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Lymphatic drainage from subcutaneous tissue in the foot and leg in the sitting human.

To determine how fast lymph is drained from the foot in the sitting, completely relaxed position, we injected 99mTc-labelled human serum albumin subcutaneously between the first and second toe of both feet in three subjects sitting with legs down. Radioactivity appeared in the calf within the first 30 s, in the thigh within 1 min and in the blood between 2 and 5 min after injection. A scintigram of the calves showed distinct strands of activity. Radioactivity was found in the inguinal lymph nodes and in no other lymph nodes. The radioactivity in the segments of the calf showed rhythmic variations. EMGs showed minimal muscular activity during the examination. We conclude that interstitial fluid is drained by way of the lymphatics against gravity and most probably as a result of the intrinsic contractions of the lymphatics.

Adult↗

Studies on the pharmacokinetics of cefoxitin, cefuroxime, cephaloridine and cephalothin using subcutaneous tissue cages.

The present study was undertaken to compare the ability of three cephalosporins--cephalothin, cephaloridine and cefuroxime--and a cephamycin--cefoxitin--to penetrate into extravasal compartments. The study was performed using female adult rabbits with subcutaneously implanted steel net cages. All antibiotics were given in a dose of 50 mg/kg b.w. parenterally as i.v. injections. The concentrations of the different antibiotics were determined simultaneously in serum and in fluid obtained from the cages. The concentrations were followed after single doses as well as after repeated doses using an agar well technique for the assays. To control the experimental conditions electrolyte and protein contents of the fluid in the different cages were followed and were found to be stable during the experimental period. All antibiotics were rapidly eliminated from serum. The concentrations in the cages reached its maximum 1.5-3 hours after administration. The highest concentrations in the extravasal compartments were obtained with cephaloridine and the lowest with cephalothin with the values of the other antibiotics ranging in between.

Animals↗

Case report: phaeohyphomycosis due to Curvularia lunata involving skin and subcutaneous tissue after an explosion at a chemical plant.

Cases of phaeohyphomycosis due to dematiaceous fungi have been reported in increasing numbers and diversity. The optimal roles of antifungal chemotherapy and surgical debridement in the management of these infections have not been determined. A case of acute cutaneous and subcutaneous phaeohyphomycosis due to Curvularia lunata after an explosion at a chemical plant is reported, in which the organisms may have been inoculated into the tissues by the force of the blast. No organisms were found by histopathologic examination or culture of excisional biopsy specimens taken 10 days after initiation of therapy with intravenous amphotericin B; the antifungal therapy may have eradicated the infection.

Accidents, Occupational↗

Age-related increase of collagen fluorescence in human subcutaneous tissue.

Nonenzymatic glycation produces compounds with characteristic fluorescence in long-lived proteins. We recently described the influence of age in rat collagen-linked fluorescence. To examine the effect of age in humans, we studied the subcutaneous collagen-linked fluorescence in samples from 26 subjects of both sexes (age range, 42 to 78 years) who were undergoing vascular surgery. Intensity of fluorescence at 385 nm (upon excitation at 335 nm) and 440 nm (upon excitation at 370 nm) increased exponentially with age (r = .827, y = 114 + e0.038x, P less than .001; and r = .905, y = 36 + e0.039x, P less than 0.001, respectively). The two sets of data exhibited a high degree of correlation (r = .980, P less than .001, n = 26). Age-adjusted fluorescence data did not correlate with sex, body weight, or type of vascular pathology. The collagen fluorescence accumulation rate was 3.7% per year, and the characteristic time (CT) was 26 to 27 years. We conclude that the fluorescence measurement is a reliable methodology that can be used as a marker for biological age until new, more-specific tools are available.

Adult↗

Subcutaneous tissue reaction to synthetic auditory ossicle (Apaceram) in rats.

A study was carried out in order to obtain further information about the soft tissue response to thin Apaceram discs of dense hydroxyapatite (HA) implanted in rats for various periods of time between one day and 10 months. The Apaceram discs were implanted subcutaneously into the interscapular region of 33 rats. A sham operation was performed on eight rats used as controls. Decalcified histological sections stained with haematoxylin and eosin and Mallory's azan were examined and the different cell types found around the implants were counted. It was found that an acute inflammatory reaction occurred after one day and disappeared at about two weeks after implantation. In the test groups, macrophages and lymphocytes disappeared about one week later, and no inflammatory reaction was observed from one to three months. However, a tissue reaction occurred at six months with the appearance of macrophages and lymphocytes, and decreased gradually at 10 months. Meanwhile, a few foreign body giant cells at the Apaceram-tissue interface and a thick layer of fibrous connective tissue around the Apaceram disc were observed at 10 months. No osteogenesis was observed in any specimen. The results obtained so far suggest that Apaceram is still a useful material for reconstructive surgery, despite the possible appearance of a slight macrophage reaction at six months.

