Planta Pedis Research Articles

Pharmacokinetic investigation of oral itraconazole in stratum corneum level of tinea pedis.

In the present study, the authors administered 100 mg itraconazole (ITCZ) twice daily for a period of 1 week to six patients with hyperkeratotic type tinea pedis, and examined its efficacy, safety profile, and usefulness. ITCZ concentration in stratum corneum was also measured to examine the mobility of the drug into the affected site of planta pedis. ITCZ concentration in the stratum corneum of the affected part was first detected at 1 week after the completion of administration, gradually increased over time, and peaked at 3 weeks, with the sum of ITCZ and hydroxyitraconazole (OH-ITCZ) amounting to 163.7 ng g(-1) on a average. It then gradually decreased to a total sum of 10.3 ng g(-1) on average at 8 weeks following the completion of administration. When compared with the geometric mean minimum inhibitory concentration (MIC) of ITCZ against fresh clinical isolates of dermatophytes (Trichophyton rubrum) (0.06 microg ml(-1)), the stratum corneum ITCZ concentration in this study was 2.1-fold of the geometric mean MIC at 2 weeks following the completion of administration, and 2.4-fold at 4 weeks. Although ITCZ does not produce therapeutic effectiveness (fungistasis) during the period of administration, it starts appearing at 2 weeks after the completion of administration, and after it peaks out at 3-4 weeks, clinical symptoms started improving. These results suggest that satisfying effects can be achieved in a short-term oral ITCZ at a dose of 100 mg twice daily for a period of 1 week in cases of hyperkeratotic type tinea pedis.

Intracutaneous distributions of fluconazole, itraconazole, and griseofulvin in Guinea pigs and binding to human stratum corneum.

We have compared the distribution of fluconazole (FLC) with that of itraconazole (ITC) and griseofulvin (GRF) in the abdominal skin tissues after a single oral dose was administered to guinea pigs. The FLC concentrations in the stratum corneum reached a peak at 2 h after administration and were similar to those of ITC and higher than those of GRF in spite of the administration of a lower dose. GRF was eliminated from the stratum corneum faster than FLC and ITC. The FLC concentrations were also remarkably higher than those of ITC and GRF in the epidermis-cutis but lower in the subcutaneous fatty tissue. The distribution characteristics of each drug result from differences in their physicochemical properties. Following the administration of multiple doses, the FLC concentrations in the stratum corneum were highest in the abdominal skin tissues; those at 24 h after each administration increased gradually and were maintained at a level more than 10 times higher than that of the plasma concentrations. The FLC concentrations in the planta pedis stratum corneum and in the nail showed good dose proportionality and obvious accumulation and were 60 and 40 times as high as that in plasma on day 14. The extent of binding of FLC to human corneous keratin in vitro was about 10%, which is lower than those of ITC (94 to 97%) and GRF (36 to 38%). FLC, unlike ITC, therefore, is presumed to exist in the stratum corneum at high concentrations in an active nonbinding form. These excellent intracutaneous pharmacokinetic properties of FLC probably account in large part for the in vivo efficacy of FLC.

Neuroma prevention by end-to-side neurorraphy: an experimental study in rats

Purpose The successful treatment of painful neuromas remains a difficult goal to attain. In this report we explore the feasibility of neuroma prevention by insertion of the proximal end of a nerve through an end-to-side neurorraphy into an adjacent mixed nerve to provide a pathway and target for axons deprived of their end organ. Methods Experiments were performed on a total of twenty 250-g Sprague-Dawley rats. Two groups of 10 animals were prepared. Group A served as an anatomic control. In group B the right saphenous nerve was transected and implanted end-to-side through an epineurial window into the tibial nerve distal to the trifurcation of the sciatic nerve. After 12 weeks the corresponding sensory neurons were identified by retrograde labeling techniques and histomorphometric analysis of the proximal and distal tibial nerve segments, and regular histology of the end-to-side site were performed. Results The results of the retrograde labeling of the corresponding sensory neuron pool of the saphenus nerve showed extensive labelling of the L1 to L3 spinal ganglions after intracutaneuous tracer application of the planta pedis. The morphology of the end-to-side coaptation site and histomorphologic analysis prove that sensory neurons penetrate the perineurial sheath and axons regenerate along the tibial Schwann cell tubes toward their targets. Conclusions Axons of a severed peripheral nerve that are provided with a pathway and target through an end-to-side coaptation will either be pruned or establish some type of end-organ contact so that a neuroma can be prevented. Whether these axons will lead to disturbing sensations such as paresthesia or dysesthesia in the newly found environment or remain silent codwellers, this experiment cannot answer. Long-term results of future clinical work will have to decide whether the prevention of the neuroma through end-to-side coaptation will be an appropriate therapy for this difficult problem.

