Endoscopic tattooing of colorectal lesions:Is it a risk-free procedure?

Endoscopic tattooing is one of the most useful tools for the localization of small colorectal lesions especially in the laparoscopic setting.This is a minimally invasive endoscopic procedure without risk of major complications.However,many studies have revealed complications resulting from this procedure.In this article,several topics are reviewed including the accuracy,substance preparation,injected techniques and complications related to this procedure.

Role of preoperative endoscopic ultrasound-guided fine-needle tattooing of a pancreatic head insulinoma

Although insulinomas are rare, they are the most com-mon pancreatic neuroendocrine tumor, with an inci-dence of four cases per million population. Insulinomas are generally benign indolent intrapancreatic tumors. Surgical resection remains the main option for treat-ment. However, up to 67% of a pancreatic head insu-linomas are nonpalpable, thus surgical resection of the nonplapable insulinoma in this area could become prob-lematic resulting in prolonged surgical time, increased risk of pancreatic duct injury and need for pancreati-coduodenectomy. Endoscopic ultrasound-guided fine- needle tattooing(EUS-FNT), has been shown to have a crucial role for localization of pancreatic body and tail lesions, facilitating laparoscopic distal pancreatectomyand helping surgeons identify the location of the tumor. EUS-FNT might have a role for preoperative localiza-tion of pancreatic head insulinomas which are likely to be nonpalpable. We report a case of preoperative EUS-FNT for localization of a nonplapable pancreatic head insulinoma. This report demonstrates that EUS-FNT of pancreatic head insulinomas may facilitate surgical resection, reduce operative time and decrease surgical complications.

Simple keratectomy and corneal tattooing for limbal dermoids:results of a 3-year study

AIM:To evaluate and report the efficacy of combined surgical excision and corneal tattooing in patients with limbal dermoids.·METHODS:In a retrospective interventional case series,9 eyes of 8 patients were treated with combined surgery of simple keratectomy and corneal tattooing for limbal dermoids.Medical records,including best-corrected visual acuity,anterior segment photography,demographic,clinical data,and follow-up information were reviewed.·RESULTS:The mean follow up period in this study was 50±15(range 36-77) months.There was no evidence of infection or recurrent limbal dermoids in any of the eyes during the follow-up period.All patients achieved good cosmetic outcomes with no complications.·CONCLUSION:Simple keratectomy and corneal tattooing of limbal dermoids could be an alternative option for surgery,especially when a donor cornea is not available.

A new multiple noncontinuous puncture(pointage)technique for corneal tattooing

AIMTo assess the safety and cosmetic efficacy of a new multiple noncontinuous transepithelial puncture technique for tattooing a decompensated cornea.METHODSIt was a non-comparative clinical case series study. The study examines 33 eyes in 33 patients with total corneal opacity due to corneal decompensation, which developed following intraocular surgery. Corneal tattooing was performed using the multiple noncontinuous transepithelial puncture technique (i.e. pointage). The safety of this new surgical strategy was assessed by occurrence of adverse events for the follow-up period. The cosmetic efficacy was determined by the patient's cosmetic satisfaction and independent observer's opinion about patient appearance.RESULTSSeven women and 26 men were included in the study. The mean age was 46.4±17.5y (range: 7-67). In total, 30 of 33 patients (91%) reported cosmetic satisfaction within the follow-up period. Only 3 patients (9%) required additional tattooing due to cosmetic unsatisfaction. Cosmetic outcomes were analyzed and classified as excellent or good in 13 (39%) and 17 (52%) patients, respectively. No serious adverse events developed, except delayed epithelial healing in 3 cases.CONCLUSIONThe cosmetic outcomes of the multiple noncontinuous transepithelial puncture technique for corneal tattooing were good. The safety of this method is higher than conventional procedures. This new procedure also provides improved cost-effectiveness and safety over current corneal tattooing techniques.

Tattooing: A potential novel risk factor for iliopsoas abscess

Iliopsoas abscess(IPA) is an uncommon infection. The clinical presentation is usually insidious. Most patients present with nonspecific symptoms, leading to difficulty in prompt and accurate diagnosis. Delay in diagnosis can lead to complications, such as sepsis and death. Tattooing has become more popular over the recent years and has been associated with tattooing-related and blood-borne infections. We present two related cases of methicillin-resistant Staphylococcus aureus IPA after tattooing and review the epidemiology, etiology, clinical features, and management of IPA.

