Treatment of warts

ABSTRACT: Warts are caused by human papilloma viruses (HPV) and more than 80 types of HPV have been described. Although some HPV types in the anogenital area can lead to dysplasia and cancer, most HPV infections cause histologically benign warts. Clinically, warts produce much morbidity, mainly due to their resistance to most standard therapies. Although the choice of therapy depends partly on the location of the warts, i.e., anogenital vs. non-anogenital, most treatments in the past have been anti-wart but not antiviral. Therefore, removal of the wart was often followed by a recurrence in a few weeks due to sub-clinical or latent HPV infections surrounding the wart. Such non-antiviral therapies included a variety of acids, podophyllin, podophyllotoxin, chemotherapeutic agents, retinoids, topical sensitizers, a spectrum of surgical techniques, and cryotherapy. Two drugs approved for anogenital warts have antiviral and immunomodulatory activity, interferon and imiquimod, although imiquimod is much more convenient to use. While neither of these antiviral agents is approved for non-anogenital warts, they do appear to have efficacy in these warts when used as adjunctive therapy. Experimental therapies for warts are currently under study and include topical cidofovir and both prophylactic and therapeutic HPV vaccines.     

Spontaneous or interferon-γ-induced T-cell infiltration, HLA-DR and ICAM-1 expression in genitoanal warts are associated with TH1 or mixed TH1/TH2 cytokine mRNA expression profiles

The purpose of the study was to investigate the cytokine gene expression patterns and immunohistochemical characteristics of genitoanal warts in order to obtain a clue as to the immunological mechanisms possibly relevant for wart regression or persistence. We analysed surgically removed warts from 11 patients, 2 of whom were immunosuppressed. Lesions of five of the nine otherwise healthy individuals were additionally treated with intralesional interferon-γ (IFNγ) prior to surgery. Invasion of CD4 ⁺ T cells into the papillomas and HLA-DR and ICAM-1 expression on keratinocytes were found in two otherwise healthy patients and were intensified by intralesional IFNγ in four of five patients. The mRNA expression patterns in seven of eight nonrecurrent warts were compatible with a predominant TH1 or mixed TH1/TH2 cytokine profile. In contrast, in recalcitrant warts of three patients (one healthy, two immunocompromised) histological signs of immunoreactivity and TH1-like cytokine mRNA expression were not detected. In recurrent warts of a renal transplant patient, IL-4 and IL-5 mRNA expression was repeatedly found suggesting a predominant TH2 response. In conclusion, immunoreactivity to genitoanal warts such as T-cell infiltration, HLA-DR and ICAM-1 expression was associated with a predominant TH1 or mixed TH1/ TH2 cytokine mRNA expression profile. Received: 5 August 1996     

运动性疲劳对健康男大学生足底压力分布的影响

目的:分析运动性疲劳对健康男大学生足底压力分布的影响,为科学指导锻炼提供依据。方法:10名普通男大学生沿400米跑道慢跑至中度疲劳,应用0.5米footscan誖USB平板测试系统对受试者运动性疲劳产生前后足底压力分布情况进行测试。结果:与疲劳前相比,运动疲劳后,(1)受试者足跟着地阶段明显变短,足支撑阶段明显变长;(2)左足T2-T5、M2、M4、M5和右足T1、T2-T5、M2、M3、M5、HM、HL各区域与地面的压强峰值显著降低;左足T2-T5区域、右足T1和T2-T5区域与地面压强峰值出现时间显著缩短,而其它部位压强峰值出现时间有延迟趋势;(3)左足T2-T5区域与地面接触时间显著缩短,M2区域显著延长;右足M1、M2、M3区域显著延长;(4)左足T2-T5区域与地面的接触面积显著减小,T1、M3、M5区域显著增大,而其它部位均有增大的趋势;右足除M3显著减小外,其它区域均表现出下降的趋势;(5)左足T2-T5、M5区域和右足M2、M3区域所受压强在时间上的积累(Pt)显著减小;(6)足平衡总体上呈现内外翻程度增大的变化趋势,但10名受试者中有3例疲劳前后的变化不明显。结论:运动性疲劳导致下肢肌肉力量减弱等生理机能下降,从而引起步态分期、足底压力分布参数、足平衡等发生相应变化。     

携带感觉神经足底内侧动脉皮瓣修复足跟软组织缺损的临床应用

目的　探讨携带感觉神经的足底内侧动脉皮瓣修复足跟区软组织缺损的临床应用效果。 方法　自2016年6月至2017年11月,笔者单位收治12例足跟皮肤软组织缺损患者,其中2例合并跟骨结节缺损(缺损长度小于1 cm)。采用携带感觉神经的足底内侧动脉皮瓣修复创面,创面面积（扩创后面积）为3 cm×4 cm~10 cm× 6 cm,切取皮瓣面积为3.5 cm×4.5 cm~11 cm×7 cm。通过观察皮瓣外观、血运、弹性及两点辨别觉评价临床效果。 结果　12例皮瓣完全成活。10例患者获随访6~14个月,皮瓣外观满意,质地柔软,无臃肿,弹性佳,两点辨别觉5~ 9 mm。8例无骨缺损患者穿鞋、行走不受限;2例合并骨缺损患者需穿软底带跟鞋且持续行走半小时感觉局部刺痛。 结论　携带感觉神经的足底内侧动脉皮瓣能较好的重建足跟外观、感觉及功能,是修复足跟软组织缺损的有效方式。     