Valvular Density Alone Cannot Account for Sites of Chronic Venous Insufficiency and Ulceration in the Lower Extremity

ABSTRACTObjective: 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.Methods: 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.Results: Venous valves were observed in all tissue regions. The diameter of veins with valves ranged from 18 µm to 803 µm. 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.Conclusions: 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.

Effects of 780 nm diode laser irradiation on blood microcirculation: preliminary findings on time-dependent T1-weighted contrast-enhanced magnetic resonance imaging (MRI)

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/cm 2 at a fluence rate of 100 mW/cm 2. 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.

足底深部に発生した血管平滑筋腫の一例

Angiomyoma (vascular leiomyoma) mainly occurs in the lower leg, and it is a painful tumor. We report a rare case of angiomyoma arising from the deep soft tissue of the foot. A 81 year-old woman had a 3-month history of right foot nodule. When she visited our hospital, the tumor was seen at the planta pedis and was 5×3cm in size. X-ray showed marked calcification in the tumor. Computed tomography showed a intramuscular mass indicating low density. Magnetic resonance imaging showed an abnormal shadow, indicating low and high signal intensities in T1 and T2 weighted images, respectively. Surgical excision of the tumor was performed. The tumor was circumscribed and white-gray nodule, and calcium flecks were visible. Microscopic examination of the tumor showed the lesion was composed of a well-demarcated nodule of smooth muscle tissue punctured with thin-walled vessels.

足部に生じた血管平滑筋腫の２例

Angioleiomyoma mainly occurs in the lower leg, and it is a painful tumor. We report two cases of angioleiomyoma of the foot.Case-1: A seventy three year old woman suffered from swelling of her left lateral malleolus. X-ray showed calcification in the tumor. Resection of the tumor was performed. Pathological diagnosis was angioleiomyoma.Case-2: A sixty two year old woman suffered from swelling and pain of her right planta pedis. X-ray showed no phlebolith or calcification in the tumor. Resection of the tumor was performed. Pathological diagnosis was angioleiomyoma.We consider that if we examine a patient with a painful tumor, we should consider the diagnosis of angioleiomyoma.

Plantar load shifting in response to foreign body is impaired in patients with severe diabetic neuropathy

AbstractIn 14 diabetic patients with a history of neuropathic foot ulcers, dynamic foot pressure was measured during walking with and without a button‐shaped foreign body taped adjacent to the 1st metatarsal head. Center‐of‐pressure (COP) localisations were assessed in the metatarsal line, and shifting of plantar pressures between the medial and the lateral region of the forefoot were measured, and compared to 14 healthy control subjects matched for sex, age, and body weight. The results show a similar distribution of plantar peak pressures in the diabetic and the control forefeet without the foreign body. Walking on a foreign body induced load‐shifting from the medial to the lateral forefoot region, which was significant only in control subjects. Likewise, COP in the metatarsal line was significantly lateralised by 9.8 (95% Cl 6.7 to 110.8) mm in the control subjects, versus 3.4 (95% Cl −2.8 to 7.7) mm in the diabetic subjects (n.s.). All control subjects, but none of the patients felt uncomfortable while walking on the foreign body. Physiological load‐shifting to protect the planta pedis against injury from a foreign body is diminished in diabetic neuropathy.

Occurrence of a musculus abductor digiti minimi longus

Whilst dissecting the body of a 79 year old male we observed an accessory muscle in the right lower limb which has not yet been described. The Musculus abductor digiti minimi longus consisted of two portions originating from the dorsal parts of the supracondylar regions of the fibula and the tibia. Both heads merged distally forming a 2 mm thick tendon that curved around the Malleolus medialis, ran across the deep Planta pedis and inserted together with the Musculus abductor digiti minimi at the Facies lateralis of the Phalanx proximalis digiti quinti.

Covering skin defects of the planta pedis by transfer of free sensory flap

Based on clinical cases, the author shows the advantage of free sensory flaps for covering defects in the region of the planta. As compared with other types of flaps, these are more resistant and tolerate the normal load.

Effect of movement and external pressure on the vascular tone of the fingers.

Abstract 1. Finger plethysmograms were recorded during passive and active movements and pressure in vola manus and planta pedis, and on the muscles of the upper and lower leg. 2. They showed a rapidly occurring and passing volume change of the digit. 3. Some movements were characterized by an initial increase in volume, some by a decrease. On ceasing the movement or releasing the pressure there was a recoil to the opposite reaction. 4. Spontaneous variations of the responses were observed and different fingers sometimes reacted differently. 5. The reaction was also obtained peripheral to an obstruction of the circulation. 6. It is proposed that the observed effects are due to vasomotor reflexes produced by the stimulation of stretch receptors in the locomotion system.

