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Chen Weng Z, Tapia Salinas B, Noguera Tomas J, Del Castillo Pardo De Vera JL, De la Morena Molina JD. Anesthetic Management of a Patient with Madelung's Disease Presenting with a Giant Cervical Lipoma: A Case Report. A A Pract 2024; 18:e01779. [PMID: 38578005 DOI: 10.1213/xaa.0000000000001779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Madelung's disease is characterized by the presence of multiple symmetric and nonencapsulated facial, neck, and upper trunk lipomas. Depending on the location and size of lipomas, there may be concerns for difficult airway management and cardiovascular collapse. We present the anesthetic management case of a patient with cervical and mediastinal lipomas who underwent elective cervical lipoma resection.
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Chrysovitsiotis G, Sofokleous V, Kyrodimos E, Papanikolaou V, Giotakis E. Retropharyngeal Space Lipomas. A Systematic Review of the Reported Cases in the Literature. Indian J Otolaryngol Head Neck Surg 2022; 74:5630-5638. [PMID: 36742695 PMCID: PMC9895578 DOI: 10.1007/s12070-021-02962-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/22/2021] [Indexed: 02/07/2023] Open
Abstract
Retropharyngeal space lipomas (RSLs) comprise a group of very uncommon head and neck benign, soft tissue tumors that originally grow in the retropharyngeal space. They can develop as individual tumors or in the context of syndromic lipomatosis. Symptoms usually arise as expanding RSLs exert pressure on adjacent structures, and clinical manifestations are often atypical and overlapping. Given the rarity of this diagnosis, current evidence is scarce, providing a rather fragmented picture. A literature search was conducted in all major medical databases, without time limitations. Tumors were considered RSLs if a benign lipomatous tumor appeared to develop originally in the retropharyngeal space. Cases with syndromic lipomatosis that demonstrated at least one such tumor involving the retropharyngeal space were included. A total of 52 publications concerning 79 eligible cases were found. Two of these cases concerned patients with Multiple Symmetrical Lipomatosis. A male predominance was found (61.5%, n = 48). Dysphagia (65.2%, n = 43) was by far the most common symptom, followed by snoring (37.9%, n = 25), dyspnoea (34.8%, n = 23) and dysphonia (30.3%, n = 20). The most used imaging modality was Computed Tomography (CT) (64.1%, n = 41). Surgery was the treatment in 73 cases (93.6%). The transcervical was the most selected approach (50.7%, n = 37), followed by the transoral approach (38.4%, n = 28). Complete recovery was reported, following treatment, in 60 cases (75.9%). Retropharyngeal space lipomas are benign tumors with a higher prevalence in male patients. Dysphagia is the most common symptom. Imaging is necessary for diagnosis, with CT scanning being usually sufficient as a single modality test. More than half of the patients in the literature are treated via an external approach. Diminishing of symptoms and full postoperative recovery is the most common outcome. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-021-02962-6.
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Affiliation(s)
- Georgios Chrysovitsiotis
- 1st Otorhinolaryngology Department, General Hospital of Athens “Hippocratio”, National and Kapodistrian University of Athens, 114 Vasilissis Sofias Av., 11527 Athens, Attiki, Greece
| | - Valentinos Sofokleous
- Department of Pediatric Otorhinolaryngology, Athens Children’s Hospital “P. & A. Kyriakou”, Athens, Attiki, Greece
| | - Efthymios Kyrodimos
- 1st Otorhinolaryngology Department, General Hospital of Athens “Hippocratio”, National and Kapodistrian University of Athens, 114 Vasilissis Sofias Av., 11527 Athens, Attiki, Greece
| | - Vasileios Papanikolaou
- 1st Otorhinolaryngology Department, General Hospital of Athens “Hippocratio”, National and Kapodistrian University of Athens, 114 Vasilissis Sofias Av., 11527 Athens, Attiki, Greece
| | - Evangelos Giotakis
- 1st Otorhinolaryngology Department, General Hospital of Athens “Hippocratio”, National and Kapodistrian University of Athens, 114 Vasilissis Sofias Av., 11527 Athens, Attiki, Greece
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Zavattaro E, Lunardon C, Coppo L, Savoia P, Colombo E, Comi C, Cantello R. Is There any Link between Madelung Disease and Ischemic Stroke? A Case Report. Neurol India 2022; 70:2166-2168. [DOI: 10.4103/0028-3886.359251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Seskute G, Dapkute A, Kausaite D, Strainiene S, Talijunas A, Butrimiene I. Multidisciplinary diagnostic dilemma in differentiating Madelung’s disease — the value of superb microvascular imaging technique: A case report. World J Clin Cases 2021; 9:6145-6154. [PMID: 34368337 PMCID: PMC8316957 DOI: 10.12998/wjcc.v9.i21.6145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/13/2021] [Accepted: 05/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Madelung’s disease, also known as multiple symmetrical lipomatosis, is a rare, underrecognized disorder of fat metabolism that results in unusual accumulation of subcutaneous fat deposits around the neck, shoulders, upper arms, trunk, hips, and upper thighs. Our case demonstrates the importance of differential diagnosis and the value of a superb microvascular imaging technique for suspecting and confirming Madelung’s disease. Timely diagnosis and alcohol abstinence could prevent the progression of growing fatty masses and prevent surgery.
