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Subcutaneous Fat Necrosis

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161. Recommendation on Design, Execution, and Reporting of Animal Atherosclerosis Studies: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

atherosclerosis and results in elevated total plasma cholesterol concentrations of >1000 mg/dL. Western diet feeding results in a more foam cell–rich atherosclerosis, with lesions containing cholesterol crystals, necrotic cores, and calcifications. However, a fat-enriched diet can alter the outcomes of atherosclerosis because of the induction of pronounced hypercholesterolemia. For example, recombination-activating gene 1–deficient (Rag1 −/− ) mice on an apoE −/− background have attenuated atherosclerosis (...) lesions occur as quickly as 12 to 18 months. The atheroma is more advanced and humanoid in these pigs, characterized by complicated stenotic lesions containing fibrous caps, necrotic cores, cholesterol clefts, granular calcium deposits, and neovascularization deep within the lesion of the major coronary arteries by 24 months. Similar to the high-fat, high-cholesterol pig model, these hypercholesterolemic pigs are a long-term model with dramatic expenses and a size that presents challenges

2017 American Heart Association

164. Imaging of Deep Inferior Epigastric Arteries for Surgical Planning (Breast Reconstruction Surgery)

within the flap with an extended vascular territory beyond the midline to best provide optimal perfusion, preservation of muscle innervation, and avoid fat necrosis [14-16]. Additionally, a short intramuscular course a Principal Author, Yale University School of Medicine, New Haven, Connecticut. b Research Author, Stanford University, Stanford, California. c Panel Chair, UMass Memorial Medical Center, Worcester, Massachusetts. d Panel Vice-Chair, University of Virginia Health System, Charlottesville (...) divided into intramuscular, subfascial, and subcutaneous segments [3,4]. This unpredictable anatomy may lead to lengthy perforator vessel selection and therefore longer operative times when imaging is not used as part of the preoperative planning. Additionally, preoperative imaging planning that accurately maps the perforators and its branches leads to reduced operative time, reduced abdominal morbidity, and increased flap reliability [5-13]. The information most critical to the surgical team includes

2017 American College of Radiology

165. Hepatic Issues and Complications Associated With Inflammatory Bowel Disease: A Clinical Report From the NASPGHAN Inflammatory Bowel Disease and Hepatology Committees

: Cholelithiasis Viral Hepatitis Transplant issues IgG4 cholangiopathy Granulomatous hepatitis Primary biliary cirrhosis Hepatic amyloidosis Nonalcoholic fatty liver disease/steatohepatitis TNF ¼ tumor necrosis factor. Saubermann et al JPGN Volume 64, Number 4, April 2017 640 Copyright © ESPGHAL and NASPGHAN. All rights reserved. improve patient survival with the native liver (35). ERCP should be performed by interventional endoscopists with experience in PSC management. Perioperative antibiotics (...) , a persistent antiphospholipid antibody, oral contraceptive use, smoking, obesity, thalidomide, or having a central venous catheter (65). If thromboprophylaxis is planned, then low-molecular-weight heparin is recommended. The dosing of enoxaparin is weight based with patients>60 kg receiving either 30 mg subcutaneous twice daily, or 40 mg once daily, and patients 30 cm are associated with an odds ratio of 7 (95% confidence interval, 2.6–19.3] for the development of gallstones (70). Similarly, another study

2017 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

166. Antibacterial-coated sutures versus non-antibacterial-coated sutures for the prevention of abdominal, superficial and deep, surgical site infection (SSI)

and subcutaneous tissue of the incision (superficial incisional) and/or the deep soft tissue (for example, fascia, muscle) of the incision (deep incisional) and/or any part of the anatomy (for example, organs and spaces) other than the incision that was opened or manipulated during an operation (organ/space) [11]. Overall, Staphylococcus aureus and Escherichia coli were the most commonly reported microorganisms (A0002). SSI occurs after pathogenic organisms multiply in a wound and cause local signs (...) understood [42]. Rarely, microorganisms from a distant source of infection, principally through haematogenous spread, can cause an SSI by attaching to a prosthesis or other implant left in an operative site [62]. SSIs are potentiated by the sutures when necrotic or devascularized tissue, hematoma or dead space caused by tissue damage or poor surgical technique are present [93]. The adherence of microorganisms to the suture material is highly variable. There are several variables that affect adherence

2017 EUnetHTA

167. The Association of Coloproctology of Great Britain and Ireland Consensus Guidelines in Surgery for Inflammatory Bowel Disease Full Text available with Trip Pro

