La lipotransferencia como complemento seguro en la reconstrucción orbitaria / Lipotransfer as a Safe Adjunct in Orbital Reconstruction

Los defectos periorbitarios independientemente de su causa, suelen relacionarse con los servicios médicos oftalmológicos; sin embargo, en ocasiones requieren de la intervención del cirujano plástico. La pérdida de un globo ocular tiene repercusiones funcionales, estéticas y psicológicas en las personas que la sufren. Puede exponer asimetrías de los tejidos subyacentes más profundos que mejoran con el lipoinjerto al devolver los contornos de los tejidos blandos alrededor del ojo. El objetivo de presentar esta serie de casos es mostrar la utilidad del lipoinjerto autólogo asistido con células madre del tejido adiposo como complemento de la reconstrucción de la órbita. Se presentan tres casos que acudieron al servicio de Cirugía Plástica del Hospital Clínico Quirúrgico Hermanos Ameijeiras remitidas desde el servicio de Cirugía Plástica Ocular del Instituto Cubano de Oftalmología Ramón Pando Ferrer por atrofia de la grasa periorbitaria por cirugía de cavidades anoftálmicas. Se verificó que cumplieran con los criterios de selección de pacientes para cirugía plástica y se citaron para tratamiento quirúrgico con técnica de lipotransferencia asistida con células madre. La lipotransferencia asistida con células madre derivadas del tejido adiposo constituye un complemento terapéutico seguro y necesario para obtener mejores resultados estéticos en la reconstrucción de la órbita. El éxito final está en lograr una buena apariencia de los párpados, con la capacidad para retener una prótesis ocular que permita el crecimiento adecuado del hueso facial y mejorar el aspecto estético(AU)

Periorbital defects, regardless of their etiology, are usually related to ophthalmologic medical services; however, sometimes they require the intervention of the plastic surgeon. The loss of an eyeball has functional, aesthetic and psychological repercussions in those who suffer it. It can expose deeper underlying tissue asymmetries that improve with lipografting by restoring the soft tissue contours around the eye. The purpose of presenting this case series is to show the utility of autologous adipose tissue stem cell-assisted lipograft as an adjunct to orbital reconstruction. Three cases are presented that came to the Plastic Surgery Service of the Hospital Clínico Quirúrgico Hermanos Ameijeiras referred from the Ocular Plastic Surgery Service of the Instituto Cubano de Oftalmología Ramón Pando Ferrer for atrophy of the periorbital fat due to surgery of anophthalmic cavities. It was verified that they met the criteria for selection of patients for plastic surgery and they were scheduled for surgical treatment with stem cell-assisted lipotransfer technique. Stem cell assisted lipotransfer is a safe and necessary therapeutic complement to obtain better aesthetic results in the reconstruction of the orbit. The ultimate success lies in achieving a good appearance of the eyelids, with the ability to retain an ocular prosthesis that allows adequate growth of the facial bone and improve the aesthetic appearance(AU)

Effects of lipografts in immune-driven lipoatrophies. Case studies

Lipodystrophy is a pathological condition associated with an abnormal body adipose tissue redistribution. Facial lipoatrophy can be a consequence of congenital, acquired, or involutional. The lipograft is an autologous fat transplant, which constitutes a treatment option that provides volume, tissue regeneration, and advantages in relation to other fillers in autoimmune diseases. The aim is to highlight the filling action and the metabolic effect of facial lipotransfer, due to the grafted adipocytes survival, and the adipose tissue derived stem cells regenerative activity obtained by nano-fat in patients with facial lipoatrophy. Lipoinjection improves the architecture of the new dermis and increases its functional capacity. It is a treatment with autologous tissue (fatty graft) with great efficacy in relation to other alloplastic filler materials capable of exacerbating an inflammatory response mediated by antibody production.

