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PubMed1972

Local 'Schwartzman equivalent' reaction in active chronic hepatitis.

The development of a purpura-fulminans-like disorder which is a human equivalent of a local Shwartzman reaction in a woman with active chronic hepatitis is described. The cyclical appearance of blue-black, well circumscribed, haemorrhagic, acutely painful lesions in the buttocks, over the lateral aspects of the thighs, and on the arms suggested the diagnosis. Evidence of increased intravascular coagulation was obtained although interpretation of clotting factor deficiencies in the presence of parenchymal liver disease was difficult. Treatment with heparin arrested the disorder on three separate occasions. The reasons for the development of the syndrome are not clear and even more surprising was the occurrence of such a disorder in the presence of increased fibrinolysis. While disseminated intravascular coagulation has been described in association with liver disease, the development of features of purpura fulminans in such patients does not appear to have been noted.

Adult↗

PubMed1973

Patterns of reflex excitability change after widespread cutaneous stimulation in man.

A single-shock stimulus to the skin of widespread and distant parts of the body such as the face, sites in the upper limb, trunk, buttock, and feet produced changes in amplitude of the ankle jerk. A regulated and stabilized system was used for eliciting the ankle jerk and for delivering an unvarying single-shock conditioning stimulus; 35 normal subjects were studied. The characteristics of the recovery curve of the monosynaptic reflex after stimulation at these cutaneous sites are described.

Back↗

PubMed1980

Ischaemic neuropathy of the lumbosacral plexus following intragluteal injection.

A lesion of the lumbo sacral plexus may result from an inadvertent intra-arterial injection of vasotoxic drugs into one of the gluteal arteries. Symptoms and follow-up of three cases are reported. The neuropathy is attributed to a toxic endarteritis with retrograde propagation of spasm and thrombosis. Swelling an bluish discoloration of the buttocks ("embolia cutis medicamentosa") as well as an impaired circulation in the homolateral leg are associated with the neurological syndrome in fully developed cases and makes possible a correct diagnosis.

Adult↗

PubMed1990

Antibody response after hepatitis B immunisation in a group of health care workers.

Hepatitis B immunisation has been offered to staff of Hampstead Health Authority since 1982 and is now offered to all staff with clinical contact. Three doses of 20 micrograms of vaccine are given at zero, one, and six months and the antibody response is measured three months later. Results were analysed to seek for associations with the antibody response. At the time of analysis, 2739 people had started vaccination and 1067 had completed the course and had a measurement of antibody response. Vaccine injections were initially into the buttock and later into the arm; measurement of antibody levels was initially by radioimmunoassay (RIA) and later by enzyme immunoassay (EIA). A positive antibody response was defined as a positive/negative ratio of greater than 10 for RIA or a level of greater than 10 mIU/ml for EIA. Associations between antibody response and other variables were tested by chi 2 and a multiple logistic regression analysis was undertaken to examine the effects of variables in combination. The overall antibody response rate was 95%. Men and women did not respond differently but there were significantly more positive responses with the EIA testing method and a tendency for more positive responses with arm injections. The responders were significantly younger than the non-responders and had significantly lower values of body mass index (wt/ht2).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1988

Cutaneous reaction to contrast material.

Two children are described who developed an apparent cutaneous contact reaction to contrast material in urine. Both children had undergone uneventful voiding cystourethrography with diatrizoate meglumine injection USP 18% followed by intravenous urography with diatrizoate meglumine injection USP 60%. Approximately 1 hour after urography cutaneous bullae and surrounding erythema of the buttocks (one case) or foreskin (one case) were noted. This reaction resembled a superficial chemical burn.

Buttocks↗

PubMed1998

Percutaneous drainage of fluid collections in the extremities.

PURPOSE: To analyze the results of percutaneous drainage of fluid collections in the extremities. MATERIALS AND METHODS: From 1990-1997, 28 patients aged 14-90 years underwent percutaneous drainage of 33 fluid collections in the extremities; two patients underwent multiple drainages. Fluid collections were in the hip-groin area (n = 16), thighs (n = 6), buttocks (n = 6), knees (n = 3), calf (n = 1), and axilla (n = 1). Three intraarticular collections were included. The patients who had undergone prior procedures were eight who had undergone surgical drainage, 10 who had undergone needle aspiration, and one who had undergone surgical débridement. The two most common guidance methods of catheter placement were ultrasound localization and fluoroscopy. RESULTS: The average drainage duration was 18.2 days (range, 1-93 days). The estimated cavity sizes were 4-733 cm3. Purulent fluid was drained in 13 patients. Staphylococcus aureus was the most commonly identified organism (n = 9). Nine patients had postoperative lymphoceles; five of these patients underwent sclerotherapy. Two (7%) patients had two complications, one of which was major. Failure occurred in four (16%) of 25 patients; two needed repeat drainage for recurrence, and two needed subsequent surgery. Success could not be determined in three patients who were lost to follow-up. CONCLUSION: Percutaneous drainage of fluid collections in the extremities is an effective alternative to open-incision drainage in inpatients and outpatients.

