An exploratory study of the effectiveness of a relaxation with guided imagery protocol

Subcutaneous fat necrosis of the newborn (SCFN) alone is an uncommon condition. Its association with hypercalcemia has been reported in 19 neonates since 1926. The two occur in full-term to postterm newborns with perinatal complications associated with delivery. Erythematous to violaceous, firm, subcutaneous nodules appear approximately 1 to 4 weeks after delivery, preceding the development of signs and symptoms of hypercalcemia. Although SCFN and hypercalcemia are rare complications in neonates with perinatal problems, death due to the sequelae of hypercalcemia occurred in 3 of the 19 patients. A neonate who develops skin lesions consistent with SCFN should be followed for possible onset of hypercalcemia and treated in a timely fashion.     

Electrophoretic patterns of insoluble proteins in the sensory cerebral cortex of visually deprived and normal kittens

Specimens from two cases of subcutaneous fat necrosis of the newborn were studied by light and electron microscopy. Crystallization of the fat cell started with clearing of the central fat droplet, followed by the appearance of cylindrical crystals. The fat crystals were phagocytosed by cytoplasmic projections of macrophages as well as by foreign body giant cells. Calcium deposits were demonstrated within the central fat droplet of the degenerated fat cell of Case 2.     

Subcutaneous fat necrosis in a neonate, in association with aberrant plasma lipid and lipoprotein values

A newborn infant with subcutaneous fat necrosis after perinatal hypoxia was found to have several abnormalities of plasma lipids. Further studies are needed to determine whether such abnormalities contribute to the pathophysiology of the skin lesions.     

Surface coverage of vascular grafts with cultured human endothelial cells from subcutaneous fat tissue obtained with a biopsy needle

Surface coverage with autogeneous endothelial cells is effective in reducing thrombogenicity of an artificial vascular graft, but procedure for obtaining the cells is invasive for patients. The purpose of this study was to establish cultures of human endothelial cells separated from a small piece of subcutaneous fat tissue. A piece of tissue weighing about 10 mg was obtained from subcutaneous fat using a biopsy needle, and treated with collagenase and dispase. Microvascular endothelial cells were selected and other types of cells contaminating the cultures were eliminated by scraping with a needle under a microscope. The yield of the cells was 8362 +/- 4264/10 mg of subcutaneous fat (n = 7). The cultures reached confluence in about 2 weeks. The cells were positive for von Willebrand factor, P-selectin, and uptake of acetylated low density lipoprotein. The cells produced 15.9 +/- 3.3 ng/mg cell protein/h of 6-ketoprostaglandin F1 alpha (n = 5) when stimulated with thrombin. Thrombin also stimulated the production of platelet-activating factor: 7653 +/- 4297 dpm/10(6) cells (n = 5). Endothelin-1 accumulation in the medium of unstimulated endothelial cells was 0.54 +/- 0.16 ng/mg cell protein/10 h (n = 8). As a preliminary experiment for graft seeding, the cells were also cultured on pieces of a gelatin-coated Dacron graft, and scanning electron microscopy revealed the surface coverage of the graft. We herein described about successful culture of human microvascular endothelial cells from subcutaneous fat tissue obtained using a biopsy needle. The cultured cells may be applicable to a seeded vascular graft.     

Upper airway obstruction during midazolam/nitrous oxide sedation in children with enlarged tonsils

Steatocystoma multiplex is a rare condition characterized by multiple subcutaneous nodules classically located on the anterior chest. Diagnosis usually is made clinically or by biopsy. The lesions may be numerous, and surgical treatment may not be practical or the results may be unsatisfactory. Three patients with multiple subcutaneous nodules underwent fine needle aspiration, which produced smears with acellular debris. A diagnosis was possible in the first patient because of close collaboration with a dermatologist. The lesions in the other patients were recognized clinically and were confirmed cytologically by fine needle aspiration. A syringe holder allows the use of thin needles (22-gauge) to aspirate very small lesions (4 to 5 mm). Fine needle aspiration may provide a useful alternative to surgical methods in the treatment of these lesions because it is inexpensive, well-tolerated by the patients, and has no associated morbidity.     

Cystic mass at the suprasternal notch of a newborn: congenital suprasternal dermoid cyst

We report a case of a newborn female with an unusual suprasternal simple cystic mass found to be a dermoid cyst. Dermoid cysts of the head and neck are rare lesions, but a midline location is characteristic for these congenital masses. A dermoid cyst should be high on the list of differential diagnoses given a unilocular midline cyst in a neonate even if no fat elements are demonstrated on imaging studies.     

Frequency and severity of headache after lumbar myelography using a 25-gauge pencil-point (Whitacre) spinal needle

A 77-year-old man had been suffering from stress urinary incontinence for 2 years since he had received transurethral resection of prostate (TUR-P) for benign prostatic hypertrophy. A 60-min pad test yielded 3 g of urine. Prostatic urethra was widely open and the external sphincteric injury was suggested because of the short membraneous urethra on the urethrogram. Urethral pressure profile indicated his maximal urethral closing pressure (MUCP) of 24 cmH2O and functional urethral length of 1.6 cm and cystometry demonstrated an underactive bladder, indicating that his incontinence was caused by sphincteric injury. Autologous fat injection therapy was performed in the lithotomy position under spinal anesthesia. Fifteen ml of subcutaneous fat was obtained from his lower abdomen by liposuction through a 15G needle, and 10 ml was injected submucosally from the perineum at 6 o'clock area of the prostatic apex under the guidance of transrectal echography using a 15G needle. The patient became completely dry after the procedure. MUCP and FUL increased to 35 cmH2O and 1.9 cm, respectively, although longer follow up is necessary. The advantage of autologous fat injection to the prostate for post-TUR-P SUI patients is briefly discussed.     

Congenital muscular dystrophy: report of one case

A case is reported of a newborn who presented with generalized hypotonia shortly after delivery. Creatine kinase (CK) was highly elevated. Muscle biopsy of the rectus femoris muscle revealed varying sized muscle fibers, displacement by fat and connective tissues, necrosis and regeneration of the muscle fibers. Magnetic resonance imaging (M.R.I.) of the brain showed normal development, compatible with the patient's age. Congenital muscular dystrophy was diagnosed from clinical manifestations, laboratory findings, and the results of muscle biopsy.     

Molecular analysis of the role of the group A streptococcal cysteine protease, hyaluronic acid capsule, and M protein in a murine model of human invasive soft-tissue infection

Human invasive soft-tissue infections caused by group A Streptococcus are associated with significant morbidity and mortality. To investigate the pathogenesis of these serious infections, we characterized the host response to bacterial challenge with an M-type 3 isolate recovered from a patient with necrotizing fasciitis, or with isogenic gene replacement mutants deficient in cysteine protease, hyaluronic acid capsule, or M protein in a murine model of human invasive soft-tissue infection. Animals challenged with the wild-type or cysteine protease-deficient strain developed spreading tissue necrosis at the site of inoculation, became bacteremic, and subsequently died. Histopathologic examination of the necrotic lesion revealed bacteria throughout inflamed subcutaneous tissue. Arterioles and venules in the subcutaneous layer were thrombosed and the overlying tissue was infarcted. In contrast, animals challenged with either an acapsular or M protein-deficient mutant developed a focal area of tissue swelling at the site of inoculation without necrosis or subsequent systemic disease. Histopathologic examination of the soft-tissue lesion demonstrated bacteria confined within a well-formed subcutaneous abscess. We conclude that the group A streptococcal hyaluronic acid capsule and M protein, but not the cysteine protease, are critical for the development of tissue necrosis, secondary bacteremia, and lethal infection in a murine model of human necrotizing fasciitis.     

Mathematical analysis of epidural space location

BACKGROUND: The location of epidural space for local anaesthetic injection can be difficult. The aim of this study was to define the mathematical function of the pressure changes in the syringe during puncture of the epidural space. Knowledge of pressure changes might be of help to the anesthetist who attempts to ascertain the location of the needle, and it is essential to the design of a device with which to locate epidural space. METHODS: Epidural punctures were performed in 20 patients, using an 18-Tuohy needle connected to a 10 ml syringe. The epidural space was located by the loss of resistance technique. Pressure variations within the injection system during epidural puncture were measured and digitized at 250 Hz. Pressure curves were analyzed for amplitude and rate of a decay after entry of the needle into the epidural space. RESULTS: Pressure increased as the needle passed through skin, subcutaneous fat and muscle. The maximal pressure was observed when the needle perforated the ligamentum flavum (689 +/- 124 cm H2O). When the needle entered the epidural space, an exponential decrease in pressure was observed in all patients (R2 = 0.99; tau = 2.1 +/- 0.9 seconds). End-residual pressure was 22 +/- 12 cm H2O. The change in pressure observed when the needle entered the epidural space fitted a negative exponential function (y = e-x/2.08). CONCLUSIONS: Pressures within the injection system for epidural puncture can reach 1100 cm H2O. Location of the epidural space is characterized by an exponential decay to and end-residual pressure below 50 cm H2O, with a constant time of approximately 2 seconds.     

Spectral composition of infant auditory brainstem responses: implications for filtering

Auditory brainstem responses (ABRs) were recorded from 20 normal neonates and 10 normal-hearing adults. The spectral compositions of ABRs from both groups were compared. Results indicated that significant amounts of low-frequency information are concentrated below 150 Hz in both the neonate and the adult ABRs although the neonate ABR has a slightly greater percentage of low-frequency information than that of the adults. This has implications for filtering during ABR recording. A low high-pass setting which preserves more of the low-frequency information will allow enhanced detectability of wave V in neonate ABRs recorded at low stimulus intensities. Furthermore, our experience indicates that the use of a 30- to 3,000-Hz bandpass is feasible in the neonatal intensive care unit as well as in the regular newborn nursery. Therefore the use of a 30- to 3,000-Hz bandpass is recommended for neonate ABR recordings.     

Limulus amebocyte lysate test in neonates

The limulus amebocyte lysate test for endotoxin was done on samples of blood from 22 well babies and 33 neonates in an intensive-care nursery. The objective was to determine whether falsely positive test results occurred in samples from newborn infants during acquisition of usual bowel flora. One neonate had a transiently positive limulus amebocyte lysate test; he had clinical signs of spesis, but no bacteremia could be documented. Unlike the nitroblue tetrazolium test, the limulus amebocyte lysate test does not appear to be regularly positive in neonates. The sensitivity of the test in detection of endotoxemia associated with gram-negative spesis in the neonate remains to be determined in a large prospective study.     

Symmetric cutaneous necrosis of the hind feet and multicentric follicular lymphoma in a cat

A 7-year-old castrated male domestic shorthair cat was admitted to the veterinary teaching hospital for evaluation of symmetric necrosis of the skin of its hind feet and high liver enzyme activities. Lymphoma was diagnosed on cytologic examination of a fine needle aspirate of the liver. The owner declined treatment for the lymphoma. On postmortem histologic examination, lymphoma was found in the liver, stomach, and multiple lymph nodes. Immunohistochemical staining revealed the neoplasm to have a mixed B- and T-cell follicular arrangement, and a diagnosis of multicentric follicular lymphoma was made. The distal portion of the feet were necrotic, but a neoplastic infiltrate was not seen on histologic examination. After thrombosis and vasculitis were excluded as causes, the ischemic necrosis of the feet of the cat in this report was considered a paraneoplastic syndrome, as can be seen in people with lymphoma or other internal malignancies.     

Subcutaneous abdominal fat and thigh muscle composition predict insulin sensitivity independently of visceral fat

Whether visceral adipose tissue has a uniquely powerful association with insulin resistance or whether subcutaneous abdominal fat shares this link has generated controversy in the area of body composition and insulin sensitivity. An additional issue is the potential role of fat deposition within skeletal muscle and the relationship with insulin resistance. To address these matters, the current study was undertaken to measure body composition, aerobic fitness, and insulin sensitivity within a cohort of sedentary healthy men (n = 26) and women (n = 28). The subjects, who ranged from lean to obese (BMI 19.6-41.0 kg/m2), underwent dual energy X-ray absorptiometry (DEXA) to measure fat-free mass (FFM) and fat mass (FM), computed tomography to measure cross-sectional abdominal subcutaneous and visceral adipose tissue, and computed tomography (CT) of mid-thigh to measure muscle cross-sectional area, muscle attenuation, and subcutaneous fat. Insulin sensitivity was measured using the glucose clamp technique (40 mU.m-2.min-1), in conjunction with [3-3H]glucose isotope dilution. Maximal aerobic power (VO2max) was determined using an incremental cycling test. Insulin-stimulated glucose disposal (Rd) ranged from 3.03 to 16.83 mg.min-1.kg-1 FFM. Rd was negatively correlated with FM (r = -0.58), visceral fat (r = -0.52), subcutaneous abdominal fat (r = -0.61), and thigh fat (r = -0.38) and positively correlated with muscle attenuation (r = 0.48) and VO2max (r = 0.26, P < 0.05). In addition to manifesting the strongest simple correlation with insulin sensitivity, in stepwise multiple regression, subcutaneous abdominal fat retained significance after adjusting for visceral fat, while the converse was not found. Muscle attenuation contributed independent significance to multiple regression models of body composition and insulin sensitivity, and in analysis of obese subjects, muscle attenuation was the strongest single correlate of insulin resistance. In summary, as a component of central adiposity, subcutaneous abdominal fat has as strong an association with insulin resistance as visceral fat, and altered muscle composition, suggestive of increased fat content, is an important independent marker of insulin resistance in obesity.     

Posterior lumbar epidural fat as a functional structure? Histologic specificities

STUDY DESIGN: A topographic and histologic study was done to describe the location of the lumbar epidural fat and to find potential tissular specificities. OBJECTIVES: To search for possible histologic characteristics of posterior lumbar epidural fat, which so far has been described as semifluid tissue, and to determine whether posterior lumbar epidural fat is not a simple incidental tissue. SUMMARY OF BACKGROUND DATA: The lumbar epidural fat on two fetuses was studied. In adults, subcutaneous fat and posterior lumbar epidural fat were taken from seven corpses. The authors obtained 13 posterior lumbar epidural fat pads (two at L1-L2, three at L2-L3, six at L3-L4, and two at L4-L5) and four subcutaneous fat pads. METHODS: The authors studied abdominal axial histologic sections in two fetuses, histologic multiplanar sections in seven adults, and semithin sections in four adults of posterior lumbar epidural fat and subcutaneous fat. RESULTS: Fetal distribution of epidural fat was circumferential. Adult epidural fat distribution was limited to the posterior part of the vertebral canal and located at the disc level. Fascicles of connective tissue were less numerous and thinner in posterior lumbar epidural fat than in subcutaneous fat. Organized sliding spaces were found in the posterior epidural fat ped. CONCLUSIONS: Posterior lumbar epidural fat is not a simple incidental tissue and shows specific histologic features: sliding spaces and rarefaction of connective tissue that could explain semifluid features of the tissue. These characteristics suggest a functional role of posterior epidural fat in the lumbar spinal unit.     

Activated protein C resistance: What have we learned now that the dust has settled?

Adenovirus-induced liver necrosis is rare. Because the era of AIDS (acquired immunodeficiency syndrome) this entity was seen predominantly in infants suffering from inborn immunodeficiency syndromes or from iatrogenic immunosuppression because of bone marrow or liver transplantation. Here, we report a case of a 30-year-old woman with AIDS who developed fever and rapidly progressing liver failure. A frozen section from a needle biopsy of the liver allowed a quick diagnosis of viral liver necrosis. The light-microscopic and electron microscopic aspects were typical of adenovirus infection and should be known to the surgical pathologist. The diagnosis was confirmed by immunohistochemistry and DNA hybridization analysis.     

Gastrin concentration in plasma of the neonate at birth and after the first feeding

Plasma gastrin was determined simultaneously in 19 newborn infants and their respective mothers shortly after birth and in ten neonates before and after the first feeding. The gastrin concentrations in the umbilical vein plasma of the newborn infants were significantly higher than in the peripheral vein plasma of their mothers. The values were statistically not different from those obtained in the neonates before the first feeding. There was an increase in gastrin concentrations after the first feeding. From these results it is suggested that gastrin is produced in the neonate independently from the mother. It is already secreted after the first feeding. Experiments in rats showed that 125I-gastrin is not transported through the placenta. From these findings we assume that most likely the gastrin measured in plasma of newborn infants is of neonatal origin.     

Yeast infection of sperm, oocytes and embryos after intravaginal culture for embryo transfer

We report two patients treated with interferon-alpha who developed Raynaud's phenomenon followed by multiple digital necrosis. Arteriography of the legs revealed diffuse distal narrowing. Histological examination of the resected tissue showed ischaemic necrosis within the dermis and subcutaneous tissue without vasculitis. Resolution of the symptoms was observed when interferon-alpha was withdrawn. Since other causes of Raynaud's phenomenon and digital necrosis were ruled out, a drug cause is likely. Raynaud's phenomenon should be looked for in patients treated with interferon-alpha. If present, immediate withdrawal of the drug is required.