A Case of Necrotizing Soft Tissue Infection Secondary to Perforated Colon Cancer.

Necrotizing soft tissue infections are aggressive infections that cause necrosis of muscle, fascia, and tissue. They typically follow fascial planes that lack insufficient blood supply. Early drainage and debridement are essential for survival in these patients. This is a case of a patient who presented in diabetic ketoacidosis with a necrotizing soft tissue infection localized to the left flank and abdomen with underlying colon cancer pathology. The patient was a 54-year-old female who initially presented with acute dyspnea and left flank pain for two weeks. On admission, she was afebrile, tachycardic, tachypneic, and hypertensive. After being transferred to the ICU for diabetic ketoacidosis management, she began complaining of left abdominal pain and the CT showed concerns for a possible necrotizing soft tissue infection in the left flank region. She was taken to the operating room immediately for debridement and started on broad-spectrum antibiotics. The next day, an exploratory laparotomy was performed with a hemicolectomy and creation of an end colostomy due to concern for a perforated colonic malignancy. A final debridement was completed and a wound vacuum-assisted closure (VAC) was placed. Final pathology demonstrated well-differentiated colonic adenocarcinoma invading into the muscularis propria. Overall, necrotizing soft tissue infections can be related to a perforated viscus especially a colonic malignancy and this case demonstrates the importance of proper surgical management and high clinical suspicion for possible underlying pathology in a soft tissue infection.

Skin tissue dielectric constant in women with high body fat content.

BACKGROUND: Skin tissue dielectric constant (TDC) measurements at a frequency of 300 MHz are used to assess skin properties in many conditions. Impacts of patient obesity on these values are unknown, and its quantitative assessment was the goal of this research. MATERIALS AND METHODS: Women in a weight loss program (N = 32) had TDC measured on forearm, biceps, neck, jowl, and submental regions along with measurements of total body fat (TBF), water (TBW), intracellular water (ICW), and extracellular water (ECW) via multi-frequency bioimpedance. Group age (mean ± SD) was 40.0 ± 11.6 years (20-70 years) with body mass index (BMI) of 31.8 ± 6.7 Kg/m2 (23.0-49.9 Kg/m2 ). For analysis, subjects were divided into those with BMI < 30 Kg/m2 (subgroup A, n = 16) vs ≥30 Kg/m2 (subgroup B, n = 16). RESULTS: Tissue dielectric constant at forearm and biceps decreased significantly (P < .001) with increasing depth from 0.5 to 1.5 to 2.5 mm but TDC values and their inter-side ratios did not differ between subgroups A and B at any measured site. Although correlations between TBW, ECW, and ICW were significant (P < .001), there was no dependence of TDC values on any of these parameters. CONCLUSIONS: Previously unknown TDC values for obese persons are provided and based on subgroup analyses suggest that skin TDC values in overweight and obese persons are not confounded by variables such as TBW and TBF. Further, since inter-side ratios and their SD's yielded thresholds for forearm and biceps similar to those established for women with normal BMI, use of these clinical inter-arm TDC ratios now is extended to include a wider BMI range.

Design, synthesis of novel lipids as chemical permeation enhancers and development of nanoparticle system for transdermal drug delivery.

In the present study, we designed and developed novel lipids that include (Z)-1-(Octadec-9-en-1-yl)-pyrrolidine (Cy5T), 1, 1-Di-((Z)-octadec-9-en-1-yl)pyrrolidin-1-ium iodide (Cy5), (Z)-1-(Octadec-9-en-1-yl)-piperidine (Cy6T), and 1, 1-Di-((Z)-octadec-9-en-1-yl) piperidin-1-ium iodide (Cy6) to enhance the transdermal permeation of some selected drugs. Firstly, we evaluated the transdermal permeation efficacies of these lipids as chemical permeation enhancers in vehicle formulations for melatonin, ß-estradiol, caffeine, α-MSH, and spantide using franz diffusion cells. Among them Cy5 lipid was determined to be the most efficient by increasing the transdermal permeation of melatonin, ß-estradiol, caffeine, α-MSH, and spantide by 1.5 to 3.26-fold more at the epidermal layer and 1.3 to 2.5-fold more at the dermal layer, in comparison to either NMP or OA. Hence we developed a nanoparticle system (cy5 lipid ethanol drug nanoparticles) to evaluate any further improvement in the drug penetration. Cy5 lipid formed uniformly sized nanoparticles ranging from 150-200 nm depending on the type of drug. Further, Cy5 based nanoparticle system significantly (p<0.05) increased the permeation of all the drugs in comparison to the lipid solution and standard permeation enhancers. There were about 1.54 to 22-fold more of drug retained in the dermis for the Cy5 based nanoparticles compared to OA/NMP standard enhancers and 3.87 to 66.67-fold more than lipid solution. In addition, epifluorescent microscopic analysis in rhodamine-PE permeation studies confirmed the superior permeation enhancement of LEDs (detection of fluorescence up to skin depth of 340 µm) more than lipid solution, which revealed fluorescence up to skin depth of only 260 µm. In summary the present findings demonstrate that i) cationic lipid with 5 membered amine heterocyclic ring has higher permeating efficacy than the 6 membered amine hertocyclic ring. ii) The nanoparticle system prepared with Cy5 showed significant (p<0.05) increase in the permeation of the drugs than the control penetration enhancers, oleic acid and NMP.