Subcutaneous Fat Necrosis Research Articles

Subcutaneous fat necrosis of the newborn and hypercalcemia: A case report

Subcutaneous fat necrosis of the newborn and hypercalcemia: A case report

A Case of a Granuloma with Subcutaneous Fat Necrosis Caused by the Injection of Leuprorelin Acetate for Breast Cancer

A Case of a Granuloma with Subcutaneous Fat Necrosis Caused by the Injection of Leuprorelin Acetate for Breast Cancer

A Case of Subcutaneous Fat Necrosis of the Newborn with Hypoglycemia and Meconium Aspiration Syndrome

환아 : 김◯선아기, 생후 1일, 여아 주소 : 출생 직후 발생한 호흡곤란 출생력 및 현병력 : 환아는 타원에서 재태 기간 40주 0 일에 특별한 분만 손상 없이 제왕절개술로 출생하였으며 출생 체중은 2,860 g (10-25백분위수)이었다. 아프가 점 수는 1분 8점, 5분 8점으로 양호하였으나, 출생 시 양수가 태변 착색을 보였고 이후 호흡곤란 증상을 보여 기관 삽관 후 양압환기를 시행하며 본원 신생아 집중 치료실로 입원 하였다. 산모 병력 및 가족력 : 임신성 당뇨 외에 특이 사항 없음. 피하지방괴사(subcutaneous fat necrosis)는 다양한 연령층에서 나타날 수 있지만 신생아에서 드문 질환으로, 신생아에서는 분만 손상, 가사(birth asphyxia)와 같은 저 산소증, 저체온 치료(therapeutic hypothermia), 저혈당 증, 산모의 임신성 당뇨병과 고혈압 등의 위험 요인을 가지 는 만삭아에서 출생 후 수주 이내에 잘 발생한다. 지방 패드(fat pad)가 있는 사지, 등, 엉덩이, 허벅지 등에 주로 발 생하는 한 개 혹은 여러 개의 경계가 뚜렷한 압통을 동반한 홍반성, 경화성 피하 결절(nodules) 및 판(plaque)을 특징 으로 하는 지방층염의 드문 형태로 예후가 좋아 대부분 수 주 내지 수개월 후 소실된다. 합병증으로는 고칼슘혈증, 통 증, 지질이상, 신부전, 피하 위축 들이 있다. 국내에서는 신 저혈당증과 태변 흡인 증후군을 보인 신생아에서 나타난 피하지방괴사 1례

MRSA infection associated with subcutaneous and intraosseous fat necrosis after acute pancreatitis; A case report

MRSA infection associated with subcutaneous and intraosseous fat necrosis after acute pancreatitis; A case report

Panniculitis

The subcutaneous fat is a metabolic depot and also provides insulation from trauma. The subcutis is divided into lobules by fibrous septa. Within the fibrous septae course the small arteries, arterioles, veins and small nerve fibres. The nutrient artery supplies the centre of the lobule and drains to venules within the septum. Inflammatory disorders of the subcutaneous fat can be grouped into three main categories: 1) Septal panniculitis. 2) Lobular panniculitis. 3) Panniculitis associated with large vessel vasculitis. Most panniculitis are strictly speaking mixed but the classification is based on the predominant area of involvement. In septal panniculitis the inflammation is centred upon the connective tissue septa. There is often some spill over of the inflammatory cells into the periphery of the lobule. Erythema nodosum (EN) is the prototype of septal panniculitis. Other disorders associated with a septal panniculitis include necrobiosis lipoidica, factitial panniculitis, nephrogenic systemic fibrosis, cellulitis and microscopic polyangiitis. In the lobular panniculitides the inflammation is centered mainly within the lobule. Examples of lobular panniculitis include nodular vasculitis, lupus panniculitis, subcutaneous fat necrosis of the newborn, sclerema neonatorum, cold panniculitis, a1 anti-trypsin deficiency and pancreatic panniculitis.

