Scars Holistic Treatment

The Scar Solution Book

The Scar Solution by Sean Lowry is a new natural treatment program that provides people with an advanced and natural scar treatment. Sean Lowry is a medical researcher and a former scar sufferer. The Scar Solution book can also help to prevent scar from its first appearance, eliminate acne scars, expose the underneath layer of your face skin, and stop hyper-pigmentation immediately and permanently. After all, you will not see any of those stubborn scars on your skin ever again. Several factors determine the success rate of any plan for treating complex conditions like scar removal. There are chances that some users may get fast and positive results while others may not be so lucky. Best way to find out if this program will really work for you or not is to try it out first hand. Read more here...

The Scar Solution Natural Scar Removal Summary


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Scarring or sensitization

This notion, sometimes referred to as scarring or sensitization , has attracted a good deal of attention from investigators of the neurobiological (Post, 1992) and psychological (Rohde et al., 1990) processes that may be involved in the relapsing and remitting course of depression in adults. Post and colleagues (Post, 1992), for instance, have suggested that the first depressive episode may sensitize people to further episodes. They hypothesized that such sensitization may help to explain three characteristics of depression in adults the tendency to recur, the decreasing length of interval between episodes, and the greater role of psychosocial stress at the first episode. The idea is that the first episode of depression, which can often be linked to a psychosocial stressor, is associated with long-lasting changes in biology and responsivity to stressors. There may be biochemical and microstructural changes in the central nervous system that put the individual at risk of further...

Granulomatogenic Metals

However, only when the normal elimination mechanism fails, as in cases where the foreign body has low biological activity and resists the action of the body's degradative enzymes, and when the skin lesion persists for months or years does significant tissue destruction result and the term granuloma become appropriate. Granuloma is characterized by a collection of cells of the mononu-clear phagocyte series, with or without the presence of other inflammatory cell types, and the inflammation typically heals with scarring.

Stem Cell Therapy for Cardiovascular Disease

The adult mammalian heart lacks the potential for effective regeneration. The infarcted myocardium is usually transformed into a noncontractile fibrous scar. This remodeling process leads to expansion of the initial infarcted area and dilatation of the left ventricular lumen (8). A novel and attractive approach to the cure of ischemic heart disease is the use of stem cells (9-13). Pluripotent stem cells are cells that have not taken on the identity of any specific cell type and are not yet committed to any dedicated function they can divide indefinitely and may be induced to give rise to one or more specialized cell types. Murry et al. (14) and Balsam et al. (15) recently reported that hematopoietic stem cells failed to transdifferentiate into cardiac myocytes in myocardial infarcts. The stem cells, however, developed into different blood cell types, despite being in the heart. Thus, for physicians, the use of stem cell therapy in treating cardiac-muscle diseases remains a worthy, but...

The Migratory Process

First identified as the primary organelles of cell motility by Abercrombie in 1971, lamellipodia are sites of active actin polymerization, and their formation requires the local recruitment of a whole array of molecular components to mediate cytoskeletal reorganization. These include actin filament nucleating factors such as Arp 2 3 and SCAR filament depolymerizing proteins such as cofilin barbed-end capping proteins and actin monomer binding factors such as profilin. Filopodia also form as a result of actin polymerization however, these filaments are cross-linked into long, stiff bundles that can extend to up to tens of micrometers in length.

Advances in Computed Tomography

Figure 1 Biphasic liver imaging (A) Axial image through the upper abdomen during the late hepatic arterial phase reveals a hyper-enhancing mass in the caudate lobe (segment I) (arrow). The mass is relatively homogenous and there is no evidence of either a central scar or a capsule. (B) During the portal venous phase, the mass demonstrates subtle hypo-attenuation and is much less conspicuous. This is a metastasis from an endocrine primary tumor. Figure 1 Biphasic liver imaging (A) Axial image through the upper abdomen during the late hepatic arterial phase reveals a hyper-enhancing mass in the caudate lobe (segment I) (arrow). The mass is relatively homogenous and there is no evidence of either a central scar or a capsule. (B) During the portal venous phase, the mass demonstrates subtle hypo-attenuation and is much less conspicuous. This is a metastasis from an endocrine primary tumor.

Percutaneous tracheotomy

A more rapid procedure with less tissue trauma and scarring than the standard open surgical technique. It can be performed in the ICU, avoiding the need to transfer patients to theatre. Coagulopathy should be excluded or treated first. Subcutaneous tissues are infiltrated with 1 lidocaine and epinephrine (adrenaline). After a 1-1.5cm midline skin crease incision, the subcutaneous tissue is blunt dissected to the anterior tracheal wall. The endotracheal tube tip is withdrawn to the level of the vocal cords. The trachea is then punctured in the midline with a 14G needle between the 1st and 2nd tracheal cartilages (or lower), allowing guide wire insertion. The stoma is created by dilatation to 32-36Fr (Ciaglia technique) or by a guided forceps dilating tool (Schachner-Ovill technique). In the former case, the tracheostomy tube is introduced over an appropriate sized dilator and in the latter through the open

Colorectal Physical Evaluation

A detailed physical examination is conducted on all patients. Careful abdominal examination, looking for any evidence of tenderness, masses, incisions, or hernias is an important initial component. Anorectal examination is first conducted in the prone jackknife position. A proper light source is essential. Initial inspection of the perianal skin can reveal any dermatologic conditions such as excoriation or dermatitis. Previous scars from either episiotomy or anorectal surgery are identified. The anus is assessed, and it is noted if the anus is closed or patulous in the resting state. Assessment of sensation is the next step in the examination. Any loss of either sharp or dull sensation is noted in the perianal area. The presence or absence of the anal wink reflex is also ascertained. Absence of the anal wink may signify pudendal neuropathy.

Location Of Internalized Organisms In Plants

The xylem, composed of specialized vessels, tracheids, and associated parenchyma, connects the water-absorbing tissues in the root system with the rest of the plant 18 . Vessels and tracheids are filled with water containing dissolved minerals and occasionally organic solutes. The general structure of these water-conducting elements tends to exclude microorganisms such that only a few specialized types are able to enter and move through the system. Individual vessel cells connect through perforation plates that would appear to allow passage of suspended particulates such as bacteria 18 . However, Pao et al. 19 observed multiple, helical perforations in the walls and ends of the vessels in the stem scar of orange fruits that blocked movement of bacteria. Whether these were xylem vessels or tracheid cells, which do not possess perforation plates 18 , is unclear. Both types of water-conducting cells attach to adjacent cells through pits in their secondary walls. The pits are paired with...

Process Of Internalization

Most surface apertures of plants are large enough to allow passage of bacteria and smaller particulates, whereas fungal spores would likely be excluded. The stem scar of tomato fruit may allow the passage of spores of the sour rot fungus, Geotrichum candidum 33 , although the evidence was not conclusive. Lesions of Rhizopus stolonifer and Geotrichum candidum developed around and beneath the stem scar of tomato fruit that had been previously treated to cause an internalization of the spores of these fungi 28 . Vigneault et al. 34 reported that tomatoes cooled with water containing spores of R. stolonifer usually decayed during subsequent storage. However, whether the spores in these examples internalized through the stem scar is unclear. In contrast, wounds involving tissues with large intercellular spaces appear likely to internalize fungal spores.

Surgery for Primary Cancers

As the field of multimodality therapy has developed, the role of surgery as primary therapy for certain solid malignancies has changed. The concept of neoadjuvant therapy where chemotherapy and or radiation therapy is administered before surgical resection has become standard care for some tumors. A prime example of this is the treatment of anal squamous cell cancers. Before the 1970s, the primary therapy for this cancer was an abdominoperineal resection, which involves removal of the rectum and creation of a permanent colostomy. The discovery of effective chemoradiation therapy for this tumor has resulted in a high percentage of complete responses in many patients who then require having only excisional biopsies of residual scar.14,15 This change has spared patients from having an abdominoperineal resection, which is now reserved for those who fail to completely respond to chemoradiation or who subsequently relapse. Another example is the treatment of childhood rhabdomyosarcomas. In...

Implications And Control

Certain handling steps after harvest can reduce the internalization hazard. For example, the porosity of tomato stem scars to water is greatest immediately after harvest and then decreases over time 32 . Leaving a stem attached until just before water treatment only slightly reduces this characteristic. Studer and Kader 51 observed that tomato fruits split readily (from water uptake) if they were submerged in water immediately after harvest but did not if stored overnight before treatment. Additionally, warm fruit is more likely to absorb water than cool fruit during exposure to hydrostatic pressure as well as during exposure to water cooler than the fruit 30,31,51 . Thus, allowing tomatoes to cool overnight before packing them should decrease the likelihood of water infiltration during the unloading and washing processes at packinghouses. Although this prepacking storage would allow pathogen growth on damaged fruit (which otherwise would have been culled), small wounds would begin to...

