Alternative Ways to Treat Scars
Ron Langacker in his chapter shows how simple perceptual processes such as visual scanning are essential to the meaning of sentences such as A scar extends from his ankle to his knee, or A scar extends from his knee to his ankle, and also underlie the meaning of more abstract sentences such as The rainy season starts in December and runs through March.
In most other cases, however, our knowledge has not advanced beyond the fact that homing or related behavior (e.g., y-axis orientation) occurred. Some studies have shown no evidence of return to a site occupied before displacement. This lack of evidence gives rise to interesting speculation that the motivation to return depends on the quality of the initial habitat and the quality of the habitat in which the test animals were released. An important implication is that the animals assess their habitats and use this information to decide whether to move toward home or to adopt a new home for themselves. If such behaviors occur, the cognitive mechanisms involved in habitat assessment will prove to be even more interesting than the sensory mechanisms mediating orientation and movement toward home. The literature on reptile homing behavior contains many anecdotes that have substantially influenced our collective thinking. For example, rattlesnakes have been removed from a human...
CBV and PS are the most meaningful parameters in evaluation of any type of tumors. CBF, TTP, and MTT are more of value in vascular-occlusive diseases. The major application for microvascular assessment using dynamic contrast-enhanced CT is differentiation of the most malignant region of tumor before conducting stereotactic biopsy. This may be particularly valuable in previously treated lesions in an effort to differentiate radiation necrosis, postsurgical scar tissue, and recurrent tumor. Additionally, tumor can be graded based on its blood volume and permeability. There is limited available data on CTP in brain tumor imaging. Data from MRP studies of brain tumors can be used as a means of extrapolating meaningful conclusions as well as predicting the role of CTP in future. Increased CBV and PS (or other parameters of permeability such as k-trans) are reliable indicators of high-grade brain tumors (17). However, differentiation between high-grade and low-grade tumors needs a threshold...
Staging CT scans are reviewed to identify nodal disease, lung metastases, and (in patients with advanced disease) bloodborne metastases in other sites. It is important that the radiologist interpreting the examination should know the side of the primary tumor in order to give appropriate weight to any equivocal findings. Edema and scarring in the groin are usually obvious on CT. The detection of nodal disease relies on size criteria, and over the last two decades there has been much discussion regarding the appropriate threshold for the upper limit of normal for retroperitoneal nodes. There is now, however, a general consensus that nodes 8 mm in
In addition to the acute and organizing necrosis, there was evidence of myocellular hypertrophy and multiple foci of interstitial and replacement fibrosis all consistent with chronic diabetic and hypertensive heart disease. Larger zones of scarring were noted, particularly in the subendocardial myocardium. The sections of the right coronary artery showed focal high grade atherosclerotic complex plaques with intraplaque hemorrhage and focal plaque rupture (Figures 5 and 6). The acute plaque rupture led to fresh thrombus and plaque material in the lumen of the vessel. The acute occlusion of the vessel was consistent with the acute transmural extension of the previous subendocardial infarction.
The budding and the fission yeast are attractive systems to understand cellular asymmetry at the molecular level. First, S. cerevisiae shows polarized growth at every cell division by taking a decision where to produce the bud. Second, the complex process is genetically tractable. The budding pattern is easily observed by staining yeast cells with a fluorescent dye calcofluor, which fluoresces after binding to cell wall chitin. Bud scars are especially rich in chitin and fluoresce brightly (Figure 6.5). Birth scar Birth scar
The patient measured 157 cm and weighed 59 kg. External examination revealed no clubbing, cyanosis or edema. The heart weighed 450 g and the shape was normal. The pericardium was smooth. The atria were unremarkable. Both ventricular chambers were dilated and hypertrophic. The myocardium showed a hemorrhagic subendocardial and focally transmural infarct of the antero-septal wall, approximately 2 weeks old. Other foci of scarring were also noted. The coronaries showed severe atherosclerosis with 100 occlusion of the left anterior descending artery and right coronary artery, and up to 70 stenosis of the left main and left circumflex arteries.
Histological changes in established HS. a Chronic folliculitis - dense lymphocytic infiltrate around hair follicle. b (i) Acute and chronic inflammatory cells around apocrine glands - low power. (ii) Acute and chronic inflammatory cells around apocrine glands - high power. c Pus in follicle. d Sinus tract formation. e Scarring around hair follicle Fig. 4.4 a-e. Histological changes in established HS. a Chronic folliculitis - dense lymphocytic infiltrate around hair follicle. b (i) Acute and chronic inflammatory cells around apocrine glands - low power. (ii) Acute and chronic inflammatory cells around apocrine glands - high power. c Pus in follicle. d Sinus tract formation. e Scarring around hair follicle
Unlike conventional diagnostic modalities, such as CT and US, which provide mainly anatomic information on malignancies, FDG-PET provides information on tumor metabolism. In this technique, a radioactive glucose analog is administered, and the glucose-avid nature of tumors is used to visualize cancers. The first reports on the clinical application of FDG-PET in colorectal cancer concentrated on differentiating scar tissue from local recurrence in rectal cancer, which often shows a similar appearance on CT (108,109). Recent studies concentrated on the added value of FDG-PET in staging patients with liver metastases of colorectal carcinoma (110-112).
There is left ventricular hypertrophy, extensive multifocal myocytolytic necrosis (the darker areas in the subendocardium and mid-wall), and multifocal fibrosis (the paler areas involving the papillary muscle, trabeculae, and ventricular wall). The recent and organizing necrosis, together with remote scarring, leads to replacement of large areas of functional myocardium, equivalent to myocardial infarction. diabetic cardiomyopathy. There is left ventricular hypertrophy, extensive multifocal myocytolytic necrosis (the darker areas in the subendocardium and mid-wall), and multifocal fibrosis (the paler areas involving the papillary muscle, trabeculae, and ventricular wall). The recent and organizing necrosis, together with remote scarring, leads to replacement of large areas of functional myocardium, equivalent to myocardial infarction.
Clinically, dissecting folliculitis of the scalp is characterized by peri-follicular pustules, nodules, abscesses and sinus that progressively evolve into scarring alopecia. The clinical picture is often complicated by a keloid tendency 4, 9, 15, 23 . The course of the disease is chronic and relapsing. Squamous cell carcinoma may arise in chronic relapsing lesions and has a recognized metastasizing potential. Death from metastatic carcinoma has been described in one patient 9 . In contrast to acne, the tendency for scarring and the recalcitrant nature of this disease bear clear similarities to HS. In the absence of actual genetic classification, the absence of specific
Transductional and transcriptional targeting can be combined to create double-targeted viruses. Conceivably, this approach could be synergistic with regard to safety and efficacy. Initial proof of concept was achieved by using a pulmonary vascula-ture specific promoter and a lung endothelium-targeted adaptor strategy (56). Impressively, the tumor-to-liver ratio of gene expression was increased 300,000-fold when both targeting modalities were used. Also, double targeting for ovarian cancer has been achieved in vitro and in vivo (89). Transductional targeting with a sCAR-fibritin-antiErbB2-sFv adapter was able to increase gene transfer to target cells while reducing transduction of nontarget cells. When combining transcriptional targeting with the SLPI promoter, an increase in selectivity was seen. Also, the transductional targeting increased the level of SLPI-mediated transgene expression in target cells, thereby compensating for the lower gene expression typically seen with TSPs.
