The medial instep plantar fasciotomy

A review of the anatomy, etiology, and conservative and surgical treatments of plantar fasciitis are presented and a simple surgical technique is introduced. The medial instep plantar fasciotomy was performed by the authors on 50 feet previously untreated by surgery (41 patients). The follow-up results (average length of time to follow-up was 11.3 months) revealed that 82.6% of the patients experienced at least 90% pain relief and 97.8% experienced at least 80% pain relief. Overall, 91.3% of the patients related at least 80% satisfaction with the results of the surgery and all but one of the patients stated that they would recommend and/or have the procedure performed again if the need arose. Complications arising from the instep procedure were limited, and the most frequent complaint was scar formation. Stress was placed on exhausting conservative measures before attempting surgical correction, and the average patient utilized five different modalities of conservative treatment over an average period of 13 months. Postoperatively, patients were encouraged to continue, or begin using, orthotics/arch supports to avoid problems such as arch pain.     

A case of subcutaneous cysticercosis

We report the fourth case of subcutaneous cysticercosis infected in Japan since 1975. The patient noticed a subcutaneous nodule on his left shoulder without symptoms for three years. No remarkable changes were found in laboratory findings and physical examination after surgical excision of the subcutaneous nodule. The adult worm of Taenia solium could not be found in the intestine. Histological findings revealed a cystic structure with a fibrous capsule and a protoscolex with suckers, hooks, and calcareous corpuscula. It was identified as a Cysticercus cellulosae hominis based on morphological characteristics. The patient has been living in the Kanto area of Japan and has never been outside Japan since he was born.     

A subcutaneous uterus with unusual presenting features

A 32 year old female, para 2 + 0 presented with a hard lump in the scar of a lower midline incision. She had had a myomectomy 2 years previously and subsequently noticed the lump 3 months later. Her only complaints were urinary frequency during menstruation and the suprapubic mass. Surgery was performed for what was initially thought to be a desmoid tumour. At surgery the uterus was found to be lying in the subcutaneous position with no peritoneal sac. The uterus was dissected free of the sheath and reduced into the pelvis, uneventfully. This rare occurrence of a subcutaneous non-gravid uterus in the absence of a hernial sac is reported and its clinical features and possible preventative measures are discussed.     

The role of prophylactic fasciotomy and medical treatment in limb ischemia and revascularization

Multiple studies have demonstrated that muscle poorly tolerates ischemia. When the ischemic state is unduly prolonged, the successfully replanted or revascularized limb undergoes deleterious biochemical reactions that cascade to vessel intimal damage, increased vessel permeability, and lowering of pH. The resultant tissue edema leads to increasing compartment pressures, which not only impede the recovery of function, but also can lead to irreversible muscle necrosis, increased risk of infection, and sepsis if not reversed in a timely fashion. The development of compartment syndrome jeopardizes not only the injured limb, but life itself secondary to the biochemical toxins produced by the ischemic extremity. A thorough understanding of the biochemistry of ischemia and reperfusion provides insight into the role of fasciotomy in the replanted or revascularized extremity. The scientific basis for fasciotomy in the revascularized or replanted limb is discussed as well as the potential "protective" role of pharmacologic agents in ischemic and reperfusion injury.     

Effect of calcaneal osteotomy and plantar fasciotomy on arch configuration in a flatfoot model

Expressed emotion is a robust and reliable predictor of psychiatric relapse across a range of psychopathological conditions and diagnoses. Theoretical speculation about the expressed emotion construct has suggested that high levels of criticism in relatives might be linked to attributions and beliefs about the patient's ability to control his or her symptoms or problem behaviors. Although there is some empirical support for this notion, no study to date has examined relatives' beliefs about their own abilities to control problem situations. This study compared high- and low-critical relatives of patients with schizophrenia on a measure of locus of control. Consistent with prediction, the locus of control scores of high-critical relatives were indicative of a more internal locus of control, whereas those of the low-critical relatives were indicative of a more external locus of control.     

