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<Provider Id="sundheddkcms"> <Item Id="{853E9B41-9EFE-48F4-82F0-83E0D8BEA826}" Name="lipoedem" Type="LHContentPage" ParentProviderId="sundheddkcms" ParentItemId="{DD170F45-7FCE-4784-80E6-0E93DD16970E}" SortOrder="500" PublishDate="2023-02-03T10:41:00" DeleteDate="2999-12-31T00:00:00" PotItemType=""> <Content> <HtmlField Name="PageContent"><![CDATA[<h2>Diagnose</h2> <ul> <li>Lipødem diagnosticeres på baggrund af anamnese, klinisk undersøgelse og udelukkelse af andre årsager</li> <li>Lipødem er et fund af bilateral, symmetrisk, disproportional hypertrofi af fedt på ekstremiteterne, primært underekstremiteterne, uden involvering af hænder eller fødder</li> <li>Tilstanden er kronisk</li> <li>Trods navnet er der ikke væske i underhuden</li> <li>Lipødemfedt er forskelligt fra normalt subkutant fedt på mange måder: <ul> <li>Det ophobes i overskud i udvalgte områder, afhængigt af typen</li> <li>Det ophobes ude af proportioner med resten af kroppen</li> </ul> </li> <li>Dette giver lipødemramte to-kropssyndromet – for eksempel en slank overkrop, men betydeligt større underkrop</li> <li>Patienter med lipødem har smerter i fedtvævet og/eller ømhed ved palpation. Intensiteten af smerte kan variere fra ingen til svær, og dens frekvens kan være konstant, komme og gå eller kun opstå, når fedtet presses på. Patienterne kan have let ved at få blå mærker</li> <li>Lipødemet kan være ledsaget af en usædvanlig tekstur i fedtet, der kan føles som ris, ærter eller valnødder under hudens overflade</li> </ul> <h3>Kliniske fund</h3> <ul> <li>Bilateral, symmetrisk, uforholdsmæssig fedtvævshypertrofi på arme og/eller ben</li> <li>Ikke involvering af hænder og fødder (manchetfænomen)</li> <li>Ca. 70% involverer ben, ca. 30% involvering af armene</li> <li>En følelse af tyngde og spænding i de berørte lemmer</li> <li>Smerter ved tryk og berøring</li> <li>Markant tendens til at danne blå mærker</li> <li>Stabil omkreds af ekstremiteten ved vægtreduktion eller kaloriebegrænsning</li> <li>Forværring af symptomer i løbet af dagen</li> <li>Telangiektaser og synlige vaskulære markeringer omkring fedtdepoter</li> <li>Hypotermi i huden</li> </ul> <h3>Andre undersøgelser hos specialist eller undersøgelse på sygehus</h3> <ul> <li>Der er aktuelt ikke offentligt sygehus udrednings- eller behandlingstilbud</li> </ul> <h3>Differentialdiagnoser</h3> <ul> <li><a href="~/link.aspx?_id=DDBD653CE76445CE939FE4E1F1BCB424&_z=z">Lymfødem</a></li> <li><a href="~/link.aspx?_id=9FEF27C7B60445CFBAFE436810A348B7&_z=z">Overvægt</a>, eller følger efter overvægt</li> <li>Smertetilstande af anden årsag</li> </ul> <h2>Behandling</h2> <h3>Generelt om behandlingen</h3> <ul> <li>Evidensen for behandling er dårligt belyst</li> <li>Den europæiske konsensus nævner følgende terapeutiske behandlingstiltag </li> </ul> <h3>Forebyggende behandling</h3> <h4>Vægtkontrol</h4> <ul> <li>Patienter med lipødem er ofte også overvægtige 80-88%<a href=" " data-type="journal-reference" data-value="Bertsch T, Erbacher G, Elwell R, Lipoedema: a paradigm shift and consensus. J Wound Care 2020;29: 1-51" data-value-piped="Bertsch T, Erbacher G, Elwell R|Lipoedema: a paradigm shift and consensus.