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Subcutaneous Fat Necrosis

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921. A 1-week-old newborn with hypercalcemia and palpable nodules: subcutaneous fat necrosis. (PubMed)

A 1-week-old newborn with hypercalcemia and palpable nodules: subcutaneous fat necrosis. We present a 1-week-old newborn with subcutaneous fat necrosis complicated by hypercalcemia. She received conservative treatment of adequate hydration and restricted supplementary vitamin D.

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2008 Canadian Medical Association Journal

922. Adiponectin and resistin response in the onset of obesity in male and female rats. (PubMed)

adiponectin and resistin and tissue mRNA levels were analyzed by western blot and reverse transcription-PCR, respectively. Serum levels of insulin, tumor necrosis factor-alpha (TNFalpha), and glucose were measured by enzyme-linked immunosorbent assay and by a glucose sensor. Insulin resistance was assessed by the homeostasis model assessment (HOMA).Energy intake and adipose-tissue weight were significantly increased in the CAF rats, with higher increase in visceral than in subcutaneous fat, especially (...) Adiponectin and resistin response in the onset of obesity in male and female rats. Studying the sex-dependent response of adiponectin and resistin adipose tissue expression and circulating levels in the onset of dietary obesity.Male and female 4-week-old Wistar rats were fed a control or cafeteria (CAF) diet for 15 days. Body weight and energy intake were monitored. Gonadal (visceral), retroperitoneal (visceral) and inguinal (subcutaneous) white adipose tissue (WAT) depots were collected. Serum

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2008 Obesity

923. Inducible Toll-like receptor and NF-kappaB regulatory pathway expression in human adipose tissue. (PubMed)

adipose tissue.We biopsied subcutaneous abdominal fat from 16 obese subjects (age 39+/-11 years, BMI 49+/-14 kg/m2) and characterized TLR expression using quantitative real-time PCR and confocal immunofluorescence imaging. In tissue culture, we stimulated isolated human adipocytes with Pam3CSK4 and lipopolysaccharide (LPS) (TLR2 and TLR4 agonists, respectively) and quantified TLR activity, interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) production, and nuclear factor-kappaB (NF-kappaB (...) Inducible Toll-like receptor and NF-kappaB regulatory pathway expression in human adipose tissue. Inflammatory activity in fat tissue has recently been implicated in mechanisms of insulin resistance and obesity-related metabolic dysfunction. Toll-like receptors (TLRs) play a key role in innate immune responses and recent studies implicate the TLR pathway in mechanisms of inflammation and atherosclerosis. The aim of this study was to examine differential TLR expression and function in human

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2008 Obesity

924. Macrophages regulate tumor necrosis factor-alpha expression in adipocytes through the secretion of matrix metalloproteinase-3. (PubMed)

with THP-1 Mphi or the Mphi-conditioned medium were used to investigate the role of Mphi-MMP on the TNF-alpha gene in 3T3-L1 adipocytes by the addition of MMP inhibitors. For animal experiments, male C57BL/6J mice were rendered insulin resistant by feeding a high-fat diet, and the expression of an Mphi marker F4/80, and MMP-3 genes in mesenteric and subcutaneous fat tissue specimens were examined.Mphi-conditioned media (Mphi-CM) increased the levels of TNF-alpha mRNA expression in 3T3-L1 adipocytes (...) Macrophages regulate tumor necrosis factor-alpha expression in adipocytes through the secretion of matrix metalloproteinase-3. Adipocytes accumulated in the visceral area change their function to induce tumor necrosis factor-alpha (TNF-alpha) secretion with concomitant matrix metalloproteinase (MMP)-3 induction in mice. This study was performed to clarify the role of macrophages (Mphi)-secreted MMP on the functional changes in adipocytes using a culture system.Cultures of 3T3-L1 adipocytes

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2008 International Journal of Obesity

925. Expression of 25-hydroxyvitamin D(3)-1alpha-hydroxylase in subcutaneous fat necrosis. (PubMed)

Expression of 25-hydroxyvitamin D(3)-1alpha-hydroxylase in subcutaneous fat necrosis. The most serious complication of subcutaneous fat necrosis (SCFN), a rare condition of the newborn characterized by indurated purple nodules, is hypercalcaemia. However, the mechanism for this hypercalcaemia remains unclear.To determine whether the hypercalcaemia associated with SCFN involves expression of the vitamin D-activating enzyme 25-hydroxyvitamin D(3)-1alpha-hydroxylase (1alpha-hydroxylase

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2008 British Journal of Dermatology