Initial radiographs should assess for overall anatomic alignment, bony contours, and mineralization with comparison to preoperative studies. Postoperative changes involving arthroscopic osteochondroplasty, open resection osteoplasty, or acetabular realignment should assess for any residual FAI. Plain films may detect postoperative myositis ossificans, which can be a rare postoperative complication. However, when clinically indicated, symptomatic postoperative evaluation primarily involves analysis of the labrum searching for recurrent labral tears or detachments (Fig. 21). Although no published data exists, evaluation of the postoperative labrum can be difficult. It is essential that the interpreting physician is familiar with the original surgical technique to properly diagnosis recurrent problems. Intrasubstance suture or granulation tissue may mimic tear, much like postoperative MR appearance of meniscal repair. In our experience, if bioabsorbable suture anchors are used they are...
Symptoms such as fever, vomiting, diarrhoea and failure to thrive. Symptoms of dysuria and frequency appear only after the age of 2 years when the child is able to indicate the source of the discomfort. In a girl or boy (rare presentation) with symptoms of dysuria and frequency an underlying abnormality is likely to be present with a reported incidence of vesicoureteric reflux as high as 40 and scarred kidneys (reflux nephropathy) in 27 . 3 Thus the early detection of children with vesicoureteric reflux and control of recurrent renal infection could prevent the development of scars, hypertension and chronic renal failure. Radiological investigation of children with UTIs shows normal kidneys in approximately 66 and reflux in approximately 33 .
Sometimes, a precaval metastasis invades the inferior vena cava and it becomes necessary to resect the vein, with a patch repair, during RPLND (Figure 11-9). Also, the left renal vein may be adherent to residual disease or scar tissue at the point of entry of the spermatic vein a wedge resection is usually sufficient (Figure 11-10). Last, but not least, a laparoscopic RPLND can also be performed in selected cases of residual teratoma.30
Calcific valve disease occurs when valves become thickened and distorted by fibrous scarring and calcium nodules. It most commonly affects the aortic valve. Calcific valve disease renders the valve cusps immobile and impairs blood flow from the left ventricle during systole, thereby leading to heart failure.
A cut in the epidermis is filled in by dividing epithelial cells. Clots close deeper cuts, sometimes leaving a scar where connective tissue replaces skin. Granulations form as part of the healing process. 2. A superficial partial-thickness burn heals quickly with no scarring. The area is warm and red. A burn penetrating to the dermis is a deep partial-thickness burn. It blisters. Deeper skin structures help heal this more serious type of burn. A full-thickness burn is the most severe and may require a skin graft.
The major component (80 -90 ) of the cell wall is polysaccharide. This includes 3-glucans, mannoproteins, and chitin. 3-Glucan is a glucose homopolymer. In Saccharomyces, one finds (3-1,3 straight chains up to 1500 residues long with some (3-1,6 branches. These long polymers are intertwined to form microfibrils that are interwoven into the meshwork that makes the basic support structure of the cell wall, much like the steel rods in reinforced concrete. Imbedded into this meshwork are the mannoproteins or mannans. These are secreted proteins with large, highly branched, covalently bound carbohydrate side groups consisting mostly of mannose residues but also including glucose and N-acetylglucosamine residues. Some of these glycoproteins are also attached to lipids of the plasma membrane via a GPI anchor (glycosyl phosphatidylinositol) at the C-terminus of the protein. Cell wall proteins include the agglutinins and flocculins that play important roles in cell adhesion. Enzymes such as...
All patients should stop aspirin, low molecular weight heparin, and similar medication likely to interfere with platelet function, at least one week beforehand. These simple measures will reduce the risk of postoperative ooze into the thyroid bed and prevent haematoma formation within the wound, which may take several weeks to resolve. After resolution of a haematoma, the scar may be tethered and unsightly and may need re-excision to improve the cosmetic appearance.
Classified in order of severity from night blindness (XN) to corneal ulceration and kera-tomalacia that involves one-third of the cornea or greater (X3B). A corneal scar (XS) is not a sign of active vitamin A deficiency. Xerophthalmic fundus (XS) is usually considered to be a rare condition. Fig. 14. Corneal scar. (Courtesy of Task Force Sight and Life.) Fig. 14. Corneal scar. (Courtesy of Task Force Sight and Life.) 4.1.8. Corneal Scar The sequelae to corneal ulcer and keratomalacia include the formation of a corneal scar or leucoma (Fig. 14). Corneal scarring can arise from causes other than vitamin A deficiency, such as following trauma and infectious keratitis unrelated to vitamin A, thus, the interpretation of corneal scarring must be made with caution in surveys. The corneal scarring that occurs with measles and vitamin A deficiency cannot be distinguished from corneal scarring from vitamin A deficiency without measles. Many surveys of the causes
Formation of protective glial scar Figure 9.1 Stages of reactive astrogliosis. Insults to the CNS trigger release of numerous factors that interact with astroglial cells and trigger reactive astrogliosis, which is generally represented by hypertrophy and proliferation of astrocytes. Astrogliosis ultimately ends up in complete substitution of previously existing tissue architecture with a permanent glial scar (see the text for detailed explanation) at a distance from the primary lesion. Astrocytes located immediately around the damaged zone undergo a robust hypertrophy and proliferation, which ultimately ends up in complete substitution of previously existing tissue architecture with a permanent glial scar, this process is called anisomorphic (i.e. changing the morphology) astrogliosis. Reactive astrocytes in these areas produce chondroitin and keratin, which inhibit axonal regeneration, and thus prevent nerve processes from entering the damaged zone. Reactive astroglia also release...
Vahlquist and Griffiths 36 treated a 47-year-old man with etretinate (0.7 mg kg per day). Within a few weeks the lesions had become less painful. After a treatment period of 11 months, the patient was essentially free of active lesions and the etretinate therapy was discontinued. Although scarring was still a problem, the patient had no longer pain. A minor relapse was recorded 1 year after stopping etret-inate and this was successfully controlled by a short course of oral antibiotics 36 . Chow and Mortimer 37 treated a 31-year-old man with etretinate (0.5 mg kg per day) for 9 months, the first 3 months together with erythromycin 1 g daily. Within 2 months, he was showing signs of improvement, with less pain, less discharge, and a decrease in the number of acute exacerbations. After 3 months there was no sign of disease activity, although linear fibrotic bands of scarring remained. Disease was still in remis- a Clear defined as no disease activity fibrotic bands and scarring remain b...
If the released oocyte is not fertilized within 1-2 days, then the corpus luteum will continue to increase in size for 10-12 days. This is then followed by virtual total regression of the gland to produce a small white ovarian scar known as the corpus albicans and concomitant cessation of progesterone and estrogen secretion (see Figure 13-3). If the released oocyte is fertilized, the corpus luteum continues to grow and function for the first 3 months of pregnancy. Then it slowly regresses, leaving a white scar on the ovary. The progesterone from the corpus luteum is essential for maintenance of the first 2 months of pregnancy after this time the production of progesterone by the placenta is adequate for the continued maintenance of pregnancy.
Primary treatment of Wegener's granulomatosis is pharmacologic. Steroids are usually effective. Second-line therapy includes cytotoxic drugs. Medical therapy may keep the disease in check, but often the disease progresses. In systemic disease, death results from pulmonary and or renal failure. Laryngeal stenosis may require endoscopic excision to relieve airway obstruction but may be complicated by scarring, with further voice impairment and recurrent obstruction (Fig. 1). Tracheotomy is an alternate way of relieving obstruction. Surgical management of stenosis and scarring may be attempted when there is no active disease, but it may be complicated by reactivation (1).