CASE SUMMARY A 62-year-old male was admitted to the Rheumatology center complaining of symmetric subcutaneous tumors in the area of the parotid and submandibular salivary glands, small soft masses in the occiput and upper third of the forearm, rashes on calves. A high titer of rheumatoid factor and low concentrations of serum complements were detected. The high-end ultrasound and magnetic resonance imaging examinations of all affected areas of the soft tissues showed predominantly adipose tissue (lipomas) without suspicion of liposarcoma. The biopsy from the small salivary gland revealed no pathology. After evaluating the patient’s clinical presentation (symmetrical lipomatosis, cirrhosis, gynecomastia, anemia, hyperuricemia), Madelung’s disease, type I, along with the psoriatic rash and psoriatic arthritis and secondary liver cirrhosis were established.
CONCLUSION Madelung’s disease consists of many co-occurring disorders imitating and overlapping with other conditions. Ultrasonography is the first choice for suspecting and confirming symmetrical lipomatosis.
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Affiliation(s)
- Goda Seskute
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Austeja Dapkute
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | | | - Sandra Strainiene
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Andrius Talijunas
- Institute of Dentistry, Faculty of Medicine, Vilnius University, Vilnius 01512, Lithuania
| | - Irena Butrimiene
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
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Zewde YZ. Madelung's disease in a non-alcoholic Ethiopian male patient mistaken for obesity: a case report. BMC Endocr Disord 2021; 21:142. [PMID: 34217263 PMCID: PMC8254943 DOI: 10.1186/s12902-021-00803-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/21/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Madelung's disease (MD) is a rare disorder of fat storage characterized by the presence of diffuse, symmetrical deposition of subcutaneous fat around the neck, shoulder, arm, trunk and thigh. Although its cause is not fully understood, this benign condition is commonly presented among adult males with Mediterranean origin and history of alcohol abuse. Patients often presents with compression of vital structures, cosmetic disfigurement and associated psychosocial problems and systemic comorbidities. It is often under-recognized by physicians, possibly due to obliviousness of the condition and often misdiagnosed as obesity. CASE PRESENTATION We present a 65-year-old non-alcoholic black Ethiopian man, presented with a slowly growing body fat in his trunk and proximal limbs associated by multiple joint and back pain which got worse recently. He denied any history of chronic alcohol use. On examination, huge, bilateral, non-tender, soft, globular masses in his torso, shoulder, arm and thigh with bilateral breast enlargement. On investigation his biochemical profile was normal except hyperuricemia (10.6 mg/dl). Imaging of the cervical and lumbar vertebrae showed excess subcutaneous fat depositions with degenerative disc disease. Biopsy from the mass revealed non-encapsulated lipoma and he was diagnosed with type II MD. We treated his pain with supportive therapy and discharged in stable condition. The patient deferred surgical treatment. CONCLUSIONS Madelung's disease is often reported among white adult males with chronic alcoholism. However, our case reported a black man without the typical risk factor which was misdiagnosed as obesity. Hence, clinicians should be aware of MD and need to consider it in their differential diagnosis when encountered with a patient having progressive centripetal fat deposition with or without a history of alcoholism and systemic comorbidities. As early detection of this disorder helps to avoid diagnostic delays and prevent complications through timely interventions which will in turn improves patient quality of life.
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Affiliation(s)
- Yared Zenebe Zewde
- Department of Neurology, College of Health Sciences, Addis Ababa University, P. O. Box: 41690, Addis Ababa, Ethiopia.
