Question-based Self-reported Experience of Patients with Subcutaneous Adipose Tissue (SAT) Disease Prescribed Sympathomimetic Amines
Main Article Content
Abstract
Objective: Women with lipedema have painful excess subcutaneous fat on the limbs sparing the trunk. The fat in lipedema has fibrosis making it resistant to loss by diet and exercise (persistent fat). People with Dercum disease (DD) have painful masses in their fat tissue on the trunk and limbs. Lipedema can be confused with DD. Sympathomimetic amines such as amphetamine, dextroamphetamine or phentermine anecdotally appear to improve weight loss and quality of life in people with lipedema or DD. The primary objective was to address perceived benefits and downsides of prescribed sympathomimetic amines (SA) including dextroamphetamine, amphetamine or phentermine in women with lipedema and men and women with DD.
Methods: Fifty-four participants with lipedema and 26 with DD prescribed SA for ³3 months were consented to respond to a set of 82 categorical scale and descriptive questions and the validated lower extremity functional scale, based on the clinical experience of one of the authors (XXX) and her patients. Significance was set at a<0.05. Data were analyzed by Wilcoxon signed rank tests; continuous data was assessed by t-tests.
Results: Participants with lipedema and DD prescribed SA perceived significant improvements in energy level, ability to exercise, leg heaviness, body pain, functionality, and memory. Average self-reported weight decreased by ~25 kg in participants with DD and ~12 kglothing size About 90% of participants felt their quality of life improved. Less than 20% of participants reported side effects from the sympathomimetic amines including insomnia, abdominal pain and visual changes.
Conclusions: People with lipedema and DD report a significant benefit to risk ratio for their fat, pain and quality of life when prescribed sympathomimetic amines. A randomized prospective study would confirm benefits, safety and side effects.
Keywords:
appetite, weight loss medication, adipose tissue, obesity, sympathomimetic amines, lipedema, Dercum disease
Article Details
How to Cite
HERBST, Karen L; ABU-ZAID, Laila; FAZEL, Maryam.
Question-based Self-reported Experience of Patients with Subcutaneous Adipose Tissue (SAT) Disease Prescribed Sympathomimetic Amines.
Medical Research Archives, [S.l.], v. 7, n. 6, june 2019.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/1933>. Date accessed: 22 nov. 2024.
doi: https://doi.org/10.18103/mra.v7i6.1933.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Herbst K, Mirkovskaya L, Bharhagava A, Chava Y, Te CH. Lipedema Fat and Signs and Symptoms of Illness, Increase with Advancing Stage. Archives of Medicine. 2015;7(4:10):1-8.
2. Szolnoky G, Nemes A, Gavaller H, Forster T, Kemeny L. Lipedema is associated with increased aortic stiffness. Lymphology. 2012;45(2):71-9.
3. Földi E, Földi M. Das Lipödem. In: Földi M, Földi E, Kubik S, editors. Lehrbuch der Lymphologie für Mediziner, Masseure und Physiotherapeuten. Munich Elsevier, Urban&Fischer; 2005. p. 443-53.
4. Waxler JL, Guardino C, Feinn RS, Lee H, Pober BR, Stanley TL. Altered body composition, lipedema, and decreased bone density in individuals with Williams syndrome: A preliminary report. (1878-0849 (Electronic)).
5. Crescenzi R, Marton A, Donahue PMC, Mahany HB, Lants SK, Wang P, Beckman JA, Donahue MJ, Titze J. Tissue Sodium Content is Elevated in the Skin and Subcutaneous Adipose Tissue in Women with Lipedema. Obesity (Silver Spring). 2018;26(2):310-7.
6. Harvey NL, Srinivasan RS, Dillard ME, Johnson NC, Witte MH, Boyd K, Sleeman MW, Oliver G. Lymphatic vascular defects promoted by Prox1 haploinsufficiency cause adult-onset obesity. Nat Genet. 2005;37(10):1072-81. Epub 2005 Sep 18.
7. Suga H, Araki J, Aoi N, Kato H, Higashino T, Yoshimura K. Adipose tissue remodeling in lipedema: adipocyte death and concurrent regeneration. J Cutan Pathol. 2009;3:3.
