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Subcutaneous Fat Necrosis

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921. 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 (...) Physical examination every 4 to 8 hours Observe for Abdominal exam for marked abdominal firmness ( , third spacing) Laboratory tests every 6 to 12 hours Comprehensive metabolic panel Imaging Consider repeat for clinical worsening or signs of complications Electrolyte disturbance Hypocalemia (related to saponification) Replace as needed Antibiotics Absolutely indicated only for concurrent infection Controversial whether to use in pancreatic necrosis Infections occur in one third of necrotizing

2015 FP Notebook

922. 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

923. Decubitus Ulcer

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 (...) 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

2015 FP Notebook

924. 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

925. 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

926. 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 (...) or systemic symptoms or signs (lymphangitis, ) Immunocompromised patients or elderly Patients requiring surgery Recurrent, persistent or large abscess or Skin biopsy (25% sensitivity) Indicated in necrotizing lesions (especially those requiring derbidement) Obtain sample of leading margin of lesion Fine Needle Aspiration Saline injection and aspiration Listed for historical purposes only (rarely done in clinical practice) Technique Leading edge injection and aspiration with saline Efficacy May assist

2015 FP Notebook

927. 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

928. Post-Surgical Pifalls

thickening in the near fields Cobblestoning (fluid interspersed with subcutaneous fat) Abscess (well demarcated hypoechoic fluid region) signs of biliary leak Free fluid in region of bile duct suggests bile leak IV. References Weinstock in Majoewsky (2012) EM:RAP 12(3): 1-3 Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Post-Surgical Pifalls." Click on the image (or right click) to open the source website in a new browser window (...) diagnostic evaluation Incision site Take off surgical bandages and carefully examine the incision site A clean appearing incision site does not exclude deep infection which is a more likely post-surgical infection scenario does not completely exclude serious complications Necrotizing infection demonstrates wound site gas in only 50% of cases is typically normal in related by a skilled operator can identify many post-operative complications signs of soft tissue infection with linear probe Tissue

2015 FP Notebook

929. Characterization of Transient Alterations of Cutaneous Sensory Nerve Function by Cryolipolysis

loss of fat. There is no histologic evidence of necrotic or inflammatory damage to skin or nerves, however a single small human study has reported prolonged temporary altered sensation (hypoesthesia) in the area of cryolipolysis procedure. This hypoesthesia seen in about 2/3 of patients, is completely reversible, lasts up to 8 weeks after treatment, and suggests that cooling under these conditions can temporarily alter sensory nerve function. The purpose of this study is to further characterize (...) Posted : April 10, 2017 Sponsor: Massachusetts General Hospital Information provided by (Responsible Party): Richard Rox Anderson, MD, Massachusetts General Hospital Study Details Study Description Go to Brief Summary: Cryolipolysis with Zeltiq CoolSculpting device is a novel method of non-invasive fat removal. The technique works by application of cold plates to the skin surface for a single cooling cycle lasting 60 minutes, after which a cold-induced inflammatory panniculitis leads to selective

2012 Clinical Trials

930. 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

931. 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

932. Deep Tissue Injury Treatment With MIST Therapy Versus Standard Care: REVERSE DTI Study

the treatment groups the effect of the assigned study treatment on the rate of progression of DTI to advanced stage pressure ulcer (Stage III or greater, continued DTI, or a pressure ulcer that is unable to be staged due to necrotic tissue). Stage I - Intact skin with non-blanchable redness of a localized area Stage II - Partial thickness loss of dermis Stage III - Full thickness loss, subcutaneous fat may be visible Stage IV - Full thickness tissue loss with exposed bone, tendon or muscle Unstageable

2012 Clinical Trials

933. 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

934. 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 available with Trip Pro

, 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

935. Little evidence of systemic and adipose tissue inflammation in overweight individuals(†). Full Text available with Trip Pro

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

936. Nicolau Syndrome after Intramuscular Injection: 3 Cases Full Text available with Trip Pro

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

937. Altered adipocyte structure and function in nutritionally programmed microswine offspring Full Text available with Trip Pro

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

938. Adipose Tissue Promotes a Serum Cytokine Profile Related to Lower Insulin Sensitivity after Chronic Central Leptin Infusion Full Text available with Trip Pro

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

939. PASSAGE OF COXSACKIE VIRUS (CONNECTICUT-5 STRAIN) IN ADULT MICE WITH PRODUCTION OF PANCREATIC DISEASE Full Text available with Trip Pro

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

940. THE TOXIC EFFECTS OF FORMALDEHYDE AND FORMALIN Full Text available with Trip Pro

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

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