The Institute for Safe Medication Practices and the American Society of Health-System Pharmacists have advocated for removing all injectable promethazine from inpatient and outpatient settings; however, this drug is still being used despite the risk for tissue necrosis, gangrene, and possible amputation when it inadvertently is given by the subcutaneous or intra-arterial route. This article describes alternative injectable medications that can be selected based on patient comorbidities, indications, and clinician experience.

• MeSH
• Injections, Subcutaneous MeSH
• Injections MeSH
• Humans MeSH
• Promethazine * administration & dosage   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

Syphilis, known as "the great mimicker," is caused by the spirochete Treponema pallidum and is characterized by a diverse array of clinical and histopathologic presentations. In secondary cutaneous syphilis, the most consistent morphological features include a superficial and deep perivascular infiltrate containing plasma cells, varying degrees of endothelial swelling, irregular acanthosis, elongation of rete ridges, a vacuolated pattern, and the presence of plasma cells. Although serologic tests are essential for definitive diagnosis, spirochetes can sometimes be directly identified in silver-stained tissue slides or through immunohistochemistry. Granuloma annulare is a relatively common, benign, self-limiting condition with 3 main variants: conventional, subcutaneous, and interstitial, each with distinct characteristics. In this study, we report 2 cases of cutaneous secondary syphilis with a striking granulomatous reaction pattern that closely mimics the interstitial variant of granuloma annulare. Owing to the severity of the tertiary stage of syphilis, distinguishing between these 2 entities is crucial.

• MeSH
• Granuloma Annulare * pathology   diagnosis   microbiology   MeSH
• Diagnosis, Differential MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Syphilis, Cutaneous pathology   diagnosis   microbiology   MeSH
• Syphilis * diagnosis   pathology   microbiology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

Úvod: Lipómy patria k najčastejším nádorom mäkkých tkanív. Ak dosahujú aspoň 10 cm alebo vážia min. 1 000 g, označujú sa ako „obrovské“ lipómy. Takéto lézie môžu vyvolávať diagnostické rozpaky pri bioptickom vyšetrení. Kazuistika: Opísaný je prípad 58-ročného muža, ktorý pozoroval 2 roky nárast podkožného tumorózneho útvaru na pravej strane chrbta. Ultrasonograficky imponoval ako fibrolipóm. Chirurgicky bol kompletne exstirpovaný. Makroskopicky išlo o opuzdrený laločnatý lipomatózny nádor rozmerov 12 × 10 × 4 cm. Histologicky pozostával z kompozitného klasického a vretenobunkového lipómu. Vretenobunkovú zložku bolo potrebné odlíšiť od atypického lipomatózneho tumoru, ktorý je prognosticky nepriaznivejšou onkologickou jednotkou. Záver: Subkutánne lipómy presahujúce 10 cm sú zriedkavé a pre klinikov aj patológov predstavujú diagnostickú výzvu. V príspevku sme sa snažili poukázať, že lipomatózne nádory väčších rozmerov a najmä s rôznorodejším morfologickým vzhľadom by mali patológa nútiť uvažovať o potenciálnej malignite a vyžadujú si komplexnejší diferenciálno-diagnostický prístup.

Introduction: Lipomas belong to the most common soft tissue tumors. If they reach at least 10 cm or weigh at least 1,000 g, they are referred to as giant lipomas. Such lesions can cause diagnostic quandaries at a biopsy examination. Case report: The article describes a 58-year-old man who observed the progression of a subcutaneous tumor mass in the right side of the back for two years. It looked like a fibrolipoma on an ultrasound. Complete surgical extirpation was performed. Grossly, it was an encapsulated lobulated lipomatous tumor measuring 12 × 10 × 4 cm. It consisted of a composite classical and spindle cell lipoma. The spindle cell component required differentiation from an atypical lipomatous tumor, which is an oncological entity with a worse prognosis. Conclusion: Subcutaneous lipomas over 10 cm are rare and represent a diagnostic challenge for both clinicians and pathologists. We tried to point out that lipomatous tumors of larger dimensions and especially those with a heterogeneous morphological appearance should urge the pathologist to think about a potential malignancy and require more complex differential-diagnostic approach.