8. Brorson H, Fagher B. [Dercum's disease. Fatty tissue rheumatism caused by immune defense reaction?]. Lakartidningen. 1996;93(15):1430, 3-6.
9. Beltran K, Herbst KL. Differentiating lipedema and Dercum's disease. Int J Obes (Lond). 2017;41(2):240-5.
11. Herbst KL, Asare-Bediako S. Adiposis Dolorosa is More than Painful Fat. The Endocrinologist. 2007;17(6):326-44.
12. Westfall TC, Westfall DP. Adrenergic Agonists and Antagonists. In: Brunton LL, Lazo JS, Parker KL, editors. Goodman and Gilman's The Pharmacological Basis of Therapeutics, eleventh edition. New York: McGraw-Hill Medical Publishing Division; 2006. p. 237-95.
13. Denning DW, Dunnigan MG, Tillman J, Davis JA, Forrest CA. The relationship between 'normal' fluid retention in women and idiopathic oedema. Postgrad Med J. 1990;66(775):363-6.
14. Mach RS, Fabre J, Muller AF, Neher R. Oedemes par retention de chlorure de sodium avec hyperaldosteronuria. Schweiz med Wschr,. 1955;85:1229.
15. Badr KF. Idiopathic edema. In: Brenner BM, Stein JH, editors. Contemporary Issues in Nephrology (Body Fluid Homeostasis). 16. New York: Churchill Livingstone; 1987.
16. Speller PJ, Streeten DH. Mechanism of the Diuretic Action of D-Amphetamine. Metabolism. 1964;13:453-65.
17. Streeten DH. The role of posture in idiopathic oedema. S Afr Med J. 1975;49(13):462-4.
18. McHale NG, Allen JM, Iggulden HL. Mechanism of alpha-adrenergic excitation in bovine lymphatic smooth muscle. Am J Physiol. 1987;252(5 Pt 2):H873-8.
19. McHale NG, Thornbury KD. The effect of anesthetics on lymphatic contractility. Microvasc Res. 1989;37(1):70-6.
20. De Micheli P Fau - Glasser AH, Glasser AH. The effects of catecholamines and adrenoceptor blocking drugs on the canine peripheral lymph flow. British Journal of Pharmacology. 1975;53(4):499-504.
21. Sjoberg T, Alm P, Andersson KE, Norgren L, Steen S. Contractile response in isolated human groin lymphatics. Lymphology. 1987;20(3):152-60.
22. Wold LE, Hines EA, Jr., Allen EV. Lipedema of the legs; a syndrome characterized by fat legs and edema. Ann Intern Med. 1951;34(5):1243-50.
23. Herbst KL. Rare adipose disorders (RADs) masquerading as obesity. Acta Pharmacol Sin. 2012;33(2):155-72. doi: 10.1038/aps.2011.153.
24. The Diagnosis and Treatment of Peripheral Lymphedema: 2016 Consensus Document of the International Society of Lymphology. Lymphology. 2016;49(4):170-84.
25. Herbst KL, Ussery C, Eekema A. Pilot study: whole body manual subcutaneous adipose tissue (SAT) therapy improved pain and SAT structure in women with lipedema. LID - 10.1515/hmbci-2017-0035 [doi] Horm Mol Biol Clin Investig. 2017 Sep 20;33(2)
26. Baumgartner A, Hueppe M, Schmeller W. Long-term benefit of liposuction in patients with lipoedema.A follow-up study after an average of 4 and 8 years. Br J Dermatol. 2015;17(10):14289.
27. Szypula I, Kotulska A, Szopa M, Pieczyrak R, Kucharz EJ. Adiposis dolorosa with hypercholesterolemia and premature severe generalized atherosclerosis. Wiad Lek. 2009;62(1):64-5.
28. Cortese S, Adamo N, Del Giovane C, Mohr-Jensen C, Hayes AJ, Carucci S, Atkinson LZ, Tessari L, Banaschewski T, Coghill D, Hollis C, Simonoff E, Zuddas A, Barbui C, Purgato M, Steinhausen HC, Shokraneh F, Xia J, Cipriani A. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2018;7(18):30269-4.
29. EVEKEO® (amphetamine sulfate tablets, USP) Package Insert. Arbor Phramaceuticals. Atlanta, Georgia: Arbor Phramaceuticals; 2016.
30. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) – A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-81.
31. Binkley JM, Stratford PW, Lott SA, Riddle DL. The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. Phys Ther. 1999;79(4):371-83.
32. Nonogaki K. New insights into sympathetic regulation of glucose and fat metabolism. Diabetologia. 2000;43(5):533-49. doi: 10.1007/s001250051341.
33. Dudek JE, Bialaszek W, Ostaszewski P, Smidt T. Depression and appearance-related distress in functioning with lipedema. Psychol Health Med. 2018;3:1-8.
34. Atkinson JN, Galton DJ, Gilbert C. Regulatory defect of glycolysis in human lipoma. Br Med J. 1974;1(5898):101-2.
35. Bast JH, Ahmed L, Engdahl R. Lipedema in patients after bariatric surgery. Surg Obes Relat Dis. 2016;12(5):1131-2. doi: 10.016/j.soard.2016.04.013. Epub Apr 14.
36. Package Insert: Dextroamphetamine Sulfate Tablets USP 5 mg and 10 mg. Webster Groves, MO: Mallinckrodt; 2017.
37. Takenoshita S, Nishino S. Pharmacologic Management of Excessive Daytime Sleepiness. Sleep Med Clin. 2017;12(3):461-78.
38. Check JH. Dextroamphetamine sulfate treatment eradicates long-term chronic severe headaches from temporomandibular joint syndrome--a case that emphasizes the role of the gynecologist in treating headaches in women. Clinical and experimental obstetrics & gynecology. 2016;43(1):119-22.
39. Check JH, Cohen R. Marked improvement of pain from long-term fibromyalgia with dextroamphetamine sulfate in a woman who failed to improve with conventional pharmacologic treatment. (0390-6663 (Print)).
40. Foldi E, Foldi M. Lipedema. In: Foldi M, Foldi E, editors. Foldi's Textbook of Lymphology. Munich, Germany: Elsevier GmbH; 2006. p. 420.
41. Levick JR, Michel CC. Microvascular fluid exchange and the revised Starling principle. Cardiovasc Res. 2010;87(2):198-210. doi: 10.1093/cvr/cvq062. Epub 2010 Mar 3.
42. Ausprunk DH, Berman HJ, McNary WF. Intramural distribution of adrenergic and cholinergic nerve fibers innervating arterioles of the hamster cheek pouch. American Journal of Anatomy. 1973;137(1):31-45.
43. Skagen K, Petersen P, Kastrup J, Norgaard T. The regulation of subcutaneous blood flow in patient with Dercum's disease. Acta Derm Venereol. 1986;66(4):337-9.
44. Williams SA, Rayman G, Tooke JE. Dependent oedema and attenuation of postural vasoconstriction associated with nifedipine therapy for hypertension in diabetic patients. Eur J Clin Pharmacol. 1989;37(4):333-5.
45. Vissing SF, Secher NH, Victor RG. Mechanisms of cutaneous vasoconstriction during upright posture. Acta Physiol Scand. 1997;159(2):131-8.
46. Ghazala S, Bilal J, Ross E, Riaz IB, Kalb B, Herbst KL. Low-Dose d-Amphetamine Induced Regression of Liver Fat Deposits in Dercum Disease. Am J Med. 2018;31(18):30015-9.
47. Rutkowski JM, Stern JH, Scherer PE. The cell biology of fat expansion. J Cell Biol. 2015;208(5):501-12. doi: 10.1083/jcb.201409063.
48. Fallah G, Moudi S, Hamidia A, Bijani A. Stimulant use in medical students and residents requires more careful attention. Caspian J Intern Med. 2018;9(1):87-91. doi: 10.22088/cjim.9.1.87.
49. Velure HK, Vatsko E, Bygum A. [Idiopathic oedema may cause many different clinical visits]. Ugeskr Laeger. 2017;179(40).(pii):V06170466.
50. de Godoy J, de Godoy H, de Sene Souza A, Filho R, Godoy M. Case Report: Lipolymphedema Associated with Idiopathic Cyclic Edema: A Therapeutic Approach. Case Reports in Vascular Medicine. 2017;2017(Article ID 5470909):3.