Fine Needle Aspiration

Fine-needle aspirations obtain cell suspensions suitable for cytology or flow cytometry. This technique can be helpful in aspirating a thyroid nodule, sometimes a breast lump, or a lymph node whenever lymphoma is not primary in the differential diagnosis. The advantages to fine-needle aspiration include the lack of a scar, lack of need for anesthetic, good patient tolerance of the procedure, and the relatively fast turnover of cytology in obtaining a diagnosis. Cell-surface receptors cannot be evaluated, and cytology cannot distinguish between invasive and noninvasive cancers. A fine-needle aspiration should be done only when the determination of atypical or malignant cells will help in diagnosis or treatment, such as proceeding with a thyroid lobectomy or documenting whether a lesion is recurrent cancer in a patient with a known history of the disease. Although a determination of cell abnormality and malignancy can be done, it is usually not sufficient for determining the definitive...

Noninvasive investigations

In the presence of significant coronary stenosis, exercise or other chronotropic and inotropic stimuli (e.g. infusion of adrenergic agonists such as dobutamine) will result in localized ischemia. This manifests itself as typical pain and also results in changes in the contractility of the ischemic myocardium, which can be detected by echocardiography (stress echo) or isotope ventriculography (multiple-gated acquisition (MUGA) scanning). ECG changes are repolarization abnormalities with ST segment depression. Thallium-201 is distributed in the myocardium in proportion to blood flow. Areas of infarction and scar tissue do not take up the isotope, and ischemic areas take up less than normal. The isotope is detected by a gamma camera.

Morphological changes in infarction

After the onset of arterial occlusion. In non-reperfused infarcts, the myocytes swell and lose all intracytoplasmic organization, and myofibrillary material forms amorphous masses. In reperfused infarcts the myocyte shows brightly eosinophilic cross-banding in the cytoplasm. This appearance (contraction band necrosis) is due to intense hypercontraction of the myofibrils owing to the influx of calcium ions and occurs only when blood supply is restored by fibrinolysis to myocardium which is undergoing infarction. Infarcted myocardial tissue invokes an inflammatory repair response. By 12 h small intramyocardial vessels contain polymorphs which also infiltrate the interstitial tissue. By 24 h myocytes have begun to disintegrate, and there is a florid macrophage response followed in turn by invasion of the infarct zone by fibroblasts and new capillaries. Collagen deposition begins by day 4 and continues for many weeks. The rate of repair depends on the original structure of the infarct....

Microbial Stress Adaptation On Produce

Information in published literature regarding microbial stress adaptation on produce is scarce. However, greater processing resistance of natural microbial contaminants on produce surfaces compared with those inoculated onto these products may support the hypothesis that most produce microbiota are adapted to stresses encountered in the field and throughout the production chain. Readers are cautioned that apparent processing resistance of produce microbiota also could be attributed to their inaccessibility to treatments, or the inability of the analyst to recover these microorganisms using common sample preparation and processing techniques. Association of microbial contaminants with pores, stem scars, wounds, and other surface irregularities could protect microorganisms and make them appear resistant to processing.

Morphology And Development The flowering plant

The 'dormant' narcissus bulb in autumn consists of a more-or-less disc-shaped stem plate (base or basal plate) bearing adventitious roots below and storage organs (bulb scales) surrounding a bud above. The bulb 'scales' consist of true scales, which are almost entirely within the bulb and serve a purely storage function, and the bases of foliage leaves after anthesis the base of the flower stalk becomes flattened and is also scale-like in function. Leaf bases can be distinguished from bulb scales because the former have a thicker tip and a scar where the leaf lamina became detached. In the 'model' case of a narcissus bulb with a single, terminal growing point (a 'single nosed round' bulb), a transverse section of the bulb in autumn shows a series of concentric 'scales' surrounding the old flower stalk base and a terminal bud (Figure 1.3). The exception to the concentric nature of the 'scales' is that the inner leaf, which subtends the flower, has a semi-circular base with keeled...

Macular Hole and Vitreomacular Traction

Case 3-17, Macular Hole and Atrophic Laser Scar A 75-year-old man with age-related macular degeneration had undergone indocynanine green enhanced diode laser photocoagulation in his right eye eight months earlier for choroidal neovascularization. Slit-lamp biomi-croscopv (A) showed an atrophic laser scar in the center of the macula with no subretinal fluid, hemorrhage, or exudate. The visual acuitv in this eve was 20 100. Flu ores- cein angiography (B) showed an area of hypofluorescence in the macula with surrounding hyper fluorescence, and late staining consistent with a fibrovascular scar

Thyroid Follicular Hyperplasia And Neoplasia

Adenomatoid Nodule Thyroid

Sporadic nodular goitre is characterised by numerous follicular nodules with heterogeneous architecture and cytology, features that have suggested a hyperplastic rather than neoplastic pathogenesis (7-10). The gland may be distorted by multiple bilateral nodules and can achieve weights of several hundred to a thousand grams, but this disorder is often identified as a dominant nodule in what clinically appears to be an otherwise normal gland. Histologically, the nodules are irregular some are poorly circumscribed while others are surrounded by scarring and condensation of thyroid stroma, creating the appearance of complete encapsulation. They are composed of follicles of variable size and shape. Some follicles are large, with abundant colloid surrounded by flattened, cuboidal or columnar epithelial cells, often with cellular areas composed of small follicles lined by crowded epithelium with scant colloid in a small lumen, alone or pushing into large colloid-filled follicles as...

Inoculation of G mellonella Larvae

Larvae of G. mellonella are easy to inoculate via injection into the haemocoel through the last left proleg (Cotter et al., 2000). The base of the proleg can be opened by applying gentle pressure to the sides of the leg and this aperture will reseal after removal of the syringe needle without leaving a scar. Inoculation of larvae with test micro-organisms must be accompanied by inoculation of larvae with the buffer used to re-suspend the test micro-organisms to ensure that this has no impact on larval viability. A number of workers also suggest the 'mock-inoculation' of a number of larvae per experiment to ensure that the handling and inoculation procedures are not deleterious to the health of the larvae (Dunphy & Webster, 1984 Cotter et al., 2000). Larvae can be stored at 15 C prior to use and, once inoculated, may be maintained at temperatures up to 37 C, as long as appropriate controls are implemented to quantify the effect of temperature on survival. Larvae should be handled with...

Cellular Composition And Organization Of The Adult Mouse

Epithelial layers with a stem cell component often display a remarkable regenerative capacity in pathological conditions. If the lateral ventricle ependyma contains a stem cell, then one might expect this epithelium to regenerate after injury. However, there is at present no convincing evidence that the lateral ventricle ependyma regenerates after injury. Interestingly, injury to the ependymal cells stimulates the subependymal astrocytes to proliferate and form a gliotic scar, which appears to substitute for the missing ependyma (55,59). Again, ependyma of more caudal regions may behave differently and have some capacity to proliferate, and comparisons of the molecular characteristics of the ependyma throughout the neuraxis would be revealing.

Etiology and risk factors

The second important factor for epilepsy is the epileptogenic abnormality itself. Epilepsies attributable to identifiable brain defects are referred to as symptomatic epilepsies. Symptomatic epilepsies can be caused by a variety of disorders, including brain malformations, infections, vascular disturbances, neoplasms, scars from trauma, including strokes, and disorders of cerebral metabolism. Treatment for symptomatic epilepsy is most effective if it is directed at the underlying cause. The most common symptomatic epilepsy is temporal lobe epilepsy, usually associated with a characteristic lesion called hippocampal sclerosis . Hippocampal sclerosis appears to be caused by cerebral injury within the first few years of life in individuals with a genetic predisposition to this condition. Some forms of epilepsy are unassociated with identifiable structural lesions or diseases and are usually unassociated with other neurological or mental deficits. These are genetically transmitted,...

Local Complications After Radiation Synovectomy

More severe complications are local skin and needle track ulcerations which may occur if drops of the radionuclide flush back out of the needle during retraction from the joint. This can be easily avoided by flushing the needle with steroids or 0.9 saline after application of the radionuclide, as described before. Savaser et al. (48) report on a needle track ulceration after radiation synovectomy of an ankle joint with Re-186, which showed healing by scar formation after a few weeks without any further treatment. Necrosis of periarti-cular tissue is the worst local complication in radiation synovectomy and is caused by accidental para-articular injection of the radionuclide. A very low frequency of two cases of necrosis out of 11,000 treatment procedures was reported by Kolarz and Thumb in 1982 (49). With at least 23,000 radiation synovectomy

Imaging of tumour tissue

Thallium-201 is widely used for myocardial perfusion imaging. Over the past few years there has been growing interest in the use of 201T1 in oncology. It may be useful in the differentiation between low-and high-grade glial tumours and between tumour recurrence and scar tissue. Thallium-201 scintigraphy can assess residual tumour viability after chemotherapy in bone and soft-tissue sarcomas.

