Planta Pedis Research Articles

Exploring morphological variations and clinical significance of interconnections between flexor hallucis longus and flexor digitorum longus tendons

BackgroundThe tendons of the flexor hallucis longus (FHL) and flexor digitorum longus (FDL) are commonly utilized in reconstructive foot surgery to address deformities. These tendons intersect on the plantar surface and exhibit varying interconnections that can significantly impact graft length and complicate the tendon harvesting process. The objective of this study was to comprehensively categorize these interconnections using a modified classification system and precisely determine their positional relationships with surgically significant bony landmarks. MethodsSixty embalmed feet of 30 cadavers were studied to analyze the interconnections between FHL and FDL in the planta pedis, classify them in a modified classification system and measure distances to surgically relevant anatomic landmark. ResultsThe study revealed three primary types of interconnections. Type I, representing a proximal-to-distal connection from the FHL to the FDL, was observed in 85% of the feet. Type II, signifying a proximal-to-distal connection from the FDL to the FHL, was found in 11.66% of the feet. Type III, characterized by a crossed connection, was identified in 3.33% of the feet. The average point of branching for the FHL and FDL tendons was situated 4.5 cm and 3.5 cm distal to the navicular tuberosity, respectively. ConclusionThe presence of atypical proximal-to-distal interconnections from the FHL to the FDL may play a role in preserving residual function in the lesser toes following FDL transfer procedures. Awareness of anatomical variations in the location of these interconnections is crucial for preserving them during surgical interventions, ultimately mitigating the risk of functional impairment in the lateral toes post-tendon grafting.

N-of-1 Trial of Electrical Sensory Stimulation Therapy on the Tibial Innervated Area during Gait in a Case of Post-stroke Sensory Disturbance

Transcutaneous electrical sensory nerve stimulation (TESS) is used to enhance the recovery of sensorimotor function in post-stroke hemiparesis. However, TESS efficacy for post-stroke gait disturbance remains unknown. We hypothesized that TESS on the area innervated by the tibial nerve, targeting the superficial plantar sensation, combined with gait training would improve gait function in patients with gait disturbance caused by severe superficial sensory disturbance after stroke.A 42-year-old man was referred to the convalescent rehabilitation hospital 4 months after a left pontine hemorrhage. He showed severe superficial sensory disturbance without motor paresis in the right lower leg and planta pedis. Gait training with TESS on the tibial nerve innervated area was performed, targeting plantar sensation according to an N-of-1 study design of a single-case ABCAB that included two 10-min sessions of gait training without TESS (phase A), two gait training sessions with TESS targeting the right plantar sensation (phase B), and one session with TESS targeting the upper leg sensation as control (phase C). The patient showed increased gait distance and stride length, improved superficial sensation on the right planta pedis, and improved balance after phase B, but not after phases A and C.Gait training with TESS on the tibial nerve innervated area improved gait ability, superficial plantar sensation on the targeted side, and balance function in a post-stroke patient with sensory disturbance. Gait training with TESS may be effective for gait dysfunction caused by sensory disturbance in patients with central nervous system disorders.

Rheocarna® therapy after distal bypass surgery.

