Standard of care for lipedema in the United States.

BACKGROUND: Lipedema is a loose connective tissue disease predominantly in women identified by increased nodular and fibrotic adipose tissue on the buttocks, hips and limbs that develops at times of hormone, weight and shape change including puberty, pregnancy, and menopause. Lipedema tissue may be very painful and can severely impair mobility. Non-lipedema obesity, lymphedema, venous disease, and hypermobile joints are comorbidities. Lipedema tissue is difficult to reduce by diet, exercise, or bariatric surgery. METHODS: This paper is a consensus guideline on lipedema written by a US committee following the Delphi Method. Consensus statements are rated for strength using the GRADE system. RESULTS: Eighty-five consensus statements outline lipedema pathophysiology, and medical, surgical, vascular, and other therapeutic recommendations. Future research topics are suggested. CONCLUSION: These guidelines improve the understanding of the loose connective tissue disease, lipedema, to advance our understanding towards early diagnosis, treatments, and ultimately a cure for affected individuals.

A clinical study of a cardiac rehabilitation program (phase II)

Little has been published concerning the practice of cardiac rehabilitation in Puerto Rico. The purpose of this paper was to study and analyze the clinical data collected at the Cardiac Rehabilitation Program Phase II, in order to determine how adequate has been this program in its population. It was intended in this clinical study to determine the characteristics that describe the cardiac population which enters a cardiac rehabilitation program in Puerto Rico. Also, it was the purpose of this study to compare the initial and final evaluation of the patients that completed the program. Seventy-one patients were evaluated and 17 of them finished the whole program. The general population had a low level of daily physical activity, vital capacity, low back and hamstring flexibility, and a high percent of body fat. Theroup that completed the program showed significant increase in low back and hamstring flexibility, vital capacity and estimated daily energy expenditure. Low density lipoprotein and estimated daily resting energy expenditure significantly decreased; the patients were more active and resting less at the end of the program. This data suggest that the patients evaluated present various risk factors of coronary disease that might predispose to a second cardiac or surgical event, or progression of the disease. Also, these results suggest that this program might help in improving the risk factors related to health related fitness and physical inactivity.

Nerve conduction velocities: normal values for median and ulnar nerves

Cada laboratorio debe establecer sus propios parámetros normales para velocidades de conducción nerviosa, ya que, factores como temperatura, técnicas de medición y la localización de los electrodos pueden afectar los resultados. Cuarenta y cinco voluntarios (35 mujeres y 10 varones) entre las edades de 15 a 64 años, fueron sometidos a un historial completo y examen físico para excluir la posibilidad de neuropatía periférica. Las pruebas de laboratorios incluyeron hemograma, análisis de orina, SMA-12, glucosa plasmática 2 horas post prandial y pruebas de función tiroidea. Los valores obtenidos para las velocidades de conducción de los nervios medianos y ulnares fueron comparables con aquellos descritos previamente en la literatura. Cuando los valores fueron comparados entre grupos de edades, no se hallaron diferencias significativas. El proceso de envejecimiento no se encontró ser un factor determinante en la prolongación de velocidad de conducción o de la latencia distal