Animals↗

Adjuvators to the propagation of mouse mammary tumor cells on expanses of subcutaneous tissue.

The cells of a mouse mammary cancer were obtained with enzymes in suspensions which could be filtered to exclude all which were not single and most which were already dead. Heavy suspensions of these individual cells were plated over the dorsal subcutaneous expanses of female weanling mice where they implanted and grew to form coalescent tumors covering the back more or less entirely. Sparser suspensions, similarly plated (a) gave rise to fewer tumors, and (b) gave rise to tumors reaching measurable size later. These two consequences of sparser plating left room for the testing of adjuvators to transplantation. Adjuvator effects were obtained by splitting the subcutaneous expanses beforehand and by injecting liver along with the plated cells. Through 28 plated generations over 4 yr the tumor maintained completely stable, morphological heterogeneity. These findings with a complex tumor indicate strongly that its heterogeneity comes not from repeated cellular mutation late in its development, but from diverse potentiality to give rise to cells of specific and differing character, inherent in its individual cells at the time of its multicellular origin.

Animals↗

Transcapillary forces in subcutaneous tissue of patients following operation for lower limb atherosclerosis.

Colloid osmotic pressure in plasma (COPpl) and in interstitial fluid (COPif) was measured in 18 healthy controls and 38 patients with leg oedema following femoropopliteal arterial reconstruction. Interstitial fluid was collected from nylon wicks which had been implanted subcutaneously for 1 h. Interstitial fluid pressure was measured with the 'wick-in-needle' technique. The patients were examined once in the period 1-16 days after surgery. Twenty-three had oedema at the time of examination. Nearly all recordings of patients with oedema were performed 4-16 days postoperatively. Mean increase in leg volume in patients with oedema was 20%. Mean COPif of the operated extremity were 5.4, 6.8 and 7.5 mmHg in the periods 1-3, 4-7 and 8-16 days after surgery, respectively. These values were lower than in controls (9.3 mmHg, P less than 0.05). Mean COPif in the operated leg was 1.2 mmHg lower than in the contralateral leg of patients without oedema. In patients with moderate oedema (less than 15% leg volume increase) this difference was approximately three times higher. For more extensive oedema the difference declined, and above 20% leg volume increase, COPif of nearly all legs operated on was higher than the contralateral. This probably reflects an increased transcapillary fluid filtration in patients with moderate oedema whereas lymphatic obstruction due to the surgical procedure is the main causative factor in patients with extensive oedema. Compared to the contralateral leg, mean increases in Pif of the leg operated on were 0.6, 2.3 and 3.6 mmHg in the three investigation periods respectively. Pif in operated legs in the two last periods was also higher than in controls (-0.7 mmHg, P less than 0.005). Increased Pif may thus contribute towards limiting oedema formation postoperatively.

Adolescent↗

Leiomyosarcomatosis involving the duodenum and the subcutaneous tissue.

Soft tissue sarcomas include only 0.7% of all malignancies and leiomyosarcomas constitute about 10% of all sarcomas. Very rarely leiomyosarcoma may present as multifocal primaries. We report a 65-year-old patient with multiple subcutaneous nodules. During the investigation period the patient had hematemesis and melena. Upper gastro-intestinal endoscopy was performed and multiple polipoid lesions were discovered in the duodenum. The rest of gastrointestinal system was normal with barium graphies. Biopsies from the subcutaneous nodules and duodenal lesions showed leiomyosarcoma. Although we cannot rule out the possibility of metastases, we strongly consider a multicentric origin since no other metastasis is present and duodenal lesions are also multiple.

Aged↗

The effectiveness of local injections of vasodilating agents to produce vasodilation in subcutaneous tissue in rabbits.

