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Subcutaneous Fat Necrosis

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841. Suction-assisted lipectomy fails to improve cardiovascular metabolic markers of disease: a meta-analysis. (Abstract)

(interquartile range (IQR) 1-6, range 0.5-10.5). The mean amount of extracted fat ranged from 2063 to 16,300 ml, with a mean ± standard deviation (SD) of 6138 ± 4735 ml. After adjusting for time and body mass index (BMI), leptin and fasting insulin were the only markers that were significantly associated with the amount of aspirated fat. No associations were observed for high sensitive C-reactive protein (hCRP), interleukin-6 (IL-6), adiponectin, resistin, tumour necrosis factor-α (TNF-α), Homeostasis Model (...) of Assessment (HOMA), total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, free fatty acids or systolic blood pressure.Based on the results of our analysis, we conclude that there is no evidence to support the hypothesis that subcutaneous fat removal reduces early cardiovascular or metabolic disease, its markers or its risk factors.Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

2013 Journal of plastic, reconstructive & aesthetic surgery : JPRAS

842. The Origin of Human Mesenchymal Stromal Cells Dictates Their Reparative Properties (Full text)

induced greatest infarct vascularization as well as highest inflammation score 27 days after transplantation. Surprisingly, cardiac dysfunction was worst after transplantation of hMSCs from atrium and epicardial fat and minimal after transplantation of hMSCs from subcutaneous fat. These findings were confirmed by using hMSC transplantation in immunocompromised mice after myocardial infarction. Notably, there was a correlation between tumor necrosis factor-α secretion from hMSCs and posttransplantation (...) The Origin of Human Mesenchymal Stromal Cells Dictates Their Reparative Properties Human mesenchymal stromal cells (hMSCs) from adipose cardiac tissue have attracted considerable interest in regard to cell-based therapies. We aimed to test the hypothesis that hMSCs from the heart and epicardial fat would be better cells for infarct repair.We isolated and grew hMSCs from patients with ischemic heart disease from 4 locations: epicardial fat, pericardial fat, subcutaneous fat, and the right atrium

2013 Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease PubMed abstract

843. Acute Pancreatitis

to evaluate for complications) Consider in severe , pancreatic necrosis or when other complications are suspected Acute Pancreatitis typically shows peripancreatic inflammation and fat stranding (but may be absent early in course) Identifies pancreatic edema and necrosis as well as extrapancreatitc changes including fluid accumulation for severe Pancreatitis: 78% (and LR+ 5.57) for severe Pancreatitis: 86% (and LR- 0.26) Predicts and evaluates Pancreatitis complications, length of hospital stay (...) symptoms or Indigestion , distention or fullness Clay-colored stool Other associated symptoms Decreased s Tactile warmth IV. Signs ral Low grade fever (severe cases) Cardiopulmonary Exam (25%) Left basilar rales ( ) Abdominal Exam Abdominal tenderness and guarding in the upper quadrants Peritoneal signs may be present (e.g. abdominal rigidity or sounds decreased Palpable upper abdominal mass (periumbilical discoloration with subcutaneous and edema) (flank discoloration with ) Skin Exam Erythematous

2015 FP Notebook

844. Burn Injury

(lower layers of reticular ) Findings Wet, weaping lesions with clear s White or pale to that when touched does not blanch Course Healing typically takes >21 days Scarring and contractures are common complications (involves stem cells, follicles, glands) Third degree (Full thickness) Pathophysiology Kills all skin layers Also involves underlying subcutaneous fat Findings Waxy, leathery, dark-brown to black, tan or white skin Bright red burns without blanching or sensation are Third Degree Burns (...) , flames, chemicals, electricity, friction or radiant and electromagnetic energy. A first degree burn is associated with redness, a second degree burn with vesication and a third degree burn with necrosis through the entire skin. Definition (MSH) Injuries to tissues caused by contact with heat, steam, chemicals (BURNS, CHEMICAL), electricity (BURNS, ELECTRIC), or the like. Definition (CSP) damage inflicted on any part of an organism as the direct or indirect result of exposure to steam, chemicals, heat