BACKGROUND: Polymorphisms in thiopurine methyltransferase (TPMT) are a predominant cause of azathioprine-induced leucopenia in Western countries. The exact role of these polymorphisms in the Indian population with dermatological disorders is uncertain. OBJECTIVES: To evaluate the frequency of genetic polymorphism of TPMT and its impact on the safety of azathioprine in dermatological disorders. METHODS: We included consecutive patients on azathioprine who were initiated for dermatological disorders from South India. Three TPMT polymorphisms (c.238G>C, c.460G>A and c.719A>G) were assessed. The proportions of adverse events to azathioprine, especially myelosuppression, were compared between those with the wildtype genotype and those with TPMT polymorphisms. RESULTS: Of the 123 patients (61 male and 62 female, mean age 46 years), 65% had an autoimmune blistering disorder. Adverse events to azathioprine were noted in 25 (20.3%), of whom 16 (13.0%) had myelosuppression and 4 (3.2%) each had hepatotoxicity and gastrointestinal intolerance. TPMT polymorphisms were detected in 13 (10.6%), of whom 5 had experienced adverse events. The polymorphisms could explain 25% (4 of 16) of the cases of leucopenia. The odds of developing leucopenia in patients with TPMT polymorphism were not significant (odds ratio 3.63, 95% confidence interval 0.96-13.6; P = 0.06). CONCLUSIONS: The tested TPMT polymorphisms could not predict the adverse events of azathioprine, particularly the haematological toxicity, in dermatological use among the South Indian population.

• MeSH
• Azathioprine * adverse effects   therapeutic use   MeSH
• Adult MeSH
• Genotype MeSH
• Immunosuppressive Agents * adverse effects   therapeutic use   MeSH
• Clinical Relevance MeSH
• Skin Diseases * drug therapy   genetics   MeSH
• Leukopenia chemically induced   genetics   MeSH
• Middle Aged MeSH
• Humans MeSH
• Methyltransferases * genetics   MeSH
• Adolescent MeSH
• Young Adult MeSH
• Polymorphism, Genetic MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• India MeSH

Angioedémy jsou přechodné lokalizované otoky podkoží a sliznic, způsobené dočasně zvýšenou cévní permeabilitou. Při ošetření a další péči o pacienta s touto diagnózou je nutné především odlišit, zda se jedná o otoky vyvolané mediátory žírných buněk nebo způsobené bradykininem. V prvním případě zpravidla uspějeme s použitím antihistaminik a kortikosteroidů, ve druhém případě je nutné volit léčbu, která specificky ovlivňuje kaskádu kalikrein-kininy.

Angioedemas are transient localized swellings of the subcutaneous tissue and mucous membranes caused by temporarily increased vascular permeability. When treating and providing further care for a patient with this diagnosis, it is crucial to distinguish whether the swellings are triggered by mast cell mediators or caused by bradykinin. In the first case, treatment with antihistamines and corticosteroids is usually successful, while in the second case, specific treatment that specifically affects the kallikrein-kinin cascade is required.

• MeSH
• Angioedema * diagnosis   etiology   classification   therapy   MeSH
• Histamine Antagonists therapeutic use   MeSH
• Bradykinin MeSH
• Histamine MeSH
• Humans MeSH
• Disease Management MeSH
• Mast Cells MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Transcatheter Aortic Valve Implantation (TAVI) has revolutionized severe aortic stenosis treatment, but risk stratification remains challenging. This systematic review examined the association between computed tomography (CT)-derived adipose tissue parameters and TAVI outcomes. We searched major databases for studies on visceral (VAT), subcutaneous (SAT), and intramuscular (IMAT) adipose tissue parameters and post-TAVI outcomes. Fourteen studies (9692 patients) were included. Higher SAT area/volume was consistently associated with better survival (5 studies, HR range: 0.83-2.77, p < 0.05). Lower SAT and VAT density also correlated with better survival (5 and 4 studies, respectively, HR range: 1.31-1.46, p < 0.05). VAT area showed mixed results. A VAT:SAT ratio < 1 was associated with better cardiovascular outcomes in one study. Lower IMAT index correlated with shorter hospital stays in a single study. This review reveals complex relationships between adipose tissue parameters and TAVI outcomes. Lower adipose tissue density and higher subcutaneous adiposity were most consistently associated with better outcomes. These findings suggest that detailed analysis of adipose tissue characteristics may enhance risk stratification in TAVI candidates.

