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Subcutaneous Fat Necrosis

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141. The Association of Coloproctology of Great Britain and Ireland Consensus Guidelines in Surgery for Inflammatory Bowel Disease

, the underlying principle has to be bowel sparing . Unfortunately, there are few high‐quality randomized controlled trials to assess different surgical techniques for surgery in small bowel Crohn's disease and much of the evidence is from small studies and historic data . Indications for surgery Failure of medical treatment Crohn's disease is a lifelong chronic inflammatory disease which is mainly treated medically. Biological therapies, including anti‐tumour necrosis factor α (TNFα) agents, are very (...) bowel can be differentiated from the normal one by palpating the mesenteric border of the bowel wall, where it is usually thickened with fat wrapped on the sides of the wall . Some older studies were in favour of extended resection for the involved bowel , . However, a RCT of 152 patients comparing a macroscopically limited resection margin of 2 cm with an extended resection margin of 12 cm, found that the width of the excised margin did not affect recurrence. More significantly, recurrence rates

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2018 Association of Coloproctology of Great Britain and Ireland

142. Renal Cell Carcinoma

size of papillary adenoma was 5 mm. From now, papillary adenoma is de?ned as a papillary renal tumour =15 mm in itslargestdimension. - The main prognostic factors in chromophobe RCC are tumour stage, the presence of necrosis, a sarcomatoid and/or rhabdoidcomponentandsmallvesselinvasion. - Hybrid tumours present overlapping features of oncocyto- mas and chromophobe RCC. They have indolent behaviour andareusuallyobservedinBirt–Hogg–Dubésyndrome. - The diagnosisof the highlyaggressive collecting duct (...) is 31 years. The diagnosis is based on a strong nuclear TFE3/TFEB immunoreactivity and the presence of a translocation involving TFE3 or TFEB genes:t(X;1)(p11.2;q21)andt(6,11)(p21;q12),respectively. - Among angiomyolipomas (AMLs), epithelioid AML is now recognised as a separate entity with a risk of progression or metastasis. The prognostic factors for the risk of progression are association with tuberous sclerosis, multiple AML, the presence of necrosis, tumour size >7 cm, extrarenal extension

2017 European Society for Medical Oncology

143. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

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

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2016 American Heart Association

144. Practice Guidelines for the Diagnosis and Management of Aspergillosis

). 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

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2016 Infectious Diseases Society of America

145. Stress (Fatigue/Insufficiency) Fracture, Including Sacrum, Excluding Other Vertebrae

There is limited evidence on the utility of ultrasound in diagnosing stress fractures. Ultrasound is a first-line imaging modality in assessing muscles, tendons, joints, and nerves in the extremities [33], so the radiologist should know the typical sonographic appearance of stress fractures. Sonographic findings of stress fractures include subcutaneous edema, periosteal thickening, cortical bone irregularity, local hyperemia [33-35], and periosteal callus. Overall, ultrasound appears to be more sensitive than (...) of delayed union, nonunion, displacement, and avascular necrosis [17]. Given the importance of recognizing these high-risk fractures in the femoral head and neck, MRI is the preferred second-line study after initial negative radiographs to prevent delayed diagnosis. Variant 3: Suspected stress (fatigue) fracture, excluding hip and vertebrae. Negative radiographs. Next imaging study. See variant 2. Certain stress fractures are considered high risk based on a tendency for nonunion or delayed union. High

2016 American College of Radiology

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

-tissue or juxta-articular swelling. Suspected soft-tissue infection. Additional imaging following radiographs. Radiologic Procedure Rating Comments RRL* MRI area of interest without and with IV contrast 9 Radiographs and MRI are both indicated and complementary. This procedure provides better delineation of fluid collection and areas of necrosis with contrast. O MRI area of interest without IV contrast 7 This procedure is an alternative to MRI without and with contrast if contrast is contraindicated (...) on fluid-sensitive sequences such as T2-weighted fat- saturated and short tau inversion recovery. Studies have confirmed both high sensitivity and high specificity of T1-weighted signal abnormalities for assigning true positive and true negative in suspected osteomyelitis [10,11]. 1 Principal Author and Panel Vice-chair, University of Kentucky, Lexington, Kentucky. 2 Research Author, University of Kentucky, Lexington, Kentucky. 3 Panel Chair, Mayo Clinic, Phoenix, Arizona. 4 NYU Center

2016 American College of Radiology

147. 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

149. Liposuction for chronic lymphoedema

Recommendations 1.1 Current evidence on the safety and efficacy of liposuction for chronic lymphoedema is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit. 1.2 Patient selection should only be done by a multidisciplinary team as part of a lymphoedema service. 2 2 Indications and current treatments Indications and current treatments 2.1 Lymphoedema is the abnormal accumulation of subcutaneous fat and fluid in body tissue (...) are stopped the patient is fitted with a custom- made compression garment, which is worn every day. These techniques aim to reduce the pain and discomfort associated with lymphoedema. In very severe cases, surgical treatment can be used to reduce the size of the limb or to restore lymphatic flow. Repeated debulking procedures to excise skin and subcutaneous tissue may be needed. Procedures to restore lymphatic flow from the limb include constructing an alternative lymph drainage pathway via lymphovenous

