Securing the airway is a crucial aspect during reconstructive surgeries of patients with extensive post-burn mentosternal scar contractures; however, the American Society of Anesthesiologists Difficult Airway Management Algorithm recommendation of initial direct laryngoscopy may not be appropriate for these complicated patients. Consequently, there is a significant risk for failure of intubation and airway emergency. We suggest that initial attempts at securing the airway be made with indirect laryngoscopy. Many airway techniques have been effectively used in burn patients, but the role of awake blind or fiberoptic bronchoscopy, although well established in the non-burn population, has yet to be evaluated in burn patients. We report a case series of successful management of difficult airways with fiberoptic bronchoscopy in patients with varying degrees of post-burn head and neck scar contractures.
Han, Tae-Hyung; Teissler, Hana; Han, Richard J; Gaines, Joshua D; Nguyen, Tho Qynh
This article discusses scar contracture of the hand. It contains a brief outline of the anatomy of the hand and upper extremities and the types of injuries involved. Hand reconstruction, including examination, nonoperative treatment, surgery, excision and skin grafting, flaps, postoperative management, and complications, are covered. PMID:22032588
Hegge, Theresa; Henderson, Megan; Amalfi, Ashley; Bueno, Reuben A; Neumeister, Michael W
First web space adduction contractures are a common consequence of hand burns. Many reconstructive techniques are used and investigation for more effective methods continues. Effective hand reconstruction usually considers anatomy as its foundation. Based on the experience of over 500 web space contracture elimination cases, three anatomical types of thumb adduction contractures were identified: edge, medial and total. Edge contractures (80% of all thumb adduction contractures) are caused by a fold in which only one sheet is scarred, either the palmar or dorsal surface. The contraction is caused by a trapeze-shaped length deficiency of the scar sheet, which has a surface surplus in width. Reconstruction consists of surface deficiency compensation with trapezoid flap prepared from the non-scarred side and skin-fat tissues of the web space. In most cases, the small scar-fat trapezoid flaps should be prepared from the non-scarred side to cover the donor wounds on both sides of the main flap. Medial contractures (10% of thumb adduction contractures) are caused by the fold, both sheets of which are scarred and have trapeze-shaped surface deficiency in length and surplus in width. Both fold sheets are converted into one or several pairs of trapezoid scar-fat flaps by radial incisions. The oppositely located flaps are transposed towards each other. As a result of the counter flaps transposition, the contracture is eliminated; the web space's shape and depth are restored by the use of flaps alone or in combination with skin grafting. The trapeze-flap plasty is very simple and effective with the length gain of up to 100-200%. Neither flap loss nor re-contracture occurs. Total contractures (about 10% of all) have no fold. Reconstruction consists of the creation of the central zone of the first web space depth with the rectangular subdermal pedicle flap; the wounds on both sides of the flap are skin grafted. The flap sustains normal web depth and prevents the contracture recurrence and skin graft shrinkage. PMID:20851529
Grishkevich, Viktor M
Trunk burns result in various complications, deformities, and contractures. Contracture of the lateral surface of the trunk is one of the serious complications that limits movements of the spine; children experience structural changes in the form of scoliosis. Therefore, the lateral truncal contracture should be the subject of early surgical treatment. The currently used method has been the stage-by-stage incisions on the contracture scars and skin grafting or Z-plasty. Skin grafts have a tendency to shrink; thus, compression garments are recommended for an extended period of time after surgery. Triangular flaps are small to complete contracture elimination. The need for development of a more effective surgical technique is apparent. Lateral truncal contracture is caused by a crescent-shaped fold; both sheets of the fold are scars. The sheets have a trapeze-shaped surface deficit in length, which causes the contracture and creates the skin surplus in width. The contracture is of medial type; therefore, it is subject to treatment with local tissues using trapeze-flap plasty. The fold and the adjacent contracted scars are converted into trapezoid flaps by radial incisions. The distance among incisions ranges from 4 to 5 cm, which determines the width of the flap's top. One or several trapezoid flap pairs are planned. The scar flaps are elevated with the subcutaneous fat layer and transposed one toward another with tension, so that the end of one flap reaches the base of the counter flap. As a result, the zone of the plasty is elongated by 100 to 150%. Twelve patients with lateral truncal contractures were operated using trapeze-flap plasty. Good immediate and late results have been achieved. It is the author's belief that trapeze-flap plasty is the most effective technique in light of today's proposed methodology. PMID:20861744
Grishkevich, Viktor M
Summary Marjolin's ulcer is a rare and aggressive cutaneous malignancy that occurs in previously traumatized and chronically inflamed skin, especially after burns. The majority of burn scar carcinomas are seen after a lag period in burns that were not grafted following injury. Between 2000 and 2006, 48 patients with Marjolin's ulcer were treated in our centre (Sulaimani Teaching Hospital and Emergency Hospital). All the lesions were secondary to burns from various causes. The medical records of these 48 patients were reviewed prospectively. The mean age at tumour diagnosis was 40 yr and the ratio of male to female was 2:1 (67% males and 33% female). Upon histological examination, all the cases were diagnosed as well-differentiated squamous cell carcinoma. The scalp was most frequently affected (16 patients = 33.3%), followed by the lower limb (14 patients = 29.1%). Treatment of the neoplasm consisted of excision and grafting in 36 patients (75.0%), excision and reconstruction with flaps in eight patients (16.6%), and amputation in three patients (6.2%). A chemotherapy combination of the above treatments was used in two patients (4.1%). Local recurrence was noted in 16 patients (33.3%) out of the 48, and all died from these recurrences.
Linear and cord-like burn scar contractures are commonly treated by severing the scar in a transverse direction and skin grafting or performing Z-plasties. However, skin grafts may result in suboptimal take and contract gradually and the Z-plasty requires undermining flaps in scarred skin which may lead to the distal tip necrosis. In this article the authors present their experience with multiple Y-V plasty technique. From May 2005 to September 2009, 44 linear and narrow cord-like burn contractures in various regions of upper and lower extremities of 32 patients were treated by multiple Y-V plasty technique. The contracted scars were treated successfully in all of the patients. No major post-operative complications or contracture recurrence were observed during the follow up period of 6 to 24 months in this series of patients. By creating a longer length, running Y-V plasty can relax the contracted scar. Considering the advantages and excellent results in the treated patients in this study group, and also other presented series, multiple Y-V plasty can be recommended as a very useful and safe technique for the treatment of linear and cordlike burn contractures. PMID:23292623
Arasteh, Ehsan; Yavari, Masoud
Heterotopic calcification (HC) is abnormal deposition of calcium salts in tissues other than bone and enamel. The heterotopic calcification in the burn patients is commonly found either in periarticular region or in the muscles, but the occurrence of heterotopic calcification of the burn scar itself in the presence of normal serum calcium, phosphate and alkaline phosphatase is not reported earlier. We present four adult male patients of lower limbs heterotopic calcification in burn scars with unusual presentation of non-healing ulcers with a latent period of 15-20 years. In one of the patient it was Marjolin's ulcer although the lesion was away from the calcified area. Excision of the calcified scars and the release of contracture have cured the non-healing ulcers and this may prevent re-calcification in future. PMID:12880726
Ebrahim, Mohammed K; Kanjoor, James R; Bang, Rameshwar L
Reconstruction of oral scar contracture is often a challenging problem due to the complex structures and functions of the oral cavity. This report describes the treatment of a patient who sustained extensive oral scar contracture following caustic liquid soda ingestion. Surgical release of the scar contracture formed an S-shaped, thin, long defect that was difficult to cover with a conventional flap or skin graft. A jejunal segment was transferred microsurgically as a patch to reconstruct the defect. It sustained a sufficient oral space to provide full opening of the mouth and good movement of the tongue. A free jejunal flap, used occasionally for reconstruction following oral cancer resection, has significant advantages for restoration of function after release of an oral scar contracture. PMID:10402992
Ichioka, S; Nakatsuka, T; Yoshimura, K; Kaji, N; Harii, K
Joints involved in deep burn often result in joint contracture, limb dysfunction, psychological disorder, or even loss of living and working abilities. The management of post-burn joint contracture will directly orientate the functional recovery of the patients. Comprehensive intervention may prevent the contracture process of the affected joints. Orthoses application is an important measure and should be maintained throughout the whole process of burn care, from positioning the joints at the early stage to maintaining the range of joint motion at the late stage. Orthoses should be used on the premise of protecting the joint functions. In order to maintain the tissue tension while enhancing the joint mobility and muscle strength, the static orthoses and the dynamic orthoses are often alternately used. It is showed in clinical practice that orthoses are designed and applied on the basis that biomechanics will lead to a better outcome. PMID:24495637
Yi, Nan; Hu, Da-hai; Wang, Bing-shui
In addition to burn surgeons, skilled nurses, and therapists, hand surgeons are a key part of the multidisciplinary team caring for patients following thermal injury to the hand. Despite appropriate initial treatment and compressive therapy, contractures are common after deep burn. The most common and functionally limiting are web space and hand contractures. Web space contractures can be managed with excision followed by local soft tissue rearrangement or skin grafting. The classic burn claw hand deformity includes extension contracture of the metacarpophalangeal joints and flexion contractures of the proximal interphalangeal joints. The mainstay of management of these postburn contractures includes complete surgical release of scar tissue and replacement by full-thickness skin graft. In cases in which scar contracture release results in major exposure of the tendons or joints, distant tissue transfer is required. This review focuses on prevention and management of late sequelae of thermal injury to the hand focusing on contractures of the webspaces and hand. PMID:24288147
Fufa, Duretti T; Chuang, Shiow-Shuh; Yang, Jui-Yung
Objective: Hand burns are common injuries. Children frequently sustain burn injuries, especially to their hands. Contractures are a common sequel of severe burns around joints. The prepuce, or foreskin, has been used as a skin graft for a number of indications. We conducted this study to evaluate the feasibility of utilising the preputial skin for the management of post-burn contractures of fingers in uncircumcised male children. Materials and Methods: Preputial skin was used for the coverage of released contractures of fingers in 12 patients aged 2-6 years. The aetiology of burns was “Kangri” burn in eight patients and scalding in four patients. Six patients had contracture in two fingers, four patients in one finger, and two patients had contractures in three fingers. Results: None of the patients had graft loss, and all the wounds healed within 2 weeks. All patients had complete release of contractures without any recurrence. Hyperpigmentation of the grafts was observed over a period of time, which was well accepted by the parents. Conclusions: Preputial skin can be used successfully for male children with mild-to-moderate contractures of 2-3 fingers for restoration of the hand function, minimal donor site morbidity.
Zaroo, Mohammed I.; Sheikh, Bashir A.; Wani, Adil H.; Darzi, Mohammad A.; Mir, Mohsin; Dar, Hameedullah; Baba Peerzada, U. F.; Zargar, Haroon R.
Dorsal contracture is one of the most common complications of burned hand and can result in a spectrum of deformities and functional disabilities. The injury usually necessitates surgical reconstruction and to the majority of patients, cosmetic end result is a very important issue. In this retrospective study, the authors present the technique of super-thin skin abdominal pedicle flap for the treatment of dorsal hand hypertrophic burn contracture, and review the results. Overall 42 medium or large hypertrophic and contracted scars of the dorsal hand in 34 patients were treated using this procedure. Generally, the functional and aesthetic outcomes were evaluated as good. The functional results were comparable to employment of other types of flap with no relapse of contracture. From the aesthetic point of view, the reconstructed skin was similar to the skin of the rest of the extremity, with good color match, bulkiness, laxity, and suppleness. The scar of the donor region was comparable to the scar of abdominoplasty procedures on the ipsi-lateral side of the lower abdomen. Therefore, this procedure can be considered a reliable and technically simple modality in the treatment of dorsal hand burn contractures. PMID:17822855
Gousheh, J; Arasteh, E; Mafi, P
Vast areas of southeastern Russia have been scorched by fires over the last few weeks. All across Siberia fires have been raging, and this Moderate Resolution Imaging Spectroradiometer (MODIS) image from May 15, 2002, shows extensive, dark burn scars along with actively burning fires (red dots) on the north side of the Amur River, which separates Russia (north) and China (south). The southern Amur region is largely devoted to farming and other agriculture, and these fires may have been set intentionally to prepare the land for the growing season. Fire is often used to clear land of unwanted vegetation, and to return the nutrients stored in vegetation back to the soil. However, fires that are too frequent or severe can devastate the soil, eventually making it unsuitable for farming or grazing. Fires can also escape control and spread into protected areas. In this image, fires are mostly concentrated in a lowland area within the drainage basin of the Zeya River, which drains from the frozen lake at the top of the image. Image courtesy Jacques Descloitres, MODIS Land Rapid Response Team at NASA GSFC
Purpose The Patient and Observer Scar Assessment Scale (POSAS) is a questionnaire that was developed to assess scar quality. It consists\\u000a of two separate six-item scales (Observer Scale and Patient Scale), both of which are scored on a 10-point rating scale. After\\u000a many years of experience with this scale in burn scar assessment, it is appropriate to examine its psychometric properties
Martijn B. A. van der Wal; Wim E. Tuinebreijer; Monica C. T. Bloemen; Pauline D. H. M. Verhaegen; Esther Middelkoop; Paul P. M. van Zuijlen
There are many problems in the anesthetic management of patients with scar contracture. In this case, a 41-year-old male with severe scar contracture on his face, neck, anterior chest, and both shoulders underwent surgery for resurfacing with flaps. We tried to awake fiberoptic orotracheal intubation with GlideScope® Video laryngoscope guide after surgical release of contracture under local anesthesia. We report a successful management of a patient with severe burn contracture achieved by combined effort of surgeons and anesthesiologists.
Lee, Hye-Kyoung; Yim, Ji-Yeon; Kang, Im-Hong
Full-thickness burn and other types of deep skin loss will result in scar formation. For at least partial replacement of the lost dermal layer, there are several options to use biotechnologically derived extracellular matrix components or tissue scaffolds of cadaver skin origin. In a survey, we have collected data on 18 pts who have previously received acellular dermal implant Alloderm. The age of these patients at the injury varied between 16 months and 84 years. The average area of the implants was 185?cm2. Among those, 15 implant sites of 14 patients were assessed at an average of 50 months after surgery. The scar function was assessed by using the modified Vancouver Scar Scale. We have found that the overall scar quality and function was significantly better over the implanted areas than over the surrounding skin. Also these areas received a better score for scar height and pliability. Our findings suggest that acellular dermal implants are especially useful tools in the treatment of full-thickness burns as well as postburn scar contractures.
Juhasz, I.; Kiss, B.; Lukacs, L.; Erdei, I.; Peter, Z.; Remenyik, E.
This study examined the potential usefulness of combining remote sensing data with hydrologic models and mapping tools available from Geographic Information Systems (GIS), to evaluate the effects of wildfire. Four subprojects addressed this issue: (1) validation of burn scar maps derived from the Advanced Very High Resolution Radiometer (AVHRR) with the National Fire Occurrence Database; (2) testing the potential of thermal MODIS (Moderate Resolution Imaging Spectroradiometer) data for near-real time burn scar and fire severity mapping; (3) evaluation of Landsat derived burn severity maps within WEPP through the Geo-spatial interface for the Water Erosion Prediction Project (GeoWEPP), and (4) predicting potential post-fire erosion for western U.S. forests utilizing existing datasets and models. Wildfire poses incredibly complex management problems in all of its stages. Today's land managers have the option of trying to mitigate the effects of a severe fire before it occurs by fuel management practices. This process is expensive especially considering the uncertainty of when and where the next fire in a given region will occur. When a wildfire does occur, deciding when to let it burn and when to suppress it may lead to controversial decisions. In addition to the threat to life and property from the fire itself, smoke emissions from large fires can cause air quality problems in distant airsheds. Even after the fire is extinguished, erosion and water quality problems may pose difficult management questions. Contributions stemming from these studies include improved burn scar maps for studying historical fire extent and demonstration of the feasibility of using thermal satellite data to predict burn scar extent when clouds and smoke obscure visible bands. The incorporation of Landsat derived burn severity maps was shown to improve post-fire erosion modeling results. Finally the potential post-fire burn severity and erosion risk maps generated for western US forests will be used for planning pre-fire fuel reduction treatments.
Miller, Mary Ellen
For preventing the scar contracture of host tissue and adjusting the tensile strength of covering cell sheets, a controlled collagen crosslinking step process in the preparation of skin-fibroblast sheets for repairing wound was investigated by using ?-aminopropionitrile (BAPN), a collagen crosslinking inhibitor, in the culture medium. Skin fibroblasts obtained from neonatal rats were cultured in medium with and without 0.25?mm BAPN for 7?days and seeded on temperature-responsive culture dishes. After the confluent cells were non-invasively harvested as a monolithic cell sheet, two cell sheets were transplanted to a lung-injury site of athymic rats, which was closed by neither fibrin glue nor suturing. Four weeks after the transplantation the animals were sacrificed and the lungs with the transplanted cell sheets were examined. Although the control cell sheet-transplanted lungs contracted the surrounding tissue, BAPN-treated cell sheet-transplanted lungs showed no contraction of the tissue. Collagen fibres of control cell sheets were more dense and thick than those of BAPN-treated cell sheets, where the crosslinking of collagen fibres was clearly inhibited. Sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) showed that BAPN-treated cell sheets gave no ?-chain band, indicating that the collagen crosslinkings of the fibroblast sheets were able to be controlled by BAPN. BAPN-treated fibroblast sheets promise to allow wound clefts to be repaired without scar contractures. PMID:22298460
Kanzaki, Masato; Yamato, Masayuki; Takagi, Ryo; Kikkawa, Takuma; Isaka, Tamami; Okano, Teruo; Onuki, Takamasa
BACKGROUND: To date, many techniques for the surgical treatment of postburn scar contractures have been described. Some of the most popular techniques are Z-plasty, V-Y-plasty and their analogues. A major limitation of these techniques is that the excess tissue requires excision of the dog ear. The current study presents a new modification of the double-opposing Z- and V-plasty, called ‘K-M-N plasty’. METHODS: Twenty postburn scar contractures were successfully treated with K-M-N plasty. The postoperative results depict the versatility of this technique in the surgical treatment of postburn scar contractures, especially in the upper and lower extremities. RESULTS: There was no distal flap necrosis, and postoperative recovery was uneventful in all operated patients. K-M-N plasty is an effective and alternative method for the surgical treatment of postburn scar contractures. In addition, drawing and flap transpositions were not complicated. DISCUSSION: There are many advantages to using this technique: K-M-N plasty can be safely used when skin tension crosses the contracture line; it is superior to other local flaps because of its rich vascularity and mobility for superficial scars; it can be recommended to the inexperienced surgeon because it can be performed with ease; it is also an effective procedure for the pericontracture area due to its V limb (it can prevent recontracture); the colour and texture matches are more cosmetically acceptable, and the resultant contracture release is similar to other techniques; the dog ear formation is not seen; it can be performed under local anesthesia in most cases (not in children); and it has a shorter period of operation and hospitalization than other techniques.
Emsen, Ilteris Murat
A 13 year- old girl presented to the department with sternomental contractures as a result of facial burns from kerosene explosion. Difficult airway was envisaged. Over the period of time she developed sub-mental contracture with keloids; and was scheduled for release of contractures and flap closure. Anaesthesia was induced with halothane and 100% oxygen. A size 3 laryngeal mask airway (LMA) was inserted and anaesthesia maintained with oxygen/nitrous oxide/halothane/muscle relaxant technique. The successful placement of LMA at 2nd attempt was aided by a surgical incision on the submental contracture. Blood loss was 600 mls and a unit of packed red blood cells was transfused. She made full recovery and was discharged home after 1 month.
Severe post-burn contractures in the neck often cause anatomical distortion and restriction of neck movements, resulting in varying degrees of difficulty in airway management. Any mode of anesthesia that may obviate the need for imperative airway control may be desirable in such situations in which a difficult airway may be anticipated. Here we present one such situation where tumescent local anesthesia was employed to manage a case of severe post-burn neck contractures posted for contracture release and split-skin grafting. The other benefits of this method were minimal blood loss and excellent postoperative analgesia. In conclusion, it can be emphasized that the application of tumescent anesthesia is an important anesthetic tool in patients with predicted difficult airway management. PMID:21986719
Prasad, Mukesh Kumar; Puneet, Pulak; Rani, Kanchan; Shree, Divya
A modeling approach is presented for quantitative burn scar assessment. Emphases are given to: (1) constructing a finite element model from natural image features with an adaptive mesh, and (2) quantifying the Young's modulus of scars using the finite element model and the regularization method. A set of natural point features is extracted from the images of burn patients. A Delaunay triangle mesh is then generated that adapts to the point features. A 3D finite element model is built on top of the mesh with the aid of range images providing the depth information. The Young's modulus of scars is quantified with a simplified regularization functional, assuming that the knowledge of scar's geometry is available. The consistency between the Relative Elasticity Index and the physician's rating based on the Vancouver Scale (a relative scale used to rate burn scars) indicates that the proposed modeling approach has high potentials for image-based quantitative burn scar assessment.
Tsap, L V; Zhang, Y; Goldgof, D B; Sarkar, S
Over a 5-year period, 63 children aged 15 years and less had surgical correction of 74 axillary contractures in our center. They were grouped into three severity categories based on the Kurtzman and Stern's classification. Accordingly, 56 were type I, 11 were type II and 7 were type III axillary contractures. While local flaps sufficed in all the type I contractures, skin grafts and fasciocutaneous flaps were required in types II and III. The principal movements at the shoulder joint were assessed at 2 years after, and functional outcome classified into three outcome categories. Excellent result (A) was obtained in all the type I contractures, 82% of the type II contractures and 28% of the type III contractures. Good result (B) was obtained in 18% of the type II and 57% of the type III contractures and poor result (C) was obtained in 14% of the type III contractures. PMID:18692966
Asuku, Malachy E; Ibrahim, Abdulrasheed; Ijekeye, Ferdinand O
Background: A post-burn flexion contracture of the knee joint is a disabling condition which interferes with an upright posture and a bipedal locomotion. Islanded perforator flaps have been used to resurface the tissue defect which is produced as a result of the contracture release. Despite their various advantages, they are limited by an increased tendency to undergo venous congestion. Perforator-plus flaps can be used to overcome this limitation, while retaining the merits of the islanded perforator flaps. Methods: Ninteen patients with post flame burn flexion contractures of the knee joints underwent surgical releases and coverages by various local fasciocutaneous perforator-plus flaps. The patients were followed up for 6 months and the various aspects of the functional and the aesthetic rehabilitations were assessed. Results: All the local fasciocutaneous perforator-plus flaps resurfaced the tissue defect over popliteal fossa with good colour and texture match and maintenance of the contour. None of the flaps had any significant early or delayed complications (which included venous congestions) which necessitated reoperations. All the patients were satisfied with the functional and aesthetic outcomes. Conclusion: Local fasciocutaneous perforator-plus flaps can be considered as one of the primary treatment modalities for the surgical release and reconstruction of post burn flexion contractures of the knee.
Gupta, Madhumita; Pai, Ashwin A.; Setty, Ravi R.; Sawarappa, Raghavendra; Majumdar, Bijay Kumar; Banerjee, Tibar; Kanoi, Aditya; Bhattacharya, Abhimanyu
Background: A post-burn flexion contracture of the knee joint is a disabling condition which interferes with an upright posture and a bipedal locomotion. Islanded perforator flaps have been used to resurface the tissue defect which is produced as a result of the contracture release. Despite their various advantages, they are limited by an increased tendency to undergo venous congestion. Perforator-plus flaps can be used to overcome this limitation, while retaining the merits of the islanded perforator flaps. Methods: Ninteen patients with post flame burn flexion contractures of the knee joints underwent surgical releases and coverages by various local fasciocutaneous perforator-plus flaps. The patients were followed up for 6 months and the various aspects of the functional and the aesthetic rehabilitations were assessed. Results: All the local fasciocutaneous perforator-plus flaps resurfaced the tissue defect over popliteal fossa with good colour and texture match and maintenance of the contour. None of the flaps had any significant early or delayed complications (which included venous congestions) which necessitated reoperations. All the patients were satisfied with the functional and aesthetic outcomes. Conclusion: Local fasciocutaneous perforator-plus flaps can be considered as one of the primary treatment modalities for the surgical release and reconstruction of post burn flexion contractures of the knee. PMID:23814737
Gupta, Madhumita; Pai, Ashwin A; Setty, Ravi R; Sawarappa, Raghavendra; Majumdar, Bijay Kumar; Banerjee, Tibar; Kanoi, Aditya; Bhattacharya, Abhimanyu
Pentoxifylline modifies three-dimensional collagen lattice model contraction and expression of collagen types I and III by human fibroblasts derived from post-burn hypertrophic scars and from normal skin
Fibroblasts are thought to be partially responsible for the persisting contractile forces that result in burn contractures. Using a monolayer cell culture and fibroblast populated collagen lattice (FPCL) three-dimensional model we subjected hypertrophic scar and non-cicatricial fibroblasts to the antifibrogenic agent pentoxifylline (PTF – 1mg\\/mL) in order to reduce proliferation, collagen types I and III synthesis and model contraction. Fibroblasts
Cesar Isaac; Mônica Beatriz Mathor; Giovani Bariani; André Oliveira Paggiaro; Marisa Roma Herson; Claudia Goldenstein-Schainberg; Solange Carrasco; Walcy Rosolia Teodoro; Natalino Hajime Yoshinari; Marcus Castro Ferreira
Burn scar extraction using remote sensing data is an efficient way to precisely evaluate burn area and measure vegetation recovery. Traditional burn scar extraction methodologies have no well effect on burn scar image with blurred and irregular edges. To address these issues, this paper proposes an automatic method to extract burn scar based on Level Set Method (LSM). This method utilizes the advantages of the different features in remote sensing images, as well as considers the practical needs of extracting the burn scar rapidly and automatically. This approach integrates Change Vector Analysis (CVA), Normalized Difference Vegetation Index (NDVI) and the Normalized Burn Ratio (NBR) to obtain difference image and modifies conventional Level Set Method Chan-Vese (C-V) model with a new initial curve which results from a binary image applying K-means method on fitting errors of two near-infrared band images. Landsat 5 TM and Landsat 8 OLI data sets are used to validate the proposed method. Comparison with conventional C-V model, OSTU algorithm, Fuzzy C-mean (FCM) algorithm are made to show that the proposed approach can extract the outline curve of fire burn scar effectively and exactly. The method has higher extraction accuracy and less algorithm complexity than that of the conventional C-V model. PMID:24503563
Liu, Yang; Dai, Qin; Liu, Jianbo; Liu, ShiBin; Yang, Jin
Summary Hypertrophic burn scars pose a challenge for burn survivors and providers. In many cases, they can severely limit a burn survivor’s level of function, including work and recreational activities. A widespread modality of prevention and treatment of hypertrophic scarring is the utilization of pressure garment therapy (PGT). Despite the magnitude of the problem of hypertrophic scarring and the ubiquitous use of pressure garments as therapy, strong clinical evidence of the efficacy of PGT in the literature is lacking. Some of the challenges facing measurement of efficacy of PGT on hypertrophic scarring are lack of clear definitions for degree of hypertrophic scarring, inability to quantify pressure applied to scars, patient noncompliance to strict PGT time schedules, and inability to conduct randomized controlled trials comparing PGT to no therapy for ethical reasons since PGT is considered a standard of care. In this review, we attempt to summarize and analyze evidence-based literature on PGT and its efficacy in burn hypertrophic scars published in English language in the past 15 years.
Atiyeh, B.S.; El Khatib, A.M.; Dibo, S.A.
Pentoxifylline modifies three-dimensional collagen lattice model contraction and expression of collagen types I and III by human fibroblasts derived from post-burn hypertrophic scars and from normal skin.
Fibroblasts are thought to be partially responsible for the persisting contractile forces that result in burn contractures. Using a monolayer cell culture and fibroblast populated collagen lattice (FPCL) three-dimensional model we subjected hypertrophic scar and non-cicatricial fibroblasts to the antifibrogenic agent pentoxifylline (PTF - 1mg/mL) in order to reduce proliferation, collagen types I and III synthesis and model contraction. Fibroblasts were isolated from post-burn hypertrophic scars (HSHF) and non-scarred skin (NHF). Cells were grown in monolayers or incorporated into FPCL's and exposed to PTF. In monolayer, cell number proliferation was reduced (46.35% in HSHF group and 37.73% in NHF group, p<0.0001). PTF selectively inhibited collagen III synthesis in the HSHF group while inhibition was more evident to type I collagen synthesis in the NHF group. PTF also reduced contraction in both (HSHF and NHF) FPCL. PMID:19303218
Isaac, Cesar; Mathor, Mônica Beatriz; Bariani, Giovani; Paggiaro, André Oliveira; Herson, Marisa Roma; Goldenstein-Schainberg, Claudia; Carrasco, Solange; Teodoro, Walcy Rosolia; Yoshinari, Natalino Hajime; Ferreira, Marcus Castro
Restoration of form and function after burn injury remains challenging, but emerging laser and pulsed light technologies now offer hope for patients with hypertrophic scars, which may be associated with persistent hyperemia, chronic folliculitis, intense pruritis, and neuropathic pain. In addition to impairing body image, these scars may limit functional recovery, compromise activities of daily living, and prevent return to work. Three different platforms are now poised to alter our reconstructive algorithm: (1) vascular-specific pulsed dye laser (PDL) to reduce hyperemia, (2) ablative fractional CO2 laser to improve texture and pliability of the burn scar, and (3) intense pulsed light (IPL) to correct burn scar dyschromia and alleviate chronic folliculitis. In this paper, we will provide an overview of our work in this area, which includes a systematic review, a retrospective analysis of our preliminary experience, and interim data from our on-going, prospective, before-after cohort trial. We will demonstrate that laser- and light-based therapies can be combined with each other safely to yield superior results, often at lower cost, by reducing the need for reconstructive surgery. Modulating the burn scar, through minimally invasive modalities, may replace conventional methods of burn scar excision and yield outcomes not previously possible or conceivable.
Hultman, C. Scott; Edkins, Renee E.; Lee, Clara N.; Calvert, Catherine T.; Cairns, Bruce A.
Perforator flaps are well established as a versatile option in reconstructive surgery that provide thin, pliable cutaneous or fasciocutaneous tissue. They are particularly useful in the reconstruction of large shallow defects, such as after the release of a burn contracture, however there are situations where the additional time spent islanding these flaps may be unnecessary, and the flap is then essentially a fasciocutaneous flap based, but not islanded, on a perforator artery. This paper documents a series of 22 severe burn contractures in 17 patients reconstructed with fasciocutaneous flaps in this way. The arteries were all located pre-operatively with a hand held Doppler probe, around half at the site of a known perforator and half by systematic scanning of the surrounding skin for an ad hoc perforator. All patients achieved a good functional range of motion. There were three cases of partial superficial flap necrosis treated with split skin grafting. The functional and aesthetic outcomes were far better then those expected with split skin grafting, and published series show that contractures treated with perforator flaps are unlikely to ever need further surgery. Without islanding the flap it becomes a feasible option for reconstructing these patients even in the extremely resource poor environment in which they often present, and is an option for all plastic surgeons to consider in the reconstruction of large superficial defects. PMID:21237734
Tucker, S C
It is estimated worldwide that over 6 million people per annum experience a burn injury. Despite advances in management and improved survival rates, the incidence of hypertrophic scarring remains high. These scars are particularly common after burns and are often raised, red, hard and may cause abnormal sensations. Such pathological scarring can lead to severe functional impairment, psychological morbidity, and costly long term healthcare. Wound healing is an inherent process which restores the integrity of the skin after injury and although scarring is a frequent by-product, the scarless wound healing observed in early human gestational fetuses suggests that it is not an essential component of the response. This has lead to a large body of research attempting to understand the mechanisms behind scarring and in turn prevent it. One of the main focuses of recent research has been the role played by the growth factor TGF-? in the process of both wound healing and scar formation. The three isoforms (TGF-?1, TGF-?2 and TGF-?3) appear to have overlapping functions and predominantly mediate their effects through the intracellular SMAD pathway. Initial research suggested that TGF-?1 was responsible for the fibrotic scarring response whereas the scarless wound healing seen in fetal wounds was due to increased levels of TGF-?3. However, the reality appears to be far more complex and it is unlikely that simply altering the ratio of TGF-? isoforms will lead to scarless wound healing. Other aspects of the TGF-? system that appear promising include the downstream mediator CTGF, the proteoglycan decorin and the binding protein p311. Other putative mechanisms which may underlie the pathogenesis of hypertrophic scars include excessive inflammation, excessive angiogenesis, altered levels of matrix metalloproteinases, growth factors, and delayed apoptosis of fibrotic myofibroblasts either due to p53 genetic alterations or tensile forces across the wound. If an effective treatment for hypertrophic scars following burns injury is to be developed then further work must be carried out to understand the basic mechanisms of pathological scarring.
Penn, Jack W; Grobbelaar, Adriaan O; Rolfe, Kerstin J
Marjolin's ulcer is an aggressive ulcerating cutaneous malignancy that may arise in chronically inflamed or traumatized skin. Frequently overlooked, this rare condition is classically associated with burn scars, with the process of malignant degeneration typically occurring over two to three decades. The most common histopathological pattern is squamous cell carcinoma; however, compared to typical squamous cell carcinomas, Marjolin's ulcers have an increased rate of metastasis. The correlation between radiotherapy for benign hypertrophic scarring and carcinogenesis is controversial, with few reports in the literature. We present a unique case of a 61 year old Caucasian male who was burned by scald at age 4, received radiotherapy for his post-burn hypertrophic scars, and later developed multiple Marjolin's ulcers on his left arm, chest, and right temporal scalp. PMID:24290855
Zuo, Kevin J; Tredget, Edward E
Il s'agit d'une étude faisant ressortir les aspects épidémiologiques, cliniques et thérapeutiques des séquelles de brûlures du membre inférieur chez l'enfant, à propos de 42 cas colligés au service de chirurgie infantile de l'Hôpital Aristide Le Dantec (Sénégal). L'âge moyen retrouvé est de 5 ans et 3 mois, et le sex-ratio garçons/filles de 1,8/1. La brûlure thermique est causée par une flamme dans 33% des cas, par un liquide chaud dans 21% des cas, et par des braises dans 21% des cas. Les cicatrices rétractiles intéressent le genou et le creux poplité dans 47% des cas et le pied dans 45% des cas. Elles sont bilatérales dans 21% des cas, et concernent une autre localisation associée dans 21% des cas. Quant aux brides, 21% ont bénéficié d'une chirurgie, avec un délai moyen de 3 ans et 2 mois après la brûlure. Cette procédure chirurgicale consiste en une plastie en Z dans 91% des cas, à laquelle est associée une greffe de peau dans 54% des cas. Une rééducation fonctionnelle est pratiquée chez 54% des opérés. Parallèlement aux données de la littérature, nos résultats montrent que l'optimisation de la prise en charge passe par une meilleure prévention des accidents domestiques et une bonne codification thérapeutique. PMID:21991202
Sankale, A A; Manyacka Ma Nyemb, P; Coulibaly, N F; Ndiaye, A; Ndoye, M
One consequence of a facial burn is nasal contracture. In pediatric patients, scar tension presents a particular problem because of facial growth. The forehead and nasal scar contraction deform the nose dorsum, especially between the eyes. The nasofrontal angle becomes smoothened, wide, and flat; the scar edges cover the inner canthus. The dorsum nose scar stretching delays nasal development, pulls the nose up, making it shorter, and causes nasal ectropion. Secondary deformity of the nose's solid structures develops as a consequence of scar contracture, and its reconstruction poses a major problem. At the same time, it is suggested that nasal reconstruction in the pediatric patients should be planned as a staged procedure. Therefore, scar contracture release should be performed early, at the first stage of pediatric nasal reconstruction, to create conditions for normal nasal development. In this author's opinion, the most suitable procedure is trapeze-flap plasty. The scar tissue surplus in the nasofrontal angle allows contracture release with local tissues. Reconstruction with local trapezoid flaps releases the scar tension and elongates the nasal dorsum surface by approximately 1.5 cm; the epicanthus is eliminated, and the nasofrontal angle (nasal root) is restored. Eight children were operated. Good results were observed in all patients for the duration of 3 years. PMID:21799438
Grishkevich, Viktor M
The purpose of this study is to test the hypothesis that hypertrophic burn scars can be remodeled by fractional laser treatment and administration of stem cells. Finding the best ways to combine these approaches is a goal of this proposal. During the peri...
E. Badiavas R. Christy S. Davis
We report a case of a melanoma arising after about 10 years after a burn injury. This is an uncommon example of a carcinogenetic event that could be prevented or diagnosed early. Usually, the mutagenic event clinically appears many years after the burn especially if it was not treated correctly with a careful surgical approach. The average time of latency could be found in literature as 46.5 years from the burn, whereas our case was only 10. A frequent and very long follow-up of the burn scars could represent a valid prophylactic option to avoid neoplastic proliferation if the tumor appears. PMID:22627497
Ribero, Simone; Grassi, Marcella; Caliendo, Virginia; Lauro, Danilo; Macripò, Giuseppe
The Lena River in central Siberia is hidden beneath a veil of smoke from multiple wildfires burning around the city of Yakutsk, Russia. Fires have been burning in the region off and on since late May 2002, and may be agricultural in cause. This image was acquired by the Moderate Resolution Imaging Spectroradiometer (MODIS) on the Terra satellite on July 23, 2002. In the false=-color image, vegetation is bright green, smoke is blueish-white, and burned areas are reddish-brown. In both images, fire detections are marked with red outlines. Credit: Jacques Descloitres, MODIS Land Rapid Response Team, NASA/GSFC
The hand burns can be complicated with the scar contracture of the ulnar or radial hand border. The contracture restricts the mobility of adjacent joints (fifth interphalangeal, wrist joints), causing deviation of the small finger and the whole hand. The contracture and deviation are caused by semilunar fold sheets of which are scars (medial contracture). The fold sheets have the trapeze-shaped surface deficiency in length and surface surplus in width. Thus, the local tissue flaps should have the corresponding form (trapeze-shaped flaps) for surface deficiency compensation. The sheets are transformed into trapezoid flaps along the total length of the semilunar fold with radial incisions until the full tension release is achieved. The incision's ends are split to complete the scar tension release. The distance between radial incisions at the fold's top is approximately 2 to 3 cm, which matches the width of the flap's end. The flaps are mobilized with the full fatty layer and transposed toward each other until the end of one flap reaches the base of the opposite flap. As a result, the skin surface lengthens by two to three times, which allows complete contracture elimination. The contractures were liquidated in all 16 patients without complications. The trapeze-flap plasty is recommended for a wide use in treatment of hand boarder contractures. PMID:20182381
Grishkevich, Viktor M
The Rodeo Fire in east-central Arizona is burning within the Fort Apache Indian Reservation about 100 miles east-northeast of Phoenix (seen southwest of the fire as a large area of grayish pixels surrounded by scattered spots of dark green vegetation). The fire was about 48,000 acres as of June 20, 2002, and was 0 percent contained. These images from the Moderate Resolution Imaging Spectroradiometer (MODIS) on the Terra satellite was captured on June 19, 2002. In the false-color image the vegetation is green, and burned areas are red.
