Skin Of Foot Research Articles

CIC-rearranged sarcoma: a clinicopathological analysis of four cases

Objective: To investigate the clinicopathological features and differential diagnosis of CIC-rearranged sarcoma (CRS). Methods: Five CRSs of 4 patients (2 biopsies of pelvic cavity and lung metastasis from case 4) diagnosed in the First Affiliated Hospital of Nanjing Medical University were enrolled from 2019 to 2021. All cases were evaluated by clinical presentation, H&E, immunohistochemical staining and molecular analysis and the related literature was reviewed. Results: There were one male and three females, the age at diagnosis ranged from 18 to 58 (mean 42.5) years. Three cases were from the deep soft tissues of the trunk and one case from the skin of foot. Grossly, the tumor size ranged from 1 to 16 cm. Microscopically, the tumor was arranged in nodules or solid sheets. The tumor cells were typically round or ovoid, with occasional spindled or epithelioid morphology. The nuclei were round to ovoid with vesicular chromatin and prominent nucleoli. Mitotic figures were brisk (>10/10 HPF). Rhabdoid cells were seen in four of five cases. Myxoid change and hemorrhage were observed in all samples and two cases showed geographic necrosis. Immunohistochemically, CD99 was variably positive in all samples, while WT1 and TLE-1 were positive in four of five samples. Molecular analysis showed CIC-rearrangements in all cases. Two patients succumbed within 3 months. One had mediastinal metastasis 9 months after surgery. One underwent adjuvant chemotherapy and remained tumor-free 10 months after diagnosis. Conclusions: CIC-rearranged sarcoma is uncommon and shows aggressive clinical course with dismal prognosis. The morphological and immunohistochemical characteristics can largely overlap with a variety of sarcomas; hence, knowledge of this entity is vital to avoid potential diagnostic pitfalls. Definitive diagnosis requires molecular confirmation of CIC-gene rearrangement.

Agnikarma treatment in the management of Corn (Kadar): A case report

Background: Agnikarma is regarded as the best of the Anushastras because of its quick results and long lasting effects. It is said that there is no recurrence of disease when treated with Agnikarma and also diseases which are not treated with medicine, shastras and kshar are best treated with agnikarma. For (apunarbhav) non recurrence of disease Agnikarma is advised. Ayurvedic classics stated the use of agnikarma in the management of various kshudraroga , Kadar (corn) is one among them. The pathophysiology of kadar is caused by vitiated meda and rakta by injury to foot which in turn leads to gland like hard skin texture at foot known as Kadar( corn). In present case study efficacy of agnikarma in the management of Kadar as stated in ayurvedic texts is evaluated. Methodology: Agnikarma was done with loh shalaka with exision of Kadar followed by application of oil with 3 settings in which each setting is for 3 days. Proper follow up was taken for about six months in order to observe for any recurrence. Observation: It was observed that within a month the complete skin of foot healed without leaving any sign of slough discharge. The patient observed after 1 year there is no recurrence of corn again at that particular site. Conclusion: It can be concluded that Agnikarma is not only a successful tratment in treating corn (kadar ) but also there is no recurrence again.

The skin of birds' feet: Morphological adaptations of the plantar surface

The skin of the foot provides the interface between the bird and the substrate. The foot morphology involves the bone shape and the integument that is in contact with the substrate. The podotheca is a layer of keratinized epidermis forming scales that extends from the tarsometatarsus to the toe extremities. It varies in size, shape, amount of overlap and interacts with the degree of fusion of the toes (syndactyly). A study of toe shape and the podotheca provides insights on the adaptations of perching birds. Our analysis is based on micro-CT scans and scanning electron microscopy images of 21 species from 17 families, and includes examples with different orientations of the toes: zygodactyl (toes II and III forward), anisodactyl (toes II, III, and IV forward), and heterodactyl (toes III and IV forward). We show that in these three groups, the skin forms part of a perching adaptation that involves syndactyly to different degrees. However, syndactyly does not occur in Psittacidae that use their toes also for food manipulation. The syndactyly increases the sole surface and may reinforce adherence with the substrate. Scale shape and toe orientation are involved in functional adaptations to perch. Thus, both bone and skin features combine to form a pincer-like foot.