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Gutiérrez-Ortiz C, Rodrigo-Rey S. Hereditary optic neuropathy and associated systemic diseases due to 2 overlapping mitochondrial mutations. NEUROLOGÍA (ENGLISH EDITION) 2021; 36:472-473. [DOI: 10.1016/j.nrleng.2020.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/09/2020] [Indexed: 11/25/2022] Open
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Matsushita T, Mizumaki K, Kawase M, Numata N, Okamura A, Komuro A. A rare case of Madelung's disease in Asian female. DERMATOL SIN 2021. [DOI: 10.4103/ds.ds_47_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Gutiérrez-Ortiz C, Rodrigo-Rey S. [Hereditary optic neuropathy and systemic disease of the overlapping of two mitochondrial mutations]. Neurologia 2020. [PMID: 32900529 DOI: 10.1016/j.nrl.2020.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- C Gutiérrez-Ortiz
- Departamento de oftalmología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - S Rodrigo-Rey
- Departamento de oftalmología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
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Cui Y, Cui X, Gao S, Zhu Z, Yin W. Multiple symmetric lipomatosis with secondary laryngeal obstruction: A case report. Medicine (Baltimore) 2020; 99:e21014. [PMID: 32629721 PMCID: PMC7337445 DOI: 10.1097/md.0000000000021014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Multiple symmetric lipomatosis (MSL) is an uncommon medical condition characterized by symmetric fat accumulation mainly in the neck and other upper body regions. The involvement of the larynx is rare according to the literature, and we present a case of MSL with larynx involvement treated with a surgical approach. PATIENT CONCERNS A 55-year-old male was admitted to our hospital due to progressively aggravated breathing difficulty, and tracheotomy was performed before transfer. When he tried to block the cannula, the breathing difficulty returned. The patient's neck had been thickening for the past 2 years. DIAGNOSIS Pathological examination confirmed the diagnosis of MSL. INTERVENTIONS The patient underwent lumpectomy and neck exploration. OUTCOMES The lipoma was removed, the patient was free of any dyspnea symptoms and recovered well, and the tracheal cannula was removed at a local hospital. CONCLUSION MSL can infiltrate the larynx and grow into the preepiglottic space and paraglottic spaces, resulting in breathing difficulties. Lipomas present in the spaces described above must be removed at the same time; otherwise, symptoms of dyspnea cannot be alleviated.
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Affiliation(s)
- Yu Cui
- Departments of Otolaryngology
| | | | | | - Zhanpeng Zhu
- Departments of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, P.R. China
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Casas Deza D, Gotor Delso J, Bernal Monterde V. Madelung's disease in a patient with advanced hepatocellular carcinoma. GASTROENTEROLOGIA Y HEPATOLOGIA 2019; 41:645-647. [PMID: 29759923 DOI: 10.1016/j.gastrohep.2017.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/10/2017] [Accepted: 12/06/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Diego Casas Deza
- Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - Jesús Gotor Delso
- Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España
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Maximiano LF, Gaspar MT, Nakahira ES. Madelung disease (multiple symmetric lipomatosis). AUTOPSY AND CASE REPORTS 2018; 8:e2018030. [PMID: 30101135 PMCID: PMC6066263 DOI: 10.4322/acr.2018.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/08/2018] [Indexed: 12/16/2022] Open
Abstract
Madelung disease or multiple symmetric lipomatosis (MSL) is a rare entity among the overgrowth syndromes. It is characterized by painless non-encapsulated and symmetric fatty deposits in the neck, torso, mammary, and abdominal areas, and in the upper and lower limbs. The etiology of the disease is still unknown. Chronic alcohol consumption may play a role in adipocyte hyperplasia in genetically susceptible individuals. Besides the overgrowth of adipose tissue, patients with MSL present features of metabolic syndrome. Patients seek medical attention usually for esthetic reasons. We present the case of a middle-aged man who sought the outpatient clinic complaining of bulging masses in the posterior upper part of the thorax, the occipital area, and the neck. The masses grew over a period of 2 years. The physical examination and imaging study revealed the presence of symmetric lipomatosis. A two-step surgical treatment was undertaken for the excision of the lipomatous tissue. The postoperative outcome was uneventful with satisfactory esthetic results.
