前臂后皮神经营养血管远端蒂筋膜皮瓣修复手部软组织缺损

目的：探讨前臂后皮神经营养血管远端蒂筋膜皮瓣修复手部软组织缺损的临床效果。方法：对18例手部创伤性软组织缺损创面采用带前臂后皮神经营养血管远端蒂筋膜皮瓣进行修复,其中机器绞伤11例,压砸伤5例,电锯伤2例,皮瓣面积最大为12cm×8cm,最小7cm×5cm。结果：17例皮瓣完全成活;1例皮瓣边缘部分坏死,经清创换药痊愈。术后随访6～12个月,皮瓣质地良好,外观满意。结论：前臂后皮神经营养血管远端蒂筋膜皮瓣切取简便、成功率高,是修复手部软组织缺损的理想供区。     

前臂桡动脉皮支血管网逆行筋膜皮瓣的解剖学基础

目的；为前臂桡动脉皮支逆行筋膜皮瓣修复手部创面提供解剖学基础。方法：采用２３民人上肢标本，分别从桡骨茎突上５ｃｍ处桡动脉和肱动这灌注墨汁和红色乳胶，解剖观测动脉下段发出的皮动脉分支数目、管径、高度、分布范围及与其它皮动脉的交通与吻合。结果：桡动脉下段（桡骨茎突尖上５ｃｍ范围内）桡侧发出有２￣３知，尺侧发出有２￣２条皮劝脉。官些与腕部动脉网的皮支间有广泛的交通与吻合。结论：桡动脉下段的皮动脉与腕部网     

Cutaneous zygomycosis: necrotising fascitis due to Saksenaea vasiformis

Saksenaea vasiformis is an emerging human pathogen, most often associated with cutaneous or subcutaneous lesions following trauma. This is the report of a case of subcutaneous zygomycosis from which Saksenaea vasiformis was isolated on culture. As the patient developed acute interstitial nephritis, amphotericin B could not be administered in full dose. Surgical debridement was carried out, but the patient deteriorated gradually and died. To the best of our knowledge, this is the first reported case of Zygomycosis due to Saksenaea vasiformis from Visakhapatnam.     

Constitutive Modeling of Rate-Dependent Stress–Strain Behavior of Human Liver in Blunt Impact Loading

An understanding of the mechanical deformation behavior of the liver under high strain rate loading conditions could aid in the development of vehicle safety measures to reduce the occurrence of blunt liver injury. The purpose of this study was to develop a constitutive model of the stress–strain behavior of the human liver in blunt impact loading. Experimental stress and strain data was obtained from impact tests of 12 unembalmed human livers using a drop tower technique. A constitutive model previously developed for finite strain behavior of amorphous polymers was adapted to model the observed liver behavior. The elements of the model include a nonlinear spring in parallel with a linear spring and nonlinear dashpot. The model captures three features of liver stress–strain behavior in impact loading: (1) relatively stiff initial modulus, (2) rate-dependent yield or rollover to viscous “flow” behavior, and (3) strain hardening at large strains. Six material properties were used to define the constitutive model. This study represents a novel application of polymer mechanics concepts to understand the rate-dependent large strain behavior of human liver tissue under high strain rate loading. Applications of this research include finite element simulations of injury-producing liver or abdominal impact events.

Cutaneous actinomycosis: a rare case

Cutaneous actinomycosis is a rare presentation. Here we present a case of cutaneous actinomycosis with no history of trauma or systemic dissemination. The isolate was identified as Actinomyces viscosus by standard methods. The isolate was found to be penicillin resistant by Kirby Bauer disc diffusion method. Therefore, the patient was treated with cotrimoxazole and improved. Thus, this case highlights the importance of isolation and susceptibility testing in actinomycotic infection. The sinuses have healed, and the patient has recovered.     

Cutaneous larva migrans--a case report

Cutaneous larva migrans or creeping eruption is an uncommon parasitic skin infection caused by the filariform larvae of dog or cat hook worms. We report a case of larva migrans on the anterior abdominal wall, in a 52 year old lady, who did gardening as a hobby.     

Cutaneous histoplasmosis in AIDS

A patient with human immunodeficiency virus (HIV) infection presented with multiple cutaneous lesions on upper extremities, trunk, face and with ulcers involving oral mucosa. Histoplasma capsulatum was isolated in culture from scrapings from both cutaneous as well as oral mucosal lesions. The patient responded well initially to the treatment with Amphotericin B followed by itraconazole; however, lesions recurred after three months with the further deterioration of immune status of the patient indicated by decline in CD4 counts. The same treatment was restarted and the patient is still being followed-up.     