Although cutaneous resurfacing with CO2 lasers is not a new technique, the older systems were not well suited for the delicate areas around the eyes and mouth. The newest generation of high-energy pulsed (''ultrapulse'') CO2 lasers produces high-energy bursts that allow maximal lesional ablation with minimal heat conduction to uninvolved skin which greatly reduces the risks of scarring. Alster 16 has shown that although both the surgi-pulse and ultrapulse high-energy CO2 lasers are effective in reducing the appearance of periorbital rhytides, computer analysis of skin-surface impressions shows a more substantial improvement after ultrapulse laser treatment. Indeed, the skin-surface texture was found to be comparable to normal. Alster 17 has also used optical profilometry to document that laser resurfacing can also effectively improve or even eliminate atrophic facial acne scars.
After neurones reach their final sites, they extend axons, which in some cases grow for considerable distances and have to cross the brain midline (decussate) to reach their synaptic targets. Channels formed by astrocytes provide a mechanical and guidance substrate for axon growth. In the corpus callosum, for example, astrocytes form a bridge (the glial sling) that connects left and right sides of the developing telencephalon. The ability of astrocytes to support axon growth decreases with age embryonic astrocytes strongly support axon growth, whereas mature astrocytes inhibit axon growth - hence, the astroglial scar that forms following damage to the adult CNS is a major barrier to axon regeneration. Astrocytes produce a number of membrane bound and extracellular matrix molecules that serve as molecular cues for axon growth. These are generally considered to act by activating receptors on axonal growth cones to regulate process outgrowth for example, N-cadherins and fibroblast growth...
If the pathology shows stage I nonseminoma, the previous scrotal scar should be widely excised at the time of retroperitoneal node dissection, along with the remaining spermatic cord. If a node dissection is not planned, this excision should be performed as a separate procedure. In the case of gross scrotal contamination, a formal hemiscro-tectomy should be performed.
The majority of patients diagnosed with PCP are not pre-treated with antiretroviral drugs, even today, and many of these do not know of their HIV infection status (or do not want to). PCP is a life-threatening disease which should be treated by an HIV specialist. It often requires mechanical ventilation and still continues to have a high fatality rate. Older patients have a particularly high mortality risk (Benfield 2001). The relapses that were frequently seen in the past have become rare, thanks to HAART and prophylaxis. Scar tissue formation may result in susceptibility to recurring pneumothoraces. PCP may also rarely occur in relation to an immune reconstitution syndrome (see below).
MMP is a chronic autoimmune mucocutaneous disease in which autoantibodies directed at structural proteins of the hemidesmosome destroy the epithelial-connective tissue attachment at the level of the basement membrane, producing a subepithelial separation (24,25). The protein targets of the autoantibodies include BP-1, BP-2, and laminin-5 (epiligrin), all components of the epithelial anchoring apparatus. MMP is a generalized term for a group of closely related disease processes (26). The term oral mucous membrane pemphigoid is used if the lesions are confined to the oral mucosa (Fig. 31). The term cicatricial pemphigoid is applied to patients with involvement of the ocular mucosa, which produces scarring and may result in blindness. The term bullous pemphigoid is the untoward effects of treatment. Involvement of the ocular mucosa in cicatricial pemphigoid produces scarring and may result in blindness. The lesions may remain localized to the gingiva for a period but generally progress...
Hyperkeratosis of the follicular infundibu-lum forming comedo-like impactions occludes the pilosebaceous apparatus 5, 34, 69 . This is followed by rupture of the follicular canal and the spilling of foreign-body material into connective tissue. The dumping of foreign material such as corneocytes, bacteria, sebaceous matter, and hairs into the connective tissues excites an inflammatory infiltrate. The infiltrate consists initially of granulocytes, followed by mononu-clear cells, and forms a foreign-body granuloma. Epithelial strands are formed and evolve to keratin-producing sinuses lined with squamous epithelium, and fistulas and secondary comedones are typical features 5, 34, 69 . The tissue reaction is complicated by extensive inflammation and enhanced by secondary bacterial colonization and secondary bacterial infection 28, 39, 48 . This chronic inflammatory process produces richly deforming and contracting fibrotic scar tissue with subsequent functional defects 5, 34, 37, 72 . In...
In general, there are three requirements for reentry to occur (1) the presence of a substrate, for example, an area of scar tissue (2) two parallel pathways that encircle the substrate and (3) one pathway that conducts slowly and one that exhibits unidirectional block. An impulse reaching the substrate is slowed by the unidirectional block and is allowed to conduct slowly down the slow pathway. As the impulse continues to move around the substrate, it conducts in a retrograde manner up the fast pathway, and the impulse continues to conduct in a circular fashion.
Atheromatous plaques and related scarring cause narrowing of the arteries and ultimate occlusion of these vessels with ischaemia or reduction of blood supply to the structures supplied by such arteries and resultant infarction due to dead tissue formed by the lack of blood supply. According to the area involved atherosclerosis can lead to hypertension, angina pectoris, myocardial infarction, arrhythmias, paralysis, gangrene of the extremities and cerebral insufficiences leading to confusion, amnesia, personality changes or strokes.
Because VZV becomes latent in cranial nerve, dorsal root, and autonomic ganglia along the entire neuroaxis, the virus can manifest anywhere on the body. Typically, the activated virus causes a prodrome consisting of skin sensitivity and mild-to-severe radicular pain, and after five days, a rash appears. The pain is associated with itching and dysesthesia. As with HSV-1, VZV infection decreases sensation in the affected dermatome, yet the affected skin is exquisitely sensitive to touch. The rash may continue to produce pustules that lead to crusting and ulceration. In many affected patients, healing is delayed beyond two weeks and is accompanied by increased skin pigmentation and scarring. Lesions can erupt outside the affected dermatome but rarely cross the midline and are not clinically significant. Distribution of 10 or more lesions outside a single dermatome suggests early evidence of viral dissemination. The term zoster sine herpete is used to describe VZV that is reactivated...
Diagnosis is established by immunofluorescence to detect the antibodies causing the lesions. Biopsy is often negative because it shows nonspecific necrosis, particularly in the center of ulcerated lesions. Serology is sometimes helpful. Before the advent of drug treatment, pemphigus vulgaris was fatal in 99 of cases, but with treatment including dapsone, steroids, and azathioprine, mortality is 5 to 15 . The mucosal lesions of pemphigus and pemphigoid generally respond well to medical management, but untreated lesions may become infected and cause scarring sufficient to obstruct the airway.
Pantothenic acid has been both used as an oral supplement and applied topically in a cream base to enhance wound healing and it has been shown to accelerate closure of wounds and increase strength of scar tissue in experimental animals (Plesofsky 2002, Vaxman et al 1990). Although these results are encouraging, there has been little investigation in humans. One double-blind study testing the effects of vitamin C (1000 mg) and pantothenic acid (200 mg) supplements over a 21 -day period showed no significant alteration to wound healing with this treatment regimen (Vaxman et al 1995).
(8)(a) A scar extends from his ankle to his knee. (b) A scar extends from his knee to his ankle. (9) A scar extends to his knee from his ankle. step is not required. Nor in (8)(b), where we scan only once along the path but in the opposite direction. But in all cases the scar itself is static - the spatial path reflects our dynamic construal of the static situation.
