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Ultrasonography of nodular and infiltrative lesions of the skin and subcutaneous tissues.

Ultrasonography with high-frequency probes was performed on 80 dermatological patients carrying palpable lesions of the skin. The case list included hemo- and lymphangiomas (16 cases), cysts (13 cases), Kaposi sarcomas (9 cases), and panniculitis (20 cases). All lesions underwent open biopsy and histological examination. Ultrasound yielded technically adequate images in 74/80 cases (93%). Angiomas appeared as multiple transonic cavities separated by hyperechoic septa; cysts were usually echo free or weakly echogenic, with smooth outlines. Kaposi sarcomas corresponded to superficial hypoechoic nodules with blurred margins, while panniculitis appeared as a diffuse thickening of the subcutaneous space. When acute inflammation was present, as in most cases of erythema nodosum, a nonhomogeneous hypoechoic pattern was found.

Cysts↗

Clinical usefulness of the glucose concentration in the subcutaneous tissue--properties and pitfalls of electrochemical biosensors.

Biosensors are miniaturized analytical tools which comprise a biological detection element providing specificity to the analyte, and a physical transducer which guarantees an output signal, e.g. an electric current the size of which is proportional to the concentration of the analyte. They provide the unique possibility of continuous in vivo monitoring. Glucosensors were in fact the first biosensors under study. Among them, the most advanced devices are measuring amperometrically the hydrogen peroxide generated in a stoichiometric relation to the prevailing glucose concentration during glucose oxidase-mediated glucose oxidation. They proved useful in commercially available glucose analyzers and in experimental subcutaneous monitoring. Here it is shown (a) that under steady state conditions the s.c. glucose concentration is nearly identical to that in blood, (b) that s.c. inserted glucose electrodes do mirror the intracorporal glucose concentration both under hypo-, normo-, and hyperglycaemic conditions with a clinically relevant accuracy, (c) that even stable feedback control of intracorporal glucose concentration is possible employing s.c. glucosensor signal as an input to automated insulin pump controller, and (d) that stable function of s.c. sensor is usually accomplished over intervals up to one day but in some cases applications over up to ten days could be realized. The underlying problem consists in an insufficient functional biostability which is a function of biocompatibility and size of the sensor, of its sterility, and of the permanent skin penetration. The latter is still required to get the device in place, to keep it in function, and to make use of the data under any condition.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Radiation therapy and hyperthermia in the treatment of superficial lesions: preliminary analysis: treatment efficacy, and reaction of skin, tissues subcutaneous.

Superficial and measurable tumors were treated with hyperthermia and radiation therapy according to RTOG protocol 78-06. This study focuses on a subset of patients who were heated with microwaves. Eighty patients representing 88 lesions were treated between 1978 and 1981 with a schedule which allowed 48-96 hours to elapse between treatment sessions. The mean value of the average temperatures for individual lesions was 42.3 degrees C. The mean total radiation dose was 33.95 Gy. Skin reaction was examined in terms of the maximum score reported, using a modified Fowler scale. Erythema, the most common finding, was reported as the maximum skin reaction in 24% of the cases. Ulcerations and blisters occurred with frequencies of 18% and 7%, respectively. No reaction or desquamation was reported in 19% and 17% of the cases. Complete regression was noted in 48% of the treated lesions, partial regression in 17%, and no change in 24%. Twenty-five percent of the patients enjoyed sustained response for greater than 180 days. Refinement of hyperthermia treatment equipment and technique may result in less normal tissue reaction and improved clinical responses. In view of the encouraging initial results, we recommend aggressive pursuit of hyperthermia as a new treatment modality.

Adenocarcinoma↗

Porcine and human insulin absorption from subcutaneous tissues in normal and insulin-dependent diabetic subjects: a deconvolution-based approach.

The mechanisms of sc insulin absorption are not understood, and models for interpreting in vivo data cannot be developed without gross simplification. To overcome this difficulty we developed a new approach which makes use of deconvolution analysis and does not require any model of the sc tissue. In five normal subjects and seven insulin-dependent diabetic (IDDM) patients endogenous insulin secretion was suppressed by means of a hypoglycemic glucose clamp procedure (approximately 2.8 mmol/L) sustained by a continuous insulin infusion (approximately 4 pmol/min.kg). A bolus injection of insulin (5.4 nmol) was administered iv, and plasma insulin concentrations were measured frequently for 2 h to assess iv insulin kinetics. Insulin then was injected sc in the abdominal region, and plasma insulin concentrations were measured for 8 h. Each subject was studied twice, with porcine and semisynthetic human insulin (Actrapid, Novo). The rate of insulin absorption was reconstructed by deconvolution from the plasma concentrations and iv insulin kinetic data. Linearity of the iv insulin kinetics, essential for deconvolution analysis, was confirmed by a dose-response study in the range of the measured concentrations (150-1800 pmol/L). In most instances, a two-compartment model was adequate to describe the iv response. The mean plasma insulin clearance rates were 15.5 +/- 1.9 (+/- SD) mL/min.kg (porcine) and 17.2 +/- 6.0 (human) in normal subjects and 20.7 +/- 8.8 (porcine) and 20.9 +/- 9.1 (human) in the IDDM patients. The rate of appearance of human insulin from sc tissue was faster than that of porcine insulin in both normal and IDDM subjects, but no significant differences were found in bioavailability, which was 55 +/- 12% (+/- SD; porcine) and 61 +/- 34% (human) in the normal subjects, and 84 +/- 28% (porcine) and 86 +/- 23% (human) in the IDDM patients. The rate of absorption and bioavailability were higher in the IDDM patients than in the normal subjects, a difference possibly related to increased sc blood flow in the IDDM patients. No differences were found with regard to glucose requirement values, normalized to plasma insulin concentrations, in agreement with the finding that the bioavailability of the two insulin species was similar.

Adolescent↗

Suture materials for closing the skin and subcutaneous tissues.

The rationale for our current day use of absorbable and nonabsorbable suture materials is based upon the biology of wound healing and the physiologic response of tissue to implanted sutures. An understanding of the fundamental characteristics of suture materials and surgical needles is necessary if one is to obtain optimal surgical results.

Absorption↗