Necrosis grasa subcutánea múltiple: correlación ecográficohistopatológica. Multiple encapsulated fat necrosis: histopathological relation to ultrasound findings.

Encapsulated fat necrosis is a benign entity that has multiple possible conditions in the differential diagnosis. Because of this, the ultrasound and histological studies become highly relevant. We present a 14-year-old boy with this condition who exhibited numerous nodules that were detected after an intentional weight loss of 20kg. The ultrasound and histopathological examinations were necessary to confirm the diagnosis. Even though there is not a clear traumatic record in all cases, trauma constitutes the main hypothesis for its development, by decreasing the blood supply to the adipose tissue lobules and causing subsequent ischemic necrosis. Similar lesions have been described in the omentum and in the breast after surgical procedures or invasive diagnostic tests. In the ultrasound study, at least three presentation patterns have been described, which might match the three histological states, from early fat tissue degeneration to ultimate necrosis and even calcification. It is important to know the clinical characteristics, the ultrasound patterns, and the histological findings of this condition for an accurate diagnosis.

Urgencias dermatológicas: estudio transversal de un hospital de complejidad intermedia / Dermatological emergencies: a cross-sectional study of a hospital of intermediate complexity

OBJETIVO: Conocer si la introducción de criterios de derivación en la urgencia dermatológica modifica el número de pacientes y las patologías derivadas desde el servicio de Urgencias generales, así como el perfil del paciente que hace uso de este servicio. MATERIAL Y MÉTODOS: Estudio observacional que incluyó de forma consecutiva a los pacientes vistos en Urgencias de Dermatología del Hospital Príncipe de Asturias en un periodo de 31 días de 2015, de marzo a mayo, y en el mismo periodo en 2016. Como variables se recogieron sexo, edad, tiempo de evolución, día de la semana, pruebas complementarias, procedencia, motivo de consulta, diagnóstico y grupo, así como el cumplimiento de los criterios, el destino y si tenía cita previa. RESULTADOS: En 2015 acudieron 525 pacientes y 371 en 2016 (p < 0,001). Fueron atendidos 896 pacientes en total (14,45 pacientes/día); el 55,7% eran mujeres y el 44,3% varones. Se realizaron 121 diagnósticos diferentes, siendo los más frecuentes: otras dermatitis, toxicodermias y dermatitis atópica. Tan solo 32 enfermedades suponen el 70% de los diagnósticos. El 51,6% no cumplió los criterios de derivación urgente. CONCLUSIONES: La introducción de criterios de derivación ha permitido reducir el volumen de pacientes en un 30% en el año 2016. Otras dermatitis y las toxicodermias fueron los principales diagnósticos en ambos grupos. El perfil del paciente coincide con el descrito en la literatura

OBJECTIVE: To determine if the introduction of some referral criteria in the dermatology emergency department has changed the number of patients referred from the emergency department, as well as the type of diseases, and the profile of the patient who uses this service. MATERIAL AND METHODS: A cross-sectional study was conducted on all consecutive patients attended in the emergency department of the Hospital Príncipe de Asturias during a 31-day period from March 2015 to May 2015 and in the same period in 2016. Variables collected were: gender, age, days from the onset, day of the week, complementary diagnostic tests, referral, reason for consultation, diagnosis and group, whether or not they met the criteria, destination, and whether or not they had a previous appointment. RESULTS: A total of 525 patients were seen in dermatology emergency department in 2015, and 371 in 2016 (P < .001). Of the 896 patients seen 55.7% were women and 44.3% men (14.45 patients per day). A total of 121 diagnoses were made, with the most common being: other dermatitis, drug reactions, and atopic dermatitis. Only 32 pathologies made up 70% of the diagnoses. More than half (51.6%) did not meet the referral criteria. CONCLUSIONS: The introduction of referral criteria has led to a reduction of 30% in the number of patients in 2016. The main diagnoses in both groups were other dermatitis and drug reactions. The profile of the patient is in accordance with the description in the literature

[Dermatological emergencies: a cross-sectional study of a hospital of intermediate complexity]. / Urgencias dermatológicas: estudio transversal de un hospital de complejidad intermedia.

