Complications of tattoos and permanent makeup: overview and analysis of 308 cases.

BACKGROUND: Worldwide 10-20% of the population is tattooed. However, tattoo complications can occur, such as allergic tattoo reactions, infections, and manifestations of autoimmune dermatoses. Despite the growing popularity of tattoos and changes in tattoo ink composition over the last decades, little is known about these complications, its clinical aspects, pathomechanism, and relative occurrence. OBJECTIVE: The aim of this article is to describe the types and clinical aspects of dermatological tattoo complications, its relative occurrence and underlying conditions. METHODS: We performed a retrospective cohort study enrolling all patients with tattoo complications from the Tattoo Clinic. Tattoo complications were categorized into infections, inflammatory tattoo reactions, neoplasms, or miscellaneous reactions and correlated to clinical data. RESULTS: Of the total of 326 patients, 301 patients were included with 308 complications. The majority of the complications were chronic: 91.9%. Allergic red tattoo reactions and chronic inflammatory black tattoo reactions (CIBTR) accounted for 50.2% and 18.2%, respectively, of all tattoo complications. Of these CIBTR reactions, extracutaneous involvement was found in 21.4%, including tattoo-associated uveitis (7.1%) and systemic sarcoidosis (14.2%). Of all black tattoo reactions, systemic sarcoidosis was found in 7.8%. CONCLUSION: Tattoos can cause a wide range in complications that may start years after getting the tattoo. The most frequent tattoo reactions are allergic red tattoo reactions and chronic inflammatory black tattoo reactions, making these the most relevant for the dermatologist. CIBTR have a high percentage of multi-organ involvement, and therefore, screening for sarcoidosis, including ocular involvement, is advised.

Dynamic exercise echocardiography of the left ventricle in physically trained children compared to untrained healthy children.

To evaluate the effect of physical training on left ventricular function, we investigated 52 children, aged 7 to 14 years, who had trained for endurance sports over a period of at least 1 year. The children (24 boys and 28 girls) were investigated echocardiographically during supine exercise on a bicycle at increasing work loads of 6, 9, 12 and 15 kpm/min/kg body weight. The parameters of left ventricular function (specifically fractional shortening and the velocity of circumferential fiber shortening; both these parameters corrected for heart rate) were evaluated before, during and after the test. The values obtained were compared to those in untrained children investigated in a previous study. Fractional shortening in trained children rose from 37 +/- 5% to 54 +/- 5%, and in untrained children from 37 +/- 4% to 46 +/- 4%. The velocity of fiber shortening in trained children rose from 1.27 to 3.15 circ/sec while in untrained children it increased from 1.25 to 2.53 circ/sec. Left ventricular contraction, therefore was significantly greater in trained than in untrained children during exercise. While untrained children increased their cardiac output in the first minutes of exercise mainly by elevating their heart rate, trained children increased simultaneously the stroke volume. There were no significant differences between boys and girls, or between stages of maturity. Thus, physical training causes quick adaptations of left ventricular function to exercise in children of all ages.

Dynamic exercise echocardiography in children with congenital heart disease affecting the left heart.

Thirty-five children (male 22, female 13) with congenital heart disease resulting in volume and pressure overload of the left ventricle were investigated echocardiographically during supine bicycle exercise. The children had to follow a test-protocol with increasing workload. Left ventricular function parameters were measured from M-mode-echocardiography, electrocardiography and phonocardiograms before, during and after exercise and were expressed as fractional shortening (FS), velocity of circumferential fiber shortening (VcF) and the frequency corrected parameters: FScorr. = FS X 100/HR and VcFcorr. = VcF X 100/HR (HR = heart rate). The data of this group of children under study were compared to those obtained from 140 healthy children examined under similar conditions. In children with pressure overload, values for fractional shortening, velocity of circumferential fiber shortening and the frequency corrected parameters were significantly higher than in normals throughout exercise testing. In some children with moderate to severe aortic stenosis or coarctation the frequency corrected parameters showed a decrease at higher exercise levels instead of an increase as seen in the majority of cases. In these cases cardiac output was increased by an abnormal rise in heart rate. This was considered as a diminished left ventricular reserve. After aortic valve replacement in two cases with aortic stenosis, parameters of left ventricular function were still elevated at rest and during exercise testing. In two children with hypertrophic cardiomyopathy the almost maximally elevated rest values did not change during exercise. In children with mild volume overload (small ventricular septal defect or aortic incompetence) the left ventricular function parameters were within the normal range or slightly below.

Echocardiographic evaluation of left ventricular reserve in normal children during supine bicycle exercise.

To evaluate left ventricular reserve in normal children 127 healthy boys and girls (71 males, 56 females) were investigated with echocardiography during supine bicycle exercise at levels of 6, 9, 12 and 15 kpm/min/kg body weight. Left ventricular function parameters were obtained from the M-mode echocardiogram, electrocardiogram and phonocardiogram. The children were separated into three groups according to body surface area: group I less than 1.1 m2, group II 1.1-1.4 m2, and group III greater than 1.4 m2. Fractional shortening (FS) of the left ventricle rose during exercise from 37 +/- 4 to 46 +/- 4% with no significant differences between the three groups. Velocity of circumferential fiber shortening (Vcf) in group I augmented from 1.3 to 2.25 circ./sec, in group II from 1.29 to 2.60 circ./sec, and in group III from 1.17 to 2.74 circ./sec (P = 0.01). In the recovery period heart rate (HR) and blood pressure normalized earlier than did fractional shortening and velocity of circumferential fiber shortening. This could be expressed best by the ratios FS/HR and Vcf/HR. There were no significant differences between sexes, although there was a tendency to higher blood pressure and heart rate, a greater increase in velocity of circumferential fiber shortening and a smaller increase in fractional shortening in girls. These data indicate that girls increased cardiac output during exercise more by increasing their heart rate than did boys.

[Congenital nesidioblastosis. Successful treatment with total pancreatectomy]. / Kongenitale Nesidioblastose. Erfolgreiche Behandlung mit totaler Pankreatektomie.

A 6,410 g newborn baby suffered from severe hypoglycemia despite therapy with high doses of diazoxide and glucagon as well as intravenous application of glucose. There was no persistent response of blood glucose to continuous infusion of somatostatin. A 85% pancreatectomy was performed at the age of 6 weeks, after biochemical findings had indicated hyperinsulinism. As the hypoglycemia reappeared postoperatively, the child underwent total pancreatectomy. Now, at the age of 9 months, the baby's growth and development is normal under substitution therapy with Pankreon and depot-insulin 0.2 U/kg/day.