Objectives: Rheocarna® therapy has recently been reported to improve peripherally measured blood flow as an adjuvant treatment after revascularization in patients with chronic limb-threatening ischemia. We investigated whether skin perfusion pressure and continuous walking distance were improved by performing Rheocarna® therapy after distal bypass surgery. Methods: This study included 10 patients who underwent Rheocarna® therapy after distal bypass surgery between June 2022 and March 2023. Rheocarna® therapy was performed five times after distal bypass surgery, and the skin perfusion pressure and continuous walking distance after distal bypass surgery were compared with those after Rheocarna® therapy. Results: The average age was 74.7 years, and nine patients (90%) were male. All patients were undergoing dialysis, with an average of 14.5 years of dialysis history. There were six patients (60%) with diabetes mellitus and five (50%) with hyperlipidemia. The ankle-brachial index was 0.62 ± 0.36 before distal bypass surgery and 0.936 ± 0.16 after Rheocarna® therapy, indicating a significant increase (p = 0.0117). Skin perfusion pressure dorsalis pedis was 71.5 ± 27.0 mmHg after Rheocarna® therapy, showing a marked increase from the preoperative value (p = 0.0020). Skin perfusion pressure planta pedis was 65.0 ± 26.3 mmHg after Rheocarna® therapy, which was a significant increase from the preoperative value (p = 0.0293). The continuous walking distance was 78.5 ± 102.7 m after the Rheocarna® therapy, which was a significant increase from the preoperative value (p = 0.0039). Conclusion: The skin perfusion pressure and continuous walking distance were significantly improved by Rheocarna® therapy after distal bypass surgery.

Mechanical Irritation in Vascularized Composite Tissue Allotransplantation Triggers Localized Skin Rejection.

Mechanical and thermal stress has been observed to trigger skin rejection in hand-transplanted patients. This study aims to investigate this phenomenon. Syngeneic and allogeneic orthotopic hindlimb transplantations were performed using male rats (Brown Norway to Lewis). Using a specially designed device, standardized mechanical skin irritation at a force of 5 N was applied to the planta pedis of the transplanted limb for 10 days, 4 times daily for 10 minutes. Biopsies, taken on day 10 and after a 5-day observational period, were assessed for macroscopic alterations using a standardized scale, by histopathology and immunohistochemistry, and for inflammatory protein expression using Luminex technology. Allogeneic animals displayed significant aggravated macroscopic skin alterations compared with naive (P < 0.0001) and syngeneic controls (P = 0.0023). Histopathology showed a trend toward higher rejection/inflammation grades in allogeneic animals compared with syngeneic controls. Minor skin alterations in syngeneic limbs recovered quickly; however, in allogeneic limbs, macroscopic skin alterations were significantly more pronounced (P < 0.0001) 5 days after irritation. Interleukin-1b and interferon-γ levels were upregulated in skin of allogeneic limbs. Mechanical skin irritation in vascularized composite allotransplantation can trigger localized skin inflammation consistent with rejection.

Structure, morphology and composition of fur on different parts of reindeer (Rangifer Tarandus) foot

In the long-distance migration of reindeer in winter, furs of reindeer foot, as the part in direct contacting with the external environment, can play the role of protection and heat preservation. With furs on different parts of the right posterior foot (fibular side, tibial side and planta pedis) as research objects, the microstructure of reindeer foot furs was observed with a scanning electron microscope. The image displayed that the reindeer foot furs was divided into 3 layers, namely cuticular layer, cortical layer and medulla layer. It was observed from the fur surface that the scales of fur on tibial side had smooth edge, with the scale structure in mosaic and coronary types. The scale structure of furs on the other parts showed the irregular waves due to abrasion to different degrees. From the cross-section view of fur, there was a non-medullated segment on the medial part of fur on planta pedis. The medulla layer of fibular and tibial sides showed a porous foam structure. The medulla index (MI) of fur on fibular side and tibial side at distal part was 70.35% and 81.79%, respectively, and MI at medial part was 77.88% and 88.08%. The composition of reindeer foot fur was measured through infrared spectroscopy and energy spectrum analysis respectively. The element contents of foot fur varied on different parts. The content of sulfur of the furs on planta pedis was higher than that on other parts. The research results can provide foundations for the functional study and bionic design of reindeer foot furs during long distance migration and swimming.