926. Shoulder Injection

appropriate follow-up. Side-effects Often the result of poor technique, too large a dose, too frequent a dose, or failure to mix and dissolve the medications properly. Local Infection (1/10,000). Post-injection flare of pain (2-5%); reduced incidence with rest for 24 hours. Skin discolouration; improves with time. Subcutaneous fat atrophy. Bleeding (rare). [ ] Soft tissue calcification with repeated injection at the same site Joint injury (do not move the needle from side to side within the joint (...) ); cartilage damage and osteoporosis: avoid repeated injections (no more than four injections in each location per year). Tendon atrophy and rupture (<1%): avoid direct tendon injection. [ ] Pericapsular calcification(>40%). Avascular necrosis. Systemic Flushing of skin. Temporary impairment of diabetic control. Vasovagal reaction. Anaphylaxis (rare but adrenaline (epinephrine), etc, should be close at hand). Knee joint injection [ ] See also separate article. The patient should lie still on a couch

2008 Mentor

927. Minor Surgery in Primary Care - Procedures Under a Direct Enhanced Service

vertical to the skin, cut outside the line. On hairy skin, cut at the angle the hairs exit the skin. You should try to cut down to the subcutaneous fat in one stroke but avoiding reaching the deep fascia. Remember that skin varies in thickness over the body. Try not to 'fish-tail' at the ends of the wound. Avoid or take special care in those areas where important structures lie close to the surface, eg: The side of the face near the ears. The neck. The axillae or popliteal fossa. The wrist or palmar (...) aspect of the fingers. The femoral or inguinal triangle. The shins. Performing skin biopsy The area of skin needs to be removed with minimum damage for optimum examination results: By using either a skin hook or a silk suture at a corner of the specimen, instead of forceps. By gently dissecting skin away from subcutaneous fat, with blunt-tipped scissors using 'separate and snip'. The specimen is then placed in 10% formalin in saline and sent to the laboratory. Suturing For small wounds not under

2008 Mentor

928. Minor Surgery in Primary Care - Basic Procedures

outside the line. On hairy skin, cut at the angle the hairs exit the skin. You should try to cut down to the subcutaneous fat in one stroke but avoiding reaching the deep fascia. Remember that skin varies in thickness over the body. Try not to 'fish-tail' at the ends of the wound. Avoid or take special care in those areas where important structures lie close to the surface, eg: The side of the face near the ears. The neck. The axillae or popliteal fossa. The wrist or palmar aspect of the fingers (...) . The femoral or inguinal triangle. The shins. Performing skin biopsy The area of skin needs to be removed with minimum damage for optimum examination results: By using either a skin hook or a silk suture at a corner of the specimen, instead of forceps. By gently dissecting skin away from subcutaneous fat, with blunt-tipped scissors using 'separate and snip'. The specimen is then placed in 10% formalin in saline and sent to the laboratory. Suturing For small wounds not under tension, the edges can be held

2008 Mentor

929. Varicose Eczema

). Pathophysiology [ , ] The exact pathophysiology behind the skin changes is unclear. Leakage of blood constituents into the surrounding tissues and activation of inflammatory cells and fibroblasts are broadly responsible for the changes observed. These skin changes progress through the following changes: Mild pigmentation from haemosiderin deposition. Areas of inflammatory change and eczema. Lipodermatosclerosis - inflammation of the subcutaneous fat causing fibrosis, and hard, tight skin which may be red (...) above the malleoli. It may look like cellulitis but the latter will be hot and shiny and without scaling on the surface. Erythema and dryness of the skin are the major signs to look for. Small blisters (vesicles) are common in eczema. These break down and the serous fluid released dries to form crusts which coalesce. Although blister formation is uncommon in cellulitis, if blisters do develop they are large and herald the onset of skin necrosis. Skin changes are often bilateral. Note considerable

2008 Mentor

930. Erythema Induratum (Bazin's Disease)

to describe chronic inflammatory nodules of the legs that showed histopathological changes similar to those of erythema induratum, but without an association with TB. The vasculitis is of the larger vessels with panniculitis - an inflammation involving subcutaneous fat and occasionally muscle, with or without vasculitis. Erythema induratum and nodular vasculitis had been seen as the same disease for many years but nodular vasculitis is now considered to be a multifactorial syndrome of lobular panniculitis (...) in a formalin-fixed, paraffin-embedded specimen. This can differentiate tuberculous disease from other aetiologies. [ ] An excision biopsy is usually recommended, going down to an adequate level of subcutaneous fat. Stains for bacteria and fungi may be used and an attempt to culture the tubercle baccillus and other organisms. Histopathological examination demonstrates a predominant lobular panniculitis with granulomatous inflammation. A neutrophilic vasculitis is usually present and affects contiguous small