Cutaneous vasodilatation responses synchronize with sweat expulsions

To examine whether cutaneous active vasodilatation is mediated by sudomotor nerve fibres we recorded cutaneous blood flow and sweat rates continuously with laser-Doppler flowmetry and capacitance hygrometry, respectively, from the dorsal and plantar aspects of the foot in 11 male subjects at varying ambient temperatures (T _a) between 22 and 40°C (relative humidity 40%). In a warmer environment (T _a 29–40°C), predominant responses of the blood flow curve from the sole of the foot were transient depressions (negative blood flow responses, NBR), whereas those from the dorsal foot were transient increases (positive blood flow responses, PBR). The PBR on the dorsal foot occurred spontaneously or in response to mental or sensory stimuli, and when PBR did not fuse with each other the rate of PBR was linearly related to tympanic temperature. When dorsal foot sweating was continuous, PBR on the dorsal foot almost entirely synchronized with sweat expulsion. When dorsal foot sweating was intermittent PBR sometimes occurred on the dorsal foot without corresponding sweat expulsions, but these PBR showed a complete correspondence with subthreshold sweat expulsion seen on a methacholine-treated area. The amplitude and the duration of PBR showed a significant linear relationship with the amplitude and the duration of the corresponding sweat expulsion. In a thermoneutral or cooler environment (T _a 22–29°C), PBR occurred on the sole of the foot when mental or sensory stimuli elicited sweating in that area. Thus, PBR occurred when and where sweating appeared. Atropine failed to abolish PBR on the dorsal foot. Blockade of the peroneal nerve eliminated both PBR and NBR on the dorsal foot. The results indicate that an active vasodilatation mechanism is present on the sole of the foot as well as on the dorsal foot, and thus suggest that active vasodilatation is closely related to sudomotor nerve activation.     

Cutaneous zygomycosis caused by Saksenaea vasiformis in a diabetic patient.

A 49-year-old woman with diabetes mellitus rapidly developed necrotizing cellulitis with fat necrosis and vasculitis after minor trauma to the right arm. Zygomycosis was diagnosed histologically. The lesion responded to aggressive debridement, amphotericin B, and normalization of blood glucose. Cultures yielded structures characteristic of Saksenaea vasiformis only after transfer to saline agar.     

Innate Immunity: A Cutaneous Perspective

The first responsibility for protection against microbial infection rests on the normal function of the innate immune system. This system establishes an antimicrobial barrier, recognizes attempts to breach this barrier, and responds rapidly to danger, all based on an innate defense system. Here, we review this system as it applies to mammalian skin, highlighting how a physical, cellular, and chemical barrier is formed to resist infection. When challenged, the diverse cellular components of the skin recognize the nature of the challenge and respond with an appropriate antimicrobial program including the release of antimicrobial peptides and, when necessary, recruitment and coordination with adaptive immune responses. Recent insights into these processes have advanced the understanding of disease pathogenesis and provided new therapeutic options for a variety of skin diseases.     

Immunohistochemical Characterization of Human Cutaneous Mast Cells in Urticaria Pigmentosa (Cutaneous Mastocytosis)

To clarify the origin and function of human cutaneous mast cells (CMCs), immunohistochemical characterization was done in 19 cases of urticaria pigmentosa (cutaneous mastocytosis) using 9 antibodies (anti leukocyte common antigen, MX-PanB, anti lysozyme, anti α₁, antitrypsin, anti α₁-antichymotrypsin, anti vimentin, anti-neuron specific enolase, anti factor VIII related antigen, and anti-ACTH). CMCs showed positive reactions with anti α₁ anti-chymotrypsin and anti vimentin in almost all of the specimens. In more than half of the specimens, CMCs were stained positively with anti -α₁-antitrypsin, MX-PanB, and anti factor VIII related antigen. Anti-leukocyte common antigen and anti ACTH also showed positive reactions in some specimens. These results confirm the existence of vimentin filaments in CMCs and suggest a functional role of CMCs in hemostasis via factor VIII. Furthermore, immunohistochemical similarity between CMCs and granulocyte/macrophage group cells is also suggested.     

Cutaneous infection with Mycobacterium fortuitum: an unusual presentation

Cutaneous infection with rapidly growing mycobacteria is uncommon and its diagnosis can be missed unless there is strong clinical suspicion coupled with microbiological confirmation. We report a case of localized recurrent soft tissue swelling of the foot by Mycobacterium fortuitum in a healthy adult male. The case is being reported for its uncommon clinical presentation and the associated etiological agent. The patient recovered completely following therapy with amikacin and clarithromycin.     