Surgical Management of Plantar Melanoma: A Retrospective Study in One Center

Cutaneous melanoma is a highly malignant skin tumor, and in China, the planta pedis is a commonly involved site. The sites of plantar melanomas are a challenge to reconstruct after wide excision. Our experience with surgical management of melanomas was based on the 4 different anatomic subunits of the planta pedis. From January 1, 2002 to December 31, 2016, 35 patients who had had plantar melanoma had undergone surgical treatment in our clinic. The tumor locations were as follows: the toe in 6, the ball of the foot in 5, the arch in 15, and the heel in 9. Surgical management involved extended resection of the tumor, repair of defects with skin grafts or flaps, and inguinal lymphadenectomy. The skin flaps included a residual toe flap, an anterograde or retrograde medial plantar flap, and a retrograde sural neurocutaneous vascular flap. Of the 35 cases of flaps and skin grafts, 33 (94.29%) survived, and the wounds had healed by first intention. After a follow-up period of 6 months to 7 years, 24 patients (68.57%) were free of local and systemic disease and 30 patients (85.71%) were ambulatory using shoes, and all the flaps and skin grafts showed a good appearance. The personalized surgical treatments we used for melanoma in the planta pedis resulted in overall satisfactory outcomes and adequate disease clearance, and allowed the patients to resume normal lives. The function of the foot was maintained or restored to the greatest possible degree, and the patients' quality of life improved postoperatively.

Application of selectively thinning of free anterolateral thigh flap in repair of heel skin and soft tissue defect

To investigate the effectiveness of selectively thinning of the free anterolateral thigh flap in repair of the heel skin and soft tissue defect. Between April 2013 and August 2015, 8 patients with tissue defect of heel caused by different reasons were recruited. There were 6 males and 2 females with an average age of 31.2 years (range, 15-49 years). The size of wound ranged from 14 cm×10 cm to 19 cm×14 cm. All the wounds were repaired with the contralateral free anterolateral thigh flap. The partial flap which was going to repair the defects of the heel and non-weight-bearing area of planta pedis was selectively thinned. The size of flap ranged from 14 cm×10 cm to 19 cm×14 cm. The donate site was repaired by skin grafting. All flaps survived after operation, and wounds healed by first intention. The marginal necrosis of skin graft occurred in 2 cases, and healed after changing the dressing. The other skin grafts survived. All patients were followed up 8-20 months (mean, 12.3 months). All patients could walk normally. During follow-up, 2 flaps were injured and cured after symptomatic management. The appearance of flap was good in 7 cases with no influence in wearing shoes. Only 1 patient received the second-stage surgery of thinning the flap after 1 year. Application of the selectively thinning of the free anterolateral thigh flap can repair the heel skin and soft tissue defects, and achieve an ideal appearance and function.

P 36 Structural and functional imaging findings in somatoparaphrenia

Background With regard to somatosensory delusion, neglect or deficits of body integrity a great number of overlapping pathophysiological concepts exist. Moreover, the range of assumed underlying psychiatric and neurologic syndromes only partially is thought to be related to even diverse neuroanatomical structures so far: Alien Hand Syndrome, Body Dysmorphic Disorder (BDD), Body Integrity Identity Disorder (BIID), Depersonalization, Somatoparaphrenia and Xenomelia. Specific deafferentiation within temporal regions, the insula or representational structures of the somatosensory cortex of the right parietal lobe is thought to be related only in some variants. We report a case of a 58-year old right-handed woman that experienced a progressive left-sided hemiparesis which initially could be related to a space occupying lesion and edema in the right central region of the brain. After anti-edematous therapy and consecutive surgical evacuation a cortical and subcortical defect in between the right postcentral gyrus junction to the precentral gyrus resulted into inanimate, not inherent sensations especially of the left forearm and knee without anosognosia after complete recovery of motor function and sensitivity. The neuropsychological assessment showed no impairments. Methods We demonstrate structural (conventional MRI) and functional imaging findings (diffusion tensor imaging; DTI, and, motor and somatosensory functional MRI) in relation to the subject”s somatosensory delusions. Results Structural MRI displayed a well-defined cortical and subcortical lesion in deep central sulcus surrounded by gliosis and hemosiderin deposits. DTI revealed a marked reduction of structural inter-connection between precentral and postcentral gyrus. In fMRI the motor paradigm series of dorsal flexion of the feet or clenching the fists showed no difference in activation of the correspondent precentral gyrus. The sensor paradigm series in contrast revealed a lower posterior activation of the right postcentral area during brushing the planta pedis and the left forearm. Discussion The hereby presented case possesses rare clinically segregated symptoms of somatoparaphrenia without anosognosia or hemiparesis in conjunction with a well-defined postcentral lesion. The symptoms may be related to a corresponding reduced postcentral activation and restricted functional interconnection between motor and sensory cortex. From our point of view these results document the essential requirement of postcentral gyrus activation and regional conduction for regular experience of sensorial authenticity.