In the extremely severe, untreated cases, one or several affected sites are covered by a mixture of permanently draining sinus and severe scarring with oedema and limitation of mobility. The sinuses can dissect deep into the underlying tissues and go much further than can be estimated clinically. Cases have been reported where an apparent breast abscess proved to be the extension of axillary HS. Ulceration may also occur and burrowing abscesses may perforate neighbouring structures such as muscles or fascia, leading to various fistulas in the genital and perianal region. Fistula formation may involve the rectum, urethra and vagina, and has to be differentiated from fistulas arising within these organs.
This same region of chromosome 4 has been more finely mapped using a series of lines containing small overlapping introgressions from S. peruvianum and S. habrochaites (Yates et al. 2004). The results show that QTLs for soluble solids content, fruit weight and stem scar are not allelic between the two wild species, which suggests that it may be possible to combine the S. habrochaites and the S. peruvianum alleles in a single line with the potential of obtaining improved lines characterized by extremely high soluble solids content.
Limbal dermoids are similar to subcutaneous dermoid cysts and consist of epidermal tissue and, frequently, hair (Fig. 1-25). Corneal astigmatism is common in patients with limbal dermoids. Astigmatisms greater than +1.50 are usually associated with meridional and anisometropic amblyopia. Removal of limbal dermoids is often indicated for functional and cosmetic reasons, but the patient should be warned that a secondary scar can recur over this area. Limbal dermoids can involve deep corneal stroma, so the surgeon must take care to avoid perforation into the anterior chamber. Dermolipomas (lipodermoids) are usually located in the lateral canthal area and consist of fatty fibrous tissue (Fig. 1-26). They are almost never a functional or cosmetic problem and are best left alone. If removal is necessary, only a limited dissection should be performed to avoid symblepharon and scarring of the lateral rectus. Unfortunately, restrictive strabismus with limited adduction frequently occurs after...
Complications related to cervical mycobacterial infections are few. Uncommonly, soft-tissue breakdown may occur to the extent that wide debridement is required, resulting in significant fibrosis and scarring. In the immuno-competent patient, response to therapy is generally favorable, with a low incidence of recrudescence. Immunocompromised patients may respond slowly or not at all to therapy and are at risk for recurrence. Mycobacterial infections are discussed in more detail in Chapter 12.
Cicatricial pemphigoid (CP), Stevens-Johnson syndrome (SJS), and epidermolysis bullosa (EB) are rare causes of pharyngitis that deserve mentioning. CP is a rare, chronic blistering disease that involves the oral mucosa in nearly all patients lesions may extend to the oropharynx in a significant number of persons. Blisters, ulcers, erosions, and scarring are demonstrated clinically. Diagnosis is made by tissue biopsy and immunostaining microscopy. Steroids and other immunosup-pressants are used for supportive treatment. EB is a rare disorder characterized by skin and mucosal blister formation in response to mechanical trauma. The majority of cases are genetically inherited, although spontaneous cases are possible. Several forms of EB have been described, including EB simplex, EB junctional, and EB dystrophic, in order of decreasing incidence. The pathophysiology of this disease results from IgG autoantibodies targeting anchoring fibrils of collagen in the...
Acne is an inflammatory dermatosis, the genetics of which have not been well studied. Acne is characterized by the development of inflammatory papules, comedones and pustules, leading on to possible disfiguring scarring. At a minimal level of severity, acne is ubiquitous in adolescence, and only a minority of cases will develop scarring or have a clinical course running into the second quarter of life.
The mucocutaneous manifestations of CS are the most common, yet the most difficult to recognize, with an estimated penetrance of 99 by the end of the third decade (17). The characteristic skin lesions of CS are trichilemmomas and papillomatous papules (25). Trichilemmomas are hamartomas of the infundibulum of the hair follicle and are characteristically found at or near the hairline while papillomatous papules are condyloma-like lesions occurring frequently on the face, hands, feet, or oral mucosa. It is not uncommon to see papillomatous papules proliferate at pressure points particularly on the palmar and plantar surfaces. Additional cutaneous manifestations include acral keratoses, small punctate lesions commonly seen on the palmar surface of the hands, which are often associated with a central depression or pit. Lipomas are a feature, but are seen more commonly in BRRS (14). Patients appear predisposed to excessive scarring, even cheloid formation, at the site of traumatic or...
Both keratan sulfate I and dermatan sulfate are present in the cornea. They lie between collagen fibrils and play a critical role in corneal transparency. Changes in proteoglycan composition found in corneal scars disappear when the cornea heals. The presence of der-matan sulfate in the sclera may also play a role in maintaining the overall shape of the eye. Keratan sulfate I is also present in cartilage.
Skin alterations after surgery The retraction of the skin and the scarring of the cutaneous and breast tissue may assume the mammographic appearance of a tumor recurrence. In addition, therapeutic radiation leads to skin thickening and the parenchyma may develop some radiation fibrosis this makes mammographic evaluation of the treated breast extremely difficult (Fig. 12.19). Contrast-enhanced MRI of the breast may be of use in this situation and is being evaluated as an adjunct tool to mammography.
Although histopathological studies have demonstrated peripheral and central degenerative changes in many PHN patients, i.e. ganglion cell loss, fibrosis and atrophy of the dorsal horn, dorsal root ganglion, dorsal root and peripheral nerve 3-7 , the most incapacitating symptom of PHN is the nearly intractable pain and not just simple sensory loss. Most patients with PHN are able to distinguish three distinct components of their discomfort (1) a constant, spontaneous usually deep burning pain, (2) a brief recurrent shooting tic-like pain and (3) a sharp radiating pain of burning character evoked by very light touching of the skin, which is called dynamic mechanical allodynia (evoked-pain). The patient may undergo extraordinary efforts to protect the diseased area from innocuous mechanical stimuli. Yet, firm compression of the skin mostly does not exacerbate the pain and may even provide relief. Clinical investigations show that negative (i.e. sensory deficits) and positive (i.e....
The initial steps in cell migration require the formation of protrusive structures (lamellipodia) at the leading edge of the cell and the stabilization of the protrusion by newly formed adhesion complexes. Cell protrusions are regulated by the activity of surface receptors and Rho family GTPases Cdc42 and Rac 17 . Actin polymerization at the cell front is regulated by Cdc42 and Rac via their interaction with members of the Wiskott-Aldrich syndrome protein (WASP) Scar1 superfamily 18 . Binding of Cdc42 Rac to WASP Scar proteins activates the Arp2 3 complex 19 , triggering its binding to the sides of preexisting actin filaments and stimulating new filament formation, which results in branched actin networks 20 . The formation of the branched actin network serves to drive the forward extension of the cell membrane, leading to the formation of lamellipodia 20,21 .
Re-excisions The most common cause for re-excision is when a malignant tumour is incompletely excised, or in the case of a malignant melanoma, despite complete primary excision, the margins are not wide enough to follow standard guidelines. Re-excision biopsies are sampled as for primary excisions. Tumour, if present, is usually at the edge of the previous biopsy scar. Again, margins of excision are commented on.
Salpingitis (acute and chronic) is a bacterial infection (most commonly gonococcus) of the uterine tube with acute inflammation (neutrophil infiltration) or chronic inflammation that may lead to scarring of the uterine tube, which predisposes affected women to ectopic tubal pregnancy.