Subcutaneous fat necrosis of the newborn: clinical manifestations in two cases

Subcutaneous fat necrosis of the newborn is an unusual form of panniculitis, with few cases described in medical literature. The disease affects newborns at term or post-term, with normal general health. We describe two cases of newborns affected by the disease. One of them already had lesions since birth. Also, we discuss the use of puncture for diagnostic assistance.

THU0493 Approaches to Treatment of Weber-Christian Disease

BackgroundWeber-Christian disease (WCD) is a rare understudied disease, which manifests itself in recurrent subcutaneous fatnecrosis often involving damage of the internals. Treatment of the disease is not standardized, and as...

Intérêt de l’échographie rénale dans la cytostéatonécrose sous-cutanée

Subcutaneous fat necrosis is an uncommon disease that may be complicated with potentially fatal hypercalcemia or with nephrocalcinosis. We report on the case of a patient with a history of significant perinatal asphyxia, hospitalized for a urinary tract infection. Lesions of subcutaneous fat necrosis were noted, with asymptomatic hypercalcemia at 3.9mmol/L. A renal ultrasound was performed and showed echogenic medullary pyramids bilaterally, consistent with nephrocalcinosis and left nephrolithiasis. The treatment of hypercalcemia included hyperhydration, a diuretic and corticosteroids. Progression was characterized by the total regression of skin lesions and normalization of serum calcium. Hypercalcemia is a rare complication of subcutaneous fat necrosis. It develops within days to weeks after the appearance of skin lesions. Nephrocalcinosis appears after several weeks or months. Hypercalcemia must be treated in due time to avoid the impact on the kidney.

Encapsulated fat necrosis mimicking subcutaneous liposarcoma: radiologic findings on MR, PET-CT, and US imaging

We present a case of a subcutaneous encapsulated fat necrosis of the upper extremity that mimicked subcutaneous liposarcoma because of heterogeneous signal intensity, its relatively large size, and pronounced enhancement on magnetic resonance imaging (MRI). For this case, we present the radiologic findings including MRI, positron emission tomography-computed tomography (PET-CT), ultrasonography, and radiography. We emphasize the imaging features of this lesion, which has a fibrous capsule and briefly discuss its nomenclature and pathophysiology.

Subcutaneous fat necrosis after selective head cooling in an infant

Hypoxic-ischemic encephalopathy in neonates causes irreversible damage to tissue and organs and results in multiple organ failure and poor outcome. Therapeutic hypothermia is the most effective therapy in neonates with hypoxic-ischemic encephalopathy. We report here a case of subcutaneous fat necrosis (SCFN) after therapeutic hypothermia by selective head cooling. Selective head cooling was provided for 72 h after birth. SCFN developed on the patient's cheeks and back at the age of 21 days. Thus, SCFN may be caused by selective head cooling, similarly to whole-body cooling.

Idiopathic infantile hypercalcemia or an extrapulmonary complication of tuberculosis?

Calcium metabolism disturbances are common in childhood. In infancy, hypercalcemia generally occurs due to hyperparathyroidism, familial hypocalciuric hypercalcemia, subcutaneous fat necrosis, total parenteral nutrition administration, hyperthyroidism, and adrenal insufficiency. Granulomatous disorders such as tuberculosis and sarcoidosis are rarer cause of hypercalcemia. Hypercalcemia outcomes including nephrocalcinosis, brain, eye, artery calcifications and encephalopathic features are life-threatening. We report a seven-month-old girl with miliary tuberculosis who presented with severe hypercalcemia.

An infant with multiple subcutaneous nodules, hypercalcemia, and nephrocalcinosis: Questions

1. The assessment of urine calcium excretion rate, serum iPTH, and 1,25(OH)2 vitamin D3 is essential in the approach to hypercalcemia. 2. Subcutaneous fat necrosis with hypercalcemia and medullary nephrocalcinosis. 3. Ectopic production of 1,25(OH)2 vitamin D3 by the infiltrated macrophage in the necrotic fat tissue. 4. Volume expansion, loop diuretics, and potassium citrate are the mainstay treatments for normalizing serum calcium and preventing further calcium deposition in the kidney. Prednisolone can be used as an alternative in refractory cases.

