Use of a Skin-Covering Pocket as a Local Flap and Negative Pressure Wound Therapy with Instillation and Dwell Time/Negative Pressure Wound Therapy for the Treatment of Diabetic Foot Ulcer with Calcaneal Osteomyelitis: A Case Report.

For diabetic foot ulcers with "pockets" (wound edge undermining), a surgical incision to the undermining space and debridement are required primarily. Osteomyelitis should be treated if present. Furthermore, it is necessary for the foot to be able to withstand load after controlling the infection and necrosis. We report a case of a patient treated with a skin-covering pocket as a local flap and negative pressure wound therapy with instillation and dwell time and negative pressure wound therapy to relieve osteomyelitis and promote wound contraction. There was no involvement of other body parts, and only the pocket consisting of skin at the sole of the foot was used, and load could be withstood.

Vasodilating Effects of Antispasmodic Agents and Their Cytotoxicity in Vascular Smooth Muscle Cells and Endothelial Cells-Potential Application in Microsurgery.

This study aimed to elucidate the vasodilatory effects and cytotoxicity of various vasodilators used as antispasmodic agents during microsurgical anastomosis. Rat smooth muscle cells (RSMCs) and human coronary artery endothelial cells (HCAECs) were used to investigate the physiological concentrations and cytotoxicity of various vasodilators (lidocaine, papaverine, nitroglycerin, phentolamine, and orciprenaline). Using a wire myograph system, we determined the vasodilatory effects of each drug in rat abdominal aortic sections at the concentration resulting in maximal vasodilation as well as at the surrounding concentrations 10 min after administration. Maximal vasodilation effect 10 min after administration was achieved at the following concentrations: lidocaine, 35 mM; papaverine, 0.18 mM; nitroglycerin, 0.022 mM; phentolamine, 0.11 mM; olprinone, 0.004 mM. The IC50 for lidocaine, papaverine, and nitroglycerin was measured in rat abdominal aortic sections, as well as in RSMCs after 30 min and in HCAECs after 10 min. Phentolamine and olprinone showed no cytotoxicity towards RSMCs or HCAECs. The concentrations of the various drugs required to achieve vasodilation were lower than the reported clinical concentrations. Lidocaine, papaverine, and nitroglycerin showed cytotoxicity, even at lower concentrations than those reported clinically. Phentolamine and olprinone show antispasmodic effects without cytotoxicity, making them useful candidates for local administration as antispasmodics.

Case Report of Complete Second Branchial Fistula.

Background: Branchial fistulas are anomalies of embryonic development of the branchial apparatus, with the most common being second branchial fistulas. However, complete fistulas are infrequent and may relapse. Furthermore, they are difficult to manage without adequate treatment. Methods: This article presents the case of a complete second branchial fistula in a 1-year-old female patient who had a sinus on the right side of the neck since birth. Excision of the fistula tract was performed without preoperative fistulography. The tract was then ligated and dissected immediately below the mucosa. Results: The postoperative course was uneventful, and there was no evidence of recurrence. Conclusions: Previous case reports have also demonstrated good outcomes without excision of the internal opening or tonsillectomy.

Cutaneous Angiokeratoma Treated With Surgical Excision and a 595-nm Pulsed Dye Laser.

Background. Angiokeratomas are vascular neoplasms with hyperkeratotic red to black papules and plaques, which may present as solitary or multiple lesions with variations in color, shape, and location. Successful treatment not only involves improvement of these symptoms but also cosmetic improvement. This report reviews 2 cases of cutaneous angiokeratoma treated with surgical excision and a 595-nm pulsed dye laser (PDL) in which the patients showed improvement of symptoms and cosmetic appearance. There are various types of angiokeratomas, and their extent, size, condition, and symptoms are different. Therefore, lesion-specific combined treatments may yield better results.

Surgical Management of Pachydermodactyly (PDD) via Midaxial Incision: A Case Report.

Pachydermodactyly (PDD), meaning "thick skin finger" in Greek, is a rare, noninflammatory, benign, superficial fibromatosis. We report the case of PDD in a 15-year-old boy who visited our clinic because of asymptomatic swelling of the proximal interphalangeal (PIP) joints on the third finger of both left and right hands. Physical examination revealed thickening of the skin in the radial and ulnar aspects of the PIP joints of his third finger of both hands without functional limitation or neurological symptoms. He had a habit of biting his swelling fingers, and he belonged to a basketball club at his junior high school. He had no medical history. Plain radiographs and magnetic resonance imaging of both hands showed only soft tissue thickening outside of the radial and ulnar collateral ligament of the bilateral third PIP joint. The lesions were suggestive of PDD. Surgical resection was performed via a midaxial incision and a Z-plasty to confirm the diagnosis and improve the aesthetic appearance of his hands. Histopathological examination of the lesions was compatible with PDD. After surgery on the left hand, the patient underwent the same surgery on the right hand. No recurrence or complications were observed at the one-year follow-up after surgical intervention. Thus, surgery for PDD via a midaxial incision may be a good treatment option for patients who wish to rectify the appearance of their digital deformity.