Patients seen at the specialist level are frequently Stage II patients. The treatment aims to cure these patients or at least reduce them to Stage I disease. The presence of sinus tracts and scarring requires a combined treatment involving both medical and surgical therapies. The balance between the two depends on the amount of scarring and permanent suppuration present. The medical therapy aims to control acute inflammation and may also be used to prepare the patient for surgery. For patients with little scarring and much inflammation, intensive, long-term antibiotic therapy with systemic clindamycin and rifam- For patients with scarring and sinus tracts the medical treatment should always be supplemented with local surgery, either using cold steel or laser evaporation. In milder cases exteri-orization of sinus tracts may suffice, whereas actual excisions may be necessary for larger lesions. Limited excisions are particularly useful when an abscess-sinus tract recurs frequently with...
The Swanson silicone implant has been used for more than 40 years and remains the gold standard for MCP arthroplasty in RA. The silicone MCP joint arthroplasty is based on Swanson's theory of joint encapsulation this suggests that the silicone implant serves as a joint spacer, allowing the formation of scar tissue to provide joint stability 17 . The initiation of early motion promotes the development of a functionally adapted fibrous capsule during this process 22 . Additional fixation and bony ingrowth are not needed, because the implant becomes stable through the encapsulation process. In fact, rigid fixation is contraindicated joint pistoning may increase the life of the implant because of broader implant force dispersion with joint motion. By contrast, newer preflexed box designs enable more joint flexion at the hinge.
Despite the fact that the clinical response to antibiotics is poor and that bacteria are found in only 50 of lesions, the recommendation for systemic antibiotics is clear and this is derived from empirical attempts to control the disease. Also, it is reasonable to try antibiotic treatment, as various bacteria are suspected as having a role in the inflammatory process and in destructive scarring in HS patients. Approximately 10 of patients have some benefit from the use of systemic antibiotics 57 .
Fibrin sealant has come a long way, and it is being used as a haemostatic agent for operations of heart, liver, and spleen. It is also used for prevention of sarcoma formation after soft tissue dissection, closure of fistulas, and reduced suture vascular and intestinal anastomosis.27 It was used in nephron sparing surgery by Stojkovic et al.28 in 2005 and was found to be an efficient haemostatic agent for polar resection of kidney. Histology showed less intense and smaller scarring, compared with sutures. Vaiman et al.29 compared fibrin sealant Quixil in a prospective random trial on 179 patients for rates of haem-orrhagic complications between bipolar and needle point electro-cautery with fibrin glue after tonsillectomy and adenoidectomy. The results of haemostasis were better, with good systemic and local compatibility. Pruthi et al 30 used it for hand assisted laparoscopic partial nephrectomy and found that in addition to haemostatic properties, the fibrin sealant had sealing...
DDD was first described by Dowling and Freudenthal in 1938 35 , then by Degos and Os-sipowski in 1954 36 . It is characterized by a reticulate pigmentation of the flexures with prominent comedo-like lesions and pitted scars 37-56 . The disease runs in families, it has a genetic autosomal dominant transmission 42, 44 but it may be more prominent in women. DDD, usually localized in axillae, neck and groin, may occur during childhood or early adulthood and may extend progressively. Also noteworthy are the pitted acneiform scars around the mouth present in most of the patients described in the literature.
At this stage, however, the only possibilities for curative treatment are extensive surgery and radiation therapy, if one is not afraid of the risk of cancer promotion (see Table 25.4). Healing by secondary intention has generally been advocated, although this extends the postoperative need for additional nursing and wound care. In general, postoperative scarring is less of a problem than scarring from the disease itself.
In this stage of the disease long-lasting suppuration has previously led some patients to complications such as anaemia, hypoprotein-emia and amyloidosis. This kind of wasting syndrome is generally not seen today however, other complications may occur. Carcinoma may occur, particularly on the buttocks. These cancers appear to have a particularly bad prognosis, possibly because of the local immunodeficiency caused by the long-lasting inflammation and scarring. Except for the common paraclinical signs of inflammation, such as elevated sedimentation rate, low serum iron and elevation of alpha-2 and gamma globulin, the patients are however usually in good general health and without biological repercussions, even in cases of long-lasting severe disease.
Late lesions in the ano-perineal location are to be distinguished from other chronic scarring inflammations such as tuberculosis, actinomycosis, cat-scratch disease and lymphogranuloma venereum. For this region an important and difficult differential diagnosis is anal Crohn's disease (see Chap. 7).
The obvious goal of therapy in HS is to heal existing lesions and prevent the development of new lesions. This is potentially possible in early lesions (Hurley stage I), where scarring does not dominate the clinical picture, although this form of treatment is more likely to alleviate symptoms than to cure patients. Therapy may furthermore not influence established fibrosis, although intralesional steroids, for example, are commonly used to treat hypertrophic scars.
Curettage a curetted specimen is used to remove or sample small warty-type lesions which are usually benign or small basal or squamous cell carcinomas. This can be associated with cautery to the lesion base (C+C). Occasionally, a basal cell carcinoma, actinic keratosis or squamous cell carcinoma may be removed by curettage and then formal surgical excision is carried out of the curetted area. The laboratory in this case will receive two specimens from the one patient a curet-tage and the excision biopsy. This combined technique is used to give a good cosmetic result. The curettage removes the bulk of the tumour and the excision results in a neat scar.
Worldwide, there are an estimated 140 million preschool children and 7.2 million pregnant women who have vitamin A deficiency (597). In low-income countries worldwide, there are an estimated 453,000 children with blindness or severe visual impairment, and 200,000 have corneal scarring attributed mostly to measles and vitamin A deficiency (2). There is a close synergism between measles and vitamin A deficiency that can result in blindness, and of an estimated 30 million children who develop measles each year, there are an estimated 15,000-60,000 children who become blind (598). Others have suggested that there may be about 350,000 children who go blind from vitamin A deficiency annually (599).
Abdomen Scars, bowel sounds, right upper quadrant tenderness liver span, hepatomegaly liver margin texture (blunt, irregular, firm), splenomegaly (hepatitis) or hepatic atrophy (cirrhosis), ascites. Umbilical venous collaterals (Caput medusae). Courvoisier's sign (palpable nontender gallbladder with jaundice pancreatic or biliary malignancy).
Bacterial pneumonia occurs more often in HIV-positive than in HIV-negative patients, and, like PCP, leaves scars in the lung. This often results in a restriction of pulmonary function which persists for years (Alison 2000). Although bacterial pneumonia occurs in the early stages of HIV infection, the risk grows along with increasing immunosuppression. A case of bacterial pneumonia significantly worsens the long-term prognosis of the patient (Osmond 1999). Thus, contracting bacterial pneumonia more than once a year is regarded as AIDS-defining. The introduction of HAART went hand in hand with a significant reduction in the occurrence of bacterial pneumonia (Jeffrey 2000).
Placenta previa abnormal implantation of the placenta in the lower uterine segment incidence is 0.1-1.0 (higher in subsequent pregnancies) presents with painless vaginal bleeding typically around the 32nd week of gestation potential for massive blood loss risk factors include prior uterine scar, prior placenta previa, advanced maternal age, and multiparity.
All living cocculiniforms have cap-shaped shells. The apex of the shell is typically situated at the center or nearer the posterior end of the shell. Shells are sculpted with concentric growth lines, and in some species, additional fine radial threads or beads extend from the apex to the shell margin, while in other species, the surface appears cancel-late. The shell aperture is typically oval. The inner surface of the shell bears a horseshoe-shaped muscle scar that opens anteriorly where the head is located. The head is not very flexible and the mouth opens ventrally for grazing on the substrate. Copulatory organs are present and are typically part of the right cephalic tentacle. The Cocculiniform radula is rhipdoglossate, as in the Vetigastropoda and Neritopsina. The Cocculiniform gill consists of a vestigial pseudoplicate structure that does not resemble the typical molluscan gill or ctendium.