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Affiliation(s)
- Linda Ferreira Maximiano
- Universidade de São Paulo (USP), Hospital Universitário, Surgical Clinics Division. São Paulo, SP, Brazil
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Felthaus O, Schön T, Schiltz D, Aung T, Kühlmann B, Jung F, Anker A, Klein S, Prantl L. Adipose tissue-derived stem cells from affected and unaffected areas in patients with multiple symmetric lipomatosis show differential regulation of mTOR pathway genes. Clin Hemorheol Microcirc 2018; 69:141-151. [PMID: 29758934 DOI: 10.3233/ch-189107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Multiple symmetric lipomatosis is a rare disease characterized by the excessive growth of uncapsulated masses of adipose tissue. Although the etiology has yet to be elucidated, a connection to brown adipose tissue has been proposed recently. The mTOR pathway which is found to be regulated in lipomatous tissue as well as associated with brown adipose tissue can be inhibited by a compound called rapamycin. METHODS We isolated adipose tissue derived stem cells from both affected and unaffected tissue and treated these cells with different concentrations of rapamycin. RESULTS The differences in both proliferation and differentiation between adipose tissue derived stem cells (ASCs) from lipomatous and normal tissue decreased after mTOR pathway inhibition. In some patients regulation of mTOR genes was opposed in the ASCs from the two different tissues. CONCLUSIONS Treatment with rapamycin might be a novel therapeutical approach for patients suffering from multiple symmetric lipomatosis.
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Affiliation(s)
- Oliver Felthaus
- Department of Plastic-, Hand-, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Teresa Schön
- Department of Plastic-, Hand-, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Daniel Schiltz
- Department of Plastic-, Hand-, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Thiha Aung
- Department of Plastic-, Hand-, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Britta Kühlmann
- Department of Plastic-, Hand-, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Friedrich Jung
- Institute of Biomaterial Science and Berlin-Brandenburg Centre for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Kantstrasse, Teltow, Germany
| | - Alexandra Anker
- Department of Plastic-, Hand-, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Silvan Klein
- Department of Plastic-, Hand-, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic-, Hand-, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
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Abstract
Madelung disease is an uncommon disease characterized by large subcutaneous adipose masses. Mediterranean countries show higher disease incidence. We review the current concepts concerning this pathology, including etiology, diagnosis, and treatment. Madelung disease usually affects the upper half of the body, but we describe a patient with scrotal lipomas. As this location is rare, we review the cases found in literature, as well as the specific nuances regarding local symptoms and treatment.
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Gao Y, Hu JL, Zhang XX, Zhang MS, Lu Y. Madelung's Disease: Is Insobriety the Chief Cause? Aesthetic Plast Surg 2017; 41:1208-1216. [PMID: 28791470 DOI: 10.1007/s00266-017-0920-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 06/07/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Madelung's disease (MD) is a rare disease of unknown etiology that is characterized by massive fatty deposits distributed in a symmetrical pattern mainly in the head, neck, and upper trunk. Here, we sought to explore the pathogeny and treatment of MD. METHODS We enrolled ten patients who underwent surgical operations and one patient who refused an operation at our hospital between January 2009 and December 2016. We collected their medical histories and the preoperative and postoperative serological indices. The serum chemistry clinical outcomes were compared between the preoperative and postoperative states. RESULTS The mean alcohol intake of the eleven patients exceeded 450 g daily. Ten patients underwent open excisions, and the other patient refused an operation. No significant differences were observed between the preoperative and postoperative serum chemistry results. No recurrence has yet been observed in any of the ten operated patients. CONCLUSIONS All of the patients in our study had associated alcoholism. Thus, insobriety might be one of the causes of MD. We believe that open operations may be an effective treatment based on the outcomes of the surgeries. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Yuan Gao
- Department of General Surgery, The Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road Huangdao District, Qingdao, 266555, Shandong, People's Republic of China
| | - Ji-Lin Hu
- Department of General Surgery, The Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road Huangdao District, Qingdao, 266555, Shandong, People's Republic of China
| | - Xian-Xiang Zhang
- Department of General Surgery, The Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road Huangdao District, Qingdao, 266555, Shandong, People's Republic of China
| | - Mao-Shen Zhang
- Department of General Surgery, The Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road Huangdao District, Qingdao, 266555, Shandong, People's Republic of China
| | - Yun Lu
- Department of General Surgery, The Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road Huangdao District, Qingdao, 266555, Shandong, People's Republic of China.
- Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, Qingdao, People's Republic of China.