Features of skin care for feet in patients with diabetes and diabetic neuropathy: the role of dexpanthenol

The feet have an increased load, they are often injured, especially with diabetes. Because of the violation of innervation, patients do not notice minor injuries: abrasions, bruises, cracks, cuts. Because of the circulatory disorders associated with diabetes, the protective function of tissues decreases, and the smallest injury can lead to the formation of a long-term wound that does not heal, which turns into an ulcer when infected. Despite advances in the study of the pathogenesis of diabetes and its complications, diabetic foot ulcers are difficult to treat, can recur, and lead to amputations of the lower limbs. The main reason for pathological dryness of the foot skin in diabetes is dysfunction of the sweat glands of the skin of feet due to diabetic neuropathy. Regular skin care with specially selected products can help restore and improve the barrier function of the skin, as well as increase the moisture level of the stratum corneum. Adequate skin hydration reduces itching and the risk of infection if the skin is damaged. In most patients with diabetes, conventional cosmetics slowly eliminate dry skin of the feet. In addition, traditional remedies contain a large amount of oils and can cause unpleasant sensations, which often causes rejection of their use. In patients with DM, it is desirable to use drugs that quickly and effectively eliminate dryness and cracks. Treatment of dry skin is indicated as a prevention of diabetic foot syndrome. Taking into account the fact that the skin of patients with diabetes mellitus has a low level of humidity, we recommend daily care using moisturizing or nourishing creams or lotions. Some studies have confirmed that the use of external dry skin care products containing dexpanthenol improves the protective function of the skin, increasing the hydration of the stratum corneum.

Dry skin in nursing care receivers: A multi-centre cross-sectional prevalence study in hospitals and nursing homes

BackgroundMaintaining and improving skin health of patients and long-term care receivers is a widely agreed upon goal in health and nursing care. Care dependent and aged persons have a high predisposition to develop dry skin conditions. ObjectivesThe aim of this study was to estimate the prevalence and severity of skin dryness in hospitals and nursing homes and to identify person- and health-related variables associated with this skin condition. DesignThe study was part of a bigger annual multicentre descriptive cross-sectional prevalence study of health problems. Settings/participantsFourteen nursing homes and six hospitals in Germany participated in this study in 2014. A total of 1710 subjects (n=1091 long-term care residents and n=619 in-patients) were included. MethodsSkin assessments were conducted and skin dryness was measured using the Overall Dry Skin Score. Mobility was measured using the respective item of the Care Dependency Scale. Demographic, functional and physiological parameters were compared between subjects with and without dry skin. A logistic regression model predicting skin dryness was created. ResultsThe prevalence of skin dryness was 48.8% (95% CI 46.5–51.2). Nursing home residents were most often affected (52.6%; 95% CI 49.6–55.6) compared to in-patients (42.2%; 95% CI 38.3–46.1). The skin of feet and legs were most often affected by skin dryness (42.9%) compared to other skin areas. Being older (OR 1.01; 95% CI 1.01–1.02), having pruritus (OR 14.21; 95% CI 8.00–22.95), oncological (OR 1.95; 95% CI 1.30–2.91), musculoskeletal diseases (OR 1.31; 95% CI 1.04–1.64), being skin care independent (OR 0.48; 95% CI 0.32–0.70) were the strongest covariates for the presence of dry skin in the multivariate model. ConclusionsBased on a large sample results indicate that approximately every second nursing home resident and hospital in-patient are affected by dry skin. Severe forms occur more often in hospital in-patients compared to nursing home residents. Skin care interventions to tackle dry skin are recommended particularly for hospital patients and nursing home residents who are affected by pruritus or oncological diseases, who are in need of washing/bathing assistance, and who have musculoskeletal diseases.