Adolescent↗

PubMed2000

Coincidence of multiple, disseminated, tardive-eruptive blue nevi with cutis marmorata teleangiectatica congenita.

A 71-year-old woman reported a slow progression of multiple bluish dark asymptomatic macules and papules on the pretibial region of both lower legs for over 30 years. At birth a left-sided hypoplasia of the leg including the buttock accompanied by a connatal vascular nevus had been diagnosed. The ipsilateral deep veins of the pelvis and leg had a normal anlage. Histopathological examination revealed multiple blue nevi of the common type. The association of multiple blue nevi and cutis marmorata teleangiectatica congenita with limb hypoplasia has not previously been reported and is discussed in this paper. One could speculate whether these symptoms represent a new syndrome, because by thorough examination the NAME syndrome could be ruled out.

Aged↗

PubMed2003

Prevention of Candida colonization prevents infection in a neonatal unit.

This study represents a 1-year surveillance period using our epidemiology-based principles published and successfully followed since 1979: weekly culture for yeasts of oral and anal swabs, treatment with oral nystatin of all colonized newborns, and good hygiene/handwashing. Colonization was demonstrated in 23 out of 791 newborns admitted from October 1998 to September 1999. Twenty-two strains of Candida were identified: 16 C. albicans, 2 C. parapsilosis, 3 C. glabrata, and 1 C. tropicalis. Symptoms were erythema of the buttocks in 6 colonized newborns. No other culture positive for Candida could be found. Previous contamination was the main source (previous stay in an intensive care unit, rarely maternal origin). Contamination in the unit was unlikely. Eradication of Candida could be observed within 1 week. These good results, controversial in the literature, were obtained following epidemiological conclusions and support our guidelines.

Buttocks↗

PubMed2006

Body contouring following massive weight loss resulting from bariatric surgery.

A sharp increase in bariatric surgery has resulted in spike in the population of patients seeking body-contouring procedures. Skin and soft tissue redundancy of the trunk, buttocks, breasts, upper arms, and thighs following massive weight loss is unsightly and results in medical problems such as musculoskeletal strain from increased tissue weight, intertrigo or functional limitation with walking, maintaining adequate hygiene, bowel and bladder habits and sexual activity. These elements compound the inherent psychosocial issues related to massive weight loss. Using time-tested plastic surgical techniques, several operations have been designed and perfected to address the needs of these patients. These include breast, thigh and lower body lift, abdominoplasty, face and neck lifts as well as brachioplasty or arm lift. Recognizing that there is a qualitative as well as a quantitative difference in the type and amount of tissues in postbariatric patients these techniques have been suitably refined to optimize outcomes and provide safe and durable re-contouring. Consequently, bariatric surgery and the subsequent weight loss require an additional 2-3 years commitment towards body contouring procedures. Restoring their body image through reshaping procedures is an integral part of completing the treatment of post-weight-loss patients. Strategic skills in terms of assessment of each patient, careful planning, timing, especially for patient safety and technique are fundamental for the success of these often complex and extensive procedures.

Bariatric Surgery↗

PubMed2006

Sodium thiosulphate as a promising therapeutic option to treat calciphylaxis.

A 35-year-old haemodialysis-dependent woman with chronic renal failure developed large, very painful necrotic ulcers and necrosis on the thighs, buttocks and the abdomen with signs of fast progression. The skin biopsy specimens showed a broad necrosis of the epidermis and thrombosed dermal vessels with focal calcium deposits within the wall. In addition, laboratory findings presented an increased product of serum calcium and phosphate concentrations. Thus, we diagnosed calciphylaxis on the basis of clinical, biochemical and histopathological criteria. We initiated a therapy in which our patient was treated with intravenous sodium thiosulphate 3 times weekly. Already after 2 weeks of treatment, no new lesions were detectable and there was a dramatic pain relief. In the following 4 weeks, a successive decline of the ulcers and the healing of individual tissue defects could be seen. Four months after the start of the therapy, the patient underwent successful renal transplantation. Thus, the intravenous therapy of calciphylaxis with sodium thiosulphate might be a new effective alternative in the treatment of this life-threatening disease.