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Witmanowski H, Banasiak Ł, Kierzynka G, Markowicz J, Kolasiński J, Błochowiak K, Szychta P. The use of high tumescent power assisted liposuction in the treatment of Madelung's collar. Postepy Dermatol Alergol 2017; 34:366-371. [PMID: 28951714 PMCID: PMC5560187 DOI: 10.5114/ada.2017.69319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 07/26/2016] [Indexed: 12/25/2022] Open
Affiliation(s)
- Henryk Witmanowski
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical College in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
- Department of Physiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Łukasz Banasiak
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical College in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Grzegorz Kierzynka
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical College in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Jarosław Markowicz
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical College in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Jerzy Kolasiński
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical College in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Katarzyna Błochowiak
- Department of the Oral Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Paweł Szychta
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical College in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
- Department of Oncological Surgery and Breast Diseases, Polish Mother’s Memorial Hospital-Research Institute, Lodz, Poland
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Pinto CIC, Carvalho PJMC, Correia MMO. Madelung's Disease: Revision of 59 Surgical Cases. Aesthetic Plast Surg 2017; 41:359-368. [PMID: 28032179 DOI: 10.1007/s00266-016-0759-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 11/29/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Madelung's disease (MD) is a rare disease, more common in Mediterranean countries and associated with alcohol abuse. However, MD etiology remains not completely understood. OBJECTIVE The aim of this study was to investigate clinical features, treatment options and outcomes in patients with MD treated in our plastic surgery department. METHODS We retrospectively reviewed 59 cases of MD operated on between 2004 and 2013. Demographic information, location of the deposits, associated pathology and habits, number and type of surgeries performed, surgical complications and disease evolution were analyzed. RESULTS Ninety percent of the patients were males. Active or past history of alcohol abuse was reported by 86%. The main affected areas were anterior and posterior neck. A total of 230 surgical procedures were performed. Open surgery was used on 192 occasions (83.5%), liposuction alone on 30 procedures (13%) and lipectomy combined with liposuction on 8 interventions (3.5%). Surgical complications were found in 41 procedures (17.8%). Twenty-three patients (39%) were identified as having disease recurrence of the operated site in a mean time of 3.8 years. Alcohol consumption was not clearly associated with disease recurrence. CONCLUSIONS Demographic characteristics of the studied cohort stand for published data. It is our opinion that lipectomy/dermolipectomy provides better aesthetic and functional results. Lipectomy procedures allow a thorough excision, correct identification of noble structures and careful hemostasis. Liposuction techniques, even ultrasound-assisted ones, had limited efficacy for the treatment of large masses. A long follow-up period is recommended considering the high propensity and mean time to recurrence. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Joven MH, McKenzie TJ, Lindell RM, Robert Shen K, Gillaspie EA, Gharib H. Co-Existent Symptomatic Large Retrosternal Nontoxic Multinodular Goiter With Mediastinal Lipoma. AACE Clin Case Rep 2017. [DOI: 10.4158/ep161385.cr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Tadisina KK, Mlynek KS, Hwang LK, Riazi H, Papay FA, Zins JE. Syndromic lipomatosis of the head and neck: a review of the literature. Aesthetic Plast Surg 2015; 39:440-8. [PMID: 25860506 DOI: 10.1007/s00266-015-0478-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 03/16/2015] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Patients with syndromic causes of lipomatosis of the head and neck, although rare, often present late in the course of the disease in a myriad of ways, including concomitant airway obstruction, severe functional limitations, and/or significant cosmetic defects. The goal of this report was to review the literature and present a concise overview of the major syndromes causing lipomatosis of the head and neck. METHODS A literature search was performed to gather information on syndromic lipomatosis of the head and neck region. PubMed was searched for the following conditions: Familial multiple lipomatosis (FML), multiple symmetrical lipomatosis (MSL), congenital infiltrating lipomatosis of the face (CIL-F), and Nasopalpebral lipoma-coloboma syndrome (NLCS). Data gathered included results of surgical cases of the head and neck region. RESULTS A total of 48 reports comprising 172 cases of syndromic lipomatosis of the head and neck region were deemed eligible for review. Eighty-five percent of patients were male with an average age of 35 years. Seventy-four percent of cases appeared in the neck region, whereas 23 % presented in the face and scalp. 89 % of cases were treated with surgical excision, with 11 % of cases treated with liposuction. The most common complications were hematoma and seroma in MSL, recurrence in FML, neuropraxia in CIL-F, and mild telecanthus in NLCS. CONCLUSIONS Syndromic causes of lipomatosis are generally benign in nature but difficult to control long term. Because these conditions include frequent recurrence and subsequent difficulty in clearing the disease, the authors advocate early and aggressive surgical excision of syndromic lipomatosis. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Kashyap Komarraju Tadisina
- Department of Plastic Surgery, Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave, Suite A60, Cleveland, OH, 44195, USA
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Scrotal Lipomatosis Mimicking Varicocele: A Case Report and Review of the Literature. Case Rep Urol 2015; 2015:695314. [PMID: 26664817 PMCID: PMC4664782 DOI: 10.1155/2015/695314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 10/28/2015] [Accepted: 11/02/2015] [Indexed: 12/01/2022] Open
Abstract
Scrotal lipomatosis is a rarely seen disease with an etiology that is not fully understood. Some information suggests that this disease may be associated with infertility. It is characterized by pain-free scrotal swelling. In this study, we reported a scrotal lipomatosis case presenting due to infertility and pain-free scrotal swelling. It was operated on with the initial diagnosis of varicocele, but once fatty tissue was observed in the scrotum, the case was diagnosed as scrotal lipomatosis. Here, we present this rare case with a literature review.