Local tolerance of subcutaneous injections

Human insulin-like growth factor I (hIGF-I) has several possible clinical applications. Because subcutaneous administration of the drug can cause pain, local tolerance to injection of different formulations with or without hIGF-I has been investigated in man using isotonic saline solution as reference. The formulations, made isotonic with NaCl, ranged in pH from 6 to 7 with phosphate buffer concentrations of 5 to 50 mM. The local tolerance after injection was assessed as injection pain on a visual analogue scale, pain duration and local tolerance (redness, paleness and oedema). The discomfort at the injection site was lowest with 10 mM phosphate, pH 7. Injection of buffer at pH 6 (50 mM phosphate) caused significantly more pain than using 10 mM phosphate, whereas the pain at pH 6 using 10 mM phosphate did not differ significantly from that experienced on injection of the solution at pH 7 using either 10 or 50 mM phosphate. hIGF-I itself did not seem to cause pain. We concluded that for subcutaneous injections at non-physiological pH, the buffer strength should be kept as low as possible to avoid pain upon injection. We also hypothesize that when a non-physiological pH must be used for stability reasons, a lower buffer strength enables more rapid normalization of the pH at the injection site.     

Fine needle aspiration cytodiagnosis of subcutaneous fat necrosis of newborn. A case report

We recently diagnosed subcutaneous fat necrosis in a newborn female infant using fine needle aspiration cytology. The neonate had perinatal asphyxia and her mother a difficult labor, but otherwise the neonate was well developed and healthy and within a few days developed well-defined areas of subcutaneous induration all over. On cytologic examination of the aspirated material, many necrotizing fat cells were found with refractile, needle-shaped crystals arranged in a sheaflike or starburst pattern. Subcutaneous fat necrosis of the newborn is uncommon today, and although the histologic findings from excised tissue are known, this appears to be the first case in which the diagnosis was possible from a sample of fine needle aspirate.     

Delayed-type hypersensitivity to subcutaneous enoxaparin

Organ dysfunction following hematopoietic stem cell transplantation (HSCT) may be a manifestation of a systemic inflammatory response. We speculate that part of the platelet transfusion requirement in HSCT patients results from this systemic inflammatory response, and increased transfusion requirement would be associated with, or precede, organ dysfunction. We studied 199 adults undergoing autologous (n=173) or allogeneic (n=26) HSCT. Patients with CNS (P=0.008) or pulmonary (P=0.002) dysfunction, or with VOD (P=0.05) received a higher mean number of platelet transfusions per week than patients who did not have these dysfunctions. Furthermore, a higher number of platelet transfusions during any 1 week period was significantly associated with development of pulmonary (P=0.0002) or renal (P < 0.0001) dysfunction in the following week. This predictive value was strongest early in the HSCT course, but remained significant over all 4 weeks. In multivariate analysis the number of platelet transfusions during the previous week was independently predictive for development of pulmonary dysfunction in week 2 (P=0.01) and week 3 (P=0.055). We believe that occurrence of increased platelet transfusion requirement prior to onset of dysfunction is consistent with the concept that an antecedent inflammatory response results in both platelet consumption and various organ dysfunctions. Increased platelet transfusion requirement may act as an early marker of subsequent organ dysfunction. Additionally, there may be a direct role of platelets in the development and progression of organ dysfunction in HSCT patients.     

Ambulatory subcutaneous internal sphincterectomy]

The internal anal sphincterotomy operation represents the best therapy for the treatment of those anal lesions, above all anal fissures, which cause hypertrophy and spasms of the internal anal sphincter. The Authors report their experience of 253 operations of internal subcutaneous sphincterotomy carried out between 1989 and 1995 under local anaesthesia in the outpatient clinic. The excellent results achieved prove that the procedure can easily be carried out under local anaesthesia in an outpatient clinic and, therefore, it is preferable to the surgical technique of isolation of the internal sphincter, not only for its practicality but also for the improved results.     