Burns are very frequent. Skin cancer on burns scars are one of the known complications. The mechanisms and the risk factors of this disease are not very well known. To review the risk factors and the mechanisms of transformation of burn scars into cancer, we analyzed 67 retrospective cases of Marjolin's ulcer to describe the epidemiological features of the disease in our practice and identify the factors of relapse. Our patients are young (means age 41), mainly male (54%), with disease localized on arms and legs (88%). The initial burn was from flames (54%), charcoal or hot cooking oil (19.5%) and never from ionizing radiation. It was never a superficial burn and covered from 4 to 37% of the body surface (mean 14%). The initial treatment was medical in only 9% of cases and ended with 85% of complete healing. After 4 to 67 years of evolution, 95% of re-ulceration occurred. Abnormal lymph node and distant metastasis were diagnosed in respectively 68 and 7% of the cases. Amputation and groin dissection were respectively done in 63 and 50%. One third of patients were lost during the follow up. 25% of the cases are still alive and free of disease. We found 30% of local recurrence and 17.5% of regional recurrence. By univariate analysis we found that the factors significantly associated to loco-regional relapse are: male status (p = 0.0327), burns by cooking oil (p = 0.0118), lack of treatment during initial burn (p = 0.0001), sclerous scar (p = 0.0281), supra regional lymph nodes (p = 0.028) lack of treatment during re ulceration (p = 0.0308). Squamous cell carcinomas on burn scars are rare diseases and of bad prognosis. Mainly associated to domestic accidents they frequently occur on limbs and arms on an articulation. Metastasis is not frequent. Conservative treatment is associated with 30% of recurrence. In our practice, the relapse risk factors are male status, burns by cooking oil, lack of treatment during the initial burn, sclerous scar, supra regional lymph nodes, lack of treatment during re ulceration. PMID:11957286
Kasse, A A; Betel, E; Dem, A; Diop, M; Fall, M C; Diop, P S; Dembele, B; Drabo, B; Timbely, G; Neloum, J; Toure, P
Anterior chest burns in young females frequently result in complicated problems such as scar contracture, damage to the nipple–areolar complex and breast tissue. Furthermore, an absent breast mound, hypoplasia or disfigurement of developed breasts can result in breast asymmetry and psychological problems. So we presented an alternative procedure that combines burn scar reconstruction and augmentation mammaplasty performed during one operative
Yen-Chang Hsiao; Jui-Yung Yang; Shiow-Shuh Chuang; Jiunn-Yuan Huang; Chung-Ho Feng
Paediatric burn follow-up optimally follows a balance between complication detection and avoiding unnecessary hospital visits. In a long-term review, we assessed complication patterns in children with burns requiring surgery. Using the Welsh Burns Centre database, a retrospective note review of paediatric burns over 3 years from 1995 was performed, identifying all children undergoing surgery for their burns. 94 patients were identified with a median follow-up since injury of 13.6 years. Mean age was 5.27 (SD=4.9) years. TBSA ranged from <1 to 70%. 94% underwent split-skin grafting. 18% (n=17) developed contractures and 33% (n=31) developed hypertrophic scarring. Those developing contractures were younger, and suffered significantly greater TBSA burns (p<0.05) than those developing hypertrophic scarring or those without complications. All contractures developed within 1-13 months, and hypertrophic scarring within 1-17 months. All patients sustaining axillary burns developed contractures, whilst 75% of contractures developed around the upper limb. In conclusion, younger patients with larger TBSA burns in the upper limb were at higher risk for contractures and hypertrophic scarring, which all presented within 18 months. Therefore any patients that are complication-free 18 months after-injury can be safely discharged, allowing streamlining of follow-up for the benefit of patients, parents and hospital resources. PMID:22727656
Kidd, L R; Nguyen, D Q; Lyons, S C; Dickson, W A
In the European context, Portugal presents the highest number of fire occurrences and has the largest area affected by wildfires. Like other southern regions of Europe, Portugal has experienced a dramatic increase in fire incidence during the last few decades that has been attributed to modifications in land-use as well as to climatic changes and associated occurrence of weather extremes. Wildfire activity also presents a large inter-annual variability that has been related to changes in the frequency of occurrence of atmospheric conditions favorable to the onset and spreading of large-fires. Since 1990, the Portuguese Authority for Forests (AFN) has been producing yearly maps of fire perimeters under a protocol with the Department of Forest Engineering of the Institute of Agronomy (DEF/ISA). The AFN fire atlas uses end of fire season Landsat TM/ETM imagery to map all fire perimeters with area larger than 5ha. Because it relies on end-of-season imagery, the atlas provides a spatial snapshot of the yearly area burned, and dates of burn for individual events cannot be estimated. Such information is nevertheless crucial to understand the fire regime and fire seasonality and to disentangle the complex interactions among fire, land cover and meteorology. The aim of the present work is to develop an automated procedure that allows using time series of moderate resolution imagery, such as the one provided by the MODIS instrument on-board TERRA and AQUA, to assign dates of burning to scars larger than 500 ha in the Landsat based fire atlas. The procedure relies on the so-called (V,W) burned index that uses daily reflectance obtained from the 1km MODIS Level 1B calibrated radiance from bands 2 (NIR) and 20 (MIR). The algorithm detects persistent changes in the (V,W) burned index time series, within each Landsat burned scar. The day of maximum change is then identified by means of a discrimination index, together with thresholds from the (V,W) time series. A spatial filter is finally applied to remove the outliers. An assessment of the temporal accuracy of the algorithm was conducted for the year 2005. For this year, Landsat based fire scars larger than 500ha have an associated detection date, based on field information provided by the AFN. The detection date is here assumed as ignition date of each scar. It is also assumed that each scar corresponds to a single fire event. Using 78 fire scars, we computed the time difference, in days, between the detection date and the date of burn, estimated by the algorithm. Our results show that 70% of all scars were correctly dated by the algorithm with differences to the AFN detection date up to three days. These correspond to 83% of the overall burned area used in the accuracy assessment.
DaCamara, C. C.; Libonati, R.; Barros, A.; Gaspar, G.; Calado, T. J.
In selected cases of cervical retractions after burns, the authors show that pedicled latissimus dorsi musculocutaneous flaps may be of great help if properly performed. The main advantages of this method are its simplicity and the lack of need for a postoperative cervical splint. PMID:11447628
Pittet, B; Cheretakis, A; Montandon, D
Pentoxifylline (PTF), a methylxanthine derivative, has therapeutic use as an antifibrotic agent. In vitro, PTF inhibits the production of collagen and reduces the proliferation of fibroblasts in hypertrophic scars. This study aimed to evaluate changes in the elasticity of hypertrophic scars in the peribuccal area in burned patients, who presented with mouth-opening limitation. Eighteen patients were divided into two groups. The case group (n=10) was treated with PTF 1 mg ml(-1), while in the control group (n=8) no treatment was performed. Measurements of mouth opening (lip-to-lip and tooth-to-tooth distances in mm) were taken, before and after five therapeutic sessions with pentoxifylline with weekly intervals. The variations of these measures (Delta%) were calculated and submitted to statistical analyses. There was a significant improvement in the opening of the mouth, in vermilion distance (V=3.20 mm) as much as the dental distance (DD=4.19 mm) in the treated group, than in the control group. It was noted that pentoxifylline increases the elasticity of hypertrophic scars in the perioral area. PMID:20064692
Isaac, Cesar; Carvalho, Viviane Fernandes; Paggiaro, André Oliveira; de Maio, Mauricio; Ferreira, Marcus Castro
It is important for clinicians to understand which are the clinical signs, the patient characteristics and the procedures that are related with the occurrence of hypertrophic burn scars in order to carry out a possible prognostic assessment. Providing clinicians with an easy-to- use tool for predicting the risk of pathological scars. A total of 703 patients with 2440 anatomical burn sites who were admitted to the Department of Plastic and Reconstructive Surgery, Burn Center of the Traumatological Hospital in Torino between January 1994 and May 2006 were included in the analysis. A Bayesian network (BN) model was implemented. The probability of developing a hypertrophic scar was evaluated on a number of scenarios. The error rate of the BN model was assessed internally and it was equal to 24·83%. While classical statistical method as logistic models can infer only which variables are related to the final outcome, the BN approach displays a set of relationships between the final outcome (scar type) and the explanatory covariates (patient's age and gender, burn surface area, full-thickness burn surface area, burn anatomical area and wound-healing time; burn treatment options such as advanced dressings, type of surgical approach, number of surgical procedures, type of skin graft, excision and coverage timing). A web-based interface to handle the BN model was developed on the website www.pubchild.org (burns header). Clinicians who registered at the website could submit their data in order to get from the BN model the predicted probability of observing a pathological scar type. PMID:22958613
Berchialla, Paola; Gangemi, Ezio Nicola; Foltran, Francesca; Haxhiaj, Arber; Buja, Alessandra; Lazzarato, Fulvio; Stella, Maurizio; Gregori, Dario
Purpose: The objective of the study was to compare the performance of i-gel supraglottic airway with cLMA in difficult airway management in post burn neck contracture patients and assess the feasibility of i-gel use for emergency airway management in difficult airway situation with reduced neck movement and limited mouth opening. Methods: Prospective, crossover, randomized controlled trial was performed amongst forty eight post burn neck contracture patients with limited mouth opening and neck movement. i-gel and cLMA were placed in random order in each patient. Primary outcome was overall success rate. Other measurements were time to successful ventilation, airway leak pressure, fiberoptic glottic view, visualization of square wave pattern. Results: Success rate for the i-gel was 91.7% versus 79.2% for the cLMA. i-gel required shorter insertion time (19.3 seconds vs. 23.5 seconds, P=0.000). Airway leak pressure difference was statistically significant (i-gel 21.2 cm H20; cLMA 16.9 cm H20; P=0.00). Fiberoptic view through the i-gel showed there were less epiglottic downfolding and better fiberoptic view of the glottis than cLMA. Overall agreement in insertion outcome for i-gel was 22/24 (91.7%) successes and 2/24(8.3%) failure and for cLMA, 19/24 (79.16%) successes and 5/24 (16.7%) failure in the first attempt. Conclusion: The i-gel is cheap, effective airway device which is easier to insert and has better clinical performance in the difficult airway management of the airway in the post burn contracture of the neck. Our study shows that i-gel is feasible for emergency airway management in difficult airway situation with reduced neck movement and limited mouth opening in post burn neck.
Singh, Jeevan; Yadav, Manohar Kumar; Marahatta, Sujan Babu; Shrestha, Bikash Lal
Following traumatic or surgical injury to the skin, wounds do not heal by tissue regeneration but rather by scar formation. Though healing is definitely a welcomed event, the resultant scar, very often, is not aesthetically pleasing, and not infrequently, may be pathologic causing serious deformities and contractures. Management of problematic scars continues to be a frustrating endeavor with less than optimal results. Prophylactic methods of wound management to minimize serious scarring are being developed. In a previously published study, we have demonstrated improved healing of split thickness skin graft donor sites following treatment with Moist Exposed Burn Ointment (MEBO, Julphar Gulf Pharmaceutical Industries, Ras Al-Khaimah, UAE). At present, we are reporting the results of a comparative clinical prospective study evaluating scar quality following primary healing of elective surgical and traumatic facial wounds with prophylactic MEBO application, topical antibiotic ointment application, and no topical therapy at all. Scars were evaluated according to the Visual Analogue Scale for scar assessment. Statistical analysis of scar assessment scores demonstrated marked prevention of unfavorable scars with improved cosmetic results following MEBO prophylactic therapy. PMID:12621572
Atiyeh, Bishara S; Ioannovich, John; Al-Amm, Christian A; El-Musa, Kusai A; Dham, Ruwayda
During the 1997/98 El Niño-induced drought peatland fires in Indonesia may have released 13-40% of the mean annual global carbon emissions from fossil fuels. One major unknown in current peatland emission estimations is how much peat is combusted by fire. Using a light detection and ranging data set acquired in Central Kalimantan, Borneo, in 2007, one year after the severe peatland fires of 2006, we determined an average burn scar depth of 0.33 +/- 0.18 m. Based on this result and the burned area determined from satellite imagery, we estimate that within the 2.79 million hectare study area 49.15 +/- 26.81 megatons of carbon were released during the 2006 El Niño episode. This represents 10-33% of all carbon emissions from transport for the European Community in the year 2006. These emissions, originating from a comparatively small area (approximately 13% of the Indonesian peatland area), underline the importance of peat fires in the context of green house gas emissions and global warming. In the past decade severe peat fires occurred during El Niño-induced droughts in 1997, 2002, 2004, 2006, and 2009. Currently, this important source of carbon emissions is not included in IPCC carbon accounting or in regional and global carbon emission models. Precise spatial measurements of peat combusted and potential avoided emissions in tropical peat swamp forests will also be required for future emission trading schemes in the framework of Reduced Emissions from Deforestation and Degradation in developing countries. PMID:19940252
Ballhorn, Uwe; Siegert, Florian; Mason, Mike; Limin, Suwido
During the 1997/98 El Niño-induced drought peatland fires in Indonesia may have released 13–40% of the mean annual global carbon emissions from fossil fuels. One major unknown in current peatland emission estimations is how much peat is combusted by fire. Using a light detection and ranging data set acquired in Central Kalimantan, Borneo, in 2007, one year after the severe peatland fires of 2006, we determined an average burn scar depth of 0.33 ± 0.18 m. Based on this result and the burned area determined from satellite imagery, we estimate that within the 2.79 million hectare study area 49.15 ± 26.81 megatons of carbon were released during the 2006 El Niño episode. This represents 10–33% of all carbon emissions from transport for the European Community in the year 2006. These emissions, originating from a comparatively small area (approximately 13% of the Indonesian peatland area), underline the importance of peat fires in the context of green house gas emissions and global warming. In the past decade severe peat fires occurred during El Niño-induced droughts in 1997, 2002, 2004, 2006, and 2009. Currently, this important source of carbon emissions is not included in IPCC carbon accounting or in regional and global carbon emission models. Precise spatial measurements of peat combusted and potential avoided emissions in tropical peat swamp forests will also be required for future emission trading schemes in the framework of Reduced Emissions from Deforestation and Degradation in developing countries.
Ballhorn, Uwe; Siegert, Florian; Mason, Mike; Limin, Suwido
Burns are ubiquitous injuries in modern society, with virtually all adults having sustained a burn at some point in their lives. The skin is the largest organ of the body, basically functioning to protect self from non-self. Burn injury to the skin is painful, resource-intensive, and often associated with scarring, contracture formation, and long-term disability. Larger burns are associated with morbidity and mortality disproportionate to their initial appearance. Electrical and chemical burns are less common injuries but are often associated with significant morbidity. PMID:21624716
Purdue, Gary F; Arnoldo, Brett D; Hunt, John L
Fas (Apo-1\\/CD95) is a cell-surface receptor involved in cell death signaling, and recent reports have suggested that defects within the Fas receptor pathway such as Fas mutation play an important part in the development and progression of human tumors. Burn scar-related squamous cell carcinoma of skin is a unique subtype of cutaneous squamous cell carcinoma, and tends to be more
Sug Hyung Lee; Min Sun Shin; Hong Sug Kim; Won Sang Park; Su Young Kim; Ja June Jang; Kyung Jin Rhim; Jin Jang; Hun Kyung Lee; Jik Young Park; Ro Ra Oh; Seo Young Han; Jong Heun Lee; Jung Young Lee; Nam Jin Yoo
The scope of this paper is to demonstrate, evaluate and compare two burn scar mapping (BSM) approaches developed and applied operationally in the framework of the RISK-EOS service element project within the Global Monitoring for Environment and Security (GMES) program funded by ESA ( http://www.risk-eos.com). The first method is the BSM_NOA, a fixed thresholding method using a set of specifically designed and combined image enhancements, whilst the second one is the BSM_ITF, a decision tree classification approach based on a wide range of biophysical parameters. The two methods were deployed and compared in the framework of operational mapping conditions set by RISK-EOS standards, based either on sets of uni- or multi-temporal satellite images acquired by Landsat 5 TM and SPOT 4 HRV. The evaluation of the performance of the two methods showed that either in uni- or multi-temporal acquisition mode, the two methods reach high detection capability rates ranging from 80% to 91%. At the same time, the minimum burnt area detected was of 0.9-1.0 ha, despite the coarser spatial resolution of Landsat 5 TM sensor. Among the advantages of the satellite-based approaches compared to conventional burn scar mapping, are cost-efficiency, repeatability, flexibility, and high spatial and thematic accuracy from local to country level. Following the catastrophic fire season of 2007, burn scar maps were generated using BSM_NOA for the entirety of Greece and BSM_ITF for south France in the framework of the RISK-EOS/GMES Services Element project.
Kontoes, C. C.; Poilvé, H.; Florsch, G.; Keramitsoglou, I.; Paralikidis, S.
Summary - This article reports on the effective use of a single session of eye movement desensitization (EMD) in the treatment of an exceptionally severe case of post-traumatic stress disorder (PTSD). The patient was the survivor of burns that left him with massive scarring, total deafness, bilateral amputations of the upper extremities above the elbow, severe contractures, and severely damaged
DAVID L. MCCANN
Background We conducted an experimental study to compare the effect of massage using topical agents (Kelo-cote or Contractubex) on scar formation by massaging the healed burn wound on the dorsal area of Sprague-Dawley (SD) rats. Methods Four areas of second degree contact burn were made on the dorsal area of each of 15 SD rats, using a soldering iron 15 mm in diameter. After gross epithelialization in the defect, 15 SD rats were randomly divided into four groups: the Kelo-cote group, Contractubex group, Vaseline group, and control group. Rats in three of the groups (all but the Control group) were massaged twice per day for 5 minutes each day, while those in the Control group were left unattended. For histologic analysis, we performed a biopsy and evaluated the thickness of scar tissue. Results In the Kelo-cote and Contractubex groups, scar tissue thicknesses showed a significant decrease, compared with the Vaseline and control groups. However, no significant differences were observed between the Kelo-cote and Contractubex groups. In the Vaseline group, scar tissue thicknesses showed a significant decrease, compared with the control groups. Conclusions The findings of this study suggest that massage using a topical agent is helpful in the prevention of scar formation and that massage only with lubricant (no use of a topical agent) also has a considerable effect, although not as much as the use of a topical agent. Thus, we recommend massage with a topical agent on the post-burn scar as an effective method for decreasing the scar thickness.
Ko, Won Jin; Suh, Bum Sin; Kim, Hyeon A; Heo, Woo Hoe; Choi, Gum Ha; Lee, Seo Ul
Purpose We reviewed the results of cross finger flaps after surgical release and vigorous postoperative exercises for long-standing, severe flexion contractures of the Proximal Interphalangeal (PIP) joints of fingers. Materials and Methods In 9 patients, all contracted tissue was sequentially released and the resultant skin defect was covered with a cross-finger flap. The cause of the contracture was contact burn in 4, skin graft in 3, and a previous operation in 2. The mean follow-up period was 41.2 months. Results The mean flexion contracture/further flexion in the joints were improved from 73.4/87.8° to 8.4/95.4° at the last follow-up. A mean of 19.5° of extension was achieved with vigorous extension exercise after the operation. The mean gain in range of motion (ROM) was 79.4°. Near full ROM was achieved in 3 cases. There were no major complications. Conclusions In severe flexion contractures with scarring of the PIP joints of fingers, cross finger flaps after sufficient release and vigorous postoperative exercise seems to be a reasonable option to obtain satisfactory ROM of the joints.
Hahn, Soo Bong; Kang, Ho Jung; Kang, Eung Shick
Burning of slashed tropical forests and pastures is among the most significant global sources of atmospheric emissions, yet the composition of the fuels and fires that creates these emissions is not well characterized. As part of the Smoke, Clouds, and Radiation-Brazil (SCAR-B) experiment, we measured total aboveground biomass (TAGB) as well as carbon, nitrogen, and sulfur pools in one cattle
Liane S. Guild; J. Boone Kauffman; Lisa J. Ellingson; Dian L. Cummings; Elmar A. Castro; Ron E. Babbitt; Darold E. Ward
Burning of slashed tropical forests and pastures is among the most significant global sources of atmospheric emissions, yet the composition of the fuels and fires that creates these emissions is not well characterized. As part of the Smoke, Clouds, and Radiation-Brazil (SCAR-B) experiment, we measured total aboveground biomass (TAGB) as well as carbon, nitrogen, and sulfur pools in one cattle
Liane S. Guild; J. Boone Kauffman; Lisa J. Ellingson; Dian L. Cummings; Elmar A. Castro; Ron E. Babbitt; Darold E. Ward
Type 3 axillary burn retractions, involving the neck, the axilla, the upper arm and the lateral aspect of the chest, can cause difficult static and dynamic deficits altering the aesthetic appearance and the function of the shoulder. The posterior scapular area can provide an autonomized skin flap, based on the circumflex scapular vessels. This scapular flap, used as an island vascular flap, easily covers the anterior and posterior aspects of the axilla, obtaining a smooth skin surface, with a good underlying subcutaneous fatty tissue. Its elastic properties are well adapted to the dynamic requirements of the separate movements of the shoulder joint. Performed on 25 axillary burn retractions in 20 patients, this flap provided a convincing improvement in the shoulder range of movement and a return to a normal activity. PMID:1726350
Téot, L; Martinetto, J P; Griffe, O; Souyris, F
Rehabilitation is an essential and integral part of burn treatment. It is not something which takes place following healing of skin grafts or discharge from hospital; instead it is a process that starts from day one of admission and continues for months and sometimes years after the initial event. Burns rehabilitation is not something which is completed by one or two individuals but should be a team approach, incorporating the patient and when appropriate, their family. The term ‘Burns Rehabilitation’ incorporates the physical, psychological and social aspects of care and it is common for burn patients to experience difficulties in one or all of these areas following a burn injury. Burns can leave a patient with severely debilitating and deforming contractures, which can lead to significant disability when left untreated. The aims of burn rehabilitation are to minimise the adverse effects caused by the injury in terms of maintaining range of movement, minimising contracture development and impact of scarring, maximising functional ability, maximising psychological wellbeing, maximising social integration
Flexion contracture of the elbow is a common sequela of burn injury. Numerous methods have been suggested for release, including grafting, Z-plasty, Y-V flaps, local or distant fasciocutaneous flaps, muscle or myocutaneous flaps, free flaps, tissue expanders and non-surgical orthotics. In this article the authors present their experience with the propeller flap method in seven cases of elbow flexion contracture. Sufficient extension and an acceptable aesthetic outcome were obtained. Other benefits include easy design and rapid flap elevation that permits a single stage correction of the deformity without further sacrificing an artery or muscle. We think that the main disadvantage of the propeller flap is using the same skin that has suffered from the burn insult which has a poorer cosmetic result. Other than this and excluding deep burn injuries, we believe that the propeller flap is a useful alternative for elbow contracture release. PMID:16384651
Aslan, Gurcan; Tuncali, Dogan; Cigsar, Bulent; Barutcu, Ayse Yuksel; Terzioglu, Ahmet
Unique anatomic and pathophysiologic features of the thermally burned pediatric hand are reviewed, with a focus on direct management of the injured tissue in the early phases of the treatment process. A nonoperative approach to most pediatric hand burns is advocated, and principles of early wound care, including antimicrobial therapy, and escharotomy are described. Specific emphasis is placed on distinctive characteristics of the fifth digit which make it prone to contracture patterns resembling a boutonniere-type deformity and on newer wound care technologies that simplify the application process without loss of antimicrobial and barrier function. The technical principles of full-thickness burn excision, as well as considerations in selecting suitable graft for burn closure, are also discussed. Finally, basic techniques for splinting, positioning, and exercising the burned pediatric hand are described. When properly applied, the principles discussed herein have rendered the severely scarred, functionless hand a rarity after thermal injury. PMID:18650716
Feldmann, Mark E; Evans, Jill; O, Seung-Jun
The purpose of this project was to develop an advanced orthosis which is effective in reducing upper and lower limb contractures in significantly less time than currently required with conventional methods. The team that developed the JCO consisted of an ...
K. McGee K. Parsons T. Krouskop T. R. Lunsford
The purpose of this project was to develop an advanced orthosis which is effective in reducing upper and lower limb contractures in significantly less time than currently required with conventional methods. The team that developed the JCO consisted of an engineer, orthotist, therapist, and physician.
Lunsford, Thomas R.; Parsons, Ken; Krouskop, Thomas; McGee, Kevin
A case of burn injury to lips and cheek mucosa is reported who developed severe contracture of cheek mucosa leading to inability to open mouth. Patient was misdiagnosed as a case of temporomandibular ankylosis and was managed on those lines to no relief. When the contracture was released and soft tissue defect repaired with nasolabial flap, patient gained near normal mouth opening. PMID:16499819
Cheema, Saeed Ashraf; Amin, Farhat
Most surgical patients end up with a scar and most of these would want at least some improvement in the appearance of the scar. Using sound techniques for wound closure surgeons can, to a certain extent, prevent suboptimal scars. This article reviews the principles of prevention and treatment of suboptimal scars. Surgical techniques of scar revision, i.e., Z plasty, W plasty, and geometrical broken line closure are described. Post-operative care and other adjuvant therapies of scars are described. A short description of dermabrasion and lasers for management of scars is given. It is hoped that this review helps the surgeon to formulate a comprehensive plan for management of scars of these patients.
Sharma, Mohit; Wakure, Abhijeet
... of treatment for acne scars. To obtain the best results, a dermatologist first examines your skin. After the exam, some patients are surprised to learn that their acne scars are actually a different skin problem. You’ll find pictures of different types of acne scars — and related ...
Deformities of the hands are a fairly common sequel of burn especially in the developing world. This is because of high incidence of burns, limited access to standard treatment and rehabilitation. The best outcome of a burnt hand is when deformities are prevented from developing. A good functional result is possible when due consideration is paid to hands during resuscitation, excisional surgery, reconstructive surgery and physiotherapy. The post-burns deformities of hand develop due direct thermal damage or secondary to intrinsic minus position due to oedema or vascular insufficiency. During the acute phase the concerns are, maintenance circulation minimize oedema prevent unphysiological positioning and wound closure with autogenous tissue as soon as possible. The rehabilitation program during the acute phase starts from day one and goes on till the hand has healed and has regained full range of motion. Full blown hand contractures are challenging to correct and become more difficult as time passes. Long-standing cases often land up with attenuation of extensor apparatus leading to swan neck and boutonniere deformity, muscle shortening and bony ankylosis. The major and most common pitfall after contracture release is relapse. The treatment protocol of contracture is solely directed towards countering this tendency. This article aims to guide a surgeon in obtaining optimal hand function and avoid pit falls at different stages of management of hand burns. The reasons of an unfavourable outcome of a burnt hand are possible lack of optimal care in the acute phase, while planning and performing reconstructive procedure and during aftercare and rehabilitation.
Objective: The aim was to evaluate the effect of honey dressing and silver sulfadiazene (SSD) dressing on wound healing in burn patients. Materials and Methods: We retrospectively reviewed the records of 108 patients (14–68 years of age), with first and second degree burns of less than 50% of the total body surface area admitted to our institution, over a period of 5 years (2004–2008). Fifty-one patients were treated with honey dressings and 57 with SSD. Time elapsed since burn, site, percentage, degree and depth of burns, results of culture sensitivity at various time intervals, duration of healing, formation of post-treatment hypertrophic scar, and/or contracture were recorded and analyzed. Results: The average duration of healing was 18.16 and 32.68 days for the honey and SSD group, respectively. Wounds of all patients reporting within 1 h of burns became sterile with the honey dressing in less than 7 days while there was none with SSD. All wounds treated with honey became sterile within 21 days while for SSD-treated wounds, this figure was 36.5%. A complete outcome was seen in 81% of all patients in the “honey group” while in only 37% patients in the “SSD group.” Conclusion: Honey dressings make the wounds sterile in less time, enhance healing, and have a better outcome in terms of hypertropic scars and postburn contractures, as compared to SSD dressings.
Gupta, Shilpi Singh; Singh, Onkar; Bhagel, Praveen Singh; Moses, Sonia; Shukla, Sumit; Mathur, Raj Kumar
Reconstruction of the oral commissure following electrical burn injury is a challenging problem. The commissure is a thin, delicate structure that is highly mobile and essential to normal facial appearance and expression. When there is full-thickness destruction of vermilion, mucosa, skin, and orbicularis muscle, the resulting contracture alters adjacent structures, displaces the commissure, and distorts facial animation. Utilizing a composite ventral tongue flap of mucosa and muscle in the reconstruction of the commissure permits effective release of scar contracture and replaces destroyed mucosa and muscle bulk. Remaining structures can be returned to their normal location, and the three-dimensional contours of the oral commissure can be better restored. The use of this flap in 21 patients has resulted in improved mobility, more normal facial expression, and more consistent results in the reconstruction of a wide range of commissure deformities. PMID:7761501
Donelan, M B
Chemical burns represent a major challenge for reconstructive surgeons. They are caused by exposure to acids, alkalis or other corrosive substances which result in various degrees of injury. This report highlights the challenges faced in managing such patients in a Nigerian teaching hospital. The medical records of seven patients (four females and three males) treated for chemical burns injury from January 2001 to December 2010 were retrospectively reviewed. All patients were younger than 30, with a mean age of 23.3. Most of them (85.7%) had sustained full thickness burns ranging from 8% to 33% of their body surface area. All cases were result of assaults. The male to female ratio was 1:1.3, and the average duration of hospital stay was 7.5 months. The face was affected in all patients. Patients presented with multiple deformities, like ectropion of eyelids, keratopathies, blindness, nasal deformities, microstomia, loss or deformities of the pinna, mentosternal contractures, and severe scarring of the face. Twenty-nine surgical procedures were performed, which included nasal and lip reconstruction, ectropion release, commissuroplasty, contracture release, and wound resurfacing. Management of chemical burns, especially in a developing country lacking specialised burn centres with appropriate facilities, is challenging. Prevention through public awareness campaigns, legislation for control of corrosive substances, and severe punishment for perpetrators of assaults using these substances will go a long way in reducing the incidence of chemical burns. PMID:23467188
Tahir, C; Ibrahim, B M; Terna-Yawe, E H
Background. Groin and perineal burn contracture is a rare postburn sequel. Such postburn contractures causes distressing symptoms to the patients and in the management of these contractures, both functional and cosmetic appearance should be the primary concern. Aims. To study the outcome of surgical treatment (STSG and multiple Z-plasties) in postburn contractures of groin and perineum. Material and Methods. We conducted a study of 49 patients, with postburn groin and perineal contractures. Release of contracture with split thickness skin grafting (STSG) was done in 44 (89.79%) patients and release of contracture and closure by multiple Z-plasties was done in 5 (10.21%) patients. Results. Satisfactory functional and cosmetic outcome was seen in 44 (89.79%) patients. Minor secondary contractures of the graft were seen in 3 (6.81%) patients who were managed by physiotherapy and partial recurrence of the contracture in 4 (8.16%) patients required secondary surgery. Conclusion. We conclude that postburn contractures of the groin and perineum can be successfully treated with release of contracture followed by STSG with satisfactory functional and cosmetic results. Long term measures like regular physiotherapy, use of pressure garments, and messaging with emollient creams should not be neglected and should be instituted postoperatively to prevent secondary contractures of the graft and recurrence of the contracture.
Sajad, Wani; Hamid, Raashid
Congenital contractural arachnodactyly (Beals syndrome) is an autosomal dominantly inherited connective tissue disorder characterized by multiple flexion contractures, arachnodactyly, severe kyphoscoliosis, abnormal pinnae and muscular hypoplasia. It is caused by a mutation in FBN2 gene on chromosome 5q23. Although the clinical features can be similar to Marfan syndrome (MFS), multiple joint contractures (especially elbow, knee and finger joints), and crumpled ears in the absence of significant aortic root dilatation are characteristic of Beals syndrome and rarely found in Marfan syndrome. The incidence of CCA is unknown and its prevalence is difficult to estimate considering the overlap in phenotype with MFS; the number of patients reported has increased following the identification of FBN2 mutation. Molecular prenatal diagnosis is possible. Ultrasound imaging may be used to demonstrate joint contractures and hypokinesia in suspected cases. Management of children with CCA is symptomatic. Spontaneous improvement in camptodactyly and contractures is observed but residual camptodactyly always remains. Early intervention for scoliosis can prevent morbidity later in life. Cardiac evaluation and ophthalmologic evaluations are recommended. PMID:16740166
Tunçbilek, Ergül; Alanay, Yasemin
We studied the amount and time-course of tension recovery after quick releases (0.25 mm) during experimental tetanus, potassium chloride contracture (KCl), hypoxic contracture (H) as well as joint glucose and oxygen deficiency contracture (HG) in left ventricular papillary muscles of rat and right ventricular papillary muscles of cat myocardium. Both in experimental tetanus and KCl contracture, the tension recovery was
The incidence of Dupuytren's contracture in a polyvinyl chloride (PVC) manufacturing plant, where a great deal of bagging and packing took place by hand, was higher than in another plant in which there was no bagging or packing. The incidence in the packing plant was double that found in an earlier survey by Early at Crewe Locomotive Works of 4801 individuals, most of whom were manual workers. The implication is that the nature of the work of bagging and packing in our PVC compounding plant may have triggered Dupuytren's contracture.
Aim: To determine the types of functional disabilities in adult and paediatric burns survivors, with specific emphasis on potential risk and socio-economic factors of burn disabilities present in Ghana. Patients and Methods: The descriptive study was carried out in Komfo Anokye Teaching Hospital, Kumasi, Ghana from May 2011 to April 2012. Burn survivors who came for follow-up visits after been discharged home and had functional disability were the participants of the study. They were physically examined and interviewed using a pre-tested questionnaire after their informed consent/or that of their parents (in the cases of paediatrics burns survivors) was sought. Results: A total of 70 participants consented for the study. Their ages ranged from 8/12 – 78 years, with a mean age of 12±1.7 years. Majority (60.0%, N=42) of the participants had third degree burns. The nature of disabilities of participants were mostly scar contractures (42.9%, N=30) of which 36.7% (N=11) had impeded arm elevation; 23.3% (N=7) could not fold the palm or move the digits. From the multiple regression analysis risk factors for burn victim to have disability were paediatric age (OR=11.1, P=0.043), third degree of burn (OR=6.2, P=0.001) and anatomical part affected (OR=18.3, P=0.031). Socio-economic factors that affected burn disability victims were nuclear family compensation (OR=4.2, P=0.021), community mockery/stigmatization (OR=0.1, P=0.052) and caretakers time and finance (OR=5.2, P=0.033). Conclusion: The commonest functional disabilities recorded were scar contractions of the axilla region which had impeded the ability of the patients to lift the arm. Risk factors for burns disability included childhood age, third degree of burn incurred and anatomical part affected. Social factors influencing the lives of burn survivors with disability were good family and negative community interactions. Significant economical factors recorded were caretakers’ time and financial constrains.
Scars due to burns cause important aesthetic and functional squeal, causing psicologic disorders that can limit personal and social relationships of these patients. In this article we review the type of scars, the factors influencing its function, its characteristics, and we update the different options to prevent and treat pathologic scars in these patients. The text concludes with an exhibition of camouflage techniques of scars through make-up. PMID:24738173
Peñas Raigoso, Carmen; Varga del Hoyo, Raquel; Blanco Arrien, Gloria; Díez Sanz, Ma Jesus
Limited data are available to assess the long-term effects of burns to the trunk sustained during early childhood on subsequent pregnancies. This population-based retrospective longitudinal study uses linked Western Australia hospital morbidity and midwives notification data for the period 1983-2008. During the study period, 824 girls younger than 15 years with non-erythema burns (partial thickness, full thickness, or unspecified burn depth) to the trunk were hospitalized in Western Australia. During the follow-up, 134 subjects with burns to the trunk during childhood were identified as having later pregnancies. The mean age at admission for burn injury was 5.7 ± 4.0 years, and the majority of burns were caused by scalds (51.5%) and flame (37.3%). For these subjects (N = 134), there were a total of 213 subsequent pregnancies. All pregnancies resulted in full-term live births. There were 142 (64.3%) vaginal deliveries, 26 (12.2%) breech or instrument, and 45 (21.2%) deliveries were by cesarean section. No admissions for scar conditions or revisions of burn scar or contracture were identified during any pregnancy (first to fourth) for subjects with burns to the trunk. Mode of delivery was not statistically significantly different from that experienced by subjects with burns sustained during childhood to other anatomical sites. For subjects in this study with less severe burns to the trunk, no specific detrimental impacts during pregnancy or delivery or to the fetus were identified. Further surveillance is required to gauge an accurate assessment of complications associated with severe trunk burns sustained during childhood. PMID:22269824
Duke, Janine; Wood, Fiona; Semmens, James; Edgar, Dale W; Rea, Suzanne
Dupuytren contracture is a condition that affects the palmar fascia. It most commonly affects men of northern European ancestry and initially presents at middle age. The diseased fascia may form cords that extend into the digits, resulting in limited motion and function. Treatment is aimed at either releasing or removing the diseased cord so that the finger can extend fully. Common interventions include surgery, needle aponeurotomy, and collagenase injection. Surgery remains the gold standard in treatment and most commonly includes a limited fasciectomy. Although often successful, surgery carries inherent risks and may involve a lengthy recovery with extensive therapy. Needle aponeurotomy and collagenase injections are office-based alternatives that aim to weaken the cord and release the contracture. Needle aponeurotomy involves repeated needling along the cord in intervals and collagenase injections to dissolve a portion of the cord. Despite being less invasive, problems such as nerve and/or tendon injury, skin tears, and autoimmune reactions have been reported. Regardless of treatment, recurrence remains a concern. PMID:24720301
Rizzo, Marco; Stern, Peter J; Benhaim, Prosper; Hurst, Lawrence C
The aim of this study was to explore the clinical value of the porcine acellular dermal xenograft (ADX) in combination with autologous split-thickness skin and pure autologous split-thickness skin grafting applied in deep full-thickness burns and scar wounds. A total of 30 patients with deep burns were randomly divided into experimental and control groups following escharectomy. The patients were separately treated with porcine acellular dermal xenograft (ADX) in combination with autologous split-thickness skin and pure autologous split-thickness skin graft. The wound healing was observed routinely and the scores were evaluated using Vancouver scar scale at different times following transplant surgery. The samples of cograft regions and the control group (pure transplant split-thickness skin autograft) were observed using light microscopy and electron microscopy, and the follow-up results were recorded. No conspicuous rejections on the cograft wound surface were observed. Compared with the control group, the cograft wounds were smooth, presented no scar contracture and exhibited good skin elasticity and recovery of the joint function. The cografted skin combined well and displayed a clear and continuous basal membrane, as well as gradually combined skin structure, a mature stratum corneum, downward extended rete pegs, a mainly uniform dermal collagen fiber structure, regular alignment, and fewer blood capillaries. Clear desmosome cograft regions were identified among heckle cells, as well as a clear and continuous basal membrane. The cografted skin of the combined split-thickness autograft and the acellular heterologous (porcine) dermal matrix showed an improved shape and functional recovery compared with the pure split-thickness skin autograft. The combination of the meshed ADX and the split-thickness skin autograft applied in deep full-thickness burns and scar wounds may induce tissue regeneration via dermis aiming. This method also has superior shape and functional recovery, and has an extensive clinical application value.