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21
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Jang JH, Lee A, Han SA, Ryu JK, Song JY. Multiple Symmetric Lipomatosis (Madelung's Disease) Presenting as Bilateral Huge Gynecomastia. J Breast Cancer 2014; 17:397-400. [PMID: 25548590 PMCID: PMC4278061 DOI: 10.4048/jbc.2014.17.4.397] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 11/11/2014] [Indexed: 12/15/2022] Open
Abstract
Multiple symmetric lipomatosis (MSL), or Madelung's disease, is a rare disease of unknown etiology. It is characterized by the presence of loose adipose tissue deposits localized in the cervical region and upper body. MSL presenting as bilateral huge gynecomastia is an extremely rare phenomenon. The present report describes a case of MSL in a 66-year-old man. The patients presented with bilateral breast bulging. He had a history of cigarette and alcohol use. His condition was treated with a bilateral nipple-sparing mastectomy. MSL can present as a form of gynecomastia, for its accurate diagnosis and proper treatment of MSL, increasing awareness of the clinical characteristics of the disease is required, especially amongst breast surgeons. Herein, we review the literature and discuss the clinical characteristics, pathology, and surgical treatment of MSL.
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Affiliation(s)
- Jae Hoon Jang
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Anbok Lee
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Sang-Ah Han
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jung-Kyu Ryu
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jeong-Yoon Song
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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22
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Tai CJ, Huang CT, Voon WC, Lee KT. Madelung's disease mimicking deep vein thrombosis: an unusual case. Int J Cardiol 2013; 172:e74-5. [PMID: 24411206 DOI: 10.1016/j.ijcard.2013.12.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 12/21/2013] [Indexed: 01/30/2023]
Affiliation(s)
- Chi-Jung Tai
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Chia-Tsuan Huang
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Family Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Wen-Chol Voon
- Department of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Cardiovascular Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Kun-Tai Lee
- Department of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Cardiovascular Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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23
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Dinis-Oliveira RJ, Magalhães T, Moreira R, Proença JB, Pontes H, Santos A, Duarte JA, Carvalho F. Clinical and forensic signs related to ethanol abuse: a mechanistic approach. Toxicol Mech Methods 2013; 24:81-110. [PMID: 24274640 DOI: 10.3109/15376516.2013.869782] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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24
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Starkman SJ, Olsen SM, Lewis JE, Olsen KD, Sabri A. Lipomatous lesions of the parotid gland: analysis of 70 cases. Laryngoscope 2013; 123:651-6. [PMID: 23401010 DOI: 10.1002/lary.23723] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 07/27/2012] [Accepted: 08/13/2012] [Indexed: 12/14/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate presenting signs and symptoms, preoperative workup, operative therapy, and morbidity of benign and malignant lipomatous lesions of the parotid gland. STUDY DESIGN Medical literature review and retrospective chart review for all patients who underwent surgery for lipomatous lesions of the parotid gland at our institution from 1959 to 2009. METHODS Seventy patients underwent surgery for such lesions. Histologic sections were stained with hematoxylin-eosin and reviewed, and clinical information was obtained from hospital medical records for each case. RESULTS Forty-nine patients (70.0%) were male and 21 (30.0%) female (mean age, 49.9 years). Of the lesions, 43 (63.2%) were intraparotid, 25 (36.8%) periparotid, 69 (98.6%) unilateral, and 1 (1.4%) bilateral (average size, 3.7 cm). Fifty-nine patients were treated with superficial or partial superficial parotidectomy, 10 were treated with total parotidectomy, and one was treated with parapharyngeal space dissection. Complications included six cases (8.6%) of facial paresis or paralysis and two cases of hematoma. No lesions recurred. CONCLUSIONS We present the largest series, to our knowledge, of lipomatous lesions of the parotid gland. These masses, although rare, should be considered in the evaluation of a parotid mass. This series provides insight into the clinical presentation, diagnostic evaluation, and surgical treatment of parotid lipomatous lesions. Surgical extent depends on lesion location in the gland. Lipomatous masses can be effectively treated surgically with low morbidity and high cure rates.