La lipodistrofia es una condición patológica asociada a una redistribución anómala del tejido adiposo en el cuerpo. La lipoatrofia facial puede ser consecuencia de defectos congénitos, adquiridos o involutivos. El lipoinjerto es el trasplante de grasa autógena y constituye una opción de tratamiento que aporta volumen, regeneración tisular y ventajas en relación con otros materiales de relleno en enfermedades autoinmunes. Se busca resaltar la acción de relleno y el efecto metabólico de la lipotransferencia facial, por la supervivencia de los adipocitos injertados y la actividad regenerativa de las células madre provenientes del tejido adiposo obtenidas por nanofat en pacientes con lipoatrofia facial. La lipoinyección mejora la arquitectura de la nueva dermis y aumenta su capacidad funcional, es un tratamiento con tejido autógeno (injerto graso) con gran eficacia en relación con otros materiales de relleno aloplásticos capaces de exacerbar una respuesta inflamatoria mediada por la producción de anticuerpos.

Hemangioma de crecimiento mínimo o detenido con lipoatrofia: presentación de un caso clínico / Hemangioma with minimal or arrested growth

Los hemangiomas de la infancia (HI) son tumo-res vasculares que presentan un patrón evolutivo característico. Existe un subgrupo de HI que pre-senta un tipo de crecimiento distinto denominados hemangiomas de la infancia con crecimiento míni-mo o detenido (HI-CMD). En estos, el componen-te proliferativo no supera el 25% de la superficie total; además, afecta a niños de al menos dos meses de edad en la consulta inicial o a niños menores de dicha edad en los que se realiza un seguimiento mayor a 2 meses. Los HI- CMD con lipoatrofia son una variante poco frecuente de HI de la cual exis-ten escasos reportes en la literatura. El objetivo de nuestro trabajo es presentar un caso de HI-CMD con lipoatrofia en una lactante. Los HI-CMD presentan un desafío diagnóstico ya que deben ser reconocidos precozmente y diferencia-dos de otras lesiones vasculares.

Infantile hemangiomas (IH) are vascular tumors that present a characteristic evolutive pattern. There is a subgroup of hemangiomas that pre-sents a different type of growth called infantile hemangiomas with minimal or arrested growth (IH-MAG). In these, the proliferative component does not exceed 25% of the total surface; it also affects children of at least two months of age in the initial consultation or children under that age in which a follow-up of more than 2 months is carried out. IH-MAG with lipoatrophy is a rare variant of IH of which there are few reports in the literature.The aim of our report is to present a case of IH-MAG with lipoatrophy in an infant. IH-MAGs present a diagnostic challenge since they must be recognized early, and differentiated from other vascular lesions.

Human insulin and its analog injection-induced localized lipoatrophy: 6 case reports and systemic review / 中华临床营养杂志

Objective To investigate clinical and pathological characteristics of insulin-induced localized lipoatrophy and treatment.Methods We retrospectively analyzed clinical manifestation, skin biopsy pathology, treatment regimen and follow-up of 6 diabetic patients with insulin-induced localized lipoatrophy in Peking Union Medical College Hospital from January, 2010 to March, 2016, with systemic review of related literatures.Results Among 6 cases with insulin-induced localized lipoatrophy, 5 patients were with insulin allergy.5 patients were with positive insulin-autoimmune antibody, which was similar to the ratio reported in the systematic review (18 out of 19).Insulin-induced lipoatrophy could be caused by various types of preparations of insulin and insulin analogs.Subcutaneous biopsy, performed on the atrophied area, revealed the decrease of the number and volume of adipocytes and tissue fibrosis, probably accompanied with lymphocytes, eosinophils or mast cells infiltration.Lipoatrophy could sometimes be relieved by changing injection sites, types of insulin preparations or drug-delivery way, sometimes by application of systemic/local glucocorticoid or local cromolyn sodium.Conclusions Insulin-induced localized lipoatrophy is a rare adverse reaction of insulin preparations.It might be related to immune response of local tissue and heterogeneous pathological manifestations.The lipoatrophy might be improved by changing injection sites, changing the type of insulin preparations or drug-delivery way, and with possibility to carry out targeted immunosuppressive therapy according to the biopsy pathology in the future.

A Case of Semicircular Lipoatrophy / 대한피부과학회지

No abstract available.

Comments to “A Case of Lipoatrophia Semicircularis Confirmed by Ultrasonography” / 대한피부과학회지

No abstract available.