|J Wound Care|2020|29|1-51|33170068" data-url="reference-link" data-pubmedid="33170068" title="Bertsch T, Erbacher G, Elwell R, Lipoedema: a paradigm shift and consensus. J Wound Care 2020;29: 1-51"><sup>1</sup></a>, ved vægtøgning forværres lipødemet</li> <li>For at få kontrol over lipødemet må patient anerkende, at fedme er til stede. Vægttab bør tilrådes for at reducere mængden af fedtvæv og forebygge udvikling af komorbiditeter</li> <li>Det subkutane fedtvæv ved lipødem responderer minimalt på vægttab, men vægtnormalisering kan lindre symptomerne og forbedre prognosen. Et vægttab vil være lavere i de ekstremiteter, der er påvirket af lipødem, end i resten af kroppen<a href=" " data-type="journal-reference" data-value="Szél E, Kemény L, Groma G, Szolnoky G, Pathophysiological dilemmas of lipedema. Med Hypotheses 2014;83: 599-606" data-value-piped="Szél E, Kemény L, Groma G, Szolnoky G|Pathophysiological dilemmas of lipedema.|Med Hypotheses|2014|83|599-606|25200646" data-url="reference-link" data-pubmedid="25200646" title="Szél E, Kemény L, Groma G, Szolnoky G, Pathophysiological dilemmas of lipedema. Med Hypotheses 2014;83: 599-606"><sup>2</sup></a>,<a href=" " data-type="journal-reference" data-value="Kruppa P, Georgiou I, Biermann N, Prantl L, Klein-Weigel P, Ghods M, Lipedema-Pathogenesis, Diagnosis, and Treatment Options. Dtsch Arztebl Int 2020;117: 396-403" data-value-piped="Kruppa P, Georgiou I, Biermann N, Prantl L, Klein-Weigel P, Ghods M|Lipedema-Pathogenesis, Diagnosis, and Treatment Options.|Dtsch Arztebl Int|2020|117|396-403|32762835" data-url="reference-link" data-pubmedid="32762835" title="Kruppa P, Georgiou I, Biermann N, Prantl L, Klein-Weigel P, Ghods M, Lipedema-Pathogenesis, Diagnosis, and Treatment Options. Dtsch Arztebl Int 2020;117: 396-403"><sup>3</sup></a>,<a href=" " data-type="journal-reference" data-value="Czerwińska M, Ostrowska P, Hansdorfer-Korzon R, Lipoedema as a Social Problem. A Scoping Review. Int J Environ Res Public Health 2021;18: " data-value-piped="Czerwińska M, Ostrowska P, Hansdorfer-Korzon R|Lipoedema as a Social Problem. A Scoping Review.|Int J Environ Res Public Health|2021|18||34639524" data-url="reference-link" data-pubmedid="34639524" title="Czerwińska M, Ostrowska P, Hansdorfer-Korzon R, Lipoedema as a Social Problem. A Scoping Review. Int J Environ Res Public Health 2021;18: "><sup>4</sup></a>,<a href=" " data-type="journal-reference" data-value="Hardy D, Williams A, Best practice guidelines for the management of lipoedema. Br J Community Nurs 2017;22: S44-S48" data-value-piped="Hardy D, Williams A|Best practice guidelines for the management of lipoedema.|Br J Community Nurs|2017|22|S44-S48|28961048" data-url="reference-link" data-pubmedid="28961048" title="Hardy D, Williams A, Best practice guidelines for the management of lipoedema. Br J Community Nurs 2017;22: S44-S48"><sup>5</sup></a></li> </ul> <h3>Anden behandling</h3> <h4>Bevægelsesterapi</h4> <ul> <li>Lipødem patienter skal holde sig fysisk aktive</li> <li>Træning i vand eller svømning kan være gavnlig, fordi det mindsker belastningen af leddene, og vandet udøver en let kompression af fedtvævet<a href=" " data-type="journal-reference" data-value="Bertsch T, Erbacher G, Elwell R, Lipoedema: a paradigm shift and consensus. J Wound Care 2020;29: 1-51" data-value-piped="Bertsch T, Erbacher G, Elwell R|Lipoedema: a paradigm shift and consensus.|J Wound Care|2020|29|1-51|33170068" data-url="reference-link" data-pubmedid="33170068" title="Bertsch T, Erbacher G, Elwell R, Lipoedema: a paradigm shift and consensus. J Wound Care 2020;29: 1-51"><sup>1</sup></a>,<a href=" " data-type="journal-reference" data-value="Hardy D, Williams A, Best practice guidelines for the management of lipoedema. Br J Community Nurs 2017;22: S44-S48" data-value-piped="Hardy D, Williams A|Best practice guidelines for the management of lipoedema.