CUTANEOUS REFLEXES DURING POSTNATAL DEVELOPMENT

Acta Physiologica ScandinavicaVolume 71, Issue s297 p. 83-115 CUTANEOUS REFLEXES DURING POSTNATAL DEVELOPMENT First published: December 1967 https://doi.org/10.1111/j.1748-1716.1967.tb03783.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Summary 1). In order to analyze the postnatal changes in cutaneous reflexes of the hindlimb the following experiments were made: a) flexor and extensor mono- synaptic test potentials wereconditioned by either electrical stimulation (single shocks or tetanus) of an ipsilateralcutaneous nerve in kittens anaesthetized with pentobarbital or by adequate skin stimuli applied to different skin areas of decerebrate kittens and b) EMG was recorded and the exci-tatory and inhibitory skin areas for extensor and flexor muscles mapped in decerebrate kittens before and after spinalization. 2). Following a single conditioning stimulus applied to the ipsilateral sural nerve a manifest facilitation of the flexor test potential was not observed until an age of 5–6 days postnatally, but there was a small inhibition of extensors in newborn kittens. The magnitude of the facilitation and inhibition increased progressively up to an age of 60 days postnatally when adult values were attained. 3). During tetanisation of the ipsilateral surd nerve in newborn kittens the extensor and flexor monosynaptic potentials were usually unaffected but at later developmental stages a facilitation, which attained adult values at an age of 60 days, was observed. 4). Extensor and flexor test potentials were usually unaffected by mechanical skin stimuli in newborn kittens. In somewhat older kittens small inconstant effects were observed and in 30 days old kittens the effects were adult-like. 5). By recording the EMG it was found that in the newborn kittens excitatory effects on both flexor and extensor muscles could be elicited from large cutaneous areas, whereas the flexors could not be inhibited at all and the extensors only from the distal planta pedis. 6). The excitatory effects became gradually concealed as postnatal development proceeded and eventuallly reversed into inhibitory action elicitable from progressively larger skin areas. The adult pattern of the excitatory and inhibitory skin areas is already present in the 2–3 weeks old kittens The developmental changes during the first 2–3 weeks furnish an explanation for the existence of concealed reflexes in the adult stage. 7). Spinalization did not change the reflex pattern until an age of 2–3 weeks. 8). The general responsiveness of the muscles to skin stimuli was high in newborn kittens and decreased with increasing age. In an individual newborn kitten proximal muscles were less responsive to skin stimuli than distal muscles. This difference diminished with increasing age. 9). The source of the most effective excitation of the motoneurones shifted postnatally from cutaneous exteroceptors to muscle proprioceptors and the postnatal changes in the cutaneous reflex effects ran in parallel with the appearance of tonic discharges from, and gamma innervation of, the muscle spindles. When a muscle contracts in the immature kitten it will be autogenously inhibited since the muscle spindles lacking gamma activation will cease firing. The cutaneous afferent discharge, on the other hand, is unaffected by such mechanisms and will be effective in activating the muscles. It is concluded that the posnatal change in the influence of cutaneous afferents both with regard to muscle responsiveness and amplitude alterations of monosynaptic potentials might be explained by a change brought about in the excitability of the interneurones by the increasing influence from muscle sense organs, and a gradual appearance of a subliminal fringe in the motoneurone pool, although a change in the ratio of excitatory and inhibitory inflows from cutaneous afferents in favour of the inhibitory inflow cannot be excluded. Volume71, Issues297December 1967Pages 83-115 RelatedInformation

Un document arverne original : estampille « in planta pedis » cloutée

A new Arvern stamp « in planta pedis » A curious stamp on plain ware has been discovered in the « Champ des Potiers de Terre-Franche » and is characterized by the name of the Potter representated by letters in dots or nail-heads, in the frame of a « planta pedis » ; such a Stamp is unusual from several points of view. — As concerns the name of the Potter, it seems to be CATIO, a Potter of Lezoux and Vichy, from the Antonine Period. — The Stamps « in planta pedis » don't exist in Eastern Gaul and are not frequent in Switzerland, but, till the present time, none has been discovered in Central Gaulish Workshops. — In fact, a problem is not clearly elucidated, the problem of the origin of the central gaulish « Officinae » and of their connections with the arretine ones, either in a direct way or through South gaulish -Workshops.

An Insulting Latin Graffito

IN spite of its unedifying character, the graffito herewith presented (fig. 1) is not without interest. It is inscribed on the upper surface of a plate of Arretine ware acquired years ago by the late Professor George N. Olcott, presumably in Rome, and presented by him to the museum of the Latin Department of Columbia University. The plate itself is signed by C. Gavius, a potter who worked at Arezzo and whose signature appears several times there and at Rome.Since he usually signed in a plain rectangle, as on our plate, he may be considered an Augustan craftsman, although his scattered use of stamps in the shape of the planta pedis, the tabella ansata, the framed rectangle and the circle, implies an extension of his activity into the principate of Tiberius. The shape of our plate (fig. 2) is consistent with an Augustan date.