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Affiliation(s)
- Sidney J Starkman
- Mayo Medical School, College of Medicine, American University of Beirut, Beirut, Lebanon
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25
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An Unusual Case of Madelung's Disease with Multiple Atypical Fractures. Case Rep Orthop 2012; 2012:180506. [PMID: 23346439 PMCID: PMC3549382 DOI: 10.1155/2012/180506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 12/20/2012] [Indexed: 12/25/2022] Open
Abstract
Madelung's disease is a rare acquired disorder of fat metabolism characterized by multiple symmetric lipomas with typical distribution mainly around the upper trunk, neck, and shoulders. The condition is strongly associated with chronic alcohol use and has various systemic manifestations like polyneuropathy, muscle weakness, and small bone fractures. Herein, we report a 56-year-old male patient with Madelung's disease and multiple fractures and discuss possible underlying factors leading to multiple fractures.
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Olsen AB, Grebe TA, Joganic E. Multiple symmetric lipomatosis as a genetic disorder: a review. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-012-0697-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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27
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Fakhry N, Michel J, Varoquaux A, Antonini F, Santini L, Lagier A, Turner F, Dessi P, Giovanni A. Is surgical excision of lipomas arising from the parotid gland systematically required? Eur Arch Otorhinolaryngol 2011; 269:1839-44. [PMID: 22116381 DOI: 10.1007/s00405-011-1843-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 11/09/2011] [Indexed: 12/16/2022]
Abstract
Lipomas arising from the parotid gland are very rare. We report a 10-year experience in a single institution (La Timone University Hospital of Marseille, France). Among 614 parotidectomies for neoplasms performed from 1998 to 2008, 12 lipomas were identified. A retrospective analysis based on medical records was made. Evaluation, analysis and current management of lipomas of the parotid gland are described. Lipomas accounted for 2% of all parotid neoplasms and 2.6% of benign tumors in our series. The median age of patients was 60 years with a M/F sex ratio of 5-1. The main presentation was a soft asymptomatic, slow-growing, mobile mass although 30% had an indurated mass on palpation. Diagnosis of lipoma, based on the results of imaging, was made preoperatively in all cases. The mean tumor duration prior to excision was 11.5 months. The surgical decision was made regarding increased swelling with functional/esthetic discomfort in 83% of cases. Partial parotidectomy was performed in most cases. Postoperative complications occurred in 16% of cases although no permanent complication was observed. No recurrence was observed in our series. Histologically, 92% of tumors were classic lipomas. Lipomas can be clinically misleading since 30% of patients in our series showed an indurated mass on palpation. Preoperative imaging, especially MRI, is the cornerstone of their management as it allows very accurate lipoma diagnosis. Since in our series, diagnosis of lipoma had been made preoperatively in all cases, the surgical excision could be delayed and finally surgical decision has been made for esthetic and/or functional considerations in more than 80% of cases.
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Affiliation(s)
- Nicolas Fakhry
- Service ORL et Chirurgie Cervico-Faciale, Pôle Cervico-Facial, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire, La Timone, 264, rue Saint Pierre, 13385 Marseille cedex 05, France.
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Gomes da Silva R, Detoffol Bragança R, Ribeiro Costa C, Torres de Melo L, Weiss Telles R, Costa Silva L. Multiple symmetric lipomatosis. J Cutan Med Surg 2011; 15:230-5. [PMID: 21781630 DOI: 10.2310/7750.2011.10026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Multiple symmetric lipomatosis (MSL) is a relatively uncommon entity of unknown etiology characterized by symmetrically subcutaneous accumulation of nonencapsulated adipose tissue. Approximately 200 to 300 cases have been published. OBJECTIVES The aims of this article are to report the case of a 58-year-old Brazilian patient with MSL and provide a comprehensive overview of the current concepts concerning this disease. METHODS Our search yielded 28 articles on MSL, including case reports and reviews of the literature. RESULTS MSL predominantly affects Mediterranean males with a history of chronic alcohol abuse. It is usually asymptomatic and may be associated with diabetes mellitus, hyperlipidemia, hyperuricemia, macrocytic anemia, and oral cancer. Surgical resection is the best treatment option. CONCLUSION The case reported is a classic presentation of MSL; however, it is particularly uncommon owing to the association with immune thrombocytopenic purpura. This association has been described only once in the medical literature.