Indications for free flaps

Mutilating, high-energy injuries that lead to extensive soft tissue destruction can preclude any possibility of using local pedicled flaps for coverage. Free tissue transfer is warranted when local flaps cannot be harvested outside the zone of injury or when soft tissue defects are extensive and involve exposed vital structures such as bone, tendons, nerves, and vessels. Other major indications for free flap coverage include coverage following extensive scar contracture release due to trauma or burn, and coverage following tumor excision 1,2,8,14,23 . Mutilating hand injuries are particularly amenable to free flap reconstruction because of the ability to transfer multicomponent

Tissue Response To Gdc Histopathological Findings

Neck has been demonstrated as early as 36 h after coiling and has been suggested to serve as a substrate for endothelialization (30). Complete isolation of the aneurysm from the parent vessel can promote scar formation and stabilization of the thrombus (Fig. 2). Ishihara et al. (31) showed endothelialization of platinum coils at the orifice of human cerebral aneurysms at 2 wk and at 20 mo after embolization in five cases of small neck aneurysms. Bavinzski et al. (32) studied the histopathological changes in 18 human cerebral aneurysms treated with GDC and concluded that endothelialization of the aneurysm orifice after coiling can occur but seems to be the exception rather than the rule. They found tiny gaps between the coils at the aneurysm neck in 50 of densely packed aneurysms that appeared completely occluded on angiography. Small neck size and dense coil packing across the aneurysm neck are important factors to induce endothelialization, which excludes the aneurysm from the parent...

General Laboratory Screening Tests

In addition to assessing the airways and lung parenchyma, the chest radiograph should be reviewed for the absence or presence of a thymus in infants and for the possibility of a thymoma, which may be associated with hypogammaglobulinemia in adults (39). Hyperinflation with patches of atelectasis, suggestive of asthma, might suggest that additional details of the past history should be carefully reviewed in patients, particularly small children, referred because of cough or recurrent pneumonia, because similar densities seen on previous films may not have actually been due to infection. The presence of old scars and active disease should be documented. Hilar adenopathy may be seen in cellular and humoral immune defects. Abnormalities of the ribs resembling those seen in rickets might suggest ADA deficiency (13), and cardiovascular abnormalities may suggest asplenia (40) or DiGeorge syndrome (41) or may steer the workup away from immune deficiency and toward Kartagener syndrome (situs...

Clinical Characteristics of Probable Chorea Acanthocytosis from 25 Early Cases

The disease onset varied from 18 to 42 years old with the mean age of onset at 30.5 years. The male female ratio was 18 7. No X-linked family pedigree of disease inheritance was reported in these male patients. Choreiform involuntary movements were noted in 23 of 25 cases, with mainly oro-lingual-buccal dyskinesia and choreiform limb movements. The knee-buckling gait (flamingo-like walk), often seen in patients with Huntington's disease (HD), was noted in four cases among 25 22, 33, 42 . Twenty-two patients of 23 had decreased deep tendon reflexes suggesting polyneuropathy. Self-mutilation was noted in 22 patients of 24. Among 14 cases of MLS reported in Japan, self-mutilation was not noted except for one patient with a tongue scar due to a bite 35 . Severe oro-facial dyskinesia with lip-biting was considered to most likely indicate a diagnosis of ChAc. WAIS-IQ less than 80 was reported in ten cases of 25. Seizures were seen in ten, and of those, generalized seizures of the grand mal...

Immediate Questions

Is patient taking any new medication(s) or herbal supplements) Has there been any exposure to toxins Food refusal can be secondary to acute ingestion of poisons that ulcerate or scar the mucosal lining of the mouth. Some decrease in appetite may be seen with medications or herbal supplements that directly cause disordered taste sensations or exacerbation of GI upset.

Need for vigorous treatment of the first episode

The finding that the first episode of depression can lead to scarring is important because it suggests that much greater attention should be paid to the recognition and treatment of the first episode of depression. Since late adolescence is a common period for the onset of adult depressive disorders (Smith & Weissman, 1992), the implication is that child and adolescent psychiatry could have an important part to play in the prevention of depression in adulthood. Indeed, there are plenty of developmental examples of the ways in which early disorders that are not managed appropriately can lead to permanent changes in both the biology of individuals and their psychosocial functioning (Wolkind & Rutter, 1985).

Burch Colposuspension

After all four sutures are placed in the vagina and through the Cooper's ligaments, the assistant ties first the distal sutures and then the proximal ones, while the surgeon elevates the vagina with the vaginal hand. In tying the sutures, one should leave a suture bridge between the vaginal wall and Cooper's ligament, so as not to place too much tension on the vaginal wall. After the sutures are tied, one can easily insert two fingers between the pubic bone and the urethra, thus avoiding compression of the urethra against the pubic bone. Vaginal fixation and urethral support depend more on fibrosis and scarring of periurethral and vaginal tissues over the obturator internus and levator fascia than on the suture material itself.

Specific Conditions 2631 Mydriasis

Whether caused by central (third nerve palsy) or local (i.e., sphincter muscle damage, retroiridal scarring) pathology or other etiologies 6 , the condition requires surgical correction if it results in photophobia that compromises vision. If mydriasis represents a major cosmetic problem for the patient, this is also an indication for corrective surgery. Scarring usually occurs in the context of anterior PVR, and treatment of the mydriatic pupil should be addressed during vitrectomy. The goal is to remove the scar tissue that lines the pars plana, ciliary body, and the back surface of the iris. If the lens is present, it must be sacrificed. Endoscopy-assisted vitrectomy offers several advantages traditional viewing cannot match (see Chap. 2.20). Complete scar removal is not always possible, and even if it is, return of iris pupil mobility is not guaranteed.

Prevention opportunities

In still another group of patients, low-grade chronic depressive developments occur in the setting of disabling systematic medical and neurological disorders, and are best categorized as 'secondary dysthymias' 78 For instance, poliomyelitis may not only lead to deformities in musculoskeletal structures in children, but could permanently scar the sufferer's sense of enjoyment, fulfilment, and outlook of life. Likewise, low-grade chronic depressive development often complicates neurodegenerative cerebrovascular disease later in life. In both situations, psychological factors might be operative, yet the contribution of specific cerebral lesions to

General Clinical Considerations of Brain Computer Interfaces

In addition to the processing issues that define the requirements of a BCI system, there is a unique set of factors that a clinician must consider about a given platform when considering application to a patient population. The most fundamental issue is that a BCI system is safe. First, surgical placement must have acceptable clinical risk, and then subsequently over time the implant must be reliable and durable in its ability to acquire signals. Understanding the risks of initial surgical application is reasonably straightforward as they will most likely utilize variants of standard neurosurgical practices. There are equivalent types of technical procedures, which include the placement of deep brain stimulators, placement of cortical stimulators for pain, and placement of grid electrodes. What will require closer examination is the construct's likelihood for ongoing function. This can be affected by how the device is designed (i.e., will the construct break down in a couple years )...

Watersoluble b vitamins what impact do they have on wound healing

Although the role of nutrition in the various phases of wound healing is well recognized, the action of each of the B vitamins in this regard is still being defined. It is clear that the B vitamins have specific metabolic functions, and that they interact with one another in order to ensure that wound-related energy metabolism and tissue synthesis occur appropriately. Studies have shown that B vitamins play initial coen-zymatic roles during the inflammatory phase and during the removal of dead tissue and bacteria. B vitamins also have critical roles in the proliferative and remodeling phases of wound healing in that they participate in the synthesis and interlinking of collagen and, therefore, the synthesis of new tissues and blood vessels. During the third or final phase of wound healing, myofibroblasts are dependent on B vitamins when they pull the edges of wounds inward and continue to strengthen the scar for up to 2 yrs.2 During all phases of wound healing, substantial amounts of...

Molecular Basis of Disease

Ducts and subsequent scarring and destruction of exocrine functions. Neonatal meconium ileus occurs in approximately 15 of newborns with CF. Other manifestations include chronic sinusitis, nasal polyps, liver disease, pancreatitis, and congenital bilateral absence of the vas deferens (CBAVD). Males with CBAVD are azoospermic and have an increased frequency of mutations in one or both CFTR alleles or an incompletely penetrant mutation (the intron 8 variant 5T allele) in a noncoding region of CFTR. These men usually have no pancreatic disease and may have normal, borderline, or elevated sweat electrolytes. A small subset of patients with atypical CF have chronic Pseudomonas bronchitis, normal pancreatic function, and normal or intermediate sweat electrolytes.