51. Pereira de Godoy JM, Pereira de Godoy HJ, de Sene Souza AA, Budtinger Filho R, de Fatima Guerreiro Godoy M. Lipolymphedema Associated with Idiopathic Cyclic Edema: A Therapeutic Approach. Case Rep Vasc Med. 2017;2017:5470909.(doi):10.1155/2017/5470909. Epub 2017 Aug 23.
52. Pfister C, Dawzcynski H, Schingale FJ. Sodium selenite and cancer related lymphedema: Biological and pharmacological effects. J Trace Elem Med Biol. 2016;37:111-116.(doi):10.1016/j.jtemb.2016.05.005. Epub May 24.
53. Jiang X, Nicolls MR, Tian W, Rockson SG. Lymphatic Dysfunction, Leukotrienes, and Lymphedema. Annu Rev Physiol. 2018;80:49-70.(doi):10.1146/annurev-physiol-022516-34008. Epub 2017 Oct 13.
54. Soudet S, Lambert M, Lefevre G, Maillard H, Huglo D, Hatron PY. Long term use of metformin in idiopathic cyclic edema, report of thirteen cases and review of the literature. Pharmacol Res. 2017;119:237-239.(doi):10.1016/j.phrs.2017.02.009. Epub Feb 14.
2. Szolnoky G, Nemes A, Gavaller H, Forster T, Kemeny L. Lipedema is associated with increased aortic stiffness. Lymphology. 2012;45(2):71-9.
3. Földi E, Földi M. Das Lipödem. In: Földi M, Földi E, Kubik S, editors. Lehrbuch der Lymphologie für Mediziner, Masseure und Physiotherapeuten. Munich Elsevier, Urban&Fischer; 2005. p. 443-53.
4. Waxler JL, Guardino C, Feinn RS, Lee H, Pober BR, Stanley TL. Altered body composition, lipedema, and decreased bone density in individuals with Williams syndrome: A preliminary report. (1878-0849 (Electronic)).
5. Crescenzi R, Marton A, Donahue PMC, Mahany HB, Lants SK, Wang P, Beckman JA, Donahue MJ, Titze J. Tissue Sodium Content is Elevated in the Skin and Subcutaneous Adipose Tissue in Women with Lipedema. Obesity (Silver Spring). 2018;26(2):310-7.
6. Harvey NL, Srinivasan RS, Dillard ME, Johnson NC, Witte MH, Boyd K, Sleeman MW, Oliver G. Lymphatic vascular defects promoted by Prox1 haploinsufficiency cause adult-onset obesity. Nat Genet. 2005;37(10):1072-81. Epub 2005 Sep 18.
7. Suga H, Araki J, Aoi N, Kato H, Higashino T, Yoshimura K. Adipose tissue remodeling in lipedema: adipocyte death and concurrent regeneration. J Cutan Pathol. 2009;3:3.
8. Brorson H, Fagher B. [Dercum's disease. Fatty tissue rheumatism caused by immune defense reaction?]. Lakartidningen. 1996;93(15):1430, 3-6.
9. Beltran K, Herbst KL. Differentiating lipedema and Dercum's disease. Int J Obes (Lond). 2017;41(2):240-5.
11. Herbst KL, Asare-Bediako S. Adiposis Dolorosa is More than Painful Fat. The Endocrinologist. 2007;17(6):326-44.
12. Westfall TC, Westfall DP. Adrenergic Agonists and Antagonists. In: Brunton LL, Lazo JS, Parker KL, editors. Goodman and Gilman's The Pharmacological Basis of Therapeutics, eleventh edition. New York: McGraw-Hill Medical Publishing Division; 2006. p. 237-95.
13. Denning DW, Dunnigan MG, Tillman J, Davis JA, Forrest CA. The relationship between 'normal' fluid retention in women and idiopathic oedema. Postgrad Med J. 1990;66(775):363-6.
14. Mach RS, Fabre J, Muller AF, Neher R. Oedemes par retention de chlorure de sodium avec hyperaldosteronuria. Schweiz med Wschr,. 1955;85:1229.
15. Badr KF. Idiopathic edema. In: Brenner BM, Stein JH, editors. Contemporary Issues in Nephrology (Body Fluid Homeostasis). 16. New York: Churchill Livingstone; 1987.
