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Subcutaneous Fat Necrosis

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961. The effect of pioglitazone on peroxisome proliferator-activated receptor-gamma target genes related to lipid storage in vivo. (Abstract)

The effect of pioglitazone on peroxisome proliferator-activated receptor-gamma target genes related to lipid storage in vivo. Pioglitazone is a member of the thiazolidinediones (TZDs), insulin-sensitizing agents used to treat type 2 diabetes. The aim of this study was to define the effect of pioglitazone on the expression of genes related to carbohydrate and lipid metabolism in subcutaneous fat obtained from type 2 diabetic patients.Forty-eight volunteers with type 2 diabetes were divided (...) for LPL, CAP, ACS, 11beta HSD 1, GyK, fatty acid synthase, leptin, and GPDH, whereas PPAR-gamma2 mRNA was correlated with CAP, PEPCK-C, leptin, and GPDH.Treatment with pioglitazone increased body weight, and this is associated with upregulation of some, but not all, genes previously demonstrated as "TZD responsive" in subcutaneous fat. The results suggest that TZDs might increase body weight through the upregulation of genes facilitating adipocyte lipid storage in vivo.

2004 Diabetes Care

962. Congenital Volkmann ischaemic contracture: a case report and review. (Abstract)

fat necrosis and epidermolysis bullosa, dermatologists play a significant role in the diagnosis and, consequently, the treatment of the patient. We describe a premature newborn who had a unilateral, well-demarcated necrotic plaque with a central pallor at birth. The plaque extended circumferentially over the left forearm from the wrist to the elbow. Left wrist oedema, bullae over the fingers and flaccid paralysis at the wrist were also noted. (...) Congenital Volkmann ischaemic contracture: a case report and review. Congenital Volkmann ischaemic contracture or neonatal compartment syndrome has rarely been discussed in the literature of dermatology. The condition often involves the upper extremity with cutaneous lesions, contractures and neuropathy. Because the lesions can be mistaken for other entities including necrotizing fasciitis, neonatal gangrene, congenital varicella, aplasia cutis congenita, amniotic band syndrome, subcutaneous

2004 British Journal of Dermatology

963. Partial breast irradiation with interstitial 60CO brachytherapy results in frequent grade 3 or 4 toxicity. Evidence based on a 12-year follow-up of 70 patients. (Abstract)

, 85% of the patients experienced Grade > or =2 telangiectasis and 41% had Grade 3 telangiectasis. Eighty-eight percent had fibrosis of some form, and 35% had grade > or =3 fibrosis. Forty-one percent of the cohort displayed fat necrosis, which was always accompanied by Grade > or =3 fibrosis or telangiectasis. The cosmetic results were poor in 50% (17/34) of the patients. The radiosensitivity of the fibroblasts was increased in only 2/24 patients (8% of the investigated cases, in agreement (...) postoperative lumpectomy cavity (i.e., plane). For radiobiologic considerations, the clinical target volume (CTV) was calculated retrospectively with a 10-mm safety margin, resulting in a 72-cm(3) median CTV (range, 36-108 cm(3)) irradiated with a reference dose of 28 Gy. In the assessment of the skin and subcutaneous toxicity, the RTOG late radiation morbidity scoring system was applied. The radiosensitivity of the cultured fibroblasts was determined by clonogenic assay to check whether individual

2004 Biology and Physics

964. Accelerated partial breast irradiation: an analysis of variables associated with late toxicity and long-term cosmetic outcome after high-dose-rate interstitial brachytherapy. (Abstract)

. 0.71; p=0.009). Late subcutaneous toxicity was rated as Grade 0, 1, 2, 3, or 4 in 55%, 15%, 12%, 5%, and 13% of patients, respectively. The risk of Grade 0/1 vs. Grade 2-4 subcutaneous toxicity was significantly associated only with a lower value of DHI (0.77 vs. 0.73; p=0.02). To further explore factors that might contribute to the risk of fat necrosis (symptomatic or asymptomatic), a separate analysis showed that only dose hotspots as reflected in V150 and V200 were significantly associated (...) with elevated risk. The use of adriamycin-based chemotherapy after APBI was found to be associated with a significant increase in the incidence of higher-grade skin toxicity and a higher risk of fat necrosis and suboptimal cosmetic outcome. Patient age, volume of resection, extent of axillary surgery, a history of diabetes or hypertension, and the use of tamoxifen were not found to be significantly associated with cosmetic outcome or late normal tissue complications.Long-term cosmetic results and the risk

2006 Biology and Physics

965. Recurrent and self-healing cutaneous monoclonal plasmablastic infiltrates in a patient with AIDS and Kaposi sarcoma. (Abstract)

-old man with AIDS and Kaposi sarcoma (KS) previously treated with doxorubicin who, following treatment with highly active antiretroviral therapy, developed an erythematous infiltrated nodule on the right arm. Histology showed subcutaneous fat necrosis and clusters of atypical large plasma cells (plasmablastic cells). Immunohistochemistry revealed lambda light chain restriction. Epstein-Barr virus (EBV) mRNA was detected by in situ hybridization within the plasmablastic cells. Polymerase chain

2005 British Journal of Dermatology

966. Association between altered expression of adipogenic factor SREBP1 in lipoatrophic adipose tissue from HIV-1-infected patients and abnormal adipocyte differentiation and insulin resistance. (Abstract)

compared fat morphology and mRNA and protein expression of major adipocyte differentiation markers and cytokines in subcutaneous abdominal adipose tissue from 26 HIV-1-infected patients who developed peripheral lipoatrophy while on protease inhibitors and from 18 HIV-1-seronegative healthy controls.Patients' fat contained a higher proportion of small adipocytes than control fat, together with lower mRNA concentrations of the adipogenic differentiation factors CCAAT-enhancer binding protein (C/EBP) beta (...) and alpha, peroxisome proliferator-activated receptor (PPAR) gamma, and the 1c isoform of SREBP1, with a median decrease of 93% in the latter. The SREBP1 protein concentration was increased 2.6-fold, whereas the PPARgamma protein concentration was decreased by 70%. The expression of adipocyte-specific markers, including leptin, was lower in fat from patients than in fat from controls, whereas expression of tumour necrosis factor (TNF) alpha was higher and correlated negatively with the expression

2002 Lancet

967. 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

968. Joint Injection and Aspiration Full Text available with Trip Pro

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 Controlled trial quality: predicted high

969. 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

970. 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

971. 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

972. 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

973. 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

974. 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

975. 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

976. 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

977. 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

978. 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

979. 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

980. Systemic administration of ciliary neurotrophic factor induces cachexia in rodents. Full Text available with Trip Pro

Systemic administration of ciliary neurotrophic factor induces cachexia in rodents. Ciliary neurotrophic factor (CNTF) has previously been shown to promote the survival of several classes of neurons and glial. We report here that in addition to its effects on the nervous system, CNTF can induce potent effects in extra-neural tissues. Implantation of C6 glioma cells engineered to secrete CNTF either subcutaneously or into the peritoneal cavity of adult mice, or systemic injections of purified (...) rat or human recombinant CNTF, resulted in a rapid syndrome of weight loss resulting in death over a period of 7-10 d. This weight loss could not be explained by a reduction in food intake and involved losses of both fat and skeletal muscle. CNTF also induced the synthesis of acute phase proteins such as haptoglobin. Implantation of C6 lines expressing a nonsecreted form of CNTF, or the parental C6 line itself, did not result in wasting effects. Analysis of this CNTF-induced wasting indicates

1994 Journal of Clinical Investigation

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