• MeSH
• Aortic Valve Stenosis * surgery   mortality   diagnostic imaging   MeSH
• Humans MeSH
• Tomography, X-Ray Computed * methods   MeSH
• Postoperative Complications * etiology   mortality   MeSH
• Transcatheter Aortic Valve Replacement * adverse effects   mortality   MeSH
• Adipose Tissue * diagnostic imaging   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Systematic Review MeSH

An increasing number of studies have characterized the bone as an endocrine organ, and that bone secreted factors may not only regulate local bone remodeling, but also other tissues and whole-body metabolic functions. The precise nature of these regulatory factors and their roles at bridging the bone, bone marrow adipose tissue, extramedullary body fat and whole-body energy homeostasis are being explored. In this study, we report that KIAA1199, a secreted factor produced from bone and bone marrow, previously described as an inhibitor of bone formation, also plays a role at promoting adipogenesis. KIAA1199-deficient mice exhibit reduced bone marrow adipose tissue, subcutaneous and visceral fat tissue mass, blood cholesterol, triglycerides, free fatty acids and glycerol, as well as improved insulin sensitivity in skeletal muscle, liver and fat. Moreover, these mice are protected from the detrimental effects of high-fat diet feeding, with decreased obesity, lower blood glucose and glucose tolerance, as well as decreased adipose tissue inflammation, insulin resistance and hepatic steatosis. In human studies, plasma levels of KIAA1199 or its expression levels in adipose tissue are positively correlated with insulin resistance and blood levels of cholesterol, triglycerides, free fatty acids, glycerol, fasting glucose and HOMA-IR. Mechanistically, KIAA1199 mediates its effects on adipogenesis through modulating osteopontin-integrin and AKT / ERK signaling. These findings provide evidence for the role of bone secreted factors on coupling bone, fat and whole-body energy homeostasis.

• MeSH
• Adipogenesis * physiology   MeSH
• Diet, High-Fat MeSH
• Energy Metabolism * MeSH
• Hyaluronoglucosaminidase MeSH
• Insulin Resistance MeSH
• Humans MeSH
• Mice, Inbred C57BL MeSH
• Mice MeSH
• Obesity metabolism   MeSH
• Proteins * metabolism   MeSH
• Adipose Tissue metabolism   MeSH
• Animals MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Mice MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH

The global rise in obesity has emerged as a significant health concern, amplifying susceptibility to various diseases, including asthma. Epidemiological evidence demonstrates a higher prevalence of asthma among obese individuals, with obesity exacerbating asthma severity and control. This review aims to explore the interplay between asthma and obesity assessed by objective imaging methods and discusses the consistency between anthropometric and imaging methods. A literature search was conducted with the main keywords "asthma", "obesity", and "imaging techniques" using databases such as PubMed, Web of Sciences, and Scopus for the relevant articles published up to January 2024. The consistency between Body Mass Index (BMI), Waist Circumference (WC), and results from imaging techniques is uncertain. Unlike anthropometric methods, imaging methods provide us with the exact location of adipose tissue as well as fat and lean mass distinction, which can be further correlated with different airway parameters and respiratory system functions and dysfunctions. Studies indicate that the relationship between lung functions and obesity is more complex in females. Abdominal visceral fat is supposed to be the major asthma predictor already in the pediatric population. The connection between obesity and asthma is already evident in children and adolescents. Imaging methods can measure visceral and subcutaneous fat mass and both contribute to the association between obesity and lung functions. These methods are more accurate and reproducible but require more time and expertise. Key words Asthma, Obesity, Magnetic resonance imaging, Dual-energy, X-ray absorptiometry, Bioimpedance analysis.

• MeSH
• Asthma * diagnostic imaging   epidemiology   physiopathology   MeSH
• Body Mass Index MeSH
• Humans MeSH
• Magnetic Resonance Imaging methods   MeSH
• Obesity * diagnostic imaging   complications   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

Úvod: Pleomorfný dermálny sarkóm (PDS) je zriedkavý malígny mezenchýmový nádor kože. Klinicky aj histogeneticky zdieľa podobné črty s atypickým fibroxantómom (AFX) a predpokladá sa, že tieto dva nádory predstavujú morfologické spektrum jednej neoplázie. Kazuistika: 60-ročný muž s anamnézou karcinómu hlasivky pozoroval niekoľko mesiacov rast ulcerovaného tumoru na koži kapilícia. Odstránený bol chirurgickou excíziou. Histologicky išlo o solídne rastúci mezenchýmový nádor pozostávajúci z atypických buniek epiteloidného a histiocytoidného vzhľadu. Na spodine infiltroval podkožný tuk a zasahoval až po hlbokú fasciu. Prítomná bola krvná cieva vyplnená nádorovým trombom. Imunohistochemicky exprimoval CD68, CD10, CD163, CD99 a sčasti aj αSMA a CD31. Nález zodpovedal PDS. Pacient absolvoval PET/CT vyšetrenie s negatívnym výsledkom. Krčné lymfatické uzliny neboli zväčšené. Vykonaná bola široká reexcízia miesta jazvy bez nádorových reziduí. Pacient je ďalej sledovaný, aktuálne bez známok recidívy. Záver: PDS predstavuje pre patológov diagnostickú výzvu. Najčastejšie vzniká u starých mužov na vlasatej časti hlavy a v tejto lokalite, typickej pre nemelanómovú rakovinu kože, predstavuje významnú diferenciálnu diagnózu. Jeho odlíšenie od histogeneticky a štrukturálne príbuzného, ale klinicky omnoho priaznivejšieho AFX môže byť veľmi obtiažne, ale z hľadiska ďalšej prognózy a klinického manažmentu pacienta zásadné.