Complication after nipple-areolar complex tattooing performed by a non-medical person:A case report

BACKGROUND Compared to earlier,there has been an increase in the tattoo procedures for cosmetic purposes;and there has also been an increase in the tattoo procedures performed by non-medical personnel.In South Korea,only tattoos performed by a doctor are considered legal;however,there is still some debate over whether tattoo procedures performed by non-healthcare providers should be considered legal.CASE SUMMARY A 28-year-old woman visited our hospital with pain in both nipples and heat sensation over the last 4 d.She had a history of a nipple tattoo performed by an unlicensed person.Pinpoint bleeding was noted in both areolar areas,and the exudate mixed with pus and orange color ink was discharged.Oral medication and tulle with foam dressing were performed under the impression of cellulitis and allergic reaction.After 4 wk,nipples remained dark brown in color,resulting in a color mismatch between the nipple and orange-colored areola.The size of the areola was also found to be distinctly asymmetrical after healing.This complication may have been caused by the use of illegal ink or unsanitary procedures,or a problem may have occurred in the post-tattoo management stage.CONCLUSION Doctors use approved ink,aseptic procedure and appropriate postoperative care,and appropriate management can be performed in case of complications.

Tattooing of the Dai People

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Usefulness of colonic tattooing using indocyanine green in patients with colorectal tumors

AIM To prove that tattooing using indocyanine green(ICG) is feasible in laparoscopic surgery for a colon tumor.METHODS From January 2012 to December 2016, all patients who underwent laparoscopic colonic surgery were retrospectively screened, and 1010 patients with colorectal neoplasms were included. Their lesions were tattooed with ICG the day before the operation. The tattooed group(TG) included 114 patients, and the non-tattooed group(NTG) was selected by propensity score matching of subjects based on age, sex, tumor staging, and operation method(n = 228). In total, 342 patients were enrolled. Between the groups, the changes in [Delta(Δ), preoperative-postoperative] the hemoglobin and albumin levels, operation time, hospital stay, oral ingestion period, transfusion, and perioperative complications were compared. RESULTS Preoperative TG had a shorter operation time(174.76 ± 51.6 min vs 192.63 ± 59.9 min, P < 0.01), hospital stay(9.55 ± 3.36 d vs 11.42 ± 8.23 d, P < 0.01), and postoperative oral ingestion period(1.58 ± 0.96 d vs 2.81 ± 1.90 d, P < 0.01). The Δ hemoglobin(0.78 ± 0.76 g/dL vs 2.2 ± 1.18 g/dL, P < 0.01) and Δ albumin(0.41 ± 0.44 g/dL vs 1.08 ± 0.39 g/dL, P < 0.01) levels were lower in the TG. On comparison of patients in the "N0" and "N1 or N2" groups, the N0 colon cancer group had a better operation time, length of hospital stay, oral ingestion period, Δ hemoglobin, and Δ albumin results than those of the N1 or N2 group. The operation methods affected the results, and laparoscopic anterior resection(LAR) showed similar results. However, for left and right hemicolectomy, both groups showed no difference in operation time or hospital stay.CONCLUSION Preoperative tattooing with ICG is useful for laparoscopic colectomy, especially in the N0 colon cancer group and LAR.

Protection Measures and Change in the Perception of Work Risks with COVID-19, in a Representative Sample of Portuguese Tattoo Artists

Introduction: Tattoo Artists are exposed to Occupational Hazards, but the bibliography is scarce. Methodology: this is a Mixed Exploratory Study carried out with a quantitative component (online questionnaire) and a qualitative component (online interview). The questionnaire was available between April 2020 and March 2021 and was distributed by the companies/professionals that work on Tattoos, main national magazines in the sector, companies that supply products and equipment and organizing committees of the main national congresses. The research project was approved by the Ethics Committee of the Faculty of Arts of the University of Porto (28.04.2020) and an informed consent was obtained. As an inclusion criterion, it was considered to carry out tattooing tasks on a paid basis. As exclusion criteria, working outside the country or not mastering the Portuguese language stood out. Results: 207 Tattoo Artists answered the questionnaire (25.87% of professionals registered in Portugal) and nine interviews took place. Numerous statistically significant associations were found between the variables analysed. Final considerations: the main weaknesses of the study are related to the difficulties inherent in data collection: as it was carried out using an online questionnaire, it was not controlled whether all respondents practiced the profession of Tattoo Artists. Furthermore, as it is a voluntary questionnaire, it is possible that the sample retained professionals who value Occupational Health issues. This investigation combined quantitative and qualitative techniques, so that it was possible to take advantage of and mitigate the disadvantages of both;in fact, the qualitative aspect sequentially completed and explored the data initially obtained in the survey, as well as it allowed to deepen issues initially not programmed, such as the possible interference of the Pandemic associated with SARS-COV2 in the general Risk Perception and compliance with the Standards of Good Practices. Regarding the interviews, the sample was reduced, although the answers were reasonably repeated. During those, even though the questions were posed based on what the Tattoo Artists’ thoughts on what most of the colleagues considered and not having to answer only for themselves, this may still have motivated them to respond in a more politically correct manner. In the overall project, very complete data were obtained on Occupational Health applied to this professional sector, part of which had not been published before, which will certainly constitute an asset to acting more effectively. Overall, Portuguese Tattoo Artists believe that most of their colleagues try to comply with the standards of Good Practice, and this attitude was boosted by the COVID-19 pandemic.

