Scars Holistic Treatments

Scar Solution By Sean Lowry

This training system is developed by Sean Lowry a medical researcher and also a former scar sufferer. The Scar Solution book is actually an useful treatment available online that guides users on how to get clear skin without scars fast. Sean Lowry put her skills and knowledge as a medical researcher and scientist to good use, and in the process she came up with the scar solutions discussed in her aptly-titled The Scar Solution e-book. Sean Lowry adopted a different biotech approach to removing the appearance of scars avoiding harsh chemical solutions and toxic herbs. Instead of providing for a one-size-fits-all scar solution, she researched, tested and developed detailed treatments for the different types of scars! The results are amazing: Fast results in terms of removing the appearance of large, raised and discolored scars on the skin. This is because each type of scar has different causes and requires different techniques of treatment. Anyone can easily pick up a copy of this guide and start using it immediately. Written in simple English this guide clearly explains in detail about what is required to be done to treat the scars naturally. All that is required on part of users is to follow the instructions step by step for the time period specified. Read more...

The Scar Solution Natural Scar Removal Summary


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Previous abil surgeryNo midline scars

Of midline scars, the umbilical position is usually favored for establishing pneumoperitoneum and laparoscope placement. LUS examination of the liver requires access from the right subcostal region when using a (semi-)rigid probe, introduced laterally, between the midclavicular and anterior axillary lines. A second port is needed for full examination, preferably in the left subcostal or infra-umbilical areas. For LUS of the hepatoduodenal ligament, the transducer needs to be placed longitudinally and this requires access from the subxiphoid region. Usually two ports are sufficient although a third 5 mm trocar is useful for manipulation or retraction and for taking biopsies.

VT related to regions of scar

The majority of sustained monomorphic VTs are caused by re-entry involving a region of ventricular scar. The scar is most commonly caused by an old myocardial infarction, but arrhythmogenic right ventricular dysplasia, sarcoidosis, Chagas' disease, other non-ischaemic cardiomyopathies and surgical ventricular incisions for repair of tetralogy of Fallot, other congenital heart diseases, or ventricular volume reduction surgery (Batista procedure) can also cause scar related re-entry. Dense fibrotic scar creates areas of anatomic conduction block. Secondly, fibrosis between surviving myocyte bundles decreases cell to cell coupling, and distorts the path of propagation causing slow conduction, which promotes re-entry (fig 25.2).5 These re-entry circuits often contain a narrow isthmus of abnormal conduction. Depolarisation of the small mass of tissue in the isthmus is not detectable in the body surface ECG. The QRS complex is caused by propagation of the wavefront from the exit of the...

Scars And Contracture Scars

Scarring is a normal part of tissue repair except during fetal and early neonatal life. Whenever there is damage, fibro-blasts are attracted and they multiply and align themselves before extruding collagen fibrils which mature and undergo shortening. As a result of this, a longitudinal incision often shortens over a period of months unless it is subjected to excessive strain, when it stretches. The collagen is remodelled in order to adjust the alignment of the fibrils to strains exerted on them, but it never reaches the strength of the unwounded tissue.

Keloids and hypertrophic scars

Hypertrophic scars are characteristically elevated but remain within the limits of the initial injury and regress spontaneously. Keloids extend beyond the original wound and do not regress (Fig. 7-6).13 Even though they are most prevalent in patients between 10 and 30 years of age, keloids can occur at any age. Keloids are far more common in African-Americans than in other races. The underlying mechanism of hypertrophic scar and keloid formation is excessive collagen production with concomitant decreased collagen degradation. Although keloids have been shown to have an underlying genetic basis, various other contributing factors, such as andro-gens estrogens, immunologic alterations, and others have been implicated as well.

Keloid scars

Keloid scars differ from hypertrophic scars in that they extend outside the area of the original wound. Keloid scars tend to develop more commonly in those of African ancestry, and in certain parts of the body, notably over the shoulders, upper back and sternum. They are prone to develop following ear piercing. Their development is reduced if continuous pressure is exerted on the wound during healing and for up to 12 months afterwards elastic compression devices must be individually designed. Radiotherapy to the healing wound also diminishes the laying down of collagen but the safety of this has been questioned. Triamcinolone, a potent steroid, can be injected through a fine needle into the scar until it pales, this is quite painful. The injection can be repeated after 6 weeks.

Renal Anatomy and Basic Concepts and Methods in Renal Pathology

Sclerosis refers to increased extracellular matrix and other material leading to obliteration of capillaries and solidification of all or part of the tufts. Sclerosis (glomerular scarring) may be associated with obliteration of the urinary space by collagen along with increased extracellular matrix in the capillary tufts. When the entire glomerulus is involved, this is known as complete sclerosis an older and less precise term is glomerular hyalin-ization. Segmental glomerulosclerosis implies a completely different pathologic process and often a disease. With segmental sclerosis, only portions of the capillary tufts are involved capillaries are obliterated by increased extracellular matrix and or large precipitates of plasma protein known as insudates. Crescents represent accumulation of cells and extracellular material in the urinary space. Crescents are the result of severe capillary wall damage with disruptions in continuity and spillage of fibrin from inside the damaged...

Endometriosis and your fallopian tubes

Scarred Fallopian

Endometriosis can implant on the outside surface of the fallopian tubes and cause scarring. Just like burn scars can lead to contractures that distort limbs and other body parts, the endometriosis scarring can distort the fallopian tubes so they can't function properly. Endometrial implants can totally block the fallopian tube by forming scar tissue that destroys the fimbriae and sticks these tiny fingers together. As these delicate fingers become distorted and stuck, the end of the tube can close off, literally, keeping sperm and egg separated. When endometriosis develops on the surface of the ovary by retrograde menstruation or metaplasia, the inflammatory process begins and leads to adhesions (scar tissue). As a result, the ovary can become stuck to the tube, uterus, intestines, or pelvic wall. These adhesions (check out Figure 3-3) can cause pain and problems with the intestines and they can cause infertility. Another severe problem is endometrioma (cysts) inside the ovary. These...

Repair of Forehead Lacerations

Forehead Scars From Laceration

The deep layers may be approximated in a similar fashion to the scalp. In this area, unrepaired muscle layers are more likely to produce noticeable scars, especially when the facial muscles of expression are involved. The superficial layers may be closed with 6-0 nonabsorbable interrupted suture (nylon, coated nylon, or polypropylene) or tissue adhesive. For deep wound under tension, a buried 5-0 intradermal, absorbable monofilament (e.g., Monocryl) or multifilament (e.g., Dexon or Vicryl) can be used. The epidermal layer can be closed with 6-0 nonabsorbable nylon in a simple, interrupted fashion with wound closure strips e.g., Steri-strips (3M Company) or Dermaseal (Personna Medical) over tincture of benzoin or with tissue adhesive.1 l6 These alternate methods of closure are especially attractive if the patient is at risk to develop keloids or hypertrophic scars (e.g., people with darkly pigmented skin). Care should be taken in the forehead to approximate the skin tension lines and...

Skin Surface Analysis

Microanatomy The Epidermis

Skin surface analysis is often tailored to the goals of restorative surgery or nonsur-gical treatments. Patients undergoing scar revisions require analyses to include the resting skin tension lines. In the patient undergoing nasal reconstructive surgery after Mohs' resection, an analysis of the topographical units of the face is important. If cutaneous resurfacing is planned, an analysis of skin type and reaction to solar damage are also needed. Koebner's phenomenon is also an important consideration. This phenomenon describes the tendency for some skin diseases such as psoriasis, lichen planus, discoid lupus erythematosus, and herpes simplex to localize to areas of recent surgery or scars.

Endometriosis and your pelvic cavity

Male Reproductive System

Endometriosis that implants on the peritoneum in the pelvic cavity (see Figure 3-5) can cause severe inflammation that leads to adhesions or scar tissue. These adhesions can then cause all these organs and tissues the uterus, ovaries, tubes, intestines, and bladder to stick to each other so they don't move in the usual manner. This restriction of movement and the inflammation due to endometriosis cause the pain or discomfort. In addition, these same adhesions can make the intestines, bladder, and reproductive organs malfunction. Endometrial implants in the pelvic cavity can result in scar tissue, which binds organs and tissue together. When the tissues and organs stick together, movement (such as occurs during sexual intercourse) results in pain. The eventual result may be a frozen pelvis, which is as bad as it sounds. S Scar tissue causes pain when structures stick together in unnatural ways. (Chapter 13 shows you how you can manage the physical pain associated with endometriosis in...

Clinical Description

The arthrochalasis type of EDS (the former EDS type VIIA and B) is inherited as an autosomal dominant trait. The clinical hallmark of this type is congenital bilateral hip dislocation.1-18-1 There is also severe generalized joint hypermobility with recurrent dislocations of large and small joints and ligamentous tears. The skin is moderately involved, with skin hyperextensibility, a velvety touch, and poor wound healing with formation of atrophic scars. Other features include easy bruising, muscular hypotonia and delay in gross motor development, kyphoscoliosis and osteopenia with wormian bones and sometimes a history of fractures.

Etiology Pathogenesis

Hypertension has been presumed to cause end-organ damage in the kidney, and hypertension undoubtedly accelerates progressive scarring of renal parenchyma, but the relationship of hypertension and arterionephrosclero-sis is not simple and linear (11). In a large series of renal biopsies in patients with essential hypertension, arterionephrosclerosis was present in the vast majority, and the severity of arteriolar sclerosis correlated significantly with level of diastolic blood pressure (9). However, in several large autopsy series of patients with presumed benign hypertension, significant renal lesions were rare (4,5). Further, the level of blood pressure does not directly predict degree of end-organ damage African-Americans have higher risk for more severe end-organ damage at any level of blood pressure (2). The African American Study of Kidney Disease (AASK) trial showed that African Americans with presumed arterionephrosclerosis indeed did not have other lesions, by renal biopsy,...

TABLE 791 Vomiting and Diarrhea The Gastroenteritis Mnemonic

PHYSICAL EXAMINATION Clinical clues may also assist in making the diagnosis. In addition to evaluating the ABCs, much of the physician's initial attention should be directed toward the assessment of hydration status. Severely volume-depleted patients require immediate intervention, lest circulatory collapse be imminent. The abdominal, genitourinary, and pelvic examinations are often revealing. Physicians should search carefully for tenderness, peritoneal signs, hernias, masses, and evidence of obstruction or torsion. The findings of a careful physical examination may point toward unsuspected causes of vomiting, such as bulimia (scars on the dorsum of hands), pneumonia (consolidative findings on lung examination), or Addison's disease (hyperpigmentation). The rectal examination is important. An anal fistula may be the only clue to Crohn's disease in an otherwise healthy teenager with vomiting, or may demonstrate fecal impaction.

Clinical features

Photographs of a patient with AIDS (a) shows perineal scarring after recurrent peri-anal infections and (b) a mouth ulcer on the hard palate, probably due to an opportunistic viral infection. Figure 11.13. Photographs of a patient with AIDS (a) shows perineal scarring after recurrent peri-anal infections and (b) a mouth ulcer on the hard palate, probably due to an opportunistic viral infection.

Clinical experience

Since isopotential maps are predominantly used, ventricular repolarisation must be distinguished from atrial depolarisation and diastolic ventricular activity. Early diastole may be challenging to map. Virtual electrogram quality deteriorates at a distance greater than 4 cm from the MEA, which at times may require MEA repositioning to acquire adequate isopotential maps. Lastly, substrate mapping (based on scar or diseased tissue) is limited with this technology at present.

Distraction Osteogenesis

Distraction Osteogenesis Mandible

The method of distraction osteogenesis for maxillofacial application is extrapolated largely from the experiences with long bone distraction. First, division of the bone cortex (corticotomy) is required, preserving the medullary blood supply (e.g., inferior alveolar artery) and the periosteum. A latent period of up to 15 days (shorter for younger patients) is required for adequate callus formation and regeneration of central vessels and periosteal tissue. The external distraction device is connected to the underlying bones percutaneously via pins attached to a threaded bar for manual separation. Internalization of the distraction device to avoid cutaneous scarring has recently been studied (64). New bone formation occurs in -g Potential complications using distraction in the facial region include premature union, nonunion, elongated cutaneous scars, and patient intolerance of the device. Even very minor movement, other than the controlled daily distractions, can lead to fibrous...

External Examination of a Submerged Body

Drowning Froth

Unzippered pants of an inebriated male who slipped into the water is seen uncommonly (1,9). Finding of material (e.g., weeds, sand) clutched in a victim's hands suggests struggling (6). Dirt under the fingernails could indicate the flailing of hands along a muddy bottom (Fig. 4). Wrist scars or recent self-inflicted sharp force injuries on a drowning victim point toward suicide (see Heading 3. and refs. 9 and 137). Facial or scalp blunt trauma means ruling out underlying cranial and cervical spine trauma however, cutaneous injuries are possible when the victim assumes a head-down position and scrapes the bottom (see Chapter 2, Subheading 3.3. Fig. 5 and refs. 11 and 29). The absence of external trauma in an unwitnessed submersion does not mean that drowning is the cause of death (13).

MTP Stiffness after Weil Osteotomy

Weil Osteotomy

Contraindications of Weil osteotomy are trophic troubles with cold foot, very thin foot or cheloid scar tendency, or very anxious and young patient (2). Fig. 17f.Weil osteotomy stiffness The best way to eliminate MTP stiffness is a large and harmonised shortening of the metatarsals with Weil osteotomy (and if necessary with M1 shortening by scarf, as in this picture).

Reversal of Hartmanns procedure Figure

The operation involves reopening the old laparotomy scar, taking the colostomy back into the abdomen, and joining the proximal end to the distal end of the colon. The patient will then have two scars the laparotomy scar and the scar where the colostomy was in the left iliac fossa.

Traditional Surgical Approaches

Delayed Union Nonunion Decortication

There are many potential applications for the trochanteric slide. These include revision total hip replacement with or without leg length adjustment periprosthetic femoral fracture access to and treatment of femoral cortical deficiency removal of extraosseous bone cement osteotomy of the femur to correct varus, valgus, or rotational malalignment and trochanteric repositioning or rotational, length, or offset improvement. On the acetabular side, the slide approach facilitates bone grafting insertion of bilobed cups vertical relocation of the high hip center for developmental dysplasia, or girdlestone conversion and removal of heterotopic bone or excessive scarring.

UShaped Flaps and Jagged Lacerations

Trapdoor Deformity

A U-shaped skin flap is often caused by compressive forces on skin overlying bone. The flap usually has abraded skin and extends deep with attached subcutaneous tissues. The edges of the flap are usually irregular and fit together with adjacent wound edges, like a jigsaw puzzle. The survival of a rectangular-shaped flap is dependent on the blood supply from vessels that enter the flap at its base. Survival of a flap is more dependent on its length and not the width of the base wide and narrow-based flaps survive equally if they are of the same length. Other factors that favor survival include the following (1) the presence of direct cutaneous arteries or veins coursing the longitudinal axis of the flap (axial-pattern flap) (2) location of the flap in the head or neck, where the vascularity is excellent (3) younger patients and those without diabetes mellitus or arteriosclerosis (4) location above the knee and not in areas of scar or previous exposure to radiation, which, especially in...

Clinical examination

An accurate and thorough clinical examination of the patient in general and also the particular joint or joints involved is essential to determine the cause of an arthropa-thy. Clinical examination involves assessing the alignment and stability of the joint and associated soft-tissue swellings, including any effusion within the joint. Scars or sinuses suggesting surgery and infections must be noted. It is important to palpate for local temperature (warm in case of inflammatory pathologies and hot in acute infections) any bony areas for tenderness and to assess the range of both active and passive movements. General examination must assess other joints involved as well as the musculoskeletal system, looking for signs that may confirm an inflammatory or infective arthropathy. The format most popular in orthopaedics is took, feel, move (inspection, palpation, movements) followed by special tests for specific pathologies suspected, neurological assessment, vascular assessment, assessment...

Surgical considerations

Limb amputations are generally carried out with a tourniquet however, prior to stump closure, the tourniquet must be released to make sure that all bleeding vessels have been carefully ligated. Nerves must be carefully divided prox-imally so that they can retract into the soft tissues and will not be irritated by the scar at the tip of the stump thus neuromatous pain is avoided. In the closed amputation technique, which is used particularly in diabetics, skin flaps must be repaired without undue tension so as to avoid the possibility of postoperative sepsis and dehiscence of the stump.

Lichen Simplex Chronicus

Hidradenitis suppurativa is a chronic scarring inflammatory disorder of the apocrine gland-bearing areas of the body. These glands are located predominantly in the groin, intergluteal cleft, vulva, and axilla. Hidradenitis suppurativa begins after puberty and is seen slightly more frequently in women. It is more likely seen in obese

Tumors with Sebaceous Differentiation

Adnexal tumors are best treated with surgical excision. Multiple small trichoe-pitheliomas may be managed with dermabrasion or resurfacing lasers but recurrence is common. Sebaceous hyperplasias can be eradicated with electrodesiccation or cryotherapy. Multiple cylindromas are difficult to manage because recurrence is the rule.

Anatomic Blood Supply

Figure 17-2 (A) Postoperative result after excision of a SCC at the modiolus with resultant scarring and microstomia (B and C) defect coverage with a randomized rotational flap (D) flap in place (E) result after 9 months. Figure 17-2 (A) Postoperative result after excision of a SCC at the modiolus with resultant scarring and microstomia (B and C) defect coverage with a randomized rotational flap (D) flap in place (E) result after 9 months.

Circumcision Complications

POSTCIRCUMCISION PHIMOSIS Improper seating of a circumcision bell clamp at the time of foreskin removal may result in excess residual foreskin following the procedure. Since the circumcision site is circumferential in nature, the inevitable contraction of the scar may yield a progressive narrowing of the foreskin orifice. At some point, the narrowed foreskin orifice slides distally over the glans penis, entrapping it. Further contraction of the circumcision scar may result in such a degree of phimosis that urine flow is obstructed. This phenomenon is more common in boys with prominent peripenile fat pads, particularly in boys with a retracted-appearing penis. SURGICAL PENILE GLANS ADHESIONS Contact of a postcircumcision scar with the recently denuded glans penis may result in a very thick adhesion between the epithelial surface of the glans penis and the circumcision scar. These adhesions cannot be separated by blunt dissection, requiring surgical separation instead. They are...

Radiographs Consultation and Disposition

Radiologic evaluation should include at a minimum a posteroanterior (PA), lateral, and oblique projection. Similar projections are used for the digits, except that the x-ray beam is centered over the digits. Actual or suspected injuries of tendons and nerves should be referred to a hand specialist. Whether consultation is provided in the emergency department or in follow-up (1 to 3 days) depends on local resources. Often the skin can be closed, the hand splinted in the position of function, and at follow-up the wound can be extended, explored, and definitive repair performed by the hand specialist. Most hand specialists prefer to do definitive repair within a 3-to 5-day window after acute injury. While most tendon injuries < 20 percent may not be surgically repaired, hand specialist follow-up and rehabilitation are still necessary to accurately determine the extent of injury, minimize scarring and tendon contraction, and minimize neuroma formation.

Reconstructive Ladder Direct Primary Closure

Surrounding tissue must allow for direct closure without tension or distortion of surrounding anatomic units. The lower eyelid is particularly susceptible to deformity and if too much tension in the cheek or nasal area is applied there is the risk of an ectropion (outward scarring of the lower lid).

Clinical Evaluation

PHYSICAL EXAMINATION The examination of the hip begins with a detailed history and complete examination of the patient. The pelvis and hip are then carefully evaluated. The unclothed, erect patient is inspected for a list, injuries, scars, or asymmetry of the muscles. Gait should be tested, if possible.

Background Definition

Bullous pemphigoid (BP) is an acquired non-scarring autoimmune subepidermal bullous disease characterised by tense blisters. Circulating IgG autoantibodies (rarely IgA and IgE) bind to BP230 and BP180 antigens, which are components of the hemidesmosome adhesion complex found in the basement membrane zone of the skin. Direct antibody and antigen interaction, local activation of complement and release of cytokines lead to loss of dermoepidermal adherence and formation of subepidermal blisters.1 Blistering typically occurs on the flexures although BP may be generalised or localised to one site such as the lower legs. Erosions and blisters occur on the mucous membranes, particularly the mouth, in about 50 of cases. Blister formation may be preceded by pruritus or an urticarial or

Pathologic Findings Light Microscopy

The glomerular features are not specific for chronic graft rejection, but are typical. The glomeruli have an increase in mesangial cells and matrix and thickening and duplication of the GBM, with various degrees of scarring and adhesions (Fig. 20.12). This lesion has been shown to derive from acute allograft glomerulopathy in a few cases (10,14). Extensive crescents, diffuse granular or linear deposits of IgG, or subepithelial deposits are unusual and suggest recurrent or de novo glomerulonephritis.

TABLE 2764 Conditions Associated with Migratory Arthritis

Valvular heart disease is a recognized extraarticular manifestation of the seronegative spondyloarthropathies, particularly ankylosing spondylitis. Fibrotic changes of the aortic valve are usually asymptomatic, with dysfunction occurring more often in patients with long-standing, severe disease. Scar tissue also may impair cardiac conduction, leading to drop attacks. Relapsing polychondritis can affect the valves, causing aortic insufficiency and aneurysm. This may develop early after diagnosis and is a grave development. Table.276-5. summarizes cardiac involvement in rheumatic diseases.

Pathologic Findings

Which are classically in a beaded pattern in the media. The usual hyaline deposits in hypertension or diabetes are subendothelial. The endothelial or smooth muscle cells may be vacuolated. Later biopsies show progressive scarring of arterioles, intimal fibrosis, and segmental glomerular obsolescence. Immunofluorescence of early lesions may show that the vessels have deposits of immunoglobulin M (IgM), C3, and fibrin. Electron microscopy shows apoptosis or necrosis of smooth muscle cells and replacement with hyaline material. Focal myocyte necrosis in the media of small arteries, in the absence of intimal changes, is regarded as a reliable indicator of CsA toxicity (3,4). The reversibility of the these lesions is debated.

Renal Transplantation

The surgical management of an injured transplanted kidney is a complex procedure. A very short vascular pedicle and ureter, dense scarring, and a fibrous capsule may prevent any attempts at the direct repair of parenchymal, collecting system, and vascular pedicle injuries. Grade 1-3 injuries can be managed nonope-ratively with adequate hydration and observation. Grade 4-5 injuries may require exploration with de-bridement and drainage or simply a subcapsular ne-phrectomy if associated with life-threatening bleeding. Isolated vascular injuries have a poor prognosis. Renal arteriography may be helpful with embolization of the main artery to stop bleeding or with more selective embolization to salvage part of the kidney. When renal graft injury occurs, saving the patient's life is the first priority but the saving of the graft is also very important to maintain renal function.

1541 Proximal Endovascular Aortic Control

In certain situations, such as in scar tissue, thorough dissection of a vascular segment can be technically very challenging and should thus be avoided. Balloon occlusion can be a very good alternative for distal as well as temporary proximal control. Control is, however, best achieved by surgical exposure and clamping of a more proximal segment, while balloon occlusion is always an alternative for distal control. Embolectomy catheters of adequate size connected to a three-way stopcock and a saline-filled syringe are used. Inspection of the open segment, under continuous evacuation of blood from the backbleeding branches with suction, allows identification of the orifice into which the catheter should be inserted. After insertion the balloon is insufflated until the backflow has ceased. The stopcock is closed, and the balloon is left in place to occlude the artery. It is important not to overinflate the balloon, which could damage the arterial wall. In analogy with a vascular clamp,...

Free Fasciocutaneous Flap Esophageal Replacement

Using skin flaps for pharyngeal reconstruction has many advantages. Skin is the most donatable and easily accessible organ in the body it is relatively ischemia-tolerant providing it is sufficiently pliable and thin, it can be formed into a tube easily morbidity associated with harvest can be insignificant and tracheo-neoesophageal speech is better than that achieved with visceral flaps. The fact that skin flaps do not provide a moist or secreting surface and that they are adynamic appears to make no difference with respect to a functional swallow compared to visceral flaps. The most common microvascular skin flaps used are the radial forearm and lateral thigh. The radial forearm flap is easily tubed and readily available in most patients (Fig. 24). It is rapidly harvested with large donor vessels. The ease, reliability, and functionality of this flap for pharyngeal reconstruction are unsurpassed. A useful alternative is the lateral thigh flap, although its harvest is more difficult...

Prosthetic Management

Prosthetic management of the radical maxillectomy defect is the traditional method of rehabilitation. Clinical experience using prosthetic devices for this purpose is significant and it has become clear that certain factors are favorable with regard to prosthesis retention and function. These include the presence of an intact opposite hemipalate, retention of healthy teeth adjacent to the palatal defect, retention of the majority of the soft palate, and formation of a linear contracted scar around the cheek facilitated by the placement of a skin graft at the time of the extirpative surgery. The size of the defect is proportional to the likelihood of excessive prosthesis movement and failure. The presence of stable teeth, especially next to the defect, significantly improves this relationship. Using a prosthesis after maxillectomy nonselec-tively will result in several patients experiencing difficulties that include leakage and poor mastication. Approximately 70 of patients describe...

New etiologies in restenosis the role of chronic vascular remodeling and adventitia

Intravascular ultrasound (IVUS) has become an important means to understand the concept of remodeling. IVUS imaging has shown that after PTCA there is an axial plaque redistribution, and that failure to cause dissection is one of the causes of early lumen loss by elastic recoil.39,42 More recently, serial IVUS studies indicated that the restenotic lesion led to contraction of the artery and late lumen nar-rowing.5,318-320 While the mechanisms of chronic remodeling are poorly understood, several explanations have been postulated to explain the late lumen narrowing after PTCA fibrosis of the vessel wall underlying the lesion, rearrangement of extracellular matrix composition and structure, and response to increased shear stress.4,321-323 A recent paper suggests that avp3 may regulate contraction of the vessel wall.324 The integrins may therefore play a role in active contraction as well as migration of SMC. Animal studies indicate that after PTCA, stretching of the adventitia may result...

Minimal Change Disease and Focal Segmental Glomerulosclerosis

Focal Segmental Glomerulosclerosis

By interstitial fibrosis, proportional to the degree of scarring in the glomerulus. In HIV nephropathy and collapsing glomerulopathy, tubular lesions are disproportionally severe, with cystic dilation and a more prominent infiltrate (18). Many insults to the kidney may result in secondary FSGS, either as the sole manifestation of injury or superimposed on other renal disease manifestations (6,10). The lesion of FSGS may be seen in association with, for example, substantial loss of nephron mass, diabetes, obesity, HIV infection, or heroin abuse. Hilar-type sclerosis may often manifest with these secondary forms of FSGS (see above). Secondary sclerosis also occurs in the chronic stage of many immune complex or proliferative diseases. In some of these settings, the morphologic appearance of sclerosis can indicate the nature of the initial insult obesity-associated FSGS shows mild mesangial expansion, GBM thickening, subtotal foot process effacement, and marked glomerulomegaly (44). The...

Lacerations Subjected to Strong Skin Tensions

Lacerations subjected to strong skin tensions are prone to wound dehiscence and healing with wide, hypertrophic scars. Ihese lacerations can be identified by retraction of their wound edges more than 5 mm and the alignment of the long axis of the wound with the wrinkle lines or transverse axis of the joint. Undermining the wound edges is one method to reduce tension, but this technique can diminish the blood supply to the wound, thereby damaging wound defenses and inviting the development of infection. Attempting to reduce tension by closure of adipose tissue is to be avoided because it enhances infection without strengthening the wound. Dermal skin closure is recommended in these wounds to maintain their strength and prevent the development of wound dehiscence after removal of the skin sutures or the exfoliation of skin-closure tapes or tissue adhesives. Because dermal sutures allow early removal of the percutaneous suture, needle puncture scars and tracts do not develop, but there...

12522 Physical Examination

In addition to a general physical examination, including graft function, the operation wound is examined with special emphasis on infection signs and secretions (Fig. 12.2). Also, the areas around the scars need to be investigated for fistulas, pulsating masses, and tender swellings. If an infected

Other Diseases That Mimic Traumatic Injury

Hot Hot Forensic

Newborns with severe EB may present with peeling and blistering (bullae) of the skin at intrauterine pressure points, particularly the elbows, knees, and ankles (Fig. 1). The lesions look strikingly similar to partial thickness burns and are treated with protective dressings. In older children, trivial trauma, such as a fall, may lead to large areas of partial-thickness (and sometimes full-thickness) skin injury that may be confused with an intentional burn injury. Fortunately, many children with EB have both a family and a personal history of chronic cutaneous scarring from past injuries that allows for the appropriate diagnosis. Patients with EB who present with severe scarring will develop pseudosyndactyly of the digits. In longstanding cases (usually beyond childhood), squamous cell cancer can develop in the chronically damaged skin. Children with Ehler-Danlos syndrome are not, in general, born with abnormal-appearing skin and do not develop burn-like lesions from trivial trauma....

Loxosceles and Necrotic Arachnidism

What Considered Urin Discoloration

CLINICAL FEATURES Bites by Loxosceles spiders are initially painless, prohibiting definitive identification of the spider. The most common manifestation of a Loxosceles bite consists of a mild erythematous lesion that may become firm and heal with little or no scar over several days to weeks. 9 Occasionally, a more severe reaction occurs, with mild to severe pain several hours after the bite. There may be erythema and blister formation and bluish discoloration within the first 24 h ( Fig

Aneurysm formation and left ventricular thrombus

True aneurysms complicate transmural infarction and are caused by dilatation of an area of scar (fig 24.5). An aneurysm is defined as deformation of both the diastolic and systolic LV contours with dyskinesis in systole. TTE is a sensitive tool for the diagnosis but occasional false negatives occur, usually when the aneurysm involves a small part of the apex or the

Applying an Integrated Cultural Epidemiological Approach

People in the Rift Valley, as were cognitive processes such as thinking about problems or imagining things. Some in Kenya thought epilepsy was contagious, particularly if one touched a person with epilepsy during the seizure. Consequently, in rural areas where people cooked over open fires, some people were not moved away from fires during their seizures. Fully one-third of the 89 people I interviewed in Kenya bore large keloid scars from such burns, further stigmatizing them. Some thought epilepsy was a form of supernatural punishment for their misdeeds. Strikingly, few people with epilepsy in Kenya identified epilepsy as something involving the brain 71 of interviewees said their seizures were originally caused by malaria, 13 said they were caused by pneumonia, and only 13 called it epilepsy. In summary, the incidence and prevalence of epilepsy are influenced by many forces, some natural and some social and cultural. Its symptoms prompt specific reactions (e.g., social isolation)...

Management of Primary SCC

Cryosurgery with liquid nitrogen is an excellent modality for well-delineated and well-differentiated SCCs of any size and location. It is extremely useful for patients with coagulopathies to reduce tumor bulk in combination approaches, and for palliation of inoperable tumors. Relative contraindications include poor tumor margins, recurrent SCC, tumors deeper than 4mm, and poorly differentiated neoplasms. Cryosurgery is contraindicated in patients with cryoglobulinemia, Raynaud's syndrome, and cold intolerance. The reported 5 year cure rate for suitable SCCs is 96-98 (116). Cosmesis is similar to other modalities. The technique is particularly advantageous for tumors of the ear and nose because cartilage is relatively resistant and lacrimal architecture is preserved. It is also adequate for preservation of lacrimal structures. Complications include edema, hypertrophic scarring, neuropathy, infection during healing, delayed hemorrhage, ectropion, and hypopigmentation.

Repair of Scalp Lacerations

It is not necessary to shave the scalp prior to closure shaving actually increases the likelihood of a wound infection and produces a less desirable cosmetic result in the short term. In most cases, the hair can be brushed aside. One can also apply an ointment such as bacitracin zinc or petrolatum to mat down the hair adjacent to the laceration. Hair braiding has been described as an alternate closure technique. 13 Large galeal defects should be repaired if possible to prevent a wide, depressed appearance of the final scar and to minimize the development of a subgaleal hematoma. Buried 4-0 nonabsorbable monofilament nylon e.g., Surgilene (Sherwood Davis & Geck) , or polypropylene e.g., Prolene (Ethicon, Inc.) interrupted or horizontal mattress sutures may be used ( Tab.l. , 38-1). In large wounds, the muscle layer may be approximated with 4-0 absorbable monofilament e.g., Monocryl (Ethicon, Inc.) or multifilament e.g., Dexon (Sherwood Davis & Geck) or Vicryl (Ethicon, Inc.) in a...

Bullous Diseases Pemphigus Vulgaris and Bullous Pemphigoid

BP is characterized by the presence of tense blisters (up to 10 cm in diameter) that arise from either normal skin or from erythematous or urticarial plaques ulceration with tissue loss follows. Sites of predilection include the intertriginous and flexural areas. Pruritus, occasionally accompanied by a burning sensation, is noted with the appearance of the blistering. Lesions of the oral cavity occur in BP, but with less consistency and severity than in PV. Because the blisters in the oral cavity rupture very easily and heal without scarring, involvement in the mouth is often overlooked. Oral involvement may occur in as many as 40 percent of patients. It is unusual for oral mucosal lesions to precede the cutaneous eruption as in PV.

Cultural Construction of Gender

Sometimes have decorative scarification on their chests, though this is now rare among younger men. Women also sometimes had decorative scars on their arms, but this, too, has all but disappeared. There is considerable variation among men in the length of hair and the wearing of beards. Young men, postcircumcision, left their hair uncut and wore it in the shape of a bun, bugurdi this was also the name of this stage of initiation.

Membranoproliferative Glomerulonephritis

Membranoproliferative Glomerulonephritis

Merulonephritis has also been used for MPGN type I. Increased mononuclear cells and occasional neutrophils may be present. The proliferation is typically uniform and diffuse in idiopathic MPGN, contrasting the irregular involvement most commonly seen in proliferative lupus nephritis (Fig. 3.1). In secondary forms of MPGN, the injury may be more irregular. Crescents may occur in both idiopathic and secondary forms. Deposits do not involve extraglomerular sites. Lesions progress with less cellularity and more pronounced matrix accumulation and sclerosis over time (6). Tubular and vascular fibrosis and sclerosis proportional to glomerular scarring are seen late in the course.

Determining diffusivitiesoffruits

There have been several reports on determiningthediffusivitiesofbulkyplant organs. Burg and Burg (1965) defined a resistancefactor (P)whichcouldbeesti-mated for bulky plant organs, in to the ratio of production of carbondioxideandethyleneinthesteady state. They estimated that more than 60 ofgasexchangetakes placethrough the stem scar in tomatoes. But this resistantfactorisonlyan empiricalvalue without conventional dimensions and is notconstantwithchangesinthesurface to volume ratio. Cameron and Yang (1982) measured the efflux of a metabolic inert gas, ethane, which is neither produced nor metabolized to a significant degree by the tissue. It was shown that over97 ofgasexchangeintomatofruits occurs through the stem scar. However, the measurement of ethane efflux introduces several uncertainties because they did not measure the diffusivities of exocarp, pericarp and stem scar separately. Wax undoubtedly serves as a gas barrier to oxygen, carbon dioxide and water vapor and other...

Light Microscopy Immunofluorescence and Electron Microscopy

In the pathology report, the proportion of glomeruli with active and with sclerotic lesions and the proportion of glomeruli with fibrinoid necrosis or cellular crescents should be indicated. The lesions may be superimposed on a diffuse mesangial expansion, as seen in class II lupus nephritis. Narrowing and obliteration of the capillary lumina is often present with segmental intracapillary and extracapillary proliferation and adhesions of visceral and parietal epithelial cells (Figs. 8.2 and 8.3). In addition, nuclear debris is seen as well as influx of inflammatory cells, which has been ascribed to altered expression of adhesion molecules in the diseased vessel walls (7,8). The inflammatory process may also lead to disruption of the glomerular basement membrane and fibrinoid necrosis. Amorphous eosin-ophilic material staining bright red in trichrome staining and present most often in the context of an extracapillary proliferative lesion is regarded as fibrinoid necrosis. However,...

The Use of Diuretics in the Treatment of Ascites and Edema in Hepatic Cirrhosis

Salt Poor Albumin For Ascites

A great deal of clinical and experimental evidence is consistent with the classic underfill hypothesis which is outlined in Fig. 1. Hepatic pathology produces scarring, fibrosis, and nodular hypertrophy of the liver. These anatomic alterations restrict the flow of blood out of hepatic sinusoids producing post-sinusoidal venous blockade. Hydrostatic pressure within the sinusoids increases and the higher pressures are transmitted into the splanchnic veins and mesenteric capillary beds. These elevated hydrostatic pressures accelerate the filtration of fluid into the hepatic interstitium (spaces of Disse). The epithelium lining hepatic sinusoids is very permeable to albumin (it has a low albumin reflection coefficient), so that the fluid which accumulates in the hepatic inter-

Specific Foreign Bodies and Removal Procedures

If vigorous scrubbing does not remove the particulates, the patient can be referred to specialists for dermabrasion or block excision. The graphite from pencil lead can produce a pigmentation that will never dissolve, and graphite tattoos should be excised in cosmetic areas.

Soft Palate Resection

In cases of total or near-total removal of the soft palate or if the remaining soft palate is dysfunctional, mechanical obturation is preferred to obturation using flap tissue because adjusting the amount of leak is difficult with a soft tissue flap. However, if adequate dynamic soft palate remains then reconstruction with a flap is preferred. The amount of soft palate necessary to effect an adequate seal is usually about half. The palate must be dynamic and of adequate length to reach the posterior oropharyngeal wall and Passavant's ridge. Minor tissue loss at the lateral margin of the soft palate may be amenable to primary closure along the free edges of the palatal and pharyngeal defect margins. More extensive tissue loss will require reconstruction. With regard to flap reconstruction, two choices are available recreate the form of the soft palate using thin folded tissue, or obliterate the portion of the oropharynx on the side of the defect with no attempt to recreate the form of...

Well Being Assessment Physiological Criteria

There can be confounding factors in any measure of stress. For example, ceiling effects can make interpretation difficult. A ceiling effect occurs when the response is already high and cannot be any higher physiologically. Branding is used for identification of beef cattle in the United States. Although the modern techniques of micro-chipping would also make identification possible, what the rancher needs is a symbol, unique to his ranch, that is visible from a distance. There are two methods of branding hot-iron branding and freeze branding. Hot-iron branding destroys the hair follicles and creates a scar. Freeze branding does not destroy the hair follicles, but causes the hair to regrow white rather than pigmented. These brands are somewhat harder to read than hot-iron brands, but presumably are more humane. When the responses of beef cattle to the two types of branding were compared, the heart rate and catecholamine levels were high following both procedures. The explanation is...

Another option Choosing laparotomy

T Laparotomy makes viewing and removing extensive adhesions and distorted anatomy easier. With the exposure of a laparotomy, the surgeon and his assistants can actually place their hands into the pelvis to feel for problems and expose areas better. This accessibility is very important when dealing with dense scar tissue, anatomic distortions and malformations, and large growths (such as fibroids and cysts).

Cirrhosis and Complications of End Stage Liver Disease

Hepatic cirrhosis results from fibrous scarring mixed with hepatocellular regeneration in response to sustained inflammatory, toxic, metabolic, and congestive insults. Over time, the functional anatomy of the liver is replaced by scar tissue isolating nodules formed by foci of regenerating hepatocytes. Normal function of the liver is dependent not only on preservation of hepatocyte number but also on the elaborate microscopic architecture of the functional hepatic units. In addition to progressive loss of synthetic and metabolic function, scarring and degeneration of the liver contribute to increased resistance to blood flow from the splanchnic circulation, contributing to portal-systemic shunting and portal hypertension. Shunting isolates the remaining functional tissue of the liver, further contributing to the metabolic derangements that characterize progressive and end-stage liver disease. Emergent complications of cirrhosis and end-stage liver disease include gastroesophageal...

Evolving Concepts of Regeneration

Stem Cells For Acne Scars

Newt cardiomyocytes can readily proliferate after injury and contribute to the functional regeneration of the damaged heart. Newts repair their hearts efficiently in response to cardiac damage, leaving none of the dysfunctional scar tissue typical of the post-infarct mammalian myocardium. The recognition that cardiac tissue in other vertebrates can undergo extensive repair has prompted the proposal that regeneration may be a primordial attribute that has been lost during mammalian evolution. Regeneration of the zebra fish heart offers a more genetically accessible model for dissecting the molecular basis of cardiac repair. After surgical removal of the ventricular apex and rapid clotting at the site of amputation, proliferating cardiac myofibers replace the clot and regenerate missing tissue, with minimal scarring. The requirement for cell cycle reentry in this model was supported by the decreased regeneration and increased fibrosis in a temperature-sensitive mutant of a mitotic...

Introduction Clinical Setting

III (A C) Active and chronic lesions focal proliferative and sclerosing LGN III (C) Chronic inactive lesions with glomerular scars focal sclerosing LGN IV-S (C) Chronic inactive lesions with scars diffuse segmental sclerosing lupus nephritis IV-G (C) Chronic inactive lesions with scars diffuse global sclerosing lupus nephritis Class V membranous lupus nephritis

Chronic Cutaneous Lupus Erythematosus

Chronic cutaneous lupus erythematosus is referred to as discoid lupus erythematosus (DLE). It is an eruption that results in scarring and pigmentary changes in the skin. DLE is most commonly seen in African-Americans. Only 10 percent of patients with this type of lupus develop systemic disease. papules or plaques that enlarge leaving central depigmentation ( Fig 2.3.8.-3.). Follicular plugging may be visible, especially in ear lesions. On the scalp, a scarring

Left ventricular restoration

Patients with large left ventricular aneurysms gain symptomatic relief from simple linear aneurysmectomy. So called ventricular restoration has recently extended from scarred paradoxical segments to akinetic areas which were not previously thought suitable for surgery.13 The goal of surgical reversal of remodelling is to exclude the infarcted septum and free wall and reshape the left ventricle from globular to elliptical without critically reducing Reversible ischaemia LVESVI < 60ml m2 Full thickness scar and left ventricular aneurysm Akinetic dyskinetic left ventricle LVESVI > 60 In the Dor procedure, or the Buckberg modification, the left ventricle is opened through scar and subtotal endocardectomy (fig 11.2), performed over the septum and posterior wall.14 In the event of recurrent ventricular arrhythmias, cryotherapy is applied at the limits of the resection. The boundary between normal endocardium and scar is defined and a circumferential endoventricular (Fontan) circular...

Urinary Tract Infection UTI

Renal cortical scintigraphy (RCS) using Tc99m-DMSA is the most sensitive imaging modality for establishing the diagnosis of pyelonephritis. 24 In animal models, RCS has a sensitivity of 91 percent and specificity of 99 percent as compared with histopathology. 25 Results in humans with culture-positive UTI have shown a sensitivity of only 50 to 66 percent.26 While its sensitivity is low, RCS is more sensitive than ultrasound, CT, or IVP. 27 Controversy exists concerning the necessity of documenting renal scarring and pyelonephritis in a child with an apparently simple UTI. 2 29 Some clinicians advocate treating all patients with a 10-day course of antibiotics, as opposed to the usual 5- to 7-day course, to avoid the need to document the presence of pyelonephritis. 30 Also, patients with vesiculoureteral reflux do not always demonstrate scarring on RCS therefore, a normal RCS does not obviate the need to proceed with voiding cystography. RCS has more accepted utility in following renal...

Selected Structural Obstructive Causes

Esophageal stricture occurs as a result of scarring from GERD or other chronic inflammation. Generally they occur in the distal esophagus, proximal to the gastroesophageal (GE) junction. Strictures may interfere with LES function. Symptoms may build over years and are often noted solely with solids. Stricture can serve as a barrier to reflux, so heartburn may decrease as dysphagia increases. Workup involves ruling out malignancy and treatment is dilatation. 9

Normal Physiology and Function

Astrocytes have several structural functions. They are necessary in conjunction with endothelial cells for the formation of the blood-brain barrier, an anatomic and metabolic barrier at the level of the capillary endothelial cells. The endfeet of astrocytes help to maintain a continuous layer between brain tissue and blood vessels, forming the perivascular glial membrane. The blood-brain barrier is the major obstacle preventing foreign compounds and toxins in the bloodstream from entering and damaging the brain. In effect, this barrier functionally and structurally sequesters the brain from the rest of the body. This protective barrier, however, also hinders the administration of drugs or other therapeutic compounds into the parenchyma of the brain. Another structural function of astrocytes is the formation of the glia limitans, a continuous lining of astrocyte processes, covered by a basal lamina, which is formed between the brain and the meninges. Again, the formation of the glia...

Looking at endometriosis under the scope

T The surgeon may not recognize the active areas. The textbooks describe classic endometriosis as black, stellate (star-shaped) lesions. But this definition is only for the end stage of the disease, so the biopsy may only contain scar tissue and old inflammatory cells and debris, not endometriosis. The surgeon may not even recognize the active areas because they may be too small, hidden, or unusual in appearance. Sometimes the earliest lesions are clear and hard to see. Or the surgeon may biopsy red areas that are actually bruises from the instruments.

TABLE 751 Common Causes of Intestinal Obstruction

Tables Bowel Obstruction

Colonic obstruction is almost never caused by hernia or surgical adhesions. Neoplasms are by far the most common cause of large bowel obstruction. 45 Therefore, anyone who has symptoms of colonic obstruction should be evaluated for a neoplasm. Diverticulitis may create significant secondary obstruction and mesenteric edema. Stricture formation may occur with chronic inflammation and scarring. Fecal impaction is a common problem in elderly, debilitated patients and may present with symptoms of colonic obstruction.

Hasan Aziz and Zarin Mogal

Drug noncompliance is highly prevalent in persons with epilepsy in the developing world. The reasons are multiple. Poor health infrastructure, scarcity of trained medical personnel, poor doctor-patient rapport, poor socio-economic status, high costs, nonavailability or inconsistent supply of anti-epileptic drugs, lack of treatment seeking behavior, traditional concepts and seeking of alternative treatment methods are some of the many reasons. All can result in poor seizure control and consequent impact on the quality of life. Epilepsy has been known for many centuries. Remarkable advancement on different aspects of this disorder has helped in reducing the associated physical agony to a considerable degree. However, scientific advancements have not yet succeeded in penetrating and eradicating the deep-rooted myths, misconceptions, superstitions and stigma which go hand in hand with epilepsy resulting in enhanced physical, psychological and social scarring, thus multiplying the...

Disorders of the Labia

The characteristic appearance of the vulva is white, atrophic, and finely wrinkled. Ulcerations, blisters, excoriations, and inflammation are seen over the vulva, perineum, and perianal area, often giving rise to the terms hourglass or figure-eight to describe the pattern of skin involvement. Secondary infection is possible. Progression of the disease leads to distortion, thickening, and scarring of vulvar and perineal architecture. The condition is differentiated from vitiligo by absence of inflammation or atrophy in the latter. The diagnosis of lichen sclerosis atrophica is made on clinical grounds and may be confirmed histologically from biopsy specimen in atypical cases.

Evaluation of posture gait and strength

The patient is observed at rest for abnormalities in body posture and limb position and tone. Increased muscle tone is judged by increased resistance to flexion. The claws are checked for wear and for scars indicating previous trauma. The skeleton is palpated for crepitus, masses, deviation of the normal contour and motion (e.g. fractures and luxations). The muscles are palpated to check for size and symmetry.

Laparoscopic Ultrasonography

The patient is placed in a supine position and supported to allow tilting of the operating table as necessary. The surgeon stands on the left side with the radiologist opposite. Video monitor and ultrasound screen are on the upper right side (Fig. 8.1). Many patients will have a history of previous abdominal surgery, certainly those coming for the evaluation of colorectal metastases. The placement of trocars obviously depends on existing abdominal scars, but also on the type of surgery the patient has undergone. Although creative improvisation is necessary, there are certain guidelines for safe and effective positioning (Fig. 8.2). Abdominal insufflation may often be achieved using blind puncture with a Veress needle in the right upper abdomen (after left colonic surgery) or left subcostal region (after right-sided colon resections), with the patient placed in anti-Trendelenburg position. It is also possible to visualize intra-abdominal adhesions with transcutaneous ultrasound by...

Vessel Selection in the Difficult Neck

Dorsal vascular pedicle provides both arterial and venous components of large caliber (3-4 mm for the artery and vein) without manipulation of the carotid system that may be encased in scar (Fig. 26). This technique possesses several advantages the vessels are not in the typical radiation field for head and neck cancer they are of sufficient length to reach the lower neck easily and the necessity for additional anastomoses is eliminated, thus reducing operating time.

Tendinitis and Tenosynovitis

Tenosynovitis can develop in the flexor sheaths of the fingers and thumb. Scarring or inflammation may cause the tendon to become nodular which results in friction and catching between the tendon and its sheath, usually in the vicinity of the A1 pulley. This is referred to as stenosing tenosynovitis, or trigger finger. The patient experiences binding of the tendon, usually as the finger extends, relieved by a painful snap as the tendon clears the obstruction. Occasionally, this condition may progress to the point that the finger locks, usually in flexion. Early stages of trigger finger have been treated successfully with depot steroid injection into the tendon sheath, although there may be recurrence. Surgical division of the A1 pulley is usually curative.

The destructive process literally eats away the area of the ovary that houses the primordial follicles leaving you with

Scar tissue that covers the surface of endometrial implants on the ovary is tough and fibrous. As this endometriosis spreads across the ovary, it takes the path of least resistance by growing into the softer stroma (the inside) of the ovary. As a result, chocolate cysts, or endometriomas, form from the surface of the ovary inwards. (The term chocolate refers to the brown-colored liquid made of old blood and tissue that's inside the cyst.)

Contribution to Disease

Gliosis, also called astrocytic gliosis or astrocytosis, is a common term that refers to the reactive astrocytic response to a brain injury or insult. Almost all brain lesions have a component of gliosis, even with different glial pathologies. Gliosis is a secondary event to CNS damage and may persist for weeks or months after brain injury. This condition occurs after infarct and is associated with infections and neoplasm as well as with demyelinating, toxic, and metabolic diseases. In glio-sis, astrocytes hypertrophy, the nuclei become enlarged, and the chromatin becomes less dense while nucleoli become more prominent. There is an increased number of organelles and higher production of the intermediate filaments GFAP, nestin, and vimen-tin, which results in greater and more highly condensed glial processes and fibers. The increased glial processes replace injured CNS cells and form a gliotic scar. It is thought that the glial scar limits edema and prevents neuronal regeneration in...

Digital Tip Injuries with Skin and Pulp Tissue Loss Only

Distal fingertip amputations that are 1 cm2 or less in size without exposed bone can usually be treated conservatively in the ED with serial dressing changes alone. This is a desirable option, because healing occurs by secondary intention and results in very little scarring. Follow-up is arranged in 2 days for wound check and the patient is made aware that wound care is vital to the success of this technique. The patient is instructed to soak the injured fingertip in warm water to which an antibacterial soap has been added once a day for 10 min, followed by tap-water irrigation and application of a sterile nonadherent dressing. This procedure is performed daily for the first 10 to 15 days and every other day thereafter. On average, complete healing may take 4 to 8 weeks, and both the cosmetic appearance and sensibility of the fingertip are quite satisfactory with this technique. Conservative management is advocated in children less than 12 years of age, since they have greater...

Origins of Multistage Theory

In the 1920s, several laboratories began to apply chemical carcinogens to experimental animals. Deelman (1927) summarized observations in which repeated applications of tar to skin led to a small number of tumors, after which tarring was stopped. A few days later, the skin was cut where no tumors had appeared. Most incisions developed tumors in the scars most such tumors were very malignant. Two distinct processes, tarring and wounding, combined to cause aggressive cancers.

Effects on Particular Organs or Organ Systems

Mechanisms that impair the release of triglycerides to the blood. Carbon tetrachloride and ethanol are among the substances that can cause this. Necrosis is caused by carbon tetrachloride, which forms free radicals in the liver, as well as by other halogenated hydrocarbons. Cirrhosis is the formation of scar tissue in the liver. It is also caused by carbon tetrachloride, although ethanol is most commonly associated with this condition. Although there is evidence to the contrary, the effect of ethanol may be related to nutritional deficiency associated with alcoholism. Cholestasis is an inflammation of the ducts carrying bile or a decrease in bile flow by other mechanisms. There are many types of liver cancer, and many chemicals are known to cause cancer in laboratory animals. The role of chemicals in human liver cancer is less clear, except for the notable case of vinyl chloride, which is known as a potent cause of angiosarcoma.

Sarcomas of Fibrous Tissue

Fibrosarcoma is a rare malignant tumor from deep tissues such as fascia or tendons. Well-established causative factors include ionizing radiation (204), chronic scars, and certain chromosomal aberrations. Fibrosarcoma affects all ages but is more common during the fourth to sixth decade of life. Tumors present clinically as subcutaneous masses with intact overlying skin. Ulceration indicates aggressive growth. Pain is present in 50 of cases. Approximately 50 of lesions occur on the lower extremity with marked predominance of the thigh (205). On histopathological examination, there are masses of spindle cells with variable differentiation, storiform pattern, and myxoid changes. IHC stains are positive for CD34 and vimentin, but not for epithelial, muscular, neural, melanocytic, or vascular markers (see below). Treatment is similar for all soft tissue sarcomas. Wide local excision with or without amputation is the usual approach. Adjuvant radiation therapy is indicated for aggressive or...

Postulated Mechanisms of Reorganization of Function

Comparable changes may occur following brain damage. A specific human case of recovered function has been interpreted in the context of unmasking Following brain damage, the unmasking activated previously existent pathways that (previous to the injury) had not had the same relationship to the function. The extensive damage included the destruction of a pyramidal tract that, at autopsy 7 years after the stroke, was composed of scar tissue except for approximately 3 of normal appearing fibers scattered through the scar tissue. The recovery was interpreted in terms of the possible unmasking of pathways to the dendrites of the cells with long pyramidal tract fibers and their axonal ramifications. It is possible that connections to large numbers of motoneurons that had previously been relatively inactive were rendered active, possibly in part due to postinjury receptor plasticity in those motoneurons.

PCR based molecular markers

SCAR Sequence characterised amplified regions (SCARs) were first described in 1993 (Paran and Michelmore, 1993), shortly after the invention of RAPD markers. A Fig. 1.9 Application of SCAR markers, PCR amplification followed by restriction with endonucleases evidences the homozygotic (left and centre) or heterozygotic (right) state SCAR is identified by two specific primers that amplify a well-defined genetic locus, derived by sequencing a RAPD product. This type of technique (Fig. 1.9) exploits first the advantages of RAPDs in terms of simplicity and rapidity. When the interesting RAPD markers have been singled out, they are sequenced, also partially, and the sequence information used to design long primers, 24-25 nt, to amplify that locus in a specific way. The polymorphism between SCAR bands is determined by variation in length of the sequence between the two primers, or by lack of annealing. In some cases therefore SCARs can be co-dominant. However, SCARs amplified by different...

The Brain Consists Of Two Major Classes Of Cells

Glial cells may play a very important role in scar formation after injury to the brain. Gliosis, or proliferation of glial cells, is an almost universal response to brain injury. It has even been proposed that gliosis after brain injury actually inhibits the reparative processes in the brain, in which neurons try to reestablish connections with their normal target regions. It is possible though that, by so doing, astrocytes help seal off damaged brain tissue after injury, thus inhibiting abhorrent reorganization within a damaged brain region.

Renal Cortical Scintigraphy RCS

Two hours after administration of Tc99m-DMSA, scanning is performed using a gamma camera. DMSA binds to the renal tubules and accumulates in the functioning renal cortex. Intrarenal blood flow and proximal tubular cell membrane transport determine cortical uptake. Focal or diffuse areas of decreased cortical uptake of tracer without any loss of volume indicate the presence of pyelonephritis. Areas of decreased uptake with volume loss indicate old scars. Images are evaluated for the size of the kidneys, their shape and location, and differential renal function as well as the distribution of cortical uptake.

The Classification of Disease

Injury that cannot be limited at the cellular level calls forth an inflammatory response. If the stimulus is terminated, then the acute reaction subsides and there is usually healing and regeneration of the tissue, although specialized tissue such as the brain is replaced by scar tissue. If stimulus and inflammation continue, then a chronic phase follows. Regeneration and repair are attempted, with scarring the almost inevitable result.

Coonrad Morrey Semiconstrained Total Elbow Replacement Operative Technique

Coonrad Morrey Elbow

The procedure is carried out with the patient supine, a tourniquet applied to the limb, and the arm flexed over the chest. Old scars are utilized in the approach, which would otherwise ideally be via a midline posterior approach. The ulnar nerve is identified at the triceps and mobilized sufficiently for its protection. In this approach, the extensor mechanism is left intact, thus facilitating the patient's rehabilitation. The exposure is deepened and the common flexor origin plus the medial collateral ligament are elevated from the medial epicon-dyle. With elevation of the triceps from the distal humerus, removal of all medial

Gestational Carrier Surrogacy

Gestational surrogacy may be an option if you have normally functioning ovaries but do not have a uterus. You may lack a uterus because you were born that way or perhaps you've had a prior hysterectomy. This type of surrogacy may also be indicated when you possess untreatable scarring or other such abnormalities within your uterus. Another reason to choose gestational surrogacy could be if you have a medical condition where pregnancy would be dangerous to you (severe heart disease is one example).

Tips For A Plastic Closure

Ihere are several general principles to cosmetic closure. All wounds heal with some scarring, the goal is to use techniques that make the scar as small and invisible as possible. Scars become visible when they cast a shadow, have a rough surface, are wide, or develop permanent secondary color change. Scars most often cast a shadow when they become concave from wound contraction during healing. Wound-edge eversion during the initial repair will therefore gradually flatten with healing and have a final appearance that is cosmetically acceptable. Wounds that are not everted will contract into linear depressions that will become noticeable cosmetic defects because of the tendency to cast shadows under incident light. In closing a laceration, it is important to match each layer of a wound edge to its counterpart. Ihe epithelium-to-epithelium interface should match perfectly to create a hairline smooth scar. Care must be taken to avoid having one wound edge rolled inward, so that the cut...

Pyelonephritis and Pyonephrosis

DMSA scan showing multiple photopenic areas consistent with renal scars (Courtesy H.G. Rushton) Although VCUG and renal US are necessary investigations that must be performed following the diagnosis and treatment of UTI in children, controversy persists regarding the utility of nuclear medicine renography to diagnose acute pyelonephritis. In general, most investigators believe that dimercaptosuccinic acid (DMSA) scanning could be safely omitted in children with mild to moderate infection however, patients with signs of upper urinary tract infection, including high fever (> 38.5 C), flank pain, or abnormalities detected on US, should undergo renography (Naber et al. 2001 Deshpande and Jones 2001) (Fig. 8.16). Not only will this act as a baseline, but also acute photopenic areas detected on DMSA can be subsequently reevalua-ted in order to determine if renal scarring has occurred.

Siderophages Brain Demyelinating Injury

Scarring process including production of glial and collagenous fibers ing the so-called gliomesenchymal scarring process, which originates in the mesenchymal tissue components of the perivascular tissue, the leptomeninges, and the local glia. The mechanical insult to the axons causes axonal injury at the margins, which resembles that seen in MBI (Fig. 10.6c-f). The final (scarring) phase commences 3-6 weeks after wounding in some cases and involves mechanically induced syringomyelia, which leaves a cavity surrounded by glial tissue within the center of the spinal cord. In a few cases the cavity extends rostral

Cutting away adhesions

The simplest conservative treatment for endometriosis is the removal of adhesions (scar tissue) around the ovaries, tubes, and uterus. The risks of this treatment are minimal (unless the scar tissue is very dense and around vital structures), but the results can be dramatic. Surgery is via a laparoscopy or a laparotomy, using scissors, electrosurgery, laser, harmonic scalpel, or a blunt instrument to simply break down thin, filmy adhesions.

Determining diffusivities of fruits

There have been several reports on determining the diffusivities of bulky plant organs. Burg and Burg (1965) defined a resistance factor (R) which could be estimated for bulky plant organs, in banana and tomato, as the ratio of internal concentration to the ratio of production of carbon dioxide and ethylene in the steady state. They estimated that more than 60 of gas exchange takes place through the stem scar in tomatoes. But this resistant factor is only an empirical value without conventional dimensions and is not constant with changes in the surface to volume ratio. Cameron and Yang (1982) measured the efflux of a metabolic inert gas, ethane, which is neither produced nor metabolized to a significant degree by the tissue. It was shown that over 97 of gas exchange in tomato fruits occurs through the stem scar. However, the measurement of ethane efflux introduces several uncertainties because they did not measure the diffusivities of exocarp, pericarp and stem scar separately. Wax...

Characteristics of the organism and its antigens

Cutaneous leishmaniasis (CL) is termed 'Old World' or 'New World' according to geographical boundaries and the parasite species involved, although the diseases are essentially the same. A lesion develops in the skin at the site of parasite inoculation it can take some time to heal and may also allow secondary infection. These lesions are typically resolved but may leave a disfiguring scar. Old World CL is caused by L. major or L. tropica and is found in the Middle East, Africa and parts of Asia it is variously referred to as Oriental sore, Baghdad boil, Delhi

The Definition Of Neoplasia

As an illustration of the enigma that cancer has presented to physicians and scientists over the years, it was not until the 1920s that meaningful attempts were made to define cancer. In the ensuing half-century, a number of definitions of this biological phenomenon were proposed, mostly by physicians and scientists but more recently also by lay persons writing for the scientific press. Some definitions have been rather extensive and detailed, usually reflecting the author's basic experience and research interests others have been of a more general character. To confuse the field further, clinicians, scientists, and lay persons have used such terms as cancer, neoplasm, tumor, and malignancy as if they were synonymous in every way (cf. Maugh and Marx, 1975). In this text we use the terms neoplasm and neoplasia for the basic disease process defined below. Cancer has come to be used almost exclusively to indicate a process that has the biological characteristics of a malignant neoplasm...

Autoimmune bullous dermatoses

Eosinophilic granulocytes and mast cells are thought to be important in bullous pemphigoid. Proteolytic enzymes derived from eosinophils, such as metalloproteases (gelatinase), may be involved in destruction of components of the BMZ. T cells have been implicated in the chronic stages of bullous pemphigoid and have been linked to the scarring in cicatricial pemphigoid (especially of the conjunctivae). Neutrophilic granulocytes and T cells have been implicated in the pathogenesis of dermatitis herpetiformis and in linear bullous IgA disease. Acquired epidermolysis bullosa seems to have a spectrum in which neutrophils play some role in certain subtypes but none in others. Finally, in the pemphigus group, evidence for a role of cellular mechanisms is generally lacking.

Mechanisms Operative in the Developing Brain

In the year 2000, three decades after FAS was first described, Ikonomidou and colleagues demonstrated that administration of ethanol to infant rodents during the brain growth spurt period triggers widespread apoptotic degeneration of neurons in many regions of the developing brain. The degeneration pattern they observed (Fig. 1) was so extensive that it could readily explain the reduced brain mass and also the myriad neurobehavioral disturbances associated with FAE FAS. Numerous prior studies had failed to detect this dramatic pattern of neurodegeneration because optimal methods were not applied at the optimal time for detecting this type of damage, the acute period when the degenerating neuronal profiles are conspicuously evident. Examining the brains of ethanol-treated animals after a long delay interval is not optimal because at late intervals there is nothing to detect except a scattered pattern of missing neurons. If the pattern of neuronal dropout is diffusely distributed over...

Malignant Liver Tumours 14621

Cholangiocarcinoma is the second most common primary liver tumour after HCC representing 10 of all primary hepatic malignancies. MRI demonstrates peripheral high signal on T2 weighted images with a central hypointense area due to scar tissue. Multi-phasic contrast enhanced studies showed progressive moderate enhancement in the peripheral part of the tumour. Although the morphological pattern of enhancement is similar to that seen in haemangio-mas the rate of enhancement is far slower.

Neuropathological Evidence for Neural Injury before Birth in Schizophrenia

Imaging data suggests that this is indeed the case, but it has not been fully appreciated until recendy because of technical difficulties,47 although the consistent presence of ventriculomegaly in patients strongly suggests diffuse white matter atrophy.48 Instead the focus has been on whether lesions exist. Traditionally, the absence of gliosis (i.e., astrocytic activation or scarring) in histopathological and imaging studies of patients with schizophrenia has been taken to mean two things (1) that this must be a neurodevelopmental process and not a neurodegenerative one (which would leave tell-tale scars), and or (2) that any changes must have taken place before the third trimester, based on the study by Friede, which supposedly showed that gliosis cannot occur until after the end of the second trimester.5 In fact both conclusions are highly likely to be erroneous. There is evidence that that astrocytic activation can occur as early as 20 weeks of gestation,49 and in any case a few...

Alcoholic Liver Disease

Alcoholic liver disease is among the top ten causes of mortality in the US with somewhat higher mortality rates in western European countries where wine is considered a dietary staple, and is a leading cause of death in Russia. Among the three stages of alcoholic liver disease, fatty liver is related to the acute effects of alcohol on hepatic lipid metabolism and is completely reversible. By contrast, alcoholic hepatitis usually occurs after a decade or more of chronic drinking, is associated with inflammation of the liver and necrosis of liver cells, and carries about a 40 mortality risk for each hospitalization. Alcoholic cirrhosis represents irreversible scarring of the liver with loss of liver cells, and may be associated with alcoholic hepatitis. The scarring process greatly alters the circulation of blood through the liver and is associated with increased blood pressure in the portal (visceral) circulation and shunting of blood flow away from the liver and through other organs...

General features of CAH

The general features include symptoms of hepatitis, including nausea, anorexia, jaundice, hepato-splenomegaly, and biochemical evidence of liver parenchymal damage, in particular high levels of transminase enzymes in serum. The biopsy of the liver may show either of two histological lesions, named as chronic persistent hepatitis which is indolent and nondestructive, or chronic active hepatitis in which the main morphological feature is the disruption of the peripheral limiting plate of the liver lobule, with a periportal 'spillover' of the inflammatory exudate into the liver parenchyma 'piecemeal necrosis' (Figure 1). This lesion generates scarring and eventually macronodular cirrhosis (Figure 2). Hepatocellular carcinoma is a frequent late sequel in CAH due to chronic virus infection but is seldom seen in autoimmune hepatitis. There are features unique to each of the individual categories, as indicated below. Figure 2 Liver from a female aged 45 years with autoimmune hepatitis,...

How To Reduce Acne Scarring

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.

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