CHEN, XIAODONG; FENG, XIANGSHENG; XIE, JULIN; RUAN, SHUBIN; LIN, YAN; LIN, ZEPENG; SHEN, RUI; ZHANG, FENGGANG
Excessive scars form as a result of aberrations of physiologic wound healing and may arise following any insult to the deep dermis. By causing pain, pruritus and contractures, excessive scarring significantly affects the patient’s quality of life, both physically and psychologically. Multiple studies on hypertrophic scar and keloid formation have been conducted for decades and have led to a plethora of therapeutic strategies to prevent or attenuate excessive scar formation. However, most therapeutic approaches remain clinically unsatisfactory, most likely owing to poor understanding of the complex mechanisms underlying the processes of scarring and wound contraction. In this review we summarize the current understanding of the pathophysiology underlying keloid and hypertrophic scar formation and discuss established treatments and novel therapeutic strategies.
Gauglitz, Gerd G; Korting, Hans C; Pavicic, Tatiana; Ruzicka, Thomas; Jeschke, Marc G
Objective: Some of the most difficult problems to solve in a postburn breast are the correction of the breast mound deficiency, contour, and projection deformity, which are often associated with an anterior trunk scar. The aim of this study was to describe our experiences of postburn breast reconstruction by the island latissimus dorsi musculocutaneous flap (LDMCF). Method: Operative procedures were planned after measuring the volume, dimensions, sternal notch-to-nipple distance, deviation, asymmetry, contour, and projection. Scar contracture release was carried out and complete muscle elevation was performed in all patients. The size of the skin paddle depended on the envelope deficiency. Afterward, LDMCF was transferred by a subcutaneous tunneling, and the muscle was sutured in retroglandular, inferomedial, and inferolateral ways to shape the inframammary fold (IMF) contour, breast mound, and projection. The skin of the flap was trimmed to match the envelope deficiency. Result: A total of 9 burned patients (11 breasts), who had burnt anterior trunks due to scalds and flame, entered the study. They were reconstructed by LDMCF. The patients achieved breast contour (re-creating the IMF), projection, and breast mound increase. The means of breast mound and projection increase were about 140 mL and 2.5 cm, respectively. Conclusions: This study demonstrates that the method used for reconstructing the burned breast depends on the patient's clinical presentation. For the patients with anterior trunk scar who have breast mound deficiency, IMF, and projection deformity, LDMCF is one of the best options of reconstruction. PMID:21369368
Mousavizadeh, Seyed Mehdi; Motamed, Sadrollah; Hosseini, Seyed Nejat; Yavari, Parvin
Objective: Some of the most difficult problems to solve in a postburn breast are the correction of the breast mound deficiency, contour, and projection deformity, which are often associated with an anterior trunk scar. The aim of this study was to describe our experiences of postburn breast reconstruction by the island latissimus dorsi musculocutaneous flap (LDMCF). Method: Operative procedures were planned after measuring the volume, dimensions, sternal notch-to-nipple distance, deviation, asymmetry, contour, and projection. Scar contracture release was carried out and complete muscle elevation was performed in all patients. The size of the skin paddle depended on the envelope deficiency. Afterward, LDMCF was transferred by a subcutaneous tunneling, and the muscle was sutured in retroglandular, inferomedial, and inferolateral ways to shape the inframammary fold (IMF) contour, breast mound, and projection. The skin of the flap was trimmed to match the envelope deficiency. Result: A total of 9 burned patients (11 breasts), who had burnt anterior trunks due to scalds and flame, entered the study. They were reconstructed by LDMCF. The patients achieved breast contour (re-creating the IMF), projection, and breast mound increase. The means of breast mound and projection increase were about 140 mL and 2.5 cm, respectively. Conclusions: This study demonstrates that the method used for reconstructing the burned breast depends on the patient's clinical presentation. For the patients with anterior trunk scar who have breast mound deficiency, IMF, and projection deformity, LDMCF is one of the best options of reconstruction.
Mousavizadeh, Seyed Mehdi; Motamed, Sadrollah; Hosseini, Seyed Nejat; Yavari, Parvin
The concentrations of wave functions about classical periodic orbits, or quantum scars, are a fundamental phenomenon in physics. An open question is whether scarring can occur in relativistic quantum systems. To address this question, we investigate confinements made of graphene whose classical dynamics are chaotic and find unequivocal evidence of relativistic quantum scars. The scarred states can lead to strong conductance fluctuations in the corresponding open quantum dots via the mechanism of resonant transmission.
Huang, Liang [Department of Electrical Engineering, Arizona State University, Tempe, Arizona 85287 (United States); Lai Yingcheng [Department of Electrical Engineering, Arizona State University, Tempe, Arizona 85287 (United States); Department of Physics, Arizona State University, Tempe, Arizona 85287 (United States); Ferry, David K.; Goodnick, Stephen M. [Department of Electrical Engineering, Arizona State University, Tempe, Arizona 85287 (United States); Department of Physics, Arizona State University, Tempe, Arizona 85287 (United States); Center for Solid State Electronics Research, Arizona State University, Tempe, Arizona 85287 (United States); Akis, Richard [Department of Electrical Engineering, Arizona State University, Tempe, Arizona 85287 (United States); Center for Solid State Electronics Research, Arizona State University, Tempe, Arizona 85287 (United States)
When a wound heals, as everyone has observed, it contracts, thickens and wrinkles the neighbouring skin, forming a scar. The morphology of the scar depends on the type of wound; an urgent tracheotomy leads to a very different scar than a carefully planned face lift. The surgical challenges of intrusive procedures such as removal of skin lesions, skin transplantation or
Objective Contractures are a major clinical issue for patients with muscular dystrophies. However, it is unknown whether contractures are present in the widely used mdx mouse model of Duchenne muscular dystrophy. Therefore, the objectives of this study were to develop methods to measure muscle contractures in mice, to determine whether plantarflexion contractures are present in mdx mice, and to analyze the composition of the major muscles involved. Design Hindlimbs of eight wild type and six mdx mice were assessed every 2 wks during the course of a 12-wk study. Assessments included range of motion and in vivo torques about the ankle. At the end of the study, mice were euthanized, and muscles were analyzed for composition. Results The mdx mice had ~10 degrees less dorsiflexion, increased passive torque moving the ankle into dorsiflexion, and an increased passive-to-active torque ratio relative to wild type mice. Gastrocnemius muscle composition alterations included increased wet mass, decreased protein content, and increased collagen. Conclusions The results indicate that mdx mice have plantarflexion contractures similar to those seen in children with Duchenne muscular dystrophy. In future studies, these measures can be used to assess strategies to slow the progression of contractures that occur with muscular dystrophies.
Garlich, Michael W.; Baltgalvis, Kristen A.; Call, Jarrod A.; Dorsey, Lisa L.; Lowe, Dawn A.
Repair of wounds usually results in restoration of organ function, even if suboptimal. However, in a minority of situations, the healing process leads to significant scarring that hampers homeostasis and leaves the tissue compromised. This scar is characterized by an excess of matrix deposition that remains poorly organized and weakened. While we know much of the early stages of the repair process, the transition to wound resolution that limits scar formation is poorly understood. This is particularly true of the inducers of scar formation. Here, we present a hypothesis that it is the matrix itself that is a primary driver of scar, rather than being simply the result of other cellular dysregulations.
Yates, Cecelia C.; Bodnar, Richard
Keloids and hypertrophic scars are thick, raised dermal scars, caused by derailing of the normal scarring process. Extensive research on such abnormal scarring has been done; however, these being refractory disorders specific to humans, it has been difficult to establish a universal animal model. A wide variety of animal models have been used. These include the athymic mouse, rats, rabbits, and pigs. Although these models have provided valuable insight into abnormal scarring, there is currently still no ideal model. This paper reviews the models that have been developed.
Seo, Bommie F.; Lee, Jun Yong; Jung, Sung-No
Malignancies arising from burn scars though rare are well documented in the literature; squamous cell carcinoma is the most common burn scar neoplasm, and adenocarcinoma is an extremely uncommon and rarely reported tumor in these scars. We hereby report a case of a young woman who presented with a rapidly growing lump in a scar in the mammary region that sustained severe burns 20 years back. It was diagnosed as duct carcinoma breast on cytology and later confirmed on histopathology and immunohistochemistry. The case mandates regular follow-up of patients with post-burn scars, and any lump arising in that region should be promptly investigated.
Singh, Neha; Rao, Seema; Jain, Shyama
An embodiment of the invention includes methods for the long-term augmentation and/or repair of skin defects (scars, skin laxness, skin thinning, and skin augmentation), cellulite, breast tissue, wounds and burns, urological and gastroesophageal sphincter structures, hernias, periodontal disease and disorders, tendon and ligament tears and baldness, by the injection or direct surgical placement/implantation of autologous cultured cells and/or cultured cell-produced extracellular matrix that is derived from connective tissue, dermis, fascia, lamina propria, stroma, adipose tissue, muscle, tendon, ligament or the hair follicle. The corrective application is done on tissue proximal or within the area of the defect. The method involves retrieving viable cells from the subject, a neonate or human fetus. Alternatively, the corrective application involves the cells placed in a matrix, preferably comprised of autologous extracellular matrix constituents as a three-dimensional structure or as a suspension, prior to placement into a position with respect to the subject's defect. In a further embodiment, the preferable autologous extracellular matrix constituents are collected from culture and placed in a position with respect to the subject's defect.
The objective of the program is the development of a synthetic polymer burn covering which will reduce dehydration, sepsis, sodium loss, scar formation and mortality of burn patients. Two approaches were successfully investigated. The first utilizes a sol...
J. B. Gregory J. D. Gresser D. L. Wise
Summary A 6-yr-old boy was the victim of a burns accident in a public bathhouse. The burns involved the face, neck, upper and lower extremities, anterior and posterior trunk, and both buttocks, covering 72% of the total body surface area (TBSA). The lesions in the lower extremities and parts of the right upper extremity were deep partial-thickness, comprising 40% TBSA. On day 5 post-burn, the lesions in both lower extremities were excised to the extent of the fascia under general anaesthesia. Meshed J1 Jayya Acellular Dermis®, a kind of acellular allodermal (ADM) matrix, was then placed on the left knee joint. The right knee joint served as control. The wounds in both lower extremities were then overlaid with microskin autografting. At 19 days post-application, the lesions in both lower extremities had almost completely resurfaced. Follow-up at six months revealed well-healed and stable skin of acellular ADM and microskin autografts on the left knee. However, the skin of the right knee was unstable and there was a chronic residual ulcer. Both legs showed some significant hypertrophic scars. The left knee joint (acellular ADM grafted site) showed mild contractures, while the right knee joint developed a significant contracture. The "skin" of the co-graft covered site appeared thicker and more elastic. The movement range of the left knee joint was much larger than that of the right knee joint. These results suggest that co-graft of acellular dermal matrix and autogenous microskin may be an effective way to repair this functional site in children with extensive burns and to improve the functional and cosmetic results.
Chen, X.L.; Xia, Z.F.; Fang, L.S.; Wang, Y.J.; Wang, C.H.
The purpose of this study was to determine, in principle, whether microdermabrasion can alter waffle-pattern (meshed split-thickness skin graft) burn scars after scar maturation. Matured waffle-pattern mesh-graft scars were treated with multiple microdermabrasion sessions over the course of a year (maximum 20). Before and after treatment, the treated scars and the control scar on the same patient were assessed with subjective and objective scar assessment tools (scar scales, cutometer [elasticity], laser Doppler flowmeter [vascularity], Semmes-Weinstein filaments [sensation], and high-resolution ultrasound [thickness]). The treatment resulted in continuous improvement of some physiologic skin functions like perfusion response (feedback), thickness, and elasticity when compared with nontreated scar, although no statistical significance was reached. Both Vancouver scar scale and patient assessment scales showed significant improvement. The study showed that even mature waffle pattern scars can be modified by minimally invasive interventions. Larger study groups and more economic treatment modalities need to be studied in the future. PMID:22079914
Blome-Eberwein, Sigrid A; Roarabaugh, Chad; Gogal, Christina; Eid, Sherrine
The etiology of hypertrophic scarring, a pathological end point of wound healing, is unknown. The scars most commonly occur when epithelialization has been delayed during, for example, the healing of deep dermal burn wounds. Hypertrophic scars are conventionally described as a dermal pathology in which the epidermis has only a passive role. In this study, the expression of keratin intermediate filament proteins and filaggrin has been investigated in the epidermis of hypertrophic scars and site-matched controls from the same patients. Hypertrophic scar epidermis was found to express the hyperproliferative keratins K6 and K16 in interfollicular epidermis in association with K17 and precocious expression of filaggrin. K16 mRNA was localized by in situ hybridization using a highly specific cRNA probe. In contrast to the immunohistochemical location of K16 protein, the K16 mRNA was found to be expressed in the basal cell layer of normal skin. In hypertrophic scars the mRNA distribution corroborated the abnormal K16 protein distribution. These results suggest the keratinocytes in hypertrophic scar epidermis have entered an alternative differentiation pathway and are expressing an activated phenotype. Activated keratinocytes are a feature of the early stages of wound healing producing growth factors that influence fibroblasts, endothelial cells, and the inflammatory response. We propose that cellular mechanisms in the pathogenesis of hypertrophic scarring are more complex than isolated dermal phenomena. The persistence of activated keratinocytes in hypertrophic scar epidermis implicates abnormal epidermal-mesenchymal interactions. Images Figure 1 Figure 3
Machesney, M.; Tidman, N.; Waseem, A.; Kirby, L.; Leigh, I.
Most cutaneous wounds heal with scar formation. Ideally, an inconspicuous normotrophic scar is formed, but an abnormal scar (hypertrophic scar or keloid) can also develop. A major challenge to scientists and physicians is to prevent adverse scar formation after severe trauma (e.g. burn injury) and understand why some individuals will form adverse scars even after relatively minor injury. Currently, many different models exist to study scar formation, ranging from simple monolayer cell culture to 3D tissue-engineered models even to humanized mouse models. Currently, these high-/medium-throughput test models avoid the main questions referring to why an adverse scar forms instead of a normotrophic scar and what causes a hypertrophic scar to form rather than a keloid scar and also, how is the genetic predisposition of the individual and the immune system involved. This information is essential if we are to identify new drug targets and develop optimal strategies in the future to prevent adverse scar formation. This viewpoint review summarizes the progress on in vitro and animal scar models, stresses the limitations in the current models and identifies the future challenges if scar-free healing is to be achieved in the future. PMID:24750541
van den Broek, Lenie J; Limandjaja, Grace C; Niessen, Frank B; Gibbs, Susan
The Smoke, Clouds, and Radiation-Brazil (SCAR-B) field project took place in the Brazilian Amazon and cerrado regions in August-September 1995 as a collaboration between Brazilian and American scientists. SCAR-B, a comprehensive experiment to study biomass burning, emphasized measurements of surface biomass, fires, smoke aerosol and trace gases, clouds, and radiation, their climatic effects, and remote sensing from aircraft and satellites.
Y. J. Kaufman; P. V. Hobbs; V. W. J. H. Kirchhoff; P. Artaxo; L. A. Remer; B. N. Holben; M. D. King; D. E. Ward; E. M. Prins; K. M. Longo; L. F. Mattos; C. A. Nobre; J. D. Spinhirne; Q. Ji; A. M. Thompson; J. F. Gleason; S. A. Christopher; S.-C. Tsay
A microbiological survey was carried out among different types of frost scars. Surface samples from soils supporting extensive vegetation contained significantly more mesophilic and psychrophilic bacteria than samples from bare, mineral soils. There were ...
W. L. Boyd J. W. Boyd
Post-burn or post-inflammatory scarring of the breast may have significant effects on the shape and volume of the breast as well as on the nipple-areola complex (NAC). Significant asymmetry of the breasts and distortion of the NAC may result, with marked consequent psychological and physiological sequelae for the patients. This report presents three cases of scar-induced breast deformities and the use of modified reduction mammoplasty for their management. The breast scarring was induced either by burn injuries or by chronic granulomatous mastitis. Reduction mammoplasty was used to reshape the deformed scarred breast and to balance the volume asymmetry between the scarred and the non-scarred breasts. The NAC was mobilized safely on a dermal parenchymal pedicle in any direction regardless of the orientation of the pedicle. In conclusion, cosmetic surgery in the scarred breast was found to be a safe and rewarding procedure with good aesthetic results. However, it has to be carefully planned. PMID:21991184
Summary Post-burn or post-inflammatory scarring of the breast may have significant effects on the shape and volume of the breast as well as on the nipple-areola complex (NAC). Significant asymmetry of the breasts and distortion of the NAC may result, with marked consequent psychological and physiological sequelae for the patients. This report presents three cases of scar-induced breast deformities and the use of modified reduction mammoplasty for their management. The breast scarring was induced either by burn injuries or by chronic granulomatous mastitis. Reduction mammoplasty was used to reshape the deformed scarred breast and to balance the volume asymmetry between the scarred and the non-scarred breasts. The NAC was mobilized safely on a dermal parenchymal pedicle in any direction regardless of the orientation of the pedicle. In conclusion, cosmetic surgery in the scarred breast was found to be a safe and rewarding procedure with good aesthetic results. However, it has to be carefully planned.
Special emphasis is placed on the clinical management of facial scarring because of the profound physical and psychological impact of facial burns. Noninvasive methods of facial scar management include pressure therapy, silicone, massage, and facial exercises. Early implementation of these scar management techniques after a burn injury is typically accepted as standard burn rehabilitation practice, however, little data exist to support this practice. This study evaluated the timing of common noninvasive scar management interventions after facial skin grafting in children and the impact on outcome, as measured by scar assessment and need for facial reconstructive surgery. A retrospective review of 138 patients who underwent excision and grafting of the face and subsequent noninvasive scar management during a 10-year time frame was conducted. Regression analyses were used to show that earlier application of silicone was significantly related to lower Modified Vancouver Scar Scale scores, specifically in the subscales of vascularity and pigmentation. Early use of pressure therapy and implementation of facial exercises were also related to lower Modified Vancouver Scar Scale vascularity scores. No relationship was found between timing of the interventions and facial reconstructive outcome. Early use of silicone, pressure therapy, and exercise may improve scar outcome and accelerate time to scar maturity. PMID:23816994
Parry, Ingrid; Sen, Soman; Palmieri, Tina; Greenhalgh, David
Healed partial thickness wounds including burns and donor sites cause hypertrophic scar formation and patient discomfort. For many patients with hypertrophic scars, pruritus is the most distressing symptom, which leads to wound excoriation and chronic wound formation. In spite of the clinical significance of abnormal innervation in scars, the nervous system has been largely ignored in the pathophysiology of hypertrophic scars. Evidence that neuropeptides contribute to inflammatory responses to injury include inflammatory cell chemotaxis, cytokine and growth factor production. The neuropeptide substance P, which is released from nerve endings after injury, induces inflammation and mediates angiogenesis, keratinocyte proliferation, and fibrogenesis. Substance P activity is tightly regulated by neutral endopeptidase (NEP), a membrane bound metallopeptidase that degrades substance P at the cell membrane. Altered substance P levels may contribute to impaired cutaneous healing responses associated with diabetes mellitus or hypertrophic scar formation. Topical application of exogenous substance P or an NEP inhibitor enhances wound closure kinetics in diabetic murine wounds suggesting that diabetic wounds have insufficient substance P levels to promote a neuroinflammatory response necessary for normal wound repair. Conversely, increased nerve numbers and neuropeptide levels with reduced NEP levels in human and porcine hypertrophic scar samples suggest that excessive neuropeptide activity induces exuberant inflammation in hypertrophic scars. Given these observations about the role of neuropeptides in cutaneous repair, neuronal modulation of repair processes at two extremes of abnormal wound healing, chronic non-healing ulcers in type II diabetes mellitus and hypertrophic scars in deep partial thickness wounds, may provide therapeutic targets. PMID:17727464
Scott, Jeffrey R; Muangman, Pornprom; Gibran, Nicole S
Limb-girdle muscular dystrophies (LGMDs) is a heterogeneous group of muscular dystrophies that mostly affect the pelvic and shoulder girdle muscle groups. We report here a case of neuromuscular disease associated with Dupuytren's contracture, which has never been described before as cosegregating with an autosomal dominant type of inheritance. Dupuytren's contracture is a common disease, especially in Northern Europe. Comorbid conditions associated with Dupuytren's contracture are repetitive trauma to the hands, diabetes, and seizures, but it has never before been associated with neuromuscular disease. We hypothesize that patients may harbor mutations in genes with functions related to neuromuscular disease and Dupuytren's contracture development.
Lace, Baiba; Inashkina, Inna; Micule, Ieva; Vasiljeva, Inta; Naudina, Maruta Solvita; Jankevics, Eriks
Synopsis Limb contractures are a common impairment in neuromuscular diseases (NMD). They contribute to increased disability due to decreased motor performance, mobility limitations, reduced functional range of motion, loss of function for activities of daily living (ADL), and increased pain. The pathogenesis of contractures is multifactorial. Myopathic conditions are associated with more severe limb contractures in comparison to neuropathic disorders. Although the evidence supporting the efficacy of multiple interventions to improve ROM in NMD in a sustained manner is lacking, there are generally accepted principles with regard to splinting, bracing, stretching, and surgery that help minimize the impact or disability from the contractures.
Skalsky, Andrew J.; McDonald, Craig M.
Bleach is a common household product which can cause caustic injuries. Its effects on mucosal tissues and the eye have been well-described in the literature. However, there is little information published regarding the appearance and effect of bleach on a child's skin. We report three children who sustained chemical burns after contact with bleach. All three children sustained accidental bleach burns while at home, and each child had a distinct brown discoloration to the skin from the injury. All three children had treatment and follow-up for their burns. Two of the children sustained more severe burns, which were extensive and required more time to heal. There was also long-term scarring associated with the severe burns. Like most burns, pain control is required until the injury heals. PMID:23545350
Lang, Cathleen; Cox, Matthew
Background Uterine rupture at the site of a previous cesarean scar is an uncommon but catastrophic complication of pregnancy, which is associated with significant maternal and fetal morbidity and mortality. Case Presentation A 30-year old woman at 24th week of gestation and complaint of pain, contractions and spotting was admitted in Royan Institute in Tehran, Iran. She had a past medical history of an EP and a cesarean section delivery, respectively 4 and 2 years before hospitalization. Herniation of an amniotic membrane into the maternal bladder was found on ultrasound examination. Conclusion Risk factors of cesarean scar rupture should be considered in women undergoing subsequent pregnancies as they need extra care. Ultrasonography can be used to evaluate women with previous cesarean section to assess the risks of scar rupture during subsequent pregnancies.
Ahmadi, Firoozeh; Siahbazi, Shiva; Akhbari, Farnaz
Dupuytren contracture is not a rare disorder. However, the contracture limited to the DIP joint is rare conditions. In this study, we describe a case of Dupuytren contracture limited to the DIP joint occurred in the ring finger. PMID:20478727
Background Pirfenidone (PFD), a new antifibrotic and antiinflammatory agent, prevents and resolves fibrous tissue. This study evaluated\\u000a the effect of PFD on adverse events in mammary implants using an animal model. Mammary implantation, the most frequent aesthetic\\u000a surgery, may present several complications after surgery such as swelling, capsule contracture, hardness, and pain.\\u000a \\u000a \\u000a \\u000a Methods Wistar rats underwent submammary implantation with either smooth or
Matias Gancedo; Luis Ruiz-Corro; Adriana Salazar-Montes; Ana Rosa Rincón; Juan Armendáriz-Borunda
Psoriasis is a relatively frequent inflammatory dermatosis. Scarring alopecia due to scalp psoriasis was first reported in 1972, but few reports have been written since then, showing that this is a very rare complication of a common disorder. We report a young Brazilian woman with longstanding scalp psoriasis, which progressed to scaring alopecia.
Almeida, Maiana Carneiro; Romiti, Ricardo; Doche, Isabella; Valente, Neusa Yuriko Sakai; Donati, Aline
Scar formation is an inevitable consequence of wound healing from either a traumatic or a surgical intervention. The aesthetic appearance of a scar is the most important criteria to judge the surgical outcome. An understanding of the anatomy and wound healing along with experience, meticulous planning and technique can reduce complications and improve the surgical outcome. Scar revision does not erase a scar but helps to make it less noticeable and more acceptable. Both surgical and non-surgical techniques, used either alone or in combination can be used for revising a scar. In planning a scar revision surgeon should decide on when to act and the type of technique to use for scar revision to get an aesthetically pleasing outcome. This review article provides overview of methods applied for facial scar revision. This predominantly covers surgical methods.
Garg, Shilpa; Dahiya, Naveen; Gupta, Somesh
... surgery Resurfacing: Laser therapy, chemical peeling, dermabrasion, microdermabrsion Fillers Skin tightening Collagen-induction therapy, aka needling Electrodesiccation Treatment for raised acne scars Injections (corticosteroids, interferon, 5-FU, etc.) Acne scar surgery ...
Dupuytren's contracture is a condition commonly encountered by hand surgeons, although it is rare in the Asian population. Various surgical procedures for Dupuytren's contracture have been reported, and the outcomes vary according to the treatment modalities. We report the treatment results of segmental fasciectomies with multiple transverse incisions for patients with Dupuytren's contracture. The cases of seven patients who underwent multiple segmental fasciectomies with multiple transverse incisions for Dupuytren's contracture from 2006 to 2011 were reviewed retrospectively. Multiple transverse incisions to the severe contracture sites were performed initially, and additional incisions to the metacarpophalangeal (MCP) joints, and the proximal interphalangeal (PIP) joints were performed if necessary. Segmental fasciectomies by removing the fibromatous nodules or cords between the incision lines were performed and the wound margins were approximated. The mean range of motion of the involved MCP joints and PIP joints was fully recovered. During the follow-up periods, there was no evidence of recurrence or progression of disease. Multiple transverse incisions for Dupuytren's contracture are technically challenging, and require a high skill level of hand surgeons. However, we achieved excellent correction of contractures with no associated complications. Therefore, segmental fasciectomies with multiple transverse incisions can be a good treatment option for Dupuytren's contracture.
Lee, Hyunjic; Cho, Sanghun; Jones, Neil F.
Scars from burn injuries have a negative influence on body image. Patients with borderline symptoms with nonsuicidal self-injuries (NSSIs), which often result in scars, report body image disturbances. We study whether the origin and characteristics of scars are associated with body image. Altogether, 125 female participants (n = 65 with NSSI) filled in multidimensional body image questionnaires. The participants with NSSI reported a significantly more negative body image on most subscales compared with the participants with scars of other origins. This result remained significant after partialling out scar characteristics from regression equations. On a scale assessing body image after injuries, a significant correlation with origin of scars was found after additionally partialling out body mass index and borderline symptoms. These results indicate that self-inflicted scars may adversely affect body image. Addressing NSSI, which is relevant in a multitude of disorders, early in treatment might help to reduce the extent of scarification and therefore reduce the disturbance of body image. PMID:24284644
Dyer, Anne; Hennrich, Linda; Borgmann, Elisabeth; White, Andrew J; Alpers, Georg W
Posterior capsular contracture is a common cause of shoulder pain in which the patient presents with restricted internal rotation and reproduction of pain. Increased anterosuperior translation of the humeral head occurs with forward flexion and can mimic the pain reported with impingement syndrome; however, the patient with impingement syndrome presents with normal range of motion. Initial management of posterior capsular contracture should be nonsurgical, emphasizing range-of-motion stretching with the goal of restoring normal motion. For patients who fail nonsurgical management, arthroscopic posterior capsule release can result in improved motion and pain relief. In the throwing athlete, repetitive forces on the posteroinferior capsule may cause posteroinferior capsular hypertrophy and limited internal rotation. This may be the initial pathologic event in the so-called dead arm syndrome, leading to a superior labrum anteroposterior lesion and, possibly, rotator cuff tear. Management involves regaining internal rotation such that the loss of internal rotation is not greater than the increase in external rotation. In the athlete who fails nonsurgical management, a selective posteroinferior capsulotomy can improve motion, reduce pain, and prevent further shoulder injury. PMID:16675620
Bach, H Gregory; Goldberg, Benjamin A
Congenital contractural arachnodactyly (CCA) is a heritable connective tissue disorder caused by defects in the gene encoding fibrillin-2 (FBN2). People with CCA typically have a marfanoid habitus, flexion contractures, severe kyphoscoliosis, abnormal pinnae, and muscular hypoplasia. Because of the relative infrequency of the syndrome and its generally mild to moderate severity, prenatal diagnosis had not previously been sought. Here we report prenatal diagnosis in a family with CCA. Because the course of the disease in the proband was rather severe, she had requested genetic counseling as early as age 17. She delayed childbearing until prenatal diagnosis for CCA became possible. This decision was supported by her mother and later her husband. Because she shared the same genotype with her husband, genetic linkage analysis of this family did not alter the a priori 50% risk of having an affected child. The possibility of unambiguously ascertaining the affected status of a fetus homozygous for the tested FBN2 marker was sufficient for the family to pursue prenatal diagnosis. This case strongly points to the importance of informed decisions now that genetic testing is becoming commonplace. PMID:10464661
Belleh, S; Spooner, L; Allanson, J; Godfrey, M
We describe a scar-related reentrant ventricular tachycardia circuit with a proximal segment in an endocardial basal septal scar and an exit in a region of slow conduction in a non-overlapping region of epicardial basal lateral scar. The 12-lead EKG demonstrates criteria for a basal lateral epicardial VT, however the same morphology could be produced with a longer stim-latency with pace mapping or VT induction from the endocardial septal region of scar. A significant segment of myocardium demonstrated no endocardial or epicardial scar on electroanatomic mapping, suggesting the presence of a mid-myocardial isthmus. Further evidence was provided by assessment of unipolar settings. The epicardial VT that initially appeared to originate from the basal lateral epicardial region, was successfully treated with radiofrequency ablation of the lateral aspect of the endocardial septal scar.
Bradfield, Jason S; Tung, Roderick; Shivkumar, Kalyanam
Summary Aim: To evaluate the differences between keloid and hypertrophic scars by biochemical and ultrastructural techniques. Method: Over 1000 patients with different types of scars were studied and followed up for a period of 20 years. The histochemical and biochemical analysis with respect to the composition of the extracellular matrix of the dermis was conducted. At the ultrastructural level, collagen deposition and assembly were studied using electron microscopy. The rate of proliferation and metabolic activity of the dermal fibroblasts isolated from the normal skin and scar biopsies were studied to assess the cause of excess matrix deposition in scar tissues. Results: Evaluation of different types of scars showed that both keloid and hypertrophic scars have excess matrix deposition in terms of collagen and proteoglycans. Keloid shows a high amount of acid-soluble collagen. The assembly of collagen fibrils is also abnormal in keloids. Studies on the proliferation and metabolic activity showed that keloid fibroblasts have a higher rate of proliferation and metabolic activity than fibroblasts from hypertrophic scars and normal skin. Finally, keloid fibroblasts show high and intense staining for the endoplasmic reticulum, suggesting a possible reason for high activity of these fibroblasts. Conclusion: Keloids and hypertrophic scars show distinct ultrastructural patterns of both collagen deposition and assembly. These parameters could be refined by further research, and they would thus serve as a useful tool for surgeons to distinguish different types of scars and adopt suitable therapeutic strategies.
Meenakshi, J.; Jayaraman, V.; Ramakrishnan, K.M..; Babu, M.
Keloids and hypertrophic scars are quite common diseases that can occur after any kind of wound and skin inflammation in predisposed individuals. Despite their benign nature, they can be aesthetically disabling and they are often accompanied by unpleasant symptoms such pain, burning and itching. Several approaches have been tried but most of them with poor results. Ablative fractional CO(2) laser seems to be an encouraging approach in treatment of keloids and hypertrophic scars, not only for its efficacy, but also for its low harmfulness. Radiotherapy following surgical excision is commonly used to treat these scars, but an increased incidence of different kinds of cancer from radiation has been demonstrated in several cases. Compared to radiotherapy, the use of CO(2) laser after surgical excision of keloids has shown great results with no recurrence and without the risk of carcinogenesis. PMID:22384790
Scrimali, Luca; Lomeo, Giuseppe; Tamburino, Serena; Catalani, Alexei; Perrotta, Rosario
Cutaneous scarring can cause patients symptoms ranging from the psychological to physical pain. Although the process of normal scarring is well described the ultimate cause of pathological scarring remains unknown. Similarly, exactly how early gestation fetuses can heal scarlessly remains unsolved. These questions are crucial in the search for a preventative or curative antiscarring agent. Such a discovery would be of enormous medical and commercial importance, not least because it may have application in other tissues. In the clinical context the assessment of scars is becoming more sophisticated and new physical, medical and surgical therapies are being introduced. This review aims to summarise some of the recent developments in scarring research for non-specialists and specialists alike.
Baker, Richard; Urso-Baiarda, Fulvio; Linge, Claire; Grobbelaar, Adriaan
An excess of 70 million cutaneous surgical procedures are conducted annually in the United States that may result in scarring. Skin scars are a normal outcome of the tissue repair process. However, individuals with abnormal scarring may have aesthetic, psychological, and social consequences. As a result, there is a high patient demand for products that will reduce the scarring. The principles underlying scar formation are now better understood. Products are being developed to address those critical components of the wound-healing process, namely inflammation, hydration, and collagen maturation. A multicomponent scar product was previously shown effective in preventing exaggerated scarring in patients undergoing various surgical procedures. The present outpatient study was conducted in patients undergoing shave biopsies. Following reepithelialization, this investigator-blinded, randomized, 8-week trial compared twice-daily application of either the scar product or the standard of care, white petrolatum. Evaluation visits were conducted at baseline and at weeks, 1, 2, 4 and 8. Subjects were evaluated by the blinded investigator for clinical efficacy and tolerability using grading scales. Standardized digital photographs were taken at each visit, and subjects completed a self-assessment questionnaire regarding treatment effectiveness and satisfaction. Twenty-eight subjects completed the 8-week study. The scar product provided earlier improvements than the white petrolatum. At week 1, 70% of subjects receiving the scar product demonstrated at least 50% global improvement in scar appearance vs only 42% of the subjects receiving white petrolatum. The more rapid improvement was accompanied by greater reductions in stinging/burning and itching with the scar product at all visits. Importantly, there was also greater subject satisfaction with the scar product at all visits. This scar product may be useful in hastening the healing of cutaneous shave biopsies and reducing the stinging/burning and itching associated with the normal healing process. PMID:23377333
Kircik, Leon H
Color photographs of burned and nonburned children were used to study the attitudes of 218 practice teachers, nursing students, and counselors-in-training. Findings revealed that children with severe burns and facial scarring were regarded less favorably. Stresses that professionals should be well-trained and empathic in order to assist burned…
Holaday, Margot; McPhearson, Ruth
The aetiology of pathologic scarring is unknown today regarding the keloids. The authors have analyzed the literature and own experience retrospectively according to the evidence based treatments and prevention of the hypertrophic and keloid scars. The corticosteroids have been used intralesionally since the beginning of the 1960-ies. It was followed by the pressure garment therapy in order to treat the widespread burns scars in the early 1970-ies. The silicone gel sheeting is being used since the 1980-ies. The basic treatment of keloids changed, radiotherapy was combined with the above mentioned methods because of its high recurrence rate. Newer methods, cryosurgery as well as lasers were used to treat keloids. The number of effective topical agents was increased. The researchers have been looking for other, intralesionally usable medicine and genetic causes for more than ten years. The clinicians have had the standard protocols of the adjunct and alternative methods too. After having the standard and internationally accepted scar assessment system (Vancouver-scar scale and score), the controlled, randomized trials were practicable. The prospective evaluation of the efficacy of different protocols with adequate follow-up became performable. The comparison of different methods is difficult because of the lack of its standard outcome. PMID:17649846
Kelemen, Ottó; Kollár, Lajos
PURPOSE: Scar formation is one of the most functionally and cosmetically debilitating results of thermal injuries. Burn team members continuously search for new, cost effective, ways to prevent and treat hypertrophic scar formation. This study is a retrospective review of one facility's use of neoprene based products as an adjunct to, or in place of, traditional scar management techniques. METHODS: Records of all patients treated with neoprene patches or neoprene splints from March 2008 through April 2011 were retrospectively reviewed. Vancouver Scar Scores (VSS) were collected, photographs were reviewed and any documented problems reported by the patients were noted. RESULTS: Mean VSS scores were significantly lower at follow-up (5.3, SD 2.8) than at initial appointment (11.7, SD 1.4) with an estimated mean difference of 6.3 (P=0.0001). A 95% confidence interval for this mean difference is 3.9-8.7. CONCLUSIONS: In the reviewed cases, the use of neoprene inserts or splints resulted in a statistically significant reduction in hypertrophic scars with no secondary complications. PMID:23312910
Yelvington, Miranda; Brown, Susan; Castro, Maria Melguizo; Nick, Todd G
Objective (s): Scar formation in injured peripheral nerve bed causes several consequences which impede the process of nerve regeneration. Several animal models are used for scar induction in preclinical studies which target prevention and/or suppression of perineural scar. This study evaluates the translational capacity of four of physical injury models to induce scar formation around the sciatic nerve of rat: laceration, crush, mince and burn. Materials and Methods: Functional (Toe out angle), macroscopic, and microscopic evaluations were performed weekly for four weeks and correlation of findings were analyzed. Result: While macroscopic and microscopic findings suggested a well-developed and adhesive fibrosis surrounding the sciatic nerve, functional assessment did not reveal any significant difference between control and experimental groups (P>0.05). Conclusion: Our study suggests that none of the applied animal models reproduce all essential features of clinical perineural scar formation. Therefore, more studies are needed to develop optimal animal models for translating preclinical investigations.