Discordance beteeen body mass index and anthropmetric measurements among hiv-11-infected patients on antiretroviral therapy and with lipoatrophy/lipohypertrophy syndrome / Discordância entre o índice de massa corporal e outras medidas antropométricas em pacientes infectados pelo HIV com a síndrome de lipoatrofia/lipohipertrofia em uso de medicação antirretroviral

Introduction: Highly Active Antiretroviral Therapy (HAART) has improved and extended the lives of thousands of people living with HIV/AIDS around the world. However, this treatment can lead to the development of adverse reactions such as lipoatrophy/lipohypertrophy syndrome (LLS) and its associated risks. Objective: This study was designed to assess the prevalence of self-reported lipodystrophy and nutritional status by anthropometric measurements in patients with HIV/AIDS. Methods: An observational study of 227 adult patients in the Secondary Immunodeficiencies Outpatient Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo (3002 ADEE-HCFMUSP). The sample was divided into three groups; Group 1 = 92 patients on HAART and with self-reported lipodystrophy, Group 2 = 70 patients on HAART without self-reported lipodystrophy and Group 3 = 65 patients not taking HAART. The nutritional status of individuals in the study sample was determined by body mass index (BMI) and percentage of body fat (% BF). The cardiovascular risk and diseases associated with abdominal obesity were determined by waist/hip ratio (WHR) and waist circumference (WC). Results: The prevalence of self-reported lipoatrophy/lipohypertrophy syndrome was 33% among women and 59% among men. Anthropometry showed depletion of fat mass in the evaluation of the triceps (TSF) in the treatment groups with HAART and was statistically independent of gender; for men p = 0.001, and for women p = 0.007. Similar results were found in the measurement of skin folds of the upper and lower body (p = 0.001 and p = 0.003 respectively). In assessing the nutritional status of groups by BMI and % BF, excess weight and body fat were more prevalent among women compared to men (p = 0.726). The WHR and WC revealed risks for cardiovascular and other diseases associated with abdominal obesity for women on HAART and with self-reported LLS (p = 0.005) and (p = 0.011). ...

Objetivos: A terapia antirretroviral altamente ativa (HAART) tem melhorado e aumentado a vida de milhares de pessoas que vivem com a infecção pelo HIV/AIDS em todo o mundo. No entanto, este tratamento pode levar ao desenvolvimento da síndrome da lipodistrofia (LDS). Este estudo foi desenvolvido para avaliar a prevalência de auto-relato de LDS, perfil nutricional e medidas antropométricas de pacientes com HIV/AIDS. Métodos: Estudo observacional de 227 pacientes adultos, divididos em: Grupo 1: 92 pacientes em HAART e com LDS; Grupo 2: 70 pacientes em tratamento com HAART e sem LDS e Grupo 3: 65 pacientes que não tomam HAART. O estado nutricional foi avaliado pelo índice de massa corporal (IMC) e o percentual de gordura corporal (%GC) por meio de medidas antropométricas. Resultados: A prevalência de auto-relato de LDS foi de 44% entre as mulheres e 39% entre os homens. DC do tríceps (PCT) apresentou-se mais elevada no grupo HAART e LDS (homens p < 0,001; mulheres p < 0,007) em comparação com aqueles sem HAART, respectivamente. IMC revelou excesso de peso para a maioria dos indivíduos. Conclusões: As medidas antropométricas foram úteis para confirmar a prevalência de auto-relato da síndrome da lipodistrofia. A avaliação das dobras dos braços e pernas revelou-se um bom método para avaliação antropométrica de lipoatrofia de membro, independentemente do sexo. Estes resultados permitiram o estabelecimento de estratégias para o diagnóstico precoce da LDS na prática clínica, em pessoas vivendo com HIV / AIDS. .

Two Cases of Lipoatrophy after Local Corticosteroid Injection / 대한임상신경생리학회지

The adverse effects of systemic steroid medications are well known, whereas those of local steroid injections are unclear even to clinicians. We report two cases of localized lipoatrophy and depigmentation following local steroid injection. Although the incidence of soft tissue atrophy after local steroid injection is rare, it will increase in proportion to the frequency of the procedure. All clinicians, even those who do not perform steroid injections, should be aware of the occurrence of this cosmetically disturbing adverse effect.

Bilateral Facial Lipoatrophy-As Sole Manifestation of Lupus Panniculitis.

