title: Liposuction in Dercum's disease: impact on haemostatic factors associated with cardiovascular disease and insulin sensitivity.
abstract: OBJECTIVE
  To study the impact of adipose tissue removal by liposuction on factors associated with increased risk of cardiovascular atherosclerotic disease within the coagulation and fibrinolytic system and glucose metabolism.
  
  
  METHODS
  Liposuction was performed in 53 patients with Dercum's disease. The levels of fibrinogen, von Willebrand factor antigen (VWF:Ag) and plasminogen activator inhibitor type 1 activity (PAI-1) were measured preoperatively, and 2 weeks, 4 weeks and 3 months postoperatively. In a subsample of 10 patients, insulin sensitivity was determined before and 2-4 weeks after surgery using the 2-h euglycaemic hyperinsulinaemic clamp technique. The study was performed as a single-centre study.
  
  
  METHODS
  Fibrinogen, PAI-1 and VWF:Ag levels, and glucose uptake before and after removal of adipose tissue.
  
  
  RESULTS
  Weight reduction was sustained throughout the follow-up period with a mean decrease from 90.7 to 86.6 kg (P < 0.0001). There was a slight increase in levels of coagulation factors 2 and 4 weeks postoperatively, probably in reaction to the surgical trauma. After 3 months the values had returned to preoperative levels except for PAI-1, which still showed a slight increase (P < 0.05). In the subsample of 10 patients, glucose uptake was improved (P < 0.05) from a short-term perspective after surgery.
  
  
  CONCLUSIONS
  Surgical removal of adipose tissue, without change in lifestyle, does not seem to improve the levels of coagulation and fibrinolytic factors associated with cardiovascular atherosclerotic disease, whereas glucose takeup may be facilitated and insulin sensitivity increases from a short-term perspective.
authors.affiliation: Department of Coagulation Disorders, University of Lund, Malmö University Hospital, Sweden. erik.berntorp@medforsk.mas.lu.se
authors.forename: E
authors.initials: E
authors.lastname: Berntorp
authors.forename: K
authors.initials: K
authors.lastname: Berntorp
authors.forename: H
authors.initials: H
authors.lastname: Brorson
authors.forename: K
authors.initials: K
authors.lastname: Frick
mesh_terms: D000274:Adiposis Dolorosa / Q000503:physiopathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D001161:Arteriosclerosis / Q000453:epidemiology*; D005260:Female; D005342:Fibrinolysis; D005947:Glucose / Q000378:metabolism; D006487:Hemostasis; D006801:Humans; D007328:Insulin / Q000378:metabolism*; D015187:Lipectomy; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D007328:Insulin; D005947:Glucose