Science on the Development of Standards and Their Compliance in a Representative Sample of Portuguese Tattoo Artists

Introduction: The number of Tattoo artists has been increasing and there are important Occupational Risks associated. The aim of this article was to describe the position of these professionals regarding the Recommendations and to analyze their compliance when working alone or accompanied. Methodology: It is a Mixed Exploratory Study, involving a quantitative component (Observational Analytical of transversal nature), operated through an online survey and, in a second phase, a qualitative one (Case Study), through the use of interviews. A representative sample of the population under study was obtained, considering a 90% confidence interval. The research project was approved by a Ethics Committee and informed consent was obtained. Presentation and Discussion of the Results: The sample considered 207 questionnaires and nine interviews. The compliance with Standards increases with experience;those who reported that they do not always comply are those who use less the Personal Protective Equipment (t = 2.659;p = 0.008). Compliance is also influenced by the Perception of Risk, information, social pressure (more accentuated by COVID19) and motivation to increase profit. Those who considered the Recommendations to be adequate were statistically associated with compliance with Collective Protection Measures. Regarding the compliance when working alone or not, 86.0% stated that they maintained the same posture;of those who answered the opposite, 85.7% complied more alone. Those with less education were statistically associated to less compliance with the rules when alone (X2 = 12.763;p = 0.005). Final Considerations: Previously unpublished data has been obtained, valuable to act effectively in this professional sector. It is fundamental to invest in training, as well as to elaborate Standards (developed jointly by Doctors/Safety Technicians and Tattoo artists). The organization of the Conventions should guarantee adequate conditions (area, access to disinfection/sterilization methods) and share Standards, promoting inspection and punishments for non-compliance, since they are the most unsafe places.

Factors Influencing Hepatitis C Viral Infections in the Population of Algamosi Locality, Gezira State, Central Sudan

Hepatitis C (HCV) remains a global health challenge and is transmitted via contact with contaminated blood and body fluids. This study aimed To find the factors influencing hepatitis c viral infections and to identify its prevalence among populations of the Algamosi area, Gezira state central Sudan. This cross-sectional community-based study was conducted. A total of 492 participants were randomly selected from among 4 villages and were interviewed to find out the factors that lead to transmission of infection and tested for markers of hepatitis C infection. ELISA confirmed all the positive card tests. The results showed that the individuals within the age groups > 45 and 31 - 45 years are more affected by HCV the percentage was 3.37% and 0.6% respectively, while the age groups of 15 - 30 and p < 0.05). Among the possible cause (1.4%) had a previous history of tattooing and were significantly reactive for anti-HCV (X2 = 14.588 and p value = 0.001) The study concluded that the prevalence of hepatitis C viruses was only detected in three areas. This study explored many possible causes associated with viral hepatitis, tattooing is the common cause of hepatitis C virus. Based on the finding the study recommends, the crucial intervention program to screen most of the Algamosi population who have been not screened for HCV, proper treatment for HCV, and the health education program is strongly recommended to create awareness among the general population.

Symptoms, Pathologies, Accidents and Expectations, Regarding the Occupational Doctor and Safety Technician, in a Representative Sample of Portuguese Tattoo Artists

Introduction/Objectives: As Tattoo is being more accepted, more professionals dedicate to it. A study was designed with the aim of analysing the perception of Tattoo Artists regarding their Occupational Health/Safety team (opinion about the support provided);as to find out what type accidents, symptoms and occupational diseases they have, in order to provide a better service. Methods: This is a mixed exploratory study, containing a quantitative observational (analytical, cross-sectional) and a qualitative component (Case Study). For the statistical analysis, predominantly non-parametric tests were used. The project was approved by the Ethics Committee and informed consent was obtained. Results: In terms of symptomatology/illnesses, musculoskeletal pathology is the most reported. In terms of accidents, cuts stand out. Several statistically significant relationships were found between the variables analysed. Discussion/Conclusions: The Occupational Health and Security services are considered insufficient by most of the Tattoo artists. It would be desirable that the Occupational Doctor has concrete knowledge regarding Tattooing, in particular semiology/pathology;makes recommendations in pharmacology and/or indicates which exams could be useful. In relation to the Safety Technician, it would be desirable also to have specific knowledge about the sector, making plausible suggestions for improvement.

