ABSTRACT
Resumen El lipedema es un trastorno crónico que se caracteriza por una hiperplasia del tejido adiposo subcutáneo simétrico, deformante, asociado a hematomas y dolor, que afecta fundamentalmente a mujeres tras la pubertad, que suele ser familiar y tiene influencia hormonal. Sin tratamiento, el lipedema puede progresar a linfedema, y se ha asociado al aumento en la rigidez de la aorta. La mecánica rotacional del ventrículo izquierdo (VI) tiene un papel significativo en la circulación normal. En circunstancias normales, la base del VI rota en el sentido de las agujas del reloj, mientras que el ápex del VI rota en sentido contrario, provocando un movimiento como de retorcer una toalla llamado torsión del VI. En el presente caso, mediante ecocardiografía speckle-tracking tridimensional se reveló una torsión del VI demostrando un ápex VI en el sentido de las agujas del reloj y la rotación antihoraria de la base del VI en un paciente con características clínicas de lipedema.
Abstract Lipoedema is a chronic disorder that is characterised by a symmetric, deforming, hyperplasia of the subcutaneous adipose tissue, and is associated with haematomas and pain. It mainly affects women after puberty, is usually familial and is influence by hormones. Untreated, the lipoedema can progress to lymphoedema, and has been associated with the increase in aortic stiffness. The mechanical rotation of the left ventricle (LV) has an important role in normal circulation. In normal circumstances, the base of the LV rotates clockwise, while the LV apex rotates in the opposite direction, leading to a movement like wringing a towel, called LV twist. In the present case, using three-dimension speckle-tracking echocardiography, an LV twist is observed, showing an LV apex in the clockwise direction and the anti-clockwise rotation of the LV base in a patient with clinical characteristics of lipoedema.
Subject(s)
Humans , Female , Middle Aged , Echocardiography , Lipedema , Rotation , Heart Ventricles , HyperplasiaABSTRACT
Although gait problems have been reported in patients with lower limb lymphedema (LLL), the gait pattern (GP) changes have not been documented yet. However, it is possible that patients with LLL show abnormal GP that can be related to biomechanical complications related to osteoarthritis or falls affecting the quality of life. Ground reaction force analysis during gait allows objective assessment of the patients and it can be used to plan a rehabilitation approach. Objective: To analyze the GRF during gait in patients LLL. Methods: An experimental descriptive study was realized with twenty-three LLL patients, both unilateral and bilateral and classified as moderate and severe, participated in the experiments. The patients walked on a force plate while the three ground reaction force (GRF) components, vertical, mediolateral (M-L) and anteroposterior (A-P), under their feet were recorded and analyzed. Results: In the patients with unilateral lymphedema, either moderate or severe, the vertical GRF components of the affected limb were similar to the sound one and also resembling those found in healthy adults. The M-L GRF was smaller in the non-affected side. In patients with bilateral lymphedema gait speed was significantly slower. More interestingly, the vertical GRF pattern was flat, not showing the typical 2-peak shape. Finally, the large M-L forces found suggest gait stability problems. Conclusions: The patients showed abnormal GRF patterns, including compensation with the non-affected leg. The GRF variability was higher in the patients with severe unilateral lymphedema. Bilateral lymphedema results in lower A-P forces. Stance phase duration was longer in patients with bilateral and severe lymphedema