O Zanjani, Leila; Firouzi, Masoumeh; Nabian, Mohammad-Hossein; Nategh, Mohsen; Rahimi-Movaghar, Vafa; S Kamrani, Reza
The distal arthrogryposis (DA) syndromes are a distinct group of disorders characterized by contractures of two or more different body areas. More than a decade ago, we revised the classification of DAs and distinguished several new syndromes. This revision has facilitated the identification of five genes (i.e., TNNI2, TNNT3, MYH3, MYH8, and TPM2) that encode components of the contractile apparatus of fast-twitch myofibers and cause DA syndromes. We now report the phenotypic features of a novel DA disorder characterized primarily by plantar flexion contractures in a large five-generation Utah family. Contractures of hips, elbows, wrists, and fingers were much milder though they varied in severity among affected individuals. All affected individuals had normal neurological examinations; electromyography and creatinine kinase levels were normal on selected individuals. We have tentatively labeled this condition distal arthrogryposis type 10 (DA10).
Stevenson, D.A.; Swoboda, K.J.; Sanders, R.K.; Bamshad, M.
We assessed the efficacy of progressive soft tissue distraction using monolateral external fixation in the management of severe knee flexion contractures. We prospectively evaluated 10 knee deformities in seven pediatric patients. After gradual distraction using the modified Orthofix Limb Reconstruction System (LRS), most recent functional status and knee range of motion were determined. This treatment was applied to 10 extremities in seven patients, ranging in age from 2 to 16 years. Diagnoses included arthrogryposis (4), sickle cell disease (1), previous sepsis (1), and congenital pterygium (1). Average preoperative flexion contracture was 80.5 degrees. Each patient achieved full extension. There was one recurrence, despite bracing, which was managed with replacement of the fixator and soft tissue procedures. Management of knee flexion contractures using a monolateral fixator appears to be a viable alternative to extensive release or femoral osteotomy. Long-term follow-up will be essential to assess the overall risk of recurrence and complications. PMID:12132840
Mooney, J F; Koman, L A
A scar is a mark that remains after the healing of a wound or other morbid processes. In the past, treatment was mainly focused on severe scarring, such as the hypertrophic and burn scars. However, scars from relatively minor wounds can also be stressful. The site of an open thyroidectomy is the anterior neck, a prominently exposed part of the body, where postoperative scarring can cause patients distress. The cosmetic outcome of the scar after thyroidectomy is of particular importance to women, who constitute the majority of patients with thyroid disease. Active prevention is more likely to yield better cosmetic results and would require fewer treatment sessions and less expense than scar revision procedures. Many interventions have been proposed, but there is yet no universal consensus on optimal treatment. Recently, focus has been made on 'laser scar prevention', where various types of lasers have been used to improve the appearance of scars. The purpose of this study was to improve the appearance of scars, by laser intervention of the wound healing process. In this pilot study, we comparatively examined the effect of non-ablative 1550-nm fractional Er: glass laser and ablative 2940-nm fractional Er: YAG laser on fresh surgical scars of patients with Fitzpatrick skin type III-IV. PMID:22409153
Kim, Hei Sung; Lee, Ji Hae; Park, Young Min; Lee, Jun Young
The authors report the case of a 65-year-old, right-hand-dominant man who had severe Dupuytren's disease with multiple cords and flexion contractures of the metacarpophalangeal and proximal interphalangeal joints of both hands and underwent repeated collagenase injections for treatment. Collagenase has been shown to be safe and effective in the treatment of Dupuytren's contractures when administered as a single dose, but the results of multiple injections over a prolonged period are unknown. Antibodies to collagenase develop in all patients after several treatments, raising concerns about safety and efficacy as a result of sensitization from repeated exposures. The antibodies generated as a result of repeated exposure to collagenase could theoretically render it less effective with time and could also lead to immune reactions as severe as anaphylaxis. The authors present the case of a single patient who experienced continued correction of his contractures with only minor and self-limited adverse reactions after administration of 12 collagenase doses through 15 injections during a 4-year period. Over time, the injections continued to be effective at correcting metacarpophalangeal joint contractures, but less effective at correcting proximal interphalangeal joint contractures. The patient did eventually require a fasciectomy, but the safety and modest success of the repeated collagenase injections shows promise for a less invasive treatment with a better risk profile than open fasciectomy. Although further studies are needed, repeated administration of collagenase appears to be safe and modestly effective for severe Dupuytren's contractures, although a fasciectomy may ultimately be required in the most severe cases. PMID:24992063
Gajendran, Varun K; Hentz, Vincent; Kenney, Deborah; Curtin, Catherine M
Congenital contractural arachnodactyly (CCA) is caused by mutations within the fibrillin-2 gene (FBN2), which is crucial for microfibril structure. Affected individuals may have contractures, chest wall deformities, scoliosis, abnormal ear folding and elongated limbs. We describe a novel FBN2 mutation in a woman with CCA who also had pulmonary non-tuberculous mycobacteria (NTM) infection. The population with pulmonary NTM infections shares phenotypic features with CCA, such as elongated body habitus, scoliosis and pectus deformities. While it is unlikely that FBN2 defects account for susceptibility to NTM infection in the majority of cases, the overlap between these two diseases suggests some shared pathophysiology. PMID:22325249
Paulson, M L; Olivier, K N; Holland, S M
Congenital contractural arachnodactyly (CCA) or Beals-Hecht syndrome is an autosomal dominant disorder caused by mutations in the fibrillin-2 (FBN2) gene. The principal features of CCA are a marfanoid habitus, multiple congenital contractures, camptodactyly, arachnodactyly, kyphoscoliosis, muscular hypoplasia, and external ear malformations. Our case is the first that shows typical sonographic signs in a fetus at 25 weeks' gestation with molecular genetically verified CCA in a large family with many members affected over four generations. This demonstrates that CCA can be detected prenatally by non-invasive ultrasonography. The importance of confirmation of CCA by means of DNA sequence analysis of the FBN2 gene is stressed. PMID:12383326
Kölble, N; Wisser, J; Babcock, D; Maslen, C; Huch, R; Steinmann, B
SUMMARY Congenital contractural arachnodactyly (CCA) is caused by mutations within fibrillin-2 (FBN2), which is crucial for microfibril structure. Affected individuals may have contractures, chest wall deformities, scoliosis, abnormal ear folding and elongated limbs. We describe a novel FBN2 mutation in a woman with CCA who also has pulmonary nontuberculous mycobacterial infection. The population with pulmonary nontuberculous mycobacterial infections shares phenotypic features with CCA, such as elongated body habitus, scoliosis and pectus deformities. While it is unlikely that FBN2 defects account for susceptibility to nontuberculous mycobacterial infection in the majority of cases, the overlap between these two diseases suggests some shared pathophysiology.
Paulson, Michelle L.; Olivier, Kenneth N.; Holland, Steven M.
Correction of soft tissue varus contracture with total ankle replacement is a challenge. In the present techniques report, I describe tibialis posterior recession using topographic anatomic landmarks that can be useful in correcting soft tissue contracture of the tibialis posterior musculotendinous unit associated with longstanding varus contractures during primary and revision total ankle replacement. PMID:23632066
Roukis, Thomas S
Approximately 2457 research articles were published with burns in the title, abstract, and/or keyword in 2012. This number continues to rise through the years; this article reviews those selected by the Editor of one of the major journals in the field (Burns) and his colleague that are most likely to have the greatest likelihood of affecting burn care treatment and understanding. As done previously, articles were found and divided into these topic areas: epidemiology of injury and burn prevention, wound and scar characterization, acute care and critical care, inhalation injury, infection, psychological considerations, pain and itching management, rehabilitation, long-term outcomes, and burn reconstruction. Each selected article is mentioned briefly with comment from the authors; readers are referred to the full papers for further details. PMID:24252249
Wolf, Steven E; Arnoldo, Brett D
Objectives: We wanted to estimate the birth prevalence of multiple congenital contractures (MCC), determine the cause of the MCC according to the primary level of involvement of the developing motor system, and compare the different groups in terms of inheritance, mortality, and morbidity. Study design: A retrospective epidemiologic study through the screening of registers, reviews of medical records, and clinical
Niklas Darin; Eva Kimber; Anna-Karin Kroksmark; Már Tulinius
Dupuytren's disease is a relatively rare occurrence in a patient of the black race. The coexistence of a Dupuytren's contracture in a black patient who also presents with severe gouty tophi is described. This is the first reported case in the English literature.
LeFlore, I.; Antoine, G. A.
Dermatan sulfate (DS) widespread as a component of extracellular matrix proteoglycans, is char- acterized by great bio-reactivity and remarkable structural heterogeneity due to distinct degrees of sulfation and glucuronosyl epimerization and different polymerization degrees. However, DS metabolism under various biological conditions is poorly known. Dupuytren's contracture is a benign fibromatosis leading to complex remodeling of the palmar fascia structure and
Ewa M. Ko?ma; Krystyna Olczyk; Magdalena Ciecierska
Backgroud Gluteal muscle contracture (GMC) is a multi-factor human chronic fibrotic disease of the gluteal muscle. Fibrotic tissue is characterized by excessive accumulation of collagen in the muscle's extracellular matrix. Transforming growth factor (TGF)-?1 and -?2 are thought to play an important role in fibrogenesis, while TGF-?3 is believed to have an anti-fibrotic function. We hypothesize that the expression of collagen and TGF-?s would be up-regulated in GMC patients. Methods The expression of collagen type I, type III and TGF-?s were studied in 23 fibrotic samples and 23 normal/control samples in GMC patients using immunohistochemistry, reverse transcription and polymerase chain reaction (RT-PCR) and western bolt analysis. Results Compared to the unaffected adjacent muscle, increased expression of TGF-?1 and -?3 was associated with deposition of collagen type I and type III in the fibrotic muscle of the GMC patients at the mRNA level. Strong up-regulation of these proteins in fibrotic muscle was confirmed by immunohistochemical staining and western blot analysis. TGF-?2 was not up-regulated in relation to GMC. Conclusion This study confirmed our hypothesis that collagen types I, III, TGF-?1 and TGF-?3 were up-regulated in biopsy specimens obtained from patients with GMC. Complex interaction of TGF-?1 with profibrotic function and TGF-?3 with antifibrotic function may increase synthesis of collagens and thereby significantly contribute to the process of gluteal muscle scarring in patients with GMC.
Gluteal muscle contracture is common after repeated intramuscular injections and sometimes is sufficiently debilitating to require open surgery. We asked whether arthroscopic release of gluteal muscle contracture using radiofrequency energy would decrease complications with clinically acceptable results. We retrospectively reviewed 108 patients with bilateral gluteal muscle contractures (57 males, 51 females; mean age, 23.7 years). We used inferior, anterosuperior, and posterosuperior portals. With the patient lying laterally, we developed and enlarged a potential space between the gluteal muscle group and the subcutaneous fat using blunt dissection. Under arthroscopic guidance through the inferior portal, we débrided and removed fatty tissue overlying the contractile band of the gluteal muscle group using a motorized shaver introduced through the superior portal. Radiofrequency then was introduced through the superior portal to gradually excise the contracted bands from superior to inferior. Finally, hemostasis was ensured using radiofrequency. Patients were followed a minimum of 7 months (mean, 17.4 months; range, 7–42 months). At last followup, the adduction and flexion ranges of the hip were 45.3° ± 8.7° and 110.2° ± 11.9°, compared with 10.4° ± 7.2° and 44.8° ± 14.1° before surgery. No hip abductor contracture recurred and no patient had residual hip pain or gluteal muscle wasting. We found gluteal muscle contracture could be released effectively with radiofrequency energy. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. Electronic supplementary material The online version of this article (doi:10.1007/s11999-008-0595-7) contains supplementary material, which is available to authorized users.
Liu, Yu-Jie; Wang, Yan; Xue, Jing; Lui, Pauline Po-Yee
AIM—To investigate the role of mast cells in surgical and pathological scar reactions by their identification and quantification using immunohistochemistry.?METHODS—Surgical scars and pathological scar reactions were stained immunohistochemically for tryptase to identify mast cells. These were quantified in the scar tissue and surrounding dermis. Statistical analyses were performed to test the hypothesis that mast cell numbers were different in the varying types of scar reaction.?RESULTS—A significant difference was found between the mean number of mast cells in periocular scars compared with keloids, hypertrophic scars, and surgical scars from other sites (p<0.05). No significant difference was found in mast cell numbers between the other scar types either within the lesions or surrounding dermis. There were significantly more mast cells in the dermis than in the scar tissue itself, except for the small group of periocular scars. The ratio of mast cells in the lesion compared with the dermis was not significantly different between the scar types, except for the periocular scars.?CONCLUSIONS—Mast cell numbers are similar in and around keloid, hypertrophic, and surgical scars. The increased number of mast cells at periocular scar sites was contrary to expectation since keloids are rare at this site. Absolute mast cell numbers may not be an accurate measure of tissue concentrations of active mast cell products. Further comparisons between immunological characteristics of keloid and periocular scars may elucidate specific immunological abnormalities of keloid scars, and this has implications for the development of immunotherapy.?? Keywords: mast cells; keloid; hypertrophic scar; cicatrix
Beer, T; Baldwin, H; West, L; Gallagher, P; Wright, D
Burned landscapes present several challenges to quantifying landscape carbon balance. Fire scars are composed of a mosaic of patches that differ in burn severity, which may influence postfire carbon budgets through damage to vegetation and carbon stocks. We deployed three eddy covariance towers along a burn severity gradient (i.e., severely burned, moderately burned, and unburned tundra) to monitor postfire net ecosystem exchange of CO2 (NEE) within the large 2007 Anaktuvuk River fire scar in Alaska, USA, during the summer of 2008. Remote sensing data from the MODerate resolution Imaging Spectroradiometer (MODIS) was used to assess the spatial representativeness of the tower sites and parameterize a NEE model that was used to scale tower measurements to the landscape. The tower sites had similar vegetation and reflectance properties prior to the Anaktuvuk River fire and represented the range of surface conditions observed within the fire scar during the 2008 summer. Burn severity influenced a variety of surface properties, including residual organic matter, plant mortality, and vegetation recovery, which in turn determined postfire NEE. Carbon sequestration decreased with increased burn severity and was largely controlled by decreases in canopy photosynthesis. The MODIS two-band enhanced vegetation index (EVI2) monitored the seasonal course of surface greenness and explained 86% of the variability in NEE across the burn severity gradient. We demonstrate that understanding the relationship between burn severity, surface reflectance, and NEE is critical for estimating the overall postfire carbon balance of the Anaktuvuk River fire scar. PMID:21563578
Rocha, Adrian V; Shaver, Gaius R
The face is the central point of the physical features of the human being. It transmits expressions and emotions, communicates feelings and allows for individual identity. It contains complex musculature and a pliable and unique skin envelope that reacts to the environment through a vast network of nerve endings. The face hosts vital areas that make phonation, feeding, and vision possible. Facial burns disrupt these anatomical and functional structures creating pain, deformity, swelling, and contractures that may lead to lasting physical and psychological sequelae. The management of facial burns may include operative and non-operative treatment or both, depending on the depth and extent of the burn. This paper intends to provide a review of the available options for topical management of facial burns. Topical agents will be defined as any agent applied to the surface of the skin that alters the outcome of the facial burn. Therefore, the classic concept of topical therapy will be expanded and developed within two major stages: acute and rehabilitation. Comparison of the effectiveness of the different treatments and relevant literature will be discussed. PMID:18538480
Leon-Villapalos, Jorge; Jeschke, Marc G; Herndon, David N
Wound care is the central theme of burn patient management after successful resuscitation. Burn wound care has been revolutionized during the past four decades. The development of effective topical chemo-therapy, the timely surgical removal of burned tiss...
B. A. Pruitt
Matriderm is a dermal substitute consisting of a native (non-cross-linked) collagen matrix supplemented by a elastin hydrolysate. It is available in sheets of 1 mm and 2 mm thickness, and may be covered in a single step procedure with immediate split thickness skin grafting. Duration of the surgical procedures are only marginally increased. There is no diminished take of split thickness graft and only marginally prolonged healing time compared with the split thickness graft only. In experimental models the matrix reduces wound contracture, histologically collagen bundles in the scar are more randomly orientated. Clinical trials with a long-term clinical evaluation showed no difference in scar elasticity between the described dermal substitute and split thickness grafts alone. There is a lack of clinical data on the development of wound contracture. PMID:18629763
Kolokythas, P; Aust, M C; Vogt, P M; Paulsen, F
Aims: To demonstrate success with immediate split-skin graft application over Matriderm dermal matrix in a difficult neck contracture release. Methods: An aggressive neck contracture release, accompanied by complete platysmectomy, was followed by application of Matriderm, split-skin graft, Mepitel, and vacuum-assisted closure (VAC) dressing. Results: At VAC removal (day 7), graft take was almost complete over the dermal matrix and with minor "touch-up" were complete by day 9 postrepair. Results at 4 months show graft contraction and a marked diminution of the release obtained. The results, however, are still good and the patient is very happy. Conclusion: Immediate grafting over a dermal matrix appears to provide a good solution, with a gentle surgical learning curve, in this difficult postburn scenario. Postrelease contraction is, however, as inevitable as with other techniques. PMID:21451729
Greenwood, John E; Mackie, Ian P
The surgical and non-surgical treatment of localised prostate cancer may be complicated by bladder neck contractures, prostatic urethral stenoses and bulbomembranous urethral strictures. In general, such complications following radical prostatectomy are less extensive, easier to treat and associated with a better outcome and more rapid recovery than the same complications following radiotherapy, high-intensity focussed ultrasound and cryotherapy. Treatment options range from minimally invasive endoscopic procedures to more complex and specialised open surgical reconstruction.In this chapter the surgical management of bladder neck contractures following the treatment of prostate cancer is described together with the management of prostatic urethral stenoses and bulbomembranous urethral strictures, given the difficulty in distinguishing them from one another clinically. PMID:24531675
Bugeja, Simon; Andrich, Daniela E; Mundy, Anthony R
Intrinsic contracture of the hand may result from trauma, spasticity, ischemia, rheumatologic disorders, or iatrogenic causes. In severe cases, the hand assumes a posture with hyperflexed metacarpophalangeal joints and hyperextended proximal interphalangeal joints as the contracted interossei and lumbrical muscles deform the natural cascade of the fingers. Considerable disability may result because weakness in grip strength, difficulty with grasping larger objects, and troubles with maintenance of hygiene commonly encumber patients. Generally, the diagnosis is made via history and physical examination, but adjunctive imaging, rheumatologic testing, and electromyography may aid in determining the underlying cause or assessing the severity. Nonsurgical management may be appropriate in mild cases and consists of occupational therapy, orthoses, and botulinum toxin injections. The options for surgical management are diverse and dictated by the cause and severity of contracture. PMID:24084432
Tosti, Rick; Thoder, Joseph J; Ilyas, Asif M
Congenital contractural arachnodactyly (CCA) is an autosomal dominant connective tissue disorder, comprising marfanoid habitus, flexion contractures, severe kyphoscoliosis, abnormal pinnae, and muscular hypoplasia. It is now known that mutations in the gene encoding fibrillin-2 cause CCA. Interestingly, mutations described to date cluster in the fibrillin-2 region homologous to the so-called neonatal Marfan syndrome region of fibrillin-1. Thus, it has been hypothesized that the relative infrequency of CCA compared with the Marfan syndrome is due to the limited region of the gene targeted for mutations. In support of the above hypothesis, we report here the finding of two additional FBN2 mutations in CCA, C1141F (exon 26) and C1252W (exon 29). In addition, a new 3' UTR polymorphism is also described. PMID:10797416
Belleh, S; Zhou, G; Wang, M; Der Kaloustian, V M; Pagon, R A; Godfrey, M
Aims: To demonstrate success with immediate split-skin graft application over Matriderm dermal matrix in a difficult neck contracture release. Methods: An aggressive neck contracture release, accompanied by complete platysmectomy, was followed by application of Matriderm, split-skin graft, Mepitel, and vacuum-assisted closure (VAC) dressing. Results: At VAC removal (day 7), graft take was almost complete over the dermal matrix and with minor “touch-up” were complete by day 9 postrepair. Results at 4 months show graft contraction and a marked diminution of the release obtained. The results, however, are still good and the patient is very happy. Conclusion: Immediate grafting over a dermal matrix appears to provide a good solution, with a gentle surgical learning curve, in this difficult postburn scenario. Postrelease contraction is, however, as inevitable as with other techniques.
Greenwood, John E.; Mackie, Ian P.
. The authors report their experience on the nonsurgical treatment of capsular contractures due to breast implant augmentation\\u000a mammaplasty. External ultrasonic repeated applications have been applied to 24 patients after closed capsulotomy procedures\\u000a in order to reduce the recurrency rate. The new ultrasonic device used was based on a 2-MHz generator with a timing adjustable\\u000a power emission connected to eight
Jorge Planas; Emilia Migliano; Sebastian Castillo
Dermatan sulfate (DS) widespread as a component of extracellular matrix proteoglycans, is characterized by great bio-reactivity and remarkable structural heterogeneity due to distinct degrees of sulfation and glucuronosyl epimerization and different polymerization degrees. However, DS metabolism under various biological conditions is poorly known. Dupuytren's contracture is a benign fibromatosis leading to complex remodeling of the palmar fascia structure and properties. However, it remains unclear whether the disease affects the structure of DS, which is the major tissue glycosaminoglycan. Thus the aim of the study was to examine the structure of the total DS in Dupuytren's fascia. DS chains were extracted from 5 samples of normal fascia and 7 specimens of Dupuytren's tissue by papain digestion followed by fractionation with cetylpyridinium chloride. Then, DS structure analysis was performed comprising the evaluation of its molecular masses and sensitivity to hyaluronidase and chondroitinase B. Dupuytren's contracture is associated with significant remodeling of DS chain structure revealed by (1) a distinct profile of chain molecular masses characterized by the appearance of long size components as well as the increase in the content of small size chains; (2) a different glucuronosyl epimerization pattern connected with the enhanced content of glucuronate disaccharide blocks; (3) chain oversulfation. These structural alterations in total DS may modify the GAG interactions especially affecting collagen fibrillogenesis and growth factor availability. Thus, Dupuytren's contracture associated DS remodeling may promote the phenomena typical for advanced disease: apoptosis and reduction in cell number as well as the appearance of dense pseudotendinous collagen matrix. PMID:18066404
Ko?ma, Ewa M; G?owacki, Andrzej; Olczyk, Krystyna; Ciecierska, Magdalena
Management of burn injury has always been the domain of burn specialists. Since ancient time, local and systemic remedies have been advised for burn wound dressing and burn scar prevention. Management of burn wound inflicted by the different physical and chemical agents require different regimes which are poles apart from the regimes used for any of the other traumatic wounds. In extensive burn, because of increased capillary permeability, there is extensive loss of plasma leading to shock while whole blood loss is the cause of shock in other acute wounds. Even though the burn wounds are sterile in the beginning in comparison to most of other wounds, yet, the death in extensive burns is mainly because of wound infection and septicemia, because of the immunocompromised status of the burn patients. Eschar and blister are specific for burn wounds requiring a specific treatment protocol. Antimicrobial creams and other dressing agents used for traumatic wounds are ineffective in deep burns with eschar. The subeschar plane harbours the micro-organisms and many of these agents are not able to penetrate the eschar. Even after complete epithelisation of burn wound, remodelling phase is prolonged. It may take years for scar maturation in burns. This article emphasizes on how the pathophysiology, healing and management of a burn wound is different from that of other wounds.
Tiwari, V. K.
The psychological aspects of a child's reaction to major burn injuries include acute emotional reactions resulting from upsetting reactions of family members and unfamiliar hospital surroundings. Emotional and social adjustment problems of severely scarred children are viewed, and suggestions are made as to what health professionals might do to…
Luther, Stephen L.; Price, James H.
Despite advances in breast implant surgery, capsular contracture remains a challenging sequela of reconstructive and cosmetic breast implant surgery. Although there are established modalities for treatment, most recently, acellular dermal matrix products have been suggested to have a role in preventing or diminishing the pathologic process of capsular contracture. In this article, the author presents a review of the literature to highlight the level of evidence on the role of acellular dermal matrices in the treatment of capsular contracture. PMID:23096960
Basu, C Bob; Jeffers, Lynn
Varying surgical techniques, patient groups and results have been described regards the surgical treatment of post traumatic flexion contracture of the elbow. We present our experience using the limited lateral approach on patients with carefully defined contracture types.Surgical release of post-traumatic flexion contracture of the elbow was performed in 23 patients via a limited lateral approach. All patients had an established flexion contracture with significant functional deficit. Contracture types were classified as either extrinsic if the contracture was not associated with damage to the joint surface or as intrinsic if it was.Overall, the mean pre-operative deformity was 55 degrees (95%CI 48-61) which was corrected at the time of surgery to 17 degrees (95%CI 12-22). At short-term follow-up (7.5 months) the mean residual deformity was 25 degrees (95%CI 19-30) and at medium-term follow-up (43 months) it was 32 degrees (95%CI 25-39). This deformity correction was significant (p < 0.01). One patient suffered a post-operative complication with transient dysaesthesia in the distribution of the ulnar nerve, which had resolved at six weeks. Sixteen patients had an extrinsic contracture and seven an intrinsic. Although all patients were satisfied with the results of their surgery, patients with an extrinsic contracture had significantly (p = 0.02) better results than those with an intrinsic contracture. (28 degrees compared to 48 degrees at medium term follow up). Surgical release of post-traumatic flexion contracture of the elbow via a limited lateral approach is a safe technique, which reliably improves extension especially for extrinsic contractures. In this series all patients with an extrinsic contracture regained a functional range of movement and were satisfied with their surgery. PMID:18783605
Brinsden, Mark D; Carr, Andrew J; Rees, Jonathan L
Varying surgical techniques, patient groups and results have been described regards the surgical treatment of post traumatic flexion contracture of the elbow. We present our experience using the limited lateral approach on patients with carefully defined contracture types. Surgical release of post-traumatic flexion contracture of the elbow was performed in 23 patients via a limited lateral approach. All patients had an established flexion contracture with significant functional deficit. Contracture types were classified as either extrinsic if the contracture was not associated with damage to the joint surface or as intrinsic if it was. Overall, the mean pre-operative deformity was 55 degrees (95%CI 48 – 61) which was corrected at the time of surgery to 17 degrees (95%CI 12 – 22). At short-term follow-up (7.5 months) the mean residual deformity was 25 degrees (95%CI 19 – 30) and at medium-term follow-up (43 months) it was 32 degrees (95%CI 25 – 39). This deformity correction was significant (p < 0.01). One patient suffered a post-operative complication with transient dysaesthesia in the distribution of the ulnar nerve, which had resolved at six weeks. Sixteen patients had an extrinsic contracture and seven an intrinsic. Although all patients were satisfied with the results of their surgery, patients with an extrinsic contracture had significantly (p = 0.02) better results than those with an intrinsic contracture. (28 degrees compared to 48 degrees at medium term follow up). Surgical release of post-traumatic flexion contracture of the elbow via a limited lateral approach is a safe technique, which reliably improves extension especially for extrinsic contractures. In this series all patients with an extrinsic contracture regained a functional range of movement and were satisfied with their surgery.
Brinsden, Mark D; Carr, Andrew J; Rees, Jonathan L
Tendon contractures are a well-known sequele to compartment syndrome. It is most often seen in the upper limb [Santi MD, Botte MJ. Volkmann's ischaemic contracture of foot and ankle: evaluation and treatment of established deformity. Foot Ankle Int 1995;16(6):368–77] but have been infrequently described in the foot [Botte MJ, Santi MD, Prestianni CA, Abrams RA. Ischaemic contracture of foot and
G. Sharma; N. K. Makwana; A. R. Guha
In man and domestic animals, scarring in the skin after trauma, surgery, burn or sports injury is a major medical problem, often resulting in adverse aesthetics, loss of function, restriction of tissue movement and/or growth and adverse psychological effects. Current treatments are empirical, unreliable and unpredictable: there are no prescription drugs for the prevention or treatment of dermal scarring. Skin wounds on early mammalian embryos heal perfectly with no scars whereas wounds to adult mammals scar. We investigated the cellular and molecular differences between scar-free healing in embryonic wounds and scar-forming healing in adult wounds. Important differences include the inflammatory response, which in embryonic wounds consists of lower numbers of less differentiated inflammatory cells. This, together with high levels of morphogenetic molecules involved in skin growth and morphogenesis, means that the growth factor profile in a healing embryonic wound is very different from that in an adult wound. Thus, embryonic wounds that heal without a scar have low levels of TGFbeta1 and TGFbeta2, low levels of platelet-derived growth factor and high levels of TGFbeta3. We have experimentally manipulated healing adult wounds in mice, rats and pigs to mimic the scar-free embryonic profile, e.g. neutralizing PDGF, neutralizing TGFbeta1 and TGFbeta2 or adding exogenous TGFbeta3. These experiments result in scar-free wound healing in the adult. Such experiments have allowed the identification of therapeutic targets to which we have developed novel pharmaceutical molecules, which markedly improve or completely prevent scarring during adult wound healing in experimental animals. Some of these new drugs have successfully completed safety and other studies, such that they have entered human clinical trials with approval from the appropriate regulatory authorities. Initial trials involve application of the drug or placebo in a double-blind randomized design, to experimental incision or punch biopsy wounds under the arms of human volunteers. Based on encouraging results from such human volunteer studies, the lead drugs have now entered human patient-based trials e.g. in skin graft donor sites. We consider the evolutionary context of wound healing, scarring and regeneration. We hypothesize that evolutionary pressures have been exerted on intermediate sized, widespread, dirty wounds with considerable tissue damage e.g. bites, bruises and contusions. Modem wounds (e.g. resulting from trauma or surgery) caused by sharp objects and healing in a clean or sterile environment with close tissue apposition are new occurrences, not previously encountered in nature and to which the evolutionary selected wound healing responses are somewhat inappropriate. We also demonstrate that both repair with scarring and regeneration can occur within the same animal, including man, and indeed within the same tissue, thereby suggesting that they share similar mechanisms and regulators. Consequently, by subtly altering the ratio of growth factors present during adult wound healing, we can induce adult wounds to heal perfectly with no scars, with accelerated healing and with no adverse effects, e.g. on wound strength or wound infection rates. This means that scarring may no longer be an inevitable consequence of modem injury or surgery and that a completely new pharmaceutical approach to the prevention of human scarring is now possible. Scarring after injury occurs in many tissues in addition to the skin. Thus scar-improving drugs could have widespread benefits and prevent complications in several tissues, e.g. prevention of blindness after scarring due to eye injury, facilitation of neuronal reconnections in the central and peripheral nervous system by the elimination of glial scarring, restitution of normal gut and reproductive function by preventing strictures and adhesions after injury to the gastrointestinal or reproductive systems, and restoration of locomotor function by preventing scarring in tendons and ligaments.
Ferguson, Mark W J; O'Kane, Sharon
The Smoke, Clouds, and Radiation-Brazil (SCAR-B) field project took place in the Brazilian Amazon and cerrado regions in August-September 1995 as a collaboration between Brazilian and American scientists. SCAR-B, a comprehensive experiment to study biomass burning, emphasized measurements of surface biomass, fires, smoke aerosol and trace gases, clouds, and radiation. their climatic effects, and remote sensing from aircraft and satellites. It included aircraft and ground-based in situ measurements of smoke emission factors and the compositions, sizes, and optical properties of the smoke particles; studies of the formation of ozone; the transport and evolution of smoke; and smoke interactions with water vapor and clouds. This overview paper introduces SCAR-B and summarizes some of the main results obtained so far. (1) Fires: measurements of the size distribution of fires, using the 50 m resolution MODIS Airborne Simulator, show that most of the fires are small (e.g. 0.005 square km), but the satellite sensors (e.g., AVHRR and MODIS with I km resolution) can detect fires in Brazil which are responsible for 60-85% of the burned biomass: (2) Aerosol: smoke particles emitted from fires increase their radius by as much as 60%, during their first three days in the atmosphere due to condensation and coagulation, reaching a mass median radius of 0.13-0.17 microns: (3) Radiative forcing: estimates of the globally averaged direct radiative forcing due to smoke worldwide, based on the properties of smoke measured in SCAR-B (-O.l to -0.3 W m(exp -2)), are smaller than previously modeled due to a lower single-scattering albedo (0.8 to 0.9), smaller scattering efficiency (3 square meters g(exp -2) at 550 nm), and low humidification factor; and (4) Effect on clouds: a good relationship was found between cloud condensation nuclei and smoke volume concentrations, thus an increase in the smoke emission is expected to affect cloud properties. In SCAR-B, new techniques were developed for deriving the absorption and refractive index of smoke from ground-based remote sensing. Future spaceborne radiometers (e.g., MODIS on the Earth Observing System), simulated on aircraft, proved to be very useful for monitoring smoke properties, surface properties, and the impacts of smoke on radiation and climate.
Kaufman, Y. J.; Hobbs, P. V.; Kirchoff, V. W. J. H.; Artaxo, P.; Remer, L. A.; Holben, B. N.; King, M. D.; Ward, D. E.; Prins, E. M.; Longo, K. M.; Mattos, L. F.; Nobre, C. A.; Spinhirne, J. D.; Ji, Q.; Thompson, A. M.; Gleason, J. F.; Christopher, S. A.; Tsay, S.-C.
Introduction: The aim of the article was to study the histopathological features of various lesions of Scarring Alopecia (SA) and to classify Primary SA on the basis of the predominant type of inflammatory cell component. Scarring or cicatricial alopecias are those that are produced as a result of the malformation, damage or destruction of the pilosebaceous follicles, which are replaced by cicatricial tissue, in such a way that they cannot again produce hair. Material and Methods: This prospective study included 32 biopsy – proven cases of SA, who had attended our hospital. Primary SA was classified according to the North American Hair Research Society. The informed consents of the subjects and the institutional ethical clearance was obtained for the study. The SPSS, version 14 software was used to analyse the data. Frequencies and percentages were used to describe the data. Results: During the study period, 32 cases of scarring alopecia were diagnosed, of which 24 were primary SA and 8 were secondary SA. Among the primary SA, there were 23 cases of lymphocyte associated primary scarring alopecias, of which, 19 of lupus erythematosus, 3 of lichen planopilaris (LPP) and one case of non specific SA. 1 case of neutrophil associated primary scarring (folliculitis decalvans) was also noted and among the secondary SA, there were 4 cases of morphea and 1 case each of lupus vulgaris, congenital absence of skin, burn and sarcoidosis. Conclusion: To conclude, histopathology is a dependable tool for identifying the underlying cause in scarring alopecia, which is helpful for an early diagnosis and treatment.
Kumar U., Mahesh; Yelikar, Balasaheb Ramling
The effect of focal adhesion kinase (FAK) on suppressing scarring and the potential molecular mechanism underlying it has been investigated. Ten samples of human hypertrophic scars (HS) tissue cultured in vitro were transfected with FAK siRNA mediated by liposome. Quantitative real-time PCR was used to detect the expression of integrin ?, transforming growth factor-? (TGF-?), FAK and ?-smooth muscle actin (?-SMA) after transfection. MTT assay was used as a measure of fibroblast proliferation. Flow cytometry and (3) H-proincorporation technique gave measurements of the cell cycle and the quantity of collagen synthesis, respectively. Expression of FAK was effectively blocked, accompanied by decreasing expression of integrin ?, TGF-? and ?-SMA in hypertrophic scars fibroblast (HSFB) cells. One to 4?h after transfection with FAK siRNA, proliferation of HSFB cells was strongly inhibited (P?0.01), reaching a maximum at 48?h. The proportion of G1 cells was higher and the proportion of the S and G2 cells lower after transfection. The amount of collagen synthesis in HSFB cells decreased when HSFB cells were transfected for 48?h. RNA interference targeting the FAK gene can block the two abnormal signal transduction pathways mediated by the integrin and TGF-? receptors that are responsible for hyperplasia and contracture of the scar, making FAK iRNA therapy a potentially effective approach in HS treatment. PMID:24523242
Chen, Rui; Zhang, Zhiliang; Xue, Zhujia; Wang, Lin; Fu, Mingang; Lu, Yi; Bai, Ling; Zhang, Dongqing; Fan, Zhihong
To compare the effect of honey dressing and silver-sulfadiazene (SSD) dressing on wound healing in burn patients. Patients (n=78) of both sexes, with age group between 10 and 50 years and with first and second degree of burn of less than 50% of TBSA (Total body surface area) were included in the study, over a period of 2 years (2006-08). After stabilization, patients were randomly attributed into two groups: ‘honey group’ and ‘SSD group’. Time elapsed since burn was recorded. After washing with normal saline, undiluted pure honey was applied over the wounds of patients in the honey group (n=37) and SSD cream over the wounds of patients in SSD group (n=41), everyday. Wound was dressed with sterile gauze, cotton pads and bandaged. Status of the wound was assessed every third and seventh day and on the day of completion of study. Patients were followed up every fortnight till epithelialization. The bacteriological examination of the wound was done every seventh day. The mean age for case (honey group) and control (SSD group) was 34.5 years and 28.5 years, respectively. Wound swab culture was positive in 29 out of 36 patients who came within 8 hours of burn and in all patients who came after 24 hours. The average duration of healing in patients treated with honey and SSD dressing at any time of admission was 18.16 and 32.68 days, respectively. Wound of all those patients (100%) who reported within 1 hour became sterile with honey dressing in less than 7 days while none with SSD. All of the wounds became sterile in less than 21 days with honey, while tthis was so in only 36.5% with SSD treated wounds. The honey group included 33 patients reported within 24 hour of injury, and 26 out of them had complete outcome at 2 months of follow-up, while numbers for the SSD group were 32 and 12. Complete outcome for any admission point of time after 2 months was noted in 81% and 37% of patients in the honey group and the SSD group. Honey dressing improves wound healing, makes the wound sterile in lesser time, has a better outcome in terms of prevention of hypertrophic scarring and post-burn contractures, and decreases the need of debridement irrespective of time of admission, when compared to SSD dressing.