|Br J Community Nurs|2017|22|S44-S48|28961048" data-url="reference-link" data-pubmedid="28961048" title="Hardy D, Williams A, Best practice guidelines for the management of lipoedema. Br J Community Nurs 2017;22: S44-S48"><sup>5</sup></a></li> </ul> <h4>Kompressionsbehandling</h4> <ul> <li>Kompressionsbehandling er et vigtigt element i behandlingen af lipødem, grundet den formodede antiinflammatoriske virkning på det subkutane væv<a href=" " data-type="journal-reference" data-value="Hardy D, Williams A, Best practice guidelines for the management of lipoedema. Br J Community Nurs 2017;22: S44-S48" data-value-piped="Hardy D, Williams A|Best practice guidelines for the management of lipoedema.|Br J Community Nurs|2017|22|S44-S48|28961048" data-url="reference-link" data-pubmedid="28961048" title="Hardy D, Williams A, Best practice guidelines for the management of lipoedema. Br J Community Nurs 2017;22: S44-S48"><sup>5</sup></a> <ul> <li>Kompressionsbehandlingen bør være med skræddersyet, fladstrikket kompressionsbeklædning (kompression klasse II-III)</li> </ul> </li> <li>Kompressionen skal udøves på hele det område, hvor der er konstateret lipødem</li> <li>Kompression resulterer ikke i en reduktion af fedtvæv, men kan lindre smerter, øge mobiliteten og mindske eventuel ødemdannelse<a href=" " data-type="journal-reference" data-value="Andersen MT, Burian EA, Nissen CV, Rungby J, Karlsmark T, Lipoedema. Ugeskr Laeger 2022;184: " data-value-piped="Andersen MT, Burian EA, Nissen CV, Rungby J, Karlsmark T|Lipoedema.|Ugeskr Laeger|2022|184||36621873" data-url="reference-link" data-pubmedid="36621873" title="Andersen MT, Burian EA, Nissen CV, Rungby J, Karlsmark T, Lipoedema. Ugeskr Laeger 2022;184: "><sup>6</sup></a>,<a href=" " data-type="journal-reference" data-value="Hardy D, Williams A, Best practice guidelines for the management of lipoedema. Br J Community Nurs 2017;22: S44-S48" data-value-piped="Hardy D, Williams A|Best practice guidelines for the management of lipoedema.|Br J Community Nurs|2017|22|S44-S48|28961048" data-url="reference-link" data-pubmedid="28961048" title="Hardy D, Williams A, Best practice guidelines for the management of lipoedema. Br J Community Nurs 2017;22: S44-S48"><sup>5</sup></a></li> <li>Patienter med lipødem og et højt BMI kan udvikle regelret ødem grundet dårlig lymfetransport og inaktivitet, hvorfor intermitterende pneumatisk kompression med flerkammerenheder kan være et supplement til behandlingen<a href=" " data-type="journal-reference" data-value="Bertsch T, Erbacher G, Elwell R, Lipoedema: a paradigm shift and consensus. J Wound Care 2020;29: 1-51" data-value-piped="Bertsch T, Erbacher G, Elwell R|Lipoedema: a paradigm shift and consensus.|J Wound Care|2020|29|1-51|33170068" data-url="reference-link" data-pubmedid="33170068" title="Bertsch T, Erbacher G, Elwell R, Lipoedema: a paradigm shift and consensus. J Wound Care 2020;29: 1-51"><sup>1</sup></a>,<a href=" " data-type="journal-reference" data-value="Buso G, Depairon M, Tomson D, Raffoul W, Vettor R, Mazzolai L, Lipedema: A Call to Action!. Obesity (Silver Spring) 2019;27: 1567-1576" data-value-piped="Buso G, Depairon M, Tomson D, Raffoul W, Vettor R, Mazzolai L|Lipedema: A Call to Action!|Obesity (Silver Spring)|2019|27|1567-1576|31544340" data-url="reference-link" data-pubmedid="31544340" title="Buso G, Depairon M, Tomson D, Raffoul W, Vettor R, Mazzolai L, Lipedema: A Call to Action!. Obesity (Silver Spring) 2019;27: 1567-1576"><sup>7</sup></a>,<a href=" " data-type="journal-reference" data-value="Kruppa P, Georgiou I, Biermann N, Prantl L, Klein-Weigel P, Ghods M, Lipedema-Pathogenesis, Diagnosis, and Treatment Options. Dtsch Arztebl Int 2020;117: 396-403" data-value-piped="Kruppa P, Georgiou I, Biermann N, Prantl L, Klein-Weigel P, Ghods M|Lipedema-Pathogenesis, Diagnosis, and Treatment Options.