Livedo racemosa pathology
Decompression sickness and arterial gas embolism, collectively known as decompression illness DCIare serious medical conditions that can result from compressed gas diving. DCI can present with a wide range of physiologic and neurologic symptoms. In diving medicine, skin manifestations are usually described in general as cutis marmorata CM.
Mainly in the Anglo-American literature the terms cutis marmorata, livedo reticularis LRand livedo racemosa LRC are used interchangeably but actually describe pathophysiologically different phenomena. CM is a synonym for LR, which is a physiological and benign, livid circular discoloration with a net-like, symmetric, reversible, and uniform pattern. The decompression-associated skin discolorations, however, correspond to the pathological, irregular, broken netlike pattern of LRC.
This concept of arterial occlusion suggests that the decompression-associated livedo racemosa may be also caused by arterial gas embolism. To further investigate this hypothesis, a retrospective analysis was undertaken in a population of Austrian, Swiss, and German divers.
Decompression illness DCI is caused by bubble formation from dissolved inert gas during or after a compressed gas dive. These bubbles may form as a result of supersaturation of a tissue in relation to the ambient pressure. Very frequent DCI symptoms are skin bends.
Skin lesions are visual clinical manifestations, which to some extent reflect the condition of DCI; however, they cannot fully represent the severity of the whole body. In diving medicine, there are several types of skin manifestations with different pathologies.
Hitherto one of the most common types has been termed cutis marmorata in the literature, a non-specific, erythematous macular eruption, occasionally with itching or painful cutaneous red-bluish discoloration.
In the diving literature, the term cutis marmorata is used to summarize livedo reticularis and livedo racemosa in a uniform manner. However, this is not correct as livedo reticularis and livedo racemosa are clinically and pathophysiologically totally different entities.
In addition, the finding that in dermatology livedo racemosa is caused by a thromboembolic occlusion of arterial vessels supports the theory of shunt-related arterial gas embolisms in diving patients with cutis marmorata. For this retrospective study the following patients were selected: From all diving patients from Austria, Switzerland, and Germany admitted to the University Clinic of Innsbruck in the period of — only the patients who suffered from an undeserved DCI no decompression obligations were omitted and presented with documented skin manifestations were selected.
The maximum depth and overall dive time exposures are displayed in Figure 1. Figure 1. Maximum diving depth and overall dive time exposures of the 18 divers. All cases with probable decompression omissions were excluded. Arrested diving activity or a history of previous diving accidents was not considered as exclusion criterion.
All dive profiles were carefully analyzed, and the events during the dive and especially after ascending to the surface reviewed. A blinded dermatologist analyzed and diagnosed the documentations of the skin manifestations. Although the study did not need to be ethically approved, it was conducted following the internationally accepted guidelines, and personal data were treated according to actual European law on data management.
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Note that this may not provide an exact translation in all languages.Garodia school reviews
Author: Vanessa Ngan, Staff Writer, Livedo reticularis refers to various conditions in which there is mottled discolouration of the skin.
It is described as being reticular net-like, lace-likeas cyanotic discolouration surrounds pale central skin. Livedo reticularis results from a disturbance of blood flow to the skin, causing low blood flow and reduced oxygen tension to the skin.
Cutaneous vasculature is comprised of a series of 1—3 cm cones. The apex of each cone is located deep within the dermis at the site of an ascending arteriole. At the margin of each cone, the density of the arterial bed is decreased, and the superficial venous plexus is more prominent. Any pathological or physiological process which impairs blood flow to the skin results in higher amounts of deoxygenated haemoglobinleading to a livid discolouration. Physiological arteriolar vasospasm in response to cold, produces reversible skin discolouration, such as in cutis marmorata.
Prolonged vasospasm, thrombosis or hyperviscosity can cause the pathological skin changes of livedo racemosa. A unilateral form of livedo reticularis due to local heat injury is known as erythema ab igne.
Cutis marmorata telangiectatica congenita is a rare condition in which pronounced livedo is present at birth or soon after. It often improves with age. There are several congenital abnormalities associated with cutis marmorata telangiectatica. Primary livedo reticularis is the idiopathic form in adults and can be persistent. The diagnosis is usually made once other more severe causes of livedo reticularis have been ruled out. Occlusion of vessels may occur because of a hypercoagulable state.
This may present as blue toe syndrome. Amantadine dopamine agonist used to treat Parkinson disease, multiple sclerosis and attention deficit hyperactivity disorder causes livedo through arteriolar vasospasm associated with depletion of catecholamines.
Drug-associated livedo has also been reported with:. In cutis marmoratamottling is diffusemild and usually symptomless. The livedo commonly occurs on the legs and gradually resolves on rewarming. Cutis marmorata telangiectatica congenita is more pronounced than cutis marmorata. Primary livedo reticularis in adults is intermittent, and the changes in skin colour are less influenced by ambient temperature.
Cutis marmorata Cutis marmorata. Livedo racemosa often affects the trunk and buttocks as well as legs. The net-like violaceous pattern tends to be composed of irregular, broken macules with an annular pattern. Livedo racemosa Livedo reticularis. Livedo reticularis itself is relatively benign. However, thromboembolic disease due to associated conditions such as antiphospholipid syndrome may lead to serious arterial events, including the death of the patient. Investigations are undertaken to seek for an underlying cause see above based on careful history and examination, as extensive screening studies are unlikely to be helpful.
The lupus anticoagulant panel should be ordered in acquired livedo that is not induced by the cold.
A palpable site is ideal for a biopsy if present. The red area may just show non-diagnostic telangiectasia.Log in to renew or change an existing membership.