Organic and Inorganic Pigments from Commercial Inks Used in Eyebrows’ Microblading: Approach for Assessing the Safety Use by Bacterial Reverse Mutation Assay

Background and Objective: The aesthetic products’ safety should not be neglected to the detriment of the market. This study aimed to evaluate the mutagenic potential of commercial inks. It was formulated with organic (P1) and inorganic (P2) pigments for eyebrows microblading using a validated method by regulatory agencies, the Salmonella/microsome assay, to assure the safety of use. Methods: The assay was carried out in three steps: preliminary toxicity, medium without (-S9), and presence (+S9) of metabolic activation. The strains, auxotrophic to histidine (His-) TA97a, TA98, TA100, and TA102, were exposed to both types of inks, in triplicate, compared to negative and positive controls. Data were statistically analyzed, and values with mutagenic index ≥ 2.0 were indicative of mutagenicity. Results: The inks with organic (P1) and inorganic (P2) pigments were not toxic to TA98 and TA100 S. typhimurium tester strains, even at concentrations applied in humans. Both inks were not mutagenic either in the absence or presence of metabolic activation in the tested concentrations, including that applied in humans. The assay showed that P1 and P2 were not direct (-S9) or indirect (+S9) mutagens as commercially formulated. Conclusions: These results indicate that applying these inks on organisms with microsomal enzymes, including humans, is safe since no compound in the inks became more toxic to induce the bacterial reverse mutation.

Large polyps:Pearls for the referring and receiving endoscopist

Polyps are precursors to colorectal cancer,the third most common cancer in the United States.Large polyps,i.e.,,those with a size≥20 mm,are more likely to harbor cancer.Colonic polyps can be removed through various techniques,with the goal to completely resect and prevent colorectal cancer;however,the management of large polyps can be relatively complex and challenging.Such polyps are generally more difficult to remove en bloc with conventional methods,and depending on level of expertise,may consequently be resected piecemeal,leading to an increased rate of incomplete removal and thus polyp recurrence.To effectively manage large polyps,endoscopists should be able to:(1)Evaluate the polyp for characteristics which predict high difficulty of resection or incomplete removal;(2)Determine the optimal resection technique(e.g.,snare polypectomy,endoscopic mucosal resection,endoscopic submucosal dissection,etc.);and(3)Recognize when to refer to colleagues with greater expertise.This review covers important considerations in this regard for referring and receiving endoscopists and methods to best manage large colonic polyps.

Tattoos as a window to the psyche:How talking about skin art can inform psychiatric practice

Tattooing the skin as a means of personal expression is a ritualized practice that has been around for centuries across many different cultures.Accordingly,the symbolic meaning of tattoos has evolved over time and is highly individualized,from both the internal perspective of the wearer and the external perspective of an observer.Within modern Western societies through the 1970 s,tattoos represented a cultural taboo,typically associated with those outside of the mainstream such as soldiers,incarcerated criminals,gang members,and others belonging to marginalized and counter-cultural groups.This paper aims to review the more recent epidemiology of tattoos in Western culture in order to establish that tattooing has become a mainstream phenomenon.We then review psychological and psychiatric aspects of tattoos,with a goal of revising outmoded stigmas about tattooing and helping clinicians working with tattooed patients to facilitate an exploration of the personal meaning of skin art and self-identity.We suggest that as a kind of augmentation of the physical exam,looking at and talking to patients about their tattoos can provide a valuable window into the psyche,informing clinical practice.

Quantitative evaluation of enhanced laser tattoo removal by skin optical clearing

Lasers have been widely used for tattoo removal,but the limited light penetration depth calused by high skin scattering property restricts the therapeutic outcome of deep tattoo.Skin optical clearing method,by introducing optical clearing agent(OCA)into skin,has shown some im-provement in the effect of laser tattoo removal.In this study,the enhanced laser tattoo removal has been quantitatively assessed.OCA was applied to the skin of tattoo animal model and Q switched Nd:YAG laser(1064 nm)irradiation was used to remove the tattoo.The skin evaluation instrument(Mexameter probe,MPA580)was applied to measure the content of tattoo pigment before and after laser treatment,and then the clearance rate of pigment was calculated.Further,Monte Carlo(MC)method was utilized to simulate the efecet of skin optical clearing on light transmission in tattoo skin model.By comparing the pigment change of tattoo areas respectively treated with OCA plus laser and single laser,it was found that pigment clearance of the former tattoo area was increased by 1.5-fold.Further,the MC simulation verifed that the reduced light scattering in skin could increase the effective dose of lumninous fux reaching to the deep tattoo regions.It can be concluded from both experiment and theoretical simulations that skin optical clearing technique could improve the outcome of laser tattoo re moval,which should be beneficial for clinical laser tattoo removal and other laser pigment elimination.