Vessels with planta pedis stamp in the area of Aquincum

This study is an amended version of an earlier communication (Nagy A.–Beszédes 2009).1 In the meantime we had the opportunity to analyse further finds and now we are able to outline the form variations and the main characteristics of the pottery group. In the case of some types we found direct links to the potter Resatus. The Aquincum Museum’s collection houses tens of thousands of so-called Pannonische Glanztonware (PGW) vessels and fragments, of which more than 5,000 pieces had stamped motifs. On the co-occurrence of different motifs, decorative styles and forms these stamped vessels could be assigned to larger groups. Therefore, it does not seem to be practical to publish this huge amount of material by sites, but by groups where motifs and their combinations are put into a system. As this is the first article on the subject of the stamped vessels found in Aquincum, the aim of the present study is the presentation of the vessels with planta pedis stamps, their forms, quality characteristics, dating and workshops.

Anatomical study for flexor hallucis longus tendon transfer in treatment of Achilles tendinopathy.

The purpose of the study was to describe the anatomical variations of the connection between the flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendons in the knot of Henry in Asians, and quantify the length of FHL tendon graft with different incisions. Sixty-four embalmed feet of 32 cadavers were analyzed anatomically with respect to the individual cross-links in the planta pedis. Single incision technique graft length was measured from the musculotendinous junction of FHL and the point at sustentaculum tali. Double incision technique was measured from musculotendinous junction of FHL and the level of the master knot of Henry. Additionally, minimally invasive incision technique was measured from musculotendinous junction of FHL to the first interphalangeal joint. These three techniques were then combined to determine the total potential tendon graft length obtainable using different approach. Only two different configurations were found. Type 1, a tendinous slip branched from the FHL to the FDL (62 of 64 feet). Type 2, a slip branched from the FHL to the FDL and another slip from the FDL to FHL (2 of 64). The average length of the FHL graft available from a single incision measured 5.08 cm (range 3.32-10.35, SD = 1.09), double incision technique measured 6.72 cm (range 4.69-12.09, SD = 1.03), and minimally invasive incision measured 17.49 cm (range 13.51-20.52, SD = 1.80). The difference between the lengths obtained from these three techniques was statistically significant (p < 0.001). The absence of no attachment and FDL tendon to the FHL between the two tendons in the foot may be more frequent than previously reported. Only two configurations of the anatomical relationship were found in this study. In over 96 % of the feet, a proximal to distal connection from the FHL to the FDL was found, which might contribute to the residual function of the lesser toes after FDL transfer.

The Impact of Skin Type and Area on Skin Rejection in Limb Transplantation

Atypical manifestation of skin rejection observed in a series of hand transplant recipients suggests that appearance and mechanisms of rejection may vary and depend on skin type and location. We herein characterize skin rejection and inflammation at 3 defined areas of a rat hind-limb allograft. Allograft skin was harvested at the thigh, dorsum and planta pedis on postoperative day 5 and analyzed for histopathology, T-cell composition and expression of cytokines associated with skin inflammation. Isografts and naive animals served as controls. Histology of the allograft skin collected on day 5 showed a diffuse cell infiltrate in the dermis and at the dermal-epidermal interface in the thigh and dorsum, whereas in the planta pedis it was mainly located perivascularly in the dermis. At all areas, epidermal involvement such as apoptotic keratinocytes and infiltrating lymphocytes were observed. Isograft skin showed only very mild or no signs of inflammation at all 3 locations. No significant difference was obse...