|Dtsch Arztebl Int|2020|117|396-403|32762835" data-url="reference-link" data-pubmedid="32762835" title="Kruppa P, Georgiou I, Biermann N, Prantl L, Klein-Weigel P, Ghods M, Lipedema-Pathogenesis, Diagnosis, and Treatment Options. Dtsch Arztebl Int 2020;117: 396-403"><sup>3</sup></a>,<a href=" " data-type="journal-reference" data-value="Aksoy H, Karadag AS, Wollina U, Cause and management of lipedema-associated pain. Dermatol Ther 2021;34: e14364" data-value-piped="Aksoy H, Karadag AS, Wollina U|Cause and management of lipedema-associated pain.|Dermatol Ther|2021|34|e14364|33001552" data-url="reference-link" data-pubmedid="33001552" title="Aksoy H, Karadag AS, Wollina U, Cause and management of lipedema-associated pain. Dermatol Ther 2021;34: e14364"><sup>8</sup></a>,<a href=" " data-type="journal-reference" data-value="Hardy D, Williams A, Best practice guidelines for the management of lipoedema. Br J Community Nurs 2017;22: S44-S48" data-value-piped="Hardy D, Williams A|Best practice guidelines for the management of lipoedema.|Br J Community Nurs|2017|22|S44-S48|28961048" data-url="reference-link" data-pubmedid="28961048" title="Hardy D, Williams A, Best practice guidelines for the management of lipoedema. Br J Community Nurs 2017;22: S44-S48"><sup>5</sup></a></li> </ul> <p><a href=" " data-type="journal-reference" data-value="Hardy D, Williams A, Best practice guidelines for the management of lipoedema. Br J Community Nurs 2017;22: S44-S48" data-value-piped="Hardy D, Williams A|Best practice guidelines for the management of lipoedema.|Br J Community Nurs|2017|22|S44-S48|28961048" data-url="reference-link" data-pubmedid="28961048" title="Hardy D, Williams A, Best practice guidelines for the management of lipoedema. Br J Community Nurs 2017;22: S44-S48"><sup>5</sup></a><strong>Selvbehandling</strong></p> <ul> <li>Brug af børstning af huden fra fod mod lyske er af patienter rapporteret, at have virkning på ujævnhederne i fedtvævet</li> <li>Antiinflammatorisk kost er ligeledes af patienter rapporteret at have effekt i kombination med vægtreduktion, motion , kompressionsbandagering og børstning</li> </ul> <h3>Råd til patienten</h3> <ul> <li>Psykosocial behandling</li> <li>Self management</li> </ul> <h3>Medicinsk behandling</h3> <ul> <li>Der findes ikke medicinsk behandling til tilstanden.</li> </ul> <h3>Kirurgi</h3> <h4>Fedtsugning</h4> <ul> <li>I observationsstudier har fedtsugning med permanent reduktion af fedtvæv vist sig at lindre symptomer i betydeligt omfang med kun få komplikationer. Evidensen er dog sparsom og baseret på ukontrollerede studier med få patienter</li> <li>I offentligt regi dækkes omkostningerne ved proceduren ikke; undersøgelser af høj metodisk kvalitet vil være nødvendige, før dette er tilfældet</li> </ul> <div> <img src="A334EE64955C440F8288C3512D693092-614-236" style="height:236px; width:614px;" alt="Graden af lipødem" height="236" width="614"> </div> <ul> <li>En lipødem patient skal fortsætte den præoperative kompresionsbandage, resten af livet, for at forebygge recidiv af den atypiske fedtfordeling. Herudover skal patienten ikke tage på i vægt</li> <li>Forventet operations tidsforbrug 6 timer for bilateral underekstremitetsbehandling</li> </ul> <h2>Baggrundsoplysninger</h2> <h3>Definition</h3> <ul> <li>Disproportional hypertrofi af fedt på ekstremiteterne, med samtidig smerteproblematik</li> </ul> <h3>Forekomst</h3> <ul> <li>Overvejende hos kvinder, udviklingen er beskrevet initieret af hormonelle ændringer</li> <li>Selvom det antages at være udbredt, kendes den nøjagtige forekomst ikke. Tal så høje som 8 % af kvinder er nævnt, norsk materiale nævner 1 :3500 kvinder</li> <li>Prævalensen er meget usikker, men er estimeret til at være 11% blandt kvinder, som er tilknyttet specialafdelinger, hvor lymfødem håndteres<a href=" " data-type="journal-reference" data-value="Andersen MT, Burian EA, Nissen CV, Rungby J, Karlsmark T, Lipoedema. Ugeskr Laeger 2022;184: " data-value-piped="Andersen MT, Burian EA, Nissen CV, Rungby J, Karlsmark T|Lipoedema.