2008 Mentor

931. Boils and Carbuncles

and underlying connective tissue, including the subcutaneous fat. The source of staphylococcal infection is usually in the nose or the perineum and it is thought that the infection is disseminated by the fingers and by clothing. Epidemiology The incidence of boils is uncertain [ ] . They are rare in children except in those with atopic eczema. They are rather more common in adolescents and in early adulthood - especially in boys - and the peak incidence is the same as for acne vulgaris. In England, hospital (...) ; the redness and oedema diminish over days to weeks. In people who have HIV, boils may coalesce into violaceous plaques. A carbuncle grows in size for a few days to reach a diameter of 3-10 cm, occasionally more. After 5-7 days, suppuration occurs and multiple pustules soon appear on the surface, draining externally around multiple hair follicles: A yellow-grey irregular crater develops at the centre. In some cases the necrosis develops more acutely without a follicular discharge and the entire central

2008 Mentor

932. Acute Pancreatitis

Gastrointestinal: Haemorrhage Ileus Weber-Christian disease: Subcutaneous fat necrosis - relapsing febrile nodular nonsuppurative panniculitis. Recurring crops of tender nodules in the skin and subcutaneous fat of the trunk, thighs and buttocks, which is more common in middle-aged women. These often ulcerate and then scar on healing. Difficult to treat - try prednisolone or immunosuppressives. Splenic vein thrombosis. Prognosis 80% of patients have mild disease and recover without complications (...) and typically cause periductal necrosis. Gallstones cause pancreatitis by blocking the bile duct, causing back pressure in the main pancreatic duct. Perilobular necrosis is less common and usually found in those with hypothermia and gross hypotension. Haemorrhagic, necrotic black discolouration is only found in the most severe cases. Studies suggest that in countries with high prevalence the main cause is alcohol, whilst in low-prevalence countries it is mainly related to biliary disease. [ ] Less common

2008 Mentor

933. Chronic Pancreatitis

and an average patient age of 40. Pathophysiology The underlying mechanism of chronic pancreatitis is unclear. There have been many theories. The most common thought is that there is obstruction or reduction of bicarbonate excretion. This in turn leads to activation of pancreatic enzymes, which leads to pancreatic tissue necrosis with eventual fibrosis. Abnormalities of bicarbonate excretion can be the result of functional defects at the level of the cellular wall, as in cystic fibrosis, or mechanical (...) -term resolution of pain. [ ] However, if patients fail to respond then they should be considered for surgical procedures. Octreotide Octreotide is a somatostatin analogue and inhibits pancreatic enzyme secretion and CCK levels. It has been used with varying success rates - but this is limited by the subcutaneous route of administration. [ ] Surgical management [ ] EUS is increasingly being used to facilitate the surgical management of complications - eg, pseudo-cyst decompression. Pancreatic duct

2008 Mentor

934. Lumps

'). Epididymal cysts. Hydroceles. Sebaceous cysts in the scrotal skin. : Fibroadenomas (mobile, 'the breast mouse'). Simple cysts. Fat necrosis. Fibroadenosis (lumpy breasts). Breast abscesses. Breast cancer. Groin, neck and axilla: These are sites of known lymph node collections (see separate article ). Sebaceous cysts. Abscesses. : Pregnancy. Hepatomegaly. Splenomegaly. Other organ enlargement and tumours. Abdominal aortic aneurysms (pulsatile and often with bruits). Management This will depend on a number (...) in hand infections. A common cause of non-staphylococcal axillary abscesses is Proteus spp. Below the waist, faecal organisms are common (aerobes and anaerobes). Treatment is by incision and drainage. Boils are recognised by the following characteristics: Furuncles are abscesses which involve a hair follicle and its associated glands. A carbuncle is an area of subcutaneous necrosis which discharges itself on to the surface through multiple sinuses. Rheumatoid nodules These are collagenous granulomas

2008 Mentor

935. Lipoma

is not usually required if MRI is available. Differential diagnosis - these may be differentiated by the punctum in their surface and also by their site in the dermis, attached to the surface. Subcutaneous tumours. Nodular fasciitis. Liposarcoma. Metastatic disease. . Nodular subcutaneous fat necrosis. Weber-Christian panniculitis (recurring inflammation in the fat layer of the skin). Vasculitic nodules. Rheumatic nodules. . Infections - eg, onchocerciasis. Haematoma. Management They can be left alone (...) . In this article In This Article Lipoma In this article Lipomas (lipomata) are slow-growing, benign, adipose tumours that are most often found in the subcutaneous tissues. They may also be found in deeper tissues such as the intermuscular septa, the abdominal organs, the oral cavity, the internal auditory canal, the cerebellopontine angle and the thorax. Most lipomas are asymptomatic, can be diagnosed with clinical examination and do not require treatment. Epidemiology [ ] Lipomas may be seen in all age groups

