Subcutaneous Fat Necrosis of the Newborn.

A boy weighing 4500 g was born at 41 weeks' gestation by Cesarean section due to fetal distress. The pregnancy was complicated by gestational diabetes. He had an Apgar score of 5 and 6 after 5 and 10 minutes, respectively. At birth, the newborn manifested respiratory distress, which needed assisted ventilation for 48 hours. He developed a convulsive attack, diagnosed as a grade 2 hypoxic-ischemic encephalopathy, which was controlled by phenobarbital. Four days later, dermatologic examination revealed subcutaneous and firm nodules, ranging from 1 to 4 cm in diameter, on the cheeks, neck, arms, legs, and back (Figure 1). Some nodules became fluctuant as abscesses. Fine-needle aspiration cytology performed on a nodule revealed a dirty background with necrotic fat-containing characteristic, radially- oriented, refractile, needle-shaped crystals (Figure 2), which was diagnosed as subcutaneous fat necrosis. The diagnosis of subcutaneous fat necrosis of the newborn was made. Laboratory studies revealed hypocalcemia at 1.65 mmol/L, hypomagnesemia at 0.48 mmol/L, and hypokalemia at 3 mmol/L. The infant received calcium, magnesium, vitamin D, and potassium supplementation. On day 18, the serum calcium increased to 3.3 mmol/L. It was associated with hypertriglyceridemia at 2.6 mmol/L. Bilateral nephrocalcinosis was detected on renal ultrasound. So, hyperhydration, diuretics, and withdrawal of vitamin D were indicated. The patient was given betamethasone 0.125 mg/kg/day for 3 weeks. After a two months course, there had been complete healing of the fat necrosis (Figure 3), normalization of the calcium and triglyceride levels, and a normal growth pattern.

Histologic features of mesotherapy-induced orbital fat inflammation.

A 67-year-old man developed acute orbital inflammation after receiving cosmetic mesotherapy (Lipo-Dissolve) to the inferior orbital fat compartments. The injection was intended to cause lipolysis and shrinkage of fat lobules with subsequent cosmetic improvement. Injections of a mixture of bile salts, phospholipid, and alcohol preservative bilaterally in inferior orbital fat lobules led to an acute inflammatory reaction characterized histologically 12 days later by mild lymphocytic infiltration, fat necrosis, and fibrosis in the target areas. Benign proliferation of peripheral nerve trunks consistent with a traumatic neuroma was also noted histologically on one side. Inflammation including fat necrosis and traumatic neuroma are all possible consequences of mesotherapy.

A Case of Traumatic Panniculitis Following Fractional Laser Therapy / 대한피부과학회지

Traumatic panniculitis can be induced through the injection of various substances into the subcutaneous fat, especially in patients with psychiatric problems. This condition can also be caused through the subcutaneous implantation of different materials for cosmetic or therapeutic reasons or through mechanical or physical means. The diagnosis is always worth considering in those patients with bizarre clinical lesions and inflammatory changes in the subcutaneous fat that defy ready classification. There have been reported cases of traumatic panniculitis induced by acupuncture, but no reported cases associated with laser therapy. Fractional photothermolysis is the newest approach to laser therapy, with multiple micro-laser beams that target water-containing tissues to cause photocoagulation of narrow columns of skin. The penetration depth of the multiple micro-laser beams is up to 900microgram, generally to the reticular dermis level. A 19-year-old female patient presented with a tender 4x7 cm sized erythematous to brownish, irregularly shaped, atrophic plaque on the right shin. She was treated for a leg scar using a 1,550 nm erbium fiber laser. Histopathologic examination showed moderate inflammatory infiltration and lipomembranous fat necrosis in the subcutaneous septa with mild inflammation in the overlying dermis. The tissue proved to be infiltrated by lymphohistiocytic cells and a few eosinophils. The patient was treated with systemic and topical corticosteroids; she has experienced no recurrence. We report an interesting case of traumatic panniculitis following fractional laser therapy.

A 1-week-old newborn with hypercalcemia and palpable nodules: subcutaneous fat necrosis.

We present a 1-week-old newborn with subcutaneous fat necrosis complicated by hypercalcemia. She received conservative treatment of adequate hydration and restricted supplementary vitamin D.

Multifocal scalp abscess with subcutaneous fat necrosis and scarring alopecia as a complication of scalp mesotherapy.