16. Speller PJ, Streeten DH. Mechanism of the Diuretic Action of D-Amphetamine. Metabolism. 1964;13:453-65.
17. Streeten DH. The role of posture in idiopathic oedema. S Afr Med J. 1975;49(13):462-4.
18. McHale NG, Allen JM, Iggulden HL. Mechanism of alpha-adrenergic excitation in bovine lymphatic smooth muscle. Am J Physiol. 1987;252(5 Pt 2):H873-8.
19. McHale NG, Thornbury KD. The effect of anesthetics on lymphatic contractility. Microvasc Res. 1989;37(1):70-6.
20. De Micheli P Fau - Glasser AH, Glasser AH. The effects of catecholamines and adrenoceptor blocking drugs on the canine peripheral lymph flow. British Journal of Pharmacology. 1975;53(4):499-504.
21. Sjoberg T, Alm P, Andersson KE, Norgren L, Steen S. Contractile response in isolated human groin lymphatics. Lymphology. 1987;20(3):152-60.
22. Wold LE, Hines EA, Jr., Allen EV. Lipedema of the legs; a syndrome characterized by fat legs and edema. Ann Intern Med. 1951;34(5):1243-50.
23. Herbst KL. Rare adipose disorders (RADs) masquerading as obesity. Acta Pharmacol Sin. 2012;33(2):155-72. doi: 10.1038/aps.2011.153.
24. The Diagnosis and Treatment of Peripheral Lymphedema: 2016 Consensus Document of the International Society of Lymphology. Lymphology. 2016;49(4):170-84.
25. Herbst KL, Ussery C, Eekema A. Pilot study: whole body manual subcutaneous adipose tissue (SAT) therapy improved pain and SAT structure in women with lipedema. LID - 10.1515/hmbci-2017-0035 [doi] Horm Mol Biol Clin Investig. 2017 Sep 20;33(2)
26. Baumgartner A, Hueppe M, Schmeller W. Long-term benefit of liposuction in patients with lipoedema.A follow-up study after an average of 4 and 8 years. Br J Dermatol. 2015;17(10):14289.
27. Szypula I, Kotulska A, Szopa M, Pieczyrak R, Kucharz EJ. Adiposis dolorosa with hypercholesterolemia and premature severe generalized atherosclerosis. Wiad Lek. 2009;62(1):64-5.
28. Cortese S, Adamo N, Del Giovane C, Mohr-Jensen C, Hayes AJ, Carucci S, Atkinson LZ, Tessari L, Banaschewski T, Coghill D, Hollis C, Simonoff E, Zuddas A, Barbui C, Purgato M, Steinhausen HC, Shokraneh F, Xia J, Cipriani A. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2018;7(18):30269-4.
29. EVEKEO® (amphetamine sulfate tablets, USP) Package Insert. Arbor Phramaceuticals. Atlanta, Georgia: Arbor Phramaceuticals; 2016.
30. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) – A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-81.
31. Binkley JM, Stratford PW, Lott SA, Riddle DL. The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. Phys Ther. 1999;79(4):371-83.
32. Nonogaki K. New insights into sympathetic regulation of glucose and fat metabolism. Diabetologia. 2000;43(5):533-49. doi: 10.1007/s001250051341.
33. Dudek JE, Bialaszek W, Ostaszewski P, Smidt T. Depression and appearance-related distress in functioning with lipedema. Psychol Health Med. 2018;3:1-8.
34. Atkinson JN, Galton DJ, Gilbert C. Regulatory defect of glycolysis in human lipoma. Br Med J. 1974;1(5898):101-2.
35. Bast JH, Ahmed L, Engdahl R. Lipedema in patients after bariatric surgery. Surg Obes Relat Dis. 2016;12(5):1131-2. doi: 10.016/j.soard.2016.04.013. Epub Apr 14.
36. Package Insert: Dextroamphetamine Sulfate Tablets USP 5 mg and 10 mg. Webster Groves, MO: Mallinckrodt; 2017.
37. Takenoshita S, Nishino S. Pharmacologic Management of Excessive Daytime Sleepiness. Sleep Med Clin. 2017;12(3):461-78.