, 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

2018 Association of Coloproctology of Great Britain and Ireland

168. CRACKCast E064 – Chemical Injuries

LIMITS the depth of acid penetration Their free hydrogen ions are easily neutralized on the skin by copious water irrigation Alkali compounds: Produce saponification and liquefactive necrosis of body fat – they produce soluble protein complexes which “permit the passage of hydroxyl ions deep into the tissue” and limiting the contact of the alkali complex on the surface of the skin. Because there is no eschar formation they usually penetrate DEEPER into the tissue 2) Describe a HAZMAT response (...) in Perspective Chemicals are everywhere, >10,000 new ones are made every year → be afraid! Most susceptible organs: skin, eyes, lungs Most commonly release substances: Volatile organic compounds (VOC’s) Herbicides Acids Ammonia Cement Drain cleaner Gasoline Pathophysiology: Most cause damage through a chemical reaction with the skin 1) Describe the difference between Alkali and Acid injuries Acidic compounds: Cause protein denaturation and coagulative necrosis with the skin The necrosis forms eschar → which

2017 CandiEM

169. CRACKCast E087 – Peripheral Arteriovascular Disease

that lodge in distal small arteries. (Ischemic strokes, cool painful cyanotic toes). Thrombosis (arterial thrombosis) ●In-stitu formation of blood clots in the arteriovascular system. ●Usually due to atherosclerosis ●Often caused by atherosclerotic plaque rupture or endothelial injury due to trauma or vasculitis Inflammation ●Can be due to drugs, irradiation, mechanical trauma, bacterial invasion, IVDU, etc. ●Noninfectious systemic: necrotizing vasculitis ( look for macules, papules, vesicles, bullae (...) occlusive disease leading to atheromatous emboli (causing multiple ulcerations) Vasculitis Chronic subcutaneous intravenous drug use Malignant ulcers (look for thickened, rolled, elevated edges with a central depression containing granulation tissue) Osteoarthritis from associated joints Spinal stenosis Cauda equina syndrome (disc, cancer, infection) Hypertensive ulcers (lateral ankle – blue-red areas of infarcted skin) 4) What is blue toe syndrome and what is its significance? Blue toe ysndrome

2017 CandiEM

170. Partial breast irradiation for early breast cancer. Full Text available with Trip Pro

/APBI (HR 0.90, 95% CI 0.74 to 1.09, five studies, 6718 participants, high-quality evidence).Late radiation toxicity (subcutaneous fibrosis) appeared worse with PBI/APBI (OR 6.58, 95% CI 3.08 to 14.06, one study, 766 participants, moderate-quality evidence). Acute skin toxicity appeared reduced with PBI/APBI (OR 0.04, 95% CI 0.02 to 0.09, two studies, 608 participants). Telangiectasia (OR 26.56, 95% CI 3.59 to 196.51, 1 study, 766 participants) and radiological fat necrosis (OR 1.58, 95% CI 1.02

2016 Cochrane

171. 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

173. Dyslipidaemias Full Text available with Trip Pro

acid ER extended release ESC European Society of Cardiology ESRD end-stage renal disease EU European Union FACE-BD Fondamental Academic Centers of Expertise in Bipolar Disorders FATS Familial Atherosclerosis Treatment Study FCH familial combined hyperlipidaemia FDA US Food and Drug Administration FDC fixed-dose combination FH familial hypercholesterolaemia FIELD Fenofibrate Intervention and Event Lowering in Diabetes FOCUS Fixed-Dose Combination Drug for Secondary Cardiovascular Prevention GFR

2016 European Society of Cardiology

174. 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

175. Odomzo - sonidegib

and triglycerides, ? kidney, thyroid, adrenal, and liver weight, enlarged kidneys, enlarged/ discoloured adrenals, distended urinary bladder, diffuse minimal hepatocellular hypertrophy, gastric mucosal necrosis, renal tubular mineralization, degeneration, and dilatation, pelvic hemorrhage, hemorrhagic inflammation of the prostate/ seminal vesicle and urinary bladder, vacuolation of seminiferous tubules, thin bone in the head, osteochondrosis, and lymphocytolysis and/or lymphoid depletion in lymphoid tissues (...) , dehydration, hunched, reddened skin, muscle tremors, ? locomotor activity. minimally ? cholesterol, compromised renal function, renal tubular necrosis and mineralization or hydronephrosis, hepatocellular damage (?ASAT, ALT, ALP, bilirubin) and cholestasis, mild inflammation, ? reticulocyte counts, ALP activity and triglyceride, adrenal cortical hypertrophy and vacuolation, ?ovary weights, distention of stomach with watery contents, haemorrhage in stomach, distension or thick wall in duodenum, ?adrenal

