Subcutaneous tissue

Plasma levels of 3—5 p.g/mL are obtained two hours after adraiinistration of 200 mg ketoconazole. No accumulation in the bloodstream was noted after a 30-wk treatment with this dose. The half-life is approximately eight hours. When ketoconazole is taken with meals, higher plasma levels are obtained. Distribution studies using radioactive ketoconazole in rats show radioactivity mainly in the Hver and the connective tissue. Radioactivity is also present in the subcutaneous tissue and the sebaceous glands. After one dose of 200 mg in humans, ketoconazole is found in urine, saUva, sebum, and cenimen. Like miconazole, the mode of action is based on inhibition of the cytochrome P-450 dependent biosynthesis of ergosterol. This results in disturbed membrane permeabiUty and membrane-bound enzymes (8,10,23,25). 

From penetration of unbroken skin, or cuts. Foreign matter, e.g. grease, metal, concrete, may also be injected into subcutaneous tissues. 

Sporotrichosis is the fungal disease caused by Sporotrix schenckii and involves the lymphatic and subcutaneous tissues. The lesions spread via the lymphatics from the original wound and form nodules or pustules that quickly ulcerate. Dissemination is rare. 

FIGURE 2-8. Z-track injection (A) The tissue is tensed laterally at the injection site before the needle is inserted. This pulls the skin, subcutaneous tissue, and fat planes into a Zformation. (B) After the tissue has been displaced, the needle is thrust straight into the muscular tissue. (Q After injection, tissues are released while the needle is withdrawn. As each tissue plane slides by the other, the track is sealed. 

The use of the transdermal route in the elderly is questionable because the amount of subcutaneous tissue is reduced in the aging process... 

Inspect die needle site and surrounding tissues at frequent intervals for leakage (extravasation, infiltration) of die solution into die subcutaneous tissues surrounding die needle site If eitiier situation occurs, establish anotiier IV line immediately, discontinue the IV containing the vasopressor, and... 

Complete reconstruction of body tissue, rebuilding of normal subcutaneous tissue, and regular regeneration of skin. 

Icepick scars are narrow (<2 mm), deep, sharply marginated epithelial tracts that extend vertically to the deep dermis or subcutaneous tissue (Fig. 11.9). 

Useful for rolling scars to free the fibrous bands that cause the scar. It is performed with a 18-gauge triangular tip needle that reaches the subcutaneous tissue and separates the fibrous cords. Once it is inserted through the dermal-subcutaneous junction plane, it is turned with the tip parallel to the skin surface. A piston-like motion is then used to release the fibers... 

It is not surprising that intramuscular injection of epinephrine into the vastus lateralis produces a prompt peak plasma epinephrine concentration, because of the large size and excellent vascularization of this muscle. It is also not surprising that subcutaneous injection of epinephrine potentially leads to delayed absorption, because of the potent Ui-adrenergic agonist vasoconstrictor effects in the skin and subcutaneous tissue, as evidenced by skin blanching at the injection site [19, 20]. 

Catheter-related infections generally occur at the exit site or the portion of the catheter that is tunneled in the subcutaneous tissue. Previous infections increase the risk and incidence of catheter-related infections. 

Insulin pump therapy consists of a programmable infusion device that allows for basal infusion of insulin 24 hours daily, as well as bolus administration following meals. As seen in Fig. 40-3, an insulin pump consists of a programmable infusion device with an insulin reservoir. This pump is attached to an infusion set with a small needle that is inserted in subcutaneous tissue in the patient s abdomen, thigh, or arm. Most patients prefer insertion in abdominal tissue because this site provides optimal insulin absorption. Patients should avoid insertion sites along belt lines or in other areas where clothing may cause undue irritation. Infusion sets should be changed every 2 to 3 days to reduce the possibility of infection. 

Cellulitis is a bacterial infection of the dermis and subcutaneous tissue. S. aureus and P-hemolytic streptococci are the most common causes of acute cellulitis in otherwise healthy hosts. Persons who are immunocompromised, have vascular insufficiency, or use injection drugs are at risk for polymicrobial cellulitis. 

Cellulitis and erysipelas are bacterial infections of the skin. Although separate entities, there is some clinical difficulty in distinguishing the two. 0 Cellulitis is a bacterial infection of the dermis and subcutaneous tissue, whereas erysipelas is a more superficial infection of the upper dermis and superficial lymphatics. Although both can occur on any part of the body, about 90% of infections involve the leg.8,9 Another 7.5% of cases involve the arm or face. Erysipelas is most common in the young and the elderly. Typically, both infections develop after a break in skin integrity, resulting from trauma, surgery, ulceration, burns, tinea infection, or other skin disorder. 

Necrotizing fasciitis (NF) is an uncommon, rapidly progressive, life-threatening infection of the subcutaneous tissue and fascia. Its associated mortality rate is approximately 25% and is nearly 70% in patients who present with septic shock.3,19... 

Mild 2 Presence of at least two manifestations of inflammation (purulence or erythema, pain, tenderness, warmth or induration), but any cellulitis/erythema extends no more than 2 cm around the ulcer, and infection is limited to the skin or superficial subcutaneous tissues no other local complications or systemic illness... 

Swartz MN, Pasternack MS. Cellulitis and subcutaneous tissue infections. In Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia Elsevier 2005 1172-1193. 

SSIs are defined and reported according to Centers for Disease Control and Prevention (CDC) criteria.5 SSIs are classified as either incisional or organ/space. Incisional SSIs are further divided into superficial incisional SSI (skin or subcutaneous tissue) and deep incisional SSI (deeper soft tissues of the incision). Organ/space SSIs involve any anatomic site other than the incised areas. For example, a patient who develops meningitis after removal of a brain tumor could be classified as having an organ/space SSI. An infection is considered an SSI if any of the above criteria is met and the infection occurs within 30 days of the operation. If a prosthetic is implanted, the timeline extends out to 1 year. 

IV Mla Skin, subcutaneous tissue, or distant lymph nodes with normal lactate dehydrogenase Mlb Lung with normal lactate dehydrogenase Mlc To all other visceral sites (liver) or distant metastasis at any site with elevated serum LDH 7-19% 3-16%... 

Ecchymoses Passage of blood from ruptured blood vessels into subcutaneous tissue, causing purple discoloration of the skin. 

Myxedema Advanced hypothyroidism characterized by a relatively firm edema of subcutaneous tissue, subnormal body temperature, dryness and loss of hair, hoarseness, and muscle weakness. 

Tophi Chalky deposits of sodium urate occurring in gout. Tophi form most often around joints in cartilage, bone, bursae, and subcutaneous tissue and in the external ear, producing a chronic, foreign-body inflammatory response. If untreated, tophi can lead to joint deformity or destruction. 

Both types are hydrophobic materials that, depending on the side group arrangements, can exist as elastomers or as microcrystalline fiber- or film-forming materials. Preliminary studies have suggested that these two classes of polyphosphazenes are inert and biocompatible in subcutaneous tissue implantation experiments. 

Cutaneous pain is felt in superficial structures such as the skin and subcutaneous tissues. A pin prick and a paper cut are examples of cutaneous pain. 

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