Cutaneous leishmaniasis: an increasing threat for travellers

Analysis of the literature on cutaneous leishmaniasis in low-prevalence countries suggests an increase in imported cases that is attributable to the growing phenomenon of international tourism, migration and military operations in highly endemic regions. Cases of imported cutaneous leishmaniasis are often missed initially, but diagnosis can be made non-invasively by PCR using skin scrapings of lesions as starting material. Cutaneous leishmaniasis is an emerging threat for travellers and should be considered in all patients presenting with slow-to-heal ulcers.     

Cutaneous depression of Ib reflex pathways to motoneurones in man

Summary Variations in the H-reflex of soleus (Sol), quadriceps (Q) and short head of biceps femoris (Bi) muscles in normal man were used to investigate the effect of volleys in low threshold cutaneous afferents from the ipsilateral limb on transmission of Ib effects from ankle and Q muscles to these different motoneurone (MN) pools. Stimulation of cutaneous afferents from the foot sole and the toes (but not from the thigh, knee or calf), which did not modify the size of the test reflexes when applied alone, strongly depressed Ib reflex pathways to MNs supplying muscles operating at the knee. The very brief central latency of this depression suggests that tactile cutaneous afferents from the foot have oligosynaptic spinal connexions with the interneurones intercalated in the Ib pathways to MNs. The same cutaneous stimuli did not at all modify Ib inhibition of Sol MNs from triceps surae. These findings are discussed with regard to the role of the different muscles in human locomotion. It is suggested that during the stance phase of heel bipedal locomotion, the cutaneous depression of Ib reflex pathways to MNs supplying muscles operating at the knee might operate in association with the strong Ia connexions from ankle to knee muscles described in the previous paper.This work was supported by grants from Pierre et Marie Curie University (Paris VI) and from the Institut National de la Santé et de la Recherche Médicale (INSERM, 78.1.269.6)Attachée de recherches à l'INSERM     

不同年龄和部位女性皮肤微循环变化

目的观察不同部位皮肤血管结构和形态差异,研究年龄对真皮微循环功能的影响.方法采用活体电视毛细血管镜(Intravital Video-capillaroscopy)和激光多谱勒血流仪(laser Doppler flowrnetry)对50名年龄在20～74岁,光皮肤类型为Ⅱ～Ⅲ型白人女性志愿者的前额、眼角、前臂内侧和手背血管作初步观察.并用计算机图象处理技术,对前臂和手背活体真皮血管密度作定量分析.结果真皮乳头毛细血管襻在活体电视毛细血管镜下为点状或逗点状;乳头下的血管丛表现为线条状或网状;年轻人皮肤血管排列整齐,年龄较大者血管扩张增粗、扭曲,排列不规则.年龄与襻状血管数、襻状血管面积显著负相关;与襻状血管间距、平行血管总长正相关;真皮血流量面部高于肢端;随年龄的增加真皮血流有逐渐增加趋势.结论年龄影响真皮微循环的形态和功能.两种无创性检测技术联合应用能动态研究活体真皮血管的形态和结构,在皮肤血管性疾病的诊断和治疗方面有较高的应用前景.     

原发皮肤“消退性”恶性黑色素瘤的临床病理特征

目的 探讨原发皮肤“消退性”恶性黑色素瘤的临床病理特点、预后和鉴别诊断.方法 收集2009至2012年间原发皮肤“消退性”恶性黑色素瘤8例,总结临床病理、治疗和随访资料.常规HE染色和免疫组织化学EnVision法染色行组织病理形态学观察.结果 患者年龄40 ～ 69岁(平均58岁),男女比3∶1,发生部位分别为背部4例,足底2例,足趾腹面1例,上臂1例.临床上,6例初始表现为逐渐增大的皮肤黑斑,随后出现局部区域皮损颜色变浅并扩大,最终可呈瘢痕样.2例表现为散在簇状分布多灶黑点黑斑.组织学上,完全消退型3例,其中1例表现为肿瘤样黑变病.广泛消退型5例,消退比例达75％ ～ 90％,大部分区域示完全消退期图像,局部区域呈消退进行期改变,Breslow厚度0.5 ～1.0 mm.免疫组织化学标记显示淋巴结内转移灶和广泛消退型原发灶内残留的少量黑色素瘤细胞均弥漫强阳性表达S-100蛋白、HMB45和Melan A.吞噬黑色素的组织细胞CD68阳性.8例均获得随访,随访时间8～ 27个月(中位时间13个月),5例无瘤生存;3例发生远处转移,其中1例带瘤生存,2例死亡.结论 消退性恶性黑色素瘤是一种好发于中老年人罕见的特殊类型的黑色素瘤,诊断时应综合临床病史和病理学改变.消退≥75％是T1期(Breslow厚度≤1 mm)恶性黑色素瘤预后的一个不利因素,建议行病灶局部广泛切除术同时予以前哨淋巴结活检.