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Subcutaneous Fat Necrosis

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181. Sivextro - tedizolid phosphate

uncomplicated skin and soft tissue infections, such as simple folliculitis, to complicated skin and soft tissue infections, including very serious conditions such as necrotizing fasciitis and Fournier's gangrene. Complicated skin and soft tissue infections involve deeper soft tissue than uncomplicated infections, and may require significant surgical intervention and parenteral antibiotic therapy. Within the hospital or long term care setting, cSSTIs are generally a consequence of surgery or regarded (...) as a secondary infection associated with an underlying disease. Within the community, they are most often associated with the consequences of trauma. Because of the great variation in seriousness and need of antibiotic treatment other interventions, diagnostic criteria and expected time to healing, it has been suggested that treatment of necrotizing fasciitis and burn wounds should be studied separately from other skin and soft tissue infections. Abscesses Aneeding immediate incision and drainage may also

2015 European Medicines Agency - EPARs

182. Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death Full Text available with Trip Pro

can aid in relating symptoms to the presence of the arrhythmia. Silent myocardial ischaemic episodes may also be detected. A 24- to 48-h continuous Holter recording is appropriate whenever the arrhythmia is known or suspected to occur at least once a day. For sporadic episodes, conventional event recorders are more useful because they can record over extended periods. Implantable subcutaneous devices that continuously monitor the heart rhythm and record events over a timeframe measured in years

2015 European Society of Cardiology

183. Diabetes - type 2

update. The section on antihypertensive treatment has been updated in line with the NICE guideline Hypertension in adults: diagnosis and management [ ]. July 2019 — minor update. Angioedema has been recognised as a very rare skin and subcutaneous tissue disorder in people taking dapagliflozin for type 2 diabetes. May 2019 — minor update. Prescribing information updated for liraglutide as the manufacturer advises that blood glucose self-monitoring is recommended to adjust dose of sulfonylurea (...) to this topic. The adverse effects section for sulfonylureas has been updated to include information about skin and subcutaneous tissue disorders and drug rash with eosinophilia and systemic symptoms (DRESS) with gliclazide [ ]. October 2016 — minor update. Increased lipase and increased amylase added as common adverse effects of liraglutide. April to July 2016 — reviewed. A literature search was conducted in April 2016 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized

2019 NICE Clinical Knowledge Summaries

185. Pulmonary embolism

progress to shock or death due to acute right ventricular failure. The deep veins of the lower limbs are most commonly affected, but thrombosis may affect other sites, including the upper limbs, cerebral veins, and splanchnic veins [ ; ; ; ]. Non-thrombotic sources of emboli include [ ; ] : Tumours — most commonly prostate and breast cancers. Fat — from long-bone fractures. Amniotic fluid in pregnant women. Sepsis — for example, tricuspid valve endocarditis in people who inject illicit drugs (...) fibrin is also produced in a wide variety of conditions, such as pregnancy, cancer, inflammation, bleeding, trauma, surgery, and necrosis, the positive predictive value of elevated D-dimer levels is low, and D-dimer testing is not useful for confirmation of PE [ ]. Giving interim immediate interim parenteral anticoagulant therapy This recommendation is based on the expert opinion of the NICE guideline development group (GDG) [ ]. The GDG considered the costs, potential adverse effects of treatment

2019 NICE Clinical Knowledge Summaries

189. Intraocular (Uveal) Melanoma Treatment (PDQ®): Health Professional Version

, such as ultrasonography, should be used to provide more accurate measurements. An important function of ophthalmic ultrasonography is the detection of extrascleral extension.[ , ] Extrascleral extension measuring 2 mm or more in thickness can be demonstrated provided it is located behind the equator where the intraocular tumor, sclera, and adjacent orbital fat are readily imaged.[ ] Orbital extraocular extension of choroidal melanoma may be found in eyes with medium and large tumors, but it is very rare in eyes (...) of nonclinically involved nodes are not done as part of the staging procedure.[ ] Systemic metastases are generally hematogenous in origin, and the first site identified is usually the liver.[ ] Lung, bone, and subcutaneous sites are also common.[ ] In the COMS trials, the liver was the only site of detectable metastasis in 46% of patients with metastases reported during follow-up or at the time of death; 43% had metastases diagnosed in the liver and other sites.[ ] In patients with a history of ocular

2018 PDQ - NCI's Comprehensive Cancer Database

190. Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ®): Health Professional Version

to be equally efficacious in the detection of bone lesions.[ ] If amyloidosis is suspected, perform a needle aspiration of subcutaneous abdominal fat and stain the bone marrow biopsy for amyloid as the easiest and safest way to confirm the diagnosis.[ ] Measure serum albumin and beta-2-microglobulin as independent prognostic factors.[ , ] The presence of circulating myeloma cells is considered a poor prognostic factor.[ ] Primary plasma cell leukemia has a particularly poor prognosis.[ , ] These initial (...) . [ ] [ ] Gertz MA, Li CY, Shirahama T, et al.: Utility of subcutaneous fat aspiration for the diagnosis of systemic amyloidosis (immunoglobulin light chain). Arch Intern Med 148 (4): 929-33, 1988. [ ] Greipp PR: Advances in the diagnosis and management of myeloma. Semin Hematol 29 (3 Suppl 2): 24-45, 1992. [ ] Durie BG, Stock-Novack D, Salmon SE, et al.: Prognostic value of pretreatment serum beta 2 microglobulin in myeloma: a Southwest Oncology Group Study. Blood 75 (4): 823-30, 1990. [ ] Greipp PR, Witzig

