Vancomycin-related partial necrosis of congenital hemangioma

The term hemangioma refers to the common tumor of infancy that exhibits rapid postnatal growth and slow regression during childhood. Infantile hemangiomas are benign vascular neoplasms that develop from the dermal capillary network. Vancomycin is a bactericidal antibiotic agent commonly used in the treatment of infections caused by Gram-positive organisms. The most common adverse effect of intravenously administered vancomycin is “red man syndrome” (RMS), which is associated with the rapid infusion of large doses of vancomycin. This reaction is secondary to mast cell degranulation and is characterized by erythema, pruritus, flushing of the upper torso, and, in severe cases, angioedema and (rarely) cardiovascular complications. We present the case of a 3.5-month-old girl who developed partial hemangioma necrosis secondarily to RMS following intravenous administration of vancomycin for the treatment of Gram-positive bacteremia.Level of Evidence: Level V, prognostic / risk study.     

Interaction of obesity and atrial fibrillation: an overview of pathophysiology and clinical management

Introduction: Obesity, defined as a Body Mass Index (BMI) of ≥30 kg/m2, is the most common chronic metabolic disease worldwide and its prevalence has been strongly increasing. Obesity is associated with various diseases such as cardiovascular disease, type 2 diabetes, and hypertension. Regarding heart rhythm disorders, obesity is associated with an increase in atrial fibrillation (AF), the most common arrhythmia in clinical practice. AF is associated with increased cardiovascular morbidity and mortality. Obesity, a novel risk factor, is responsible for a 50%-increased incidence of AF.

Areas covered: We will briefly discuss the obesity paradox and its mechanisms regarding cardiac and hemodynamic function changes. In the first main part of this review, we will be discussing risk assessment studies, pathophysiology, genetic predisposition, epicardial adipose tissue, and ventricular adaptation in relation to obesity and development of AF. In the second part, we will discuss treatment strategies like conservative management and the effect of bariatric and metabolic surgery.

Expert opinion: Cardiac arrhythmias, in particular, AF, in patients with obesity comprise complex pathophysiological mechanisms that remain poorly understood. In recent literature, there has been increased interest in the role of epicardial adipose tissue and structural remodeling in obese hearts.     

The arterial anatomy of the eyelid: importance for reconstructive and aesthetic surgery.

PURPOSE: The aim of the study was to investigate the arterial distribution of the eyelids. METHODS: The location, course, length and diameter of eyelid arteries were determined in 19 preserved and latex injected adult male cadaver heads. RESULTS: The diameter of the medial palpebral artery was found to be 1.50+/-0.28mm on the right, and 0.70+/-0.12mm on the left. The diameter of the lateral palpebral artery was measured as 0.62+/-0.10mm on the right, and 0.59+/-0.12mm on the left. The medial palpebral arteries travelling in the medial part of the eyelids usually arose as separate branches for the upper and lower lids, as superior and inferior medial palpebrals. In all cases, four arterial arcades, the marginal, peripheral, superficial orbital, and the deep orbital arcades, were revealed in the upper palpebra. These arterial arcades gave off small perforating branches. The perforating branches were identified on both sides of the tarsal plate and the orbicularis muscle. In four cases (11%) visible arterial variation was found near the inferolateral end of the levator palpebrae. Although many differences in the arterial features of the eyelid have been noted, there may not be a significant difference in the basic vasculature of the palpebra among races. A better understanding of the palpebral vascularity should allow modification of reconstructive techniques and reduce postoperative complications after eyelid surgery.