2008 Mentor

936. Joint Injection and Aspiration (PubMed)

suggesting infection. Arrange appropriate follow-up. Side-effects Often the result of poor technique, too large a dose, too frequent a dose, or failure to mix and dissolve the medications properly. Local Infection (1/10,000). Post-injection flare of pain (2-5%); reduced incidence with rest for 24 hours. Skin discolouration; improves with time. Subcutaneous fat atrophy. Bleeding (rare). [ ] Soft tissue calcification with repeated injection at the same site Joint injury (do not move the needle from side (...) to side within the joint); cartilage damage and osteoporosis: avoid repeated injections (no more than four injections in each location per year). Tendon atrophy and rupture (<1%): avoid direct tendon injection. [ ] Pericapsular calcification(>40%). Avascular necrosis. Systemic Flushing of skin. Temporary impairment of diabetic control. Vasovagal reaction. Anaphylaxis (rare but adrenaline (epinephrine), etc, should be close at hand). Knee joint injection [ ] See also separate article. The patient

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2008 Mentor

937. Infection control and instrument sterility for GP minor surgery

outside the line. On hairy skin, cut at the angle the hairs exit the skin. You should try to cut down to the subcutaneous fat in one stroke but avoiding reaching the deep fascia. Remember that skin varies in thickness over the body. Try not to 'fish-tail' at the ends of the wound. Avoid or take special care in those areas where important structures lie close to the surface, eg: The side of the face near the ears. The neck. The axillae or popliteal fossa. The wrist or palmar aspect of the fingers (...) . The femoral or inguinal triangle. The shins. Performing skin biopsy The area of skin needs to be removed with minimum damage for optimum examination results: By using either a skin hook or a silk suture at a corner of the specimen, instead of forceps. By gently dissecting skin away from subcutaneous fat, with blunt-tipped scissors using 'separate and snip'. The specimen is then placed in 10% formalin in saline and sent to the laboratory. Suturing For small wounds not under tension, the edges can be held

2008 Mentor

938. Knee Injections and Aspirations

suggesting infection. Arrange appropriate follow-up. Side-effects Often the result of poor technique, too large a dose, too frequent a dose, or failure to mix and dissolve the medications properly. Local Infection (1/10,000). Post-injection flare of pain (2-5%); reduced incidence with rest for 24 hours. Skin discolouration; improves with time. Subcutaneous fat atrophy. Bleeding (rare). [ ] Soft tissue calcification with repeated injection at the same site Joint injury (do not move the needle from side (...) to side within the joint); cartilage damage and osteoporosis: avoid repeated injections (no more than four injections in each location per year). Tendon atrophy and rupture (<1%): avoid direct tendon injection. [ ] Pericapsular calcification(>40%). Avascular necrosis. Systemic Flushing of skin. Temporary impairment of diabetic control. Vasovagal reaction. Anaphylaxis (rare but adrenaline (epinephrine), etc, should be close at hand). Knee joint injection [ ] See also separate article. The patient

2008 Mentor

939. Consensus recommendations for the diagnosis, treatment and control of Mycobacterium ulcerans infection (Bairnsdale or Buruli ulcer) in Victoria, Australia

. Epidemiology Mycobacterium ulcerans was discovered in 1948 by Australian scientists who were investigating a cluster of patients with unusual skin ulcers in the Bairnsdale region of eastern Victoria. M. ulcerans is related to the causative agents of tuberculosis and leprosy, but is transmitted from the environment rather than from person to person. The major virulence factor is a lipid toxin, mycolactone, which causes necrosis of fat and subcutaneous tissue. M. ulcerans infection is not fatal, but can (...) that undergoes necrosis and evolves to a deeply undermined ulcer. Lesions are usually painless or minimally painful. Less commonly, the initial lesion may resemble a plaque or necrotic patch of skin. Systemic symptoms (fever, malaise) are rare. Fully developed ulcers are characteristically deeply undermined, meaning a probe can be passed easily under the edge into the space left by necrotic liquefied fat tissue. Lesions can occur anywhere and may be multiple, but a single lesion on the leg or arm is most

2007 MJA Clinical Guidelines

940. Improving outcomes in breast cancer

on Hormonal Factors in Breast Cancer. Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52 705 women with breast cancer and 108, 411 without breast cancer. Lancet 1997;350:1047- 59.14 The risk of breast cancer is affected by lifestyle. Obesity is associated with a two-fold increase in risk among post-menopausal women; this has been linked with high intake of meat and dairy fat, but the precise nature of these relationships are still unclear

2002 National Institute for Health and Clinical Excellence - Clinical Guidelines

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