2015 FP Notebook

845. Adjustable Gastric Banding

under fluoroscopy Management Endoscopic port replacement or Intra-abdominal surgical correction XI. Complications: Pouch dilation Causes Band overinflation Presentations Loss of satiety or regurgitation Management: Initial Deflate band Reinforce dietary management Management: Re-evaluate at 4-6 weeks Anticipate pouch size return to normal in 4-6 weeks Consider gastric band replacement or removal XII. Complications: Port site prominence Weight loss results in decreased subcutaneous fat Port rubs (...) Adjustable Gastric Banding Aka: Adjustable Gastric Banding , Laparoscopic Adjustable Gastric Banding , Adjustable Gastric Banding Surgery , Gastric banding II. Indications Morbid III. Epidemiology Most common form of in U.S. IV. Background Introduced in 2006 Band applied around the distal esophagus or proximal e Reversible and tension can be adjusted via subcutaneous port Replaces V. Efficacy Weight loss 21% at 1 year and 13% at 10 years VI. Prognosis: Outcomes Reoperation is required in 50% of cases

2015 FP Notebook

846. Wound Repair

Debridement Recut wound for clean, fresh, surgical-incision edges Undermining May be required to ensure closure and decreased skin tension Best dissection plane is between dermal layer and connective tissue, subcutaneous fat Insert closed scissors on lateral wound margin, and then spread open Repeat for opposite lateral wound margin technique Grasp with needle driver one third of way from attachment (where needle becomes straight) Evert wound edges (do not dig a ditch, build a flask) Everted edges (...) supply to tip of corner) Everts wound edges, but risk of skin necrosis and scar Everts wound edges, but risk of skin necrosis and scar Deep (interrupted dermal s) May use in clean wounds to better approximate wound edges and reduce wound edge tension Fast technique for long Lacerations, but risk of dehiscence if breaks anywhere along its length Subcuticular May use in clean wounds (surgical wounds) for close wound edge apposition (but does not allow drainage) Removal See for timing of removal XVII

2015 FP Notebook

847. Decubitus Ulcer

or Cognitive or (and other causes of excessive moisture) Advanced age V. Signs: Distribution (bony prominences) Common Heel Ischial tuberosity Buttock Other Ear Occiput Greater Trochanter Lateral Malleolus VI. Examination: Ulcer Characterization Basic description Location Size (Length x Width x Depth) Stage (Types 1-4) See Staging precautions Accurate grading requires debridement of necrosis first Use other grading schemes for staging of s and s Macerated skin (moisture induced wounds) are not staged Stage (...) 1: Nonblanchable erythema of intact skin (pink skin, not purple) Stage 2: Superficial or partial thickness skin loss (no slough or eschar) Stage 3: Full thickness skin loss with subcutaneous damage (crater to fascia) Stage 4: Full thickness skin loss with extensive deep damage to muscle, bone, tendon Additional findings Sinus tracts Exudate Necrotic tissue Granulation tissue Discharge and signs of infection VII. Labs culture Typically not indicated except to identify Levine Technique

2015 FP Notebook

848. Venous Insufficiency

, nem meghatározott , Venás elégtelenség Norwegian Venøs insuffisiens Derived from the NIH UMLS ( ) Ontology: Lipodermatosclerosis (C0406500) Definition (SCTSPA) Disminución de la circunferencia de la pierna debida a ulceración recurrente y necrosis adiposa que produce pérdida del tejido subcutáneo en un paciente con estasis venosa Definition (SNOMEDCT_US) A decrease in lower leg circumference due to recurrent ulceration and fat necrosis causing loss of subcutaneous tissue in a patient with venous (...) stasis disease Definition (SNOMEDCT_US) A decrease in lower leg circumference due to recurrent ulceration and fat necrosis causing loss of subcutaneous tissue in a patient with venous stasis disease Concepts Disease or Syndrome ( T047 ) MSH SnomedCT 95335006 , 201301003 , 201306008 , 410016009 English Post-phlebitic liposclerosis , Acute lipodermatosclerosis , Lipodermatosclerosis , lipodermatosclerosis , lipodermatosclerosis (diagnosis) , Lipodermatosclerosis, NOS , Lipodermatosclerosis (disorder