Magnetic resonance imaging of subcutaneous diffuse neurofibroma

A 31-year-old woman presented with increasing pain and tenderness of a long-standing soft tissue mass on her back. MRI showed a network of interconnecting tubular areas, which were T1 isointense and T2 hyperintense relative to skeletal muscle, and displayed marked Gd-DTPA enhancement. The lesion was situated within the subcutaneous fat. Clinically and radiologically, this mass was considered to be a subcutaneous venous haemangioma. Histological examination of the excised mass showed a diffuse neurofibroma with ectatic vessels and entrapped adipose tissue. Similar MRI appearances of subcutaneous haemangioma and diffuse neurofibroma may result in failure to make the correct diagnosis and in inappropriate management.     

Emphysematous cystitis presenting with subcutaneous emphysema

A case is reported of subcutaneous emphysema of the neck in association with emphysematous cystitis and uncontrolled diabetes. Problems in its management are discussed. Anatomic pathway for the spread of the gas from the bladder to the subcutaneous tissues of the neck and the back is speculated.     

Microgrooved subcutaneous implants in the goat

We investigated the behavior of microgrooved implants in soft tissue using polystyrene implantable disks, either smooth or microgrooved (1-10 microm) on both sides. The implants were placed subcutaneously in a goat for 1, 4, or 12 weeks. Light and transmission electron microscopy showed that fibrous capsule formation around the implants was fairly uniform. After 1 week the implants were covered with a fibrous capsule about 80 microm thick. The collagen matrix was loose, and many inflammatory cells were present. After 4 weeks the matrix was more dense and contained many newly formed blood vessels. At the implant surface a layer of inflammatory cells about 10 microm thick had accumulated. Finally, after 12 weeks the matrix had densified. One cellular layer of inflammatory cells was present at the implant surface. We carried out histomorphometric measurements of capsule thickness, inflammatory layer thickness, and the number of blood vessels. Capsule thickness appeared not to decrease with time. Further, these measurements showed that there were no differences in tissue reaction between smooth and microgrooved implants. On the basis of our observations, we suggest that 1 microm deep and 1-10 microm wide microgrooves do not influence tissue response around polystyrene implants in soft tissue.     

Interhemispheric lipoma associated with subcutaneous lipoma

We report an extremely rare case of intracranial lipoma that was associated with subcutaneous lipoma situated on the anterior fontanelle. During ultrasonographic examination of the subcutaneous lesion, intracranial lipoma was incidentally diagnosed. Computed tomography revealed corpus callosum agenesis, interhemispheric lipoma extending into the choroid plexus. Magnetic resonance imaging demonstrated the subcutaneous lipoma and also the exact extent of the lesion. The pathogenesis of lipomas is discussed and the literature is reviewed.     

Skin necrosis following subcutaneous heparin injection

Heparin-induced skin necrosis is a rare but serious complication of subcutaneously administered heparin. Previous reports indicate that the skin necrosis is often accompanied by thrombocytopenia and occasionally by lethal thromboembolism. It thus shows features similar to the heparin-induced thrombocytopenia (HIT) syndrome and probably represents a localized form of this condition. Caution is required in the event of skin necrosis; heparin therapy should be ceased immediately and not used again if the complications of HIT are to be avoided.     

Effect of flosequinan on human small subcutaneous arteries

We have investigated the effect of the novel hypotensive agent, flosequinan, on human small artery constrictor function. Concentration-dependent tension development to both noradrenaline and K+ was reduced in the presence of flosequinan. Arteries pre-contracted with noradrenaline demonstrated a greater concentration-dependent relaxation to flosequinan than did those pre-contracted with K+. Flosequinan depressed the sensitivity to extracellular Ca2+ of arteries pre-contracted with noradrenaline, but this effect was less marked in arteries pre-contracted with K+. These data support previous studies which suggest that flosequinan may affect receptor-mediated contraction by reducing Ca2+ sensitivity.