Lupus erythematosus can have varied manifestation in skin ranging from classical lesion of DLE (Discoid Lupus Erythematosus) and photosensitivity to Necrotic lesions of vasculitis or atrophic lesion. Panniculitis as histological finding in biopsy taken from any lesion of SLE (Systemic Lupus Erythematosus) is expected as associated finding. We report one case with lipoatrophy as sole manifestation of lupus panniculitis in which patient presented to us with bilateral facial lipoatrophy. On further investigation patient was ANA (Antinuclear Antibody) positive and histopathology was also suggestive of lupus panniculitis. LE (Lupus Erythematous) presenting solely as lupus panniculitis is rare clinical manifestation and poses a considerable diagnostic challenge more so when presentation is lipoatropy.

Antiretroviral Therapy Regimen Change Among HIV/AIDS Patients in Nekemt Hospital: a Primary Care Hospital in Oromia Regional State, Ethiopia.

ART brings a complex series of choices; when to initiate therapy, what regimen to use, which class of drugs to use, when to change therapy, and which alternative drugs to use. Therefore, this study aims to assess reasons for initial ART regimen change in Nekemt Hospital. A retrospective cross sectional study was done by reviewing patient information sheet recorded from January 1, 2006 to December 31, 2010. Patients who changed their regimen were included in the study to identify the reasons for change and descriptive statistics were generated using SPSS version 16. Out of 142 patients, 57.7% were females and 57.7% were inthe age group 20-34. 61.2% were WHO clinical stage III patients and 69.7% of patients had a CD4 count below 350 cells/mm3. The most common initial regimens were D4T/3TC/NVP (42.2%), D4T/3TC/EFV (27.5%) and AZT/3TC/EFV (12.7%). The main reasons for modification of therapy were toxicity (80.3%), pregnancy (6.3%), new TB (5.6%), stock out (4.9%) and treatment failure (2.8%). The main toxicity observed was lipoatrophy (58.8%) followed by rash (12.3%) and CNS toxicity (11.4%). Toxicity was the main reason for initial regimen modification. D4T based regimens had high incidence of lipoatrophy.

Lipoatrofia semicircular, una visión general a una patología laboral emergente en Chile / Semicircular lipatrophy, an overview of emerging labor pathology in Chile

La Lipoatrofia Semicircular (LS) es una enfermedad idiopática, que se caracteriza por una atrofia reversible y localizada, ya sea total o parcial, del tejido adiposo subcutáneo y que se ubica en zonas de contacto de la piel de las extremidades con el inmobiliario. Se caracteriza por presentarse en brotes endémicos, cuyo único factor en común es el lugar de trabajo. Sus causas son desconocidas, pero en la actualidad se proponen factores asociados como: el contacto de la zona afectada con inmobiliario, presencia de radiación electromagnética, presencia de descargas electroestáticas y humedad ambiental relativa baja. Un modelo actual para explicar la patogenia de esta enfermedad involucra la participación de descargas electrostáticas, que probablemente activarían la liberación de factor de necrosis tumoral a (TNF-a) y desencadenaría la fagocitosis de adipocitos. Actualmente no tiene un tratamiento médico, siendo las medidas preventivas de mitigación de los factores previamente mencionados las que producen una reversión de la lesión. Por otro lado, la presencia de estos brotes generan un gran impacto mediático por lo que también debe ser abordada comunicacionalmente. La presente revisión pretende sintetizar la literatura sobre el tema para exponer el conocimiento actual y lograr una noción de esta nueva enfermedad, tras su primera presentación en brote en nuestro país.

Lipoatrophia semicircularis (LS) (also known as "Semicircular lipoa-trophy") is an idiopathic disease, which is characterized by a reversible and localized atrophy, either total or partial, of subcutaneous adipose tissue and located in areas of skin contact with the real estate tips. It is characterized by appearing in endemic outbreaks whose only common factor is the workplace. Its causes are unknown, but currently associated factors have been proposed, such as: the contact area with the office furniture, the presence of electromagnetic radiation, electrostatic discharge and presence of low relative humidity. A current model to explain the pathogenesis of this disease involves the participation of electrostatic discharges, which probably activate the release of tumor necrosis factor a (TNF-a) and it would trigger phagocytosis of adipocytes. Currently there is no medical treatment, being proactive mitigation measures of the before mentioned factors, those that produce a reversion of the injury. On the other hand, the presence of these buds generates great media impact so it must be also addressed from a communication standpoint. The present review aims to summarize the literature on the subject to present current knowledge and achieve a notion of this new disease, after its first appearance in outbreak in our country.