Abdomen↗

PubMed1997

Symmetric lipomatoses in female patients.

BACKGROUND: Symmetric lipomatoses are characterized by marked symmetric deposition of diffusely distributed fatty tissue. Though relatively common disorders, they are rather rarely reported in the literature, possibly being misdiagnosed as general obesity. While the differential diagnosis of symmetric lipomatosis versus general obesity may not appear difficult in males, it is obviously problematic in females. OBSERVATIONS: We describe the findings in 6 representative female patients with symmetric lipomatoses: 3 with benign (multiple) symmetric lipomatosis and 3 with female zonal obesity. The former disorder was characterized by massive, firm, symmetric fat deposition predominantly around the neck and shoulder girdle and was clearly associated with alcohol abuse and/or liver disease. There were no malignant tumors of the upper airways. In the latter case, fatty tissue had accumulated mainly at the buttocks and thighs but characteristically spared the feet and hands. Tenderness was a common symptom. This disorder showed familial predisposition. Histology in both cases revealed normal fatty tissue which was neither encapsulated nor septally divided. CONCLUSIONS: We suggest that the term 'symmetric lipomatoses' refers to two separate disorders, benign (multiple) symmetric lipomatosis and female zonal obesity.

Adipose Tissue↗

PubMed1997

Erythema induction by ultraviolet radiation points to a possible acquired defense mechanism in chronically sun-exposed human skin.

BACKGROUND: It is generally accepted that a UVA-induced erythema is difficult to detect except in the most sensitive individuals. OBJECTIVE AND METHODS: As UVA effects on human skin and skin cells have been shown to depend strongly on anatomical body sites, UVA I, UVA I + II and solar simulator radiations were compared in their ability to induce erythema and melanin pigmentation responses in individuals with skin types I-IV on both previously sun-exposed (arms, forearms, thighs) and nonexposed body sites (buttocks). RESULTS: Erythema induction by UVA I on previously nonexposed skin sites followed a dose response in all skin types which was contrary to the absence of erythema induction seen on previously sun-exposed sites. Melanin expression followed a dose and skin type response and was shown to be more enhanced in previously exposed skin and in skin types III and IV. In contrast, UVA I + II induced erythema on nonexposed skin areas and to a lesser extent on frequently sun-exposed skin. Melanin production by UVA I + II was similar to that seen with UVA I alone in individuals of skin types II and III. Solar simulator radiation was very efficient in erythema induction regardless of previous sun exposure of skin. CONCLUSIONS: We have found that contrary to the widespread opinion that UVA and in particular UVA I could not induce a significant erythema, this waveband is capable of measurable erythema induction on skin nonexposed to sunlight. The diminished erythema induction by UVA I on chronically sun-exposed skin suggests the possibility of a defense mechanism against UVA-induced damage in this tissue.

Adult↗

PubMed1996

Sacral medial telangiectatic vascular nevus: a study of 43 children.

BACKGROUND: Medial telangiectatic vascular nevi are capillary vascular malformations frequently observed at birth occurring mostly on the face or on the nape as a single lesion or as multiple macules affecting more than one site simultaneously. In 1990, Metzker and Shamir reported a medial telangiectatic vascular nevus (MTVN) in the sacral region along the midline and called this particular variety of MTVN 'butterfly-shaped mark'. OBJECTIVE: Our study was performed to investigate the morphology and localization of an MTVN in the sacral region (sMTVN) in a group of Caucasian children. METHODS: We observed 43 children with sMTVN, ranging in age from 1 month to 12 years (mean 8 years), for a period of 6 years. RESULTS: sMTVN was found as a red-violet macular lesion of rhomboid or triangular shape in 16 patients and as a group of little red-violet macules in 10 patients. In 16 patients moreover the whole back was involved with many small red-violet spots on and around the spinal column, and in 1 patient with classic sMTVN satellite macules were also present over both buttocks. Four patients suffered from epilepsy with mental deficiency. In 6 patients, the family history showed sMTVN in one or more members of the family. No case presented an association with spina bifida. CONCLUSION: In our study, sMTVN shows a morphological polymorphism while Metzker and Shamir reported the same clinical aspect in all 25 of their patients. In accordance with these authors, we noted that sMTVN persist into childhood and adult life in the same way as occipital MTVN.