First Name. Last Name. Password Again. Discount Code - Valid - Invalid Apply. Auto Renew. Livedo reticularis is a lacy rash. The rash can appear in normal people or as part of disease. It is similar, but not identical to livedo racemosa. This is because of the lacy, marbled appearance of pale and visible superficial blood vessels in the skin that are typical of these phenomena. The physiologic, primary and idiopathic types are most often benign and do not mandate treatment.
The secondary type may or may not require treatment of the underlying associated condition, depending on the extent and manifestations.
Two maneuvers help differentiate between the types — warming and elevation. The primary and physiologic types disappear with warming. The idiopathic type will not disappear with elevation while the primary type will.
Physical examination of patients with livedo reticularis should also include a pulse exam, Allen test and thoracic outlet maneuvers. Signs of vasculitis should be sought. Livedo recemosa is similar to livedo reticularis, but is more pronounced, more widespread and often constant. It has a more coarse appearance. Biopsy also reveals the diagnosis. Livedo racemosa appears as part of these conditions:. Diagnosis of livedo racemosa is clinical and pathological.DermNet provides Google Translate, a free machine translation service.
Note that this may not provide an exact translation in all languages. Livedoid vasculopathy is a rare, chronic vascular disorder characterised by persistent painful ulceration of the lower extremities. The condition occurs chiefly but not exclusively on the lower leg or foot. It is now clear that it is not primarily a vasculitis inflammation of the blood vessel wallbut to occlusion of small blood vesselshence the change in name.
Livedoid vasculopathy occurs most commonly in middle-aged women but has been reported at all ages including childhood.H85 trail camera
There is often an increased incidence during the summer months and pregnancy. Some patients with livedoid vasculopathy have an associated condition that predisposes them to occlusion of the small vessels of the lower leg. These include:. The exact cause of livedoid vasculopathy remains unclear, and various theories have been published referring to abnormalities within the blood vessel wall and in the circulating blood.
It is likely that several different abnormalities may lead to clotting within small blood vessels of the lower legs. The thrombi result in necrosis of overlying skin, ulceration and very slow healing.
There is no primary vasculitis. Livedoid vasculopathy affects lower legs, ankles, and upper surfaces of the feet.
It is nearly always bilateral. Characteristics include:. Livedoid vasculopathy Atrophie blanche. After taking a history, the patient should undergo a thorough general examination to identify any underlying associated condition. Livedoid vasculopathy is a clinical diagnosis, supported by skin biopsy of a red papule or the edge of a new ulcer. Histopathology reveals hyalinisationthickened blood vessel walls, fibrin depositionvascular occlusion by thrombosis and minimal inflammation.Decompression sickness and arterial gas embolism, collectively known as decompression illness DCIare serious medical conditions that can result from compressed gas diving.
DCI can present with a wide range of physiologic and neurologic symptoms. In diving medicine, skin manifestations are usually described in general as cutis marmorata CM. Mainly in the Anglo-American literature the terms cutis marmorata, livedo reticularis LRand livedo racemosa LRC are used interchangeably but actually describe pathophysiologically different phenomena.
CM is a synonym for LR, which is a physiological and benign, livid circular discoloration with a net-like, symmetric, reversible, and uniform pattern. The decompression-associated skin discolorations, however, correspond to the pathological, irregular, broken netlike pattern of LRC. This concept of arterial occlusion suggests that the decompression-associated livedo racemosa may be also caused by arterial gas embolism.
To further investigate this hypothesis, a retrospective analysis was undertaken in a population of Austrian, Swiss, and German divers. Abstract Decompression sickness and arterial gas embolism, collectively known as decompression illness DCIare serious medical conditions that can result from compressed gas diving.If Sylvia lost to Jemmye or Natalie, it would be a bad season for her.
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The filmmaker Charles Atlas, who returns to filming dance after a ten-year hiatus, was a frequent and innovative Cunningham collaborator. And Silas Riener and Rashaun Mitchell were two of the most striking performers in the final iteration of the company. In 1932, for example, he created sets and costumes for the American avant-garde dancer and choreographer Ruth Page.
Afterward, Dakin Hart, a Noguchi scholar, and Meglin will hold a discussion. Harkness became home to the first faculty of modern dance in the United States, and its ranks over the years have attracted many pioneers in the field. Every year, the Harkness Dance Festival and various performance series bring choreographers and performers at various stages of their careers to Buttenwieser Hall to celebrate the history and future of modern dance.
The production, a miniature version of the story, is only an hour long, performed in front of an ingenious set piece that transforms itself over the course of the evening. The British naval administrator and parliamentarian Samuel Pepys, for example, went on at great length in his journals about everything, from his bladder stones and his sexual escapades to what he had for lunch.
When Merce Cunningham died, in 2009, his collaborators spun off in all directions, like planets in a solar system that has lost its sun. Two of his dancers, Rashaun Mitchell and Silas Riener, began making work together, in a style that blends their choreographic identities.
One suspects that Cunningham would have approved. And the company is dancing especially well these daysduring its winter season (at the David H. The national company was founded long before the revolution, by the Cuban-born star Alicia Alonso, and remains a prized institution, as beloved as baseball. Modern dance has had a harder time putting down roots there, but lately that has started to change.Mardi gras colors
Malpaso Dance Company, founded in 2012, is part of this new flowering. The independently run company, stocked with vibrant, beautifully trained dancers, tours abroad extensively and, thanks in part to the Joyce Theatre Foundation, regularly commissions work from outside choreographers.
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