Canal WallDown Mastoidectomy

When CWD mastoidectomy is indicated, the posterior border of the ear canal is to be removed. The medial border of the dissection is the floor of the facial recess, which is the lateral wall of the fallopian canal at the external genu. After the sigmoid sinus and middle fossa tegmen are skeletonized, the fossa incudis and horizontal SCC are identified. The anterior buttress, where the posterior auditory canal meets the tegmen, is removed to open up the epitympanum to the mastoid antrum. Next, the facial nerve is delineated by lowering the facial ridge laterally. The posterior buttress is where the posterior canal wall meets the floor of the auditory canal lateral to the facial nerve. It has to be removed well to open up the mastoid tip. The final step is an adequate meatoplasty. Considering future scar contraction, it needs to be at least twice its future size.

Phototherapeutic Keratectomy Fig 518c

Principle Superficial corneal scars can be ablated with an excimer laser (wavelength of 193 nm).The lesion is excised parallel to the surface of the cornea to avoid refractive effects. The edges of the ablated area are merged smoothly with the rest of the corneal surface, eliminating any irregularities.

Subretinal Hemorrhage

The photoreceptors may start dying as early as within 24 h 36 , and early photoreceptor death ensues if the blood is not evacuated 57 . Late sub-retinal scarring is another threat that should force the ophthalmologist to consider fairly acute intervention if the blood is thick and submacular.

Umanganese For Pimples

Acne is a common disorder of the oil glands in the skin and can appear on the face, back, shoulders, chest, and arms. In adolescents during puberty, sex hormones stimulate the sebaceous glands resulting in excess secretion of sebum, a fatty oil that lubricates the skin. The glands become blocked and inflamed, which causes blackheads and pimples. If the glands become infected, sebum and pus build up under the skin and larger pimples and cysts appear which can eventually lead to scarring and pitting. It is important to keep the skin clean and free from oil. Facial steaming opens blocked skin pores and clears out sebum. Do not squeeze acne spots as they may become infected and leave scars. Reduce stress and avoid refined sugar and foods. For mild cases of acne, topical exfoliants and face washes are usually sufficient for medium cases, beneficial preparations should contain benzoyl peroxide or salicylic acid for severe acne, topical or oral antibiotics may be necessary or vitamin A...

Tigaro Theory and the New Hypotheses

Severe acute pancreatitis induces severe fibrosis after repair of acute inflammation. Recurrent acute pancreatitis may produce chronic pancreatitis through a necrosis-fibrosis sequence. However, little evidence of acute pancreatitis, such as scarring, has been histologically observed in chronic pancreatitis.

Use of Antifibrotic Agents

Intra- or postoperative application of topical mitomycin C or 5-fluorouracile in young children with a long life expectancy is associated with the risk of late toxicity and potential muta-genicity of these antimetabolites, even though the filtering procedures combined with the use of mitomycin are becoming increasingly routine in antiglaucomatous surgery. Further possible deleterious complications of filtering procedures with mitomycin C are rupture of thin-walled blebs, wound leakage, late endo-phthalmitis, and long-standing hypotony. Owing to extreme scleral thinning in buph-thalmia, the potential risk of localized retinal necrosis has also to be considered. However, in refractory cases the use of antimetabolites or other methods to prevent scarring seems unavoidable where goniosurgery and ab-externo procedures without antimetabolites have failed.

Behavioural expression and selfconcept

Reckless behaviour unaffected by punishment is typical of antisocial individuals, who are also exploitative, manipulative, demanding, and lacking in a sense of responsibility. An easy-going hedonistic attitude may be interrupted by rage, cruelty, and violence. Lying, truancy, running away from home, thefts, fights, substance abuse, and illegal activities may be typical experiences, beginning in early childhood. Tattoos and scars from self-mutilation are common, as well as a propensity towards substance abuse, delinquency, and criminality.

Mitral Valve Replacement

Mitral valve surgery in patients with heavily calcified mitral annulus, mitral annulus abscess due to infective endocarditis, or destroyed mitral annulus because of previous MVR can be technically very demanding and associated with high operative mortality and morbidity. We believe that the best approach is to completely excise the diseased mitral annulus (calcium bar, abscess, or scar with old pledgets) and reconstruct it with either autologous pericardium or glutaral-dehyde fixed bovine pericardium. When the entire mitral annulus needs reconstruction, a strip of pericardium 2 cm wide and 10-12 cm long is sutured to the endocardium of the left ventricle posteriorly and to the intervalvular fibrous body superiorly. The other end of the pericardial patch is sutured to left atrial wall (care

Pantothenic acid and wound healing

In a number of animal studies, oral pantothenic acid or topically applied panthenol was shown to accelerate the closure of skin wounds.28-31 Most of the mechanistic research done in this area involves looking at the impact pantothenic acid has on fibroblast function and concomitant wound closure and scar formation. Substantial amounts of work have also focused on how pantothenic acid enhances both collagen synthesis and collagen cross-linking and the role this vitamin plays in altering trace elements that have an impact on wound healing. Studies have also been done with subjects who have had tattoos removed to determine the impact pantothenic acid has on the actual strength of scar tissue.35 In this study, 18 of 49 patients were supplemented for 21 d with both pantothenic acid (0.2 g d) and vitamin C (1.0 g d) prior to the removal of tattoos by successive resection. Hydroxyproline and trace element concentrations were measured in both skin and scar tissue. Fibroblast counts and...

Extragastrointestinal manifestations

A desmoid is a mass of firm pale tissue, characteristically growing by expansion, usually rounded in shape. Desmoids begin as small scar-like foci of fibrosis in the retroperitoneal fat and, when large, typically extend around and between other structures such as the small or large bowel, ureters and major blood vessels. Histologically, these lesions are composed of sheets of elongated myofibrob-lasts, arranged in fascicles and whorls. The lesions have a dense, tough consistency and there is a variable amount of collagen. They are well vascularized and contain numerous small blood vessels that bleed profusely when incised.

Postoperative Imaging

These postsurgical changes can include perinephric fluid, fat necrosis, urine leak, scarring, or a defect at the operative site (Figs. 21 and 22). Hemostatic agents, such as oxidized cellulose (Surgicel, Johnson & Johnson, Arlington, Texas), may be present (51) and can mimic abscess formation (Fig. 23).

The Patient Who Cannot Be Fit with a Pessary

Not all female candidates can be successfully fit with a pessary. Typical reasons for inability to be fit include vaginal scarring with loss of vaginal caliber or length from previous surgery, severe urogenital atrophy, vaginal pain, and markedly restricted or enlarged vaginal introitus. In those with significantly increased vaginal caliber, performing a perineoplasty and subsequent refitting with a pessary should be considered. For elderly women with severe genital prolapse who are not, and will not become, sexually active, and cannot be fit with a pessary, consideration should be given to a colpocleisis performed under regional or local anesthesia.

Microscopic Findings in Idiopathic Myocarditis

Reparative changes within the interstitium range from loose granulation tissue with minimal alteration of the myocardial architecture to replacement by collagenous scar tissue. Increased vascularity suggesting angiogenesis may also be seen, along with compensatory hypertrophy of residual myocytes. The findings on the follow-up biopsies should be graded as persistent, healing (resolving), or healed (resolved) myocarditis according to the Dallas criteria. The progression to dilated cardiomyopathy should also be recorded.

Macular Degeneration

A 63-year-old man with age-related macular degeneration noted a gradual decrease in vision in his left eye. He had undergone indocyanine green enhanced diode laser photocoagulation 15 months earlier for choroidal neovascularization- On examination, his visual acuity in this eye was 20 160. Slit-lamp biomicroscopy (A) revealed an atrophic chorioretinal scar superonasal to the fovea and a neurosensory detachment extending inferotemporally passing beneath the fovea. The sub retinal fluid appeared cloudy with mild subretinal fibrosis.

Surgical Approaches

We will typically perform an abdominal sacro-colpopexy in a patient with advanced prolapse in which the vaginal apex reaches significantly above the ischial spines on vaginal examination, for whom maintaining normal sexual activity is very important, someone who will require another abdominal procedure for their vaginal prolapse such as an abdominal paravaginal repair, and someone with significant vaginal wall scarring, large apical fascial defects, or significant foreshortening of the vaginal canal. Vaginal approaches are typically performed in post-menopausal women for whom sexual activity may not be as important and in whom other reconstructive procedures can be appropriately performed vaginally. Obliterative procedures are performed in elderly women who are not, and will not, be sexually active, and who request the least invasive procedure for advanced vaginal prolapse. Laparo-scopic approaches are reserved for surgeons request laparoscopic skills adequate enough to...