The smooth-scaled splitjaw, Bolyeria multocarinata, is the second bolyeriid species known to science. One specimen, identified by a unique scar and believed to be the last survivor of the species, was found in faunal surveys of Round Island in the 1960s and early 1970s. It was last seen in 1974, and the species is considered extinct.
Adenocarcinoma a malignant epithelial neoplasm showing glandular differentiation. It is the lung malignancy which occurs most frequently in non-smokers, women and in the young. It often involves the upper lobes and may present peripherally as a subpleural mass or nodule, with retraction of the pleura. Central scarring in the tumour is quite common. Secondary adenocarcinomas may come from pancreas, colon, ovary or kidney and show various patterns. If there is involvement of the hilar nodes and significant scarring, then the tumour is more likely to be a primary, if multiple tumours are present it is more likely to be secondary. Lung adenocarcinoma is classified into five subtypes. Bronchioloalveolar carcinoma (BAC) is a histological variant of adenocarcinoma, which has low-grade malignant behaviour. It is composed of tall, mucin-secreting cells or non-mucinous cells with distinctive hobnail appearances, which grow along the alveolar septa in a lepidic pattern. There is no stromal...
A result of hypoxia and inflammation of the RPE. Even in the absence of CNV, the changes to the RPE Bruch's membrane and the outer plexiform layer of the retina result in scar formation at that level with concomitant damage to the neurosensory outer retina, termed geographic atrophy, which can also result in loss of central vision.
Another variation on high-throughput screening for long-lived yeast strains has been developed in which the number of chitin bud scars, a surface marker of repli-cative age, is quantified fluorescently by FACS (Chen et al., 2003). This study reported that expression of human ferritin light chain in yeast increases the number of cells with elevated bud scar counts. The authors failed to
An alternative to the chemical conjugate approach was developed by creating a single recombinant fusion molecule formed by the soluble extracellular form of CAR (sCAR) fused to epidermal growth factor (EGF) (53). Increased reporter gene expression was achieved in several EGFR-overex-pressing cancer cell lines compared with untargeted Ad or EGFR-negative cells in vitro. EGF-directed targeting to EGFR-positive cells was shown to be dependent on cell surface EGFR density. Initial proof-of-concept studies were followed up with construction of adenoviruses coding for the adapter and capable of achieving production and secretion of sCAR-EGF in human cells. Further, the effect of such retarget ing on the oncolytic potency of replication competent agents was tested in vitro and in vivo (54). To improve Ad-sCAR-li-gand complex stability, a trimeric sCAR-fibitin-anti-erbB2 single-chain antibody (sFv) adapter molecule was developed (55). The adapter displayed increased affinity to the Ad fiber...
Actinic keratosis, Bowen's disease, squamous cell carcinoma and basal cell carcinoma are the commonest solar-induced non-melanocytic tumours, other skin malignancy being relatively unusual. They arise either as red, scaly patches or as nodular lesions on the sun-exposed head and neck areas of fair-skinned people. A minority are associated with genetic disorders or areas of chronic scarring.
Many options exist for placement of the skin incisions. Often, a 5-cm transverse chest incision is made approximately 8 cm below the clavicle, centered above the nipple. The underlying fat is dissected to the level of the pectoralis fascia, and a subcutaneous pocket is fashioned superiorly. Others have suggested a deltopectoral incision with inferior dissection to create the pocket, but we believe that the scar tissue formed beneath the pectoral incision helps prevent caudal migration of the generator. Recently, we have been using a lateral incision along the anterior fold of the axilla, which affords better cosmetic results, especially among women.
In most patients, the toxicity was limited to the reaction at the vaccine injection site. All patients developed pruritic papules that progressed to pustules, sometimes with small ulcerations, that resolved into small white or pink scars. The intensity of the local reactions was ameliorated by reducing the dose of bacille Calmette-Gu rin (BCG). As expected, about one-third of patients developed nausea, sometimes with vomiting, following administration of cyclophosphamide, but systemic toxicity caused by the vaccine was uncommon Less than 5 of patients noted fever or chills following vaccine administration, and no patient experienced a decrease in performance status. One patient developed generalized urticaria 15 min after injection of her fourth dose of DNP-vaccine this was treated with an antihistamime and resolved in 5 d without sequelae. Three patients developed erythema around their lymphadenectomy sites following vaccine administration, which was asymptomatic and spontaneously...
The implantation of skeletal myoblasts into the heart after a myocardial infarct seems to be a further promising possibility for clinical use 205-210 . Since cardiomyocytes cannot regenerate, the loss of injured myocardial tissue is irreversible and the wounds are healed by replacement with scar tissue. Among the cell types that could be transplanted to injured hearts in order to replace scar tissue or to prevent scarring, skeletal myoblasts are the cells of choice for several reasons. Although cardiomyocytes appear to be more eligible, the fact that they, in contrast to skeletal myoblasts, do not proliferate in culture makes their use impractical. Skeletal myoblasts have the advantage that high numbers of autologous donor myoblasts can be cultured, allowing reparation of myocardial infarcts in humans. The implanted cells differentiate into fully developed, slow twitch fibers that not only prevent the formation of scar tissue, but also have the capacity to perform cardiac work. This...
Lesions like radial scars or papillary growths need formal histological assessment to exclude associated in-situ or invasive malignancy. Impalpable lesions and areas of microcalcification require radiological needle localisation to guide the surgeon to the area in question for adequate excision.
Chronic pyelonephritis refers to renal injury induced by recurrent renal infection in patients with urinary tract obstruction, renal dysplasia, or, most commonly, vesicoureteral reflux (VUR). It is associated with progressive renal scarring, which can lead to end-stage renal disease (ESRD). Intravenous urogram establishes the diagnosis of pyelonephritis and nephrectomy is required in cases with significant morbidity or loss of function. PUJ obstruction one of the most common congenital abnormalities of the urinary tract and associated with a number of anomalies. The aetiologies are numerous and classified on an anatomic basis as either extrinsic (scars, VUR) or intrinsic (developmental). Treatment is primarily surgical (pyeloplasty) which now can be performed laparoscopically.
Familial IP (MIM 308310) is a rare X-linked dominant disorder affecting approx 1 in 50,000 newborns. It is characterized by abnormalities of the skin, hair, nails, teeth, eyes, and central nervous system, with a distinctive pattern of hyperpigmentation and dermal scarring (25). Affected males die in utero, whereas affected females have extremely skewed X-inactivation owing to the death of cells carrying the mutation on the active X chromosome. The disorder is caused by defects in the NEMO gene that encodes a regulator of the NF-kB signal pathway (9,26). The gene spans 23 kb and consists of 10 exons. A recurrent 10-kb deletion that removes exons 4-10 accounts for 70-80 of the mutations identified in IP patients (9,26). This deletion is flanked at the ends by two identical 878-bp MER67B repeats (termed int3h repeats), one located within intron 3 of the gene and the other in the 3' flanking region (Fig. 1D1). In most of the de novo cases, the deletion occurred in the paternal germline,...
