Breast fat necrosis secondary to warfarin-induced calciphylaxis,a rare mimicker of breast cancer: A case report and a review of literature

Breast fat necrosis (BFN) is usually a benign inflammatory response to breast trauma. However, an extremely rare cause of fat necrosis is calciphylaxis, a calcification of small- and medium-sized arteries causing thrombosis and ischemia. It is classified into (A) uremic (B) nonuremic-induced calciphylaxis. Calciphylaxis has been reported to be encountered in different parts of the body. However, to the best of our knowledge there is only one case in the English literature of BFN 2ry to warfarin-induced calciphylaxis. We report a 65-year-old female, known case of atrial fibrillation on warfarin, presented with a left breast mass of 4-month duration. The mass was painful and progressively enlarging. Examination of the left breast showed 7 × 4 cm mass, spanning from 10-2 o'clock, free from surrounding structures, with preserved overlying skin. However, the mass was not visualized on mammogram. Ultrasound showed a left breast lobulated hypoechoic mass containing a hyperechoic component. Biopsy showed fat necrosis. After 1 month, she presented with ulceration of the overlying skin. After wide local excision, histopathology demonstrated a calciphylaxis-induced fat necrosis. Considering the patient's background, the diagnosis was BFN secondary to warfarin-induced calciphylaxis. Hence, the warfarin was shifted to Rivaroxaban, 6 months follow-up showed no evidence of recurrence. In conclusion, the rarity of nonuremic calciphylaxis is reflected on the delay of diagnosis in some of the reported cases and the lack of grading system used to guide the management of such difficult wounds. However, keeping a high index of suspicion is important whenever such wounds are encountered with presence of risk factors other than end-stage kidney disease.     

Visceral fat is associated with high-grade complications in patients undergoing minimally invasive partial nephrectomy for small renal masses

Introduction:Minimally invasive partial nephrectomy is standard of care treatment for small renal masses.Objective:We evaluated the relationship between subcutaneous and visceral obesity with high-grade postoperative 30-day complications in patients undergoing minimally invasive partial nephrectomy.Methods:We retrospectively identified 98 patients at our institution from 2014 to 2017 who underwent laparoscopic or robotic-assisted partial nephrectomy due to suspected renal cell carcinoma. Patients were stratified based on presence or absence of high-grade (Clavien ≥ IIIa) 30-day postoperative complications. Means were compared with the independent t test and proportions with chi-square analysis. Multivariate logistic regression was performed to determine independent predictors of high-grade 30-day complications.Results:Mean nephrometry score was 6.7 with 21 (21.4%) patients having hilar tumors. Mean estimation of blood loss was 207 mL, mean operating time was 223 min, and mean warm ischemia time was 23 min. The majority of patients had clear renal cell carcinoma (n = 83, 84.7%) and pT1a disease (n = 76, 77.6%) with negative margins (n = 89, 90.8%) on pathology. There were 5 (5.1%) patients who experienced a high-grade postoperative 30-day complication. Mean visceral fat index was an independent predictor of high-grade 30-day complications (odds ratio: 1.02; 95% confidence interval: 1.002–1.03; p = 0.027).Conclusions:Visceral obesity should be considered as a prognostic indicator of outcomes in patients undergoing surgical treatment for a small renal mass.     

Nonpancreatic Pancreatic Panniculitis: An Incidental Finding in Individuals without Pancreatic Disease? A Case Series and Review of the Literature

Pancreatic panniculitis occurs in up to three percent of all patients with pancreatic disease. This cutaneous eruption, as implied by the name, is almost exclusively encountered in the context of pancreatic disorders, such as pancreatitis or pancreatic carcinoma. We report three cases in which histopathologic examination demonstrated hallmarks of pancreatic panniculitis occurring in patients without any history or evidence of pancreatic disorder. These nonpancreatic pancreatic panniculitis eruptions might be underreported in the literature.     

