The role of carbon dioxide therapy in Symmetric Multiple Lipomatosis therapeutic strategy [Il ruolo della carbossiterapia nella strategia terapeutica della lipomatosi multipla simmetrica]

Symmetric Multiple Lipomatosis (LMS) is a rare pathology characterized by the progressive accumulation of noncapsulated adipose masses that tend to flow into and invade adjacent structures: symmetrically in the neck, shoulders and torso and proximally in the extremities. The authors describe a familial form, whose transmission mechanism is unknown, and a sporadic form, frequently related to alcohol abuse. Numerous problems for the treatment of LMS are posed by lack of knowledge on this pathology's biochemical mechanism and the characteristics of the adipose deposits related to the structure of the fat, the close relationship established with nearby structures (further aggravated by the remarkable size of these deposits) and the tendency to recur. In the absence of an etiological therapy, the only currently available form of palliation, in conjunction with a diet and total exclusion of alcohol consumption, is surgery, with or without associated liposuction. The authors report their experience in the adoption of carbon dioxide therapy, associated with surgery, in the treatment of two patients presenting fat deposits variously located in the thighs, arms and abdomen. Expectations that the carbon dioxide (administered subcutaneously) would effectively increase the physiological oxidative lypolytic process were based on recent reports in the literature regarding the effects exerted by this gas on the microcirculatory system. The aim of our work was to study the effects of this therapy and verify its efficacy in reducing adipose accumulations, with a view to demonstrating its potential role in LMS therapeutic strategy.