Baghel, P. S.; Shukla, S.; Mathur, R. K.; Randa, R.
Acne has a prevalence of over 90% among adolescents and persists into adulthood in approximately 12%–14% of cases with psychological and social implications. Possible outcomes of the inflammatory acne lesions are acne scars which, although they can be treated in a number of ways, may have a negative psychological impact on social life and relationships. The main types of acne scars are atrophic and hypertrophic scars. The pathogenesis of acne scarring is still not fully understood, but several hypotheses have been proposed. There are numerous treatments: chemical peels, dermabrasion/microdermabrasion, laser treatment, punch techniques, dermal grafting, needling and combined therapies for atrophic scars: silicone gels, intralesional steroid therapy, cryotherapy, and surgery for hypertrophic and keloidal lesions. This paper summarizes acne scar pathogenesis, classification and treatment options.
Fabbrocini, Gabriella; Annunziata, M. C.; D'Arco, V.; De Vita, V.; Lodi, G.; Mauriello, M. C.; Pastore, F.; Monfrecola, G.
Biomass Burning Data and Information This data set represents ... geographical and temporal distribution of total amount of biomass burned. These data may be used in general circulation models (GCMs) and ... models of the atmosphere. Project Title: Biomass Burning Discipline: Tropospheric Chemistry ...
Gluteal muscle contracture is a clinical syndrome that involves contracture and distortion of the gluteal muscles and fascia fibers due to multiple causes. Physical examination demonstrates a characteristic gait due to hip adduction and internal thigh rotation. This study introduces a new minimally invasive method for surgical release of gluteal muscle contracture. Patients with gluteal muscle contracture were assigned to 4 categories: type A, contracture occurred mainly in the iliotibial tract; type B, contracture occurred in the Iliotibial tract and gluteus maximus; type C1, movement of the contraction band was palpable and a snapping sound was audible during squatting; and type C2, movement of the contraction band was not palpable or almost absent and a snapping sound was audible during squatting. This classification method allowed prediction of the anatomic location of these pathological contractures and determination of the type of surgery required. Four critical points were used to define the operative field and served as points to mark a surgical incision smaller than 4 mm. The contracture was easily released in this carefully marked operative field without causing significant neurovascular damage. Over a period of 5 years, between March 2003 and June 2008, the authors treated 1059 patients with this method and achieved excellent outcomes. Most patients were fully active within 12 weeks, with the assistance of an early postoperative rehabilitation program. The most significant complication was a postoperative periarticular hematoma, which occurred in 3 patients within 10 days postoperatively and required surgical ligation of the bleeding vessel. PMID:23218623
Ye, Bin; Zhou, Panyu; Xia, Yan; Chen, Youyan; Yu, Jun; Xu, Shuogui
In several biomes, including croplands, wooded savannas, and tropical forests, many small fires occur each year that are well below the detection limit of the current generation of global burned area products derived from moderate resolution surface reflectance imagery. Although these fires often generate thermal anomalies that can be detected by satellites, their contributions to burned area and carbon fluxes have not been systematically quantified across different regions and continents. Here we developed a preliminary method for combining 1-km thermal anomalies (active fires) and 500 m burned area observations from the Moderate Resolution Imaging Spectroradiometer (MODIS) to estimate the influence of these fires. In our approach, we calculated the number of active fires inside and outside of 500 m burn scars derived from reflectance data. We estimated small fire burned area by computing the difference normalized burn ratio (dNBR) for these two sets of active fires and then combining these observations with other information. In a final step, we used the Global Fire Emissions Database version 3 (GFED3) biogeochemical model to estimate the impact of these fires on biomass burning emissions. We found that the spatial distribution of active fires and 500 m burned areas were in close agreement in ecosystems that experience large fires, including savannas across southern Africa and Australia and boreal forests in North America and Eurasia. In other areas, however, we observed many active fires outside of burned area perimeters. Fire radiative power was lower for this class of active fires. Small fires substantially increased burned area in several continental-scale regions, including Equatorial Asia (157%), Central America (143%), and Southeast Asia (90%) during 2001-2010. Globally, accounting for small fires increased total burned area by approximately by 35%, from 345 Mha/yr to 464 Mha/yr. A formal quantification of uncertainties was not possible, but sensitivity analyses of key model parameters caused estimates of global burned area increases from small fires to vary between 24% and 54%. Biomass burning carbon emissions increased by 35% at a global scale when small fires were included in GFED3, from 1.9 Pg C/yr to 2.5 Pg C/yr. The contribution of tropical forest fires to year-to-year variability in carbon fluxes increased because small fires amplified emissions from Central America, South America and Southeast Asia-regions where drought stress and burned area varied considerably from year to year in response to El Nino-Southern Oscillation and other climate modes.
Randerson, J. T.; Chen, Y.; vanderWerf, G. R.; Rogers, B. M.; Morton, D. C.
After healing up of the injury wounds, hypertrophic scars and keloids often develop, which are histologically characterised by irregulary arranged collagen fibre bundles and a strong vascularisation. Approximately 20 years ago, the so-called compression clothing, as for example suits, masks, gloves, stockings, were first employed for the prevention and therapy of these complications. These means of compressions are crosswise and lengthwise elastical and consist predominantly of elasthan and viscose. The pressure acting on the skin lies between 25 and 32 mmHg: thereby the values are above the average capillary pressure of 20 mmHg. The efficiency of the compression clothing after a burn injury is well proved by several studies, and one knows today that, for example in the case of children as from the 5th year of life, the results are better than in the case of adults from the 35th year of life. The compression effected at least during a period of 15 months slows down the blood circulation, reduces the number of capillaries and makes the scar become more pale. Furthermore, the orthologically parallel arranged collagen fibres maintain their arrangement due to the compression pressure and do not get irregularily arranged. PMID:10666821
Contracture responses to cardiotoxin (CTX) from Naja naja kaouthia venom were investigated in rat and human skeletal muscle of similar fiber type distribution to determine species differences in mechanism of action. Rat diaphragm strips and human vastus lateralis preparations were directly stimulated in a tissue bath. The calcium dependence of toxin action, synergism between CTX and phospholipase A2 (PLA2) activity and roles of Na+ + K+-ATPase activity and the sarcoplasmic reticulum Ca2+ stores in contracture induction were examined. The threshold of contracture to CTX was decreased in human and rat muscle when Sr2+ was substituted for Ca2+ in the bathing medium. In rat, but not in human muscle the threshold of contracture to CTX was decreased in a medium in which Ca2+ had been omitted. The decrease in contracture threshold may relate to toxin binding. The maximum height of contracture for preparations from humans, but not for those from rats was considerably depressed in a medium in which Ca2+ had been omitted. Exogenously added bee venom PLA2 acts synergistically with CTX in skeletal muscle in a manner similar to that in erythrocytes. Ouabain (100 microM) did not elicit contractures in any of the media tested nor affect CTX-induced contractures in Sr2+-containing medium. Dantrolene antagonized CTX-induced contractures, suggesting a role for Ca2+ derived from the sarcoplasmic reticulum in CTX action. The species difference in CTX action may reflect differences in the relative contribution of Ca2+ from the sarcolemma and sarcoplasmic reticulum to the contracture. PMID:3433297
Fletcher, J E; Lizzo, F H
Congenital, traumatic, or extrinsic causes can lead people to paraplegia; some of these are potentially; reversible and others are not. Paraplegia can couse hip flexion contracture and, consequently, pressure sores, scoliosis, and hyperlordosis; lumbar and groin pain are strictly correlated. Scientific literature contains many studies about children hip flexion related to neurological diseases, mainly caused by cerebral palsy; only few papers focus on this complication in adults. In this study we report our experience on surgical treatment of adult hip flexion contracture due to neurological diseases; we have tried to outline an algorithm to choose the best treatment avoiding useless or too aggressive therapies. We present 5 cases of adult hips flexion due to neurological conditions treated following our algorithm. At 1-year-follow-up all patients had a good clinical outcome in terms of hip range of motion, pain and recovery of walking if possible. In conclusion we think that this algorithm could be a good guideline to treat these complex cases even if we need to treat more patients to confirm this theory. We believe also that postoperation physiotherapy it is useful in hip motility preservation, improvement of muscular function, and walking ability recovery when possible.
Nicodemo, Alberto; Arrigoni, Chiara; Bersano, Andrea; Masse, Alessandro
The experience accumulated after reconstruction of 157 burned breast patients has led to the development of surgical principles and techniques tailored to this problem. Most important among these principles is that the surgeon recognize and preserve viable breast bud tissue in the debridement phase of the acute burn. Reconstruction should begin when the burned breast envelope is insufficient and restricts normal growth. Best results are obtained if contracture release is complete, if defects are covered by thick split-thickness skin grafts, and if nipple-areola reconstruction is obtained from a normal opposite breast if present. Postoperative management should continue until wounds are mature and should include techniques to prevent contracture recurrence. PMID:6755516
Neale, H W; Smith, G L; Gregory, R O; MacMillan, B G
Provide by Burns Country, this full-text, online version of "the definitive Robert Burns reference volume" serves as a useful handbook to Scotland's most famous poet and the intellectual circles in which he turned. The encyclopedia, which is in HTML format, is organized alphabetically. Burns Country offers a number of other related resources, chief among them a songs and poems archive containing 100 of the poet's works. Other features at the site include a discussion area, Burns and Scottish association links, and some commercial content.
\\u000a \\u000a Background and Purpose:\\u000a In early-stage Dupuytren’s contracture, radiotherapy is applied to prevent disease progression. Long-term outcome and late\\u000a toxicity of the treatment were evaluated in a retrospective analysis.\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a Patients and Methods:\\u000a Between 12\\/1982 and 02\\/2006, 135 patients (208 hands) were irradiated with orthovoltage (120 kV; 20 mA; 4-mm Al filter), in\\u000a two courses with five daily fractions of 3.0 Gy
Nicolas Betz; Oliver J. Ott; Boris Adamietz; Rolf Sauer; Rainer Fietkau; Ludwig Keilholz
Significance Myofibroblasts are responsible for wound closure that occurs in healed acute wounds. However, their actions can result in disfiguring scar contractures, compromised organ function, and a tumor promoting stroma. Understanding the mechanisms regulating their contractile machinery, gene expression, and lifespan is essential to develop new therapies to control their function. Recent Advances Mechanical stress and transforming growth factor beta-1 (TGF-?1) regulate myofibroblast differentiation from mesenchymal progenitors. As these precursor cells differentiate, they assemble a contractile apparatus to generate the force used to contract wounds. The mechanisms by which mechanical stress promote expression of contractile genes through the TGF-?1 and serum response factor pathways and offer therapeutic targets to limit myofibroblast function are being elucidated. Critical Issues Emerging evidence suggests that the integration of mechanical cues with intracellular signaling pathways is critical to myofibroblast function via its effects on gene expression, cellular contraction, and paracrine signaling with neighboring cells. In addition, while apoptosis is clearly one pathway that can limit myofibroblast lifespan, recent data suggest that pathogenic myofibroblasts can become senescent and adopt a more beneficial phenotype, or may revert to a quiescent state, thereby limiting their function. Future Directions Given the important role that myofibroblasts play in pathologies as disparate as cutaneous scarring, organ fibrosis, and tumor progression, knowledge gained in the areas of intracellular signaling networks, mechanical signal transduction, extracellular matrix biology, and cell fate will support efforts to develop new therapies with a wide impact.
Van De Water, Livingston; Varney, Scott; Tomasek, James J.
Wound healing consists of re-epithelialization, contraction and formation of granulation and scar tissue. TGF-? is involved in these events, but its exact roles are not well understood. Here we demonstrate that topical application of a synthetic TGF-? antagonist accelerates re-epithelialization in pig burn wounds (100% re-epithelialization in antagonist-treated wounds vs. ~ 70% re- epithelialization in control wounds on postburn day
Jung San Huang; Yao-Horng Wang; Thai-Yen Ling; Shiow-Shuh Chuang; Frank E. Johnson; Shuan Shian Huang
Analysis of scars in various conditions is essential, but no consensus had been reached on the scar assessment scale to select for a given condition. We reviewed papers to determine the scar assessment scale selected depending on the scar condition and treatment method. We searched PubMed for articles published since 2000 with the contents of the scar evaluation using a scar assessment scale with a Journal Citation Report impact factor >0.5. Among them, 96 articles that conducted a scar evaluation using a scar assessment scale were reviewed and analyzed. The scar assessment scales were identified and organized by various criteria. Among the types of scar assessment scales, the Patient and Observer Scar Assessment Scale (POSAS) was found to be the most frequently used scale. As for the assessment of newly developed operative scars, the POSAS was most used. Meanwhile, for categories depending on the treatment methods for preexisting scars, the Vancouver Scar Scale (VSS) was used in 6 studies following a laser treatment, the POSAS was used in 7 studies following surgical treatment, and the POSAS was used in 7 studies following a conservative treatment. Within the 12 categories of scar status, the VSS showed the highest frequency in 6 categories and the POSAS showed the highest frequency in the other 6 categories. According to our reviews, the POSAS and VSS are the most frequently used scar assessment scales. In the future, an optimal, universal scar scoring system is needed in order to better evaluate and treat pathologic scarring.
Bae, Seong Hwan
Endometriosis is presence of functioning endometrial tissue outside the uterine cavity. Endometriosis can sometimes occur in a previous surgical scar. Scar endometriosis is rare and difficult to diagnose. It mostly follows obstetrical and gynecological surgeries. This condition is often confused with other surgical conditions. We are reporting a case of scar endometriosis following caesarean section, which was being treated as stitch granuloma for long time. Medical treatment was not helpful. The patient required wide surgical excision of the lesion. Now the patient is under regular follow up, because there is chance of recurrence. PMID:24858173
Saha, K; Shahida, S M; Mostafa, G; Ahmed, M
... cooking food unattended on the stove. Set your water heater’s thermostat to 120 °F or lower to prevent scalding burns. And install smoke alarms on every floor of your home. Keep yourself and your family safe from unexpected ... For minor burns: Immerse in fresh, cool water, or apply cool compresses for 10-15 minutes. ...
A stretching device with intelligent control was developed to treat spastic/contractured ankles of neurologically impaired patients and evaluate the outcome. The device stretched the ankle joint safely throughout the range of motion (ROM) to extreme posit...
L. Q. Zhang S. G. Chung Z. Bai D. Xu E. M. van Rey
AIM: To evaluate endometrioma located at cesarean scatrix. METHODS: Medical data of 6 patients who presented to our institution with abdominal wall endometrioma were evaluated retrospectively and reviewed literature in this case series. The diagnostic approaches and treatment is discussed. RESULTS: All patients had a painful mass located at abdominal scars with history of cesarean section. The ages ranged from 31 to 34 and Doppler ultrasonography (US) detected hypoechoic mass with a mean diameter of 30 mm. Initial diagnosis was endometrioma in 4 and incisional hernia in 2 of 6 patients. Treatment was achieved with surgical excision in 5 patients, and one is followed by hormone suppression therapy with gonadotropin. CONCLUSION: Malignant or benign tumors of abdominal wall and incisional hernias should be kept in mind for diagnosis of endometrioma. Imaging methods like doppler US, computed tomography and magnetic resonance imaging should be used for differential diagnosis. Definitive diagnosis can only be made histopathologically. The treatment should be complete surgical excision and take care against intraoperative auto-inoculation of endometrial tissue in order to prevent recurrences.
Col, Cavit; Yilmaz, Edip Erdal
Frequently Asked Questions What is cicatricial alopecia or scarring alopecia? Are there different kinds of cicatricial alopecia? What causes cicatricial alopecia? Who is affected by cicatricial alopecia? Are cicatricial ...
The Supersonic Cruise Aircraft Research (SCAR) team analyzed six major topics: (1) aerodynamics, (2) stability and control, (3) propulsion, (4) environmental factor, (5) airframe structures and materials, and (6) design integration.
Ingestion of caustic soda can cause severe scarring of the oral cavity and the surrounding soft tissues. Free flap reconstruction for burns in the oral cavity has been described as a viable option in adults, but to the best of our knowledge has not been reported in children. We describe cases of successful microvascular reconstruction for burns caused by caustic soda in the oral cavity in children. PMID:23369780
Sadiq, Zaid; Farook, Shahme A; Ayliffe, Peter
Keratoacanthoma centrifugum marginatum (KCM) is a rare variant of keratoacanthoma (KA). It is characterized by a progressive peripheral expansion and central healing leaving atrophic scar. It is sometimes confused with squamous cell carcinoma (SCC) both clinically and histopathologically. We here report a case of KCM over the extensor aspect of the right forearm in a 57-year-old man with an abnormal looking scar.
Nag, Falguni; Biswas, Projna; Singha, Joydeep; Ghosh, Arghyaprasun; Surana, Trupti V.
This study investigated the sonographic appearance of the pulley and flexor tendon in idiopathic trigger finger in correlation with the contracture of the interphalangeal (IP) joint in the thumb or proximal IP (PIP) joint in the other digits. Sonographic measurements using axial images were performed in 177 affected digits including 17 thumbs and 34 other digits judged to have IP or PIP joint contracture and 77 contralateral control digits. The A1 pulley of the contracture group was significantly thicker than that of the non-contracture group in all digits, whereas the flexor tendon was thicker only in digits other than the thumb. In the analysis using calculated cut-off values, A1 pulley thickening in the thumb and A1 pulley and flexor tendon thickening in the other digits showed statistically significant correlations with IP or PIP joint contracture. This study sonographically confirmed previous reports showing that enlargement of the flexor tendons contribute to the pathogenesis of PIP joint contracture. PMID:24613641
Sato, Junko; Ishii, Yoshinori; Noguchi, Hideo; Takeda, Mitsuhiro
Background This study aims to explore the technique of soft tissue balance and joint tension maintenance in total knee arthroplasty (TKA) for the rheumatoid arthritis (RA) patients with flexion contracture of the knee. Methods This retrospective study reviewed flexion contracture deformity of RA patients who underwent primary TKA and ligament and soft tissue balancing. Based on the flexion contracture deformity, the remaining 76 patients available for analysis were divided into two groups, i.e., severe flexion group (SF) and moderate flexion group (MF). Results There were no intraoperative complications in this study. All patients had improved Knee Society Rating System scores and range of motion. The flexion contracture was completely corrected in MF and SF patients. There were no cases of patellar dislocation, but three cases had mild mediolateral instability in severe flexion group. Four knees (two knees in SF versus two knees in MF) had transient peroneal nerve palsy but recovered after conservative therapy. Conclusions TKA can be performed successfully in the RA knees with severe flexion contracture. It is very important in TKA to maintain the joint stability in the condition of severe flexion contracture deformity of the RA knee.
In a study of the factors surrounding the development of renal scars clinical data and serial radiographs were analysed in 74 infants and children (66 girls and eight boys) without duplex kidney or obstruction. The development of new scars was seen radiologically in 87 kidneys (74 previously normal and 13 previously scarred). New scarring was extensive in 16 kidneys. Thirty
J M Smellie; P G Ransley; I C Normand; N Prescod; D Edwards
Poor wound healing remains a critical problem in our daily practice of surgery, exerting a heavy toll on our patients as well as on the health care system. In susceptible individuals, scars can become raised, reddish, and rigid, may cause itching and pain, and might even lead to serious cosmetic and functional problems. Hypertrophic scars do not occur spontaneously in animals, which explains the lack of experimental models for the study of pathologic scar modulation. We present the results of three clinical comparative prospective studies that we have conducted. In the first study, secondary healing and cosmetic appearance following healing of partial thickness skin graft donor sites under dry (semi-open Sofra-Tulle dressing) and moist (moist exposed burn ointment, MEBO) was assessed. In the second study, healing of the donor sites was evaluated following treatment with Tegaderm or MEBO, two different types of moisture-retentive dressings. In the third study, 3 comparable groups of primarily healed wounds were evaluated. One group was treated by topical antibiotic ointment, the second group was treated by Moist Exposed Burn Ointment (MEBO), and the third group did not receive any topical treatment. In the second study, secondary healing of partial thickness skin graft donor sites was evaluated following treatment with Tegaderm or MEBO, two different types of moisture-retentive dressings. In the second and third studies, healed wounds were evaluated with the quantitative scale for scar assessment described by Beausang et al. Statistical analysis revealed that for both types of wound healing, scar quality was significantly superior in those wounds treated with MEBO. PMID:14648065
Atiyeh, Bishara S; Amm, Christian A; El Musa, Kusai A
Biomass burning may be the overwhelming regional or continental-scale source of methane (CH4) as in tropical Africa and a significant global source of CH4. Our best estimate of present methane emissions from biomass burning is about 51.9 Tg/yr, or 10% of the annual methane emissions to the atmosphere. Increased frequency of fires that may result as the Earth warms up may result in increases in this source of atmospheric methane.
Levine, Joel S.; Cofer, Wesley R., III; Pinto, Joseph P.
We report the case of a woman who presented with several facial scars following a road accident. Treatment was carried out using combined laser treatment with pulsed dye laser (PDL) and the Q-switched neodymium:yttrium-aluminum-garnet laser (QS Nd:YAG laser). No side effects or complications from treatment were noted or reported. The patient had very good cosmetic results with this combined technique. A variety of facial scars--erythematous, pigmented, atrophic and hypertrophic--may occur as a result of trauma, surgery, burns and skin disease. Surgery with other adjunctive methods including radiotherapy, intralesional steroids and pressure therapy has shown variable results. Laser treatment has been attempted for scar revision since the 1980s. The PDL is the optimal treatment for reducing scar bulk and symptoms. It also decreases the erythema and telangiectasia associated with scars, normalizes the skin surface texture and improves scar pliability. The QS Nd:YAG laser (1064 nm) is highly effective for traumatic tattoo removal, resulting in complete clearance in the majority of cases. PMID:18608707
Martins, Andrea; Trindade, Felicidade; Leite, Luiz
For treatment of skin burn injuries, there exist several methods of treatment related to tissue regeneration, including the use of autograft skin and cryopreserved skin. However, each method has drawbacks. An alternative method for tissue regeneration is allograft acellular dermal matrix, with potential as a biocompatible scaffold for new tissue growth. One recently produced material of this type is DermACELL(®), which was used in this case presentation for treating a scar resulting from second- and third-degree burns in a 33-year-old female patient. The patient presented with significant hypertrophic scarring from the elbow to the hand and with limited wrist and elbow motion. The scarring was removed, and the patient was treated with a 1:3 mesh of DermACELL. The wound was resurfaced with a split thickness skin graft, and postoperative care included application of pressure garment and silicone sheet, as well as range of motion exercise and massage. At 30 days after DermACELL application, the wound appeared well-healed with little scar formation. At 180 days post-application, the wound continued to appear healed well without significant scar formation. Additionally, the wound was supple, and the patient experienced significant improvement in range of motion. In the case presented, DermACELL appears to have been a successful method of treatment for scarring due to severe burns by preventing further scar formation and improving range of motion. PMID:23071908
Chen, Shyi-Gen; Tzeng, Yuan-Sheng; Wang, Chih-Hsin
K+ contractures of tonic bundles from cruralis muscle of the frog were studied with different K+ concentrations (10-120 mM). K+ contractures had an initial transient phase followed by a sustained tension. The amplitude of the sustained tension diminished with high K+ concentration (80-120 mM). However, in all cases, tension was maintained for several minutes. External Ca2+ reduction practically abolished the sustained phase of the K+ contractures. The initial phase was also reduced and tension spontaneously relaxed. The curve relating the peak tension with log [K+]o, showed that the threshold was not affected but the peak tension was reduced to about 70% in low-Ca2+ saline (0 Ca2+ + 3 mM-Mg2+) and 50% in Ca2+-free saline (1 mM-EGTA + 3 mM-Mg2+). The dependence of the sustained tension on external Ca2+ was further confirmed by Ca2+ withdrawal and re-establishment and/or by Ni2+ substitution for Ca2+ before or during K+ contractures. These results indicate that external Ca2+ had to be continuously present to maintain the tension during K+ contractures and that Ni2+ was not able to restore the normal temporal course of K+ contracture. The sustained phase was diminished by blocking agents of Ca2+ channels, such as nifedipine (1 microM) and diltiazem (1-10 microM). The present results can be explained by a direct control of the Ca2+ currents on K+ contracture or by specific interactions between external Ca2+ and Ca2+-binding sites in the membrane.
Huerta, M; Muniz, J; Stefani, E
Burn scars are the result of wound healing following a partial-thickness or full-thickness thermal injury. Thermal injury can frequently result in extensive scarring, which may have profound psychologic impact on the victim, serving as a visible and palpable reminder of a traumatic event. Standard treatments for scars include the use of skin grafts, intralesional steroid injections, and pulsed-dye laser treatments. The authors have previously described successful treatment of a burn scar with nonablative fractional resurfacing. Ablative fractional lasers may offer burn patients advantages over nonablative techniques, including improved function and cosmetic outcomes. In addition, ablative fractional laser may require fewer treatments, and therefore, be a more cost-effective treatment option for patients. The authors report the use of fractional ablative laser for the treatment of a disfiguring scar that was more than 50-years-old. To our knowledge, this is the first report of this technology for the treatment of a scar resulting from a third-degree burn in the literature. The demonstrated successful outcome in this case patient may indicate a progessive treatment option for many patients who have been disfigured by these types of thermal injuries. PMID:19271380
Waibel, Jill; Beer, Kenneth
The myofibroblast, a major component of granulation tissue, is a key cell during wound healing, tissue repair and connective tissue remodelling. Persistence of myofibroblasts within a fibrotic lesion leads to excessive scarring impairing function and aesthetics. Various wound-healing cytokines can be modulated by topical application of active agents to promote optimal wound healing and improve scar quality. Thus, the myofibroblast may represent an important target for wound-healing modulation to improve the evolution of conditions such as hypertrophic scars. The purpose of this work is to study the modulation of myofibroblasts and integrin alphavbeta3 in a full thickness wound performed on rabbits treated with different topical agents using: (1) saline, (2) Tegaderm occlusive dressing (3) silver sulfadiazine and (4) moist exposed burn ointment (MEBO). The reepithelialisation was 4 days faster in the MEBO group compared with the other therapies with less oedema formation, delayed contraction, less inflammatory cells and the lowest transepidermal water loss (TEWL) resulting in a soft scar. Although alpha-smooth muscle actin (alpha-SMA) was the highest around day 12 in the MEBO group, wound contraction and myofibroblast's activity were the least for the same period probably because of a downregulation of the integrin alphavbeta3. It seems that the effect of MEBO could be more pronounced on force transmission rather then on force generation. Greater insight into the pathology of scars may translate into non surgical treatments in the future and further work in myofibroblast biology will eventually result in efficient pharmacological tools, improving the evolution of healing and scar formation. PMID:19538194
El Kahi, Cynthia G; Atiyeh, Bishara S; Abdallah Hajj Hussein, Inaya; Jurjus, Rosalyne; Dibo, Saad A; Jurjus, Alice; Jurjus, Abdo
Tissue fibrosis, or scar formation, is a common response to damage in most organs of the body. The central nervous system (CNS) is special in that fibrogenic cells are restricted to vascular and meningeal niches. However, disruption of the blood-brain barrier and inflammation can unleash stromal cells and trigger scar formation. Astroglia segregate from the inflammatory lesion core, and the so-called "glial scar" composed of hypertrophic astrocytes seals off the intact neural tissue from damage. In the lesion core, a second type of "fibrotic scar" develops, which is sensitive to inflammatory mediators. Genetic fate mapping studies suggest that pericytes and perivascular fibroblasts are activated, but other precursor cells may also be involved in generating a transient fibrous extracellular matrix in the CNS. The stromal cells sense inflammation and attract immune cells, which in turn drive myofibroblast transdifferentiation. We believe that the fibrotic scar represents a major barrier to CNS regeneration. Targeting of fibrosis may therefore prove to be a valuable therapeutic strategy for neurological disorders such as stroke, spinal cord injury and multiple sclerosis. PMID:24946078
Fernández-Klett, Francisco; Priller, Josef
Aim Bacterial keratitis results in corneal scarring and subsequent visual impairment. The long-term evolution of corneal scars has not been well described. In this case series, we identified patients who had improvement in corneal scarring and visual acuity from a clinical trial for bacterial keratitis. Methods We searched the records of the Steroids for Corneal Ulcers Trial (SCUT) for patients who had improvement in vision between the 3-month and 12-month visits and reviewed their clinical photographs. Results Of the 500 patients enrolled in SCUT, five patients with large central corneal scars due to bacterial keratitis are presented. All experienced improvement in rigid contact lens–corrected visual acuity from months 3 to 12. All patients also had marked improvement in corneal opacity during the same time period. None of the patients opted to have penetrating keratoplasty. Conclusions Corneal scars may continue to improve even many months after a bacterial corneal ulcer has healed. The corneal remodeling can be accompanied by considerable improvement in visual acuity, such that corneal transplantation may not be necessary.
McClintic, S M; Srinivasan, M; Mascarenhas, J; Greninger, D A; Acharya, N R; Lietman, T M; Keenan, J D
The best treatment for burns and scalds depends on the depth of the skin necrosis. Epidermal and superficial dermal burn injuries (IIa) can heal spontaneously with conservative treatment without scar development, but deep dermal or full-thickness burns constitute an absolute indication for surgery. Full-thickness or split-thickness skin grafts are used for wound closure. In the case of extensive burn injuries allografts are used for temporary wound closure. In certain licensed laboratories autologous keratinocytes can be cultured for transplantation. In circumferential burn injuries affecting the extremities or the trunk the rigid eschar has to be incised to relieve the pressure behind it. Following a debridement conservative treatment of superficial dermal burns involving wound coverage with biosynthetic dressings or nanocristalline silver gauze dressings or use of special disinfecting ointments can be implemented. PMID:16416309
Pallua, N; von Bülow, S
At the age of 4, I incurred a major burn injury that left 45% of my body with permanent scars. Normal clothing covers most of the scars. I was able to reclaim a positive body image through a gradual process of verbal and "body" disclosure. As an adult, I joined a burn survivors' self-help group; as a result of talking with other burn survivors, my self expectations increased. Later, I joined a facilitated group in which nudity and personal growth were the norm. In this group, I was the only person who had experienced a major physical trauma. I replaced my strongly held beliefs that others could not accept my unclothed, burn-injured body with the belief that some persons can, and I came to a personal understanding of why others could not. Fun, exercise, and relaxation led to a reclamation of positive feelings about my unclothed body and allowed my femininity and the character of my body image to emerge and become integrated. PMID:1572860
Willis-Helmich, J J
Previous research has shown clinical effectiveness of dermal substitution; however, in burn wounds, only limited effect has been shown. A problem in burn wounds is the reduced take of the autograft, when the substitute and graft are applied in one procedure. Recently, application of topical negative pressure (TNP) was shown to improve graft take. The aim of this study was to investigate if application of a dermal substitute in combination with TNP improves scar quality after burns. In a four-armed multicenter randomized controlled trial, a split-skin graft with or without a dermal substitute and with or without TNP was compared in patients with deep dermal or full-thickness burns requiring skin transplantation. Graft take and rate of wound epithelialization were evaluated. Three and 12 months postoperatively, scar parameters were measured. The results of 86 patients showed that graft take and epithelialization did not reveal significant differences. Significantly fewer wounds in the TNP group showed postoperative contamination, compared to other groups. Highest elasticity was measured in scars treated with the substitute and TNP, which was significantly better compared to scars treated with the substitute alone. Concluding, this randomized controlled trial shows the effectiveness of dermal substitution combined with TNP in burns, based on extensive wound and scar measurements. PMID:23110478
Bloemen, Monica C T; van der Wal, Martijn B A; Verhaegen, Pauline D H M; Nieuwenhuis, Marianne K; van Baar, Margriet E; van Zuijlen, Paul P M; Middelkoop, Esther
Summary The lip is a part of the face that is frequently affected by burn injury. Post-burn scar sequelae in this area often result in cosmetic disfigurement and psychological upsets in patients, especially young adult females. A burn destroys the aesthetic features and lines of the lip. Plastic and reconstructive surgery of the face has a long history. Many local and regional flaps have been used for reconstruction of surgical or traumatic defects. Procedures to enhance the cosmetic features of the lips have been performed for centuries. Only within the past 25 years, however, has augmentation cheiloplasty become commonplace. Within that time, a number of different techniques have been developed. The goal of reconstruction is to achieve aesthetic results using plastic materials having the same properties as the affected area. This paper describes some clinical situations and possible reconstructive solutions.
A 60-year-old man had a combination of laser in situ keratomileusis and Kamra corneal inlay implantation to correct presbyopia. Although the outcome was favorable postoperatively, central serous chorioretinopathy was observed in the left eye along with a decrease in the uncorrected (UDVA) and corrected (CDVA) distance visual acuities and the corrected near visual acuity (CNVA). Photodynamic therapy (PDT) was later performed in a university hospital. After PDT, the patient experienced a decline in the visual acuity and came to our clinic a month after the PDT. Degeneration and a scar were observed at the location of the inlay due to the heat and burning. Flattening of the corneal topography was also observed where the corneal scar was located, along with a significant decrease in CDVA in the left eye. Prior to any surgery in which the corneal inlay is an impediment, surgeons should take advantage of the reversibility of the Kamra inlay by explanting the inlay. PMID:24160386
Mita, Mariko; Kanamori, Tomomi; Tomita, Minoru
Dupuytren contracture of the proximal interphalangeal (PIP) joint can be reversed by an extension torque transmitted from an external device, the Digit Widget, by skeletal pins to the middle phalanx. This extension torque, generated by the same elastic bands dentists use to align teeth, gradually restores length to soft tissues palmar to the PIP joint's axis of rotation. Simultaneously, tissues dorsal to the joint's axis will shorten toward normal length as the PIP progressively straightens. Although the contractile nodules and bands of Dupuytren disease may be excised either before or after reversal of the joint's contracture, a 2-staged approach is preferred: (1) reverse the PIP flexion contracture, and (2) excise the diseased tissue from the straightened finger. We believe this 2-staged approach yields better results. In addition, it is technically easier to avoid injury to nerves and arteries while excising the nodules and bands, when one operates through palmar skin of more nearly normal length. PMID:22652177
Agee, John M; Goss, Ben C
We report a case of acute (24 h) double flexor tendon rupture of the little finger after a single injection of collagenase clostridium histolyticum into a palmar Dupuytren's contracture cord which caused metacarpophalangeal joint contracture. Tendon surgery was performed 48 h postinjury with primary repair and standard rehabilitation but it resulted in poor active flexion due to adhesions. Previous papers have suggested that a needle inserted into the flexor tendon can be detected prior to the injection of collagenase by asking the patient to actively move the finger, but our test on an awake patient showed that when a 27-gauge needle was inserted into the flexor tendons through a thick palmar cord, the syringe did not move significantly when the patient moved the finger, and therefore this test does not minimise the risk of iatrogenic tendon injury when using collagenase (Xiapex) for Dupuytren's contracture. PMID:24729115
Povlsen, Bo; Singh, Sarvpreet
We present experimental studies of the propagation of a reaction front in a fluid flow composed of a chain of alternating vortices. We propose that the tools used to describe the transport of a passive impurity in a flow can be expanded to account for the behavior of a reaction front. In particular, we propose that motion of a reaction front from one region to another in the flow is determined by burning manifolds and burning lobes. These ideas are tested experimentally for both the time-independent and time-dependent vortex chain. For a time-independent flow, the time that it takes for a triggered reaction to propagate from one vortex to the next is the minimum time ? for the stable burning manifold BS(?) to envelope the original trigger point. For a time-dependent (oscillatory) vortex chain, we use the burning manifold/lobe framework to explain mode-locking behavior seen in earlier studies.ootnotetextM.S. Paoletti and T.H. Solomon, Europhys. Lett. 69, 819 (2005); Phys. Rev. E 72, 046204 (2005).
Kingsbury, Mark; Solomon, Tom
The performance of a simple method [E. L. Sibert III, E. Vergini, R. M. Benito, and F. Borondo, New J. Phys. 10, 053016 (2008)] to efficiently compute scar functions along unstable periodic orbits with complicated trajectories in configuration space is discussed, using a classically chaotic two-dimensional quartic oscillator as an illustration. PMID:22463306
Revuelta, F; Vergini, E G; Benito, R M; Borondo, F
The therapeutic management of the sequelae of deep burns always relies in principle on dermal-epidermal grafts. The latter, the price of which to pay is heavy scarring, cannot always be performed because the surface of skin available may not be sufficient. Research pathways have turned towards the creation of skin substitutes to minimise the scarring and improve the cosmetic quality of the grafts. We review the technical characteristics of collagen matrixes (Intégra(®) - Matriderm(®)) and their method of use. PMID:21924807
The severe form of congenital contractural arachnodactyly is usually associated with early mortality due to multisystem complications. Here, we report a 9-year-old male child with severe skeletal manifestations of congenital contractural arachnodactyly. He had none of the cardiovascular or gastrointestinal features that have been described in severe congenital contractural arachnodactyly. He had profound intellectual disability with autism. All exons of FBN2, the gene associated with congenital contractural arachnodactyly, were sequenced and no disease-causing mutation was found. When severe congenital contractural arachnodactyly is diagnosed in the newborn period, parents need to be aware that long-term survival is possible, particularly if no significant extraskeletal complications are present, and that significant neurodevelopmental delay may occur. PMID:16531736
Snape, Katie M G; Fahey, Michael C; McGillivray, George; Gupta, Prateek; Milewicz, Dianna M; Delatycki, Martin B
With only minimal sorting, garbage can be used to fire a boiler. But the design of a refuse-to-energy plant must account for the corrosive and abrasive nature of the fuel and must include means of scrubbing flue gases and removing ash. This paper describes the working of a typical mass-burning plant. Topics are grouped under the following headings: Firing equipment, Boiler Design, Control and operation, Research and Development, Air Pollution Controls, Ash removal.