Anatomical Variations of the Flexor Hallucis Longus and Flexor Digitorum Longus in the Chiasma Plantare

The flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendon are routinely used in reconstructive foot and ankle surgery. The tendons cross in the chiasma plantare and show variable interconnections. This can complicate harvesting of the tendons. Previous anatomical studies were inconclusive and did not reference the connections to surgically relevant landmarks. The purpose of this study was to integrate these conflicting results, introduce a thorough classification system, and analyze the position of the interconnections relative to the surgically relevant bone landmarks. Sixty embalmed feet of 30 cadavers were analyzed anatomically with respect to the individual cross-links in the planta pedis. All feet were photo documented. The interconnections were classified in a modified classification system and distances to surgically relevant anatomic landmarks measured. A proximal to distal connection from the FHL to the FDL was found in 95% of the feet (types I and III), in 3% there was a proximal to distal connection from the FDL to the FHL (type II) tendon only, and in 30% a crossed connection (type III) was found. The average point of branching of the FHL and FDL tendon was 5.3 and 4.6 cm distal to the medial malleolus, respectively. Our modified classification system accommodated all found variations. In over 90% of the feet, a proximal to distal connection from the FHL to the FDL was found, which might contribute to the residual function of the lesser toes after FDL transfer. The exact knowledge of the anatomy of the crossing of FDL and FHL in the plantar foot is essential to facilitate tendon harvesting, reduce morbidity and explain possible postoperative functional loss.

Analyzing and Mapping Sweat Metabolomics by High-Resolution NMR Spectroscopy

The content of human sweat is studied by high-resolution NMR, and the majority of organic components most often found in sweat of conditionally healthy people are identified. Original and simple tools are designed for sweat sampling from different areas of human body. The minimal surface area needed for sampling is in the range of 50–100 cm2. On all the surface parts of the human body examined in this work, the main constituents forming a sweat metabolic profile are lactate, glycerol, pyruvate, and serine. The only exception is the sole of the foot (planta pedis), where trace amounts of glycerol are found. An attempt is made to explain the presence of specified metabolites and their possible origin.

Can Vibration Stimuli to Planta Pedis Prevent the Fall Accident?

Considering the aged population increase, the prevention of falls will become increasingly importance. One of the causes of elderly people fall is the decline of the balance ability. The purpose of this study is to examine the difference of the sensitivities to the single frequency vibration of three places in planta pedis. We made a simple vibration stimulator, which can give 225 Hz vibration stimuli to three places of planta pedis. This frequency was decided by our prior study. The vibration stimuli places were the heel, the root of the big toe and the root of the little toe. The intensity of the stimulus was set to 90% of the smallest stimulus intensity that the subject could feel. We evaluated the effect of vibration stimuli by the center-of-foot-pressure (CFP) sway and the duration of one-leg standing with closed eyes. The results showed that the duration was extended and the locus length of CFP sway was decreased by the stimulation of only one place. The most effective place was the root of the big toe. Our result is that the vibration stimuli to planta pedis are useful for the fall prevention of elderly people.

