Ischemic necrosis of the breast following septic shock: A case report.

Fat necrosis of the breast is a common and benign entity, often secondary to trauma, surgery, radiation therapy, or unknown etiologies. Critically ill patients with septic shock may experience end-organ hypoperfusion and tissue infarction and necrosis, which may result in breast fat necrosis, however, to the best of our knowledge this has not been previously described. We report a case of biopsy-proven breast fat necrosis secondary to septic shock following an emergency surgery in a postmenopausal female.

Tinea pedis presenting as asymmetric purpuric papules on the sole of the foot: a case report.

In this report we describe a unique case of tinea pedis. A 29-year-old man presented with a 3-day history of asymptomatic purpuric papules predominantly on his left foot. Potassium hydroxide preparation demonstrated fungal hyphae and culture yielded Trichophyton mentagrophytes. This patient presented unusually with purpuric papules, unlike the three commonly described types of tinea pedis. Given the morphology, positive potassium hydroxide slide preparation, T. mentagrophytes on fungal culture and clinical response to ketoconazole cream, we conclude that this represents a unique variant of tinea pedis. We recognize that even common dermatological diagnoses can have unique presentations, and it is important for clinicians to maintain a broad differential for new dermatologic cases.

Posteriorly tunneled dialysis catheters for permanent use in cognitively impaired patients undergoing hemodialysis.

Cognitively impaired patients often pull at their dialysis catheters when the catheters are tunneled over the anterior chest. To potentially circumvent this, a technique was developed that tunnels the catheter posteriorly, over the patient's shoulder. A total of 32 posteriorly tunneled catheters were placed in 12 patients. The mean catheter use interval was 164 days, with a total of 5,248 catheter use days. Indications for nonelective catheter removals were catheter dysfunction (n = 7; 23.3%), removal by the patient (n = 7; 23.3%), infection (n = 5; 16.7%), and inadvertent dislodgment (n = 1; 3.3%). Only six of the 12 patients were able to dislodge their catheters. The procedure described here reduced catheter manipulation and extended catheter viability in these patients.

Measuring flow-mediated dilation through transverse and longitudinal imaging: comparison and validation of methods.

Three-dimensional ultrasound images (3DUS), having two spatial and one temporal dimension, were taken of the brachial artery during baseline conditions, in the transverse and longitudinal planes. The transverse images were analyzed by three different techniques used to quantify flow-mediated dilation (FMD): (1) measuring vessel area manually (TIMA), (2) measuring vessel area semi-automatically (TISA) and (3) measuring vessel diameter (TID). The inter- and intra-observer variability and transducer repositioning variability of each method were compared to each other and to the variability of measurements taken using the traditional method of measuring vessel FMD through measuring vessel diameter on longitudinal images (LID). The percent coefficient-of-variation describing the inter-observer variability (COV(inter)) was similar for the methods, indicating that each method was equally reproducible by the different observers. The percent coefficient-of-variation describing the intra-observer variability (COV(intra)) and the smallest detectable percent change in diameter (Δd(intra)) for each method indicated that TID was the most precise at measuring vessel diameter, and could measure the smallest changes in diameter between successive measurements (COV(intra) = 0.31%, Δd(intra) = 0.87%). LID performed the poorest (COV(intra) = 0.57%, Δd(intra) = 1.59%). The percent coefficient-of-variation describing transducer repositioning (COV(rep)) and the smallest detectable percent change in FMD over time (ΔFMD) for each method indicated that TIMA was the most reproducible method (COV(rep) = 2.35%, ΔFMD = 6.52%) closely followed by TISA. TID performed the poorest (COV(rep) = 5.37%, ΔFMD = 14.89%). TIMA and TISA were found not to be statistically different so we suggest TISA as the method of choice to maximize reproducibility between measurements over time, as it is faster and simpler to perform. In each experiment it was clear that transverse imaging introduced equal or less variability into diameter measurements as compared to longitudinal imaging and we suggest this imaging plane be used in all assessments of FMD.