OBJECTIVE: The authors provide an update on a multidisciplinary approach to the treatment of severely burned patients. A review of studies and clinical trials from the past to the present include fluid resuscitation, sepsis, immune function, hypermetabolism, early excision, wound healing, scar formation, and inhalation injury. SUMMARY BACKGROUND DATA: Advances in treating initial burn shock, infection control, early wound closure, and modulation of the hypermetabolic response have decreased morbidity and mortality in the last two decades. Specialized burn care centers, using a multidisciplinary approach, not only successfully treat large burns and their complications, but provide the necessary rehabilitation and psychological support required for readjustment back into society. CONCLUSIONS: Thermal injury results in a number of physiologic alterations that can be minimized by adequate fluid resuscitation to maintain tissue perfusion, early excision of burn wounds, and rapid wound coverage. These measures, in combination with antibiotic coverage and nutritional support in the form of early enteral tube feedings, will decrease the hypermetabolic response and the incidence of sepsis that can lead to hemodynamic instability and organ failure. Ongoing clinical trials using anabolic agents (e.g., recombinant human growth hormone) and pharmacologic agents that modulate inflammatory and endocrine mediators (e.g., ibuprofen and propranolol) show promise in the treatment of severe burn injuries.
Nguyen, T T; Gilpin, D A; Meyer, N A; Herndon, D N
We compared patch structure, fire-scar formation, and seedling regeneration in patches of low, moderate, and high burn severity following the large (~34 000 ha) Jasper fire of 2000 that occurred in ponderosa pine (Pinus ponder- osa Dougl. ex P. & C. Laws.) forests of the Black Hills of South Dakota, USA. This fire created a patchy mosaic of effects, where
Leigh B. Lentile; Frederick W. Smith; Wayne D. Shepperd
Tissue engineering and dermal substitution are currently prominent topics of wound-healing research. However, no extensive clinical trials with objective evaluation criteria have been published so far that support the clinical effectiveness of dermal equivalents in the long term. The dermal substitute that is discussed here is derived from bovine collagen and elastin-hydrolysate and has been shown to improve skin elasticity during a short-term clinical follow-up of scar reconstructions. In this study we will present the long-term outcome by means of objective and subjective scar assessment tools for dermal substitution in acute burn wounds and scar reconstructions. In a clinical trial, an intraindividual comparison was performed between the conventional split-thickness autograft and a combination of the collagen/elastin substitute with an autograft. After 1 year, scars were evaluated by the Cutometer SEM 474 for objective elasticity measurements and by planimetry to establish scar contraction. An independent observer subjected scars to a generally accepted clinical scar assessment tool: the Vancouver Scar Scale. In addition, patients gave their impression of the outcome. Forty-two paired burn wounds and 44 paired scar reconstructions were included and evaluated 1 year after surgery. Although substituted scar reconstructions demonstrated an elasticity improvement of approximately 20 percent compared with control wounds, no statistically significant differences were found for skin elasticity, scar contraction, Vancouver Scar Scale, and patient's impression in both categories after 1 year. An extensive long-term follow-up shows that the dermal substitute, which was proven effective in a clinical trial on a short-term basis, did not yield statistical evidence for a long-term clinical effectiveness of dermal substitution. PMID:11743380
van Zuijlen, P P; Vloemans, J F; van Trier, A J; Suijker, M H; van Unen, E; Groenevelt, F; Kreis, R W; Middelkoop, E
Objective: Scar contracture of the neck after a burn-injury can cause both functional and aesthetic problems, and still presents a challenge for plastic surgeons. The anatomic area and adjacent structures such as the lower lip, trachea and neuro-vascular structures which are affected by the scar make treatment diffucult. Scarring and contracture of the neck region may severely limit function, cause alterations of normal posture and make intubation for surgery difficult. When a burn scar extends toward the face, eating and swallowing may be restricted and facial distortion may develop as the scar pulls the mouthdownwards even the lower eyelids. Method: Following the upper extremity, the neck is the most common site affected by burn contracture. The method chosen for contracture release, depends on the severity of scarring and extent of involvement. If the contracture area is limited, z-plasties, skin grafts or local skin flaps are adequate for the treatment but when the whole anterior neck is affected, the treatment modalities are limited and mostly skin grafts either meshed or unmeshed are used. Results: In this study we evaluated the usage of alternative teatment methods involving skin grafts and local flaps for severe neck contractures and tried to discuss oftenly encounered difficulties in treating these group of patients. Conclusion: Many techniques have been described for correction of neck contractures, including skin grafting, expanders, local regional flaps and free flaps. The treatment of choice should be modified for every patient.
Ayhan, Meltem; Sevim, Kamuran Z; Gorgu, Metin
When undertaking image comparison of the hand between accused and perpetrator, it is not unusual for scars to be identified on the back of the hand. To investigate the occurrence of scarring in a discreet sample, a database of 238 individuals was examined, and the dorsum of the right and left hands was gridded for each individual. The position, size and type of scar were recorded within each grid. It was found that, in general, males exhibited a higher incidence of scarring than females. However, males were more likely to show scarring on their left hand whereas females were more likely to exhibit scarring on their right hand. Contrary to the literature, scarring was not most prevalent along the borders of the hand but occurred more frequently in association with the index and middle finger corridor regions. Surgical scars were rare as were large scars whereas linear scars smaller than 6 mm were the most frequently identified. Close to half of the sample did not exhibit scarring on one hand. The importance of understanding the pattern of scarring on the back of the hand is discussed in the light of forensic image comparison analysis. PMID:23404533
Black, Sue; Macdonald-McMillan, Briony; Mallett, Xanthe
Following CNS injury, in an apparently counterintuitive response, scar tissue formation inhibits axonal growth, imposing a major barrier to regeneration. Accordingly, scar-modulating treatments have become a leading therapeutic goal in the field of spinal cord injury. However, increasing evidence suggests a beneficial role for this scar tissue as part of the endogenous local immune regulation and repair process. How can
Asya Rolls; Ravid Shechter; Michal Schwartz
Purpose: To develop and evaluate a rat excised larynx model for the measurement of acoustic, aerodynamic, and vocal fold vibratory changes resulting from vocal fold scar. Method: Twenty-four 4-month-old male Sprague-Dawley rats were assigned to 1 of 4 experimental groups: chronic vocal fold scar, chronic vocal fold scar treated with 100-ng basic…
Welham, Nathan V.; Montequin, Douglas W.; Tateya, Ichiro; Tateya, Tomoko; Choi, Seong Hee; Bless, Diane M.
Background: Atrophic acne scars are difficult to treat. The demand for less invasive but highly effective treatment for scars is growing. Objective: To assess the efficacy of combination therapy using subcision, microneedling and 15% trichloroacetic acid (TCA) peel in the management of atrophic scars. Materials and Methods: Fifty patients with atrophic acne scars were graded using Goodman and Baron Qualitative grading. After subcision, dermaroller and 15% TCA peel were performed alternatively at 2-weeks interval for a total of 6 sessions of each. Grading of acne scar photographs was done pretreatment and 1 month after last procedure. Patients own evaluation of improvement was assessed. Results: Out of 16 patients with Grade 4 scars, 10 (62.5%) patients improved to Grade 2 and 6 (37.5%) patients improved to Grade 3 scars. Out of 22 patients with Grade 3 scars, 5 (22.7%) patients were left with no scars, 2 (9.1%) patients improved to Grade 1and 15 (68.2%) patients improved to Grade 2. All 11 (100%) patients with Grade 2 scars were left with no scars. There was high level of patient satisfaction. Conclusion: This combination has shown good results in treating not only Grade 2 but also severe Grade 4 and 3 scars.
Garg, Shilpa; Baveja, Sukriti
The objectives of surgical treatment for microstomia due to cicatricial contracture after burn are to obtain sufficient oral aperture, while maintaining sphincter function of the orbicularis oris muscle, and to secure favorable function for eating and conversation in addition to good oral health.The lips of the mouth have a free border, and the oral aperture, which has been enlarged by the operation, tends to be reduced, because of the actions of the orbicularis oris muscle. When the orbicularis oris muscle is resected, putting a priority on sufficient oral aperture and prevention of redevelopment of contracture, the function of the sphincter is often damaged. With the exception of those cases with deep extensive burn that damages a wide area of orbicularis oris muscle, the muscle should be preserved as expeditiously as is practical. In such cases, however, preventive measures for the redevelopment of microstomia should be established. As a postoperative adjuvant therapy, the usefulness of splint therapy has been suggested in many reports. However, a splint should be used for a long period after the surgery, and in some cases, pain is observed with therapy. When a splint is not used for an appropriate period, microstomia may redevelop. It would be ideal to take preventive measures against the redevelopment of contracture during surgery.We provided treatment with some ingenious attempts for the nasolabial flap to a patient with microstomia caused by cicatricial contracture after burn. We obtained favorable results with no postoperative use of a splint. PMID:24561375
Makiguchi, Takaya; Yokoo, Satoshi; Koitabashi, Atsushi; Ogawa, Masaru; Miyazaki, Hidetaka; Terashi, Hiroto
Work-related upper extremity burns often occur. The cause directs the course of action. Thermal burns should be assessed for system alterations, and depth of burn should be determined. Deep partial-thickness burns and more severe burns require a specialist evaluation. Chemical burns must be irrigated and the agent identified. Some chemical burns, such as those that involve phenols and metal fragments, require specific topical applications before water lavage. Hydrofluoric acid burns can cause life-threatening electrolyte abnormalities with a small, highly concentrated acid burn. The goal with any extremity burn is to provide the patient with a multidisciplinary team approach to achieve a functional, usable extremity. PMID:16647659
Pruitt, Valerie M
Many alternative therapies are used as first aid treatment for burns, despite limited evidence supporting their use. In this study, Aloe vera, saliva and a tea tree oil impregnated dressing (Burnaid) were applied as first aid to a porcine deep dermal contact burn, compared to a control of nothing. After burn creation, the treatments were applied for 20 min and the wounds observed at weekly dressing changes for 6 weeks. Results showed that the alternative treatments did significantly decrease subdermal temperature within the skin during the treatment period. However, they did not decrease the microflora or improve re-epithelialisation, scar strength, scar depth or cosmetic appearance of the scar and cannot be recommended for the first aid treatment of partial thickness burns. PMID:18603378
Cuttle, Leila; Kempf, Margit; Kravchuk, Olena; George, Narelle; Liu, Pei-Yun; Chang, Hong-En; Mill, Julie; Wang, Xue-Qing; Kimble, Roy M
[Purpose] The purpose of this case report is to describe for the first time, the use of serial casting in the management of knee joint flexion contracture for a young child with spina bifida. [Case Description] The child was 6?years old, and had L3–L4 spina bifida level lesion with quadriceps muscle strength grade 3 +. The child had previously received weekly physiotherapy including stretching for knee flexion contracture on both lower limbs, but without improvement. [Results] The knee flexion contracture, which was not corrected with passive stretching, improved with casting from ?40° knee extension to ?5° knee extension as measured by a standard goniometer over a period of 4 weeks. Careful measures were taken to ensure skin integrity. At follow up after one-year, the child could ambulate independently with the help of walking aids. [Conclusion] The outcome indicates that using serial casting and follow-up with the use of bracing may be useful for enhancing the walking ability of a young child with spina bifida with knee flexion contractures. Further investigations of serial casting as well as investigation of serial casting with other interventions are warranted.
BACKGROUND: Gluteal muscle contracture (GMC) is a clinical syndrome due to multiple etiologies in which hip movements may be severely limited. The aim of this study was to propose a detailed classification of GMC and evaluate the statistical association between outcomes of different management and patient conditions. METHODS: One hundred fifty-eight patients, who were treated between January 1995 and December
Chen-Guang Zhao; Xi-Jing He; Bin Lu; Hao-Peng Li; Dong Wang; Zhen-Zhong Zhu
[Purpose] It has been shown that an eight-hour joint fixation daily (i.e. for the remaining 16 hours, rats were set free in the cage without joint fixation) for one week induces a joint contracture. The purpose of this study was to investigate the difference between an 8 hours continuous joint fixation and an 8 hours intermittent joint fixation per day (two 4 hours joint fixations) in the development of joint contractures in rats. [Subjects and Methods] The subjects of this study were 34 Wistar rats. On the first day, all of the rats' right ankle dorsiflexion angles were measured. The right hind limbs of all the rats were fixed in plantar flexion, and then the rats were divided into three groups as follows: Group 1 was in continuous fixation for 24 hours a day; Group 2 was in continuous fixation for 8 hours a day; Group 3 was in intermittent fixation for 8 hours a day. The fixation was performed daily for seven consecutive days. On the last day, ankle dorsiflexion angles of all the rats were measured after the casts had been removed. [Results] The development of joint contractures was statistically significant for Groups 1 and 2. [Conclusion] Our results indicate that 8 hours a day of continuous fixation induces a joint contracture, but 8 hours a day of intermittent fixation does not. PMID:24567675
Ono, Takeya; Oki, Sadaaki; Umei, Namiko; Tumiyama, Wakako; Tasaka, Atsushi; Ishikura, Hideki; Aihara, Kazuki; Sato, Yuta; Shimizu, Michele Eisemann; Otsuka, Akira
[Purpose] The purpose of this case report is to describe for the first time, the use of serial casting in the management of knee joint flexion contracture for a young child with spina bifida. [Case Description] The child was 6?years old, and had L3-L4 spina bifida level lesion with quadriceps muscle strength grade 3 +. The child had previously received weekly physiotherapy including stretching for knee flexion contracture on both lower limbs, but without improvement. [Results] The knee flexion contracture, which was not corrected with passive stretching, improved with casting from -40° knee extension to -5° knee extension as measured by a standard goniometer over a period of 4 weeks. Careful measures were taken to ensure skin integrity. At follow up after one-year, the child could ambulate independently with the help of walking aids. [Conclusion] The outcome indicates that using serial casting and follow-up with the use of bracing may be useful for enhancing the walking ability of a young child with spina bifida with knee flexion contractures. Further investigations of serial casting as well as investigation of serial casting with other interventions are warranted. PMID:24926155
We present a method to efficiently compute the eigenfunctions of classically chaotic systems. The key point is the definition of a modified Gram-Schmidt procedure which selects the most suitable elements from a basis set of scar functions localized along the shortest periodic orbits of the system. In this way, one benefits from the semiclassical dynamical properties of such functions. The performance of the method is assessed by presenting an application to a quartic two-dimensional oscillator whose classical dynamics are highly chaotic. We have been able to compute the eigenfunctions of the system using a small basis set. An estimate of the basis size is obtained from the mean participation ratio. A thorough analysis of the results using different indicators, such as eigenstate reconstruction in the local representation, scar intensities, participation ratios, and error bounds, is also presented. PMID:23679503
Revuelta, F; Benito, R M; Borondo, F; Vergini, E
Infection, pain, and cosmetically unacceptable scarring frequently complicate full-thickness burns. Outpatient management can be difficult without specialized care. A retrospective case series study was conducted in a rural wound center lacking specialized burn care to assess the clinical effectiveness of acoustic pressure wound therapy, a noncontact low-frequency, nonthermal ultrasound wound therapy that accelerates healing through positive pressure, stimulating fibroblasts, clearing bacteria and debris, and relieving pain. Data from the records of 14 consecutively treated outpatients (age range 5 months to 78 years old) with mixed partial- and full-thickness burns involving the trunk, extremities, or both, averaging 7% of body surface area (range: 1% to 24%), were reviewed. Patients received acoustic pressure wound therapy with standard burn care. Burn thickness was determined by clinical appearance. Treatment effectiveness was evaluated based on scarring characteristics of healed wounds (ie, cosmetic appearance) and pain resolution. Pain was patient-rated using a 10-point visual analog scale (0 = no pain, 10 = severe). Patients were followed for 6 months post-healing. Pain improved with therapy (range: two to 10 treatments). No patient required hospitalization or developed complications related to infection. Pliable, nonhypertrophic scars developed in 86% of patients and hypertrophic scars developed in 14%. Repigmentation was seen in 79% of patients, with only minor irregularities; hypopigmentation occurred in 21%. Scars available for follow-up (71%) remained unchanged. Acoustic pressure wound therapy with standard burn care was found to heal mixed partial- and full-thickness burns and reduced pain in outpatients, resulting in cosmetically acceptable scarring without infectious complications, surgery, or skin grafts and may prove beneficial for inpatient management of extensive full-thickness burns. Further study is warranted. PMID:18456962
Samies, John; Gehling, Marie
\\u000a Minimally invasive laser therapies using fractionated laser beams have become increasingly more prevalent, especially for\\u000a treating wrinkled sun-damaged skin and acne scars. Moreover, indications for their use have also significantly increased.\\u000a Fractional lasers apply energy using microscopic dimensions and leave the surrounding tissue unaffected, intact, and therefore\\u000a vital. This permits a much shorter period of recovery than if a larger
AIM Satellite cells are the stem cells residing in muscle responsible for skeletal muscle growth and repair. Skeletal muscle in cerebral palsy (CP) has impaired longitudinal growth that results in muscle contractures. We hypothesized that the satellite cell population would be reduced in contractured muscle. METHOD We compared the satellite cell populations in hamstring muscles from participants with CP contracture (n=8; six males, two females; age range 6–15y; Gross Motor Function Classification System [GMFCS] levels II–V; 4 with hemiplegia, 4 with diplegia) and from typically developing participants (n=8; six males, two females, age range 15–18y). Muscle biopsies were extracted from the gracilis and semitendinosus muscles and mononuclear cells were isolated. Cell surface markers were stained with fluorescently conjugated antibodies to label satellite cells (neural cell adhesion molecule) and inflammatory and endothelial cells (CD34 and CD4 respectively). Cells were analyzed using flow cytometry to determine cell populations. RESULTS After gating for intact cells a mean of 12.8% (SD 2.8%) were determined to be satellite cells in typically developing children, but only 5.3% (SD 2.3%;p<0.05) in children with CP. Hematopoietic and endothelial cell types were equivalent in typically developing children and children with CP (p>0.05) suggesting the isolation procedure was valid. INTERPRETATION A reduced satellite cell population may account for the decreased longitudinal growth of muscles in CP that develop into fixed contractures or the decreased ability to strengthen muscle in CP. This suggests a unique musculoskeletal disease mechanism and provides a potential therapeutic target for debilitating muscle contractures.
SMITH, LUCAS R; CHAMBERS, HENRY G; LIEBER, RICHARD L
1. The amplitude and time course of K contractures (Cl- constant) of single twitch muscle fibres of the frog have been analysed in three external Ca2+ concentrations. 2. The resting potential, effective resistance, threshold for the Na current and K-induced depolarizations were not modified by replacing 1.8 mM-Ca2+ by 3 mM-Mg2+ in absence (low-Ca saline: 3-6 micro M-Ca2+) or in the presence of 5 mM-EGTA (Ca-free saline: less than or equal to 10(-9) M-Ca2+). 3. The tension development during the initial phase of K contractures was independent of external Ca2+ while the amplitude, the duration and the time constant of spontaneous relaxation decreased progressively as Ca2+ concentration was diminished. 4. When the concentration of Mg2+ was increased to 5 mM in Ca-free saline K contractures were slower and smaller than those in 3 mM-Mg2+. 5. In Ca-free saline the activation curve (peak tension vs. logarithm of external K+ concentration) shifted by 3-5 mV towards more positive potentials while the inactivation curve (peak tension of the test contracture vs. logarithm of external K+ concentration during the conditioning period) shifted by 16-18 mV towards more negative potentials. Both curves became steeper in Ca-free saline. 6. The effects of external Ca2+ reduction were not modified by replacing all chloride for methanesulphonate. 7. Direct effects of external Ca2+ on excitation-contraction coupling during K contractures could involve the inward Ca current and/or specific interactions between external Ca2+ ions and the coupling mechanism.
Cota, G; Stefani, E
The overall aim of this research is to assess the ability of SAR to detect moorland wildfire scars and their persistence in the landscape using the Peak District National Park (PDNP) in the UK as a case study. Spatially-robust data to monitor wildfire scar size and severity in UK moorlands is currently rare. Fires can burn deep into peat soils and contribute to the release of carbon dioxide into the atmosphere and may also affect the water quality of nearby streams. Information on fire extent would be useful for conservation organisations such as Moors For The Future who are trying to preserve the delicate peatland environment. Knowing the size and location of fire scars would help the Fire and Rescue Service to plan future response to moorland fires. Fire scar boundaries can be mapped in the field using Global Positioning Systems (GPS), however this is labour intensive. Indeed in the PDNP wildfire scar mapping is conducted by park rangers which provides essential ground truth data for assessing against the SAR data. Therefore this particular area provides a unique opportunity for testing an alternative SAR technique for monitoring wildfire scars in the moorland landscape. Previous research shows that SAR has been successfully applied for wildfire scar detection in other types of environments such as boreal (Bourgeau-Chavez et al, 1997) and the tropics (Huang and Siegert, 2004). This research presents some of the first results of the project which tests the capability of ERS 2; ASAR (C-band) and PALSAR (L-band) data to detect several wildfire scars from 2003 - 2008 of various spatial scales and fire severity. Some of the key areas of interest the paper will explore are at Bleaklow and the Kinder plateau. The Bleaklow peat fire of 18th April 2003 was larger (7km2) and more severe than at Kinder, which burned between 26-29th May 2008 and covered an area of 10 ha. All the wildfire scars were GPS, mapped just after the fire event. Archival time-series SAR imagery was supplied by the Landmap Service, originally sourced from the European Space Agency (ESA). C-band ASAR and ERS 2 data and L-band PALSAR data were pre-processed in SARscape 4.2. The results of this research will report on (a) the affect of land cover on backscatter and coherence results (b) the affect of precipitation on the backscatter signal (c) whether fire intensity and size affects the detectability of wildfire scars using SAR and InSAR (d) the degree that SAR and InSAR can be used to assess the persistence of wildfire scars in a UK moorland landscape.;
Millin-chalabi, G. R.; McMorrow, J.; Agnew, C.
A new technique for detecting aerosols from biomass burning and dust is developed. The radiative forcing of aerosols is estimated over four major ecosystems in South America. A new smoke and fire detection scheme is developed for biomass burning aerosols over South America. Surface shortware irradiance calculations are developed in the presence of biomass burning aerosols during the SCAR-B experiment. This new approach utilizes ground based, aircraft, and satellite measurements.
Christopher, Sundar A.
The most serious problem in the treatment of extensive burns is a lack of sufficient healthy skin for coverage of the affected area. Several methods have been used for the coverage of extensive burn wounds. The grafting of cultured epithelium is a potentially effective method for a permanent covering of the wound, particularly in patients with extensive burns. The condition of the recipient site is the most important factor in the success of cultured epithelium grafting and the preservation of the dermis or dermal components in the burned area will enhance the grafting process. We recommend that prior to the grafting of cultured epithelial cells, the burn wounds should be excised and covered with an allograft or artificial dermis during the first 2 weeks after admission. An allograft of cultured epithelium is also useful. This method accelerates the epithelialization of both the burn and donor sites. It is expected that cultured epithelial cell grafts will prove to be an effective treatment not only for extensive burns but also to epithelialize small area burn wounds and resurfaced burn scars. PMID:16869129
Nagase, Takehiko; Kumagai, Norio
Topical treatment of hypertrophic scars is challenging because of poor penetrability of drugs into the scar tissue. The objective of the study was to investigate the effectiveness of iontophoresis to deliver medicaments across the scar epidermis. Initially, biophysical studies were performed to investigate the differences between scar and normal skin epidermis obtained from cadaver. In case of scar skin epidermis, the transepidermal water loss was not significantly different from the normal skin epidermis, whereas the electrical resistivity was significantly higher. The passive permeation flux of sodium fluorescein was approximately one-third of that across the normal skin epidermis. Scanning electron microscopy studies revealed that the two membranes were alike except that the scar skin epidermis lacked follicles. Cathodal iontophoresis enhanced the delivery of sodium fluorescein across the scar skin epidermis by approximately 46 folds [51.90 ± 8.82 ng/(cm(2) h)]. However, the transport of sodium fluorescein across the scar skin epidermis was about an order of magnitude less than the normal skin epidermis. Overall, the studies suggest that iontophoresis could be utilized to overcome the barrier resistance of scar skin epidermis and treat the scar regionally. © 2014 Wiley Periodicals, Inc. and the American Pharmacists Association J Pharm Sci. PMID:24648369
Manda, Prashanth; Angamuthu, Muralikrishnan; Hiremath, Shobharani R; Raman, Vijayasankar; Murthy, S Narasimha
We report the case of a woman who presented with several facial scars following a road accident. Treatment was carried out using combined laser treatment with pulsed dye laser (PDL) and Q-switched neodymium:yttrium-aluminum-garnet laser (QS Nd:YAG laser). No side effects or complications from treatment were noted or reported. The patient had very good cosmetic results with this combined technique. A variety of facial scars - erythematous, pigmented, atrophic, and hypertrophic - may occur as a result of trauma, surgery, burns, and skin disease. Surgery with other adjunctive methods including radiotherapy, intralesional steroids, and pressure therapy have shown variable results. Laser treatment has been attempted for scar revision since the 1980s. The PDL is the optimal treatment for reducing scar bulk and symptoms. It also decreases erythema and telangiectasia associated with scars, normalizes the skin surface texture, and improves the scar pliability. The QS Nd:YAG laser (1064 nm) is highly effective for traumatic tattoo removal, resulting in complete clearance in the majority of cases. PMID:18789060
Martins, Andréa; Trindade, Felicidade; Leite, Luiz
Atrophic facial acne scarring is a widely prevalent condition that can have a negative impact on a patient’s quality of life.\\u000a The appearance of these scars is often worsened by the normal effects of aging. A number of options are available for the\\u000a treatment of acne scarring, including chemical peeling, dermabrasion, ablative or nonablative laser resurfacing, dermal fillers,\\u000a and surgical
T. Gerald O’Daniel
We present a series of two cases complicated by uterine rupture following termination of pregnancy (TOP) in the 1st and 2nd trimesters using misoprostol in women with caesarean section scar. Current literature and practise have also been reviewed on ruptured uterus in women with caesarean section scar undergoing TOP using misoprostol; the diagnosis of adherent placenta in the 1st and 2nd trimesters in women with previous caesarean uterine scar; and likely implications of a ruptured uterus. PMID:24456452
Bika, O; Huned, D; Jha, S; Selby, K
Geomorphic, stratigraphic, and faunal observations of submarine slide scars that occur along the flanks of Monterey Canyon in 2.0–2.5 km water depths were made to identify the processes that continue to alter the surface of a submarine landslide scar after the initial slope failure. Deep-sea chemosynthetic biological communities and small caves are common on the sediment-free surfaces of the slide scars,
C. K. Paull; W. Ussler; H. G. Greene; J. Barry; R. Keaten
Bethlem myopathy and Ullrich congenital muscular dystrophy form a spectrum of collagenopathies caused by genetic mutations encoding for any of the three subunits of collagen VI. Bethlem phenotype is relatively benign and is characterized by proximal dominant myopathy, keloids, contractures, distal hyperextensibility, and follicular hyperkeratosis. Three patients from a single family were diagnosed to have Bethlem myopathy based on European Neuromuscular Centre Bethlem Consortium criteria. Affected father and his both sons had slowly progressive proximal dominant weakness and recurrent falls from the first decade. Both children aged 18 and 20 years were ambulant at presentation. All had flexion contractures, keloids, and follicular hyperkeratosis without muscle hypertrophy. Creatinine kinase was mildly elevated and electromyography revealed myopathic features. Muscle imaging revealed severe involvement of glutei and vasti with "central shadow" in rectus femoris. Muscle biopsy in the father showed dystrophic changes with normal immmunostaining for collagen VI, sarcoglycans, and dysferlin. PMID:24339618
Saroja, Aralikatte Onkarappa; Naik, Karkal Ravishankar; Nalini, Atcharayam; Gayathri, Narayanappa
Bethlem myopathy and Ullrich congenital muscular dystrophy form a spectrum of collagenopathies caused by genetic mutations encoding for any of the three subunits of collagen VI. Bethlem phenotype is relatively benign and is characterized by proximal dominant myopathy, keloids, contractures, distal hyperextensibility, and follicular hyperkeratosis. Three patients from a single family were diagnosed to have Bethlem myopathy based on European Neuromuscular Centre Bethlem Consortium criteria. Affected father and his both sons had slowly progressive proximal dominant weakness and recurrent falls from the first decade. Both children aged 18 and 20 years were ambulant at presentation. All had flexion contractures, keloids, and follicular hyperkeratosis without muscle hypertrophy. Creatinine kinase was mildly elevated and electromyography revealed myopathic features. Muscle imaging revealed severe involvement of glutei and vasti with “central shadow” in rectus femoris. Muscle biopsy in the father showed dystrophic changes with normal immmunostaining for collagen VI, sarcoglycans, and dysferlin.
Saroja, Aralikatte Onkarappa; Naik, Karkal Ravishankar; Nalini, Atcharayam; Gayathri, Narayanappa
The purpose of this study was to see if subvastus approach would decrease incidence of postoperative contracture and pain following TKA compared to standard parapatellar approach. Retrospective review of 546 patients in Group A undergoing TKA using parapatellar approach were compared to 255 patients in Group B undergoing subvastus approach. No statistically significant differences regarding OR time, blood loss, BMI, or LOS. Total of 23 (4%) manipulations under anesthesia for contracture in Group A compared to 6 (2%) in Group B (p>0.05). Postoperative pain scores at 6 weeks was greater in Group A, p<0.05. We feel that a subvastus approach minimizes trauma to the extensor mechanism, and therefore decreases the incidence of postoperative pain following TKA. PMID:23639385
Curtin, Brian; Yakkanti, Madhu; Malkani, Arthur
CONTEXT AND AIMS: Diabetic burn patients comprise a significant population in burn centers. The purpose of this study was to determine the demographic characteristics of diabetic burn patients. MATERIALS AND METHODS: Prospective data were collected on 94 diabetic burn patients between March 20, 2000 and March 20, 2006. Of 3062 burns patients, 94 (3.1%) had diabetes; these patients were compared with 2968 nondiabetic patients with burns. Statistical analysis was performed using the statistical analysis software SPSS 10.05. Differences between the two groups were evaluated using Student's t-test and the chi square test. P < 0.05 was considered as significant. RESULTS: The major mechanism of injury for the diabetic patients was scalding and flame burns, as was also the case in the nondiabetic burn patients. The diabetic burn patients were significantly older, with a lower percentage of total burn surface area (TBSA) than the nondiabetic burn population. There was significant difference between the diabetic and nondiabetic patients in terms of frequency of infection. No difference in mortality rate between diabetic and nondiabetic burn patients was observed. The most common organism in diabetic and nondiabetic burn patients was methicillin-resistant staphylococcus. Increasing %TBSA burn and the presence of inhalation injury are significantly associated with increased mortality following burn injury. CONCLUSIONS: Diabetics have a higher propensity for infection. Education for diabetic patients must include caution about potential burn mishaps and the complications that may ensue from burns.
Maghsoudi, Hemmat; Aghamohammadzadeh, Naser; Khalili, Nasim
We investigate scarred resonances of a stadium-shaped chaotic microcavity. It is shown that two components with different chirality of the scarring pattern are slightly rotated in opposite ways from the underlying unstable periodic orbit, when the incident angles of the scarring pattern are close to the critical angle for total internal reflection. In addition, the correspondence of emission pattern with the scarring pattern disappears when the incident angles are much larger than the critical angle. The steady probability distribution gives a consistent explanation about these interesting phenomena and makes it possible to expect the emission pattern in the latter case.
Lee, Soo-Young; Rim, Sunghwan; Kim, Chil-Min [National Creative Research Initiative Center for Controlling Optical Chaos, Pai-Chai University, Daejeon 302-735 (Korea, Republic of); Ryu, Jung-Wan; Kwon, Tae-Yoon [National Creative Research Initiative Center for Controlling Optical Chaos, Pai-Chai University, Daejeon 302-735 (Korea, Republic of); Department of Physics, Sogang University, Seoul 121-742 (Korea, Republic of)
?Cat FACE? SCAR ON LONGLEAF PINE TREE, OVERHILLS HISTORIC ENTRANCE ROAD, FACING NORTHEAST - Overhills, Fort Bragg Military Reservation, Approximately 15 miles NW of Fayetteville, Overhills, Harnett County, NC
Endometriosis is presence of functioning endometrial tissue outside the uterine cavity, usually in the pelvis. However, its occurrence is very rare (0.03%-0.4%) in the scars which follow obstetrical and gynaecological surgeries. We are reporting two cases of scar endometriosis which occurred after caesarean sections. Both cases presented with abdominal pain at caesarean scar sites, one of which gave a cyclical history. Clinical examination revealed painful swellings in both cases, which were misdiagnosed as stitch granulomas. Wide surgical excisions were done and histopathology examination revealed a diagnosis of scar endometriosis. We are presenting these cases because of their rarity, their uncommon sites and difficulty in diagnosing the conditions clinically.
Patil, Nanda J; Kumar, Vijay
Objective To mechanically control the wound environment and prevent cutaneous scar formation. Approach We subjected various material substrates to biomechanical testing to investigate their ability to modulate skin behavior. Combinations of elastomeric materials, adhesives, and strain applicators were evaluated to develop topical stress-shielding devices. Noninvasive imaging modalities were utilized to characterize anatomic site-specific differences in skin biomechanical properties in humans. The devices were tested in a validated large animal model of hypertrophic scarring. Phase I within-patient controlled clinical trials were conducted to confirm their safety and efficacy in scar reduction in patients undergoing abdominoplasty surgery. Results Among the tested materials and device applicators, a polymer device was developed that effectively off-loaded high tension wounds and blocked pro-fibrotic pathways and excess scar formation in red Duroc swine. In humans, different anatomic sites exhibit unique biomechanical properties that may correlate with the propensity to form scars. In the clinical trial, utilization of this device significantly reduced incisional scar formation and improved scar appearance for up to 12 months compared with control incisions that underwent routine postoperative care. Innovation This is the first device that is able to precisely control the mechanical environment of incisional wounds and has been demonstrated in multiple clinical trials to significantly reduce scar formation after surgery. Conclusion Mechanomodulatory strategies to control the incisional wound environment can significantly reduce pathologic scarring and fibrosis after surgery.
Wong, Victor W.; Beasley, Bill; Zepeda, John; Dauskardt, Reinhold H.; Yock, Paul G.; Longaker, Michael T.; Gurtner, Geoffrey C.
Adenosine A2A receptor (A2AR) stimulation promotes wound healing and is required for the development of fibrosis in murine models of scleroderma and cirrhosis. Nonetheless, the role of A2AR in the formation of scars following skin trauma has not been explored. Here, we examined the effect of pharmacological blockade of A2AR, with the selective adenosine A2AR-antagonist ZM241385 (2.5 mg/ml), in a murine model of scarring that mimics human scarring. We found that application of the selective adenosine A2AR antagonist ZM241385 decreased scar size and enhanced the tensile strength of the scar. Within the scar itself, collagen alignment and composition (marked reduction in collagen 3), but not periostin, biglycan, or fibronectin accumulation, was improved by application of ZM241385. Moreover, A2AR blockade reduced the number of myofibroblasts and angiogenesis but not macrophage infiltration in the scar. Taken together, our work strongly suggests that pharmacological A2AR blockade can be used to diminish scarring while improving the collagen composition and tensile strength of the healed wound.—Perez-Aso, M., Chiriboga, L., Cronstein, B. N. Pharmacological blockade of adenosine A2A receptors diminishes scarring.
Perez-Aso, Miguel; Chiriboga, Luis; Cronstein, Bruce N.
Scar ulcers that spread over the Achilles tendon and posterior heel disturb patients by causing pain, impeding hygiene, and creating difficulty in finding appropriate shoe wear. As this region undergoes pressure, effective reconstruction is based on the flap use. The most popular flaps currently used are distally based sural fasciocutaneous flap, calcaneal artery skin flap, and free flaps. These flaps, however, are insensate, can create soft-tissue excess, and cause donor site morbidity. Ulcerous soft-tissue defects over Achilles tendon and posterior heel after burns, frost, and trauma were studied and reconstructed in 16 patients, using proximally based sural adipose-cutaneous flap, the anatomy of which was studied on lower extremities of 27 cadavers. Ulcerous soft-tissue defect consists of two parts: ulcer and surrounding pathologic scars that should be excised in one block. Resulting soft-tissue defects with exposed tendon and calcaneal bone varied from 6 to 20 cm in length and 6 cm in width. For such wound resurfacing a flap was developed that was sensate, thin, large, and having steady blood circulation. The flap was harvested from the lower third of the leg and lateral foot, consisting of skin and subcutaneous fat layer (without fascia), including the sural nerve and lesser vein. The blood supply was ensured through peroneal and anterior tibial artery perforators, which formed a vascular net in the flap. In 14 of 16 cases excellent and stable functional and good cosmetic results with acceptable donor site morbidity were achieved. In two patients the distal flap loss took place because of arteriitis obliterans (one case) and because of the cross-cutting of the sural nerve and vessels during previous surgeries (another case). Proximally based sural adipose-cutaneous/scar flap is the only flap that satisfies all requirements for Achilles tendon and posterior heel region resurfacing. The author believes that this technique, based on this flap use, is anatomically justified, clinically profitable, and should be considered as the first choice operation. PMID:24043244
Grishkevich, Viktor M
We describe a male neonate with severe arachnodactyly, hypermobility of the fingers, flexion contractures of elbows, wrists, hips, and knees, micrognathia, crumpled ears, rockerbottom feet, loose redundant skin, and ocular abnormalities. Severe cardiac valve insufficiency and aortic dilatation resulted in cardiac failure and death 20 hours after birth. This case represents the severe end of the clinical spectrum of Marfan syndrome. As similar patients have been reported, they may represent a separate mutation. Images
Buntinx, I M; Willems, P J; Spitaels, S E; Van Reempst, P J; De Paepe, A M; Dumon, J E
1. The present study was undertaken to investigate firstly whether a brief exposure for 5 min of guinea-pig isolated ileum to the kappa-opioid agonist, U-50,488H produced a withdrawal contracture on addition of naloxone and secondly to ascertain whether the response was due to the activation of kappa-opioid receptors. 2. Naloxone (10(-6) M) did not elicit a response in preparations exposed to U-50,488H (5 x 10(-7) M-2 x 10(-6) M). However, after exposure to U-50,488H (5 x 10(-7) M), naloxone (10(-6) M) produced a strong contracture if the agonist was washed out 1 min before the addition of the antagonist. 3. The addition of naloxone (10(-6) M) to the ileum preparation exposed to U-50,488H (10(-7) M or lower) caused a response of similar intensity irrespective of whether the agonist had been washed out. 4. The selective kappa-opioid antagonist, nor-binaltorphimine (2.7 x 10(-9) M and 2.7 x 10(-7) M), injected before the opioid agonists, prevented the naloxone-induced contracture after exposure to U-50,488H (8 x 10(-8) M) but did not affect the contracture after exposure to morphine (5 x 10(-7) M). 5. Nor-binaltorphimine (2.7 x 10(-9) M) caused a contraction of the ileum preparation when injected 5 min after exposure to U-50,488H (8 x 10(-8) M) but not after morphine (5 x 10(-7) M).(ABSTRACT TRUNCATED AT 250 WORDS)
Morrone, L. A.; Romanelli, L.; Amico, M. C.; Valeri, P.
