The Anatomical Basis of Cellulite Dimple Formation: An Ultrasound-Based Examination.

BACKGROUND: Cellulite is a common aesthetic condition that affects the majority of women. It is characterized by the inhomogeneous appearance of the skin overlying the gluteal and the posterior thigh region. Despite a wide array of treatment options, little has been done to evaluate the anatomical basis of cellulite formation. This study used ultrasound to visualize subcutaneous changes of cellulite to aid with treatment guidance and complication avoidance. METHODS: Cellulite dimples were examined on the bilateral thigh and buttock regions of 50 consecutive women and each dimple was scored with the Hexsel Cellulite Scoring System based on severity. Cellulite dimples were then analyzed by ultrasound to identify the presence, orientation, and origination of subcutaneous fibrous bands and the presence of associated vascular structures. RESULTS: Two hundred total sites were examined, with 173 dimples identified. Of these, 169 demonstrated the presence of fibrous bands (97.6 percent). The majority of bands demonstrated an oblique (versus perpendicular) orientation to the skin (84.4 percent), with the majority (90.2 percent) taking origin from the superficial fascia (versus the deep fascia). Overall, 11 percent of bands had an associated vascular structure. When stratified by body mass index, overweight and obese patients had a higher likelihood of having an associated blood vessel visualized (p = 0.01). Results were similar for dimples in the thigh compared to those located in the buttock region. CONCLUSIONS: Ultrasound appears to be a valid technique to image the subcutaneous architecture of cellulite. This technology can help guide surgeons in real time to improve outcomes and minimize complications while performing cellulite treatments.

Proteomic and Ultrastructural Analysis of Cellulite-New Findings on an Old Topic.

: Background: Cellulite is a condition in which the skin has a dimpled lumpy appearance. The main causes of cellulite development, studied until now, comprehends modified sensitivity to estrogens, the damage of microvasculature present among dermis and hypodermis. The differences of adipose tissue architecture between male and female might make female more susceptible to cellulite. Adipose tissue is seen to be deeply modified during cellulite development. Our study tried to understand the overall features within and surrounding cellulite to apply the best therapeutic approach. METHODS: Samples of gluteal femoral area were collected from cadavers and women who had undergone surgical treatment to remove orange peel characteristics on the skin. Samples from cadavers were employed for an accurate study of cellulite using magnetic resonance imaging at 7 Tesla and for light microscopy. Specimens from patients were employed for the proteomic analysis, which was performed using high resolution mass spectroscopy (MS). Stromal vascular fraction (SVF) was obtained from the samples, which was studied using MS and flow cytometry. RESULTS: light and electron microscopy of the cellulite affected area showed a morphology completely different from the other usual adipose depots. In cellulite affected tissues, sweat glands associated with adipocytes were found. In particular, there were vesicles in the extracellular matrix, indicating a crosstalk between the two different components. Proteomic analysis showed that adipose tissue affected by cellulite is characterized by high degree of oxidative stress and by remodeling phenomena. CONCLUSIONS: The novel aspects of this study are the peculiar morphology of adipose tissue affected by cellulite, which could influence the surgical procedures finalized to the reduction of dimpling, based on the collagen fibers cutting. The second novel aspect is the role played by the mesenchymal stem cells isolated from stromal vascular fraction of adipose tissue affected by cellulite.

Structural Gender Dimorphism and the Biomechanics of the Gluteal Subcutaneous Tissue: Implications for the Pathophysiology of Cellulite.

BACKGROUND: This study was performed to investigate gender differences in gluteal subcutaneous architecture and biomechanics to better understand the pathophysiology underlying the mattress-like appearance of cellulite. METHODS: Ten male and 10 female body donors [mean age, 76 ± 16.47 years (range, 36 to 92 years); mean body mass index, 25.27 ± 6.24 kg/m (range, 16.69 to 40.76 kg/m)] were used to generate full-thickness longitudinal and transverse gluteal slices. In the superficial and deep fatty layers, fat lobule number, height, and width were investigated. The force needed to cause septal breakage between the dermis and superficial fascia was measured using biomechanical testing. RESULTS: Increased age was significantly related to decreased dermal thickness, independent of sex (OR, 0.997, 95 percent CI, 0.996 to 0.998; p < 0.0001). The mean number of subdermal fat lobules was significantly higher in male body donors (10.05 ± 2.3) than in female body donors (7.51 ± 2.7; p = 0.003), indicating more septal connections between the superficial fascia and dermis in men. Female sex and increased body mass index were associated with increased height of superficial fat lobules. The force needed to cause septal breakage in male body donors (38.46 ± 26.3 N) was significantly greater than in female body donors (23.26 ± 10.2 N; p = 0.021). CONCLUSIONS: The interplay of dermal support, septal morphology, and underlying fat architecture contributes to the biomechanical properties of the subdermal junction. This is influenced by sex, age, and body mass index. Cellulite can be understood as an imbalance between containment and extrusion forces at the subdermal junction; aged women with high body mass index have the greatest risk of developing (or worsening of) cellulite.