Evaluation of treatment plans using various treatment techniques for the radiotherapy of cutaneous Kaposi's sarcoma developed on the skin of feet.

The purpose of this study was to investigate the plan qualities of various treatment modalities for the radiotherapy of cutaneous Kaposi's sarcoma developed on the skin of the foot. A total of six virtual targets were generated on the skin of the foot in CT images. Five types of treatment plans were generated using photon beams (PB), electron beams (EB), high‐dose‐rate (HDR) brachytherapy with a Freiburg flap applicator, intensity‐modulated radiation therapy (IMRT), and volumetric‐modulated arc therapy (VMAT) techniques. Plans for each of the six targets (single‐target plans) and also for the combined target consisting of the six single targets combined (multitarget plans) were generated. Dose‐volumetric analysis was performed for the targets and normal tissues. The averaged conformity index (CI) and homogeneity index (HI) values for each single target using PB, EB, HDR, IMRT, and VMAT techniques were 1.97, 2.39, 1.60, 4.60, and 0.80 and 1.05, 1.11, 1.52, 1.04, and 1.04, respectively. For the multitarget, the CI values were 3.99, 5.08, 1.38, 1.95, and 0.84, and the values of HI were 1.10, 1.36, 1.43, 1.06, and 1.04, respectively. The averaged mean doses to normal tissue were 2.5, 2.7, 3.6, 1.7, and 2.9 Gy for single‐target plans, and 21.3, 14.6, 14.2, 14.3, and 13.0 Gy for the multitarget plans, respectively. The VMAT demonstrated dosimetric advantages and better treatment efficiency over other techniques for the radiotherapy of multifocal skin disease of the feet.PACS number: 87.55.dk

SU‐E‐T‐609: Treatment Planning Evaluation of Various Modalities for the Tretment of Skin Cancer On Foot

Purpose: To investigate the characteristics of various treatment modalities for skin cancer on foot. Methods: Right foot was immersed in water reservoir and CT image was taken. Total 6 targets were virtually generated at the skin of foot. Targets are contoured at heel pad (PTV1), inner ankle (PTV2), inner arch (PTV3), dorsal surface (PTV4), inner big toe mound (PTV5) and outer little toe mound (PTV6). Four types of treatment plans using tangential‐photon‐beams (TPB), electron‐beams (EB), high‐dose‐rate (HDR) brachytherapy technique with Freiburg flap applicator and volumetric‐modulated arc therapy (VMAT) technique were generated for each 6 target (single‐target plans) and the summed target of every 6 target (multi‐target plans). TrueBeam STx™ and Microselectron™ were used for external beam and brachytherapy planning, respectively. Plan normalization was performed to cover 95% of target volume by 95% of prescribed dose. Conformity indices (CI) and homogeneity indices (HI) and the mean doses to the foot except targets were investigated. Results: The averaged CI of single‐target plans using TPB, EB, HDR and VMAT was 1.97, 2.39, 1.6 and 0.8, respectively. The averaged HI of single‐target plans using aforementioned 4 techniques was 1.05, 1.1, 1.52 and 1.04, respectively. For the multi‐target, CI was 3.99, 2.39, 1.6 and 0.8. The HI was 1.1, 1.36, 1.43 and 1.04. The averaged mean dose to the foot except target was 2.48 Gy, 2.66 Gy, 3.57Gy and 2.91 Gy for the single‐target while it was 21.3 Gy, 14.6 Gy, 14.2 Gy and 13.1 Gy for the multi‐target. Conclusion: The VMAT technique showed better target conformity and homogeneity not only at the single‐target plan but also at the multi‐target plan than the other techniques to treat skin cancer on foot. In case of single‐target treatment, the mean dose to normal tissue was lowest when using tangential‐photon‐beams while VMAT was best for multi‐target treatment.