Postoperative Problems

There are four types of postoperative problems injuries to vessels or nerves, inflammatory or infectious conditions (superficial and deep), bad scars or defacing, or joint stiffness. - Screws covered with sleeves of PMMA (polymethylmethacrylate) soaked in antibiotic (tobramycin) to prevent local infections 47 . The scars at the site of previous points of passage of wires or screws (Fig. 19) are an almost unavoidable inconvenience when dealing with axial or circular external fixation. These can be (within certain limits) avoided by a precise preoperative planning and by correctly performing the operation (insertion of the bone fixation elements avoiding tension of the soft tissues when no important modifications of the configuration in the postoperative phase are planned, and on the contrary, applying wires or screws by creating a reserve of soft tissues in cases of internal or external lengthening of the limb or correction of serious deformities, so an overload of tension of the soft...

Acute Rheumatic Fever

The myocardial lesions consist of nonspecific lymphocytic myocarditis and Aschoff nodules. The latter may be found within the endocardium, myocardium, pericardium, and conduction system and are pathognomonic of acute rheumatic fever. They represent oval collections of histiocytes, lymphocytes, plasma cells, and giant cells (Aschoff cells) located within the interstitium adjacent to small blood vessels (Fig. 14-11 see color plate 31). This granulomatous stage of Aschoff nodules arises 1 to 2 months after the onset of clinical symptoms and develops within or near foci of fibrinoid necrosis. They are eventually replaced by collagenous scar tissue.

Practical management issues

Psychiatrists may need to interface with dermatologists, plastic surgeons, and other non-psychiatric physicians from whom patients have requested or are receiving treatment. Although no one can predict how a given patient will respond to such treatment, available data indicate that patients usually do not improve and may become worse. In some cases, such treatment precipitates psychosis, suicidal behaviour, or violence. For these reasons, it seems wise to advise patients to try psychiatric treatment before obtaining surgery, and to avoid treatment such as dermabrasion or isotretinoin. Patients who damage their skin by picking it often require and benefit from a combination of dermatological and psychiatric treatment, in which case it is important and beneficial for the psychiatrist and dermatologist to collaborate.

Differential Diagnosis in Cardiac Sarcoidosis

The differential diagnosis includes granulomatous and giant cell lesions of the heart. Granulomatous infections are uncommon in immunocompetent patients, but we routinely perform histochemical stains for fungal and mycobacterial microorganisms. In general, necrotizing granulomas are found in infectious lesions. Giant cell myocarditis is characterized by the presence of giant cells but, by definition, granulomas are absent. In hypersensitivity myocarditis, the histiocytic lesions are poorly formed and are centered on collagen fibers. Eosinophils are numerous, but multinucleated giant cells and fibrosis are not found. The granuloma-like lesions of acute rheumatic fever are poorly formed, and the giant cells are generally smaller and do not resemble Langerhans type. Foreign body-type giant cells surrounding catheter sheath fragments can be found in biopsy specimens of patients undergoing repeated biopsy procedures (Fig. 14-5 A). The edge of healing ischemic infarcts can contain giant...

Morphologic Findings in IGCM

At postmortem examination or at transplantation, confluent or multifocal areas of necrosis are easily observed in the heart. The weight of the heart is usually normal or slightly increased. The 4 chambers of the heart are uniformly involved in most cases. In the late or healed stages of the disease, the ventricular wall may appear thin, but this reflects diffuse scarring and not aneurysmal changes because islands of myocytes are found within the collagenous scar tissue (Fig. 14-15 C and 15 D see color plate 35). Endocardial and pericardial involvement have been described but the process is primarily centered on the myocardium. Litovsky and colleagues150 proposed classification of IGCM into acute, healing, and healed phases. The acute or active phase is described above and is distinguished by the abundant inflammatory response, loose connective tissue stroma, and numerous giant cells of macrophage origin. In the healing or resolving stage, granulation tissue and immature fibrosis...

Central Serous Chorioretinopathy Definition

Diagnostic considerations Ophthalmoscopy will reveal a serous retinal detachment, usually at the macula. In chronic cases, a fine brown and white pigment epithelial scar will develop at the site of the fluid effusion. Swelling in the central retina shortens the visual axis and produces hyperopia. The site of fluid effusion can be identified during the active phase with the aid of fluorescein angiography (Fig. 12.26a and b).

Femoral Vein Approach

The femoral vein approach has some advantages and disadvantages relative to the jugular vein approach. Advantages include freedom from risks inherent in the jugular approach such as inadvertent carotid puncture. In addition, some patients prefer the femoral approach it is less unpleasant than to have procedures through the neck. If multiple prior biopsies have been performed from the neck, scar tissue may begin to limit access and create more discomfort with sheath placement, in which case moving to the femoral approach may help. Disadvantages of the femoral approach include the need for a long sheath in which clots may develop, risk of deep venous thrombosis, and need for patients to remain supine for approximately 30 minutes after sheath removal. In addition, directing the bioptome across the tricuspid valve and to the appropriate region of the ventricle is difficult sometimes. The bioptomes used from the femoral approach may yield smaller samples than those from the neck, but...

Animal models of Parkinsons disease based on the use of neurotoxins

Given the behavioral limitations of MPTP-intoxicated mouse model, species more closely related to humans have been used to mimic the symptoms of PD. We recently developed a model of PD in green monkeys with progressive MPTP intoxication at very low doses. After a few MPTP injections, the monkeys were assessed as normal on a monkey parkin-sonian rating scale but already displayed subtle behavioral changes in a reach and grasp test (Pessiglione et al., 2003). Indeed, whereas control animals had a fully appropriate trajectory when asked to take some food with or without an obstacle in front of their hand, MPTP-intoxicated monkeys had aberrant initial trajectories which were corrected by visual guidance. This suggests that at the early phase of the disease, some compensatory mechanisms may occur. Then, with further MPTP injections, the animals became symptomatic recovered and after more injections became parkinsonian with a stable disease. Neurochemical...

Adverse Effects of Recovery

The process of recovery of neural tissue sometimes results in several undesirable consequences. In the brain, epilepsy may follow scar formation. Central pain syndromes such as post-stroke pain, dystonia and abnormal posturing - possibly a sequel to abnormal neural connections - can be difficult to treat. Injury to the spinal cord may result in paraplegic pain and autonomic dysreflexia, which may also be from abnormal neural connections. Flexor spasms may follow hyperexcitability of damaged neurons. Phantom limb pain may result from abnormal central organization and reflex sympathetic dystrophy and causalgia may follow abnormal neural connections. In peripheral nerves, neuroma formation may result in neuropathic pain.

Ts in Organ Specific Microvascular Alterations in Diabetes

ETs have been shown to be produced by both cardiomy-ocytes and endothelial cells. We have previously demonstrated upregulation of ET-1 along with ETA and ETB receptor expression in heart tissues of diabetic rats. Such alterations were associated with focal apoptosis of car-diomyocytes, scarring of the myocardium, and increased expression of ECM proteins. Inhibition of ET receptor signaling completely prevented these structural abnormalities. Furthermore, a duration-dependant alteration of chronotropic and inotropic responses to ET-1 has been demonstrated in isolated atria of diabetic rats. Recently, we have demonstrated that ET-1 may interact with sodium-hydrogen exchanger-1 (NHE-1) in mediating diabetes-induced structural and functional changes. NHE-1 may act as the downstream mediator in the development of ET-mediated functional and structural changes in diabetic myocardium.

Tuberculosis and Other Mycobacteria Donald E Gardner PhD Fellow ATS

TB is a particularly good illustration of an infectious disease process that involves an ecological lifelong balance between a host and a microbe. TB in humans is predominately an airborne infection of the lungs that is almost always initiated by inhalation. Once the organisms have been inhaled and deposited in the lung, these organisms can be found in the lung's phagocytic cells (alveolar macrophages) that tend to protect them from antibodies and other host immune defenses. Individual susceptibility to TB and the severity of the disease are based on the virulence of the organism, the duration of exposure, concomitant exposure to other toxicants, medication for treatment of other diseases, and the nutritional status of the host. Once the organism has survived the transport through the environment and has infected a susceptible host, the TB infectious process can be divided into two stages that are commonly referred to as primary and secondary infections. During the primary phase,...

