We have encountered distal interphalangeal joint symphalangism on sites of the 5th (and sometimes 4th and 5th, or 3rd, 4th, and 5th toes) toe of patients complaining of pain of the foot or toes after trauma. Most of these cases did not involve past histories of infections or trauma involving the symphalangeal toes, nor deformities or functional disabilities noted after birth.
 Is this symphalangism evolution or devolution, rather than obsolescence?
 Polydactyly or polysyndactyly of the foot is common on the postaxial side in Japanese people. In Japan, surgical treatments for foot polydactyly and polysyndactyly are generally carried out at 1 to 2 years of age, before the appearance of phalangeal epiphyseal bodies. In daily living, distal interphalangeal joint movement of the 5th (and 3rd and 4th) toes is considered non-essential, and so non-invasive surgical methods for polydactyly or polysyndactyly are recommended.

 Objectives: Our clinical results of multiple cell-assisted lipotransfer (CAL) sessions (Step-CAL) to reconstruct postmastectomy breasts have been reported, but patients with insufficient fat are ineligible for this method. Therefore, this study was conducted to examine the safety and efficacy of breast reconstruction through Step-CAL using cultivated autologous adipose-derived stromal/stem cells (ASCs) to reduce the required fat mass.
 Methods: This single-arm, open-label, clinical study was performed involving five patients after mastectomy for breast cancer. After tissue expander insertion, the breast was reconstructed by CAL repeated for three sessions using cultured ASCs at 4-6-month intervals. Final observations were made at 6 months after the third CAL procedure. During the treatment course, all adverse events were recorded to evaluate safety, and the reconstructed breast volume was measured by three-dimensional image analysis and compared with the contralateral healthy breast to evaluate the volume recovery rate and cosmetic results.
 Results: For all five patients, no laboratory test abnormalities or adverse events attributed to treatment were observed between treatment initiation and the final observation. The amount of fat required for treatment was significantly reduced by culturing ASCs, and the operative time was shortened. The esthetic results regarding the reconstructed breasts were generally good, although differences with the contralateral breast remained in some cases.
 Conclusions: These results suggest that Step-CAL using cultivated autologous ASCs is a safe treatment, reduces the burden on patients, and is useful as a method for breast reconstruction.

 Chronic expanding hematoma (CEH) is a rare complication that persists and enlarges for more than 1 month after surgery or trauma. It can occur anywhere in the body and is occasionally misdiagnosed as neoplasm. It may result from the irritant effects of blood and its breakdown products, leading to repeated bleeding from fragile capillaries. As treatment for CEH has yet to be established, surgical excision or aspiration has commonly been performed, with a high recurrence rate. In recent years, triamcinolone acetonide injection has been reported as a better alternative treatment. We report a case of CEH following cesarean section that was successfully treated with the local injection of triamcinolone acetonide. For CEH after cesarean section, treatment with triamcinolone acetonide injections is considered to be superior regarding several points, so we report it with a review of the literature.

 Sternal clefts (SC) are rare congenital malformations that result from failure of sternal bar infusion. When the cleft is complete, it is often associated with ectopia cordis and requires early correction due to its abnormal respiratory and circulatory dynamics. It also needs correction to protect the mediastinal organ and from an esthetic viewpoint. In infants, the sternum is pliable and easy to repair directly, but it becomes rigid as they grow. Therefore, selecting an appropriate method for correction in each case is important. We herein report two cases of SC that underwent correction with different surgical methods.

 We report the case of an intraneural lipoma of the right wrist joint arising from the median nerve involving a 45-year-old man. Histopathological analysis after excision demonstrated that the tumor was located within the epineurium of the median nerve, and a diagnosis of intraneural lipoma was made. There are only 31 reported cases of intraneural lipoma arising from the median nerve in the literature, showing that the condition is rare. Patients should be informed before surgery that neuropathy is a possible complication, and detailed assessments of neurological symptoms both before and after surgery should be made. Removal of the lipoma under a microscope is advised, and carpal tunnel release is considered acceptable to prevent carpal tunnel syndrome after surgery.

 Acute infectious purpura fulminans (AIPF) is the most severe complication of septic shock, associated with disseminated intravascular coagulation by infection, rapidly progressing to ischemic changes in the extremities. We report a case of AIPF involving a living renal transplant patient with perioperative diabetic foot ulcer. The patient was a 68-year-old woman taking methylprednisolone and cyclosporin post-renal transplantation. She had a right foot ulcer which failed to resolve even after multiple operations, and so she eventually underwent a below-knee amputation. On the eighth postoperative day, she suddenly developed septic shock due to emphysematous pyelonephritis of the transplanted kidney, as well as ischemic necrosis of the extremities. She survived with her transplanted kidney preserved, but required further limb amputations.

 The periosteal ganglion, first described by Tillmanns in 1895, is a mucous-filled cystic lesion arising from the periosteum. The ganglion is a common cystic lesion arising from periarticular soft tissues and tendon sheaths, but rarely from the periosteum. Periosteal ganglions are believed to be caused by degeneration of the mucous of the periosteum.
 In the present study, we observed a case of metatarsal periosteal ganglion with a fracture, and concluded that it was caused by mass compression. However, a history of trauma may induce mucous degeneration of the periosteum, and it is possible that the fracture occurred first and was followed by periosteal ganglion development. In this report, we discuss the relationship between a periosteal ganglion and fracture by comparing our observations with those of previous reports.