38. Check JH. Dextroamphetamine sulfate treatment eradicates long-term chronic severe headaches from temporomandibular joint syndrome--a case that emphasizes the role of the gynecologist in treating headaches in women. Clinical and experimental obstetrics & gynecology. 2016;43(1):119-22.
39. Check JH, Cohen R. Marked improvement of pain from long-term fibromyalgia with dextroamphetamine sulfate in a woman who failed to improve with conventional pharmacologic treatment. (0390-6663 (Print)).
40. Foldi E, Foldi M. Lipedema. In: Foldi M, Foldi E, editors. Foldi's Textbook of Lymphology. Munich, Germany: Elsevier GmbH; 2006. p. 420.
41. Levick JR, Michel CC. Microvascular fluid exchange and the revised Starling principle. Cardiovasc Res. 2010;87(2):198-210. doi: 10.1093/cvr/cvq062. Epub 2010 Mar 3.
42. Ausprunk DH, Berman HJ, McNary WF. Intramural distribution of adrenergic and cholinergic nerve fibers innervating arterioles of the hamster cheek pouch. American Journal of Anatomy. 1973;137(1):31-45.
43. Skagen K, Petersen P, Kastrup J, Norgaard T. The regulation of subcutaneous blood flow in patient with Dercum's disease. Acta Derm Venereol. 1986;66(4):337-9.
44. Williams SA, Rayman G, Tooke JE. Dependent oedema and attenuation of postural vasoconstriction associated with nifedipine therapy for hypertension in diabetic patients. Eur J Clin Pharmacol. 1989;37(4):333-5.
45. Vissing SF, Secher NH, Victor RG. Mechanisms of cutaneous vasoconstriction during upright posture. Acta Physiol Scand. 1997;159(2):131-8.
46. Ghazala S, Bilal J, Ross E, Riaz IB, Kalb B, Herbst KL. Low-Dose d-Amphetamine Induced Regression of Liver Fat Deposits in Dercum Disease. Am J Med. 2018;31(18):30015-9.
47. Rutkowski JM, Stern JH, Scherer PE. The cell biology of fat expansion. J Cell Biol. 2015;208(5):501-12. doi: 10.1083/jcb.201409063.
48. Fallah G, Moudi S, Hamidia A, Bijani A. Stimulant use in medical students and residents requires more careful attention. Caspian J Intern Med. 2018;9(1):87-91. doi: 10.22088/cjim.9.1.87.
49. Velure HK, Vatsko E, Bygum A. [Idiopathic oedema may cause many different clinical visits]. Ugeskr Laeger. 2017;179(40).(pii):V06170466.
50. de Godoy J, de Godoy H, de Sene Souza A, Filho R, Godoy M. Case Report: Lipolymphedema Associated with Idiopathic Cyclic Edema: A Therapeutic Approach. Case Reports in Vascular Medicine. 2017;2017(Article ID 5470909):3.
51. Pereira de Godoy JM, Pereira de Godoy HJ, de Sene Souza AA, Budtinger Filho R, de Fatima Guerreiro Godoy M. Lipolymphedema Associated with Idiopathic Cyclic Edema: A Therapeutic Approach. Case Rep Vasc Med. 2017;2017:5470909.(doi):10.1155/2017/5470909. Epub 2017 Aug 23.
52. Pfister C, Dawzcynski H, Schingale FJ. Sodium selenite and cancer related lymphedema: Biological and pharmacological effects. J Trace Elem Med Biol. 2016;37:111-116.(doi):10.1016/j.jtemb.2016.05.005. Epub May 24.
53. Jiang X, Nicolls MR, Tian W, Rockson SG. Lymphatic Dysfunction, Leukotrienes, and Lymphedema. Annu Rev Physiol. 2018;80:49-70.(doi):10.1146/annurev-physiol-022516-34008. Epub 2017 Oct 13.
54. Soudet S, Lambert M, Lefevre G, Maillard H, Huglo D, Hatron PY. Long term use of metformin in idiopathic cyclic edema, report of thirteen cases and review of the literature. Pharmacol Res. 2017;119:237-239.(doi):10.1016/j.phrs.2017.02.009. Epub Feb 14.