2017 National Institute for Health and Clinical Excellence - Interventional Procedures

150. 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 (...) 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 of the leading causes of preventable blindness in children

2018 PDQ - NCI's Comprehensive Cancer Database

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

or MRI of the total spine and pelvis appears 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 (...) of the IMAJEM Study. J Clin Oncol 35 (25): 2911-2918, 2017. [ ] [ ] 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

2018 PDQ - NCI's Comprehensive Cancer Database

153. 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

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

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 with small melanomas. Metastatic Disease Systemic metastases are evident in only 1% to 4% of patients at the time of diagnosis of the primary ocular melanoma.[ ] Because the uveal tract is a vascular (...) , 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 melanoma who present with hepatic metastases of unknown origin, metastatic melanoma is considered in the differential diagnosis. It is particularly unusual for choroidal melanomas of any size to invade the optic

2018 PDQ - NCI's Comprehensive Cancer Database

157. Acute pain management: scientific evidence (3rd Edition)

140 6. ADMINISTRATION OF SYSTEMIC ANALGESIC DRUGS 153 6.1 Oral route 153 6.1.1 Opioids and tramadol 156 6.1.2 Non-selectiv e non-steroidal anti-inflammatory drugs and coxibs 157 6.1.3 Paracetamol 158 6.2 Intravenous route 158 6.2.1 Opioids and tramadol 158 6.2.2 Non-selectiv e non-steroidal anti-inflammatory drugs and coxibs 159 6.2.3 Paracetamol 159 6.3 Intramuscular and subcutaneous routes 160 6.3.1 Opioids and tramadol 160 6.3.2 Non-selectiv e non-steroidal anti-inflammatory drugs and coxibs

2015 National Health and Medical Research Council

158. Diagnosis and Management of Acute Pulmonary Embolism

. . . . . . . . . . . . . . . . . . . . . . . .3068 8.3.2 Foreign-material pulmonary embolism . . . . . . . . . .3068 ESC Guidelines 3034 Downloaded from by guest on 02 April 20198.3.3 Fat embolism . . . . . . . . . . . . . . . . . . . . . . . . . .3068 8.3.4 Air embolism . . . . . . . . . . . . . . . . . . . . . . . . . .3069 8.3.5 Amniotic ?uid embolism . . . . . . . . . . . . . . . . . . .3069 8.3.6 Tumour embolism . . . . . . . . . . . . . . . . . . . . . .3069 9 (...) , trauma, surgery and necrosis. Accordingly, the positive predictive value of elevated D-dimer levels is low and D-dimer testing is not useful for con?rmation of PE. A number of D-dimer assays are available. 110,111 The quantitative enzyme-linked immunosorbent assay (ELISA) or ELISA-derived assays have a diagnostic sensitivity of 95% or better and can therefore be used to exclude PE in patients with either a low or a moderate pre-test probability. In the emergency department, a negative ELISA D-dimer

2014 European Society of Cardiology

159. Treatment and prevention of Mycobacterium ulcerans infection (Buruli ulcer) in Australia: guideline update

or liquefied subcutaneous fat. When antibiotics are not tolerated, contraindicated or declined, curative excisional surgery can be attempted without antibiotics, or with a shorter duration of antibiotics in cases of intolerance. The excision should be performed with wide margins through uninvolved tissue. However, there is a risk of disease relapse, either locally or distantly, which is greater if histological margins of the excised specimen include visible bacteria or active inflammation, the patient (...) destructive infection of skin and of adipose and soft tissue caused by Mycobacterium ulcerans , an environmental pathogen that produces a potent toxin. It is because of progressive destruction of subcutaneous tissue that the characteristic ulcer becomes widely undermined. BU only occurs in specific endemic areas, particularly coastal Victoria, where the disease is known locally as Bairnsdale ulcer. The second major Australian focus is a small region between Mossman and just beyond the Daintree River

2014 MJA Clinical Guidelines

160. Tracking RNA to Pinpoint Time of Death: Better Than Bugs?

is more than the reverse of the “characteristics of life” list that begins most introductory biology textbooks. It’s useful. Could RNA profiling replace forensic entomology? The researchers used their data to create prediction software that can tell the time elapsed since organismal death from the RNAs in just four of the 36 tissues studied: subcutaneous fat, lung, thyroid, and sun-exposed skin on the lower leg. When they tested the software on 129 bodies with time of death known but blinded (...) parts and DNA to the RNA of the victim. Changing RNA Levels After Death Crucial to the new work is the “Genotype-Tissue Expression Project” portal at the Broad Institute, aka the tissue bank. It compiles RNA sequences from human tissues (fat, muscle, blood), organs (stomach, lung, heart), and body parts (lower leg). The researchers first looked at RNA in thousands of samples – including spleen, esophagus, small intestine, ovary, prostate, heart, nerves, salivary glands, and skin with and without sun

2018 PLOS Blogs Network

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