The oxidized porphyrins initiate degranulation of dermal mast cells, which release proteases that catabolize the surrounding proteins. This begins a cell-mediated positive feedback loop which matches the description of a type 4 delayed hypersensitivity reaction. The resulting blisters, therefore, do not appear immediately but begin to show up 2–3 days after sun exposure. Due to the highly conjugated structure of porphyrins involving alternating single and double carbon bonds, these compounds exhibit a deep purple color, resulting in the discoloration observed in the skin. Excess alcohol intake decreases hepcidin production which leads to increased iron absorption from the gut and an increase in oxidative stress. This oxidative stress then leads to inhibition of uroporphyrinogen decarboxylase, creating an excess of uroporphyrinogen III which is oxidized from the relatively harmless porphyrinogens into their oxidized porphyrins form. Concentrated instances of oxidative stress (alcohol, physical trauma, psychological stress, etc.) cause the liver to hemorrhage these porphyrins into the blood stream where they are then susceptible to oxidation.The strong association of PCT with Hepatitis C virus infection is not entirely understood. Studies have suggested that the cytopathic effect of the virus on hepatocytes can lead to the release of free iron. This iron can disrupt the activity of cytochrome p450, releasing activated oxygen species. These can oxidize the UROD substrate uroporphyrinogen, which can result in the inhibition of UROD and lead to deficient activity of this key enzyme.Excess alcohol use is frequently associated with both inducing PCT and aggravating a preexisting diagnosis of the disorder.
Post-surgical breast hematomas can also impede wound healing and therefore impact the cosmetic outcome. Hematomas are furthermore one of the risk factors for breast surgical site infections. There is preliminary evidence that, after breast implant surgery, the presence of hematoma increases the risk of developing capsular contracture.In mammography screening, scar tissue resulting from a breast hematoma can easily be confused with tumor tissue, especially in the first years following surgery. Ultimately, fat necrosis may occur in the concerned region of the breast. Diagnosis
When there is post-operative swelling after breast surgery or core needle biopsy, a breast ultrasound examination may be indicated in order to differentiate between a hematoma and other possible post-surgical complications such as abscess or seroma, A recent hematoma is usually visible in a mammogram. and it also shows typical signal intensities on MR imaging. If a differentiation from breast cancer is necessary, a hematoma biopsy may be indicated. A careful consideration of the case history is important for the diagnosis of a breast hematoma. Treatment
Small breast hematomas that cause no discomfort often require merely clinical observation, with ultrasound being used to monitor the resolution of the hematoma. Large breast hematomas, or those that are not becoming smaller or that are causing discomfort, usually require drainage. Also hematomas that occur after surgery for excision of a malignant tumor are drained, because a hematoma to which irradiation is applied is unlikely to ever resolve. A recent hematoma can be drained by means of needle aspiration or (rarely) open surgical drainage. References


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