Histoplasma panniculitis in a patient with systemic lupus erythematosus.

Histoplasmosis usually presents primarily as lung infection. Occasionally, mainly in immunocompromised hosts, it can spread and cause systemic manifestations. Skin lesions have been reported in 10 to 15 percent of cases of disseminated histoplasmosis, and panniculitis has been described as an unusual form of presentation in affected patients. We present the case of a patient with systemic lupus erythematosus who presented cellulitis due to disseminated histoplasmosis.

Histoplasma panniculitis in a patient with systemic lupus erythematosus

Abstract: Histoplasmosis usually presents primarily as lung infection. Occasionally, mainly in immunocompromised hosts, it can spread and cause systemic manifestations. Skin lesions have been reported in 10 to 15 percent of cases of disseminated histoplasmosis, and panniculitis has been described as an unusual form of presentation in affected patients. We present the case of a patient with systemic lupus erythematosus who presented cellulitis due to disseminated histoplasmosis.

Cellulite: a review of pathogenesis-directed therapy.

Cellulite is a condition that affects the majority of postpubertal women and can negatively impact quality of life. This review discusses several proposed pathophysiologies of cellulite, and examines treatment options that have been utilized, focusing on the etiologic factor targeted by the therapies. This approach aims to help clarify the pathogenesis of cellulite and provide a road map for developing effective treatment paradigms for patients.

Celulite em codornas japonesas alimentadas com extrato de orégano nas dietas e inoculadas com Escherichia coli / Cellulitis in Japanese quails fed oregano extract in the diet and inoculated with Escherichia coli

Com o objetivo de avaliar a utilização do extrato de orégano nas dietas de codornas japonesas (Coturnix coturnix japonica) e desafiadas com cepas de Escherichia coli, sobre as características de desempenho, a incidência de celulite aviária e titulação de anticorpos específicos contra antígenos de E. coli, foram utilizadas 360 codornas japonesas, com 90 dias de idade, distribuídas em gaiolas de arame galvanizado em galpão convencional. O delineamento experimental foi inteiramente casualizado, em esquema fatorial 5x2 (extrato de orégano x desafiado ou não com E. oli), totalizando dez tratamentos com seis repetições de seis aves por gaiola. Os níveis do extrato de orégano (EO) avaliados foram: 0,00; 0,025; 0,050; 0,100 e 0,150%. Foram avaliadas características de desempenho produtivo, lesões macroscópicas da celulite após períodos pós-inoculação das cepas e amostras de soro foram colhidas para verificar a titulação de anticorpos nas aves. Os dados obtidos foram submetidos à análise de variância e as médias comparadas pelo Teste T. Foi observado efeito de E. coli sobre todas as características produtivas, independentemente dos níveis de EO avaliados, onde grupos desafiados apresentaram piores resultados de desempenho. As lesões macroscópicas, características da celulite, observadas somente nas aves desafiadas com E. coli foram classificadas como grau leve e sem presença de hemorragias. Para a titulação de anticorpos específicos, houve maior quantificação para aves desafiadas com as cepas de E. coli em relação às não desafiadas. Pode-se concluir que o extrato de orégano suplementado nas rações não se mostrou eficaz frente ao desafio com E. coli em codornas na fase de postura e as aves desafiadas com E. coli apresentaram maiores respostas imunes humoral e celular, em relação às não desafiadas, caracterizadas pelo aumento na titulação de anticorpos e pela lesão macroscópica peitoral, independentemente dos níveis de extrato de orégano avaliados.(AU)