Study of the morphology of heel spur and clinical significance: base on three-dimensional computed tomography

To evaluate the characteristic morphology of heel spur, and to investigate the relationship of heel spur and plantar heel pain. From June 2005 to April 2009, 210 cases (254 feet) with heel spur (according to Denis Pain Scale) were divided into cases group 1 (P2, n = 46), 2 (P3, n = 44), 3 (P4, n = 42), 4 (P5, n = 36) and controls group (P1, n = 42). Three-dimensional reconstruction of heel spur was performed in all groups using volume rendering based on multi-slice CT data by Super Image orthopedics edition 1.0. The characteristic morphology of heel spur was observed and the data were measured and analyzed, involving the width of basilar part, the length, the angle between heel spur and planta pedis, and the angle between the longitudinal axis of calcaneus and heel spur. Parts of cases groups displayed coarse arcuate edge and undersurface with one or more little heel spurs adhere to heel spur, of which the numbers were greater than controls group, especially in cases group 4. No significant difference of the width of basilar part of heel spur was found among 5 groups (F = 2.32, P > 0.05). However, obvious difference was found in the length, the angle between heel spur and planta pedis, and the angle between the longitudinal axis of calcaneus and heel spur (F = 8.23, 6.82, 5.87, P < 0.05). Compared with the controls group, the angle between heel spur and planta pedis of cases groups had higher degrees, but the difference of the other data presented irregular. The characteristic morphology of heel spur varies in patients associated with plantar heel pain. No correlation is found between the severity and the morphological data, including the width of basilar part, the length, the angle between heel spur and planta pedis, and the angle between the longitudinal axis of calcaneus and heel spur.

Valvular density alone cannot account for sites of chronic venous insufficiency and ulceration in the lower extremity.

Class 6 chronic venous stasis is associated with abnormal venous hemodynamics and ulceration. Ulcers primarily occur over bones and tendon prominences but very rarely over muscular compartments. We hypothesized that the anatomical distribution of venous stasis ulcers in the lower extremity is related to a lower density of venous valves. The venous vasculature of six normal human legs was cast with resin, and their microvenous valvular anatomy was examined. Skin samples were obtained from the skin overlying the 1) Achilles' tendon, 2) anterior tibia, 3) medial malleolus, 4) lateral malleolus, 5) dorsal surface of the foot, 6) planta pedis, 7) dorsal aspect of the great toe; and from the skin regions overlying the 8) gastrocnemius, 9) tibialis anterior, and 10) peroneus muscles. The valvular and venous densities were determined in a scanning electron microscope, normalized to the size of specimens, and the valvular index was calculated. Analysis of variance with Bonferroni t-test was used to compare the valvular index between the regions. Venous valves were observed in all tissue regions. The diameter of veins with valves ranged from 18 microm to 803 microm. The valvular index for regions overlying bones/tendons (i.e., regions 1-7) was significantly higher versus those overlying muscular regions (i.e., regions 8-10) (p < 0.05). The valvular index was not different (p = 0.51) when regions 1 and 2 (where ulcers almost never occur) were compared to regions 3, 4, 5, 6, and 7 (where ulcers frequently occur); nor were there differences between the vascular indexes of regions overlying muscle. The largest venous valves were observed in the plantar region, and the smallest-sized ones were present in the peroneal region. This study shows that the density of venous valves is actually higher in regions of the human lower extremity overlying bones and tendons, where venous stasis ulcers are common, than those overlying muscular areas, where ulcers are rarely seen. Thus, valvular quantity alone cannot account for the higher clinical incidence of ulceration. It is likely that muscular pumping and/or valvular quality are important factors in preventing the development of venous stasis and ulceration in the lower extremity.

50 INTRAVENOUS LASER BLOOD IRRADIATION IN A PARTICULAR CASE OF JUVENILE POLYARTHRITIS

Laser therapy by low light doses shows promising results in the modulation of some cell functions. Various clinical studies indicate that laser therapy is a valuable method for pain treatment and the acceleration of wound healing. However, the mechanism behind it is still not completely understood. To explore the effect of a low-power diode laser (λ=780 nm) on normal skin tissue, time-dependent contrast enhancement has been determined by magnetic resonance imaging (MRI). In the examinations, six healthy volunteers (four male and two female) have been irradiated on their right planta pedis (sole of foot) with 5 J/cm2 at a fluence rate of 100 mW/cm2. T1-weighted magnetic resonance imaging is used to quantify the time-dependent local accumulation of Gadolinium-DPTA, its actual content in the local current blood volume as well as its distribution to the extracellular space. Images are obtained before and after the application of laser light. When laser light is applied the signal to noise ratio increases by more than 0.35±0.15 (range 0.23–0.63) after irradiation according to contrast-enhanced MRI. It can be observed that, after biomodulation with light of low energy and low power, wound healing improves and pain is reduced. This effect might be explained by an increased blood flow in this area. Therefore, the use of this kind of laser treatment might improve the outcome of other therapeutic modalities such as tumour ionizing radiation therapy and local chemotherapy.