Selected Bibliography of Journal Articles

Garg HG, Lippay EW et al. (1993) Comparison of the effects of interleukin-1 beta on proteoglycan synthesis by human skin and post-burn normal scar explant cultures. Biochem Mol Biol Int 31(3) 583-591 11. Clayman MA, Clayman SM et al. (2006) The use of collagen-glycosaminoglycan (Integra) for the repair of hypertrophic scars and keloids. J Burn Care Res 27(3) 404-409 12. Ward RS, Hayes-Lundy C et al. (1994) Evaluation of topical therapeutic ultrasound to improve response to physical therapy and lessen scar contracture after burn injury. J Burn Care Rehabil 15(1) 74-79

Sensorimotor Cortex Model

The central sulcus of either adult or adolescent monkeys is exposed through a frontal craniotomy under general anesthetic, taking great care not to damage the cortex. After opening the dura, the hand-face region of the sensorimotor cortex is identified with cortical stimulation and injected with alumina gel. Although different injection patterns have been used, one of the most successful is the Ward modification of the Kopeloff technique (Bakay and Harms, 1981). In this method, two injections are made 4mm apart in the precentral gyrus and two injections in the postcentral gyrus, paralleling each other. A 27-gauge needle is used for the injection, which is placed into the cortex to a depth of approximately 4 mm. A volume of 0.1ml of aluminum hydroxide (fully saturated solution) in the form of alumina gel is injected at each site. Each injection is made quite slowly to allow time for volume equilibrium to be reached before removing the needle. In general an injection under the pia is...

Longterm Care and Outcome in Open Myelomeningocele

Re-operation to release the cord should be considered in any child with a significant clinical deterioration. There are often dense adhesions and thick scar, making surgery difficult, and consideration to expanding the dura with a patch should be given. The results of surgery are reported to be gratifying in that most children can be stabilized and pain is often improved 12 .

Autoimmune Disease Mechanisms

AD is thought to result from the aberrant activation of the immune system together with the failure of immunoregulatory mechanisms that normally maintain immune tolerance. Despite the heterogeneous clinical expression of AD in humans, it seems clear that most ADs share several or all of the following features. They are polyclonal, with rarely a defined inciting single antigenic epi-tope and by the time of clinical disease expression, there has been extensive epitope spreading and effector cell recruitment (Davidson and Diamond, 2001). The innate immune system and tissue environment probably play a vital role in determining whether an antigen will evoke an immune reaction or anergy toler-ance (Medzhitov and Janeway, 2002) and a genetic component is present, but not sufficient. Some genes encode for major histocompatibility complex (MHC) molecules, but multiple other genes on different chromosomes play a role. In insulin-dependent diabetes mellitus for example, at least 19 such regions...

Urinary Tract Infection In Children

The ''classical'' teaching is that acute pyelonephritis is a serious disease that needs treating urgently, not only because the child is sick but also because it may lead to permanent renal scarring and eventually to chronic renal disease. This, in turn, is thought to lead to raised blood pressure and renal failure. The argument is then that early detection and treatment will lead to a reduced incidence of these major complications. Regardless, there is now good evidence that this late study should be performed at least five months after the acute episode, and most units now perform this late study at six months. If this study is abnormal, there is a consensus that the child is at risk of deterioration in renal function. Defects seen at this stage are traditionally referred to as scars. This is based on animal studies, showing that in acute pyelonephritis produced by direct intrarenal injection of bacteria (or similar models), a permanent scar may be produced. This takes us to the...

Vesicoureteric Reflux

The consensus here is that the indirect radionuclide cystogram is the method of choice for follow-up of proven reflux in children who are old enough to cooperate. Because it cannot supply morphological imaging, it cannot exclude abnormal anatomy, especially posterior urethral valves in boys. Therefore it is felt that at least one structural study micturating cystourethrography (MCUG), with or without urody-namics should be performed at first presentation. The rationale for follow-up (often not clearly formulated) is that if there is persisting reflux-accompanied urinary tract infections, surgical correction is indicated and will prevent infections, scarring, and deterioration in renal function. It is also often felt necessary to give long-term antibiotic prophylaxis as long as reflux persists. This is based on the experimental work of Risdon and Ransley, which showed that pyelonephritis developed in the setting of reflux, infection, and compound calyces.

Long Term Passive Implantation

After all tested survival times, implant sites were evaluated histologically in fixed sections stained using haematoxylin and eosin, and in frozen sections reacted for adenosine triphosphatase activity (Figure 3.4). None of the implanted articles were found to change the enzyme reactivity of surrounding muscle fibers. No obvious difference could be found in the degree of inflammatory reaction around the devices and the negative control articles when the implant sites were evaluated according to their contents of inflammatory cells of different types and the extent of fibrotic and necrotic change using scales similar to those described elsewhere.17 In addition, the thicknesses of capsules around the implants were measured and found to be similar around devices and control articles (Figure 3.5). In the first few months, implants were surrounded by a loosely structured connective tissue capsule about 100-500 microns thick that contained many inflammatory cells. In longer-term implants of...

Physical Examination

During vaginal examination, periurethral scarring may become apparent through observation and palpation. A lighted speculum is very helpful in the vaginal examination, especially in the detection of signs of erosion. The entire urethra should be palpated carefully for any tender area or mass. In cases of excessive scarring, the urethra will

Cardiac Retransplantation

Cardiac transplantation has evolved as the best therapeutic option for those with end-stage heart disease.1 However, despite improvements in selection processes, organ preservation, and immunosuppression, a percentage of patients still experience rejection of their graft necessitating a second transplant. Clinically, rejection is diagnosed and graded according to endomyocardial biopsy. In addition to acute and chronic rejection, some cardiac transplant patients are plagued by transplant coronary artery disease. This form of accelerated atherosclerosis differs from traditional atherosclerosis in that it is a concentric and diffuse hyper-plastic process. The internal elastic lamina remains intact, calcification of the vessels is rare, and intramyocardial vessels are involved as well. While coronary angiogra-phy is useful for the diagnosis of progressive narrowing, coronary angioplasty is seldom effective as discrete stenoses are unusual. Graft failure is the inevitable result. In...

Rodney K Chan Perry H Liu and Dennis P Orgill

Unlike amphibians, humans lack tissue regenerative abilities and generally respond to injury through scarring and contraction. Some exceptions, such as regeneration of liver tissue after partial hepatectomy, suggest that the capacity for regeneration exists. The skin also has the potential for repair and regeneration. In fact, wounds in the second trimester not only heal in utero with minimal scarring, but also achieve the strength of unwounded skin. Yet, in adults, chronic non-healing wounds are becoming a major problem, one made worse by our growing elderly population and a dramatic rise in the incidence of diabetes.

Evaluation And Planning

Figure 3 End result (three years postoperative) of granulation scarring of defect from transoral resection of verrucous carcinoma (Fig. 2). Figure 3 End result (three years postoperative) of granulation scarring of defect from transoral resection of verrucous carcinoma (Fig. 2).

Metastatic Disease and Recurrence

The differentiation of scar from recurrent tumor can be problematic on mammography and US. MRI may be helpful in this setting, although further study is warranted. Heywang-Kobrunner et al.134 found that in 30 of 32 (94 ) cases post-surgical scar did not enhance beyond 18 months after surgery, although delayed development of enhancement in fat necrosis can occur.135

Schwann Cell Transplantation to Remyelinate the Spinal Cord

Presumably, SCs are not antigenically predisposed to the immunological attack seen in MS as are oligodendrocytes. The demonstration of anatomical and electrophysiological repair of demyelinated axons by adult human SCs is an important prerequisite for future consideration of these cells as candidates for autologous transplantation studies in humans. One potential problem with the use of SCs to remyelinate lesions in patients with MS is the presence of a glial scar in MS lesion sites that could limit cell migration and remyelination potential. In the X-EB lesion in the rat where relatively extensive remyelination is observed, it is

Microvascular Abnormalities in SSc

Figure 1 Fibrosis and scar formation is a multistage process involving complex interactions between numerous participating cell types. Pericytes are intimately associated with this process. Preceding transmigration of monocytes is an increase in vascular permeability, brought about by a change in the interactions between endothelial cells and pericytes. Pericytes are also known to produce profibrotic growth factors that can directly modulate fibroblast function and biosynthetic profile. Finally, pericytes are considered mesenchymal precursor cells and as such can transdifferentiate directly into matrix-synthesizing myofibroblasts. (see color insert) Figure 1 Fibrosis and scar formation is a multistage process involving complex interactions between numerous participating cell types. Pericytes are intimately associated with this process. Preceding transmigration of monocytes is an increase in vascular permeability, brought about by a change in the interactions between endothelial cells...