2015 European Medicines Agency - EPARs

176. Cresemba - isavuconazole

. The transmission of fungal spores to the human host is via inhalation and Aspergillus primarily affects the lungs, causing 4 main syndromes: allergic bronchopulmonary aspergillosis (ABPA), chronic necrotizing Aspergillus pneumonia (also termed chronic necrotizing pulmonary aspergillosis [CNPA]), aspergilloma, and invasive aspergillosis. The majority of human illness is caused by Aspergillus fumigatus and Aspergillus niger and, less frequently, by Aspergillus flavus and Aspergillus clavatus. Aspergillus may (...) immunosuppressive agents—including oral or intravenous steroids and tumor necrosis factor (TNF)– alpha blockers—are at risk. In addition, hematologic cancer patients with opportunistic herpetic infections (e.g., cytomegalovirus) and graft versus host disease are at increased risk. Most mucormycosis infections are life-threatening. Severe infection of the facial sinuses, which may extend into the brain, is the most common presentation. Pulmonary, cutaneous, and gastrointestinal (GI) infections Assessment report

2015 European Medicines Agency - EPARs

177. Cotellic - cobimetinib

(Figure 2). The results showed that the combination of vemurafenib and cobimetinib inhibited pERK as well as cyclin D1 but increased expression of the BH3-only protein Bcl-2 interacting mediator of cell death, which promotes apoptosis. Figure 2: Pharmacodynamic effects of cobimetinib and vemurafenib in A375 BRAFV600E melanoma cells, 50 nM cobimetinib (GDC-0973), 10 µM vemurafenib (RO5185426) - Study 1046219 In vivo studies Assessment report EMA/685908/2015 Page 19/139 Subcutaneous xenograft melanoma (...) human dose) - Lysis and depletion of lymphocytes in the thymus - Degeneration of the red pulp of the spleen - Degeneration and necrosis in the bone marrow in the sternum and femur - Coagulative necrosis in the adrenal cortex - Increased apoptosis/necrosis in the ovary - Fibrinous thromboemboli in the choroid plexus of the brain - Increased apoptosis of epithelial cells in the seminal vesicles, epididymis, and vagina 30 mg/kg (HED=4.86 mg/kg; 292 mg = 4.9-fold human dose) 75 mg/kg 30 mg/kg XL518-NC

2015 European Medicines Agency - EPARs

178. Akynzeo (netupitant / palonosetron)

at 2000 mg/kg. Microscopically, at 1000 and 2000 mg/kg, changes were observed in multiple organs and tissues. 1009566 (GLP) Rat/ Wistar 4/sex/group (main), 2/sex/group (TK) 0, 500, 1000, 1500 and 2000 mg/kg oral gavage 2000 mg/kg 1500 mg/kg 2000: Mortality (males), clinical signs, body weight loss, lower food consumption, phosphor-lipidosis, necrosis of the liver and mesenteric lymph nodes. 1500: thinness, piloerection, body weight loss, lower food consumption, phospholipidosis, necrosis of the liver (...) . Gall bladder: microscopic signs of phospholipidosis NOAEL: 200 mg/kg B-167720 (non-GLP) Dog/ beagle 1/sex/group 3, 10, 30, 30, 60, 100 and 150; escalating dose design Oral 150 mg/kg None Slight or moderate parietal cell necrosis in the glandular stomach. Minimal vacuolated macrophage infiltration in lymphoid tissues and lungs indicates minimal phospholipidosis. Four single dose studies in mice, rats and dogs. The major toxicity findings included death, microscopic changes in multiple organs

2015 European Medicines Agency - EPARs

179. Viekirax - ombitasvir / paritaprevir / ritonavir

Committee IFN interferon IL28B interleukin 28B INR international normalized ratio ITT intent-to-treat LLN lower limit of normal LLOD lower limit of detection LLOQ lower limit of quantitation LTFU lost to follow-up MedDRA Medical Dictionary for Regulatory Activities NS5A nonstructural protein 5A pegIFN pegylated interferon pM picomolar PRO patient-reported outcome PT post treatment QD once daily RBC red blood cell RBV ribavirin RNA ribonucleic acid SC subcutaneous SOC system organ class SVR sustained

2015 European Medicines Agency - EPARs

180. Raxone - idebenone

%). Due to a high first pass metabolism occurring in liver and intestinal mucosa 10000 mg/kg following oral and subcutaneous administration and 700-800 mg/kg after intraperitoneal administration. The direct cause of death seemed to be a respiratory failure by either route of administration. Repeat dose toxicity Idebenone was tested in oral repeat-dose toxicity studies in rats up to 26 weeks and Beagle dogs up to 39 weeks (Masuoka et al., 1985; Spicer and Wazeter, 1985; Suhara et al., 1985a, 1985b (...) of submucosal inflammatory infiltrates, erosions and ulcerations of the forestomach, and hyperkeratosis, and epithelial and basal cell hyperplasia, focal necrosis and oedema. In the 39-week chronic toxicity study in dogs (plus 8 week recovery), idebenone was administered at 500, 750 or 1000 mg/kg once daily by oral gavage. Vomiting of mucus, yellow or orange fluid and/or feed was recorded in all animals at all dose levels with the incidence showing a relationship to dose. Other signs, observed on occasion

2015 European Medicines Agency - EPARs

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