OBJECTIVE: To determine if the introduction of some referral criteria in the dermatology emergency department has changed the number of patients referred from the emergency department, as well as the type of diseases, and the profile of the patient who uses this service. MATERIAL AND METHODS: A cross-sectional study was conducted on all consecutive patients attended in the emergency department of the Hospital Príncipe de Asturias during a 31-day period from March 2015 to May 2015 and in the same period in 2016. Variables collected were: gender, age, days from the onset, day of the week, complementary diagnostic tests, referral, reason for consultation, diagnosis and group, whether or not they met the criteria, destination, and whether or not they had a previous appointment. RESULTS: A total of 525 patients were seen in dermatology emergency department in 2015, and 371 in 2016 (P<.001). Of the 896 patients seen 55.7% were women and 44.3% men (14.45 patients per day). A total of 121 diagnoses were made, with the most common being: other dermatitis, drug reactions, and atopic dermatitis. Only 32 pathologies made up 70% of the diagnoses. More than half (51.6%) did not meet the referral criteria. CONCLUSIONS: The introduction of referral criteria has led to a reduction of 30% in the number of patients in 2016. The main diagnoses in both groups were other dermatitis and drug reactions. The profile of the patient is in accordance with the description in the literature.

Porocarcinoma ecrino: aspectos demográficos, clínicos, histopatológicos y terapéuticos en una serie de 7 pacientes / Eccrine Porocarcinoma: Patient Characteristics, Clinical and Histopathologic Features, and Treatment in 7 Cases

El porocarcinoma ecrino es un tumor anexial cutáneo maligno poco frecuente, que deriva de la porción ductal de las glándulas sudoríparas. Predomina en pacientes de edad avanzada, pudiendo adoptar diversas presentaciones clínicas. El estudio histológico confirma el diagnóstico y establece factores pronósticos relevantes a la hora de decidir el tratamiento. El curso evolutivo es lento, pero su pronóstico es sombrío cuando aparecen metástasis linfáticas o viscerales. Presentamos 7 pacientes diagnosticados de porocarcinoma ecrino, y describimos los aspectos epidemiológicos, clínicos, histopatológicos y los datos relacionados con el tratamiento de cada uno de ellos. Comparamos los datos obtenidos con las mayores series de casos publicadas, obteniendo similares resultados. Ante la ausencia de algoritmos terapéuticos protocolizados se propone un esquema de tratamiento basado en la literatura revisada y la experiencia personal con nuestra serie, que tiene como ejes centrales los factores pronósticos histológicos y la biopsia selectiva de ganglio centinela (AU)

Eccrine porocarcinoma is a rare, malignant cutaneous adnexal tumor that arises from the ducts of sweat glands. Found mainly in patients of advanced age, this tumor has diverse clinical presentations. Histology confirms the diagnosis, detects features relevant to prognosis, and guides treatment. Growth is slow, but the prognosis is poor if the tumor metastasizes to lymph nodes or visceral organs. We report 7 cases of eccrine porocarcinoma, describing patient characteristics, the clinical and histopathologic features of the tumors, and treatments used. Our observations were similar to those of other published case series. Given the lack of therapeutic algorithms or protocols for this carcinoma, we propose a decision-making schema based on our review of the literature and our experience with this case series. The algorithm centers on sentinel lymph node biopsy and histologic features (AU)

Eccrine Porocarcinoma: Patient Characteristics, Clinical and Histopathologic Features, and Treatment in 7 Cases. / Porocarcinoma ecrino: aspectos demográficos, clínicos, histopatológicos y terapéuticos en una serie de 7 pacientes.

Eccrine porocarcinoma is a rare, malignant cutaneous adnexal tumor that arises from the ducts of sweat glands. Found mainly in patients of advanced age, this tumor has diverse clinical presentations. Histology confirms the diagnosis, detects features relevant to prognosis, and guides treatment. Growth is slow, but the prognosis is poor if the tumor metastasizes to lymph nodes or visceral organs. We report 7 cases of eccrine porocarcinoma, describing patient characteristics, the clinical and histopathologic features of the tumors, and treatments used. Our observations were similar to those of other published case series. Given the lack of therapeutic algorithms or protocols for this carcinoma, we propose a decision-making schema based on our review of the literature and our experience with this case series. The algorithm centers on sentinel lymph node biopsy and histologic features.