Studies In Vivo On Adult Progenitors

The wide distribution of O-2A OPCs in situ also is consistent with the idea that these cells are stem cells with a primary role of participating in oligodendrocyte replacement in the normal CNS and in response to injury. It is not clear, however, whether these cells might also express other functions. For example, it is not clear whether adult O-2A OPCs contribute to the astrocytosis that occurs in CNS injury. Glial scars made from astrocytes envelop axons after most types of demyelination (113,114). It is known that O-2A OPCs produce neurocan, phosphacan, NF2 and versican, all of which are present in sites of injury (115-117) and can inhibit axonal growth (118-120). It is possible that much of the inhibitory chondroitin sulphate proteoglycans found at sites of brain injury is derived from adult O-2A OPCS, or from adults made by adult O-2A OPCs. Whether still other possible functions also need to be considered is a matter of some interest. For example, glutaminergic synapses have been...

Systemic Manifestations

Systemic manifestations reported in 30 patients with congenital HSV include low birth weight, small for gestational age, microcephaly, seizures, diffuse brain damage, intracranial calcifications, scars on skin or digits, pneumonitis, and hepatomegaly 38 . Infants with natal or postnatal herpes commonly present 5-15 days post-natally and resemble bacterial sepsis alterations in temperature, lethargy, respiratory distress, anorexia, vomiting, and cyanosis. The overall mortality rate from untreated, neonatal HSV infection is 49 and only 26 of survivors develop normally 26 .

Eye Manifestations

Retinitis, chorioretinitis, chorioretinal scarring, and white vitreous masses have been described. (Fig. 13.5) 41,53,58 . Fig. 13.5. The left fundus of a 13-year-old boy with a diagnosis of congenital herpes simplex virus infection. Centrally, there is a large white gliotic scar overlying the macular area. In the background there are areas of migration of the pigment of the retinal pigment epithelium Fig. 13.5. The left fundus of a 13-year-old boy with a diagnosis of congenital herpes simplex virus infection. Centrally, there is a large white gliotic scar overlying the macular area. In the background there are areas of migration of the pigment of the retinal pigment epithelium

Natural emotional healing

Counselling and psychotherapy have been used with increasing frequency to help children cope with traumatic events such as death, divorce, abuse, illness, and so on. It is arguable whether this trend is at all helpful. Fortunately, the human psyche is remarkably resilient and there are powerful healing processes that take time, which in most cases achieve a satisfactory result. There are similarities between the way the body and mind respond to trauma and the strong correspondence between the natural healing processes that accompany both physical and emotional trauma. The initial healing process starts with a brief period where no pain or distress is felt whatever the cause of the trauma, and this is often accompanied by disbelief that such a thing could have happened. This first phase of shock and 'denial' is then replaced by the full impact of what has happened and is accompanied by high levels of physical or emotional pain. During the second phase the pain may be so severe that it...

Historical Perspectives

Endomyocardial biopsy (EMB) and histopathologic study demonstrating cellular infiltrates (particularly lymphocytes), edema, myocyte necrosis, and myocardial scarring were developed to improve diagnostic capabilities, but results were inconsistent among pathologists. The so-called Dallas criteria,13 described in 1987, were developed in an attempt to improve the high rate of diagnostic disagreement among pathologists by using uniform criteria. However, because of insensitivity14 and possible risks involved in biopsies, particularly in small or critically ill children, many centers abandoned EMB as a diagnostic tool.

Rubinstein Taybi syndrome Prevalence and causes

This syndrome is associated with mental retardation and dysgenesis of corpus callosum. Characteristically broad thumbs, broad great toes, and persistent fetal finger pads are associated with this condition. Facial features include short upper lip, pouting lower lip, hypoplastic maxilla, beaked nose, slanted palpebral fissures (antimongoloid slant), long eyelashes, ptosis, epicanthic fold, strabismus, glaucoma, and iris coloboma. Common cardiac problems are pulmonary stenosis, pulmonary hypertension, mitral valve regurgitation, patent ductus arteriosus, and the risk of cardiac arrhythmias being induced by succinylcholine. Other features include keloid formation on surgical scars, shawl scrotum, hypoplastic kidneys, cryptorchidism, constipation, megacolon, and easily collapsible larynx leading to sleep apnoea and difficulty with anaesthesia. Most individuals with Rubinstein-Taybi syndrome are described as happy and loving, but 10 per cent have sleep disturbances, 50 per cent show...

General management

The minitracheostomy tube is secured by a neck tie or a Velcro neck strap to avoid accidental removal. A foam dressing between skin and tube prevents abrasion. The plug at the front of the tube can be closed between suction periods or used to entrain oxygen by attaching the appropriate connection. When there is a copious sputum, the plug is left open and the patient is encouraged to cough continuously onto a laryngeal bib. The tube may sometimes become blocked, in which case a replacement is required. If no longer needed, remove the tube by simply pulling it out and cover the site with a non-porous adherent dressing. Healing, except after steroid usage, is quick and the scar is barely visible. Scarring is unusual. Minitracheostomy tubes are rarely required for more than a week.

Munchausen Syndrome by Proxy Factitious Illness by Proxy

This uncommon and somewhat bizarre form of abuse involves the falsification or manipulation of medical data or physical findings such that the child has the appearance of having a medical disorder that is actually created by the perpetrator, usually the mother. For greater review of this entity, the reader is referred elsewhere 28 . Often, the mother may have secondary gains as a result of the attention the child's illness draws from a well-meaning medical team, that will often engage in numerous diagnostic interventions, even surgery, to solve the medical dilemma. These interventions may lead to prolongation of the time before the disorder is recognized and even iatro-genic injury. Reported ophthalmic manifestations include subconjunctival hemorrhages from covert suffocation, pupillary abnormalities or nystagmus from covert poisoning, recurrent periorbital cellulitis as a result of covert injections around the eye of foreign substances, corneal scarring secondary to covert...

Benefits of Combined Surgical Procedures

Optimize ability to perform multiple procedures. Because many reconstructive procedures use the same support structures, subsequent procedures could be jeopardized because of scarring around the used structure. A good example of this is the usage of the sacral promontory for both sacrocolpopexy as well as rectopexy. There is typically no difficulty in sharing the promontory when performing a combined procedure (see Prolapse Syndromes Case Presentation, Chapter 8-8). Once scarring has developed from one procedure, achieving access to the sacral promontory for another procedure at a remote time can be impossible.

Deep Granuloma Annulare

The clinical presentation is usually very typical, with an acute swelling in the tar-sal conjunctiva. In a few days the swelling becomes a firm nodule. Excision or excochleation is the treatment of choice. Because of the typical clinical presentation, many ophthalmologists will not offer the material for routine histological examination. Chalazia are caused by the obstruction of the duct of a small (Zeis) or larger (Meibomian) sebaceous gland. A small retention cyst is formed and rupture of this cyst causes the escape of fatty products into the surrounding tissues. The fatty material triggers an acute inflammatory reaction first, followed by a chronic granulomatous reaction (Fig. 10.28). In the very late stages of chalazia, fibrosis and scarring can be seen. The presence of fatty cells or even larger optical empty spaces within a granulomatous reaction is characteristic of a chalazion. The only other conditions with similar lipogranulomatous reactions are...

Initial Staging of Clinically Localized Disease

Macfarlane et al.358 found that PET accurately predicted regional nodal status in 88 of 23 patients with primary melanoma more than 1.5 mm thick. Wagner et al.359 performed a large prospective trial containing 70 patients with primary thick melanoma (more than 1.0 mm) and 4 patients with recurrent melanoma in or adjacent to the surgical scar who underwent PET and SLN biopsy. They demonstrated a sensitivity of 11 to 17 (depending on reading threshold) and a specificity of 94 to 100 . This is one of the first articles to suggest that PET is not sensitive for staging regional nodes in patients with newly diagnosed thick melanomas.

Astrocytes And Their Precursors

The range of functions that have been attributed to astrocytes is broader than for any other cell type of which we know. Astrocytes provide substrates for axonal growth, secrete mitogens and survival factors for neurons and for O-2A OPCs (28,34,90,292295), induce endothelial cells to differentiate to form the blood-brain barrier (296,297), can function as antigen-presenting cells (298-300), have been found to produce complement and inflammatory cytokines (301,302), inactivate neurotransmitters and neuropeptides through both uptake and enzymatic inactivation (303,304), modulate ion fluxes in the brain, may modulate neuronal activity through their own calcium fluxes (305,306), can produce and secrete compounds with neurotransmitter activity (307,308), play a central role in the generation of glial scar tissue (309-311), and express a host of still other functions (312-314).

Borderline and low malignant potential tumours of soft tissues

The spindle cells have a myofibroblastic appearance, with low nuclear to cyto-plasmic ratio and uniformly bland ovoid nuclei with indistinct nucleoli. Mitotic figures are infrequent and never atypical. The matrix is collagenized to focally myx-oid, and keloid-like collagen may be present. The main differential diagnoses include hypertrophic scar and fibrosar-coma.