Heart Rate and Electroencephalogram Changes Caused by Finger Acupressure on Planta Pedis

Preliminary experiments were carried out to investigate the feasibility of using an electroencephalogram and heart rates to evaluate the efficacy of finger acupressure on the key points of planta pedis (both soles). Continuous electroencephalograms were recorded from 19 electrodes based on the International 10-20 electrode placement system on 22 university students (21+/-2.3 years). Spectral power changes were obtained at each electrode site. The power of the alpha1 frequency range (8-10 Hz) increased slightly during acupressure although no statistical significance was observed, while heart rates decreased in all subjects (p<0.05). Cerebral cortex asymmetry in the spectral power changes was not clearly observed during the right and left sole acupressure. This preliminary study suggests that a classification of subjects is necessary in understanding brain wave data during acupressure on soles.

Epstein–Barr virus‐associated primary leptomeningeal lymphoma

Primary leptomeningeal lymphoma (PLML) is a rare disorder, and the pathogenesis of it has not been well described [1,2]. We report herein a case of B-cell PLML associated with Epstein–Barr virus (EBV) infection in an old patient. A 73-year-old HIV negative woman experienced a 3-month history of progression of bilateral leg weakness and paresthesias of the bilateral planta pedis. Gadolinium (Gd)-enhanced magnetic resonance imaging showed diffuse thickening of the nerve roots of the cauda equina and enhancement of the dorsal surface of the cervical cord and the root of the right oculomotor nerve (Fig. 1). A cerebrospinal fluid (CSF) examination revealed elevation of the protein concentration (292 mg/dl) and soluble interleukin-2 receptor concentration (3910 U/ml) and of the white blood cell count (224/mm). Polymerase chain reaction (PCR) studies of CSF were negative for cytomegaly,

Kaposi Sarcoma in Solid Organ Transplant Recipients: A Single Center Report

Background Human herpes virus (HHV8) is associated with Castleman’s disease, primary effusion lymphoma, and the Kaposi’s sarcoma (KS). Patients and methods Among 3815 solid organ transplants performed at our center between 1977 and 2003, five patients (0.1%) were identified with KS. Results There were one cardiac, one liver, and three renal allograft recipients of median age of 52 (range 38 to 60) years, three of whom were females. Three patients were of Italian and one of Turkish descent; only one patient was a native Austrian. The onset of the disease was 2.0, 7.5, 7.8, 9.4 months, and 22 years posttransplant. Diagnosis of KS was based in all cases on histology. The heart recipient developed a tumor on the planta pedis; one renal recipient, on both legs. The liver and the two remaining renal recipients presented with disseminated disease. Treatment in all cases consisted of reduction in immunosuppression, together with surgery ( n = 1), chemotherapy ( n = 1), or irradiation ( n = 2). Furthermore, immunosuppression was switched in two cases from Tacrolimus to Sirolimus. In the liver recipient a complete response was achieved; he died, however, due to noncompliance followed by graft failure. One renal recipient died without evidence of recurrent disease from myocardial infarction. The cardiac and two renal recipients are alive between 4 months and 17 years with well-functioning grafts and no evidence of recurrent disease. Discussion HHV8-associated lesions seem to be extremely rare in the Central European transplant population. Nevertheless, awareness of KS is important for early diagnosis and optimal treatment.