Foot-pad dermatitis in commercial broilers

In the present experiment, the presence of mycological agents in chickens with skin lesions on foot pads was investigated, in order to improve the health of broiler chickens. Foot-pad dermatitis (FPD) is described in the literature as dermatitis caused by multifactor causes. The presence of irritating chemical substances in the litter, genetic predispositions of hybrids, immune suppressive diseases of chickens, as well as the composition of commercial broiler diets that influence the occurrence of wet litter, are proven factors that contribute to a more intensive incidence of foot-pad dermatitis. Foot-pad dermatitis is a condition characterized by lesions on metatarsal and digital ventral skin of poultry feet. It is type of contact dermatitis which in severe cases shows slower weight gain, poor health condition and welfare. Taking into consideration the literature data, chickens reared in closed facilities where the bacterial and mycological agents are present partly in the litter if not properly disinfected, but also in the food or the chicken plumage, we wanted to investigate their presence in the skin of foot pads. The study was focused on incidence of foot-pad dermatitis in 500 one day old broiler chickens of Hubbard genotype, in two feeding (standard/economical) programs for broilers available on our market. Chopped straw was used as litter. At the end of fattening, all chickens were examined for the presence of lesions on the skin of the feet. Total of 39 chickens were allocated to the intensity of the lesion on foot pads rated as 2 (mild) and 3 (severe). In the mycological examination of the 9 samples of autoclaved chicken legs with lesions on the feet, we have isolated and identified the presence of fungi /mould Aspergillus fumigatus. The histopathology investigation, during which the tissue section from mild and severe skin foot pads was collected and stained using Hematoxylin and eosin, revealed the hyperkeratosis, panniculitis, ballooning degeneration and dermis inflammation. No fungal elements were observed in the sections of pads stained with Gomori methenamine silver. Birds are especially susceptible to infection with Aspergillus fumigatus. That species of fungus is also classified as allergenic factor.

Cracked skin of feet: an ignored entity in the tropics

Ceylon Medical Journal (CMJ) is a peer-reviewed, open access journal published quarterly by the Sri Lanka Medical Association in the last week of March, June, September and December each year. The mission of the CMJ is to promote the science and art of medicine and betterment of public health. The Journal publishes original papers and commentaries which have relevance to medicine and allied sciences. The CMJ is committed to maintaining and conforming to the editorial and ethical standards recommended by the International Committee of Medical Journal Editors.

Streptococcus suis serotype 2 caused streptococcal toxic shock syndrome(STSS) in a patient

Streptococcus suis ( S. suis) is a Gram-positive, facultatively anaerobic coccus that has been implicated as the cause of a wide range of clinical disease syndromes in swine and other domestic animals. S. suis has also been implicated in disease in humans, especially among abattoir workers, swine and pork handlers. Here we report a case of streptococcal toxic shock syndrome(STSS) caused by S. suis in a 59-year-old man. Despite of intensive treatment, the patient died of shock with multiple organ failure 14 h after admission. One bacterial isolate obtained from blood culture was identified to the species level by biochemical tests and serological tests as S. suis serotype 2. Identification was confirmed by PCR amplification of genes encoding 16sRNA of S. suis and the capsule of S. suis serotype 2(cps 2J). Genes encoding virulence factors were also detected. An investigation to identify the source of S. suis revealed that several days before admission the affected man had been handling sick pigs or their meat. Transmission may occur through breaks in the skin of feet with tinea due to that no measures for personal protection was taken. This case should highten awareness of the potential for occupational exposure and human infection with S. suis.

Limitation of sensitization to injured parts of receptive fields in human skin C-nociceptors.