Complications arising from transfemoral, percutaneous implantation of an indwelling port-catheter system for hepatic infusion chemotherapy: Case series of the management and salvage of the system.

INTRODUCTION: Regional hepatic arterial infusion of chemotherapy is performed for unresectable liver tumors via percutaneously implanted port-catheter systems; while these port-catheter systems are effective administration routes, they are associated with various complications. Withdrawal of the system is considered if the complications occur, but repeated hepatic arterial infusion of chemotherapy (HAIC) via an implanted port-catheter system is a last-resort treatment for unresectable advanced liver cancer, and the treatment must be continued. We discuss various cases with complications arising in the indwelling port area in hepatic arterial infusion of chemotherapy and report whether the system was salvaged. METHODS: Between August 2013 and October 2017, eight patients (six males and two females) aged 61-80 years (mean age 76.6 years) with complications arising in a transfemoral indwelling port site for HAIC were referred to our department. All patients requested preservation of the system, especially the catheter. Each patient was assessed for the presence of "gross infection" based on a comprehensive evaluation of clinical findings and blood test results. In cases of "no gross infection," we performed catheter salvage procedures. If there was no clinical improvement following the catheter salvage procedure, the port-catheter system was withdrawn. This research work has been reported in line with the PROCESS criteria. RESULTS: The port-catheter systems were withdrawn in two patients: one due to lasting infection and the other due to ulcer recurrence. Three cases were treated by removal of hematoma through an incision and ointment. The system was withdrawn in one of these cases due to exacerbation of ulcer; thus, the catheters were salvaged in five patients. None of these five patients experienced a relapse from 3 months to over 1 year after the procedure. CONCLUSION: The success of subcutaneous HAIC significantly impacts a patient's prognosis, especially for unresectable tumors and residual tumor recurrences. Initially, we chose to preserve the devices without removal, particularly if there was no infection. However, this approach led to a delay in chemotherapy, prolongation of healing time, and additional complications. These cases demonstrate the importance of a thorough consultation with the patient's oncologist to discuss whether or not the device should be conserved.

Keratin 19-positive cutaneous squamous cell carcinoma with elevated serum cytokeratin 19 fragment 21-1 level: A case report.

cytokeratin 19 fragment 21-1 (CYFRA21-1) is a marker of lung cancer useful for evaluating clinical diagnosis and prognosis. To the best of our knowledge, there have been no reports of cutaneous squamous cell carcinoma (SCC) with high levels of CYFRA21-1 to date. We herein report a case of a 79-year-old man with a large subcutaneous tumor of the left shoulder, which was diagnosed as primary cutaneous poorly differentiated SCC. The tumor nests were composed of poorly differentiated atypical squamous cells exhibiting high-grade malignancy and mitotic figures; multinuclear cells were also identified inside lymph vessels. Keratin 19 (K19) was intensely expressed in tumor cells. A significantly elevated level of CYFRA21-1 (33 ng/ml) was observed preoperatively. After surgery, the level of CYFRA21-1 was significantly decreased (from 33 to 5.0 ng/ml). Our case demonstrated that K19-positive primary cutaneous undifferentiated SCC induced high levels of CYFRA21-1 in the serum. Thus, CYFRA 21-1 may be a marker indicative of poorly differentiated cutaneous SCC exhibiting K19 expression.

Flexibility of the coordination geometry at the N-site of Cu(II)2 human serum-transferrin induced by the different orientations of Arg124.

The ESR spectra of dicupric human serum-transferrin (serum-Tf) were measured from -20 to 37°C in the liquid state (56% glycerol at pH 7.6). Two coordination geometries (types B-1 and B-2) with different ESR parameters were present at the N-site. The contents of the coordination geometry of type B-1 at the N-site increased as the temperature increased. The equilibrium constant between the coordination geometries of types B-1 and B-2 was determined by ESR spectra. The enthalpy value from type B-2 to B-1 was +5.3 kcal/mol, as obtained from a van't Hoff plot. The two conformational energies of the cluster models of the copper-binding site at the N-site of dicupric human serum-Tf, where the Arg124 residue was oriented in two different directions (conformations I and II), were calculated by Density Functional Theory, and the enthalpy value from conformation II to I was +2.1 kcal/mol. The enthalpy value was similar to that (+5.3 kcal/mol) obtained by the coordination geometrical change from type B-2 to B-1 in Cu(II)2 serum-Tf. In conformations I and II, the residue of Arg124 at the N-site is located either far from or near the copper-binding site, respectively, and in both cases the coordination geometry of the cupric ions at the N-site has changed from a flattened tetrahedron to a trigonal bipyramid. This result implies that the ESR spectral change from type B-2 to B-1 is caused by the presence of two different orientations of Arg124 in the change from conformation II to I.