|Ugeskr Laeger|2022|184||36621873" data-url="reference-link" data-pubmedid="36621873" title="Andersen MT, Burian EA, Nissen CV, Rungby J, Karlsmark T, Lipoedema. Ugeskr Laeger 2022;184: "><sup>6</sup></a></li> </ul> <h3>Klassifikation</h3> <ul> <li>Lipødem er inkluderet i den 11. reviderede version af WHOʼs internationale sygdomsklassifikation (ICD-11) med diagnosekoden EF02.2</li> </ul> <h3>Ætiologi og patogenese</h3> <ul> <li>Patofysiologien for lipødem er uklar. De formodede årsager omfatter ændret adipogenese, mikroangiopati og forstyrret lymfatisk mikrocirkulation</li> <li>Der er endnu ikke fundet nogen specifik biomarkør, og diagnosen stilles i øjeblikket alene på klinisk grundlag</li> </ul> <h3>Disponerende faktorer</h3> <ul> <li>Lipødem forekommer næsten udelukkende hos kvinder, med sjældne rapporter om udvikling hos mænd</li> <li>Lipødem antages at være udløst af hormonpåvirkning og forekommer sjældent før puberteten <ul> <li>Hormonelle ændringer i pubertet, graviditet, overgangsalder, ved gynækologisk kirurgi, der påvirker æggestokkene og andre hormonelle ændringer kan igangsætte transformationen</li> <li>Østrogenreceptorer udtrykkes i fedtvæv, og østrogen har en direkte effekt på fordelingen af fedtvævet<a href=" " data-type="journal-reference" data-value="Bertsch T, Erbacher G, Elwell R, Lipoedema: a paradigm shift and consensus. J Wound Care 2020;29: 1-51" data-value-piped="Bertsch T, Erbacher G, Elwell R|Lipoedema: a paradigm shift and consensus.|J Wound Care|2020|29|1-51|33170068" data-url="reference-link" data-pubmedid="33170068" title="Bertsch T, Erbacher G, Elwell R, Lipoedema: a paradigm shift and consensus. J Wound Care 2020;29: 1-51"><sup>1</sup></a>,<a href=" " data-type="journal-reference" data-value="Szél E, Kemény L, Groma G, Szolnoky G, Pathophysiological dilemmas of lipedema. Med Hypotheses 2014;83: 599-606" data-value-piped="Szél E, Kemény L, Groma G, Szolnoky G|Pathophysiological dilemmas of lipedema.|Med Hypotheses|2014|83|599-606|25200646" data-url="reference-link" data-pubmedid="25200646" title="Szél E, Kemény L, Groma G, Szolnoky G, Pathophysiological dilemmas of lipedema. Med Hypotheses 2014;83: 599-606"><sup>2</sup></a>,<a href=" " data-type="journal-reference" data-value="Paolacci S, Precone V, Acquaviva F, Chiurazzi P, Fulcheri E, Pinelli M, Buffelli F, Michelini S, Herbst KL, Unfer V, Bertelli M, GeneOb Project, Genetics of lipedema: new perspectives on genetic research and molecular diagnoses. Eur Rev Med Pharmacol Sci 2019;23: 5581-5594" data-value-piped="Paolacci S, Precone V, Acquaviva F, Chiurazzi P, Fulcheri E, Pinelli M, Buffelli F, Michelini S, Herbst KL, Unfer V, Bertelli M, GeneOb Project|Genetics of lipedema: new perspectives on genetic research and molecular diagnoses.|Eur Rev Med Pharmacol Sci|2019|23|5581-5594|31298310" data-url="reference-link" data-pubmedid="31298310" title="Paolacci S, Precone V, Acquaviva F, Chiurazzi P, Fulcheri E, Pinelli M, Buffelli F, Michelini S, Herbst KL, Unfer V, Bertelli M, GeneOb Project, Genetics of lipedema: new perspectives on genetic research and molecular diagnoses. Eur Rev Med Pharmacol Sci 2019;23: 5581-5594"><sup>9</sup></a></li> </ul> </li> <li>Der ses familiær ophobning af lipødem, formentlig er der tale om autosomal dominant arvegang med ufuldstændig penetrans samt kønsbegrænsning<a href=" " data-type="journal-reference" data-value="Czerwińska M, Ostrowska P, Hansdorfer-Korzon R, Lipoedema as a Social Problem. A Scoping Review. Int J Environ Res Public Health 2021;18: " data-value-piped="Czerwińska M, Ostrowska P, Hansdorfer-Korzon R|Lipoedema as a Social Problem. A Scoping Review.