The aim was to evaluate the use of oregano extract in Japanese quail (Coturnix coturnix japonica) diet, challenged with Escherichia coli strains, on performance, incidence of avian cellulitis and of antibody specific antigens against E. coli. Three hundred sixty Japanese quails with 90 days of age were distributed into galvanized wire cages in a conventional shed. The experimental design was completely randomized in factorial 5x2 design (oregano extract x challenged or not with E. coli), totaling ten treatments with six replicates of six birds per cage. Oregano extract levels were 0.00, 0.025, 0.050, 0.100 and 0.150%. Performance productive characteristics were evaluated, macroscopic lesions of cellulitis were measured after post-inoculation of the strains, and serum samples were collected for antibodies during experiment. The data were subjected to analysis of variance and averages compared by T test. Effect of E. coli was observed on all productive characteristics, regardless of the EO level evaluated, where challenged groups showed worse performance results. The macroscopic lesions, characteristic of cellulitis, observed only in birds of groups challenged with E. coli, were classified as mild and without bleeding. For specific antibodies, there was a higher number of birds challenged with E. coli strains in relation to unchallenged birds. It can be concluded that oregano extract supplemented in the diet was not effective against the challenge with E. coli in laying quails, and challenged birds with E. coli showed higher humoral and cellular immune response, compared with unchallenged birds, characterized by increased antibody titer and pectoral macroscopic lesion, regardless of the oregano extract levels evaluated.(AU)

Tratamiento laparoscópico de la apendicitis aguda en la Cátedra de Clínica y Terapéutica Quirúrgica “C”, de la Escuela de Medicina “Luis Razetti”, Servicio de Cirugía III del Hospital Universitario de Caracas / Laparoscopic treatment of acute appendicitis in the Department of Clinical and Surgical Therapeutics

Se presentan los resultados obtenidos de 186 apendicectomías laparoscópicas realizadas en pacientes mayores de doce años de edad, de ambos sexos, atendidos en la Cátedra de Clínica y Terapéutica Quirúrgica “C”, Servicio de Cirugía III del Hospital Universitario de Caracas, con diagnóstico de apendicitis aguda durante el período comprendido entre octubre 2002 y octubre 2007. La edad promedio fue de 29,42 años con un rango entre 16 y 50 años. El 40,32 por ciento de los pacientes eran de sexo femenino y 59,68 por ciento de sexo masculino. El estado anatomopatológico más frecuente fue de apendicitis flegmonosa. El tiempo operatorio promedio fue de 83,5 minutos. El promedio de hospitalización fue de 2-8 días. La tasa de complicaciones fue de 9,68 por ciento, siendo la más frecuente la infección de la pared abdominal (6,99 por ciento), el absceso intraabdominal (1,62 por ciento) y la celulitis de la pared abdominal (1,02 por ciento). El porcentaje de reconversión fue de 3,76 por ciento. La mortalidad fue de 0 por ciento. La apendicectomía laparoscópica constituye un método seguro y efectivo para el tratamiento de la apendicitis aguda

One hundred eigthy six laparoscopic appendectomy in patients olders than 16 years with diagnosis of acute appendicitis are presented in Clinic and Quirurgic Terapeutic “C” of Universitary Hospital of Caracas. The study was realized between October 2002 and October 2007. Range age was 16 to 50 years with average of 29.42 years, 40.32 percent female and 59.65 percent male patients. More frequent anatomopathology stage was flegmonous phase. Mean operative time was 83.5 minutes. Mean hospital stay was 2-8 days. Complications rate was 9.68 percent, more frecuent was wound infection, follows by intra abdominal abscess and cellulities. The mortality was 0 percent. The percentage of conversion to open surgery was 3.76 percent. Laparoscopic appendectomy is a safety and effective method for the treatment of acute appendicitis

An unusual presentation of group B streptococcal sepsis

This paper describes the devastating outcome of a neonate who presented with severe late onset group B beta-haemolytic streptococcal (GBS) disease. There were extensive infarcts of the brain and gangrene of the toes. The purpose of this report is to alert healthcare workers of the unusual presentation and that fatal late onset group B beta-haemolytic streptococcal disease may occur despite early and effective management

Infecciones Odontogénicas ceulitis / Odontogenic infections ceulitis

De la revisión de la literatura se deduce, que existen diversos tipos y grados de infección en el organismo; específicamente en el medio bucal, siendo la celulitis una entidad patológica importante dentro de estas infecciones. Se analiza sus diferentes estadios y distintos tipos de terapia quirúrgica y farmacológico de acuerdo a los últimos adelantos de la ciencia.