2015 FP Notebook

849. Z-Plasty

Betadine or Hibiclens preparation of site anesthesia Using #15 blade, make vertical incision along Z Excise scar Create full thickness skin flaps Undermine skin at subcutaneous fat Flaps should be freely mobile VII. Step 3: Transpose flap tips Flap tip E is transposed to point D (bottom end of Z) Simple interrupted stay s hold sides es used to hold flap tips in place Flap tip F is transposed to point C (top end of Z) Simple interrupted stay s hold sides es used to hold flap tips in place VIII. Step 4 (...) : Final appearance Line 1 is now reoriented by 90 degrees Z shape is a mirror image of incised Z IX. Complications Flap necrosis or sloughing hematoma (consider large bore needle aspiration) X. References Davidson in Cummings (1998) Otolaryngology, p. 440*1 Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Z-Plasty." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip

2015 FP Notebook

850. Cellulitis

and edematous conditions which are bilateral Abscess (or purulent drainage) Hallmark of Peau d'orange Skin (orange-peel like skin) Cellulitis results in edema including the fat layer s remain anchored to the Results in an indentation or pitting at each in the midst of edema of the surrounding tissue Regional spread Ascending lymphangitis Small patches of necrosis superinfection may also be present Hemorrhagic and necrotic bullae (specific conditions) Pseudomonas Cellulitis ( ) IX. Differential Diagnosis (...) , indurated Typically caused by Although can have a similar appearance on the face Cellulitis (deep, subcutaneous) Abrupt onset of indistinct faint erythema with rapidly advancing border Typically caused by group A. or Group G Although can cause this as well Purulent Cellulitis Cellulitis with pustular drainage or exudate without definitive, drainable abscess Abscess Hallmark of infection Primary management is If antibiotics are needed (Cellulitis with abscess), then cover (see below) Other l s Consider

2015 FP Notebook

851. Nicolau Syndrome after Intramuscular Injection: 3 Cases (Full text)

Nicolau Syndrome after Intramuscular Injection: 3 Cases Nicolau syndrome is a rare complication of intramuscular injection consisting of ischemic necrosis of skin, soft tissue, and muscular tissue that arises locoregionally. The characteristic pattern is pain around the injection site, developing into erythema, a livedoid dermatitis patch, and necrosis of the skin, subcutaneous fat, and muscle tissue. Three patients were injected with drugs (diclofenac sodium, ketoprofen, meperidine) for pain (...) relief. Three patients complained of pain, and a skin lesion was observed, after which necrosis developed on their buttocks. Each patient underwent debridement and coverage. The wound healed uneventfully. We report three cases of Nicolau syndrome in the buttocks following diclofenac intramuscular injection.

2012 Archives of plastic surgery PubMed abstract

852. Altered adipocyte structure and function in nutritionally programmed microswine offspring (Full text)

of acquired obesity: adiponectin and tumor necrosis factor (TNF)-α messenger ribonucleic acid (mRNA) levels and adipocyte size in intra-abdominal (ABD-AT) and subcutaneous (SC-AT) adipose tissues. Plasma cortisol, leptin and insulin levels were measured in fetal, neonatal and juvenile offspring. In juvenile low-protein offspring (LPO), adipocyte size in ABD-AT was reduced 22% (P = 0.011 v. controls), whereas adipocyte size in SC-AT was increased in female LPO (P = 0.05) and normal in male LPO; yet (...) Altered adipocyte structure and function in nutritionally programmed microswine offspring Adipose tissue (AT) dysfunction links obesity of any cause with cardiometabolic disease, but whether early-life nutritional deficiency can program adipocyte dysfunction independently of obesity is untested. In 3-5-month-old juvenile microswine offspring exposed to isocaloric perinatal maternal protein restriction (MPR) and exhibiting accelerated prepubertal fat accrual without obesity, we assessed markers