2018 PDQ - NCI's Comprehensive Cancer Database

191. Gastrointestinal Complications (PDQ®): Health Professional Version

glycol (227.1 g), sodium chloride (5.53 g), potassium chloride (2.82 g), sodium bicarbonate (6.36 g), and sodium sulfate (anhydrous, 21.5 g). Do not add flavorings. Serve chilled to improve palatability. Can be stored up to 48 hours in the refrigerator. Use: To clear bowel with minimal water and sodium loss or gain. Opioid antagonists (naloxone, methylnaltrexone, naldemedine) Caution: Administer only if other drugs have failed. Subcutaneous methylnaltrexone, 0.15 mg per kilogram of body weight, can (...) incontinence. Dis Colon Rectum 52 (2): 286-92, 2009. [ ] Memon S, Bissett IP: Rectal perforation following transanal irrigation. ANZ J Surg : , 2014. [ ] Thomas J, Karver S, Cooney GA, et al.: Methylnaltrexone for opioid-induced constipation in advanced illness. N Engl J Med 358 (22): 2332-43, 2008. [ ] Portenoy RK, Thomas J, Moehl Boatwright ML, et al.: Subcutaneous methylnaltrexone for the treatment of opioid-induced constipation in patients with advanced illness: a double-blind, randomized, parallel

2018 PDQ - NCI's Comprehensive Cancer Database

192. Childhood Vascular Tumors Treatment (PDQ®): Health Professional Version

on the right depict the hemangioma after proliferation (slightly raised with a brighter central color). Credit: Israel Fernandez-Pineda, M.D. Infantile hemangiomas can be superficial in the dermis, deep in the subcutaneous tissue, combined, or in the viscera. Combined lesions are common. They are most common in the head and neck but can be anywhere on the body. They can be localized, segmental, or multiple in nature. The cutaneous appearance of infantile hemangiomas is usually red to crimson, firm (...) compromise.[ ] This usually occurs with hemangiomas of the upper medial eyelid but any hemangioma around the eye that is large enough can obstruct the visual axis. The clinician should be aware of subcutaneous periocular hemangiomas, as these lesions can extend into the orbit, causing exophthalmos or globe displacement with only limited cutaneous manifestations. Issues with these lesions include astigmatism from direct pressure of the growing hemangioma, ptosis, proptosis, and strabismus. One

2018 PDQ - NCI's Comprehensive Cancer Database

193. Chilblains

minutes of cold exposure lasting up to 1 hour. Frostbite Superficial frostbite (skin and subcutis) presents with erythema and initial pain followed by a sense of warmth — affected skin becomes waxy and white. Deep frostbite (extends to subcutaneous tissues and may involve nerves, major vessels, muscle and bone) can result in joint immobility and paralysis. Cold panniculitis Panniculitis (inflammation of the subcutaneous fat) caused by cold exposure. Infants are particularly susceptible to cold (...) sensation in the affected extremity to exclude neuropathy. For further information, see the CKS topics on and . Carry out a general examination looking for signs of associated underlying conditions such as lupus erythematosus. Consider the need for investigations: Investigations are not usually required unless an underlying cause is suspected or there is no history of cold exposure. If symptoms are severe (for example, if ulceration, necrosis or other significant skin changes are present) or persistent

2018 NICE Clinical Knowledge Summaries

194. Mastitis and breast abscess

of the breast. It can occur after trauma, around foreign bodies in surgical wounds, or can be idiopathic. Clinical features include painful enlargement of the breast, breast ulceration, foul-smelling discharge from the breast, and fever. Fat necrosis of the breast — a firm, round lump (or lumps) may be seen on the affected breast. This is usually painless but may feel tender or even painful. The skin around the lump may look red, bruised, or occasionally dimpled. Rarely the nipple of the affected breast may (...) publications on duct ectasia [ ] and fat necrosis of the breast [ ], the Cochrane systematic review protocol Treatments for breast engorgement during lactation [ ], a textbook on common problems in lactating women [ ], case reports on breast problems [ ; ; ; ], and a pilot study on painful nipples in nursing mothers [ ]. Management Management : covers the management of mastitis in lactating women. : covers the management of mastitis in non-lactating women. : covers the management of breast abscess

