Archives

  • 2018-07
  • 2018-10
  • 2018-11
  • 2019-04
  • 2019-05
  • 2019-06
  • 2019-07
  • 2019-08
  • 2019-09
  • 2019-10
  • 2019-11
  • 2019-12
  • 2020-01
  • 2020-02
  • 2020-03
  • 2020-04
  • 2020-05
  • 2020-06
  • 2020-07
  • 2020-08
  • 2020-09
  • 2020-10
  • 2020-11
  • 2020-12
  • 2021-01
  • 2021-02
  • 2021-03
  • 2021-04
  • 2021-05
  • 2021-06
  • 2021-07
  • 2021-08
  • 2021-09
  • 2021-10
  • 2021-11
  • 2021-12
  • 2022-01
  • 2022-02
  • 2022-03
  • 2022-04
  • 2022-05
  • 2022-06
  • 2022-07
  • 2022-08
  • 2022-09
  • 2022-10
  • 2022-11
  • 2022-12
  • 2023-01
  • 2023-02
  • 2023-03
  • 2023-04
  • 2023-05
  • 2023-06
  • 2023-07
  • 2023-08
  • 2023-09
  • 2023-10
  • 2023-11
  • 2023-12
  • 2024-01
  • 2024-02
  • 2024-03
  • Here we report on a patient with LPE who underwent

    2018-10-22

    Here we report on a patient with LPE who underwent a staged fat grafting procedure with a 35% loss of transferred fat after 12 months. Fat grafting to treat three-dimensional defects of lipoatrophy has the following advantages: a simple surgical procedure, shorter convalescence period, readily available source, and potentially long-lasting effect. However, a study including 10 participants reported a 50% loss of transferred fat within 3 months of the procedure, with an additional 6% loss noted between 3 months and 6 months after the procedure; no fat loss was reported thereafter. Therefore, a staged fat grafting procedure may be required to achieve the target volume. Complications of fat grafting, such as infection, bruising, and hematoma or seroma formation, are rare. Similarly, the risk of fat embolism is believed to be low, and the incidence of fat embolism for large abdominal liposuctions is estimated to be 1.3 per 100,000 population. Liposuction with tumescent anesthesia and fat reinjection are generally regarded as safe. However, Gleeson et al described a patient with LEP who died as a result of fulminant fat tissue embolism after the grafting of a small volume (35 mL) of autologous fat for facial lipoatrophy. It appears that in cases with substantial lipoatrophy and subcutaneous scarring because of LEP, fat injection into the surrounding fibrotic tissue can facilitate the entry of fat into the venous circulation. Furthermore, because LEP is an inflammatory disease, the risk of inflammatory reaction is higher when fat and vascular endothelium come in contact. Whether fat grafting for patients with LEP is related to a higher risk of fat embolism syndrome requires in-depth study. Although fat embolism is a rare complication of the fat grafting technique, it is the most severe and lethal. To avoid fat embolism syndrome, using a large, blunt cannula rather than a small, sharp cannula can prevent the perforation of the vascular wall, thus avoiding entry of fat into the venous circulation. Epinephrine at the injection site induces vasoconstriction, thus making it more difficult to cannulate the vessel. In addition, the surgeon should ensure that only minimal force is exerted. Aspiration should be performed before fat is injected to avoid contact with osthole and arteries. Treatment for sequelae of panniculitis, including surgical techniques and filler injections, remains controversial in the active inflammatory phase of the disease because trauma itself may be an inciting factor; the lesions have a chronic, remitting course that can be exacerbated by trauma. Corrective techniques may be considered for stable, noninflammatory atrophic plaques. However, controlling the disease before initiation of such treatments is crucial.
    Introduction Bizarre parosteal osteochondromatous proliferation (BPOP) is an uncommon benign tumor that usually presents as a bony swelling on the surface of a bone. It has a notably high rate of local recurrence (20–55%), marked proliferative activity, and an atypical histological appearance. BPOP is also called “Nora\'s lesion,” which was named after the pathologist who first discovered it at the Mayo Clinic in 1983. Nora et al reported 35 lesions found on a 50-year-old male patient, all involving the small bones of the hands and feet. In 1993, Meneses et al reported 65 cases of BPOP involving various sites, such as the hands, feet, long bones, and skull bones.
    Case report A 64-year-old man presented with a 10-year osthole history of an irregular mass, measuring approximately 3 cm in diameter, on the dorsal aspect of the right index finger (Figure 1). He claimed to have no history of trauma. On examination, the mass was hard, indolent, and located at the level of the proximal phalanx. Movement of the interphalangeal joint was mildly restricted. Results of neurovascular examination were unremarkable, and all laboratory investigations were within normal limits. Roentgenograms revealed a soft tissue mass with faint calcification over the right index finger base, and the adjacent proximal phalanx displayed irregular erosion of the periosteum (Figure 2). Through magnetic resonance imaging, a few well-defined lobulated tumors were noted over the medial and lateral aspects of the proximal interphalangeal joint of the right index finger, along with bony erosion and periosteal reaction. The largest of these tumors was approximately 3 × 2 × 2 cm3. The tumors appeared isointense to muscle on T1-weighted images (Figure 3A) and heterogeneously hyperintense on T2-weighted images. They exhibited heterogeneous contrast enhancement with gadolinium injection (Figure 3B).