Especially with cases of large-volume seminoma, it is common to find a residual mass on scanning the patient after a course of chemotherapy. However, approximately 90 of these masses do not contain residual malignancies and appear to be fibrotic remnants (Figure 20-3).30,31 Attempted resection can be hazardous because of extensive dense scar tissue involving the great vessels and retroperitoneal tissues. The analysis from the Memorial Sloan-Ketter-ing Cancer Center suggested that there was a higher risk of residual malignancy if the residual mass was 3 cm in diameter.32 This suggestion has led, at some centers, to a policy of particularly close surveillance or adjuvant radiotherapy for this subset of patients.33 However, other investigators have not found that recurrence was more likely when the residual mass was 3 cm in diameter.34 Furthermore,
Even in patients with advanced disease at diagnosis, excellent response to treatment can be achieved today. As a result, imaging is now frequently performed in patients who have undergone multiple courses of chemotherapy and multiple relapses. In such patients, the imaging findings are more complex and difficult to interpret than at the time of staging. For example, such patients also frequently have undergone previous surgery scarring in the lungs or in other tissues adds to the difficulties of identifying relapse. Furthermore, previous treatment with radiotherapy may not only cause radiation fibrosis in the treated tissue volume but may also influence the site of subsequent relapse. For example, in patients with stage I seminoma who have undergone radiotherapy to the para-aortic nodes (without pelvic node irradiation), the pelvis is a common site of relapse and therefore a group who should receive surveillance pelvic CT scans.50
Many cutaneous disorders have associated esophageal involvement. The more common of these disorders include epidermolysis bullosa, cicatricial pemphigoid (CP), lichen planus, and pemphigus vulgaris. Epidermolysis bullosa is a relatively rare cutaneous disease mediated by circulating IgG antibodies directed against type VII collagen. Clinically, patients develop intradermal blistering lesions with scarring at sites of trauma (hands and feet are most common). The proximal third of the esophagus, consisting of stratified squamous epithelium, is at risk. Strictures can occur due to concentric scarring from large blisters. Treatment is dilation. There is reported treatment of severe cases by colonic interposition free tissue grafting, to replace the stratified squamous epithelium of the proximal third of the esophagus (25). Bullous pemphigoid (BP) is another autoimmune blistering disease, which generally affects patients over the age of 60. It is the most common of the bullous cutaneous...
A Hawaiian monk seal (Monachus schauinslandi) asleep wrapped in vines, showing shark bite scars. (Photo by Frans Lanting Photo Researchers, Inc. Reproduced by permission.) A Hawaiian monk seal (Monachus schauinslandi) asleep wrapped in vines, showing shark bite scars. (Photo by Frans Lanting Photo Researchers, Inc. Reproduced by permission.)
In 1965, the Western Hemisphere Nutrition Congress was organized by the American Medical Association, and W. Henry Sebrell (1901-1992), the former director of the National Institutes of Health, noted vitamin A deficiency is becoming increasingly recognized as a serious condition which is widespread in some parts of this hemisphere. Vitamin A deficiency accounts for widespread blindness or impaired vision and to a large extent contributes to high mortality (99). The Interdepartmental Committee on Nutrition for National Defense of the US National Institutes of Health conducted surveys in which data on vitamin A deficiency were collected. Vitamin A deficiency was considered a major health problem in many countries, including Jordan (100), Ethiopia (101), Vietnam (102), Thailand (103), Lebanon (104), and East Pakistan (105). These surveys defined vitamin A deficiency as a public health problem if more than 5 of the population had plasma or serum vitamin A concentration
Historically, cases of EGGCTs have been described in the literature at least since the 1930s.1 Through the years, there has been a debate as to whether these EGGCTs represent true primary lesions originating outside the gonads or are secondary metastases from occult testicular lesions. In 1961, Azzopardi and Hoffbrand published histologic evidence of testicular scars in 17 patients with presumed EGGCTs and hypothesized that these scars represented regression of primary testicular neoplasms.2 The argument that EGGCTs represent metastases is based on numerous case reports of microscopic intratesticular tumors or burnt-out scars discovered on histologic examination of testes from patients with presumed primary EGGCTs and normal testes on palpation.3-7 The majority of these A second line of evidence is that many patients with disease limited to the mediastinum or retroperi-toneum have been cured after local therapy alone.10 Only rarely are testicular recurrences reported, and most of...
Stents are now considered to reduce the incidence of restenosis, which generally occurs within 4-6 months following an angioplasty procedure. Before stents, the incidence of restenosis was about 35-45 . Restenosis is a renarrowing of the treated coronary artery, which is largely related to the development of neointimal hyperplasia (that which occurs within an artery after it has been treated with a balloon or atherectomy device). In general, restenosis can be considered as scar tissue that forms in response to a previous mechanical insult. Hence, restenosis is somewhat different from atherosclerosis, which is related to calcium, fat, or cholesterol plaque buildup. Some individuals are considered genetically predisposed to develop restenosis.
Some lymph node groups are virtually always pathological, i.e., Virchow's supraclavicular. Inguinal lymph nodes usually show non-specific lymphadenitis or scarring and are unlikely to be informative except when markedly enlarged or the patient has a previous history of malignancy.
SJS usually lasts four to six weeks and can be complicated by electrolyte imbalance, dehydration, secondary infections, and severe pneumonitis. Large areas of denudation can cause scarring leading to contractures. Ocular complications include corneal scarring, pseudomembrane formation leading to immobility of the eyelids, and lacrimal duct scarring. Lesions of the oral mucosa usually heal without complications. Esophageal or anal involvement can lead to strictures, and vaginal or urethral mucosal lesions can cause stenosis.
The majority of posttreatment esophageal strictures in our patients are secondary to radiation or due to scarring of the surgical anastomosis. Every effort is made to rule out residual or recurrent tumor at the site of stricture prior to embarking on stricture dilation. We dilate strictures only if the patient has significant dysphagia that prevents adequate nutrition and the stricture is less than 10 mm in diameter. Both bougies (Savary-Guillard dilators) and through-the-scope balloons are used for stricture dilation. The through-the-scope balloons are more convenient because they do not require fluoroscopic guidance. However, in patients with long strictures that cannot be traversed by endoscope or with tight strictures in which the lumen cannot be seen, a guidewire is used with fluoroscopic assistance. Balloon or Savary dilation over the guidewire is performed with fluoroscopic guidance. Dilation is usually limited to no more than 3 sizes in a single session, and patients are...
B1 unsatisfactory normal tissue only B2 benign e.g. fibroadenoma, sclerosing adenosis B3 benign but of uncertain malignant potential benign lesions associated with the presence of cancer and or the risk of developing it, e.g. radial scar complex sclerosing lesion, atypical ductal hyper-plasia, ALH LCIS, phyllodes tumour, papillary lesions B4 suspicious of malignancy epithelial proliferation suspicious but not diagnostic of malignancy for quantitative or qualitative reasons B5 malignant a. in situ
Although not common, sporadic cases and outbreaks of cellulitis, soft-tissue abscesses and rarely extra-cutaneous disease associated with rapidly growing NTM have been documented in healthy individuals. These have occurred in both nosocomial (contaminated surgical or clinical devices contaminated with water) and community settings (contamination of traumatic wounds with soil or water). Recently, outbreaks of cutaneous NTM infection in older children and adults have been linked to nail salon whirlpool footbaths (Winthrop et al., 2002 Gira et al., 2004). Such infections are often insidious and therefore affected individuals may not seek medical attention in the initial stages. Although some resolve without intervention, infection may result in a severe, protracted and potentially scarring furunculosis (Winthrop et al., 2004).