Scars from self-inflicted wounds to the upper extremities are the hallmark of self-mutilation. They are easy to recognize and difficult to hide. Camouflaging these scars can be an onerous task. In this case study, a 23-year-old woman who has major depressive disorder with comorbid borderline personality disorder presented for scar repair of self-inflicted wounds on the volar and dorsal forearm (each approximately 10 cm2 x 15 cm2). Following a psychological and physical evaluation, split-thickness skin grafts (10/1,000 inches in thickness) were obtained from both areas and switched. The grafts were fixed with staples, immobilized with a short arm splint, and dressed daily with gauze and neomycin ointment. Staples were removed after 10 days; at the 6-month follow up, the wounds resembled burn wound scars. The patient was satisfied with this more socially acceptable result. This method might offer a simple camouflage option in appropriately selected cases. PMID:24706403
Chou, Chang-Yi; Chang, Hsin An; Chiao, Hao-Yu; Wang, Chi-Yu; Sun, Yu-Shan; Chen, Shyi-Gen; Wang, Chih-Hsin
Objective: Ho:YAG laser had been used to treat the common diseases of urinary system such as bladder cancer and benign prostatic hyperplasia in our hospital. This study is to assess the efficacy and safety of transurethral Ho:YAG-laser resection to treat the urethral stricture and bladder neck contracture. Methods: From May 1997 to August 2004, 26 cases of urethral stricture and 33 cases of bladder neck contracture were treated by transurethral Ho:YAG-laser resection. These patients were followed up at regular intervals after operation. The uroflow rate of these patients was detected before and one-month after operation. The blood loss and the energy consumption of holmium-laser during the operation as well as the complications and curative effect after operation were observed. Results: The therapeutic effects were considered successful, with less bleeding and no severe complications. The Qmax of one month postoperation increased obviously than that of preoperation. Of the 59 cases, restenosis appeared in 11 cases (19%) with the symptoms of dysuria and weak urinary stream in 3-24 months respectively. Conclusions: The Ho:YAG-laser demonstrated good effect to treat the obstructive diseases of lower urinary tract such as urethral stricture and bladder neck contracture. It was safe, minimal invasive and easy to operate.
Bo, Juanjie; Dai, Shengguo; Huang, Xuyuan; Zhu, Jing; Zhang, Huiguo; Shi, Hongmin
There is little published information on the health impact of frozen shoulder. The purpose of this study was to assess the functional and health-related quality of life outcomes following arthroscopic capsular release (ACR) for contracture of the shoulder. Between January 2010 and January 2012 all patients who had failed non-operative treatment including anti-inflammatory medication, physiotherapy and glenohumeral joint injections for contracture of the shoulder and who subsequently underwent an ACR were enrolled in the study. A total of 100 patients were eligible; 68 underwent ACR alone and 32 had ACR with a subacromial decompression (ASD). ACR resulted in a highly significant improvement in the range of movement and functional outcome, as measured by the Oxford shoulder score and EuroQol EQ-5D index. The mean cost of a quality-adjusted life year (QALY) for an ACR and ACR with an ASD was £2563 and £3189, respectively. ACR is thus a cost-effective procedure that can restore relatively normal function and health-related quality of life in most patients with a contracture of the shoulder within six months after surgery; and the beneficial effects are not related to the duration of the presenting symptoms. PMID:23814247
Dattani, R; Ramasamy, V; Parker, R; Patel, V R
Calcium influx in the sartorius muscle of the frog (Rana pipiens) has been estimated from the rate of entry of Ca45. In the unstimulated preparation it is about equal to what has been reported for squid giant axons, but that per impulse is at least 30 times greater than in nerve fibers. The enhanced twitch when NO-2 replaces Cl- in Ringer's is associated with at least a 60 per cent increase in influx during activity, whereas this anion substitution does not affect the passive influx significantly. Calcium entry during potassium contracture is even more markedly augmented than during electrical stimulation, but only at the beginning of the contracture; thus, when a brief Ca45 exposure precedes excess K+ application, C45 uptake is increased three- to fivefold over the controls not subjected to K+, whereas when C45 and K+ are added together, no measurable increase in Ca45 uptake occurs. These findings are in keeping with the brevity of potassium contracture in "fast (twitch)" fibers such as in sartorius muscle.
Bianchi, C. Paul; Shanes, A. M.
Members of two generations of a South African family have a unique syndrome comprising poikiloderma, tendon contractures and progressive pulmonary fibrosis. The condition is clinically important as the skin changes, which involve the face, have considerable cosmetic impact, while lung involvement is potentially lethal in adulthood. Skin manifestations which facilitate diagnosis include facial telangiectasia, mottled hypo- and hyperpigmentation, papules and epidermal atrophy. The scalp, facial and body hair are fine and scanty. The tendon contractures lead to progressive digital flexion deformities and abnormalities of the ankles and feet, with disturbance of gait. Pulmonary involvement manifests as progressive dyspnoea. Pedigree data are compatible with an autosomal dominant mode of transmission. Poikiloderma of Weary is characterized by linear sclerotic and fibrous bands and not tendon contractures and is not associated with potentially lethal pulmonary fibrosis. Rather than name this disorder a variant of Weary syndrome, it might be prudent to use as an umbrella title one composed by Weary himself: 'hereditary sclerosing poikiloderma' (HSP), under which variants such as HSP Weary type, HSP with cardiac involvement (aortic stenosis described as inconsistently associated with Weary syndrome) and HSP with tendon/pulmonary involvement (current family) may be classified. The manifestations in this family differ from other poikilodermata and, to the best of our knowledge, have not been previously documented. PMID:17034542
Khumalo, N P; Pillay, K; Beighton, P; Wainwright, H; Walker, B; Saxe, N; Mayosi, B M; Bateman, E D
Pain in the tongue or oral tissues described as "burning" has been referred to by many terms including burning mouth syndrome. When a burning sensation in the mouth is caused by local or systemic factors, it is called secondary burning mouth syndrome and when these factors are treated the pain will resolve. When burning mouth syndrome occurs in the absence of identified risk indicators, the term primary burning mouth syndrome is utilized. This article focuses on descriptions, etiologic theories, and management of primary burning mouth syndrome, a condition for which underlying causative agents have been ruled out. PMID:23201368
Crow, Heidi C; Gonzalez, Yoly
Pathological cutaneous scars such as keloids and hypertrophic scars (HSs) are characterized by a diffuse redness that is caused by the overgrowth of capillary vessels due to chronic inflammation. Our group has been using long-pulsed, 1064-nm Nd:YAG laser in noncontact mode with low fluence and a submillisecond pulse duration to treat keloids and hypertrophic scars since 2006 with satisfactory results. The present study examined the efficacy of this approach in 22 Japanese patients with keloids (n = 16) or hypertrophic scars (n = 6) who were treated every 3 to 4 weeks. Treatment settings were as follows: 5 mm spot size diameter; 14 J/cm2 energy density; 300 ?s exposure time per pulse; and 10 Hz repetition rate. The responses of the pathological scars to the treatment were assessed by measuring their erythema, hypertrophy, hardness, itching, and pain or tenderness. Moreover, skin samples from 3 volunteer patients were subjected to histological evaluation and 5 patients underwent thermography during therapy. The average total scar assessment score dropped from 9.86 to 6.34. Hematoxylin and eosin staining and Elastica Masson-Goldner staining showed that laser treatment structurally changed the tissue collagen. This influence reached a depth of 0.5 to 1 mm. Electron microscopy revealed plasma protein leakage, proteoglycan particles, and a change in the collagen fiber fascicles. Further analyses revealed that noncontact mode Nd:YAG laser treatment is highly effective for keloids and hypertrophic scars regardless of patient age, the origin and multiplicity of scarring, the location of the scar(s), or the tension on the scar.
Akaishi, Satoshi; Koike, Sachiko; Dohi, Teruyuki; Kobe, Kyoko; Hyakusoku, Hiko; Ogawa, Rei
Background and purpose An internet-based discrete choice experiment (DCE) was conducted to elicit preferences for a wide range of Dupuytren’s contracture (DC)-related health states. An algorithm was subsequently developed to convert these preferences into health state utilities that can be used to assess DC’s impact on quality of life and the value of its treatments. Methods Health state preferences for varying levels of DC hand severity were elicited via an internet survey from a sample of the UK adult population. Severity levels were defined using a combination of contractures (0, 45, or 90 degrees) in 8 proximal interphalangeal and metacarpophalangeal joints of the index, middle, ring, and little fingers. Right-handed, left-handed, and ambidextrous respondents indicated which hand was preferable in each of the 10 randomly-selected hand-pairings comparing different DC severity levels. For consistency across comparisons, anatomically precise digital hand drawings were used. To anchor preferences onto the traditional 0–1 utility scale used in health economic evaluations, unaffected hands were assigned a utility of 1.0 whereas the utility for a maximally affected hand (i.e., all 8 joints set at 90 degrees of contracture) was derived by asking respondents to indicate what combination of attributes and levels of the EQ-5D-5L profile most accurately reflects the impact of living with such hand. Conditional logistic models were used to estimate indirect utilities, then rescaled to the anchor points on the EQ-5D-5L. Results Estimated utilities based on the responses of 1,745 qualified respondents were 0.49, 0.57, and 0.63 for completely affected dominant hands, non-dominant hands, or ambidextrous hands, respectively. Utility for a dominant hand with 90-degree contracture in t h e metacarpophalangeal joints of the ring and little fingers was estimated to be 0.89. Separately, reducing the contracture of metacarpophalangeal joint for a little finger from 50 to 12 degrees would improve utility by 0.02. Interpretation DC is associated with substantial utility decre- ments. The algorithms presented herein provide a robust and flexible framework to assess utility for varying degrees of DC severity.
In this Letter we propose an original mechanism to select scar modes through coherent gain amplification in a multimode D-shaped fiber. More precisely, we demonstrate the selective amplification of scar modes by positioning a gain region in the vicinity of the self-focal point of the shortest periodic orbit in the transverse motion.
Michel, Claire; Doya, Valérie; Legrand, Olivier; Mortessagne, Fabrice
Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive, rarely metastatic, spindle cell tumor. Trauma has been associated with its development. Since the 1940s, malignant tumors have been described to occur in sites of smallpox vaccination scars. Five cases in the literature document DFSP arising in sites of prior immunizations. We report a case of DFSP occurring in a smallpox vaccination scar
Justin J. Green; Warren R. Heymann
Centipedes collected in the field quite often exhibit cicatriced lesions. An overview is given on the frequency of the different kinds of scars in Lilhobiidae. Samples of populations of some species from various lo- cations are compared as to the proportion of scarred individuals. In some cases statistically significant differences can be found. Their informational value for understanding the life
Regrowth of turtle grass, Thalassia testudinum Banks ex Konig, into existing propeller scars and artificial cuts was studied in a mangal estuary located in Tampa Bay, Florida. Sediments from scars and cuts and adjacent grass beds were not significantly different in relation to particle size distribution and levels of calcium carbonate. Significantly lower concentrations of total organic matter and extractable
Clinton J. Dawes; John Andorfer; Craig Rose; Christina Uranowski; Nicholas Ehringer
Objective: The present study was designed to use an in vivo rabbit ear scar model to investigate the efficacy of systemic administration of endostatin in inhibiting scar formation. Methods: Eight male New Zealand white rabbits were randomly assigned to two groups. Scar model was established by making six full skin defect wounds in each ear. For the intervention group, intraperitoneal injection of endostatin was performed each day after the wound healed (about 15 d post wounding). For the control group, equal volume of saline was injected. Thickness of scars in each group was measured by sliding caliper and the scar microcirculatory perfusion was assessed by laser Doppler flowmetry on Days 15, 21, 28, and 35 post wounding. Rabbits were euthanatized and their scars were harvested for histological and proteomic analyses on Day 35 post wounding. Results: Macroscopically, scars of the control group were thicker than those of the intervention group. Significant differences between the two groups were observed on Days 21 and 35 (p<0.05). Scar thickness, measured by scar elevation index (SEI) at Day 35 post wounding, was significantly reduced in the intervention group (1.09±0.19) compared with the controls (1.36±0.28). Microvessel density (MVD) observed in the intervention group (1.73±0.94) was significantly lower than that of the control group (5.63±1.78) on Day 35. The distribution of collagen fibers in scars treated with endostatin was relatively regular, while collagen fibers in untreated controls were thicker and showed disordered alignment. Western blot analysis showed that the expressions of type I collagen and Bcl-2 were depressed by injection of endostatin. Conclusions: Our results from the rabbit ear hypertrophic scar model indicate that systemic application of endostatin could inhibit local hypertrophic scar formation, possibly through reducing scar vascularization and angiogenesis. Our results indicated that endostatin may promote the apoptosis of endothelial cells and block their release of platelet-derived growth factor (PDGF) and fibroblast growth factor (FGF), thereby controlling collagen production by fibroblasts. Blood vessel-targeted treatment may be a promising strategy for scar therapy.
Ren, Hai-tao; Hu, Hang; Li, Yuan; Jiang, Hong-fei; Hu, Xin-lei; Han, Chun-mao
Experimental studies were conducted to investigate the possible causes of shell scars in the bivalve mollusc Glycymeris glycymeris, including fishing disturbance, predator attacks and burrowing activity. Individuals collected from an area of sea bed experimentally fished once by a scallop dredge 12 months previously did not display significantly more shell scars than those collected before fishing or from a control area. In the laboratory, Glycymeris offered to the predatory crab Cancer pagurus had a significantly higher incidence of scars seen in acetate peels of shell cross-sections than control shells. However, scarring on Glycymeris excavated from the sediment and left to reburrow was not significantly different from those in an undisturbed control group. Currently, it is not possible in G. glycymeris to differentiate between scars caused by fishing disturbance or natural disturbances, either on the grounds of visual appearance or position of damage.
Ramsay, K.; Richardson, C. A.; Kaiser, M. J.
A major consequence of spinal cord injury (SCI) is the development of a glial scar. Although the scar has benefits for tissue repair, it also blocks neural regeneration. Inhibitory chondroitin sulfate proteoglycans (CSPGs) are elevated in the glial scar a...
D. Snow T. M. Hering
Cesarean scar pregnancy is an uncommon ectopic gestation. Without timely and proper management,it may cause major bleeding,uterine rupture,and other life-threatening complications. The causes of this condition remain unclear,and no standardized management has been available,although some medical and surgical treatment modalities have been suggested. The main treatment objectives include preventing massive blood loss,preserving the uterus function,and maintain the women's health and quality of life. Current data do not support expectant management. After early diagnosis,single or combined medical and surgical treatment options should be provided to avoid uterine rupture and haemorrhage,so as to preserve the uterus and thus the fertility. PMID:24791804
Li, Jin-jin; Liu, Xin-yan
Results of a national retrospective survey on Hyalomatrix PA in burn patients are reported.A total of 11 burn centers were contacted.A total of 57 patients were available. Hyalomatrix PA was used on young and adult patients, mainly in deep partial thickness and full thickness burns. In most cases, Hyalomatrix PA was applied immediately after the wound cleaning (wound debridement or escharectomy for adults, dermabrasion or debridement in young patients). After 7 days, reepithelization processes were more frequent in deep partial thickness burns. One-half of the patient population underwent grafting. After 29 days, complete closure was achieved in almost all patients. The Vancouver Scar Scale showed better values for adults, while no differences were observed for burn depth or patients undergoing grafting. No adverse reactions were recorded.Hyalomatrix PA is used in young and adults, in deep partial thickness and full thickness burns, as a temporary coverage before grafting or alone for wound healing. PMID:20010411
Gravante, Gianpiero; Sorge, Roberto; Merone, Antonio; Tamisani, Anna Maria; Di Lonardo, Antonio; Scalise, Alessandro; Doneddu, Giovanna; Melandri, Davide; Stracuzzi, Giorgio; Onesti, Maria Giuseppina; Cerulli, Paolo; Pinn, Raimondo; Esposito, Gaetano
We evaluated the use of Suprathel(®), a synthetic skin substitute, for partial thickness burns in children. Thirty-three children (20 females, 13 males; mean age 29 months, range 5 months to 11 years) with burns were treated with Suprathel(®). The burns were superficial partial thickness (n=24) or mid-dermal (n=19); the median %TBSA was 4% (range 1-13%). Suprathel(®) was applied after debridement, followed by Vaseline gauze, dry gauze and crepe bandage. The outer dressings were changed every 5-10 days unless clinical problems dictated otherwise. Median healing time was 16 days (range 9-38 days). Ten patients took longer than 21 days to heal, of whom four developed hypertrophic scarring, which was strongly associated with wound infection (p<0.05). Healing time of superficial partial thickness and mid-dermal burns was not significantly different (p=0.494). Suprathel(®) is an effective skin substitute for the treatment of partial thickness burns in children. The majority of burns in children are mixed depth, and Suprathel(®) has the advantage that it may also be used to treat mid-dermal burns. It behaves like a biological dressing but is not animal derived, so is acceptable to all religious and ethnic groups. Further studies to evaluate the efficacy and cost effectiveness of Suprathel(®) compared to other dressings in children are warranted. PMID:22698841
Highton, Lyndsey; Wallace, Christopher; Shah, Mamta
Rehabilitation of speech and swallowing postburns reconstructive surgery has not been previously described in detail in the literature. Severe facial burn injury requiring subsequent reconstructive surgery may result in complications including circumoral contracture and aesthetic and functional irregularities. These complications may manifest as facial and labial sensation deficits, poor oral access for intubation and oral/dental hygiene, and inadequate oral competence causing chronic drooling and poor articulation. This report describes the physical rehabilitation of a patient with full-thickness burns to the nose, lips, mouth, and chin following electrical burn injury. The severity of injury sustained placed the patient at high risk for microstomia, dysphagia, and speech disorder. A multidisciplinary team approach was used to coordinate the planning of reconstructive procedures, facilitate patient recovery, and optimize functional and aesthetic outcomes. Speech pathology intervention aimed to 1) facilitate safe transition from nonoral to oral intake, 2) improve articulation and speech intelligibility, and 3) minimize oral contracture development. At 6 months postinjury, the patient can safely tolerate a soft diet, demonstrate speech clarity at preinjury level, and has recovered functional oral range of movement. Rehabilitation of speech and swallowing is an essential factor to consider when planning postburn reconstructive procedures. PMID:19826257
Clayton, Nicola A; Ledgard, James P; Haertsch, Peter A; Kennedy, Peter J; Maitz, Peter K M
Burn injury is associated with disabling scar formation which impacts on many aspects of the patient's life. Previously we have shown that the fetus heals a deep dermal burn in a scarless fashion. Amniotic membrane (AM) is the outermost fetal tisue and has beeen used as a dressing in thermal injuries, though there is little data to support this use. To assess the efficacy of AM in scar minimisation after deep dermal burn wound, we conducted a randomised controlled study in the 1-month lamb. Lambs were delivered by caesarian section and the amniotic membranes stored after which lambs were returned to their mothers post-operatively. At 1 month, a standardised deep dermal burn was created under general anaesthesia on both flanks of the lamb. One flank was covered with unmatched AM, the other with paraffin gauze. Animals were sequentially euthanased from Day 3-60 after injury and tissue analysed for histopathology and immunohistochemically for alpha-smooth muscle actin (alphaSMA) content. AM resulted in reduced scar tissue as assessed histopathologically and reduced alphaSMA content. This study provides the first laboratory evidence that AM may reduce scar formation after burn injury. PMID:19447551
Fraser, John F; Cuttle, Leila; Kempf, Margit; Phillips, Gael E; Hayes, Mark T; Kimble, Roy M
The depth of any burn wound is an important determinant of its management and outcome. It also governs the outcome of wound healing and scarring making initial depth assessment extremely vital. Various methods both invasive and non-invasive have been described in literature for burn depth estimation. We describe a useful adjunct to clinical burn depth assessment, a VACUETTE(®) venous blood sampling device. This single cheap, ubiquitous and sterile device usually used for phlebotomy allows subjective assessment of the most useful parameters in the assessment of burn wounds, including, capillary refill, evaluation of sensation to blunt and sharp stimuli including pain. PMID:22652478
Javed, Muhammad; Shokrollahi, Kayvan
...open burning, agricultural burning, and forestry and silvicultural burning. 49.11021...open burning, agricultural burning, and forestry and silvicultural burning. (a...of a permit under Â§ 49.134 Rule for forestry and silvicultural burning...
...open burning, agricultural burning, and forestry and silvicultural burning. 49.10411...open burning, agricultural burning, and forestry and silvicultural burning. (a...of a permit under Â§ 49.134 Rule for forestry and silvicultural burning...
Loss of dermis is one of the principal factors that contributes to poor scar outcome after severe burn. Dermal loss may be due to the primary injury, surgical management or as a result of infection. Strategies for dermal preservation are therefore important to improve scar quality. We report our early experience using the Versajet hydrosurgery system, to preserve dermal tissues, both directly during surgical debridement and indirectly by reducing infection and optimising the use of biological dressings. In deep partial thickness burns softer necrotic dermis can be removed with the Versajet sparing the underlying tougher viable dermis. In superficial burns the Versajet cleans and removes loose epidermal elements providing an optimal wound surface for the application of biological dressings, even a number of days after injury. Versajet is most useful when the tissue to be removed is softer than that to be left behind. PMID:16849034
Cubison, Tania C S; Pape, Sarah A; Jeffery, Steven L A
Estimation of chronological age from skeletal material is dependent upon estimation of maturational stage observed. Following completion of epiphyseal fusion, a transverse radio-opaque line, termed "epiphyseal scar", may be observed in the region of the former growth plate. According to the literature, this line is likely to become obliterated shortly after completion of epiphyseal fusion. Consequently, presence of an epiphyseal scar has been interpreted as an indication of recent epiphyseal fusion; however, this has not been validated by quantitative research. A study was undertaken to determine persistence of the epiphyseal scars in a cross-sectional population of adults between 20 and 50 years of age. This study examined 1,216 radiographs of proximal and distal tibiae from both sexes and sides of the body. This study suggested that 98.05% of females and 97.74% of males retained some remnant of the epiphyseal scar at the proximal tibia whilst 92.72% of females and 92.95% of males retained some remnant of the epiphyseal scar at the distal tibia. General linear model (GLM) analysis determined that chronological age accounted for 2.7% and 7.6% of variation in persistence of the epiphyseal scar at the proximal and distal tibiae, respectively. This study suggests that obliteration of the epiphyseal scar is not as dependent on chronological age as previously thought. It is, therefore, recommended that this feature not be used as an indicator of chronological age during forensic age assessment. PMID:23471589
Davies, Catriona; Hackman, Lucina; Black, Sue
The purpose of this study was to report the results of the surgical treatment of spastic knee flexion contracture using tenotomy and progressive correction by external fixator-distractor devices. The study design involved a prospective observational study of 16 knees in nine patients with spastic flexion contracture greater than 30 degrees . Treatment was indicated for both ambulatory and nonambulatory patients; and, in the latter group when sitting or personal hygiene was compromised. The average age was 11.6 years (range 10-17). Five of the patients were male and four female. There was one case of hemiplegia (11.1%), two cases of paraplegia (22.2%), and six cases of quadriplegia (66.7%). Six patients retained some walking capacity, while three had none. In all cases, distal lengthening of the hamstrings was carried out. A monolateral fixator with a gradual correction device was applied for a period of 4.8 weeks. The average follow-up was 26.6 months. The preoperative straight-leg raise was 55 degrees . The popliteal angle was 58 degrees preoperatively (range 30-80 degrees ), 8.5 degrees on removal of the fixator, and 20 degrees at the end of the follow-up. Complications: There were no superficial or deep infections, and no fractures or distal sensory-motor alterations. There was one case of arthrodiatasis of the knee (6.3%) which was resolved when the fixator was removed, and 11 cases of pin-track infection (68.7%) which were resolved with local care and oral antibiotics. To conclude, spastic knee flexion contracture can be treated gradually with monolateral external fixator with distraction devices, and with distraction modules which prevent acute stretching of the posterior neurovascular structures of the knee. PMID:18427750
Carbonell, Pedro Gutiérrez; Valero, Jose Valiente; Fernández, Pedro Doménech; Vicente-Franqueira, Javier Roca
The purpose of this study was to report the results of the surgical treatment of spastic knee flexion contracture using tenotomy and progressive correction by external fixator–distractor devices. The study design involved a prospective observational study of 16 knees in nine patients with spastic flexion contracture greater than 30°. Treatment was indicated for both ambulatory and nonambulatory patients; and, in the latter group when sitting or personal hygiene was compromised. The average age was 11.6 years (range 10–17). Five of the patients were male and four female. There was one case of hemiplegia (11.1%), two cases of paraplegia (22.2%), and six cases of quadriplegia (66.7%). Six patients retained some walking capacity, while three had none. In all cases, distal lengthening of the hamstrings was carried out. A monolateral fixator with a gradual correction device was applied for a period of 4.8 weeks. The average follow-up was 26.6 months. The preoperative straight-leg raise was 55°. The popliteal angle was 58° preoperatively (range 30–80°), 8.5° on removal of the fixator, and 20° at the end of the follow-up. Complications: There were no superficial or deep infections, and no fractures or distal sensory–motor alterations. There was one case of arthrodiatasis of the knee (6.3%) which was resolved when the fixator was removed, and 11 cases of pin-track infection (68.7%) which were resolved with local care and oral antibiotics. To conclude, spastic knee flexion contracture can be treated gradually with monolateral external fixator with distraction devices, and with distraction modules which prevent acute stretching of the posterior neurovascular structures of the knee.
Valero, Jose Valiente; Fernandez, Pedro Domenech; Vicente-Franqueira, Javier Roca
Background: Atrophic facial scars are always a challenge to treat, especially the ones that are deep-seated and/or involve much of the face. Microneedling or dermaroller therapy is a new addition to the treatment armamentarium for such scars that offers a simple and reportedly effective management of these scars. Aims: The aim of the present study was to perform an objective evaluation of the efficacy of dermaroller treatment in atrophic facial scars of varying etiology. Materials and Methods: Thirty-seven patients of atrophic facial scarring were offered multiple sittings of microneedling (dermaroller) treatment and their scars were evaluated and graded clinically and by serial photography at the start as well as at two months after the conclusion of the treatment protocol. Any change in the grading of scars after the end of treatment and follow-up period was noted down. The patients were also asked to evaluate the effectiveness of the treatment received on a 1-10 point scale. The efficacy of dermaroller treatment was thus assessed both subjectively by the patients as well as objectively by a single observer. Results: Overall 36 out of the total of 37 patients completed the treatment schedule and were evaluated for its efficacy. Out of these 36 patients, 34 achieved a reduction in the severity of their scarring by one or two grades. More than 80% of patients assessed their treatment as ‘excellent’ on a 10-point scale. No significant adverse effects were noted in any patient. Conclusions: Microneedling therapy seems to be a simple and effective treatment option for the management of atrophic facial scars.
Collagen fibers are an essential component of the dynamic process of scarring, which accompanies various diseases. Scar tissue may reveal different morphologic expressions, such as hypertrophic scars or keloids. Collagen fibers can be visualized by fluorescent light when stained with eosin. Second Harmonic Generation (SHG) creates a non linear signal that occurs only in molecules without inversion symmetry and is particularly strong in the collagen fibers arranged in triple helices. The aim of this study was to describe the methodology for the analysis of the density and texture of collagen in keloids, hypertrophic scars and conventional scars. Samples were examined in the National Institute of Science and Technology on Photonics Applied to Cell Biology (INFABIC) at the State University of Campinas. The images were acquired in a multiphoton microscopy LSM 780-NLO Zeiss 40X. Both signals, two-photon fluorescence (TPEF) and SHG, were excited by a Mai-Tai Ti:Sapphire laser at 940 nm. We used a LP490/SP485 NDD filter for SHG, and a BP565-610 NDD filter for fluorescence In each case, ten images were acquired serially (512×512 ?m) in Z-stack and joined together to one patchwork-image . Image analysis was performed by a gliding-box-system with in-house made software. Keloids, hypertrophic scars and normal scar tissue show different collagen architecture. Inside an individual case differences of the scar process may be found between central and peripheral parts. In summary, the use of nonlinear optics is a helpful tool for the study of scars tissue.
Ferro, D. P.; Vieira-Damiani, G.; Adam, R. L.; Cesar, C. L.; Metze, Konradin
Using a combination of homozygosity mapping and whole-exome sequencing (WES), we identified a novel missense c.1819G>A mutation (G607S) in the endothelin-converting enzyme-like 1 (ECEL1) gene in a consanguineous pedigree of Turkish origin presenting with a syndrome of camptodactyly, scoliosis, limited knee flexion, significant refractive errors and ophthalmoplegia. ECEL1 mutations were recently reported to cause recessive forms of distal arthrogryposis. This report expands on the molecular basis and the phenotypic spectrum of ECEL1-associated congenital contracture syndromes. PMID:23808592
Shaaban, S; Duzcan, F; Yildirim, C; Chan, W-M; Andrews, C; Akarsu, N A; Engle, E C
Aim To evaluate the use of ultrasonography (US) in the diagnosis of gluteal muscle contracture (GMC) by analysis of its imaging\\u000a characteristics.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and Methods Thirty-nine patients suspected of having GMC due to abnormal gait underwent pre-operative US.\\u000a \\u000a \\u000a \\u000a Results The diagnosis of GMC was confirmed by surgery in 27 patients. Six patients were diagnosed with congenital hip dysplasia, and\\u000a the remaining six patients
Qiu Li; Zhang Lingyan; Luo Yan; Peng Yulan
Background Dupuytren's disease is a fibro-proliferative disorder affecting ~3-5% of the UK population. Current surgical treatments for\\u000a Dupuytren's contracture (DC) include fasciectomy and fasciotomy. We assessed the clinical management of DC in England over\\u000a a 5-year period; associated NHS costs were assessed for a 1-year period.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Hospital Episode Statistics were extracted from April 2003 to March 2008 for patients with Palmar
Robert A Gerber; Richard Perry; Robin Thompson; Christopher Bainbridge
Pulmonary scar carcinomas and noncarcinomatous apical scars were subjected to collagen extraction, ultrastructural, and immunocytochemical studies designed to investigate the nature of their extracellular matrix. These studies revealed marked differences in both cellular and biochemical composition of scar carcinomas, compared with apical scars. Myofibroblasts, identified by antimyosin antibodies and confirmed by electron microscopy, constituted over 90% of the stromal cells of the scar carcinomas, compared with 0-10% in the apical scars. Collagen extraction studies revealed both an absolute and relative increase in Type V collagen in the scar carcinomas, compared with that found in the apical scars. The extracellular matrix of the pulmonary scar carcinomas was, however, identical to that of scirrhous carcinomas of the breast. These findings suggest that pulmonary scar carcinomas are probably desmoplastic carcinomas, rather than scar-arising tumors. Images Figure 1 Figure 2 Figure 3
Barsky, S. H.; Huang, S. J.; Bhuta, S.
Introduction. The key element of a safe workplace for employees is the maintenance of fire safety. Thermal, chemical, and electrical burns are common types of burns at the workplace. This study assessed the epidemiology of work-related burn injuries on the basis of the workers treated in a regional burn centre. Methods. Two years' retrospective data (2005-2006) from the Trauma Registry of the American College of Surgeons of the Joseph M. Still Burn Center at Doctors Hospital in Augusta, Georgia, were collected and analysed. Results. During the time period studied, 2510 adult patients with acute burns were admitted; 384 cases (15%) were work-related. The average age of the patients was 37 yr (range, 15-72 yr). Males constituted the majority (90%) of workrelated burn injury admissions. The racial distribution was in accordance with the Centre's admission census. Industrial plant explosions accounted for the highest number of work-related burns and, relatively, a significant number of patients had chemical burns. The average length of hospital stay was 5.54 days. Only three patients did not have health insurance and four patients (1%) died. Conclusion. Burn injuries at the workplace predominantly occur among young male workers, and the study has shown that chemical burns are relatively frequent. This study functions as the basis for the evaluation of work-related burns and identification of the causes of these injuries to formulate adequate safety measures, especially for young, male employees working with chemicals. PMID:22262966
Mian, M A H; Mullins, R F; Alam, B; Brandigi, C; Friedman, B C; Shaver, J R; Hassan, Z
The National Interagency Fire Center (NIFC) is the support center for wild land firefighting in the US located in Boise, ID. One of the many activities that the NIFC coordinates is prescribed burns. Prescribed burns are one of NIFC’smanagement tools to help prevent major forest fires by burning undergrowth and they also help with maintaining and improving habitat. Recently, NIFC
Brett Alspach; Xander Harmon; Kyle Vogel; Matt Murdock
Usually the treatment of severe gluteal muscle contracture in children does not achieve a satisfactory clinical result and the disease is prone to recurrence after surgery. The aim of this study was to analyze the factors influencing the recovery of children with severe gluteal muscle contracture. Between 1997 and 2008, 428 children (mean age: 8 years) were subjected to surgical operations combined with functional exercises and physical therapy and were followed for 12-24 months with satisfactory clinical outcomes. In this series, the outcomes were found to be excellent in 400 cases, good in 22 cases, and fair in six cases with no patient having a poor result. No serious complications, such as sciatic nerve injury, dislocation, or osteonecrosis of the femoral head were found in the patients. Unsteadiness in walking and positive Trendelenburg sign were found in postoperative functional exercises in 16 patients, which may be the result of excessive resection of the gluteus medius and the gluteus minimus. However, the symptoms in all the cases disappeared within 3 months by rigorous functional exercise. We evaluated the factors that potentially influence the clinical outcome retrospectively and it was concluded that the surgery was highly beneficial for the treatment of the patients. Postoperative functional exercise and physical therapy could reduce the complications and maintain the favorable effects of surgery. In addition, the identification of the disease, the age of patients, and the rehabilitation procedures after hospital discharge were found to be very important for the successful treatment of this condition. PMID:21127436
Liu, Guo-Hui; Cao, Fa-Qi; Yang, Shu-Hua; Zhu, Jian-Fu
1. In the presence of extracellular Na ions K contractures evoked from isolated frog atrial trabeculae show an initial phasic and a subsequent tonic contractile response. 2. The phasic response shows a steep dependence on membrane potential, persists in Na-free fluid, but is blocked by Mn ions, D600 and tetracaine. It has an indirect dependence on the [Ca]0 and would seem to be associated with both the secondary inward current and the release of Ca2+ from intracellular stores. 3. The tonic component of the K contracture is unaffected by D600 or tetracaine, shows a shallow dependence on membrane potential but is absent in Na-free fluid. Its tension-depolarization curve is immediately affected by alteration of either the [Ca]0 or the [Na]0. The form of the tension-depolarization relationship and the effects of [Ca]0 and [Na]0 are consistent with the strength of the tonic tension being determined by a 3Na+ for 1Ca2+ exchange across the cell membrane. 4. The results agree well with those obtained previously with voltage-clamp experiments on the same tissue, and may also help with the interpretation of Ca-flux experiments.
Chapman, R A; Tunstall, J
The diagnosis of adrenal insufficiency is discussed in case of low blood pressure and digestive symptoms. Rare inaugural abdomino-crural muscle contracture can be a misleading symptom. Here we report two new cases. A 50-year-old woman presenting a leaning forward walking attitude and negligence for the past 2 months was referred to the neurologic unit. Abdomino-crural contracture, clinical hypogonadism, and hyponatremia directed towards a panhypopituitarism, which was confirmed by subsequent investigations. Pituitary MRI found an empty sella turcica. The outcome was dramatic after hormone replacement therapy, with drawing up of the trunk and re-establishment of walking after a few days. The second case is a 58-year-old man, hospitalized with altered general condition, with a weight loss of 22 kg, and anorexia in the aftermath of a comminuted fracture of the right lower limb, complicated by pseudoarthrosis. There was amyotrophy on the extremities with intense cruralgia. The patient had an antalgic attitude in the flexion affecting his rehabilitation. During 1 year, the symptoms were mimicking psychiatric disorders, malabsorption, or cancer before the final diagnosis of central hypocorticism with normal MRI was established. The evolution was remarkable after a few days of therapy with hydrocortisone, where the myalgia disappeared, the patient quickly gained weight, and the disappearance of the retractions allowed rehabilitation. These two observations emphasize the delayed diagnosis of adrenal insufficiency in the case of abdomino-crural-related symptoms and the presence of misleading neurological symptoms. The mechanisms of this syndrome remain unknown. PMID:20157722
Harbuz, Viorica; Bihan, Hélène; Salama, Jeffrey; Reach, Gérard; Cohen, Régis
Congenital contractural arachnodactyly (CCA) is an autosomal dominant disorder that is phenotypically similar to Marfan syndrome (MFS) and characterized by arachnodactyly, dolichostenomelia, scoliosis, multiple congenital contractures and abnormalities of the external ears. In contrast to MFS, CCA does not affect the aorta or the eyes. Two closely related genes, FBN1 located on chromosome 15q15-21.3 and FBN2 located at 5q23-31, encode large fibrillin proteins found in extracellular matrix structures called microfibrils. The MFS is caused by mutations in FBN1, while CCA has been genetically linked to FBN2 (refs 2, 5, 6). We now describe a pair of FBN2 missense mutations in two CCA patients that cause substitution of distinct cysteine residues in separate epidermal growth-factor-like (EGF) repeats. Our study provides final proof of the association between FBN2 mutations and CCA pathology, thus establishing the role of the fibrillin-2 in extracellular matrix physiology and pathology. PMID:7493032
Putnam, E A; Zhang, H; Ramirez, F; Milewicz, D M
Facial burns are generally considered severe. This is due to the possibility of respiratory complications. First responders check the nostrils for singed hairs. In severe cases there may be soot around the nose and mouth and coughing may produce phlegm that includes ash. Facial and inhalational burns compromise airways. They pose difficulties in pre-hospital resuscitation and are challenge to clinicians managing surviving burn victims in the intensive care setting. Management problems – resuscitation, airway maintenance and clinical treatment of facial injuries are compounded if the victim is child. Inhalational burns reduce survivability, certainly in adult victim. In our retrospective study we found that facial burns dominated in male gender, liquids and scalds are the most common causes of facial burns in children whereas the flame and electricity were the most common causes of facial burns in adults. We came to the conclusion in our study that surgical treatment minimizes complications and duration of recovery.