A Neonate with Subcutaneous Fat Necrosis after Passive Cooling: Does Polycythemia Have an Effect?

Subcutaneous fat necrosis (SCFN) is an inflammatory disorder of adipose tissue. The main risk factors for the development of SCFN are perinatal asphyxia and hypothermia. Presented here is a case of a newborn who developed SCFN in association with polycythemia and hypocalcemia following treatment by passive cooling. Neonates who undergo passive or whole body cooling therapy should be closely monitored for any signs of SCFN.

Subcutaneous fat necrosis during hypothermia treatment in an asphyxiated infant

Hipoksik iskemik ensefalopati (HIE), neonatal olum, serebral palsi ve ileri donemde gelisimsel gerilikle sonuclanabilen merkezi sinir sisteminin kalici hasarinin onemli bir sebebidir. Tum vucut sogutma tedavisi HIE'de gunumuzdeki tek etkin tedavi yontemidir. Tum vucut sogutmaya bagli subkutan yag nekrozu gelisimi nadir gorulen bir yan etkidir. Otuz uc yasindaki annenin 3. gebeliginden 2. yasayan olarak sezaryen ile 3500 gram olarak dogan kiz bebek postnatal 4. saatinde solunum sikintisi, hipotonisite ve konvulsiyon nedeni ile yenidogan yogun bakim unitesine (YYBU) kabul edildi. Oykuden, annenin gestasyonel diyabet nedeni ile gebelikte son trimesterde insulin tedavisi aldigi ogrenildi. YYBU'ne kabulde, hasta entube, genel durumu kotu ve hipotonikti. Hastaya postnatal 6. saatinde tum vucut sogutma yontemiyle hipotermi tedavisi baslandi. Tedavinin 48. saatinde subkutan yag nekrozu ile uyumlu lezyonlari gelisen hastanin izlemde hiperkalsemisi gelisti ve pamidronat tedavisinden fayda gordu. Hasta genel durumu iyi, lezyonlari iyilesmis ve norolojik muayenesi normal olarak postnatal 25. gunde taburcu edildi. Hipotermi tedavisinin komplikasyonlari arasinda subkutan yag nekrozu nadir gorulen bir durumdur. Subkutan yag nekrozu genellikle kendiliginden iyilesen bir patoloji olmakla birlikte hiperkalsemi riski nedeniyle hastalarin yakindan izlenmesi onemlidir.

Tender skin nodules in a newborn

Subcutaneous fat necrosis of infancy is a rare disorder of subcutaneous adipose tissue that is sometimes complicated by hypercalcemia. Complete resolution is common. From the pediatrician's point of view, the disease is a rare but important cause of inconsolable cry in a newborn.

Subcutaneous Fat Necrosis and Whole-Body Cooling Therapy for Neonatal Encephalopathy

Whole-body cooling, or therapeutic hypothermia, is increasingly becoming the standard of treatment for moderate to severe neonatal encephalopathy because it reduces neurodevelopmental disabilities and mortality in term neonates. Subcutaneous fat necrosis (SCFN) of the newborn has been identified as a potential side effect of birth asphyxia. In recent literature, there has been an increase in SCFN in infants who received whole-body cooling in treatment of neonatal encephalopathy. Subcutaneous fat necrosis is a rare and self-limiting disorder of the adipose tissue that usually occurs in full-term or postterm infants. The disorder can appear days to weeks after birth and spontaneously resolves within weeks to months without any intervention but can have potential complications. With the increasing use of whole-body cooling in the neonate population, clinicians should be aware of SCFN as a possible side effect. This article describes a case of SCFN occurring after whole-body cooling on a term infant with perinatal asphyxia.