Over the past several years, there has been a growing interest in the treatment method termed mesotherapy. Marketed for nonsurgical fat melting, skin rejuvenation, and hair regrowth, this technique has become increasingly popular and, in the public's view, it is considered to be a relatively benign intervention method. Mesotherapy was introduced over 50 years ago by M. Pistor, a French physician who utilized this technique initially as a novel analgesic therapeutic method for a variety of rheumatologic disorders. Since its introduction, the basic principal of locally injecting subcutaneous doses of varying chemicals has been expanded and is now utilized for the aforementioned cosmetic concerns. With its increased popularity, there has been an increase in the number of reported side effects resulting from mesotherapeutic intervention. We report multifocal scalp abscesses with subcutaneous fat necrosis as a direct result of mesotherapy; therefore, requiring extensive surgical repair.

Subcutaneous fat necrosis presenting as a large mass.

Subcutaneous fat necrosis, though a rare phenomenon, can occur in patients of all ages. In newborns, it is an uncommon, self-limited panniculitis of traumatic origin, while in adults it is most commonly encountered among women presenting to breast clinics following a trivial or unnoticed injury sustained long ago. An acute presentation of fat necrosis as a large mass, however, is quite unusual and that may confuse the observer. History of trauma gives a clue to the diagnosis. We report an interesting case of traumatic subcutaneous fat necrosis because of massage therapy in a 66-year-old lady.

A Case of Panniculitis Following Mesotherapy / 대한피부과학회지

Mesotherapy was first introduced in France by Pistor in 1952. This is a widely used technique of intradermal or subcutaneous microinjections of a highly diluted drug, or cocktail of drugs. The use of mesotherapy is commonplace in medicine, especially in painful disorders of the locomotory apparatus. The technique has also been employed in cutaneous affections and esthetical conditions such as keloids and hypertrophic scars, acne, psoriasis, vitiligo, wrinkles, alopecia areata and hair loss, cellulitis, lipodystrophy, obesity, telangiectasias, lymphedemas, peripheral vascular diseases, and leg ulcers. A 24-year-old woman presented with painful eczematous subcutaneous nodules located at the points where mesotherapy had been applied. Histologically, it showed panniculitis with acute inflammation, aggregation of neutrophils, and fat necrosis. We report an unusual case of panniculitis after mesotherapy.

Role of Lipistat in protection against isoproterenol induced myocardial necrosis in rats: a biochemical and histopathological study.

A test drug (Lipistat) comprising of equal-proportions of extracts of Terminalia arjuna, Inula racemosa Hook, latex of Commiphora mukul, in three different doses (225 mg/kg; 350 mg/kg; 450 mg/kg) were administered orally daily for 6 days a week for 60 days in rats. Thereafter, the rats were subjected to isoproterenol (ISO) induced (85 mg/kg, s.c. for 2 days) myocardial necrosis. Gross and microscopic examinations (histopathology) were done along with estimations of myocardial tissue high energy phosphates (HEP) stores and lactate content. Gross examination showed significant (P < 0.05) cardioprotection in Lipistat treated animals. On microscopic examination no statistically significant reduction in myocardial damage by 350 and 450 mg/kg of Lipistat were observed although loss of myocardial HEP stores and accumulation of lactate were significantly prevented. The results of the present study suggest the potential usefulness of Lipistat in the prevention of ischemic heart disease.

Necrotic stenosis of the right colon secondary to acute pancreatitis.

The authors report the case of a 52-year-old man who had stenosis and necrosis of the right colon secondary to acute pancreatitis. The right colon is a very uncommon location for this complication. The site of the stenosis was documented by contrast enema examination and computed tomography. Although conservative management is usually advocated for the initial management of this complication, laparotomy was necessary when the patient's condition failed to improve with conservative therapy. Colonic necrosis was found at laparotomy, and a partial colectomy was carried out, followed later by ileocolic reanastomosis. The authors emphasize the diagnostic and treatment options for this entity.

Therapeutic Effect of Combined Radiotherapy and Hyperthermia in Primary Hepatocellular Carcinoma / 대한치료방사선과학회지