The effect of foot plantar massage on balance and functional reach in patients with type II diabetes

Objective: The aim of this study was to investigate the effect of manual foot plantar massage (classic and friction massage) on functional mobility level, balance, and functional reach in patients with type II diabetes mellitus (T2 DM). Methods: A total of 38 subjects diagnosed with T2 DM were included in the study. A healthy control group could not be formed in this study. After the subjects’ socio-demographic data were obtained, Timed Up & Go (TUG) Test, functional reach test (FRT), one-leg standing test with eyes open-closed, and Visual Analogue Scale (VAS) to measure foot pain intensity were performed. The results were also divided and assessed in three groups according to the ages of the individuals (40–54, 55–64, and 65 and over). Results: As a result of statistical analysis, a difference was found in the values obtained from TUG, FRT, and one-leg standing test with eyes open and closed (p < 0.05). Following the massage, TUG values significantly decreased comparison with those before the massage, whereas the values of FRT and one-leg standing test with eyes open and closed significantly increased compared with those before the massage (p > 0.05). According to age groups, there were statistical differences (p < 0.05) between the TUG, one-leg standing test with eyes open and closed test values of the individuals before and after the massage. Conclusions: The results of our study indicated that application of plantar massage to patients with T2 DM caused an improvement in balance, functional mobility, and functional reach values. An increase in body balance and functional mobility may explain the improvement in TUG. Foot massage to be added to rehabilitation exercise programs of DM patients will be important in improving balance and mobility of patients.     

Sonographic diagnosis of plantar vein thrombosis: report of 3 cases.

OBJECTIVE: The purpose of this series is to describe sonographic findings in 3 patients with plantar vein thrombosis. METHODS: Three patients had sudden pain and swelling at the plantar side of the affected foot. Sonography of the plantar foot was performed with a broadband linear array working at 5 to 12 MHz. Gadolinium-enhanced magnetic resonance imaging was performed in 1 patient. RESULTS: Sonography showed enlarged incompressible plantar veins in all 3 cases. Magnetic resonance imaging confirmed venous thrombosis in 1 case. CONCLUSIONS: Pain and swelling at the plantar side of the foot can be caused by plantar vein thrombosis. This type of rare thrombosis can be diagnosed with sonography.     

Ultrasound guided injection of recalcitrant plantar fasciitis

OBJECTIVE—To determine the effect of ultrasound guided injection in recalcitrant idiopathic plantar fasciitis.
METHODS—Four patients with a clinical diagnosis of idiopathic plantar fasciitis, who were unresponsive to palpation guided injection with triamcinolone acetonide and local anaesthetic, underwent ultrasonographic examination of the heel.
RESULTS—The following ultrasonographic features were noted:- (a) increased thickness of plantar fascia in symptomatic heels compared with asymptomatic heels, (b) loss of distinction of the distal plantar fascia borders, (c) reduced echogenicity of the plantar fascia. Ultrasound guided injection of the enlarged, hypoechoic plantar fascia resulted in complete relief in four of five heels(mean duration of follow up=24 months) in three cases. One patient developed a recurrence of symptoms after six months.
CONCLUSION—Ultrasound allows for confirmation of the clinical diagnosis and ultrasound guided injection produces a good clinical response when unguided injection is unsuccessful. The technique is quick, inexpensive, and entails no radiation exposure.

Keywords: ultrasound guided; corticosteroid injection; plantar fasciitis     

The role of fasciae in Civinini–Morton's syndrome

This study evaluates the pathogenetic role of the perineural connective tissue and foot fasciae in Civinini–Morton's neuroma. Eleven feet (seven male, four female; mean age: 70.9 years) were dissected to analyse the anatomy of inter‐metatarsal space, particularly the dorsal and plantar fasciae and metatarsal transverse ligament (DMTL). The macrosections were prepared for microscopic analysis. Ten Civinini–Morton neuromas obtained from surgery were also analysed. Magnetic resonance images (MRIs) from 40 patients and 29 controls were compared. Dissections showed that the width of the inter‐metatarsal space is established by two fibrous structures: the dorsal foot fascia and the DMTL, which, together, connect the metatarsal bones and resist their splaying. Interosseous muscles spread out into the dorsal fascia of the foot, defining its basal tension. The common digital plantar nerve (CDPN) is encased in concentric layers of fibrous and loose connective tissue, continuous with the vascular sheath and deep foot fascia. Outside this sheath, fibroelastic septa, from DMTL to plantar fascia, and little fat lobules are present, further protecting the nerve against compressive stress. The MRI study revealed high inter‐individual variability in the forefoot structures, although only the thickness of the dorsal fascia represented a statistically significant difference between cases and controls. It was hypothesized that alterations in foot support and altered biomechanics act on the interosseous muscles, increasing the stiffness of the dorsal fascia, particularly at the points where these muscles are inserted. Chronic rigidity of this fascia increases the stiffness of the inter‐metatarsal space, leading to entrapment of the CDPN.