OFF-LABEL USE OF PAMIDRONATE IN HYPER-CALCEMIC NEWBORN AFFECTED BY SUBCUTANEOUS FAT NECROSIS AFTER THERAPEUTIC HYPOTERMIA

Background: Subcutaneous fat necrosis is a dermatological disorder with characteristic subcutaneous nodules or plaques. It has a benign nature and generally runs a self-limiting course, although can cause significant and dangerous complications, including hypercalcemia. Outbreak of hypercalcemia occurs even several months after hypothermic treatment in asymptomatic or symptomatic way. Irritability, lethargy, hypotonia, emesis, polyuria, polydipsia, constipation and failure to thrive are the most common symptoms of hypercalcemia while seizures, cardiac arrest and acute or chronic renal failure are the most serious manifestations. Chronic hypercalcemia is also associated with nephrocalcinosis and metastatic calcifications of skin, heart, lever and vessels. Low calcium and vitamine D formula preparation milk, diuretics, such as furosemide, and corticosteroids are first-line treatments. In some refractory case pamidronate is used. Pamidronate is a biphosphonate which can modulate bone turnover by leading hydroxyapatite crystals, and it can inhibit osteoclastic bone resorption. Observation: A male full-term infant weighing 2,300 grams was born after an emergency cesarean section due to fetal heart rate decelerations. His initial Apgar scores were 1 at 1 minute, 4 at 5 minutes and 8 at 15 minutes. Due to hypoxicischaemic encephalopathy (stage 1 of Sarnat classification, with abnormal voltage and paroxysmal activities at electroencephalogram),a whole-body therapeutic hypothermia was initiated before sixth hour of life. It was performed to a target rectal temperature of 33,5°C, for about 36 hours. In the third day of life, he developed characteristic subcutaneous fat necrosis skin lesions, such as firm, indurated plaques and red and violaceous nodules, on the upper back area and buttocks. One month after the hypotermic treatment the infant developed a rapid, asymptomatic increase of calcemia. First his milk was changed to a very low calcium and vitamin D formula preparation, without a clinical improvement. Hypercalcemia (total serum calcium 13,8 mg/dL [reference range 9-10.9 mg/dL] and ionized calcium 1,96 mmol/L [reference range 1,12-1,32 mmol/L]) was successfully treated with a 3-days therapy of intravenous pamidronate at dose of 0,5 mg/kg/die. No side effects were detected during the treatment and then serum calcium levels remained stable.

OFF-LABEL USE OF PAMIDRONATE IN HYPER-CALCEMIC NEWBORN AFFECTED BY SUBCUTANEOUS FAT NECROSIS AFTER THERAPEUTIC HYPOTERMIA

Background: Subcutaneous fat necrosis is a dermatological disorder with characteristic subcutaneous nodules or plaques. It has a benign nature and generally runs a self-limiting course, although can cause significant and dangerous complications, including hypercalcemia. Outbreak of hypercalcemia occurs even several months after hypothermic treatment in asymptomatic or symptomatic way. Irritability, lethargy, hypotonia, emesis, polyuria, polydipsia, constipation and failure to thrive are the most common symptoms of hypercalcemia while seizures, cardiac arrest and acute or chronic renal failure are the most serious manifestations. Chronic hypercalcemia is also associated with nephrocalcinosis and metastatic calcifications of skin, heart, lever and vessels. Low calcium and vitamine D formula preparation milk, diuretics, such as furosemide, and corticosteroids are first-line treatments. In some refractory case pamidronate is used. Pamidronate is a biphosphonate which can modulate bone turnover by leading hydroxyapatite crystals, and it can inhibit osteoclastic bone resorption. Observation: A male full-term infant weighing 2,300 grams was born after an emergency cesarean section due to fetal heart rate decelerations. His initial Apgar scores were 1 at 1 minute, 4 at 5 minutes and 8 at 15 minutes. Due to hypoxicischaemic encephalopathy (stage 1 of Sarnat classification, with abnormal voltage and paroxysmal activities at electroencephalogram),a whole-body therapeutic hypothermia was initiated before sixth hour of life. It was performed to a target rectal temperature of 33,5°C, for about 36 hours. In the third day of life, he developed characteristic subcutaneous fat necrosis skin lesions, such as firm, indurated plaques and red and violaceous nodules, on the upper back area and buttocks. One month after the hypotermic treatment the infant developed a rapid, asymptomatic increase of calcemia. First his milk was changed to a very low calcium and vitamin D formula preparation, without a clinical improvement. Hypercalcemia (total serum calcium 13,8 mg/dL [reference range 9-10.9 mg/dL] and ionized calcium 1,96 mmol/L [reference range 1,12-1,32 mmol/L]) was successfully treated with a 3-days therapy of intravenous pamidronate at dose of 0,5 mg/kg/die. No side effects were detected during the treatment and then serum calcium levels remained stable.