Semicircular Lipoatrophy Induced by Repetitive Microtrauma / 대한피부과학회지

No abstract available.

Tratamento da lipoatrofia facial em pessoas vivendo com HIV/AIDS: afastando o preconceito e melhorando a qualidade de vida / Tratamiento de la lipoatrofia facial en la gente infectada por HIV/AIDS: apartándose del prejuicio y mejorando la calidad de vida / Treatment of facial lipoatrophy in people infected by HIV/AIDS: moving away from prejudice and improving quality of life

Nos dias atuais observamos um maior controle da AIDS, com o advento da terapêutica anti-retroviral, mas os portadores do vírus HIV continuam suscetíveis a uma série de conseqüências físicas, psicológicas e sociais. Uma delas é a lipoatrofia facial, causada pala terapêutica antiretroviral, que causa modificações intensas no rosto. Um tratamento proposto e disponibilizado pelo SUS, neste caso, é o polimetilmetacrilato para o preenchimento cutâneo. Este artigo é o resultado de uma pesquisa que objetivou conhecer o sentimento do portador de HIV/AIDS em relaçãoa lipoatrofia facial e o significado de ter realizado o preenchimento facial. O estudo foi desenvolvido através de metodologia qualitativa, com uma amostra intencional de oito indivíduos que se submeteram à terapêutica de preenchimento cutâneo. O tratamento dos dados foi realizado através do Discurso do Sujeito Coletivo e pudemos encontrar como resultados dois momentos importantes. O primeiro relacionado à presença da lipoatrofia facial, onde as ideias centrais demonstram a redução da autoestima, insatisfação com a autoimagem, além de medos e inseguranças gerados pelos estigmas e discriminação contra HIV/AIDS. Em contrapartida a esse sentimento negativo, o preenchimento facial, se torna um marco importante e positivo, com o retorno da autoestima e melhora da autoimagem e melhora da adesão medicamentosa. Pudemos concluir que o oferecimento gratuito desse tratamento da lipoatrofia facial, aumentou a qualidade de vida desses portadores de HIV/AIDS, pois melhorou a aparência “distorcida”, ajudando-os a recuperar sua identidade e dignidade, preservando-os da discriminação e preconceito.

Nowadays we observe a higher control of AIDS, with the advent of anti-retroviral therapies, although people infected by HIV continue susceptible to a series of physical, psychological and social consequences. One of them is face lipoatrophy, caused by anti-retroviral treatments, which cause intense modifications in the face. A treatment considered and made available by SUS (Brazil’s Unified Health System), polymetilmetacrilate for skin filling. This article is the result of a research aiming at knowing how people infected by HIV/AIDS feel regarding facial lipoatrophy and the meaning of having skin filling. The study was developed through a qualitative methodology, with an intentional sample of eight individuals submitted to the skin filling treatment. Data treatment was carried through the Collective Subject Discourse and results had two important moments. The first is related to the presence of facial lipoatrophy, where central ideas demonstrate the reduction of self-esteem, non satisfaction with self-image, and fears and problems generated by stigmata and discrimination against HIV/AIDS. On the other hand this negative feeling about skin filling becomes an important and positive landmark with the return of self-esteem and improvements of self-imageand adhesion to treatment. We could conclude that free treatment of facial lipoatrophy increased the quality of life of subjects, improving their “distorted” appearance, helping them to rescue their identity and dignity, preserving them from discrimination and prejudice.