|Int J Environ Res Public Health|2021|18||34639524" data-url="reference-link" data-pubmedid="34639524" title="Czerwińska M, Ostrowska P, Hansdorfer-Korzon R, Lipoedema as a Social Problem. A Scoping Review. Int J Environ Res Public Health 2021;18: "><sup>4</sup></a>,<a href=" " data-type="journal-reference" data-value="Paolacci S, Precone V, Acquaviva F, Chiurazzi P, Fulcheri E, Pinelli M, Buffelli F, Michelini S, Herbst KL, Unfer V, Bertelli M, GeneOb Project, Genetics of lipedema: new perspectives on genetic research and molecular diagnoses. Eur Rev Med Pharmacol Sci 2019;23: 5581-5594" data-value-piped="Paolacci S, Precone V, Acquaviva F, Chiurazzi P, Fulcheri E, Pinelli M, Buffelli F, Michelini S, Herbst KL, Unfer V, Bertelli M, GeneOb Project|Genetics of lipedema: new perspectives on genetic research and molecular diagnoses.|Eur Rev Med Pharmacol Sci|2019|23|5581-5594|31298310" data-url="reference-link" data-pubmedid="31298310" title="Paolacci S, Precone V, Acquaviva F, Chiurazzi P, Fulcheri E, Pinelli M, Buffelli F, Michelini S, Herbst KL, Unfer V, Bertelli M, GeneOb Project, Genetics of lipedema: new perspectives on genetic research and molecular diagnoses. Eur Rev Med Pharmacol Sci 2019;23: 5581-5594"><sup>9</sup></a></li> <li>Forskning er i gang for at bestemme den biologiske rolle af hormoner, genetik, inflammation og stofskifte i tilstandens udvikling</li> </ul> <h2>Patientinformation</h2> <ul> <li><a rel="noopener noreferrer" href="https://dalyfo.dk/viden-om-lipoedem" target="_blank">Dansk Lymfødem Forening</a></li> <li><a href="~/link.aspx?_id=C54272774BB7483D9CEDA07D84EE6372&_z=z">Lipødem - for borgere</a></li> </ul>]]></HtmlField> <HtmlField Name="Resume"><![CDATA[<h2>Resumé</h2> <h4>Diagnose</h4> <ul> <li>Lipødem er et fund af bilateral, symmetrisk, disproportional hypertrofi af fedt på ekstremiteterne, primært underekstremiteterne, uden involvering af hænder eller fødder</li> <li>Lipødemet er smertende ved palpation</li> <li>Der er ikke væske i underhuden<span> </span></li> </ul> <h4>Behandling</h4> <ul> <li>Vægtkontrol</li> <li>Kompressionsbehandling</li> <li>Bevægelsesterapi</li> </ul> <h4>Henvisning</h4> <ul> <li>Aktuelt er der ikke hospitalsafdelinger, der kan modtage henvisninger vedrørende lipødem</li> </ul>]]></HtmlField> <LinkListField Name="Spot2"> <LinkField linktype="internal">{99A85AFD-2F7A-4B5D-A1C9-C2701D5E7D30}</LinkField> </LinkListField> <TextField Name="DoctorsHandbookID">40618</TextField> <TextField Name="PageTitle">Lipødem</TextField> <TextField Name="NavigationTitle">Lipødem</TextField> <CheckBoxField Name="ShowInMenu">true</CheckBoxField> <CheckBoxField Name="ShowInContentField">true</CheckBoxField> <DateTimeField Name="RevisedDate">2025-03-13T10:53:00</DateTimeField> <LinkListField Name="Authors"> <LinkField linktype="internal">{99AA0F74-AD39-42FE-B03A-52AA1A3B26A3}</LinkField> <LinkField linktype="internal">{9240F87A-FE81-40E5-A079-F715F683A0B5}</LinkField> </LinkListField> <LinkListField Name="Organization"> <LinkField linktype="internal">{CF77E8B9-9937-42B2-85DF-76B0F4E401F0}</LinkField> </LinkListField> <LinkListField Name="SearchAreaID"> <LinkField 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]]></Media> 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