2012 Journal of developmental origins of health and disease PubMed abstract

853. Adipose Tissue Promotes a Serum Cytokine Profile Related to Lower Insulin Sensitivity after Chronic Central Leptin Infusion (Full text)

was found in both adipose depots and IFN-γ only in visceral tissue. Activation of leptin signaling was increased and insulin signaling decreased in subcutaneous fat of L. In conclusion, leptin mediates the production of inflammatory cytokines by adipose tissue independent of its effects on food intake, decreasing insulin sensitivity. (...) and protein content as well as with leptin and insulin signaling in subcutaneous and visceral adipose tissues. In addition, we analyzed the possible correlation between circulating levels of cytokines and peripheral insulin resistance. We studied 18 male Wistar rats divided into controls (C), those treated icv for 14 days with a daily dose of 12 μg of leptin (L) and a pair-fed group (PF) that received the same food amount consumed by the leptin group. Serum leptin and insulin were measured by ELISA, mRNA

2012 PloS one PubMed abstract

854. The Effect of Dose-Volume Parameters and Interfraction Interval on Cosmetic Outcome and Toxicity After 3-Dimensional Conformal Accelerated Partial Breast Irradiation. (Abstract)

. Univariate logistic regression was used to evaluate the association of interfraction interval (IFI) with these outcomes.At a median follow-up time of 32 months, grade 2-4 and grade 3-4 subcutaneous fibrosis occurred in 31% and 7.5% of patients, respectively. Subcutaneous fibrosis improved in 5 patients (6%) with extended follow-up. Fat necrosis developed in 11% of women, and cosmetic outcome was fair/poor in 19%. The relative volume of breast tissue receiving 5%, 20%, 50%, 80%, and 100% (V5-V100 (...) ) of the prescribed dose was associated with risk of subcutaneous fibrosis, and the volume receiving 50%, 80%, and 100% (V50-V100) was associated with fair/poor cosmesis. The mean IFI was 6.9 hours, and the minimum IFI was 6.2 hours. The mean and minimum IFI values were not significantly associated with late toxicity.The incidence of moderate to severe late toxicity, particularly subcutaneous fibrosis and fat necrosis and resulting fair/poor cosmesis, remains high with continued follow-up. These toxicity

2012 Biology and Physics

855. Soy Protein Intake and the Metabolic Syndrome

will evaluate whether reduced low-grade inflammation is a possible mechanism underlying the improvement in insulin resistance and glucose homeostasis. Finally, it will be assessed whether soy protein has beneficial effects on components of the metabolic syndrome, such as cardio-metabolic risk factors, blood lipid profile, blood pressure and endothelial function, fat storage in the liver and gene-expression in subcutaneous abdominal adipose tissue. Study design: Single-blind, cross-over strictly-controlled (...) will be calculated. Inflammation markers and adipokines [ Time Frame: 4 weeks ] For low-grade inflammation interleukins, tumor necrosis factor-α, C-reactive protein and adipokines will be measured in fasting blood samples. Furthermore, peripheral blood mononuclear cells (PBMC's) will be collected to measure expression of genes involved in lipid handling and inflammation. Cardio-metabolic risk factors [ Time Frame: 4 weeks ] Blood pressure and macro vascular regional arterial stiffness will be assessed by Pulse

2012 Clinical Trials

856. External-Beam Partial-Breast Irradiation for Early Breast Cancer 40 Gy QD Over 2 Weeks

Frame: 2 years ] The safety of external-beam PBI in selected stages 0 and I female breast cancer patients utilizing 40 Gy in ten daily fractions over two weeks. The study will be deemed too toxic if >10% of enrolled patients have at least one of the following outcomes within 24 months of completion of PBI. Grade 3 or 4 skin/subcutaneous or pulmonary toxicity. The development of clinical fat necrosis. The development of rib fracture on the ipsilateral treated side, detected either clinically

2012 Clinical Trials

857. Immune deficiency could be an early risk factor for altered insulin sensitivity in antiretroviral-naive HIV-1-infected patients: the ANRS COPANA cohort. (Full text)