2018 NICE Clinical Knowledge Summaries

195. Management of Nasopharyngeal Carcinoma

-2 The survival rate is higher in rT1 (49.1% to 73%) and rT2 (24.7% to 40%) compared with higher T staging. 42, level II-3; 44, level II-2 Transient complications of nasopharyngectomy such as palatal fistula and submandibular necrosis may resolve spontaneously or require further intervention. 42, level II-3; 44, level II-2 Uncommon complications are: • permanent morbidities due to nerve injury (paralysis causing dysphagia) and severe trismus 42, level II-3; 44, level II-2 • mortality caused (...) . Severe adverse effects for re-irradiation include nasopharyngeal necrosis, cranial nerve palsy, trismus, hearing deficit and temporal lobe necrosis. 45, level II-2; 46, level III The choice of therapeutic approach depends upon local expertise and facilities, and the extend of recurrent disease. Recommendation 5 • In recurrent nasopharyngeal carcinoma, nasopharyngectomy or re- irradiation may be offered. 6.3 Advanced Disease In advanced disease with distant metastasis (M1) of NPC, options of treatment

2016 Ministry of Health, Malaysia

196. Term small for gestational age baby

, thin, dry, flaky and with decreased subcutaneous fat o Tone and alertness: ? Hyperalert, jittery, hypertonic with mild to moderate FGR ? Hypotonic with severe FGR 3.2 Growth standards Table 6. Growth charts Aspect Consideration Growth charts • Measure and plot birth weight, head circumference and length relative to gestational age 36 • The Fenton growth charts for preterm infants 39 : o May be used for determination of SGA o Considered the gold standard for 22-50 weeks gestation o Blend (...) and normal development: o Increased linear growth and lean body mass is preferred to increased fat mass, central adiposity and insulin resistance 52 Queensland Clinical Guideline: Term small for gestational age baby Refer to online version, destroy printed copies after use Page 14 of 21 5 Discharge planning Table 11. Discharge planning Aspect Consideration Criteria for discharge • Evaluate each mother and baby individually to determine the optimal time for discharge 53 • Discussion of discharge plans

2016 Queensland Health

197. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

formation can be detected by ultrasonography. Ultrasonography can also identify a subcutaneous or perigraft fluid collection that could be aspirated for analysis, culture, cell count, and other studies used to differentiate a noninfected seroma from bleeding. A sinogram can demonstrate extension of a sinus tract to the graft, which might involve an anastomotic site. A potential risk of sinograms is that an infection can be introduced during the procedure by the high-pressure instillation of contrast (...) manipulations, the presence of perigraft air is highly suggestive of VGI. CT findings often suggestive of infection include perigraft fluid with fat stranding, lack of fat plane between graft and bowel, and anastomotic leakage or aneurysm. Perigraft fluid is usually reabsorbed within 3 months postoperatively, and perigraft air is usually absorbed within the first week or so, although it can persist for as long as 2 months postoperatively. , , Intra-abdominal VGI can occur many months to years after surgery

2016 American Heart Association

198. Practice Guidelines for the Diagnosis and Management of Aspergillosis Full Text available with Trip Pro

of necrotic lesions in selected cases. 40. In the context of salvage therapy, an additional antifungal agent may be added to current therapy, or combination antifungal drugs from different classes other than those in the initial regimen may be used (weak recommendation; moderate-quality evidence) . 41. In patients currently receiving an antifungal and exhibiting an adverse event attributable to this agent, we recommend changing to an alternative class of antifungal, or the use of an alternative agent (...) ). Prophylaxis with itraconazole is limited by tolerability and absorption ( strong recommendation; high-quality evidence ). 68. We recommend continuation of antifungal prophylaxis throughout the duration of immunosuppression in patients with chronic immunosuppression associated with GVHD (corticosteroid equivalent of >1 mg/kg/day of prednisone for >2 weeks and/or the use of other anti-GVHD therapies, such as lymphocyte-depleting agents, or tumor necrosis factor α (TNF-α) inhibition, for refractory GVHD

2016 Infectious Diseases Society of America

200. Suspected Osteomyelitis, Septic Arthritis, or Soft Tissue Infection (Excluding Spine and Diabetic Foot)

. Fascial thickening, fluid collections along the deep fascial planes, and intermuscular septal edema are MRI and CT features of deep fascial inflammation. Postcontrast imaging is favored, as lack of enhancement confirms tissue necrosis, distinguishing necrotizing from non-necrotizing fasciitis. CT remains the most sensitive modality for identification of soft-tissue gas and is preferred in some situations due to rapid acquisition [13]. Summary of Recommendations ? MRI with contrast is the modality (...) AM, Herlitz GN, Gracias VH. Necrotizing soft tissue infections. J Intensive Care Med. 2014;29(3):138-144. ACR Appropriateness Criteria ® 15 Suspected Osteomyelitis/Septic Arthritis 41. Mirowitz SA. Fast scanning and fat-suppression MR imaging of musculoskeletal disorders. AJR Am J Roentgenol. 1993;161(6):1147-1157. The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified

2016 American College of Radiology

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