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Affiliation(s)
- Silviu Albu
- Department of Otolaryngology, University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
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Osteoporosis, weight gain and atypical fat accumulations - a typical feature not only for Cushing's, but also Madelung's disease: A case report. Wien Klin Wochenschr 2011; 124:188-92. [PMID: 21912940 DOI: 10.1007/s00508-011-0045-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Accepted: 07/31/2011] [Indexed: 01/30/2023]
Abstract
Madelung's disease, or multiple symmetric lipomatosis, is an extremely rare disease and very likely to be under-diagnosed. It is characterized by multiple symmetrical non-encapsulated fat accumulations mainly located around the neck, shoulders, upper extremities and upper parts of the trunk. The disorder predominantly affects middle-aged men of Mediterranean origin with a history of ethanol intake. Reports of this uncommon disorder in women are very rare. The aim of this article is to report the endocrine and metabolic workup leading to the diagnosis of this uncommon disorder. A 55-year-old woman with osteoporosis was referred to our outpatient clinic with a suspected diagnosis of Cushing's disease. The patient complained of undesired weight gain with atypical fat accumulations predominantly in the upper trunk region during the previous 10 weeks. She presented with the characteristic physical features of Madelung's disease and underwent a thorough examination with endocrine and metabolic evaluation of this rare condition and was finally diagnosed with Madelung's disease. This report demonstrates how a diagnosis of this rare disorder can be reached efficiently. A history of osteoporosis in combination with weight gain and atypical fat accumulations ultimately led to the diagnosis of Madelung's diseases, a rather unknown disorder likely to be under-diagnosed. Although treatment options are limited, a diagnosis is still important for the affected individual.
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31
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Kim JK, Kim KC. A Case of Multiple Symmetrical Lipomatosis Causing Upper Airway Obstruction. Tuberc Respir Dis (Seoul) 2011. [DOI: 10.4046/trd.2011.70.1.63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jeong Kyu Kim
- Department of Otolaryngology, Catholic University of Daegu Schoole of Medicine, Daegu, Korea
| | - Kyung Chan Kim
- Department of Internal Medicine, Catholic University of Daegu Schoole of Medicine, Daegu, Korea
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32
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Affiliation(s)
- Mei-Ju Ko
- Department of Dermatology, Ren-ai Branch, Taipei City Hospital, Taipei, Taiwan
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33
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Imai T, Michizawa M, Shimizu H, Imai T, Yamamoto N, Yura Y. Bilateral multiple spindle cell lipomas of the tongue. ACTA ACUST UNITED AC 2008; 106:264-9. [PMID: 18644522 DOI: 10.1016/j.tripleo.2008.02.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 02/18/2008] [Accepted: 02/18/2008] [Indexed: 01/30/2023]
Affiliation(s)
- Tomoaki Imai
- Department of Oral and Maxillofacial Surgery, Saiseikai Senri Hospital, Suita, Osaka, Japan.
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34
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Verna G, Kefalas N, Boriani F, Carlucci S, Choc I, Bocchiotti MA. Launois-Bensaude Syndrome: an unusual localization of obesity disease. Obes Surg 2008; 18:1313-7. [PMID: 18408978 DOI: 10.1007/s11695-008-9502-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Accepted: 03/10/2008] [Indexed: 12/25/2022]
Abstract
BACKGROUND Launois-Bensaude syndrome is a rare pathology consisting of adipose masses symmetrically distributed mainly in the superior part of the body. Men are especially affected between age of 30 and 60 as well as chronic alcohol abusers. Etiopathogenesis is attributable to mutations or deletions of mitochondrial DNA, and alcohol is a possible cofactor. METHODS The current treatment of the disease is described based on the authors' experience. Four cases treated in our department are retrospectively reviewed regarding comorbidities and type of surgery performed. RESULTS A relevant and long-lasting reduction of fat bulges has been obtained in all cases with no major complications except for a mild anemia. CONCLUSION Launois-Bensaude syndrome causes a functional rather than esthetic concern due to the peculiar localization of fat bulges. Currently, the only effective therapy is surgery, through lipectomy or liposuction of adipose bulges.
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Affiliation(s)
- Giovanni Verna
- Department of Plastic Reconstructive and Aesthetic Surgery, University of Turin, Turin, Italy
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35
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Di Scioscio V, Loffreda V, Feraco P, Luccaroni R, Palena LM, Balbi T, Zompatori M. Diffuse lipomatosis of thyroid gland. J Clin Endocrinol Metab 2008; 93:8-9. [PMID: 18178906 DOI: 10.1210/jc.2007-1667] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- V Di Scioscio
- Department of Radiology, S Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy.
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