The isotope washout method has been widely used to study characteristics of the microcirculation in localized vascular beds. Some of these studies have used local injections of vasodilating agents to maximally dilate the vascular bed. This study was undertaken to determine the agent most effective in producing this critical vasodilation. A rabbit model was constructed that allowed the study of the subcutaneous blood flow by either 133Xe and 131I-antipyrine washout. Dose-response curves were constructed for five agents. The agents used and the doses that produced the maximum washout rate, were histamine (100 micrograms), verapamil (0.5 mg), prostaglandin E1 (6 micrograms), papaverine (5 mg) and nitroprusside (60 micrograms). The five agents at these doses were compared with each other, and nitroprusside produced a greater washout rate than papaverine (P less than 0.005), histamine (P less than 0.001) and verapamil (P less than 0.005). There was no difference between nitroprusside and prostaglandin E1 (P greater than 0.01). The effect of three of the agents in producing tissue oedema was examined by comparing the washout rates values obtained with the two isotopes. Both nitroprusside and papaverine produced large oedema whereas histamine resulted in little oedema formation. Nitroprusside, therefore, appears to be the most suitable vasodilating agent for use in studies which require maximum vasodilation of localized vascular beds.

Alprostadil↗

Mixed nonseminomatous germ cell tumor presenting as a subcutaneous tissue mass.

Extragonadal germ cell tumors most commonly arise in the midline of the retroperitoneum or the mediastinum. Primary tumors involving the skin are very rare. Only one case of malignant primary germ cell tumor located in the skin has been reported. We present the case of a 44-year-old white man with a primary subcutaneous mixed nonseminomatous germ cell tumor. This man had a long-lasting subcutaneous lump of the breast, which became painful. Surgery revealed 3 juxtaposed nodules. Microscopic examination showed a mixed germ cell tumor with a 90% immature teratoma component and a 10% embryonal carcinoma component. Testicular ultrasound and computed tomography of the chest, abdomen, pelvis, and brain were normal. Serum human chorionic gonadotrophin, beta-human chorionic gonadotrophin, alpha-fetoprotein, and lactate dehydrogenase were within normal ranges. A further surgical excision was performed. The patient is presently alive with no evidence of disease after a follow-up of 7 years. Review of the literature indicates that primary cutaneous extragonadal germ cell tumors usually occur as cutaneous or subcutaneous solitary nodules or as ulcerated lesions. They mainly consist of mature teratomas in children. Only 2 cases have been reported in adults.

Adult↗

Delivery of erythromycin to subcutaneous tissues in rats by means of a trans-phase delivery system.

Topical administration of antibiotics is associated with reduced risk of systemic side-effects and alteration of gut microflora, and results in higher concentrations of antibiotics at the site of application (and so a lower dose of the drug is required). In conditions such as acne vulgaris, infiltration of the antibiotics into the infected subcutaneous layers is highly desirable. A trans-phase delivery system (TPDS), a mixture of benzyl alcohol, acetone and isopropanol, has been shown to enhance the effective transport of the antibiotic erythromycin across the epidermal barrier and enhance accumulation in the dermis. Two formulations containing N-methyl[14C]erythromycin were compared, a TPDS solution and a propylene glycol solution. They were applied to the dorsal areas of 4-6 week old Fischer rats and tissues were removed for analysis of radioactivity after 2, 4, 8, 12 or 24 h and skin was biopsied and sectioned for autoradiography. The erythromycin dissolved in the TPDS solvent mixture penetrated the stratum corneum and a relatively high concentration was maintained in adjacent tissues for up to 24 h. Penetration was very effective and the erythromycin was detected in significant amounts in the underlying muscle, various organs and later in the urine. In contrast the propylene glycol carrier, probably because of its primarily hydrophilic character, caused the erythromycin to traverse tissue barriers rapidly and appear in the urine. Microautoradiographs qualitatively revealed progressive disappearance of radioactivity from the surface; this correlated with results obtained by direct isotope counting. The route of penetration, in addition to following the interkeratinocyte spaces, seemed to include the perimeter of the pilosebaceous glands and their appendages before diffusion into the capillaries. The propylene glycol solution seemed to traverse the epidermis and the papillary and reticular dermis more rapidly, which might explain its rapid appearance in the urine. These data suggest that the different solutions penetrate the skin by different mechanisms.

Administration, Cutaneous↗

Ganglion migrans of the proximal tibiofibular joint causing lesions in the subcutaneous tissue, muscle, bone, or peroneal nerve: report of three cases and review of the literature.

Three cases illustrate the variety of ways a ganglion may arise from the tibiofibular joint. In one case, the diagnosis was initially obscure because the swelling occurred under the muscles of the lateral compartment of the lower leg; the lesion was also intraosseous and extended into a tendon. In the second case, the ganglion had invaded the peroneal nerve, and in the third, the ganglion was a palpable subcutaneous tumor.

Adolescent↗