, immunovirological and inflammatory parameters, glucose/insulin during oral glucose tolerance test (OGTT), adipokines, subcutaneous and visceral fat surfaces (subcutaneous adipose tissue [SAT] and visceral adipose tissue [VAT], assessed by computed tomography) and the body fat distribution based on dual-energy X-ray absorptiometry (DEXA).Median age was 36 years; 28% of the patients were female and 35% of sub-Saharan origin; 20% had low CD4(+) T-cell counts (≤200/mm(3)). Patients with low CD4(+) T-cell counts (...) Immune deficiency could be an early risk factor for altered insulin sensitivity in antiretroviral-naive HIV-1-infected patients: the ANRS COPANA cohort. The relationships between immunovirological status, inflammatory markers, insulin resistance and fat distribution have not been studied in recently diagnosed (<1 year) antiretroviral-naive HIV-1-infected patients.We studied 214 antiretroviral-naive patients at enrolment in the metabolic substudy of the ANRS COPANA cohort. We measured clinical

2012 Antiviral Therapy PubMed abstract

858. Little evidence of systemic and adipose tissue inflammation in overweight individuals(†). (Full text)

sensitive C-reactive protein (hsCRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), adiponectin] and inflammation-related genes [CD68, IL-6, TNF-α, macrophage migration inhibitory factor (MIF), monocyte chemoattractant protein-1 (MCP-1), adiponectin, plasminogen activator inhibitor-1 (PAI-1)] in subcutaneous adipose tissue.CR and CR + EX lost similar amounts of body weight (-10 ± 1%), fat mass (-24 ± 3%), visceral fat (-27 ± 3%), and had increased insulin sensitivity (CR: 40 ± 20%, CR + EX (...) Little evidence of systemic and adipose tissue inflammation in overweight individuals(†). The effect of weight loss by diet alone or diet in conjunction with exercise on low-grade inflammation in non-obese (overweight) individuals is not known.Test the hypothesis that 24 weeks of moderate calorie restriction (CR; 25%) by diet only or with aerobic exercise would reduce markers of systemic inflammation and attenuate inflammation gene expression in subcutaneous adipose tissue.Randomized

2012 Frontiers in genetics Controlled trial quality: uncertain PubMed abstract


PASSAGE OF COXSACKIE VIRUS (CONNECTICUT-5 STRAIN) IN ADULT MICE WITH PRODUCTION OF PANCREATIC DISEASE 1. With Conn.-5 strain of Coxsackie virus, pancreatic disease can be regularly produced in adult mice. 2. The lesions consist of widespread necrosis, followed by repair; there occurs more or less complete loss of glandular acini, with fatty or fibrous replacement. The islands of Langerhans and pancreatic ducts persist. 3. Injection of virus suspensions by the intraperitoneal, subcutaneous (...) , intramuscular, or intracerebral route is followed by selective necrosis of the pancreas. 4. The liver, in the earlier stages of the disease, is the seat of fat infiltration. There may be necrosis of individual hepatic cells, but the diffuse hepatitis described in suckling mice does not occur. In the later stages of the disease, the liver is not significantly altered. 5. Localized areas of fat necrosis, scattered through intra-abdominal adipose tissue, are usually present in the acute phase of the disease

1951 The Journal of experimental medicine PubMed abstract


which varies greatly in character. The duodenum and upper jejunum may also be involved in the inflammatory process. 4. Intraperitoneal injections of formalin cause peritonitis of a fibrino-haemorrhagic character. A definite reaction is obtained when very dilute formalin (1-1000) is employed. In the peritoneal cavity formalin exercises a destructive action upon all organs (pancreas, liver, peritoneal fat, Fallopian tubes, etc.) with which it comes in contact and causes inflammation in these organs. 5 (...) . The lethal dose of formalin when injected intraperitoneally into guinea pigs is approximately 2 cc. of 1-1000 formalin for each 100 grm. of body weight. 6. The injection of formalin into the lungs is followed by pneumonia and bronchitis. 7. The inflammation which follows subcutaneous injections of formalin is characterized by intense exudation. 8. The injection of formalin into the muscles produces myositis. 9. The injection of formalin into the anterior chamber of the eye causes the accumulation

1905 The Journal of experimental medicine PubMed abstract

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