Observamos hoy en día un control más alto del SIDA, con el advenimiento de terapias antiretrovirales aunque la gente infectada por la SIDA continúe susceptible a una serie de consecuencias de la físicas, psicológicas y sociales. Una de ellas es la lipoatrofia de la cara, causada por los tratamientos antiretrovirales, que causan modificaciones intensas en la cara. Un tratamiento considerado e disponible por SUS (sistema unificado de la salud del Brasil) es el polimetilmetacrilato para el relleno de la piel. Este artículo es el resultado de una investigación que tiene como objetivo saber como la gente infectada por el SIDA siente acerca de la lipoatrofia facial y al significado de tener relleno de la piel. El estudio fue desarrollado con una metodología cualitativa, con una muestra intencional de ocho individuos sometidos al tratamiento de relleno de la piel. El tratamiento de los datos se hizo con el discurso del sujeto colectivo y los resultados tuvieran dos momentos importantes. El primer se relaciona con la presencia de lipoatrofia facial, donde las ideas centrales demuestran la reducción del amor propio, la no satisfacción con la auto-imagen, y miedos y problemas generados por los estigmas y la discriminación contra la SIDA. Esta sensación negativa sobre el relleno de la piel se convierte en una señal importante y positiva con la vuelta del amor propio y las mejoras de la auto-imagen y de la adherencia al tratamiento. Podríamos concluir que el tratamiento gratuito de la lipoatrofia facial aumentó la calidad de vida de los sujetos, mejorando su aspecto “torcido”, ayudándoles a rescatar su identidad y dignidad, preservándolas de la discriminación y del prejuicio.

Two Cases of Idiopathic Localized Involutional Lipoatrophy

Localized involutional lipoatrophy (LIL) is a rare distinctive idiopathic form of localized lipoatrophy. The characteristic features in histopathology of LIL are diminutive fat lobules composed of small adipocyte resembling fetal fat tissue. LIL is not a well-known disorder, there have been only a few reports on LIL in the English literature. We herein report 2 cases of LIL and review the previously published cases.

A Case of Semicircular Lipoatrophy Induced by Repeated Occupational Traumas / 대한피부과학회지

Semicircular lipoatrophy is a rare entity characterized by atrophic cutaneous indentation, typically involving the anterolateral thigh of young women. Although many previous reports have failed to reveal underlying trauma histories, repeated external microtraumas seem to be the most plausible causal factor at present. We report a case of semicircular lipoatrophy which occurred on both thighs of a 23-year-old woman after she started a new job as a waitress in fast-food restaurant.

A Case of Semicircular Lipoatrophy / 대한피부과학회지

Semicircular lipoatrophy is a rare condition, which presents as a bandlike semicircular depression, 2-4cm in width on the anterolateral aspects of the thighs. Histopathologic examination shows an atrophy of the subcutaneous fat. We report a case of semicircular lipoatrophy, which occured on both thighs of 47-year-old woman with asymptomatic, band-like atrophy.

A Case of Semicircular Lipoatrophy / 대한피부과학회지

A 39-year-old woman presented with one-month-history of symmetrical linear depressions on the anterolateral aspects of both upper thighs. The patient was aware of her leaning against the table to apply make-up. Histological examination showed atrophy of the upper part of the subcutaneous fat. We herein report the clinical course and etiologic features of semicircular lipoatrophy.

A Case of Semicircular Lipoatrophy / 대한피부과학회지

Semicircular lipoatrophy is an apparently rare disease that primarily affects adult woman. The lesion is characterized by a band-like semicircular depression, 2-4cm in width on the anterolateral aspects of the thighs. The overlying skin is normal. Usually, there are no subjective symptoms. There is no treatment, but most cases resolve in a few years. We experienced a typical case of semicircular lipoatrophy in a 43 years old woman. The patient showed an unilateral semicircular depressed lesion on the anterolateral aspect of the right thigh. Histopathologically, the lesion exhibited decrease in size of the individual adipocytes. The lesion resolved after 9 months without treatment.

Localized Idiopathic Lipoatrophy Showing Involutional Histopathology

We present cases of localized idiopathic lipoatrophy occurring in two women. A 19-year-old girl had symmetrically distributed annular telangiectatic atrophy on both buttocks and a 44-year-old female had annular telangiectatic atrophy on the right buttock. The histopathologic findings of these lesions revealed numerous capillaries, various sized lobules with small round or spindle shaped cells on a background of hyaline material in subcutaneous layer. Two cases of lipoatrophy which shows the involutional phase are reported.

A Case of Semicirvular Lipoatropy / 대한피부과학회지

A 21-year-old female is presented with semicircular lipoatrophy, which had developed since birth with annular depressed strophic lesion of the left thigh. Biopsy specimen from the depressed area of left thigh showed no abnormal pathologic findings. But X-ray and CT scan of the lower extremity revealed remarkably reduced fat layer of the left thigh, compared to the right side.