Vitamin E is used both as an oral supplement and as a topical preparation in a variety of dermatological conditions. It is a popular ingredient in many moisturising preparations used to alleviate dry and cracked skin, assist in the repair of abrasions, burns, grazes and skin lesions, prevent stretch marks and diminish scar tissue. Vitamin E oil is used as a stand-alone preparation or incorporated into a cream or ointment base for these purposes. Scar tissue Although vitamin E is widely used to diminish the appearance of scars, a small double-blind study of 1 5 patients who had undergone skin cancer removal found that applying an emollient preparation known as Aquaphor with added vitamin E after surgery either had no effect or worsened the appearance of scars compared with Aquaphor alone (Baumann & Spencer 1999). A larger study of 80 people with hypertrophic scars and keloids found that treatment with vitamin E and silicone gel sheets was successful in scar treatment (Palmieri et al...
Mitral valve stenosis most commonly due to rheumatic fever with commissural fusion, cusp scarring and dystrophic calcification. Aortic valve stenosis due to calcification of a congenitally bicuspid valve, senile calcific aortic stenosis or post-inflammatory scarring. Aortic regurgitation secondary to post-inflammatory scarring, infective endocarditis or abnormalities of the cusps and commissures. Tricuspid valve abnormalities most commonly pure insufficiency and caused by postinflammatory scarring, congenital abnormalities, infective endocarditis or dilatation of the valve ring in cardiac failure.
Most apparent but not always sufficiently addressed are the cosmetic effects of surgery. Patients may be embarrassed by their own distress from a seemingly minor problem with an otherwise good outcome and consequently may not bring forth their concerns. Nonetheless, visible scars from cancer surgery can result in some cases in social isolation. Other patients find the sight and smell of an ostomy to be repugnant and greatly overestimate how much it is apparent to others around them. It is incumbent on providers caring for these patients to explore these issues with them to ensure that they are as satisfied as possible with long-term cosmesis. If distress is identified, they should look for ways to optimize the cosmetic result, and where this is not possible, try to help the patient best cope with their situation.
These results stand in contrast to previous case-series, in which 18-25 of patients with evidence of renal scarring developed hypertension on follow-up 15-30 years after their first UTI (Goonasekera et al., 1996 Smellie et al., 1998). However, those studies selected patients with severe renal parenchymal defects and used conventional and not ambulatory BP measurements, which may account for the discrepancy in results. Jacobson et al. found three of 30 patients followed up 27 years after the detection of non-obstructive pyelonephritic renal scarring had ESRD, and the remainder had significantly lower GFR than matched controls (Jacobson et al., 1989). Martinell et al. followed 54 female patients with renal scarring continuously for 15 years (Martinell et al., 1996). GFR was reduced compared to controls only in those with severe scarring. In summary, there is no clear evidence that renal scarring is a risk factor for the future development of HT, but severe renal scarring may be a risk...
Basal cell carcinoma basal cell carcinoma is the commonest malignant tumour of the skin, and overall in humans. The vast majority is associated with chronic sun exposure and occur in the head and neck area of fair-skinned people. A few occur at sites of scarring in the skin and a small number of patients with a genetic predisposition develop multiple basal cell carcinomas. These patients often present at an early age. Basal cell carcinomas have a variety of clinical appearances from a nodular lesion to an ulcer or scarred areas and they may also be multifocal. The colour of the tumours can vary. The cell of origin of basal cell carcinoma is thought to be either the basal cell layer of the epidermis or hair follicle. Basal cell carcinomas are locally aggressive tumours, often infiltrating and destroying adjacent tissue. They do not, however, metastasise to other sites. The treatment of choice is surgical removal. The clinician may submit a variety of specimen types to the laboratory...
The commissures of the aortic valve have been described above they are comparable for the pulmonic valve. The commissures of the atrio-ventricular valves are less well defined. The leaflets insert broadly into the annulae along a curved base at the junction between one leaflet and the adjacent leaflet, they form a commissure. This is a potential site for damage. Inflammation, thrombus, and calcification may scar the commissure and prevent complete opening of the valve. This is typical of rheumatic heart disease with resulting mitral, or less commonly, tricuspid valve stenosis. Separation of these commissures may occur when the annulus is stretched or damaged this results in valvular incompetence.
Good communication skills are fundamental to giving bad news appropriately. When bad news is broken insensitively or inadequately the impact can be distressing for both giver and recipient, leaving lasting scars for the latter. Doctors should have a plan for this difficult process and learn how to cope with the recipient's reaction. Most of the circumstances described apply to unexpected death.
Such stents have been produced with a variety of drug coatings in further attempts to minimize the time for, or altogether eliminate, the possibility of restenosis. The most common drug used to coat stents is sirolimus (also known as rapamycin). Drugs like sirolimus work by stopping cell growth they also stop scar tissue from forming within arteries that have been opened. For more details, refer to Chapter 33.
Opposition of the thumb to the index and long fingers is encouraged during the first 2 weeks out of plaster, avoiding opposition to the ring and small fingers so as to not stress the reconstructed ligament. Patients massage the scar several times per day. Gentle tip-to-tip pinch is begun to work on dexterity.
Decreased cavity volume in association with conditions such as hypertension. The papillary muscles also have a terminal coronary circulation with little or no collaterals. Ischemia associated with the left anterior descending or circumflex coronary arteries makes them particularly susceptible to necrosis or focal scarring. This may lead to papillary muscle dysfunction, and without the tethering effect of the muscle, mitral valve regurgitation. Typically, each papillary muscle has multiple smaller heads giving rise to chordae tendineae. The main papillary muscle body is known as the belly. The chordae from both papillary muscles fan out to support both leaflets of the mitral valve. The chordae from the 2 right ventricular papillary muscles support the anterior and middle leaflet. The septal leaflet chordae insert directly into the ventricular septum without a papillary muscle. In the right ventricle, the papillary muscles are less prominent, appearing more like hypertrophied trabeculae.
Myocardial scarring Of these risk factors, this patient had all except 6 and 7 She had significant cardiac hypertrophy with a gross heart weight of 450 g, and a left ventricular wall measuring 1.9 cm in greatest thickness (normal up to 1.5 cm). The estimated cardiac mass for a woman who weighed 63 kg is between 250300 g. The calculation is estimated by taking the weight of the individual in kilograms and multiplying by 0.4 . For males, with somewhat greater lean muscle mass, the multiplier is 0.5 . More precise estimates can be obtained by using the body surface mass-index, but for practical purposes, a 0.4-0.5 multiplier gives a reasonable approximation. The upper limits are equally significant, and are considered pathological, regardless of body size, if more than 350-400 gm in a woman, or more than 400-450 gm in a man. The proviso that the hypertrophy is non-physiologic is also an important consideration. In a well-trained athlete, particularly one performing isometric exercise...
Closed comedones ( white heads ) are never present in areas of HS. Open comedones ( black heads ) are also absent in early disease but may appear in long-lasting HS, usually as double-ended comedones. These may be taken to reflect the distortion and degradation of the dermal architecture caused by the extensive inflammation and scarring of the disease. They are particularly conspicuous in burnt out lesions, presumably when no longer obscured by the active disease (see Fig. 3.10). As in acne conglobata these are tertiary lesions i.e. tombstone comedones . They are present in 50 of patients 8 . Their prevalence does not appear to be affected by either concurrent acne or a previous history of significant acne 1 .
How To Reduce Acne Scarring
Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.