Special Considerations Regarding Securing the Electrode Array

Tympanic Membrane Pathology

For all three devices manufactured for the U.S. marketplace, securing of the electrode array at the cochleostomy site and at the facial recess is important. The cochlea and facial recess are the same size at birth as they are throughout adulthood and therefore, it is important to secure the electrode array at the cochleostomy with the fascia graft, which will scar in place and bridge the surrounding promontory to the electrode array. A second site of stabilization at the facial recess, with fascia grafts between the facial nerve and the electrode array as well as between the electrode array and the tympanic annulus, will further stabilize this relationship with the electrode array to the cochlea and facial recess (Fig. 28-9). This is important in children because of the relationship between head growth and the cochlear implant. The distal sites of stabilization at the cochleostomy and facial recess will secure the electrode array anteriorly, whereas the sutures and fibrous capsule...

Lumpy Jaw Actinomycosis

Actinomycosis is characterized by slowly progressive, sometimes painful swellings under the skin that eventually open and chronically drain pus. The openings usually heal, only to reappear at the same or nearby areas days or weeks later. Most cases involve the area of the jaw and neck the resulting scars and swellings gave rise to the popular name lumpy jaw (figure 27.13). In other cases the recurrent swellings and drainage develops on the chest or abdominal wall, or in the genital tract of women. Actinomyces israelii cannot penetrate the normal mucosa, but it can establish an infection in association with other organisms if introduced into tissue by wounds. The infectious process is characterized by cycles of abscess formation, scarring, and formation of sinus tracts, or passageways that generally ignore tissue boundaries. The disease usually progresses to the skin where pus is discharged, but occasionally it penetrates into bone, or into the central nervous system. In the tissue, A....

Ureteral Stricture Dilation

Urether Stricture Dilated

Ureteral strictures can also develop in patients with chronic calculous disease as well as after penetrating abdominal trauma, particularly high-velocity gunshot wounds. Urinary extravasation and ureteral ischemia may contribute to scar formation in these cases and in postoperative strictures (such as ureteroenteral anastomotic strictures associated with urinary diversion). Chronic inflammatory diseases, such as tuberculosis and schistosomiasis, can also cause strictures.

The Role Of Oxidative Stress In Radiationinduced Late Effects

Oxidative stress clearly plays a role in chronic renal failure (163-165). Radiation nephropathy is characterized by chronic progressive renal dysfunction, glomeruloscle-rosis and tubulointerstitial fibrosis (77). The accepted threshold dose of photon irradiation that will cause radiation nephropathy is exposure of both kidneys to 23 Gy total dose, fractionated in 20 doses over 4 weeks (166). If only one kidney is irradiated with a threshold or higher dose, radiation injury will occur in that kidney, but kidney failure from radiation nephropathy per se will not occur. However, the unirradiated kidney is likely to become damaged from the renin-mediated hypertension that occurs because of the severe unilateral renal scarring (167). Accidental radiation overexposure to the skin and underlying subcutaneous tissues can lead to severe lesions resulting in extensive fibronecrotic tissues. In high-dose radiation accidents, fibrosis is usually the result of scarring following tissue necrosis...

Retinopathy of Prematurity Definition

Laser Photocoagulation Break

Etiology Preterm birth and exposure to oxygen disturbs the normal development of the retinal vasculature. Vessel obliteration occurs, followed by proliferative neovascularization. This results in vitreous hemorrhage, retinal detachment, and, in the late scarring stage, retrolenticular fibroplasia as vessels and connective tissue fuse with the detached retina. Treatment Retinal breaks with minimal circular retinal detachment can be treated with argon laser coagulation (Fig. 12.23). The retina surrounding the break is fused to the underlying tissue whereas the break itself is left open. The scars resulting from argon laser therapy are sufficient to prevent any further retinal detachment. More extensive retinal detachments are usually treated with a retinal tamponade with an elastic silicone sponge that is sutured to the outer surface of the sclera, a so-called budding procedure (Fig. 12.24a - c). It can be sutured either in a radial position (perpendicular to the limbus) or parallel to...

Clinical features

Case Study Somatic subtype with dysmorphic delusion A man aged 35 was seen in psychiatric consultation on a surgical unit. He had been complaining for at least 6 years that an appendicectomy scar was so ugly that it was ruining his life, although he never let anyone other than surgeons see it. He had repeatedly sought cosmetic surgery, but every surgeon who examined him said the scar was normal. The patient gave up work, became reclusive, and ruminated endlessly on his 'deformity'. Finally he operated on himself, trying to excise the scar, but when he lost a lot of blood he panicked and called for an ambulance. Following operation in hospital he appeared rational on every topic except the scar, was of average intelligence and denied any suicidal feelings. At first he was thought to have a factitious disorder, but his continuing conviction that his life was useless if he could not have reparative surgery proved to be delusional.

Viral Retinitis Definition

Diagnostic considerations Slit-lamp examination will reveal cells in the vitreous body. Ophthalmoscopic findings will include retinal necrosis with intraretinal bleeding (see Fig. 12.35). Necrosis can occur as acute lesions and spread over the entire retina like a grassfire within a few days. When the retinitis heals, it leaves behind wide-area scarring. During pregnancy, rubella virus can cause embryopathy in the child. Ophthalmic examination will reveal typical fine granular pigment epithelial scars on the fundus that are often associated with a congenital cataract. The diagnosis is confirmed by measuring the serum virus titer. The possibility of compromised immunocompetence should be verified or excluded.

Ureteroenteral Anastomotic Strictures

Anastomotic Stricture

Strictures at the anastomosis of the ureter to an ileal conduit urinary diversion or continent urinary pouch or conduit are almost always benign and reportedly occur in 4 to 30 of patients (149-151). One study that compared complications in the different forms of urinary diversion reported the incidence of ureteroenteric strictures in ileal conduits to be 6.5 , compared to 10.0 in the continent reservoir group and 13.6 in patients who underwent ureterosigmoidostomy (150). The predisposing factors are ischemic necrosis and subsequent fibrosis and stricture, due to excessive mobilization and skeletonization of the ureter. Preoperative radiation therapy appears to have a compounding effect. Extravasation at the anastomosis may progress to scarring and subsequently a stricture, and, rarely, recurrent tumor in the ureter may present with obstruction. Stenoses tend to be more prevalent on the left side, probably because of the necessity for high mobilization of the left ureter (to ensure a...

Papillary hyperplasia

Psoriasiform hyperplasia and sometimes areas of pseudoepitheliomatous hyper-plasia. A mild degree of atypia may be present. Fungal hyphae are present in the superficial epithelium but are usually sparse and revealed only in multiple sections. Scarring and nodularity persist after antifungal treatment. Differential diagnosis is aided by knowledge of the specific site and includes reactive

The water content of the corneal stroma remains constant at 70

Non-ophthalmologists can evaluate the transparency of the cornea (opacities of the stroma and epithelium suggest scarring or infiltration of the epithelium), its surface luster (lack of luster suggests an epithelial defect), and possible superficial corneal injuries (see Fig. 19.1 ). A simple ruler may be used to measure the size of the cornea (see Anatomy), and sensitivity may be tested with a cotton swab (see Fig. 1.11, p. 11).

Structures That Enable Internalization

Fruit attachment structures on certain plants contain natural openings involved with gas exchange. Most of the gas exchange required by the internal cells of tomato fruit occurs through the stem scar 27 . If the stem scar is covered with wax, the carbon dioxide levels in the intercellular spaces increase two to four times above normal, evidence that the wax layer blocks equilibration of respiratory CO2 with the external environment. If the rest of the fruit is waxed and the stem scar is not, the CO2 level in the fruit remains similar to that in nonwaxed fruit. Air injected into a tomato fruit submerged in water bubbles from cracks in the edges of the stem scar 28 . Only rarely are any bubbles observed at the blossom end of the fruit. If the stem is still attached, the air bubbles from the area between the stem and fruit.

Hypointense Seminal Vesicle

Seminal Vesicle Sag Plane

Adenocarcinoma of the prostate is most commonly located in the peripheral gland and may be unifocal or multifocal. Lesions are of low signal intensity on T1-and T2-weighted imaging due to an increase in cell density and replacement of prostatic ducts (Fig. 9A and B) (4). However, it is the low T2-signal intensity that contributes to the decreased specificity in detection of cancerous lesions. Other etiologies of low T2-signal intensity include hemorrhage, prostatitis, posttherapy changes, and scar (51,52,65,66). On T1-weighted images, identification of high signal intensity blood surrounding low signal intensity tumor (halo sign) can help distinguish which components are related to hemorrhage and which to tumor, because these two abnormalities are sometimes identical in appearance on T2-weighted imaging (55).

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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