PURPOSE: This study was undertaken to show the clinical results of combined radiotherapy and hyperthermia in primary hepatoma. MATERIALS AND METHODS: Between December 1989 and March 1993, 50 patients with hepatomas were treated by combined radiotherapy and hyperthermia. Among them, we analyzed retrospectively 33 patients who received the complete course of treatment. The ages of the patients ranged from 36 to 75(mean age: 55.5 years). Twenty-six patients (78.8%) were men, and 7 (21.2%) were women. According to Child's classification, nine patients (27.3%) were A group, 9 (27.3%) were B group, 15 (45.4%) were C group. Radiation therapy was done by a 6 MV and 15 MV linear accelerator. Patients were treated with daily fractions of 150-180 cGy to doses of 2550 cGy - 4950 cGy (median: 3000 cGy). Local hyperthermia was done by 8 MHz RF capacitive heating device (Cancermia. Green Cross Co., Korea), 50-60 min/session, 1-2 sessions/wk, and 8.5 sessions (median number)/patients. We analyzed the prognostic factors including age, sex, tumor type, Child's classification, a-fetoprotein, liver cirrhosis, ascites, portal vein invasion, esophageal varix, number of hyperthermia, chemotherapy, total bilirubin level, Karnofsky performance status. RESULTS: The overall 1-year survival was 24.2%, with a mean survival of 10 months. Of 33 patients, tumor regression (PR+MR) was seen in 30.4%, no response was seen in 52.2%, 17.4% patient was progressed. In patients who had tumor regression, the overall 1-year survival was 42.1% with a mean survival of 14 months. Factors influencing the survival were sex (p=0.05), tumor type (p=0.0248), Child's classification (p=0.0001), liver cirrhosis (p=0.0108), ascites (p=0.0009), and Karnofsky performance status (p=0.0028). Complications developed in 28 patients, including 18 hot pain, 5 fat necrosis, 3 transient fever, 2 nausea and vomiting. CONCLUSION: In this study, the results suggests that combined radiotherapy and hyperthermia may improve the survival rate of hepatoma.

Influence of dietary zinc on hepatic collagen and prolyl hydroxylase activity in alcoholic rats.

The effects of dietary zinc on hepatic collagen and prolyl hydroxylase activity in normal and alcoholic rats has been investigated in four groups of pair-fed male Wistar rats given either liquid ethanol or a control diet for 12 wk. Each group of pair-fed animals received a diet with a different zinc concentration (standard diet, 7.6 mg/L; low-zinc diet, 3.4 mg/L; zinc-supplemented diet, 76 mg/L; and zinc-extrasupplemented, 300 mg/L. There were no significant differences in hepatic collagen concentration and prolyl hydroxylase activity between alcoholic and normal rats receiving a standard diet (collagen, 77 +/- 5 and 73 +/- 6 micrograms/mg protein; and prolyl hydroxylase; 37 +/- 26 and 36 +/- 22 cpm/mg protein). Alcoholic rats fed a low-zinc diet showed increased prolyl hydroxylase activity (75 +/- 10 cpm/mg protein, p less than 0.05), although no changes in hepatic collagen (77 +/- 10 micrograms/mg protein) were observed in comparison with rats fed a standard alcoholic diet. By contrast, hepatic collagen was significantly lower in alcoholic rats fed a zinc-supplemented diet (66 +/- 4 and 63 +/- 3 micrograms/mg protein, p less than 0.05 and p less than 0.01, respectively), and hepatic prolyl hydroxylase activity was particularly lower in rats receiving zinc 300 mg/L (18 +/- 20 cpm/mg protein). Similar effects were observed in normal rats. We conclude that dietary zinc influences hepatic prolyl hydroxylase activity and collagen deposition in alcoholic rats, and in consequence, the control of dietary zinc is necessary to assess the effects of alcohol on collagen metabolism in rats.

Three-dimensional gadolinium-enhanced MR imaging of the breast: pulse sequence with fat suppression and magnetization transfer contrast. Work in progress.

A pulse sequence with magnetization transfer contrast and fat suppression was used in three-dimensional magnetic resonance imaging of the breast. Two healthy volunteers, one person with silicone implants, and 12 patients with clinical and/or mammographic findings suspicious for malignancy were evaluated prior to and following infusion of gadopentetate dimeglumine. Imaging time was approximately 7 minutes for each set of data (128 sections). Final voxel dimensions ranged from 1.4 x 0.8 x 0.8 mm to 1.6 x 0.9 x 0.9 mm. All carcinomas, including ductal and lobular types, were enhanced before and after infusion of contrast medium. Multifocal carcinoma and inflammatory carcinoma could be clearly visualized. Enhancement was not evident in patients with fat necrosis (n = 1) or scar (n = 1). Fibrocystic changes in one patient were visible as areas of increased signal intensity on preinfusion images. Resolution and contrast of MR images obtained with this pulse sequence appeared to be improved over that achieved with conventional breast MR imaging techniques. This method has the potential to supplement conventional diagnostic methods in the evaluation of breast disease.