Introduction: Pleomorphic dermal sarcoma (PDS) is a rare malignant mesenchymal tumor of the skin. It clinically and histogenetically shares similar features with atypical fibroxanthoma (AFX) and they are thought to represent the morphologic spectrum of one neoplasia. Case report: A 60-year-old man with a history of vocal cord carcinoma had observed an ulcerated skin tumor in the scalp growing for several months. It was removed by surgical excision. Histology revealed a solid mesenchymal tumor consisting of atypical cells population of epithelioid and histiocytoid appearance. At the base, it infiltrated the subcutaneous fat and extended into the deep fascia. A blood vessel filled with a tumor thrombus was found. The tumor was positive for CD68, CD10, CD163, CD99 and partly reactive for αSMA and CD31. The diagnosis of PDS was established. The patient underwent PET/CT examination with a negative result. The cervical lymph nodes were not enlarged. A wide re-excision of the scar region was performed without evidence of residual tumor. The patient continues to be monitored, currently without signs of recurrence. Conclusion: PDS represents a diagnostic challenge for pathologists. It mostly occurs in old men in the capillitium and in this location, which is typical for non-melanoma skin cancer, represents an important differential diagnosis. Its differentiation from the histogenetically and structurally related but clinically much more favorable AFX can be very difficult, but essential in terms of further prognosis and clinical management of the patient.

• MeSH
• Histological Techniques MeSH
• Immunohistochemistry MeSH
• Middle Aged MeSH
• Humans MeSH
• Skin Neoplasms diagnosis   pathology   therapy   MeSH
• Sarcoma * diagnosis   pathology   therapy   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

BACKGROUND: Pulmonary hernia is a rare condition characterized by the protrusion of lung tissue through a chest wall defect. Trauma and thoracic surgery are the most common causes of acquired lung hernias. We present an unusual case of (sequential) bilateral lung herniation with parenchymal infarction after bilateral lobar lung transplantation. CASE PRESENTATION: A 50-year-old female, wait-listed as high-urgency candidate, with a body mass index (BMI) of 29 kg/m2 underwent a bilateral lobar lung transplantation for pulmonary fibrosis through a clamshell thoracotomy approach. Due to a size mismatch, stapler resection of the segment 3 and the middle lobe of the right lung, as well as an upper left lobectomy was required. The chest was closed with 3 braided non-absorbable pericostal sutures on each side. Sternal osteosynthesis was performed with a titanium sternal splint along with 7 self-tapping screws with a length of 18 mm. On the posttransplant day (PTD) 18, patient's clinical condition deteriorated. Physical examination didn't reveal any palpable subcutaneous chest resistance. However, a computed tomography (CT) scan showed a herniation of the segment 6 of the right lung. During acute surgical revision, perioperative finding revealed posterior pericostal suture failure. Therefore, a stapler resection was performed due to the infarction of the herniated segment. On the PTD 36, herniation of the left lung parenchyma was detected by acute CT scan. The protruding vital parenchyma was surgically repositioned without necessity of resection. Two posterior pericostal sutures were broken, and distal part of sternal splint detached. Thoracotomy was closed using 5 braided non-absorbable sutures. Sternum was re-osteosynthesized with the STRATOSTM system. After 3 months of intensive postoperative care, the patient was transferred to the rehabilitation department. She was discharged on the PTD 99. After 20 months of follow-up, lung function remains stable without the need for oxygen support. CONCLUSION: Clamshell incision remains ultimate approach in thoracic surgery. However, pulmonary herniation after clamshell thoracotomy is a rare complication and may manifest as acute respiratory distress syndrome with an inflammatory response. In these cases, CT scan should be always considered, even if no palpable pathology of chest is present.

• MeSH
• Hernia * etiology   MeSH
• Infarction etiology   surgery   MeSH
• Middle Aged MeSH
• Humans MeSH
• Herniorrhaphy methods   adverse effects   MeSH
• Lung diagnostic imaging   MeSH
• Lung Diseases surgery   etiology   MeSH
• Tomography, X-Ray Computed MeSH
• Postoperative Complications surgery   MeSH
• Thoracotomy * methods   MeSH
• Lung Transplantation * adverse effects   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH