Latest Treatment of Scars

Scar Solution Book By Sean Lowry

Scar Solution is a scientifically proven treatment that assists in fast scar removal naturally within months. It is effective in eliminating pitted acne scars, sunken scars and keloid scars. The author of this program is Sean Lowry, is a medical consultant and health researcher. Sean, some years ago suffered a skiing accident. This left ugly scars on her face which affected not only her skin but her whole life. On this products website you will find complete history of how the author went about searching for an all natural cure for getting rid of scars on the face completely. It was only after prolonged research and experimentation carried out over a period of many months did she finally figure out the ultimate solution which will safely and permanently remove scars. This is not a magic solution which will start working as soon as users buy the book. Unless the techniques and methods prescribed for scar elimination are followed for the time period mentioned therein the results will not be positive. Users must be committed to follow the scar treatment solution provided in this program with patience and dedication. Read more here...

The Scar Solution Natural Scar Removal Summary


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Control of Glial Scar Formation

The initiation and control of scar formation is an extremely complex subject that needs a review to itself. A recent review summarises current knowledge in this area.3 The control of scar formation has been most extensively studied in the type of reactive gliosis that occurs when a peripheral nerve is injured. Many of the studies have been performed in the facial nerve nucleus, where there is recruitment and activation of microglia and reactive astrocytosis after nerve crush. However oligodendrocyte precursors are not activated in these lesions. The control of glial reactivity involves a complex interplay between microglia, neurones and astrocytes with signals probably passing in both directions between these three cell types. The molecules involved include IL-6, TGFbeta, FGF-2, MCSF and other cytokines.

The Glial Scar and Axon Regeneration

Numerous in vivo experiments have shown that the glial scar inhibits axon regeneration. There is obviously a correlation between the environment in which axon regeneration fails and scar formation, since a scar will form where ever axons are cut. Even very small lesions, which are insufficient to excite an visible disruption of glial architecture can cause changes in the CNS environment sufficient to block axon regrowth.9 In order to show more than a correlation between glia scarring and inhibition of axon growth various transplant experiments have been performed. CNS tissue, even immature CNS tissue containing largely astrocytes and few oligodendrocytes blocks axon regeneration when it is transplanted to peripheral nerves, and tissue removed from scarred areas is very inhibitory.10 13 Until recently the question of whether all CNS tissue is equally inhibitory to axon regeneration, or whether scar tissue is particularly inhibitory was not resolved. Two experiments from Davies and...

Hyaluronan Wound Healing and Scarring A New Perspective

In 1991 a paper was published suggesting that a new perspective should be taken on HA and wound healing (163). The background to this paper was the serendipitous discovery that HA extracted from human scar tissue and highly purified still had an identifiable collagen component using cyanogen bromide digests (164). This led to further studies of other HA preparations which indicated that all HA preparations had some protein 'association' (Table 2). The sources of these preparations were all animals with the exception of the preparation from Genzyme which was produced by bacterial fermentation. The effect of these HA preparations was then assessed on models of cell proliferation and matrix organization. HA preparations were used with and without prior digestion with hyaluronidase. The conclusion of these studies was that even after hyaluronidase digestion the extracts with a high protein content had significant effects on cell proliferation. It is now possible to review these findings...

What Is the Glial Scar

The end stage of glial scar formation, which is seen weeks after injury, is a largely astrocytic structure. The astrocytes are hypertrophic, with many tighdy interweaving processes, many of them joined with junctional complexes.1 The appearance is similar in many ways to the astrocytic glia limitans which lies around the surface of the CNS under the meninges. However the scar evolves over the weeks following injury, and other cell types play critical roles. Wherever the CNS is damaged a scarring process is initiated, which involves microglia, oligodendrocyte precursors, astrocytes, meningeal cells and vascular endothelial cells. The first change seen after injury is the appearance at the injury site of blood-borne cells, particularly monocyte macrophages.2 Within a few hours the endogenous macrophage lineage cells of the CNS, the microglia, begin to respond. They hypertrophy, begin to divide, and upregulate many molecules including complement receptors, which are the antigens often...

Basic Methods of the Aging Process

Besides basic biological tools and methods that allow us to modify the aging process, techniques for analyzing the many molecular and cellular changes that occur during aging are also of high importance. A high-throughput functional genomic screening system applied to S. cerevisiae (see Chapter 18) allows identification of the many genes that can prolong life span. In this model system for aging, mother cells accumulate bud scars on their surface as they age and these bud scars contain high levels of chitin. The chitin can be stained with wheat germ agglutinin and changes in the life span of aged yeast can be assessed using a bud-scar based flow cytometry sorting system. Significant progress in microarray technology has led to the application of these techniques to biogerontology. In Chapter 19, two different protocols using oligonucleotides and cDNA microarray platforms are described. Both radioactive and non-radioactive (fluorescent) approaches may be used and these methods have...

Cardiac electrophysiology

The study of normal and abnormal mechanisms for generation and propagation of cardiac APs is termed cardiac electrophysiology . It is the basis for understanding normal sinus rhythm and cardiac arrhythmias, and also antiarrhythmic drug or device actions. There are normal and abnormal cardiac electrophysiological processes the latter can result from either an abnormal cardiac substrate (for example, accessory pathways or scar tissue) or a pathophysiological disease process (for example, ischaemia, adverse drug actions, or electrolyte imbalance).

Diane Hoffman Kim and Richard A Hopkins

Each of the tests of viability had distinctive advantages and disadvantages and clearly, to obtain a coherent picture, multiple tests would be required. In addition, tests of viability at the time of implantation of a valve do not necessarily predict prolonged cell survival. This question can only be answered by chronic implant studies, both animal and human. The retention of the full phenotypic expression capacity of these cells, now known to be myofibroblasts, obviously requires multiple tests as a retention of fibroblasts capable only of scar formation (collagen type III). Secretory function, no matter how many cells are present, would not be retention of a native population with leaflet characteristics.

Clinical Approach

Has normal or abnormal anterior pituitary function (Table 17-1). Treatment of Sheehan's syndrome consists of replacement of hormones, such as thyroxine, Cortisol, and mineralocorticoid, and estrogen and progestin therapy. Intrauterine adhesions are treated by hysteroscopic resection of the scar tissue.

Inhibitory Glial Boundaries

Oligodendrocytes produce several molecules which are extremely inhibitory to axon growth, and which play an important part in the inhibition of axon growth in the CNS. The subject of this review is the glial scar-related molecules, so only a brief description is given here. NogoA is a molecule of the reticulon family, expressed in oligodendrocytes and also some classes of neuron, which is inhibitory to all classes of axon except some embryonic axons.22 Much work has been done with a blocking antibody, IN-1 and more recently with other antibodies with blocking activity. These antibodies have been shown to stimulate axon regeneration in a variety of lesion models in the spinal cord and elsewhere.23 A receptor molecule has recently been identified.24'25 MAG is expressed in myelinating oligodendrocytes, and is also released from the cell surface to diffuse more widely. It is inhibitory to many types of axon, although inhibition varies with axonal type and age.26 28 A MAG knockout showed...

Chondroitin Sulphate Proteoglycans and Regeneration in the CNS

If CSPGs are inhibitory to axon regeneration, what strategies might be used to counteract their effects and so promote regeneration after CNS injury The first consideration in planning a strategy is to decide where CSPGs exert their effect. The molecules are expressed to some extent in the normal CNS, particularly in white matter, but are upregulated with an increase in their glycanation around injuries. If the molecules only have to be counteracted in the immediate vicinity of an injury, the task will be easier than trying to clear inhibition from the whole region where axon regeneration is needed. There is litde evidence on this issue. Three experiments from Davies and Raisman and Davies and Silver, mentioned previously, suggest that inhibition due to CSPGs is much greater around injuries than in normal CNS.9'14'15 The first experiment examined axon regeneration after very small lesions in the spinal cord which did not disturb glial architecture following this cut axons sprouted...

Hyaluronan Localization in Vocal Fold Pathologies

There has been keen interest in the measurement of HA levels in the lamina propria of vocal folds that have been scarred given the possibility of using exogenous HA to treat the resultant dysphonia. Vocal fold scarring causes devastating vocal dysphonia and there are suboptimal treatment options. HA is the most prominent glycosaminoglycan in the fetal ECM (14), which heals without scar. The role played by HA in influencing the scarless nature of fetal wound healing has been well documented (15,16). Whether or not the use of exogenous HA will decrease the incidence or decrease scar formation in the vocal folds remains to be documented, but offers a stimulating area of wound-healing research. To date, HA levels have only been measured in two animal models, the rabbit and canine (17-21). At time points representing chronic scar (2 and 6 months after scar induction), utilizing histological measures, HA levels were not significantly different between scar and control. HA levels immediately...

Surgical Protocol And Form Of The Implant

The surgical protocol implemented to assess compatibility of biomaterials and devices in tissues depends on the size and shape of the implant and certain characteristics of the tissue. The surgical trauma associated with implantation will initiate a wound healing response that has a profound effect on the subsequent assessment of the compatibility of the implant in the tissue. Therefore, surgical techniques that minimize trauma to the tissue should be employed. The greater the amount of maceration of the tissue, the more extensive the formation of scar tissue. Power tools with high-speed burrs, drills, and blades that are used to produce implant sites in bone can generate excessive heat that devitalizes adjacent tissue show-speed instruments with irrigation should be employed to minimize this effect.

In Vivo Alteration of Hyaluronan Production

Applications in voice that would benefit from such a treatment including vocal fold scar, paralysis, paresis, and atrophy. All of the work to date has been accomplished in vitro. Hirano et al. (35) have demonstrated that treatment of normal canine laryngeal fibroblasts with hepatocyte growth factor, a potent mitogen of hepatocyte and modulates hepatic stellate cell proliferation, collagen formation and the expression of transforming growth factor beta 1, stimulated HA production up to 48 h. In a supplementary study, Hirano et al. (36), found an increase in HA levels from normal canine laryngeal fibroblast cultures up to 7 days with hepatocyte growth factor, epidermal growth factor, basic fibroblast growth factor, and transforming growth factor betal. This line of voice research is intriguing, unique and offer therapeutic potential for various vocal fold pathologies. One of the most significant advantages of this line of research is the production of in vivo autologous HA that would...

The Role of Hyaluronan

There is now evidence to suggest that post-natal wound healing can be modulated, resulting in a decrease in scarring. Hellstrom (20) reported enhanced wound healing in tympanic membrane perforations in a rat model following the topical application of tissue-extracted HA. Membranes treated with HA appeared otomicroscopically normal (translucent) 3 months later in contrast to untreated membranes, which showed extensive opacification. In a follow up study it was reported that this effect was independent of molecular size or rheological properties of the HA but related to the concentration of the preparation (21). But what is the mechanism for the proposed effect of HA in wound healing and scarring The possibilities are

Hyaluronan and Wound Healing Hypotheses

Whatever the case, a mechanism must be proposed where HA has a definite role in harnessing and manipulating the natural reparative capacity of tissue fibroblasts. This raises the question whether HA alone has the capacity to control events of such complexity as wound healing and scar maturation contain hydroxyproline. In the early stages of repair, when HA levels are high, cell migration plays a prominent role in restoring cellular continuity (22). Later, when HA concentrations fall and sulfated GAG concentrations are high, cell differentiation, collagen production, and tissue organization occur (23,24). The high molecular weight HA seems to inhibit the formation of capillaries (25) while angiogenesis is induced by degradation products of HA (26). Weigel et al. (27), have proposed a model for the role of HA in wound healing in which a HA-fibrin matrix forms which attracts inflammatory cells into the wound. This matrix is in turn modified by the cells entering the wound as they secrete...

Anal Fissures Tears and Lacerations

Clinically, an anal fissure refers to a longitudinal laceration in the perianal skin and or mucosa of the anal canal. Anal fissures may be acute (usually healing within 2-3 weeks) or chronic and single or multiple. Most fissures will heal by first intention and not leave a scar. However, after healing, the site of some Whether an injury heals by first or secondary intention, the latter resulting in scar formation, depends on several factors, including the width and depth of the breach in the epithelium. Manser (134) reported scarring in 14 of the people examined because of possible anal intercourse. The Royal College of Physicians working party stated that in children, The only specific indicator of abuse is a fresh laceration or healed scar extending beyond the anal margin onto the perianal skin in the absence of reasonable alternative explanation, e.g., major trauma (173). Disappointingly, this report does not clarify how they differentiate between lacerations and fissures.

Inflammatory Phase Modulation

SCAR Maturation SCAR Maturation As the extracellular matrix forms, the peripheral keratinocytes are undergoing increased mitosis and proliferation prior to migrating across the new matrix. The HA-rich matrix supports and promotes the proliferating basal keratinocytes (95-99) and facilitates their migration again through a CD44-mediated mechanism (100). After re-epithelialization has occurred the new matrix undergoes remodeling. This remodeling process can be prolonged and the tissue is referred to as scar. In the HA-rich matrix seen in the fetal wounds, HA may reduce collagen deposition, enhance remodeling and contribute to reduced scarring (101,102).

Discomfort and complications of needle biopsy

In general, most subjects experience only minimal discomfort with a few seconds' sensation of pressure or pain during the procedure. The pain experienced during biopsy is greater if the fascia is caught in the needle or if a nerve is touched or damaged. The response of subjects to biopsy is, however, somewhat variable, as is their account of subsequent feelings of discomfort. Muscle function is usually little impaired, and patients need not restrict their activities after biopsy, although a sensation of muscle stiffness may persist for 48 h or more. Complications of the needle biopsy procedure are rare but include infection, haematoma and denervation (Goldberger et al. 1978 Edwards et al. 1980, 1983). In our experience with 1,200 biopsies, haematoma formation at the biopsy site occurred on three occasions, but they were all resorbed spontaneously. Until now we have experienced no case of infection at the biopsy site. All wounds healed with a minimal visible scar.

Safety and Efficacy Versus Toxicity Ratio

Certain completely unanticipated types of toxicity have been shown to develop long after exposure to the offending agent. Examples include retrolental fibroplasia (a scarring of the retina that occurs in children months to years after exposure to oxygen in the neonatal period), and uterine cancer (has been linked to the offspring of mothers exposed to diethylstilbestrol while pregnant (2-4).

Clinical Features

Primary extranodal organ involvement is uncommon in HL, unless related to direct extension. For example, while primary pulmonary presentations are rare, direct extension into the lung parenchyma is frequently observed, usually in the presence of adjacent mediastinal or hilar nodes. The lung is probably one of the most common nonlymphoid organs to be involved by HL, and such involvement may be manifested by linear infiltrates, pleural effusions, or nodular infiltrates demonstrated on chest X-ray or computed tomography (CT) scan. A rare patient may present with cough, wheezing, and endobronchial extension from an area of hilar lymphadenopathy. However, determination of pulmonary involvement can be quite problematic, as HL patients are predisposed to infectious complications including bacterial, viral, and atypical pneumonias. In addition, a history of granulomatous disease or fungal infection may be responsible for pulmonary scarring or nodules. The clinical setting, response to...

Swinging Flashlight Test

Swinging Flashlight Test

Since the corneal surface is the strongest refracting interface of the eye, seemingly insignificant disturbances, such as off-axis corneal scars, dystrophies, or a roughened tear film, will sometimes have a profound effect on the Snellen acuity. Early keratoconus is easy to miss, and it is often first discovered in adults with established histories of unexplained vision problems. Ophthalmometry, retinos-copy, and use of the Placido disc for corneal topography scanning are often necessary to establish the diagnosis. In this instance, a rigid contact lens on the cornea will markedly improve the image clarity and confirm the refractive nature of the poor acuity.

Advantages and limitations of needle biopsy

The needle biopsy circumvents many of the disadvantages of the open muscle biopsy, which include higher costs, the need for general anaesthetic, increased scarring and the inconvenience of repeated biopsies (Goldberger et al. 1978 Edwards et al. 1980, 1983). The fact that many of our patients and control subjects have participated in several studies involving muscle biopsies emphasises that this technique is easy to learn, repeatable and relatively atraumatic. It is a safe procedure that is almost free of complication. As repeated biopsies are generally well tolerated, biopsies can be taken before, during and after acute or chronic intervention, e.g. insulin stimulation, lipid infusion, exercise, treatment with drugs, training etc.

Implantable Cardioverterdefibrillator Implantation

The sites of venous access and methods of obtaining access are similar to that for permanent pacemakers. Unless contraindicated by an atrioventricular (AV) fistula, venous anomaly, previous chest surgery (i.e., mastectomy), severe dermatologic conditions, or scarring, a left-sided approach is preferred. Cutdown to the cephalic vein or percutaneous axillary vein access may be preferable to subclavian puncture to reduce the incidence of subclavian crush observed with these large leads.26 Leads need to be well secured to the pectoral fascia, because dislodgment of defibrillation leads remains the most common perioperative complication.27 The transvenous defibrillator leads are implanted in the same fashion as pacemaker leads. The preferred location is the right ventricular apex with the distal coil entirely within the right ventricular cavity. Adequate sensing (R waves 5mV) and pacing (threshold 1.0 V) of the right ventricular lead need to be established. If a dual-chamber ICD is...

Intravenous Pyelography IVP

Scarring, and multiple irregular infundibular stenosis or strictures with subsequent hydro-calicosis. If renal function is decreased (which happens about 50 of the time) then retrograde pyelography is indicated. If the ureteral orifice is scarred, cannulation may be very difficult. As the bladder is commonly affected, cystoscopy provides additional diagnostic benefit. Advanced disease may present as a nonfunctioning kidney (autonephrec-tomy).

Clinical Evaluation Dermal Fillers Hyaluronic Acid With Artichoke

Scar formation physiology and pathological states. Otolaryngol Clin North Am 1984 17 265-272. 17. Siebert JW, Burd DAR, McCarthy J, Ehrlich HP. Fetal wound healing a biochemical study of scarless healing. Plast Reconstr Surg 1990 85 495-502. 18. Longaker MT, Whitby DJ, Adzick NS, Crombleholme TM, Langer JC, Duncan BW, Bradley SM, Stern R, Ferguson MWJ, Harrison MR. Studies in fetal wound healing VI. Second and early third trimester fetal wounds demonstrate rapid collagen deposition without scar formation. J Pediatr Surg 1990 25 63-68. 28. Estes JM, Adzick NS, Harrison MR, Longaker MT, Stern R. Hyaluronate metabolism undergoes an ontogenic transition during fetal development implications for scar-free wound healing. J Pediatr Surg 1993 28 1227-1231. Iocono JA, Ehrlich HP, Keefer KA, Krummel TM. Hyaluronan induces scarless repair in mouse limb organ culture. J Pediatr Surg 1998 33 564-567. Meyer LJM, Russell SB, Russell J, Trupin JS, Egbert BM, Shuster S, Stern...

Classification of nerve injury

Sunderland's first-degree injuries are the same as Seddon's neuropraxia. A second-degree injury involves a rupture of the axon, but the basal lamina or endoneurium remains intact, which allows for the possibility of recovery following Wallerian degeneration. A Tinel's sign will be noted on examination. The examiner should begin percussion distal to the injury site and note the most distal extent of the Tinel's sign. This distal Tinel's sign marks the site of the regenerating nerve cone. The site of the original trauma may show percussive sensitivity for several months, which should not be mistaken for advancing nerve fibers or a nonfunctional neuroma without first testing distally. Recovery from second-degree injuries should be complete unless the injury is so proximal to the target organ that muscle atrophy or motor end-plate degeneration occurs within the period of nerve regrowth. Third-degree lesions involve injury to the endoneurium with preservation of the perineurium. With...

CSPGs Are Present in Functional Boundaries in the CNS

During development, strong immunostaining for CS often localizes to territories thought to act as barriers to migrating neurons or extending axons such as the roof plate and midline dorsal tectum,35'36 the posterior sclerotome,37'38 the glomeruli of the olfactory bulb,39'40 the somatosensory barrel field41 44 and the dorsal root entry zone and dorsal columns in the spinal cord.45'46 Thus, the CSPGs could contribute to the regulation of the establishement of axonal highways by its spatial distribution in boundaries associated with its neurite outgrowth inhibitory properties. These boundaries seem to share common properties with the glial scar, that is, the expression of CSPGs and tenascin-C at lesion sites is associated with inhibition of axonal regrowth, as has also been proposed for the dorsal root entry zone.46

The Actin Cytoskeleton

As a result of activatory signals, the polymerisation of actin filaments is initiated and maintained by nucleation and branching off from pre-existing filaments, processes thought to be catalysed by the Arp2 3 complex. Recently, proteins of the formin family were added to the list of cellular actin filament nucleators acting downstream of Rho-GTPases, and while the mechanism of creating long unbranched filaments was elucidated (Romero et al. 2004), the cellular function of the three diaphanous related formins (DRFs) and other formin family members in vertebrate cells is still far from being understood (Higgs 2005 Higgs and Pollard 2001 Zigmond 2004). The Arp2 3 complex consists of two actin-related and five additional subunits, and is essential for the protrusion of cellular projections such as lamellipo-dia (Machesky and Insall 1998 Pollard and Borisy 2003). The nucleating activity of the Arp2 3 complex can be stimulated, for instance, by proteins of the WASP WAVE family of...

Viscoaugmentation A Hyaluronan Gels

Tissue engineering with viscoelastic hyaluronan focused first on its use as a tissue filler or tissue augmentator (viscoaugmentation). Unlike collagen and non-biological tissue fillers, hyaluronan is an extremely elastic molecule and as such provides elasticity to the intercellular spaces into which it is injected. Hylan B gel was first used for viscoaugmentation of the vitreus after retinal detachment surgery, and later for correcting facial wrinkles and depressed scars for vocal cord augmentation in glottal insufficiency and augmentation of the connective tissue in sphincter muscles to treat urinary incontinence.

Congenital Heart Disease CHD

The impact of a congenital cardiac malformation on the development of the affected child depends on the type and severity of the malformation, as well as the timing and success of therapeutic measures. For some complex malformations with single ventricle physiology, only palliative solutions are available. Lesions such as tetralogy of Fallot,6 atrioventricular septal defect,7 and transposition of the great arteries8 can be successfully corrected in infancy with good long-term outcome. Regardless of the immediate procedural outcome, long-term follow-up of patients with the entire spectrum of lesions which have been corrected or palliated shows that several new problems may appear in later life including residual valvular obstruction or insufficiency, myocardial dysfunction, and new potentially life-threatening arrhythmias related to previous surgical scars. It is mandatory therefore that all patients receive some form of life-long supervision. Depending on the degree of myocar-dial...

TABLE 515 Light Colored Spots in the Fundi

Here inflammation has destroyed the superficial tissues to reveal a well-defined, irregular patch of white sclera marked with dark pigment. Size varies from small to very large. Toxoplasmosis is illustrated. Multiple, small, somewhat similar-looking areas may be due to laser treatments. Here there is also a temporal scar near the macula.

ECM Proteins Expressed during Development Are Also Upregulated in Lesions Upregulated CSPGs Could Inhibit Regeneration

Most of the expression of the proteoglycans occurs during the embryonic and postnatal period and decreases to a low basal level of expression in the adult. Interestingly, it has been shown that the expression of these CSPGs is upregulated at sites of damage to the CNS. For example, NG2,47 neurocan,48 50 decorin,51 versican,52 and brevican53'54 are all upregulated in lesions. It is meanwhile well established that the inability of the CNS to regenerate is at least in part due to inhibitory factors released by glial cells into the lesion environment. '58 The astrocytes react to lesion of the CNS to form a gliotic scar.57'59 61 These reactive astrocytes and the ECM that they produce have been shown to inhibit neurite outgrowth in vitro62'63 and in vivo.45'64,65 The demonstration that CSPGs can modulate neurite outgrowth in in vitro studies has led to the suggestion that the CSPGs may be contributing to the failure of axonal regeneration in lesions.

WASP and the Wiskott Aldrich Syndrome

In mammals, most is known about the loss of function of the haematopoietic WAS gene. In addition to the intense research on the inherited Wiskott-Aldrich syndrome (WAS), two independent WASP knockout mice have been reported (Snapper et al. 1998 Zhang et al. 1999), displaying a mild haematopoietic phenotype reminiscent of less severe WAS in humans (Burns et al. 2004). In 1996, 2 years after the discovery of WASP as the gene mutated in this disease (Derry et al. 1994), two groups independently established the direct interaction of this protein with the Rho family GTPase Cdc42 (Aspenstrom et al. 1996 Symons et al. 1996), raising the possibility of WASP acting in the translation of Cdc42 signalling to actin cytoskeletal reorganisation. The subsequent recognition of the Arp2 3-activating features of WASP Scar family members (Machesky and Insall 1998 Machesky et al. 1999 Rohatgi et al. 1999) provided the direct connection to actin filament assembly. Hence, a potential Cdc42 WASP N-WASP Arp2...

Pulmonary Artery Bifurcation Allograft

The pulmonary bifurcation allograft has been thawed and prepared. The distal right and left main pulmonary arteries are slit with a horizontal incision (Figure 53.17). The filleted allo-graft is then sutured to the native pulmonary arteriotomy with a running 5-0 polypropylene suture technique (Figure 53.18). This method uses the full circumference of the allograft pulmonary arteries to augment the anterior recipient confluence, thereby enlarging the pulmonary artery bifurcation significantly. If necessary, exposure of the right main pulmonary artery is enhanced by dividing the aorta, which can then be rejoined (Figure 53.19). (This maneuver is particularly helpful when previous scarring, due to Dacron patch enlargement of the right pulmonary artery, makes dissection behind the aorta risky.)

Herpes Simplex Virus Type

One clinically significant disease that is caused by HSV-1 is herpetic stromal keratitis (HSK) an intense inflammatory response triggered by the viral infection of the corneal stroma 3,45,54 . If left untreated, the chronic inflammatory response leads to the formation of lesions, scarring, and eventually blindness.

TABLE 81 Visible Signs of Breast Cancer

Breast Cancer Skin Dimpling

As breast cancer advances, it causes fibrosis (scar tissue). Shortening of this fibrotic tissue produces retraction signs, including dimpling, changes in contour, and retraction or deviation of the nipple. Other causes of retraction include fat necrosis and mammary duct ectasia.

Fetal Vm Tissue Transplants

Striatum Tissue

Fetal VM tissue transplanted into the dopamine-depleted caudate of the striatum always had better success than adrenal medulla grafts (50,51). Despite being allografts (the host is not the donor but is the same species as the donor), fetal VM tissue appeared to induce less immunorejection and gliotic scarring than did adrenal grafts (52-54). The immune reaction was not substantially different than that seen in sham surgeries (44). Fetal VM tissue placed into the dopamine-depleted caudate increased striatal dopa-mine content, normalized the HVA dopamine ratio, increased the density of DAT sites, and decreased dopamine receptor sensitivity (25,54-58). Additionally, in MPTP-treated monkeys, it was found that VM transplants increased cellular metabolic activity, as indicated by higher levels of mitochondrial cytochrome oxidase (59). All these measures of dopamine and metabolic activity are altered initially by MPTP treatment and subsequent dopamine depletion of the striatum (see The MPTP...

Future Directions

Mackool RJ, Gittes GK, Longaker MT. Scarless healing the fetal wound. Clin Plast Surg 1998 25 357-365. 15. Adzick N, Longaker MT. Scarless wound healing in the fetus the role of the extracellular matrix. Prog Clin Biol Res 1991 365 177-192. 16. Moriarty KP, Cromblehome TM, Kerry GE, O'Donnell C. Hyaluronic acid-dependent pericellular matrices in fetal fibroblasts implications for scar-free wound repair. Wound Repair Regen 1996 4 346-352. 17. Rousseau B, Hirano S, Scheidt T, Welham NV, Thibeault SL, Chan RW, Bless DM. Characterization of vocal fold scarring in a canine model. Laryngoscope 2003 113 620-627. 18. Rousseau B, Hirano S, Chan RW, Welham NV, Thibeault SL, Ford CN, Bless DM. Characterization of chronic vocal fold scarring in a rabbit model. J Voice 2004 18(1) 116-124. 19. Thibeault SL, Rousseau B, Welham NV, Hirano S, Bless DM. Hyaluronan levels in acute vocal fold scar. Laryngoscope in press. 20. Thibeault SL, Bless DM, Gray SD. Interstitial protein alterations in rabbit...

Etiology of Adhesion Formation

Surgically induced adhesions are a complication of invasive surgical procedures (48). Adhesions induced by either trauma, surgical or otherwise, and pathology (i.e., endometriosis) can lead to a variety of complications including infertility, bowel obstruction, pain, impaired joint mobility, and unintended complications during reoperation (49-53). The etiology of surgically induced adhesions is thought to be a result of incidental trauma caused by tissue manipulation (54), desiccation (54), tissue ischemia, and a foreign body reaction to particulates (55-57). This damage leads to a wound healing response that results in the production of a serous exudate that leads to fibrin clot production (58-60). If the fibrin clot is relatively short lived then it is resorbed with concomitant normal wound repair. If, however, the fibrin clot resides for a longer time period then cells of fibroblastic phenotype are recruited to the site. These cells begin to generate collagen leading to a scar-like...

Ocular Surface Disorders

When a modification of the tear film structure occurs, with consequent tear film instability, ocular surface stress will develop, resulting in a clinical condition known as dry eye. The classification of this disorder was carried out in 1995 by the National Eye Institute, dividing dry eye into two different types aqueous layer disorders and tear evaporation disorders (32). This classification is very useful to focus on the main causative factors of the disorder, although the clinical presentation is often a mix of the two pathogenic pathways (i.e., a reduced aqueous production often results in an inadequate lipid layer spreading and in excessive tear film evaporation meibomian gland disease is commonly associated with reduced aqueous secretion by the lacrimal gland). Aqueous layer deficiency is the most common cause of dry eye and is dependent on decreased secretion of the lacrimal glands, although increased evaporation of tears may also be involved. Main causes of tear aqueous...

Richard A Hopkins

Ventricular tissue that is stiffened with the previous scar tissue (Figures 59.1 and 59.2). This allows for an all homograft repair without the need for any additional PTFE or Dacron material. Pulmonary arterioplasties are preferentially performed with tongues of homograft or PTFE (vida supra).

Adrenocortical Carcinoma

Suspected recurrent loco-regional disease or distant metastases to the liver and lung may be imaged with chest X-ray, CT or MRI. Tumour spread into the inferior vena cava may also be accurately assessed by MRI, making caval venography obsolete. T2 weighted MRI images are useful in differentiating recurrent tumour from scar tissue in the operative field. USS or CT guided FNAC or needle biopsy provides histological confirmation of local recurrence, hepatic or other metastatic disease.

Regulation ofDSDlPGPhosphacan and Other CSPGs by Cytokines in Lesions Role ofTGFBeta

TGF-beta 2 and 3 isoforms are known to be expressed in most cells present in the uninjured CNS such as astrocytes, neurons and oligodendrocytes while TGFbeta 1 is mainly synthesized in lesioned tissue.206'208 Upon CNS injury, TGF-betal is upregulated by macrophages and astrocytes in the vicinity of adult CNS wounds212 and contributes to the formation of the glial scar, thus impairing regeneration.209'213 TGF-betas could influence core protein expression, GAG chain length, -number and -composition, or a combination of these parameters. For example, TGFbetas enlarged the size of individual GAG chains by approximately 25 kDa on a versican-like molecule expressed by smooth muscle cells, and enhance the level of mRNA that was detectable by a versican-cDNA probe 3-fold over unstimulated controls.200 It also increased the number and length of chondroitin sulfate chains attached to the proteoglycan syndecan in mouse mammary epithelial cells, while the core protein levels remained...

W Frank Peacock Md Facep

Wall tension is a product of pressure (after-load) and ventricular radius. Increasing wall tension is a stimulus for cardiac remodeling. With increasing tension, cardiac myocytes either hypertrophy or die (apoptosis) to form scar tissue. The dominant response determines HF type. Many different pathologies may ultimately lead to the clinical presentation of HF (Box 1). The dominating pathway determines the type of HF that results.

Chronic renal hemoglobin toxicity

Although GFR returns to pre-treatment levels in the days immediately following a mildly nephrotoxic exchange transfusion, chronic and progressive damage may have occurred. GFR could return to normal due to hypertrophy of undamaged nephrons, while chronic inflammatory processes may have been set in motion that will ultimately lead to chronic renal failure (Basile et al., 2001 Nath et al., 2001). Gradual release of heme from HBOCs trapped in the kidney for days to weeks (Keipert et al., 1994) could produce chronic tubulo-interstitial inflammation like that seen following repeated administration of hemoglobin to mice or repeated glycerol-induced rhabdomyolysis in rats (Nath et al., 2000a). A single episode of ischemia reperfusion in rats can produce chronic tubulo-interstitial scarring many weeks later, even though GFR and renal histology may appear normal 4-8 weeks after the initial injury (Basile et al., 2001). The possibility that long-acting HBOCs might

Pulse Generators And Lead Systems

Pacing Leads Line Drawing

Lead insulation can have an important impact on long-term stability and function. Silicone is inert, biostable, and biocompatible, but has a high coefficient friction. It is soft, making it prone to damage during implantation and can swell over time. Polyurethane is biocompatible, has a high tensile strength making small lead diameters possible, and a low coefficient of friction, but is prone to environmental stress cracking and metal ion oxidation. Recent reports highlight the high failure rate of polyurethane leads,21 so they should be avoided given the superiority of alternative insulators. Fluoropolymers (e.g., PTFE and ETFE) are the most biocompatible, have high tensile strength allowing small lead size, but are stiff, susceptible to damage from traction when the lead migrates, and they are prone to insulation micro defects and have a difficult manufacturing process. Today's lead systems have an insulating body of silicone, and in some instances supplemented by an outside...

Factors Limiting Successful Transvenous Left Ventricular Lead Placement

Epicardial Pacing Wires

Of sites for pacing is entirely dictated by navigable coronary venous anatomy. A commonly encountered problem is that an apparently suitable target vein delivers the lead to a site where ventricular capture can be achieved at only very high output voltages or not at all. This presumably relates to the presence of scar on the epicardial surface of the heart underlying the target vein and cannot be anticipated by fluoroscopic examination a priori (Fig. 9.12). If this is not successful, surgical placement of LV leads permits more detailed mapping of viable sites in the anatomic region of interest (see Fig. 9.12). Figure 9.12. Panel A Multiple diminutive lateral marginal veins. LV pacing threshold exceeded 6 V in all locations (arrows) in this vein system due to epicardial scar due to prior infarct (note surgical clips associated with prior coronary revascularization). Panel B PA chest radiograph of surgically placed epicardial LV pacing leads (arrows) in same patient. Note LV free wall...

Cellular Response to Injury

Traumatic spinal cord injury results in many cellular and molecular changes that extend over months and years after injury. During the acute phase of injury (first few days), there is disruption of the blood-brain barrier, ischemia, edema, leading to neuronal death, degeneration of axons, astrocyte proliferation, and infiltration of immune cells and meningeal fibroblasts. The subsequent secondary injury extends over a time course of several weeks and results in reactive gliosis, formation of a glial scar, strong inflammation, formation of a cystic cavity, and apoptotic cell death (for review see ref. 48). The Glial Scar CNS injury results in a rapid glial response around the injury site, leading to gliosis and formation of aglial scar. Although the functional role of glial scarring is not completely understood, it has been suggested that it protects neuronal function following injury. 9 Astrogliosis may for instance contribute to the clearance of glutamate, restoration and...

Molecular Components of Inhibition

Growth inhibitors present in myelin seem to be involved particularly during the early phase that follows CNS injury, before the glial scar forms.86 Several myelin-associated proteins have been identified that are thought to contribute to a hostile environment for regenerating nerve fibers. These proteins include Nogo RTN-4, myelin-associated glycoprotein (MAG), oligodendrocyte-myelin glycoprotein (OMgp), tenascin-R, and chondroitin-sulfate proteoglycans (CSPGs). The relative contribution of these proteins to the inhibitory activity of myelin has been a subject of intense study. The main in vivo evidence for an inhibitory effect of myelin on CNS regeneration comes from experiments using either antibodies that neutralize myelin inhibitory molecules,87 90 or a peptide that specifically acts as a NGR antagonist,91 Both approaches have improved the regeneration of corticospinal tract axons and have shown some functional recovery after dorsal hemisection of the adult spinal cord (for recent...

Transmission of Inhibitory Signals

RhoA acts on several downstream effectors to regulate the underlying cytoskeleton. One of these effectors, termed Rho kinase, or ROCK, has been implicated in neurite outgrowth inhibition by CNS myelin components.201 Treatment with Y-27632, an ATP competitive antagonist that blocks ROCK activation, promotes neuronal outgrowth on myelin-associated inhibitory substrates in vitro as well as in in vivo models of spinal cord injury.201'202'206'207 Moreover, glial-scar derived inhibitors such as CSPGs, can also be blocked by inhibitors of ROCK.206 How ROCK induces neurite retraction is a complex issue because it has been shown to phosphorylate and signal through multiple downstream effectors.208 In summary, regardless of its mechanism of activation, RhoA seems to be the point of convergence for all presently identified myelin and glial scar derived inhibitors and might therefore be an attractive molecular target for small molecules that interfere with its activation. One caveat however is...

Experimental Strategies to Promote Nerve Regeneration Following CNS Injury

Several experimental strategies have been developed to overcome inhibition after CNS injury. They involve the use of antibodies to neutralize growth inhibitors, Nogo peptides binding to NGR and blocking its activity, and blockers of the intracellular pathways mediating growth inhibition (for recent reviews see refs. 3,5,213,214) In addition, rather than blocking inhibitors, receptors, or their signaling pathways, growth of dorsal column ascending sensory axons has been improved by intraganglionic administration of cAMP98'209 or by application of rolipram.212 To decrease its inhibitory properties, the biochemical composition of the ECM has also been altered by treatment with chondroitinase ABC, the enzyme which cleaves the GAG side chains of CSPGs.164 166 Furthermore, attempts to reduce glial scarring have been made using pharmacological agents to decrease collagen deposition in the ECM.228 Matrix and ADAMs metalloproteinases, enzymes that can degrade ECM proteins and CSPGs, are also...

Mathematics and Behavior Modification

McDowell's expertise in mathematics and behavior modification spurred him to apply Her-rnstein's matching equation for a single operant to a clinically relevant problem. Carr and McDowell (1980) had been involved in the treatment of a 10-year-old boy who repeatedly and severely scratched himself (Fig. 9.15). Before treatment the boy had a large number of open sores on his scalp, face, back, arms, and legs. In addition, the boy's body was covered with scabs, scars, and skin discoloration, where new wounds could be produced. In their 1980 paper, Carr and McDowell demonstrated that the boy's scratching was operant

Planning a freemuscle transfer

Not all muscles have the same amount of excursion, or length of pull, of the distal tendon. Excursion is directly related to muscle fiber length and indirectly affected by fiber orientation relative to the long axis of the muscle. In general, excursion is approximately equal to 40 of resting muscle fiber length 43 . Excursion should ideally equal or exceed normal motion at the recipient site. Strap muscles, in which fibers run parallel to the muscle axis, provide more excursion than pinnate muscles, whose orientation is oblique to the muscle. Other factors, such as fascial connections or postoperative scarring of muscle and tendon, will limit excursion, as will anatomic

Utility for Removing the Centrosome

Centrosome Microtubules Imaging

Figure 10.1 Laser-induced ablative photo-decomposition initially converts the centrosome into a dense aggregate of denatured material that is destroyed over time. In this example, the centrosome in an interphase PtK, cell expressing GFP y-tubulin (B, arrow) was destroyed by 15 pulses of laser light (C). The operation produces the formation of a scar, which is clearly visible by DIC microscopy (arrow in D). This cell was then fixed 2 min after the operation and processed for EM. An analysis of serial semi-thick (0.25-mm) sections (E and F) revealed that the scar, which was formed from the contents of the centrosome, is composed of an amorphous, electron-opaque material. Video-LM studies reveal that, over time, the scar will wander randomly within the cell until it finally disappears. Figure 10.1 Laser-induced ablative photo-decomposition initially converts the centrosome into a dense aggregate of denatured material that is destroyed over time. In this example, the centrosome in an...

Coronary Artery Disease

Angina Pectoris With Pph And Cpd

Left ventricular aneurysm is, on occasion, an indication for surgery. The indications for operating on a left ventricular aneurysm are large size with decrease in cardiac output and congestive heart failure, and predisposition to ventricular arrhythmias. Ventricular aneurysms are seen to have a paradoxical outward motion in ventricular systole (i.e. the ventricle is dyskinetic rather than akinetic). The dyskinetic ventricle results in decrease in ejection fraction by sequestering the cardiac output within the paradoxically moving aneurysm sac. The dilated aneurysm causes an increase in wall stress by the law of La Place, resulting in increased myocardial oxygen utilization and worsening ischemia. This may result in congestive heart failure. The aneurysm and surrounding scar tissue predispose to arrhythmias and this too is an indication for surgery. Ventricular aneurysms are

Identifying Genes that Extend Life Span Using a High Throughput Screening System

We developed a high-throughput functional genomic screening system that allows identification of genes prolonging lifespan in the baker's yeast Saccharomyces cerevisiae. The method is based on isolating yeast mother cells with a higher than average number of cell divisions as indicated by the number of bud scars on their surface. Fluorescently labeled wheat germ agglutinin (WGA) was used for specific staining of chitin, a major component of bud scars. The critical new steps in our bud-scar-sorting system are the use of small microbeads, which allows successive rounds of purification and regrowth of the mother cells (M-cell), and utilization of flow cytometry to sort and isolate cells with a longer lifespan based on the number of bud scars specifically labeled with WGA. Key Words Aging budding yeast wheat germ agglutinin WGA bud scar life span. The replicative lifespan of yeast is defined as the number of cell divisions or daughter cells (D-cell) that mother cells (M-cell) produce in...

Animal models of acute and chronic toxicity

Currently there is no information about the acute effects of HBOCs on the renal vasculature and their long-term effects on tubulo-interstitial inflammation and scarring. Nor is there information about the effects of HBOCs on animals with acute tubular necrosis that simulates the human disease. These deficits should be rectified by observing the acute and chronic effects of HBOCs in animal models that more closely mimic human acute renal failure. Micro cDNA gene arrays are now being used to follow the cellular responses to renal damage (Devarajan et al., 2003). Gene arrays could help to identify markers for the toxic effects of hemoglobin and HBOCs. One such marker, KIM-1, provides a urinary marker of damage to proximal tubular cells that may help identify the early stages of acute renal failure (Han et al., 2002).

Clinical Implications Mother

Breast Pinch

Influence later lactation performance (Neifert et al., 1990). Scar tissue from injury should be evaluated for its effect on skin elasticity and the degree to which nerve reactivity may have been affected. The look of the breast does not dictate its ability to function. A case in point may be women who have sustained significant scarring from burns (see Color Plate 25). Second- and third-degree burns rarely extend so deeply into the parenchyma that they destroy the glandular tissue of the breast, even when the burns have occurred in adulthood. Significant scarring of the dermis and epidermis, however, may result in (1) reduced maternal sensation when the infant suckles, (2) minimal tissue elasticity, thus requiring the mother to alter the baby's position at the breast, and (3) reduced milk ejection if a nipple has been surgically reconstructed. Nevertheless, scar tissue on the breast or nipple does not, by itself, preclude breastfeeding.

Botulinum Toxin and Chemical Peels

BNT-A plays an amazing role with resurfacing methods. If there is no excessive muscle movement, collagen remodelling will proceed in a smoother fashion and will probably decrease the risk of hypertrophic scars. Also, the absence of excessive muscle contraction avoids rewrinkling.

CSPGs and DSDlPGPhosphacan in Neurite Outgrowth Inhibition

Neurite Outgrowth

Finally, the neuronal CSPG, neurocan, a member of the aggrecan family of PGs, binds directly to CAMs of the Ig-superfamily, inhibits homophilic LI- or N-CAM-mediated cell adhesion and interferes with both neuron adhesion to and neurite outgrowth on substrates consisting of combinations of cell adhesion molecules or monoclonal antibodies132,135 The inhibitory properties of neurocan partially reside in the core protein, consistent with a recent report which has attributed inhibition of neurite outgrowth by CSPGs to the core glycoproteins rather than the GAG moieties.130 Thus, several examples illustrate that chondroitin sulfate proteoglycans may exert inhibitory influences on axon outgrowth in the context of astroglial scar formation, or the construction of transient glial boundaries of neural tissues.13 Injection of chondroitin sufate-degrading enzymes has resulted in the modification of axon growth trajectories in vivo and application of these enzymes to choice paradigms of axon...

Infrageneric Classification of Ocimum

Paton stat. nov. (Figure 1.3, Clade H, species 1854 in enumeration). Type species O.filamentosum Forssk. Basionym Ocimum subsect. Hiantia Benth. in DC. Prodr. 12 35 (1848). Bracts caducous, scar developing into an auxiliary nectary. Calyx throat open or laterally compressed in fruit throat glabrous lateral lobes asymmetrically lanceolate or truncate. Pollen with rounded or angled muri of primary reticulum. 4. Bracts caducous, scar developing into a auxiliary nectary

Intrauterine Adhesions Ashermans Syndrome

Intrauterine scarring leading to an unresponsive endometrium is most commonly due to injury to the pregnant or recently pregnant uterus. However, any mechanical, infectious, or radiation factor can produce endometrial sclerosis and adhesion formation. The sine qua non for development of IUA is endometrial trauma, especially to the basalis layer. The adhesions usually are strands of avascular fibrous tissue, but they also may consist of inactive endometrium or myometrium. Myometrial adhesions usually are dense and vascular, carrying a poor prognosis. Women with atrophic and sclerotic endometrium without adhesions carry the worst prognosis. This condition usually is found after radiation or tuberculous endometritis and is not amenable to any therapy. Postpartum curettage performed between the second and fourth weeks after delivery, along with hypoestrogenic states such as breast-feeding or hypogo-nadotropic hypogonadism, is associated with extensive intrauterine scar formation. Uterine...

Mechanisms for clinical arrhythmias

5 Re-entry initiated by automatic or triggered beats finally, automatic or triggered premature beats might initiate re-entry of excitation involving anatomical (fibrous scar tissue) or functional re-entry loops (caused by varying depression of the fast response and inhomogeneous conduction and refractoriness). Ideal drug treatment for VT in this example is not at all obvious - although treatment may be successful, it can just as easily produce proarrhythmia (see below).

Clinical Effects Of Sulfur Mustard

Little contemporary information regarding the pathogenesis of the respiratory lesions is available, and few data from people or animals exposed to nonlethal concentrations of mustard vapor exist. Even fewer studies investigate the histopathology of the recovery process in animals exposed to mustard.9 However, two studies conducted during World War I suggest that low-level exposure or survivable exposures in dogs and rabbits may produce scar tissue following small ulcerations in the trachea and larynx, causing contractions of these areas.27,28 The more severe respiratory tract lesions described in animals exposed to mustard vapor appear to be quite similar in type and location to those described in humans.12 D. Scarring, Pigmentation Changes, and Cancer of Epithelial Surfaces Skin cancer occurring at the site of old scar formation is an acknowledged biological phenomenon.34,35 Cutaneous cancers resulting from acute mustard exposure usually localize in scars, whereas those caused by...

Getting Ready To Measure Blood Pressure

Brachial Pulse Check

Ideally, ask the patient to avoid smoking or drinking caffeinated beverages for 30 minutes before the blood pressure is taken and to rest for at least 5 minutes. Check to make sure the examining room is quiet and comfortably warm. Make sure the arm selected is free of clothing. There should be no arteriovenous fistulas for dialysis, scarring from prior brachial artery cutdowns, or signs of lymphedema (seen after axillary node dissection or radiation therapy). Palpate the brachial artery to confirm that it has a viable pulse. Position the arm so that the brachial artery, at the antecubital crease, is at heart level roughly level with the 4th interspace at its junction with the sternum. If the patient is seated, rest the arm on a table a little above the patient's waist if standing, try to support the patient's arm at the midchest level.

Botulinum Toxin and Facelift

With the development of less and less invasive procedures, the upper third is now basically treated with BNT-A alone, which promotes rejuvenation improvement such as brow lifting, erasing of horizontal lines in the forehead and vertical lines in the glabella area without scarring or downtime. So mini-lifts may focus basically on the middle and lower face and neck. Although mini-lifts are less invasive that the conventional facelift, a shorter but still not that short downtime is nevertheless an issue (Fig. 8.6a,b).

Respiratory Distress Syndrome

In respiratory distress syndrome of the adult (ARDS), the respiratory failure is associated with acute pulmonary injury from aspiration or infectious pneumonia, for example.6 Shock, burns, and near-drowning are other causes of ARDS. This can actually occur in children or adults but is termed ARDS to distinguish it from neonatal respiratory distress. At the cellular level, the most likely cause of progression of the disease is inflammatory products, including leukocytes, prostaglandins, and fibrosis, which reduce the amount of lung surfactant activity. Cells and collagen accumulate, causing severe scarring, poor respiratory function, and hypertension and V Q problems.7 The arterial blood gases initially indicate very low Po2, normal or low Pco2, and elevated pH causing respiratory alkalosis.8 Chest x-ray can reveal pulmonary changes, including edema, but these may lag behind the severity of the blood gas results. Eventually acidosis can result from prolonged hypoxia, particularly if...

Can Haemoptysis Cause Asphyxiation By Filling Up Alveolar Airs Spaces

Primary lung cancer is the leading cause of cancer deaths in both men and women. The incidence of lung cancer is increasing, mainly among women. Approximately 85 of lung cancers are linked to smoking. Cigarette smoking accounts for 90 of cases in men and approximately 70 of cases in women. A small proportion of lung cancers, 16 in men and 5 in women, is related to occupational agents, such as asbestos, radiation, and nickel chromate exposure. often overlapping with smoking. The exact role of air pollution is uncertain. Occasionally, lung cancers, especially adenocarcinoma and alveolar cell carcinoma, are associated with pulmonary scars. group of miscellaneous types. NSCLC is farther divided into three types squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. SCLC and NSCLC constitute 95 of primary lung cancers. Compared with NSCLC, SCLC tends to metastasize much earlier and more widely, and it is more likely to respond to chemotherapy. The relative frequency of the...

The Microlift Procedure BNTA as an Important Ally

The microlift facelift appeals to the patient seeking a more long-lasting improvement than fillers and surface treatments offer but without the discomfort and cost of a surgical facelift. The technique utilizes three common treatments to improve facial contours liposuction of the neck and under the chin, injection of facial fillers into wrinkles and folds, and suspension of facial muscles using polypropylene or mersilene threads. Alongside this, injection of botulinum toxin in the upper, mid and lower thirds is also a rule. Chemical peels can be added for some patients to further improve skin appearance. Patients appreciate that the microlift technique offers little scarring, minimal discomfort, and a quick recovery time. (Fig. 8.7a,b)

Introduction Bad Medicine Better Medicine

I am tall, over six feet. The vast majority of people over six feet tall have been born in the last century, perhaps in the last thirty years. In the mid-eighteenth century Frederick the Great of Prussia searched across Europe to assemble a regiment of men over six foot tall the enterprise took its point from the rarity of such giants. Anybody inspecting my body for a post mortem would find that on my upper arm there is the scar of a vaccination against smallpox, which must have occurred after 1796, when Jenner invented vaccination, and before 1980, when smallpox was officially declared eradicated. They would also find evidence of my surviving an appendix operation and a compound fracture of the tibia this, as we shall see, implies medical care received after 1865. Before that date an appendectomy was almost certain to be fatal, while the only hope for someone with a compound fracture (where the bone sticks through the skin) was amputation. The...

Literary Analysis

In Possessing the Secret of Joy the black liberal feminist Alice Walker dramatizes how her main character, Tashi, in an act oftribal allegiance, gets facial scarring and circumcision because she recognized it as the only remaining definitive stamp of Olinka tradition. The tribe's leader, who is compared to Nelson Mandela and even Jesus Christ, has instructed the people not to neglect ancient customs. He has been imprisoned by the white regime. Walker explores the effects of FGM in a dazzling style that simultaneously seems to contrast and to transcend cultural differences. The various viewpoints are artfully integrated into dialogue and flashbacks, intermixed with myths, symbols, and psychology. Walker uses the narrative device of renaming Tashi relative to her changing cultural and psychological state of mind for example, when referring to her evolving American self she is Tashi-Evelyn. In this way, Walker conveys the essence of Tashi's journey. However, Tashi is not described...

Diagnostic Confirmation of Metastatic MTC

The above radiological modalities can be used to locate metastatic disease. Ultrasound or CT guided FNAC or needle biopsy allow cytological confirmation of non-palpable recurrent, cervical or hepatic metastatic disease. MRI is potentially helpful in delineating scar tissue from recurrent disease in the neck and mediastinum. Medullary thyroid cancer does not concentrate and attempts at treatment with radioiodine have failed to demonstrate significant response (73). Radiotherapy treatment results in significant fibrosis and scarring, rendering further surgical resection difficult and hazardous. Studies on the effect of radiotherapy in medullary thyroid cancer

Biomechanical Properties of Hyaluronan

Hyaluronan Properties

An attempt to alter the in vivo viscoelastic properties of mucosal tissue with dilute (0.05 ) and concentrated (0.5 ) HA, Gray and co-workers (unpublished data) found that HA injections could possibly affect tissue viscosity. However, it appears that while increasing tissue viscosity and stiffness were possible, decreasing tissue viscosity and stiffness through HA injections were difficult. The viscoelastic effect of the dilute HA was very short, less than 24 h, possibly because of rapid diffusion away from the sight of injection. Concentrated HA did lead to a greater viscoelastic effect. This research demonstrates that optimization of HA (purity, rheological properties, molecular weight, concentration, etc.) is required and that HA is unlikely the sole factor in regulating tissue viscoelasticity. The unlikelihood of HA being the sole factor in regulating vocal fold tissue viscoelasticity is further supported by the findings of unaltered HA levels in vocal fold scar measured...

The Role Of Macrophages In C pneumoniae Immunity

Cytokine-mediated regulation of cell-mediated immunity occurs either by the supporting or inhibiting of T cell responses by the proinflammatory IL-12 and IL-18 or the antiinflammatory IL-10, respectively. IL-12 and IL-18 induce activation of type 1 T cell responses and secretion of which is acknowledged as the most important cytokine controlling Chlamydia infections,(44 46) including C. pneumoniae infection.(25'47 9)IFN-7 controls Chlamydia infection, by not only regulating the cytotoxic T cells but also through direct induction of nitric oxide synthase and the nitric oxide production in the macrophages as well as tryptophan depletion that inhibit chlamydial growth.(48,50,51) On the other hand, dominant secretion of IL-10 from macrophages and subsequently IL-4 secretion from type 2 T cells, are associated with susceptibility to C. trachomatis infection, poor elimination of the microorganism and appearance of granulomatous and fibrotic reactions in mice(44,52) and scarring trachoma(53)

Injury Induced Inflammation

Several inflammatory cytokines have been suggested to be involved in mediating glial scar formation and thus impede regeneration. For instance, interleukin-1, TGFct, TGFp, TNFa, and IFN-y all have been shown to be increased in scar tissue after brain lesion, to promote astrocyte proliferation in vitro, and or to augment gliosis in vivo.76 80 Moreover, a poor or slow appearance of inflammatory mediators in the CNS compared to the PNS may also contribute to the inefficient removal of myelin debris and thus add to the failure of regeneration in the brain.61 Interestingly, the expression of tenascin and of neurocan, a CNS-specific chondroitin sulfate proteoglycan with growth-inhibitory properties, is increased in highly purified rat astrocytes treated with TGFp. '82 However, the potential regulation of these and other myelin-associated growth-inhibitors by inflammatory mediators remains to be evaluated further.

Surgical Intervention

Three issues were particularly concerning in this patient motion loss, varus instability, and a posttraumatic defect of his medial femoral condyle. Initially, the principal focus was on helping the patient regain a functional range of motion. Because of the significant periarticular scarring, the patient underwent his second surgical procedure, which included an arthrotomy, removal of his hardware, extensive intraarticular release, manipulation under anesthesia, and placement in a well-padded long-leg hyperextension cast. Evaluation of his articular surfaces (Figure C37.4) demonstrated a large medial femoral condyle defect measuring 30 mm by 30 mm with more than 10 mm of subchondral bone loss. Following cast removal at 3 days, the patient was placed in an aggressive physical therapy program.

Changes In Aging Yeast

S. cerevisiae undergoes asymmetric division for most of its life span, producing a mother cell and a smaller daughter cell with each division. The cell wall of the daughter cell is synthesized de novo, and a permanent chitinous bud scar is left on the mother cell's surface at the site of attachment of the bud. (Adapted from Ref. 101.) Figure 1 Biomarkers of yeast aging. S. cerevisiae undergoes asymmetric division for most of its life span, producing a mother cell and a smaller daughter cell with each division. The cell wall of the daughter cell is synthesized de novo, and a permanent chitinous bud scar is left on the mother cell's surface at the site of attachment of the bud. (Adapted from Ref. 101.)

Astrocyte Meningeal Cell Boundaries

Meningeal cells are specialised fibroblast-like cells that surround the CNS and its major blood vessels, and are responsible for co-operating with astrocytes in the setting up of the glia limitans.70 72 This is a layer of hypertrophic astrocyte processes running parallel to the surface of the brain and spinal cord, with a layer of basal lamina on top in between the astrocytes and meningeal cells. Following CNS injuries, particularly those that penetrate the meninges, the meningeal cells divide, and migrate into the injury cavity. Within a few days they line the entire injury cavity, and if the injury has reduced the density of astrocytes and created space within the tissue meningeal cells may invade more diffusely.71'73 As the invading meningeal cells come into contact with astrocytes, they induce the same changes that are seen at the glia limitans. This leads eventually to the formation of a new glia limitans and often more general reactive astrocytic changes. Just as axons do not...

Post Operative Adhesions

Another area of clinical concern are the surgical scars that result in post-operative adhesions. Clinical studies have indicated that HA and cross-linked derivatives can be effective in preventing adhesions after endoscopic sinus surgery (127, 128). Experimental studies have assessed the efficacy of a hyaluronate carboxymethylcellulose gel using a rabbit uterine horn model. The positive benefits of applying the gel were demonstrated (129). Further studies confirm the positive benefits of HA based applications in rat and rabbit models of surgical adhesions (130,131).

Pss And Lung Carcinoma

Further case-reports 3-7 described a similar association between PSS and lung cancer, usually diagnosed in patients known to have had diffused scleroderma involving the lungs for many years prior to the appearance of the malignancy. . The most common type of lung cancer reported in connection with PSS is bronchiolar ( alveolar-cell ) carcinoma 2-4, 9 (representing less than 4 of all forms of lung cancer). This type of cancer can be found in areas of chronic fibrosis and has been described in association with scarring.

Clinical aspects of riotcontrol agents

Many compounds possess more or less lacrimatory properties that vary in intensity from mild to severe irritation, with copious flow of tears. The most characteristic feature of riot-control agents is their ability to cause immediate stinging sensation in the eyes with tearing (stimulatory effect) at low concentrations that results in a temporary disabling effect. These compounds produce stinging and lacrimation and reversible and non-injurious effects at low concentrations however, at high concentrations, ocular damage can result with some irritants. Moderate injury to the eyes following exposure to riot-control agents consist of corneal edema, which is reversible. More serious injurious action of riot-control agents may include corneal opacification, vascular-ization and scarring of the cornea, and corneal ulceration. Lacrimatory agents that have been associated with ocular injury, for example, include chloroacetophenone (CN), chloracetone, and bromobenzyl cyanide. Ocular injuries...

Preview Recording the Physical Examination The Pregnant Woman

Active bowel sounds. Soft, nontender no palpable hepatosplenomegaly or masses. Fundus palpable 2 fingerbreadths below the umbilicus shape is ovoid and smooth. Fetal heart rate 144. No inguinal adenopathy. External genitalia midline episiotomy scar present. No lesions, discharge, or signs of infection. Bimanual examination cervix midline, soft external os admits fingertip, internal os closed. No pain elicited on movement of cervix no adnexal masses. Fundus enlarged to 20 weeks' size, midline, smooth vaginal tone reduced.

Hypoxic Ischemic Parenchymal Necrosis

Periventricular leukomalacia, a typical white matter lesion in neonates, is situated in front of or around the anterior horns it may extend posteriorly along the ventricular walls. Grossly, the periventricular white matter is yellow, soft, and chalky (Fig. 14.3). Histologi-cally, the necrotic tissue is invaded by macrophages and, in time, is replaced by a glial scar or a small cavity. Diffuse white matter changes interfere with myelination by affecting the premyelinating oligodendrocytes.

The anatomy of abdominal incisions

Incisions to expose the intraperitoneal structures represent a compromise on the part of the operator. On the one hand he requires maximum access on the other hand he wishes to leave a scar which lies, if possible, in an unobtrusive crease, and which will have done minimal damage to the muscles of the abdominal wall and to their nerve supply.

Physical Examination Midclavicular Line At Edge Pf Costal Angle

Well-healed scar, right lower quadrant. Bowel sounds active. No tenderness or masses. Liver span 7 cm in right midclavicular line edge smooth, palpable 1 cm below right costal margin (RCM). Spleen and kidneys not felt. No costovertebral angle tenderness (CVAT).

Stephen L Hilbert Frederick J Schen and Victor J Ferrans

Cell infiltrates are absent in most explanted cryopreserved valves at all time points, including those concurrent with histologic deterioration and loss of cellular staining. This leads to the conclusion that immunologic phenomena cannot be causally implicated in the processes involved in allograft degeneration. Moreover, evidence of immunologic injury to the valves is not seen (i.e., no valvular scarring or loss of cellularity) even in heart transplant patients in whom immunologic phenomena caused cardiac allograft failure, or in patients who sustained multiple episodes of parenchymal rejection.

Peroxisomal Disorders

Cerebral X-linked adrenoleukodystrophy is typified by white matter demyelination that often starts in the parieto-oc-cipital regions bilaterally and then extends across the corpus callosum (Fig. 2A,B). The disease then progresses anteriorly and laterally as a confluent lesion to involve white matter of the temporal, parietal, and frontal lobes with relative sparing of the subcortical arcuate fibers (Fig. 1 ref. 87). In the minority of cases, the disease may start frontally and then progresses posteriorly. Pathologically, the affected areas can be divided into zones (88). Zone A is a central zone of scarring consisting of gliosis as well as scattered astrocytes. It is notable for absence of oligodendroglia, axons, myelin, and inflammatory cells. The adjacent peripheral zone B shows numerous perivascular

Transmission of Infectious Agents

Exposure to Infected Body Fluids As you learned in Chapter 9, AIDS is caused by exposure to infected blood. Hepatitis is another disease caused by contact with infected blood. There are at least six different hepatitis viruses, but the most dangerous is the virus known as hepatitis C. Exposure to hepatitis C leads to chronic liver diseases such as cirrhosis (irreversible, potentially fatal scarring of the liver), liver cancer, and liver failure. Hepatitis C ranks second to alcoholism as a major cause of liver disease and is the leading reason for liver transplants in the United States.

Classification of Organ Transplant Rejections

Clinically, organ transplant rejections can be classified into three categories and their management varies in accordance with the classification. Hyperacute rejection usually occurs within hours and is caused by antibodies already present in the recipient. Acute rejection is primarily T-cell based and can be controlled in most patients by the use of immunosup-pressants. Chronic rejection is probably T-cell based and appears to be related to poor control of drug therapy, and usually requires another transplant. It is a slow, progressive process that usually begins inside the transplant organ's blood vessels, which are lined by donor cells that interact with host white blood cells in the bloodstream. Over time, as a result of inflammation and rejection reactions, scar tissue can accumulate inside these vessels, thus reducing or preventing blood flow into the filter and chemical plant portions of the kidney. If blockages become widespread, the organ becomes compromised because of the...

Lessons From The Past

Often mining workers are exposed to high quantities of minute particles of quartz 49 . Lung fibrosis leading to fatal conditions is a result of high concentration exposure to quartz. It has become now known through rigorous research efforts that the surface of quartz particles is highly reactive oxidizing cell membranes and causing inflammation, cell death, fibrosis, and tumors 50-52 . Asbestos belongs to a family of fibrous metamorphic minerals of the hydrous magnesium silicate variety. It is naturally available in various structures and is being used for applications such as heat-resistant sheets, gaskets, brake shoes, etc. In 1918, a US insurance company brought to light the labor deaths caused in asbestos industries 53,54 . An article titled Mortality from respiratory diseases in dusty (inorganic) trades, further described the role of asbestos in premature death of workers 55 . Asbestos fibers less than 3 m (aspect ratio 3) can easily reach the lungs. After reaching the lungs,...

Biomedical Applications Of Microbial Cellulose In Burn Wound Recovery

Microbial cellulose (MC) is a very versatile biomaterial. Even though it has already been successfully deployed in such diverse scientific endeavors as electronics, acoustics, and fuel cells, it is particularly well suited for the creation of unique biomedical devices which can significantly improve the healing process. Because of the increased interest in tissue engineered products for the regeneration of damaged or diseased organs, microbial cellulose may become an essential material for a diverse array of medical treatments. Microbial cellulose from Acetobacter xylinum recently has been shown to be very beneficial in the treatment of superficial second degree and deep dermal second degree burns. In a clinical study performed on 34 patients, the MC wound dressing materials were directly applied on fresh burns covering up to 9-18 of the body surface. The following analyses were considered during the trials macroscopic observations of the wound and wound exudates, epidermal growth,...

Paramedian incision

The paramedian incision is placed 1in (2.5 cm) to 1.5in (4 cm) lateral, and parallel, to the midline the anterior rectus sheath is opened, the rectus displaced laterally and the posterior sheath, together with peritoneum, then incised. This incision has the advantage that, on suturing the peritoneum, the rectus slips back into place to cover and protect the peritoneal scar.

External Genitalia

For penile penetration of the vagina to occur, the penis must first pass between the labia minora and through the hymenal opening. The apposition of the penis and the posterior fourchette in the majority of sexual positions means that this area may be stretched, rubbed, or receive blunt trauma as vaginal penetration is achieved. Lacerations, abrasions, or bruises at the posterior fourchette have all been described after consensual sexual activity, although in all these cases, the examinations were enhanced by the use of toluidine blue or a colposcope (90,128,129). Wilson (131) has also described macroscopi-cally visible hematomata of the labia with consensual sexual activity. These injuries usually heal completely without residual scarring (90). Healing of lacerations of the posterior fourchette is predominantly by first intention, with no residual scarring being detected at follow-up assessments (90). Nonetheless, scarring may occur occasionally in these areas, but it is important...

Physical Examination

Abdominal Examination Pregnant Lady

Abdominal examination The abdomen should be inspected for scars, distension, masses or organomegaly (i.e., spleen or liver), and discoloration. For instance, the Grey-Turner sign of discoloration at the flank areas may indicate intra-abdominal or retroperitoneal hemorrhage. Auscultation of bowel sounds should be accomplished to identify normal versus high-pitched, and hyperactive versus hypoactive sounds. The abdomen should be percussed for the presence of shifting

James W Fawcett

The failure of axon regeneration after CNS injury is due to an inadequate or inappropriate regenerative response from damaged CNS axons and to a CNS environment that inhibits regeneration. This inhibitory environment contains many molecules that promote axon growth as well as molecules that inhibit it, but the balance of activities in the damaged CNS does not favour the regeneration of adult CNS axons. In principle, therefore, axon regeneration could be achieved in three ways (1) Inhibitory molecules might be destroyed or blocked, (2) the amount of permissive molecules might be increased, or new permissive molecules introduced, (3) Axons might be altered so that they can grow in the inhibitory CNS environment. Some success has been achieved with all three of these approaches. This review addresses the inhibitory properties of the glial scar, a structure which forms wherever the CNS is damaged, and which is one source of axon growth inhibitory molecules in CNS injuries.

Metastatic tumors

Patients who have metastases to the carpus usually have bony disease elsewhere and a life expectancy under 6 months. The lesions are often osteolytic on plain radiographs, and may be confused with an infectious or inflammatory processes if the patient's clinical history is not considered. Treatment is directed at symptomatic relief, with either tumor resection or amputation. Radiotherapy may cause fibrosis and stiffness more severe than the scarring associated with surgery.


Residual cell remnants can be pro-inflammatory, potentially initiating a non-specific inflammatory response that could then enhance an immune reaction, causing sensitization and or more destruction, than the gradual ebbing of a cell population by apoptosis. Third, the processing must not alter or expose the structural and matrix proteins in such fashion as to be inflammatory or even antigenic (e.g. xenograft decellularized tissues). And finally, the decellu-larization process must result in a protein scaffold commodious to recellularization with phenotypically appropriate cells (i.e. myofi-broblasts and endothelial cells) and not result in the typical fibroblastic scar response which simply mimics the optimal scenario for cryop-reserved allografts (see sheathing vida supra and Chapter 65).

Reactivation of HSV1

Due to a variety of environmental cues including UV light, stress, and immunosuppression, the virus is able to reactivate in the latently infected neurons of the TG. Through antegrade transport, the virus can again be detected in the corneal epithelium and stroma 68, 70 . The reactivation cycle can be repeated eliciting chronic and episodic immune activation, which leads to progressive scarring of the cornea resulting in decreased vision, glaucoma, iritis, cataract, and necrotizing retinitis 70 . While there is experimental evidence to suggest regulatory T cells may control ocular pathogenesis 91 , how these cells impact on local chemokine expression is not understood.

Acute pain

If the pain results from an accident there may be expressions of responsibility, or guilt, 'if only I hadn't '. Alternatively there may be expressions of anger if the sufferer feels that he or she is the victim of someone else's mistake. If the treatment of the injury is going to take a long time, and consequently the possibility of pain continuing ( such as with extensive lacerations, burns, or complicated fractures), then there may be a depressive reaction, compounded with anxiety about the outcome. The possibility of scarring or loss of function will complicate the reaction and influence the response to the pain. Again the meaning of the pain for the person is important in planning a care or rehabilitation programme.

Perfect Skin

This, then is an introduction to a chapter which is going to explore the current views on the role of hyaluronic acid in wound healing and scarring (the intrinsic role) and then look at medical developments of hyaluronic acid that have been used or are proposed to either reduce or eliminate scar development in healing wounds or to reduce the degree of matrix disorganization, a key attribute of scar tissue, in the established scar (the extrinsic role).

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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