Unmyelinated cutaneous mechano-heat fibers (CMH) in the peroneal nerve of healthy human volunteers were studied by means of a "marking" technique which allows stable recordings from identified single units over extended periods. Mechanoreceptive field sizes were 105 +/- 13 mm2 in 25 units. These large receptive fields indicate extensive terminal branching of C fibers in the skin of foot and lower leg. Sensitization of CMHs was tested by assessment of thresholds for mechanical (von Frey hair) and heat stimuli before and after topical application of mustard oil (allyl isothiocyanate) and capsaicin (8-methyl-N-vanillyl-6-noneamide). While in a group of 14 CMHs the entire receptive field was treated with these irritant substances, in another group of 11 CMH units only parts of the receptive field were treated to check for signs of spreading sensitization through axon collaterals. Mustard oil application did not change mechanical thresholds, regardless of whether parts of or complete receptive fields were treated. However, mean heat thresholds dropped by 5.6 degrees C to 36.5 +/- 1.5 degrees C in completely treated receptive fields and by 5.7 degrees C to 37.3 +/- 3.4 degrees C in treated parts of receptive fields ("primary sensitization"). In contrast, heat thresholds in the nontreated parts did not change significantly (42.1 +/- 3.4 degrees C vs 41.2 +/- 3.9 degrees C), i.e. "secondary sensitization" to heat was lacking. The absence of primary sensitization to probing with von Frey hairs indicates that sensitization of insensitive C fibers and recruitment of insensitive axon collaterals may be more important for mechanical hyperalgesia than sensitization of conventional CMH units-apart from the contribution of central mechanisms. The lack of spread of sensitization to untreated parts of the receptive fields o CMHs ("secondary sensitization") indicates that this fiber group is probably not involved in any form of secondary hyperalgesia to heating.

Morphological and morphometric studies with the electron microscope on the Merkel cells and associated nerve terminals of normal and denervated skin.

Merkel cells and associated nerve endings of dog snout skin as well as foot and toe pads of rats were studied with the transmission electron microscope. Normal Merkel cells are characterized by the following morphological features: 1) localization restricted to the basal layer of the epidermis, 2) adjoining afferent nerve endings containing many mitochondria, 3) specific small round granules usually accumulated in the cytoplasm on one side of the nucleus facing the junction of the nerve ending, 4) highly lobulated irregular shape of the nucleus, 5) well developed Golgi apparatus with a few immature granules situated on the side of the nucleus opposite the junction at the ending, 6) spine-like processes extending from the cell surface where no nerve endings abut, 7) desmosomes and desmosome-like membrane thickening on the cell surface both abutting the surrounding keratinocytes and the nerve endings. The Merkel cells with nerve endings were observed and measured at various days after denervation. The experiments were carried out on rats whose sciatic nerves were transected. The samples of skin of foot and toe pads of the denervated legs were taken almost every day from 1 to 30 days. Almost no changes were noticed after 24 hrs, but within the next day the nerves retracted and were no longer observed in the epidermis. The Merkel cell granules increased in number in 1--3 days but decreased again to about a half of the value of the control at 30 days. The polarity of granules distribution showing a strong accumulation in the cytoplasm near the nerve ending became less marked after denervation. Some cells sustained severe degeneration in the later stage of experiment. It was remarkable that the activity of Merkel cells might depend on the associated nerves, but they never completely disappeared even after a long period of denervation.

Grafting of palmar areas of the hand with plantar skin of feet

Grafting of palmar areas of the hand with plantar skin of feet

Kaposi’s Sarcoma

The collected data of 38 patients with Kaposi’s sarcoma seen within 10 years (1960–1970) were analysed. 30 were males and 8 females, with 26 originating in East and Central Europe. In the majority, the disease had begun in the 5th and 6th decade. In most patients, only the skin was involved and the outcome was relatively good. In 4 patients, there was a general spread to skin and in 4 visceral involvement, with a lethal outcome in all 8. It is concluded that the prognosis depends on the clinical form taken by the disease and that the effect of treatment is minor. It was the authors’ impression that in cases with typical initial localisation (skin of feet and legs), there is less of a tendency for a spread to other organs, with a good prognosis, while in cases in which the disease starts elsewhere, the tendency towards spreading is more pronounced and the prognosis is more serious.