The Effect of Dose-Volume Parameters and Interfraction Interval on Cosmetic Outcome and Toxicity After 3-Dimensional Conformal Accelerated Partial Breast Irradiation

To evaluate dose-volume parameters and the interfraction interval (IFI) as they relate to cosmetic outcome and normal tissue effects of 3-dimensional conformal radiation therapy (3D-CRT) for accelerated partial breast irradiation (APBI). Eighty patients were treated by the use of 3D-CRT to deliver APBI at our institutions from 2003-2010 in strict accordance with the specified dose-volume constraints outlined in the National Surgical Adjuvant Breast and Bowel Project B39/Radiation Therapy Oncology Group 0413 (NSABP-B39/RTOG 0413) protocol. The prescribed dose was 38.5 Gy in 10 fractions delivered twice daily. Patients underwent follow-up with assessment for recurrence, late toxicity, and overall cosmetic outcome. Tests for association between toxicity endpoints and dosimetric parameters were performed with the chi-square test. Univariate logistic regression was used to evaluate the association of interfraction interval (IFI) with these outcomes. At a median follow-up time of 32 months, grade 2-4 and grade 3-4 subcutaneous fibrosis occurred in 31% and 7.5% of patients, respectively. Subcutaneous fibrosis improved in 5 patients (6%) with extended follow-up. Fat necrosis developed in 11% of women, and cosmetic outcome was fair/poor in 19%. The relative volume of breast tissue receiving 5%, 20%, 50%, 80%, and 100% (V5-V100) of the prescribed dose was associated with risk of subcutaneous fibrosis, and the volume receiving 50%, 80%, and 100% (V50-V100) was associated with fair/poor cosmesis. The mean IFI was 6.9 hours, and the minimum IFI was 6.2 hours. The mean and minimum IFI values were not significantly associated with late toxicity. The incidence of moderate to severe late toxicity, particularly subcutaneous fibrosis and fat necrosis and resulting fair/poor cosmesis, remains high with continued follow-up. These toxicity endpoints are associated with several dose-volume parameters. Minimum and mean IFI values were not associated with late toxicity.

Paniculitis pancreática. Revisión de 7 casos

IntroductionPancreatic panniculitis or subcutaneous fat necrosis is an uncommon dermatosis that can be associated with benign or malignant pancreatic disease. Histological findings are highly suggestive, and cutaneous biopsy is useful for diagnosis. Patients and methodSeven cases of pancreatic panniculitis are presented. Six were associated with benign disease, the most frequently associated disease being acute pancreatitis of biliary etiology. The seventh case was associated with pancreatic adenocarcinoma. In the six patients with benign disease, both digestive and cutaneous symptoms were present. In the seventh patient, the neoplasm was diagnosed one year after the onset of cutaneous symptoms. All cases were diagnosed by using cutaneous biopsy. DiscussionThe importance of this entity lies in the fact that the cutaneous lesions frequently precede pancreatic manifestations, which can be asymptomatic at diagnosis. If a tumor has already been diagnosed, relapse or metastasis could be suspected