that a pain elicited increase in sympathetic activity in the vasoconstrictor fibres abolished the normal vasoconstrictor response to increase in venous transmural pressure. The mechanism of pain relief after intravenous lidocaine infusion is uncertain, but central as well as peripheral mechanisms may be considered.

Adiposis Dolorosa↗

Liposuction in atypical cases.

Liposuction has become the most frequent aesthetic procedure, and its indications continue to expand to different areas of plastic surgery. In this article the authors present their experience with liposuction in the treatment of nine cases termed "atypical," for not being purely aesthetic. Included are four congenital lipodystrophies-occult spinal disraphism, osteogenesis imperfecta, congenital lipomatosis difusa, and Klinefelter syndrome-and five acquired ones-posttraumatic lipoma, posttraumatic asymmetry, insulinic hypertrophic lipodystrophy, adiposis dolorosa, and TRAM flap. Particular features of each lipodystrophy are reviewed and details of fat distribution and density are described. We also review some specific details of the technique. On the other hand, we wish to point out the importance of recognizing and correctly diagnosing some specific lipodystrophies that are part of defined clinical patterns and that require an integral therapeutic approach.

Adolescent↗

Lipoma excision.

Lipomas are adipose tumors that are often located in the subcutaneous tissues of the head, neck, shoulders, and back. Lipomas have been identified in all age groups but usually first appear between 40 and 60 years of age. These slow-growing, nearly always benign, tumors usually present as nonpainful, round, mobile masses with a characteristic soft, doughy feel. Rarely, lipomas can be associated with syndromes such as hereditary multiple lipomatosis, adiposis dolorosa, Gardner's syndrome, and Madelung's disease. There are also variants such as angiolipomas, neomorphic lipomas, spindle cell lipomas, and adenolipomas. Most lipomas are best left alone, but rapidly growing or painful lipomas can be treated with a variety of procedures ranging from steroid injections to excision of the tumor. Lipomas must be distinguished from liposarcoma, which can have a similar appearance.

Adult↗

[Multiple angiolipomas--analgesics therapy with doxepin].

Angiolipomas are rare benign tumours of the subcutaneous fat; they are sometimes solitary but their occurrence is more frequently multiple. Angiolipomas can be differentiated from lipomas clinically by their pronounced tenderness and histologically by their variable vascularization. The disease occurs mostly in young adults, the sites of predilection being the trunk and proximal extremities. Multiple angiolipomas have to be differentiated from other lipomatoses, especially from adiposis dolorosa (Dercum's disease). The case reported in this paper was characterized by typical clinical and histological findings. The systemic administration of acetylsalicylic acid, diclofenac, ketotifen, ranitidine, tramadol, tilidine combined with naloxone did not provide adequate pain relief. In contrast, the therapeutic efficiency of the antidepressant doxepin, which also displays antihistaminic effects, suggests a possible role of mediators in the development of pain in angiolipomas.

Biopsy↗

The fat queen.

Explore the source record for details and available documents.

Adiposis Dolorosa↗