Progress of laser and light treatments for lower eyelid rejuvenation

Laser and light treatments have recently become popular owing to its efficacy in treating laxity, rhytids, hyperpigmentation of the lower eyelids, and drooping of septum fat. For several decades, our department has explored the application of laser and light treatment for eye rejuvenation. This paper summarizes common treatment methods and analyzes the published literature on the indications and outcomes of multiple laser and light treatments for lower eyelid rejuvenation. An extensive survey of peer-reviewed literature was performed using PubMed, with the search terms “noninvasive treatment”, “infraorbital”, “palpebral bags”, “lower eyelid”, “radiofrequency (RF)”, “laser”, “nonsurgical skin tightening”, and “noninvasive fat reduction”. The results showed that the use of lasers, intense pulsed light (IPL), monopolar RF, bipolar RF, AdipoLASER rejuvenation (ALJ), and fractional RF microneedling are safe and effective treatments for palpebral bags. We conclude that using Q-switched lasers, IPL, RF, ALJ, and fractional RF microneedling is safe and effective for lower eyelid rejuvenation, with minimal complications and quick recovery. Further research and development of optoelectronic therapy may encourage breakthroughs in lower eyelid treatment, such as simplified complex surgery and noninvasive methods.     

Validation of the Mayo Adhesive Probability score as a predictor of adherent perinephric fat and outcomes in open partial nephrectomy

BackgroundAdherent perinephric fat (APF) contributes to surgical complexity and can be associated with adverse perioperative outcomes for partial nephrectomy (PN). The Mayo Adhesive Probability (MAP) score accurately predicts the presence of APF during robotic-assisted partial nephrectomy (RAPN). Our primary aim is to validate MAP score as a predictor of APF in open partial nephrectomy (OPNx).MethodsWe reviewed 105 consecutive OPNx (100 patients) performed by a single surgeon with intraoperative determination of APF. We evaluated the ability of the MAP score to discriminate between those with APF and those without APF by estimating the area under the receiver operating characteristic curve (AUROCC). The association of perioperative outcomes with APF was evaluated as well.ResultsForty-three patients [49%; 95% confidence interval (CI), 39–59%] had intraoperative identification of APF. The MAP score had excellent ability to predict APF in OPNx (AUROCC, 0.82; 95% CI, 0.74–0.92). APF was observed in 6% of patients with a MAP score of 0-1, 27% with score 2, 52% with score 3, 75% with score 4, and 90% with score 5. The presence of APF was associated with longer operative times (P=0.004) and higher estimated blood loss (EBL) (P=0.003). Although not statistically significant, our study did suggest that APF may be associated with postoperative complications and prolonged length of stay (LOS) (>3 days).ConclusionsMAP score accurately predicts the presence of APF in patients undergoing OPNx. APF is associated with longer operative time and higher blood loss in OPNx.     

儿童青少年身体脂肪分布与维生素D营养状况的关联研究

目的探讨儿童身体脂肪分布与维生素D营养状况的关系。方法研究对象来自“儿童青少年心血管与骨健康促进项目”2017年北京基线调查。采用多重线性回归和无序多分类logistic回归分析BMI、全身体脂肪质量指数(FMI)、躯干脂肪质量指数(TFMI)、四肢脂肪质量指数(AFMI)和内脏脂肪面积(VFA)与维生素D水平及营养状况的关系。结果共纳入11960名儿童[年龄(11.0±3.3)岁,男童占49.7%]进行分析,血清25(OH)D水平为(35.0±11.9)nmol/L,维生素D缺乏率为37.2%。BMI、FMI、TFMI和AFMI与维生素D的关联性具有性别差异(交互P<0.05),在男童中呈负相关(BMI:β=-0.56;FMI:β=-0.59;TFMI:β=-0.60;AFMI:β=-0.59;均P<0.05),在女童中关联无统计学意义(均P>0.05)。VFA与维生素D缺乏和不足风险在男女童中均呈正相关,VFA每增加1个标准差,维生素D缺乏和不足的患病风险均增加17%(95%CI:9%~25%)。结论儿童内脏脂肪水平越高维生素D水平越低,腹型肥胖儿童和体脂肪过多的男童是维生素D缺乏防控的重点人群。