Changes in Aesthetic Appeal of Tattoos Are Influenced by theAttractiveness of Female Models

External perceptions of individuals based on the presence of tattoos were assessed. College students completed anonline attitudinal assessment in a 4 × 2 design. Participants were asked to rate the aesthetics of tattoos and models（11 women and 17 men） from Photoshopped images. Results （n = 152 usable of 177 collected） indicate that aswhole models and tattoos are not affected in aesthetic appeal, but individually some models and tattoos wereaffected. Tattoos were rated as better quality art when the model can be seen; thus, contextualization allows forgreater appreciation of the tattoo. Results support extant research that indicates women＇s attractiveness is notaffected by tattoos, which also providing a new approach for tattooed individuals.

A Survey of Metals Found in Tattoo Inks

While the practice of tattooing has existed for thousands of years, it has recently begun growing in popularity in the US. With the increasing prevalence of tattoos, the methods and inks involved in the tattooing process have also developed. Tattoos now use many brightly colored inks, often made using metal-based pigments. There is concern that chemicals may be present in tattoo inks in concentrations that may lead to human health concerns either during application or removal of tattoos. Since exposure to metals has been linked to tremors, liver damage, memory loss, cognitive loss, and even death, there is concern about the prevalence of metals in tattoo inks in general. To this end, a survey of 226 commercial tattoo inks was performed and each ink was analyzed for the presence of heavy metals using two different x-ray methods: Particle Induced X-Ray Emission and Scanning Electron Microscopy/ Energy Dispersive Spectroscopy. Fifteen metals were identified in various tattoo inks by these rapid x-ray methods, including chromium, manganese, nickel, copper, barium, and lead. Conclusions can be drawn about the prevalence of metals in some pigment colors and from some brands.

The Q-Switched Nd: YAG Laser in Tattoo Removal and the Effect of Lymphatic Elimination: An Experimental Study in Rabbits

Background: Previously described methods for removal of tattoos are chemical, mechanical, surgical, termal and laser assited methods. Invention of the Q-switch mode, advanced the laser method, to be one of the most effective methods of tattoo removal. Objective: Comparing the tattoo removal and rate of lymphatic elimination of 3 different wavelengths of Q-switched Nd-YAG laser (532nm, 1064nm, combination 532 + 1064). Methods: In this study we examined lymphatic elimination and the effect of 532 nm, 1064 nm, and the combination (532 + 1064 nm) wavelength of laser pulse for the possible lymphatic cleansing mechanism of black pigmented tattoos. This study was performed on 18 New-Zealand rabbits, black pigmented tattoos were engraved on the back and the four extremities of the animals. 532 nm wavelength of Q switched Nd: YAG laser beam was applied on the left upper and bilateral lower extremities of the rabbits. During this period, excisional skin biopsies and lymph node biopsies were performed on days 7, 14 and 21. Results: Day 21 lymph node biopsies revealed mixed type of reactive hyperplasia and intracellular pigments were markedly seen in the laser treatment group and no intracellular tattoo pigment was seen in the control group. Conclusion: The findingd of this study indicate that lymphatic elimination may be one of the significant mechanisms of tattoo removal and the application of different wavelengths of Q-switched Nd-YAG laser do not show statistically significant differences in tattoo removal.

Social Identity in The Tattooed Girl

The relationship between social class and social identity is that, on one hand, social identity is linked to social class and class distinction plays the most important role in determining social identity; and on the other hand, social identity stresses the individual＇s subjective feelings and it refers to the perception of the individual. What is important is the effect of the psychological essence of social identity. In Oates＇s The Tattooed Girl （2004）, an individual＇s perception of social identity has an impact on his or her behavior that causes conflicts between the characters. This paper will analyze the issue of social identity in The Tattooed Girl from the following aspects： How the lower class with a subordinate social identity experiences the personal struggles; How the middle class with a privileged social identity undergoes spiritual suffering due to the traumatic memory; And how the less advantaged attempts to break the social identity boundary, and how such efforts lead to tragedy.