Buttocks↗

PubMed1995

Primary cutaneous CD30(Ki-1)-positive lymphoma of non-T, non-B origin.

A 71-year-old Japanese woman had two dome-shaped tumors on her right buttock with several surrounding papules. Histological examination revealed that large anaplastic cells and atypical lymphoid cells densely infiltrated the entire dermis. On immunohistochemical examination, Ki-1, HLA-DR, CD25 (IL-2 receptor alpha), CD122 (IL-2 receptor beta), CD4, CD11c and CD68 were all positive in the tumor cells, whereas CD1a, CD3, CD5, CD8 and CD19 were negative. Neither rearrangement of the T-cell receptor beta, T-cell receptor gamma nor the immunoglobulin heavy-chain was seen. Ultrastructurally, most of the tumor cells contained thick bundles of intermediate filaments in the perinuclear cytoplasm. Thus, this patient was diagnosed as having Ki-1-positive lymphoma of non-T, non-B origin. No recurrence or metastasis of the tumor has been observed in the last 2 years, although surgical resection was required 3 times before control was achieved.

Aged↗

PubMed1992

Primitive neuroectodermal tumor arising in the skin. Differentiation from neuroendocrine carcinoma of the skin.

We report a 25-year-old male patient with primitive neuroectodermal tumor presenting as a subcutaneous tumor on the right buttock, which was initially diagnosed as neuroendocrine carcinoma of the skin. Subsequently, local recurrence and metastatic spread to the lung occurred. The tumor was resistant to highly aggressive chemotherapy. The patient died 6 months later with severe pulmonary and lymph node involvement.

Adult↗

PubMed1991

Eccrine porocarcinoma.

We describe a 78-year-old woman with eccrine porocarcinoma presenting a zosteriform appearance on the lateral upper part of the buttock. Erosion and bleeding were observed in the center of a 50 X 80 mm, erythematous indurated plaque with an elevated border. Posterior to the plaque, there was another erosive plaque, 50 X 20 mm in diameter, with peripheral induration overlaid by two reddish papules. Based on the previous reports of 21 patients with eccrine porocarcinoma in Japan, we discuss the relationship between the clinical pattern and lymph node metastasis. The pedunculated eccrine porocarcinoma has less tendency to metastasize to the regional lymph nodes than the nonpedunculated form.

Adenoma, Sweat Gland↗

PubMedDate not supplied

Fine needle aspiration cytology of the malignant variant of ossifying fibromyxoid tumor of soft parts: a case report.

BACKGROUND: Ossifying fibromyxoid tumor (OFMT) of soft parts is a rare, recently defined, fibroosseous neoplasm, generally regarded as clinically benign; however, one-third of cases recur locally, and several malignant examples have been reported. Fine needle aspiration (FNA) cytology of the tumor is rarely described in the literature. We provide the first cytomorphologic study of the malignant variant. CASE: A 70-year-old man presented with an intramuscular mass in the right buttock. Computed tomography revealed ossification within the mass and multiple pulmonary nodules. FNA biopsy showed round and polygonal to spindled tumor cells, arrayed singly, cordlike or in small aggregates, with scattered dense stromal fragments and a slightly myxoid background. The nuclei showed significant pleomorphism accompanied by coarse chromatin with clumping, irregular contours, and one to two distinct nucleoli. The tumor cells were recognizable as sarcoma, with no evidence of high grade malignancy. The tumor was totally excised, histopathologically confirmed as the malignant variant of OFMT of soft parts, and immunohistochemically and ultrastracturally analyzed as of neural origin. CONCLUSION: The FNA specimen revealed that the cytomorphology was consistent with the histologic features of the malignant variant of OFMT, but several characteristic histologic parameters, such as multilobular proliferation and peripherally placed mature, bony trabeculae, were not reflected in the aspirates. Although FNA cytologic findings may be of limited diagnostic utility in OFMT, radiographic evidence of calcification/ossification suggests that OFMT should be subjected to differential diagnosis with fine needle aspiration biopsy of soft tissue tumors. Additional studies will be required for further clarification.

Aged↗

PubMed1984

Lipedema--the non-lymphatic masquerader.

Two cases of lipedema are presented. They illustrate this clinical syndrome which occurs almost exclusively in women and presents as grossly enlarged legs, thighs and buttocks. The etiology remains uncertain. Although infrequently diagnosed, lipedema is not rare. We report success treating such patients with properly measured and fitted compression garments.

Adipose Tissue↗