Zatriqi, Violeta; Arifi, Hysni; Zatriqi, Skender; Duci, Shkelzen; Rrecaj, Sh.; Martinaj, M.
Second and third degree burns on breasts at preadolescent period may cause severe breast deformations. This deformation can be variable depending on severity and location of the burns, personal adolescent patterns, and treatment modality in acute burn period. A 21 year old female patient admitted to our department for her breast deformation due to burn contracture at the inferior pole of the right breast. On physical examination we defined that development of the volume of the right breast was equal to the left, and inferior pole of the right breast was flattened due to contracture, and nipple was projected to inferior. We found that inframammary crease of the right breast was 2 cm lower than that of left; andthe distance of nipple-inframamary crease was 4.7 cm while areola-inframmary crease was 2 cm. New nipple-areola complex level was identified according to left breast's level. Medial and lateral lines were planned to merge inferiorly at 2 cm above inframmary crease in a plan similar to vertical mammaplasty. Superior pedicle carrying nipple areola was desepitelised. Lower parenchymal V flap was transposed superiorly and attached to the pectoral muscle. Inferior parts of the lateral and medial glandular flaps were excised to form new inframammary crease. The desired laxity of skin at the lower pole was obtained by performing a new Z- plasty between lateral and medial skin flaps. Breast symmetry was confirmed by postoperative objective measurements between left and right breasts. Patient's satisfaction and aesthetic appearance levels were high. Breasts deformation patterns caused by burns, trauma and mass exsicion due to cancer could not be addressed with traditional defined techniques. Special deformations can be corrected by custom made plannings as we presented here.
Bayram, Yalcin; Sahin, Cihan; Sever, Celalettin; Karagoz, Huseyin; Kulahci, Yalcin
Second and third degree burns on breasts at preadolescent period may cause severe breast deformations. This deformation can be variable depending on severity and location of the burns, personal adolescent patterns, and treatment modality in acute burn period. A 21 year old female patient admitted to our department for her breast deformation due to burn contracture at the inferior pole of the right breast. On physical examination we defined that development of the volume of the right breast was equal to the left, and inferior pole of the right breast was flattened due to contracture, and nipple was projected to inferior. We found that inframammary crease of the right breast was 2 cm lower than that of left; andthe distance of nipple-inframamary crease was 4.7 cm while areola-inframmary crease was 2 cm. New nipple-areola complex level was identified according to left breast's level. Medial and lateral lines were planned to merge inferiorly at 2 cm above inframmary crease in a plan similar to vertical mammaplasty. Superior pedicle carrying nipple areola was desepitelised. Lower parenchymal V flap was transposed superiorly and attached to the pectoral muscle. Inferior parts of the lateral and medial glandular flaps were excised to form new inframammary crease. The desired laxity of skin at the lower pole was obtained by performing a new Z- plasty between lateral and medial skin flaps. Breast symmetry was confirmed by postoperative objective measurements between left and right breasts. Patient's satisfaction and aesthetic appearance levels were high. Breasts deformation patterns caused by burns, trauma and mass exsicion due to cancer could not be addressed with traditional defined techniques. Special deformations can be corrected by custom made plannings as we presented here. PMID:24987218
Bayram, Yalcin; Sahin, Cihan; Sever, Celalettin; Karagoz, Huseyin; Kulahci, Yalcin
One of the characteristics of hypertrophic scarring is its raised appearance. Its maturation often results in increased thickness. Therapists usually rely on subjective observation and palpation to document scar thickness. The result of these subjective assessments may reflect only the superficial scar thickness but is unable to measure the whole scar volume and thickness under the skin surface. Measurement of
Joy C. M. Lau; Cecilia W. P. Li-Tsang; Y. P. Zheng
In order to modulate palatal scar tissue, especially its myofibroblastic component, there is a pressing need for an in vitro model of this tissue. In the present, study we established an organ culture model of the rat palatal scar tissue. After excision of palatal mucoperiosteum, explants from the developing immature scar tissue and from the normal palatal mucosa were used to observe myofibroblasts in vivo and their maintenance in organ culture. Explants were cultured at the gas-liquid interface in serum-free Waymouth's MB 752/1 medium and in a humid atmosphere containing 55% O2/5% CO2 in air at 37 degrees C for 3 days. Viability of the cultured explants was evaluated with morphological and histological criteria and BrdU incorporation. After organ culture, the scar tissue showed good preservation of the in vivo histology. The myofibroblasts and smooth muscle cells of the cultured scar tissues showed continuous expression of alpha-smooth muscle actin (alpha-SMA), mimicking the in vivo situation. In the normal tissues, only smooth muscle cells of the blood vessels expressed alpha-SMA. These results demonstrate that the established model provides a useful in vitro experimental tool for investigating the palatal scar tissue in general and its myofibroblasts in particular. PMID:12162532
Oueis, A; Yokozeki, M; Baba, Y; Moriyama, K; Kuroda, T
In the context of growing aesthetic awareness, a rising number of patients feel disappointed with their scars and are frequently seeking help for functional and aesthetic improvement. However, excessive scarring following surgery or trauma remains difficult to improve despite a plethora of advocated treatment strategies as frequently observed in daily clinical routine. It is thus still preferable to prevent scarring by minimizing risk factors as much as possible. Hence, it remains crucial for the physician to be aware of basic knowledge of healing mechanisms and skin anatomy, as well as an appreciation of suture material and wound closure techniques to minimize the risk of postoperative scarring. Next to existing, well known prophylactic and therapeutic strategies for the improvement of excessive scarring, this article discusses emerging techniques such as intralesional cryotherapy, intralesional 5-fluorouracil, interferon, and bleomycin. Some of them have been successfully tested in well-designed trials and already have extended or may extend the current spectrum of excessive scar treatment in the near future. Innovative options such as imiquimod 5% cream, photodynamic therapy, or botulinum toxin A may also be of certain importance; however, the data currently available is too contradictory for definite recommendations.
Gauglitz, Gerd G
There is a trend of increasing childhood aggression in America, which has been tied to bullying. Although there is growing research concerning bullying in the general pediatric population, there are limited data on bullying and its effects on children with disfigurements and physical limitations. This study was conducted to assess burned children's experience with bullying. A pretest was administered regarding experience with bullying and teasing. A curriculum regarding bullying, which incorporated the Harry Potter and the Sorcerer's Stone movie, was presented. After reviewing bullying depicted in the film and participating in a class regarding bullying, children were invited to complete a survey regarding their experience with bullying. A total of 61% of these children reported being bullied at school; 25% reported experiencing headaches or stomachaches due to bullying, and 12% reported staying home from school. Nearly 25% reported bullying as a big problem. Of those with visible scars (55%), a full 68% reported bullying as a problem, versus 54% with hidden scars (P < .05). However, those with visible scars were no more likely to tell an adult (54%) than those without (56%). Children were much more willing to disclose personal bullying experiences after participating in the class (57%) than before (45%) (P < .01). This study revealed that bullying impacts many burn-injured children and has negative effects on their physical and mental well-being. Many children (with visible or hidden scars) did not seek adult intervention for the problem. Participation in a bullying course appears to give children a forum that increases their willingness to disclose personal bullying experiences and can provide them with prevention information and a safe place to seek help. PMID:17438488
Rimmer, Ruth B; Foster, Kevin N; Bay, Curtis R; Floros, Jim; Rutter, Cindy; Bosch, Jim; Wadsworth, Michelle M; Caruso, Daniel M
An 810-nm diode laser system was developed to accelerate and improve the healing process in surgical scars. Using thermal post-conditioning, the laser system provides a localised moderate heating whose maximum temperature is controlled to prevent tissue damage and stimulate the heat shock proteins (HSP) synthesis. The 810-nm wavelength allows a deep penetration of the light into the dermis, without damaging the epidermis. The time along which surgical incision is treated (continuous wave) must therefore be selected carefully with respect to the temperature precision achieved within the heated volume. A top-hat profile is preferred to a Gaussian profile in order to ensure the skin surface temperature is homogenised, as is the temperature of the heated volume. The spot shape will depend on the medical indication. The treatment should be made safe and controlled by means of a safety strip containing an RFID chip which will transmit the various operating settings to the laser device. A clinical trial aims at evaluating the 810 nm-diode laser in surgical incisions, with only one laser treatment immediately after skin closure, of patients with Fitzpatrick skin types I to IV. Surgical incisions were divided into two fields, with only portions randomly selected receiving laser treatment. At the final scar analysis (12 months) of the pilot study, the treated portion scored significantly better for both surgeon (P = 0.046) and patients (P = 0.025). Further studies may be warranted to better understand the cellular mechanisms leading to Laser-Assisted Skin Healing (LASH).
Gossé, Alban; Iarmarcovai, Gwen; Capon, Alexandre; Cornil, Alain; Mordon, Serge
Burns to children's feet are often due to scalds, from hot tap water, as an infant's skin is thinner and hence more susceptible to a full-thickness injury. In Central Asia, and particularly in Uzbekistan, many episodes of burns take place at homes because of using sandal heaters. In the case of sandal burns of the foot, it usually is not only skin that is injured but also underlying tissues: subcutaneous fat, fasciae, muscles and even bones. Many controlled studies have confirmed that wounds heal more readily in a moist, physiological environment. After performing the toilet of burn wounds of the foot, we applied Dermazin cream on the affected areas and then the foot was placed onto a polyethylene packet of large size and fixed by a bandage. Measurement of wound water evaporation was performed every day post-burn. Surgery was usually performed 15-17 days after burn by applying a perforated skin graft or a 0.2-0.3-mm-thick non-perforated skin graft. The procedures helped to improve the general condition of patients, shortened their stay in hospital and also reduced expenses and lessened joint deformities and contracture deformities. PMID:24094987
Shakirov, Babur M
Poorly consolidated scar tissue resulting from injury, surgical incisions and burns is hard to sort out and represents a cause of both functional and psychological problems for the patient. A new possibility of treatment has been sought by subjecting to clinical trial an innovative method based on Bioengineering. This method uses as its active principle a ‘reduction in entropy’ artificially
G. Marineo; E. Indrizzi; G. Gasparini; V. Terenzi; G. Fini; F. Marotta
We selected 10 keratoconus patients (20 eyes) with a wide range of disease severity. Cornea scar slide photographs were projected; the scars were manually traced and digitized to determine area and distance to the scar from the center of the pupil. LogMAR high-contrast visual acuity ranged from 0.4 to 0.0 (2050to2020 Snellen). Scarring ranged from no scar (eight eyes) to
Joseph T. Barr; Todd Yackels
Hypertrophic scarring is related to persistent activation of transforming growth factor-? (TGF-?)/Smad signaling. In the TGF-?/Smad signaling cascade, the TGF-? type I receptor (TGFBRI) phosphorylates Smad proteins to induce fibroblast proliferation and extracellular matrix deposition. In this study, we inhibited TGFBRI gene expression via TGFBRI small interfering RNA (siRNA) to reduce fibroblast proliferation and extracellular matrix deposition. Our results demonstrate that downregulating TGFBRI expression in cultured human hypertrophic scar fibroblasts significantly suppressed cell proliferation and reduced type I collagen, type III collagen, fibronectin, and connective tissue growth factor (CTGF) mRNA, and type I collagen and fibronectin protein expression. In addition, we applied TGFBRI siRNA to wound granulation tissue in a rabbit model of hypertrophic scarring. Downregulating TGFBRI expression reduced wound scarring, the extracellular matrix deposition of scar tissue, and decreased CTGF and ?-smooth muscle actin mRNA expression in vivo. These results suggest that TGFBRI siRNA could be applied clinically to prevent hypertrophic scarring. PMID:24670383
Wang, Yi-Wen; Liou, Nien-Hsien; Cherng, Juin-Hong; Chang, Shu-Jen; Ma, Kuo-Hsing; Fu, Earl; Liu, Jiang-Chuan; Dai, Niann-Tzyy
The flexor carpi radialis muscle (FCRM) of the frog was divided into phasic and tonic bundles, and the properties of the potassium contracture in the tonic bundle were examined. The potassium contracture was tonic and the contracture induced by K higher than 75 mM consisted of the initial phasic component and of the following sustained component. Both components were abolished by the transverse tubule disruption. The curve relating the peak tension to the log[K]o (activation curve) started at about 15 mM K and reached maximum at about 75 mM K. By reducing [Ca]o, the activation curve shifted downward at higher [K]o, being little affected near the mechanical threshold. The time course of inactivation induced by 20 mM K was slow and monophasic, and was markedly accelerated by reducing [Ca]o. The spontaneous relaxation of the contracture induced by high K was little affected by reducing [ca]o. PMID:7300044
Hayatsu, Y; Kosaka, I; Tsutsu-ura, M; Nagai, T
Early excision and grafting of burns with the advent of infection control, has become a most important part of any successful therapy in burn management. By this technique, an open wound is primarily closed, and thus circumvents the possibility of infection. There is less discomfort, more rapid restoration of function, quicker discharge from hospital and earlier rehabilitation. Metabolic needs are lessened and with less scar, the cosmetic result is improved. Excision is made between the third and fifth day postburn if possible, but more delay may be necessary to determine which burns are superficial and able to spontaneously heal. No area greater than 10% of body surface area is excised and grafted at one operative session and for large burns staged excisions are necessary. A limitation of 1 1/2 hours on the operation is made so as to control shock and hypothermia and to assure a quick recovery with early re-establishment of nutrition. Ketamine is the common anaesthetic employed and viable fat is preferred as the surface on which to graft. Tangential excision is a complementary form of early excision grafting to a specific depth, and may be used alone or in conjunction with other techniques. It is of value in selected burns of the deep partial skin loss variety, especially scalds, which predominate in children. Several slices of necrotic skin are taken until a punctate bleeding surface is reached in the deep dermis and a thin to moderate thickness allograft is immediately applied. The conservation of the deep dermis limits the area to be grafted, with the likelihood of less scar formation and a resultant graft of improved texture. PMID:7012929
Solomon, J R
OBJECTIVE: To describe the causes of burns associated with fondues. DESIGN: Descriptive case series. PATIENTS: All 17 patients admitted to a burn centre between Apr. 1, 1985, and Mar. 31, 1990, whose burns were associated with fondue. Eleven agreed to complete a telephone interview. RESULTS: The age of the 17 patients varied from 2 to 56 (mean 27) years. Two causes were identified: spilling of the contents of the fondue pot and explosion of the fondue fuel when added to the burner during a meal. The telephone interview revealed that eight people other than the respondents were burned during the same accidents. CONCLUSION: Although we identified only badly burned patients the problem may be more extensive. The knowledge of specific causes of burns from handling fondue equipment indicates that preventive action should be undertaken. More epidemiologic information is needed to obtain a precise estimate of the magnitude of this public health problem.
Laliberte, D; Beaucage, C; Watts, N
The Ca2+ paradox represents a good model to study Ca2+ overload injury in ischemic heart diseases. We and others have demonstrated that contracture and calpain are involved in the Ca2+ paradox-induced injury. This study aimed to elucidate their roles in this model. The Ca2+ paradox was elicited by perfusing isolated rat hearts with Ca2+-free KH media for 3 min or 5 min followed by 30 min of Ca2+ repletion. The LVDP was measured to reflect contractile function, and the LVEDP was measured to indicate contracture. TTC staining and the quantification of LDH release were used to define cell death. Calpain activity and troponin I release were measured after Ca2+ repletion. Ca2+ repletion of the once 3-min Ca2+ depleted hearts resulted in almost no viable tissues and the disappearance of contractile function. Compared to the effects of the calpain inhibitor MDL28170, KB-R7943, an inhibitor of the Na+/Ca2+ exchanger, reduced the LVEDP level to a greater extent, which was well correlated with improved contractile function recovery and tissue survival. The depletion of Ca2+ for 5 min had the same effects on injury as the 3-min Ca2+ depletion, except that the LVEDP in the 5-min Ca2+ depletion group was lower than the level in the 3-min Ca2+ depletion group. KB-R7943 failed to reduce the level of LVEDP, with no improvement in the LVDP recovery in the hearts subjected to the 5-min Ca2+ depletion treatment; however, KB-R7943 preserved its protective effects in surviving tissue. Both KB-R7943 and MDL28170 attenuated the Ca2+ repletion-induced increase in calpain activity in 3 min or 5 min Ca2+ depleted hearts. However, only KB-R7943 reduced the release of troponin I from the Ca2+ paradoxic heart. These results provide evidence suggesting that contracture is the main cause for contractile dysfunction, while activation of calpain mediates cell death in the Ca2+ paradox.
Zhang, Jian-Ying; Bi, Sheng-Hui; Xu, Ming; Jin, Zhen-Xiao; Yang, Yang; Jiang, Xiao-Fan; Zhou, Jing-Jun
A new device and method to measure rabbit knee joint angles are described. The method was used to measure rabbit knee joint angles in normal specimens and in knee joints with obvious contractures. The custom-designed and manufactured gripping device has two clamps. The femoral clamp sits on a pinion gear that is driven by a rack attached to a materials testing system. A 100 N load cell in series with the rack gives force feedback. The tibial clamp is attached to a rotatory potentiometer. The system allows the knee joint multiple degrees-of-freedom (DOF). There are two independent DOF (compression-distraction and internal-external rotation) and two coupled motions (medial-lateral translation coupled with varus-valgus rotation; anterior-posterior translation coupled with flexion-extension rotation). Knee joint extension-flexion motion is measured, which is a combination of the materials testing system displacement (converted to degrees of motion) and the potentiometer values (calibrated to degrees). Internal frictional forces were determined to be at maximum 2% of measured loading. Two separate experiments were performed to evaluate rabbit knees. First, normal right and left pairs of knees from four New Zealand White (NZW) rabbits were subjected to cyclic loading. An extension torque of 0.2 Nm was applied to each knee. The average change in knee joint extension from the first to the fifth cycle was 1.9 deg +/- 1.5 deg (mean +/- sd) with a total of 49 tests of these eight knees. The maximum extension of the four left knees (tested 23 times) was 14.6 deg +/- 7.1 deg, and of the four right knees (tested 26 times) was 12.0 deg +/- 10.9 deg. There was no significant difference in the maximum extension between normal left and right knees. In the second experiment, nine skeletally mature NZW rabbits had stable fractures of the femoral condyles of the right knee that were immobilized for five, six or 10 weeks. The left knee served as an unoperated control. Loss of knee joint extension (flexion contracture) was demonstrated for the experimental knees using the new methodology where the maximum extension was 35 deg +/- 9 deg, compared to the unoperated knee maximum extension of 11 deg +/- 7 deg, 10 or 12 weeks after the immobilization was discontinued. The custom gripping device coupled to a materials testing machine will serve as a measurement test for future studies characterizing a rabbit knee model of post-traumatic joint contractures. PMID:14986415
Hildebrand, Kevin A; Holmberg, Michael; Shrive, Nigel
The effect of confined burning explosive abutting nonburning explosive in a variety of one-dimensional geometries has been studied by numerical simulation, demonstrating the effects of confinement, burning rate, and shock sensitivity. The model includes porous bed burning, compressible solids and gases, shock-induced decomposition with possible transition to detonation, and constant velocity ignition waves. Two-phase flow, gas relative to solid, is
Charles A. Forest
Burns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. A current summary of the classifications of burn wound infections, including their diagnosis, treatment, and prevention, is given. Early excision of the eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis, but most deaths in severely burn-injured patients are still due to burn wound sepsis or complications due to inhalation injury. Burn patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. The introduction of silver-impregnated devices (e.g., central lines and Foley urinary catheters) may reduce the incidence of nosocomial infections due to prolonged placement of these devices. Improved outcomes for severely burned patients have been attributed to medical advances in fluid resuscitation, nutritional support, pulmonary and burn wound care, and infection control practices.
Church, Deirdre; Elsayed, Sameer; Reid, Owen; Winston, Brent; Lindsay, Robert
Background Early accurate assessment of burn depth is important to determine the optimal treatment of burns. The method most used to determine burn depth is clinical assessment, which is the least expensive, but not the most accurate. Laser Doppler imaging (LDI) is a technique with which a more accurate (>95%) estimate of burn depth can be made by measuring the dermal perfusion. The actual effect on therapeutic decisions, clinical outcomes and the costs of the introduction of this device, however, are unknown. Before we decide to implement LDI in Dutch burn care, a study on the effectiveness and cost-effectiveness of LDI is necessary. Methods/design A multicenter randomised controlled trial will be conducted in the Dutch burn centres: Beverwijk, Groningen and Rotterdam. All patients treated as outpatient or admitted to a burn centre within 5 days post burn, with burns of indeterminate depth (burns not obviously superficial or full thickness) and a total body surface area burned of ? 20% are eligible. A total of 200 patients will be included. Burn depth will be diagnosed by both clinical assessment and laser Doppler imaging between 2–5 days post burn in all patients. Subsequently, patients are randomly divided in two groups: ‘new diagnostic strategy’ versus ‘current diagnostic strategy’. The results of the LDI-scan will only be provided to the treating clinician in the ‘new diagnostic strategy’ group. The main endpoint is the effect of LDI on wound healing time. In addition we measure: a) the effect of LDI on other patient outcomes (quality of life, scar quality), b) the effect of LDI on diagnostic and therapeutic decisions, and c) the effect of LDI on total (medical and non-medical) costs and cost-effectiveness. Discussion This trial will contribute to our current knowledge on the use of LDI in burn care and will provide evidence on its cost-effectiveness. Trial registration NCT01489540
FBN2, FBN1, TGFBR1, and TGFBR2 were analyzed by direct sequencing in 15 probands with suspected congenital contractural arachnodactyly (CCA). A total of four novel FBN2 mutations were found in four probands (27%, 4/15), but remaining the 11 did not show any abnormality in either of the genes. This study indicated that FBN2 mutations were major abnormality in CCA, and TGFBR and FBN1 defects may not be responsible for the disorder. FBN2 mutations were only found at introns 30, 31, and 35 in this study. Thus analysis of a mutational hotspot from exons 22 to 36 (a middle part) of FBN2 should be prioritized in CCA as previously suggested. PMID:17345643
Nishimura, Akira; Sakai, Haruya; Ikegawa, Shiro; Kitoh, Hiroshi; Haga, Nobuyuki; Ishikiriyama, Satoshi; Nagai, Toshiro; Takada, Fumio; Ohata, Takako; Tanaka, Fumihiko; Kamasaki, Hotaka; Saitsu, Hirotomo; Mizuguchi, Takeshi; Matsumoto, Naomichi
AIMS--This study aimed to evaluate stromal wound healing morphology in short term unsutured compared with sutured corneal wounds, to define regional variation in healing within radial keratotomy wounds. METHODS--Stromal scar tissue orientation (fibroblast and collagen fibre orientation) was analysed in unsutured and adjacent sutured keratotomy wounds in monkeys, 2 to 9 weeks after surgery, using light and transmission electron microscopy. RESULTS--At 2 to 4 weeks, scar tissue orientation was transverse to the wound edge in unsutured wounds, but sagittal in sutured wounds. At 5 to 9 weeks, a reorientation of scar tissue sagittal to the wound was seen in the unsutured wounds, proceeding from the posterior to anterior wound regions. In sutured wounds, a scar tissue reorientation transverse to the wound was seen, proceeding from the anterior wound region in a posterior direction. CONCLUSIONS--Within the same cornea, sutured and unsutured wounds showed opposite patterns of healing. Sutured wounds initially healed more slowly, but obtained pseudolamellar continuity over time. In contrast, healing of unsutured wounds was characterised by an early approximation towards lamellar repair that was followed by an ineffective reorganisation of the scar. This latter pattern of healing, that may be associated with a variable weakening of the wound, may relate to the clinical findings of unpredictability and/or progression of refractive effect following radial keratotomy. Images
Melles, G R; Binder, P S; Beekhuis, W H; Wijdh, R H; Moore, M N; Anderson, J A; SundarRaj, N
Background Psoas contracture is known to cause abnormal hip motion in patients with cerebral palsy. The authors investigated the clinical relevance of hip kinematic and kinetic parameters, and 3D modeled psoas length in terms of discriminant validty, convergent validity, and responsiveness. Methods Twenty-four patients with cerebral palsy (mean age 6.9 years) and 28 normal children (mean age 7.6 years) were included. Kinematic and kinetic data were obtained by three dimensional gait analysis, and psoas lengths were determined using a musculoskeletal modeling technique. Validity of the hip parameters were evaluated. Results In discriminant validity, maximum psoas length (effect size r = 0.740), maximum pelvic tilt (0.710), maximum hip flexion in late swing (0.728), maximum hip extension in stance (0.743), and hip flexor index (0.792) showed favorable discriminant ability between the normal controls and the patients. In convergent validity, maximum psoas length was not significantly correlated with maximum hip extension in stance in control group whereas it was correlated with maximum hip extension in stance (r = -0.933, p < 0.001) in the patients group. In responsiveness, maximum pelvic tilt (p = 0.008), maximum hip extension in stance (p = 0.001), maximum psoas length (p < 0.001), and hip flexor index (p < 0.001) showed significant improvement post-operatively. Conclusions Maximum pelvic tilt, maximum psoas length, hip flexor index, and maximum hip extension in stance were found to be clinically relevant parameters in evaluating hip flexor contracture.
Burn injury is a ubiquitous threat in the military environment. The risks during combat are well recognised, but the handling of fuel, oil, munitions and other hot or flammable materials during peacetime deployment and training also imposes an inherent risk of accidental burn injury. Over the last hundred years, the burn threat in combat has ranged from nuclear weapons to small shoulder-launched missiles. Materials such as napalm and white phosphorus plainly present a risk of burn, but the threat extends to encompass personnel in vehicles attacked by anti-armour weapons, large missiles, fuel-air explosives and detonations/conflagrations on weapons platforms such as ships. Large numbers of burn casualties were caused at Pearl Harbor, in Hiroshima and Nagasaki, Vietnam, during the Arab/Israeli Wars and in the Falkland Islands conflict. The threat from burns is unlikely to diminish, indeed new developments in weapons seek to exploit the vulnerability of the serviceman and servicewoman to burns. Clothing can be a barrier to some types of burn--both inherently in the properties of the material, but also by trapping air between clothing layers. Conversely, ignition of the clothing may exacerbate a burn. There is hearsay that burnt clothing products within a wound may complicate the clinical management, or that materials that melt (thermoplastic materials) should not be worn if there is a burn threat. This paper explores the incidence of burn injury, the mechanisms of heat transfer to bare skin and skin covered by materials, and the published evidence for the complication of wound management by materials. Even light-weight combat clothing can offer significant protection to skin from short duration flash burns; the most vulnerable areas are the parts of the body not covered--face and hands. Multilayered combat clothing can offer significant protection for short periods from engulfment by flames; lightweight tropical wear with few layers offers little protection. Under high heat loads in the laboratory, combat clothing can ignite, but there is little evidence that clothing ignition is a common occurrence in military burn casualties. Thermoplastic materials have many benefits in civil and military clothing. There is little objective evidence that they exacerbate burns, or complicate burn management. Their use in military clothing must be based on objective evidence, not hearsay. PMID:11307683
McLean, A D
The goal of fluid resuscitation in the burn patient is maintenance of vital organ function at the least immediate or delayed physiological cost. To optimize fluid resuscitation in severely burned patients, the amount of fluid should be just enough to maintain vital organ function without producing iatrogenic pathological changes. The composition of the resuscitation fluid in the first 24 hours
Glenn D. Warden
Chemical burn under pneumatic tourniquet is an iatrogenic preventable injury and is rarely reported in the literature. The two important mechanisms are maceration (friction) and wetness underneath the tourniquent. In this report, our experience with two illustrative patients who presented with iatrogenic tourniquet associated burn is described.
Yang, Jae-Hyuk; Lim, Hyungtae; Yoon, Jung-Ro; Jeong, Hyeon-Il
We present four cases of headache with variable intensity, located in close proximity to a craniotomy incision which was performed for non-traumatic reasons. Since manual palpation of the scar often triggers pain, and infiltration with local anesthetics reduce or abolish the pain in some patients, we suggest that neuromas or nerve entrapment in the scars, as a result of the surgery, are responsible for headaches. Although local infiltrations or nerve blocks are often used for diagnostic reasons, herein we consider that they are also of therapeutic value. We review the current known pathophysiology of post-craniotomy headaches and present a hypothesis suggesting a greater recognition of the potential contribution of neuroma formation in areas of scars tissue to contribute to this kind of headache. PMID:22392114
Ferreira, Karen dos Santos; Dach, Fabíola; Speciali, José Geraldo
We propose a biomechanical model for investigating wound contraction mechanism and resulting scarring. Extracellular matrix is modeled as fiber-reinforced anisotropic soft tissue, with its elastic properties dynamically changing with the density and orientation of collagen fibers. Collagen fibers are deposited by fibroblasts infiltrating the wound space, and are dynamically aligned with both migrating fibroblasts and tissue residing tension field. Our new 2D hybrid agent-based model provides a comprehensive platform for examining the mechanobiology in wound contraction and scar formation. Simulation results are consistent with experimental observations and are able to reveal the effects of wound morphology and mechanical environment on contraction patterns. Our model results support the hypothesis that scar formation is the product of collagen fiber synthesis and alignment in the presence of the tensile stress field generated by a wound contraction process. PMID:23563057
Yang, Le; Witten, Tarynn M; Pidaparti, Ramana M
Central penetrating excisional wounds were made in the corneas of 12 rabbits and 10 trout. The scar tissue and the surrounding cornea were compared using a new method for assessing inorganic elements in the cornea: the scanning electron microscopy and energy dispersive analysis of x-ray (EDAX). Semiquantitative determination of inorganic elements within the range of atomic numbers 9-93 in the periodic system was performed, comparing the relative concentration of those elements in the scar tissue to the surrounding cornea. Results showed that calcium was the only element higher in the healing wound than in the surrounding cornea.
Bonafonte, S.; Fernandez del Cotero, J.N.; Aguirre Vila-Coro, A.
Caesarean scar pregnancy (CSP) is implantation of the gestational sac within the hysterotomy scar. Ultrasound is the main diagnostic tool. Early diagnosis and termination of pregnancy is crucial to avoid the risk of uterine rupture. The termination modalities available are dilatation and curettage, methotrexate therapy, hysteroscopy, uterine artery embolization and laparotomy. We present a case of undisturbed CSP which presented at 6 weeks + 6 days gestation. Our management was termination of pregnancy by exploratory laparotomy and hysterotomy for excision of the mass. The postoperative period was uneventful and there was rapid decline of beta human chorionic gonadotrophin to the normal level. PMID:24643804
Abdelkader, Mohamed Ali; Fouad, Reham; Gebril, Amr Hosny; El Far, Mohamed Ahmed; Elyassergi, Dina Fauzi
The degree of nonsphericity of smoke particles from biomass burning in Brazil was measured aboard the University of Washington C-131A aircraft during the Smoke, Clouds, and Radiation-Brazil (SCAR-B) project for several regions, types of fuel, and combustion. The nonsphericity (alpha0) of the particles was obtained from electrooptical light-scattering measurements, using an aerosol asymmetry analyzer, and from scanning electron microscopy (SEM)
J. Vanderlei Martins; Peter V. Hobbs; Ray E. Weiss; Paulo Artaxo
The degree of nonsphericity of smoke particles from biomass burning in Brazil was measured aboard the University of Washington C-131A aircraft during the Smoke, Clouds, and Radiation-Brazil (SCAR-B) project for several regions, types of fuel, and combustion. The nonsphericity (Co) of the particles was obtained from electrooptical light- scattering measurements, using an aerosol asymmetry analyzer, and from scanning electron microscopy
J. Vanderlei Martins; Peter V. Hobbs; Ray E. Weiss; Paulo Artaxo
Hypertrophic scarring (HS) has been considered as a great concern for patients and a challenging problem for clinicians as it can be cosmetically disfiguring and functionally debilitating. In this study, Ginsenoside Rg3/Poly(l-lactide) (G-Rg3/PLLA) electrospun fibrous scaffolds covering on the full-thickness skin excisions location was designed to suppress the hypertrophic scar formation in vivo. SEM and XRD results indicated that the crystal G-Rg3 carried in PLLA electrospun fibers was in amorphous state, which facilitates the solubility of G-Rg3 in the PLLA electrospun fibrous scaffolds, and solubility of G-Rg3 in PBS is increased from 3.2 µg/ml for pure G-Rg3 powders to 19.4 µg/ml for incorporated in PLLA-10% fibers. The released G-Rg3 content in the physiological medium could be further altered from 324 to 3445 µg in a 40-day release period by adjusting the G-Rg3 incorporation amount in PLLA electrospun fibers. In vitro results demonstrated that electrospun G-Rg3/PLLA fibrous scaffold could significantly inhibit fibroblast cell growth and proliferation. In vivo results confirmed that the G-Rg3/PLLA electrospun fibrous scaffold showed significant improvements in terms of dermis layer thickness, fibroblast proliferation, collagen fibers and microvessels, revealing that the incorporation of the G-Rg3 in the fibers prevented the HS formation. The above results demonstrate the potential use of G-Rg3/PLLA electrospun fibrous scaffolds to rapidly minimize fibroblast growth and restore the structural and functional properties of wounded skin for patients with deep trauma, severe burn injury, and surgical incision.
Hu, Changmin; Li, Haiyan; Zhang, Yuguang; Chang, Jiang
Biomechanical characterization and clinical implications of artificially induced toe-walking: differences between pure soleus, pure gastrocnemius and combination of soleus and gastrocnemius contractures.
The purpose of this study was to characterize biomechanically three different toe-walking gait patterns, artificially induced in six neurologically intact subjects and to compare them to selected cases of pathological toe-walking. The subjects, equipped with lightweight mechanical exoskeleton with elastic ropes attached to the left leg's heel on one end and on shank and thigh on the other end in a similar anatomical locations where soleus and gastrocnemius muscles attach to skeleton, walked at speed of approximately 1m/s along the walkway under four experimental conditions: normal walking (NW), soleus contracture emulation (SOL), gastrocnemius contracture emulation (GAS) and emulation of both soleus and gastrocnemius contractures (SOLGAS). Reflective markers and force platform data were collected and ankle, knee and hip joint angles, moments and powers were calculated using inverse dynamic model for both legs. Characteristic peaks of averaged kinematic and kinetic patterns were compared among all four experimental conditions in one-way ANOVA. In the left leg SOL contracture mainly influenced the ankle angle trajectory, while GAS and SOLGAS contractures influenced the ankle and knee angle trajectories. GAS and SOLGAS contractures significantly increased ankle moment during midstance as compared to SOL contracture and NW. All three toe-walking experimental conditions exhibited significant power absorption in the ankle during loading response, which was absent in the NW condition, while during preswing significant decrease in power absorption as compared to NW was seen. In the knee joint SOL contracture diminished, GAS contracture increased while SOLGAS contracture approximately halved knee extensor moment during midstance as compared to NW. All three toe-walking experimental conditions decreased hip range of motion, hip flexor moment and power requirements during stance phase. Main difference in the right leg kinematic and kinetic patterns was seen in the knee moment trajectory, where significant increase in the knee extensor moment took place in terminal stance for GAS and SOLGAS experimental conditions as compared to SOL and NW. The kinetic trajectories under SOL and GAS experimental conditions were qualitatively compared to two selected clinical cases showing considerable similarity. This implies that distinct differences in kinetics between SOL, GAS and SOLGAS experimental conditions, as described in this paper, may be clinically relevant in determining the relative contribution of soleus and gastrocnemius muscles contractures to toe-walking in particular pathological gait. PMID:16321627
Matjaci?, Zlatko; Olensek, Andrej; Bajd, Tadej
As young and elastic skin is what everyone dreams of, various measures have been implemented including chemical, laser resurfacing and dermabrasion to improve the condition of ageing skin. However, the high cost of these procedures prevents the poor from having access to treatment. Glacial acetic acid is widely used as a substitute for chemical peeling because it is readily easily available and affordable. However, its use can result in a number of serious complications. A 28-year-old female patient was admitted to our hospital with deep second-degree chemical burns on her face caused by the application of a mixture of glacial acetic acid and flour for chemical peeling. During a 6-month follow-up, hypertrophic scarring developed on the both nasolabial folds despite scar management. Glacial acetic acid is a concentrated form of the organic acid, which gives vinegar its sour taste and pungent smell, and it is also an important reagent during the production of organic compounds. Unfortunately, misleading information regarding the use of glacial acetic acid for chemical peeling is causing serious chemical burns. Furthermore, there is high possibility of a poor prognosis, which includes inflammation, hypertrophic scar formation and pigmentation associated with its misuse. Therefore, we report a case of facial chemical burning, due to the misuse of glacial acetic acid, and hope that this report leads to a better understanding regarding the use of this reagent. PMID:20708991
Yoo, Jun-Ho; Roh, Si-Gyun; Lee, Nae-Ho; Yang, Kyung-Moo; Moon, Ji-Hyun
An investigation has been made of the putative direct myocardial protective effects of the alpha 1-adrenoceptor antagonists, prazosin and WB4101, against tetanic contractures of rat isolated left atria following modified Na+ channel function and consequent Ca2+ loading elicited by veratrine. Veratrine evoked concentration-dependent, reversible, tetanic contractures which were critically dependent upon the external Ca2+ concentration. Tetrodotoxin (TTX), prazosin, WB 4101 and R 56865 (0.1-10 microM) prevented tetanic contracture elicited by veratrine (100 micrograms/ml) at concentrations which were significantly lower than those which decreased active tension development. The apparent Hill coefficients (nH) obtained for TTX, prazosin, WB 4101 and R 56865 were comparable (range 0.79-0.93), and are consistent with a single site of action. In contrast, the class 1 antiarrhythmic agents, quinidine and lidocaine, elicited no significant inhibition of veratrine-induced contracture at 30 microM, but almost completely abolished the contractures at 100 microM. The nH values for quinidine and lidocaine were found to be significantly greater than unity (3.1 and 2.6, respectively). The L-type Ca2+ channel blockers, diltiazem, nicardipine, nifedipine and verapamil only weakly prevented tetanic contracture, whilst markedly, and concentration-dependently, decreasing active tension development. Neither atropine (10 microM) nor propranolol (1 microM) significantly modified either veratrine-induced contractures or active tension development. In conclusion, evidence is presented of novel, direct protective effects of prazosin and WB 4101 against tetanic contracture following modified Na+ channel function and Ca2+ loading provoked by veratrine. The precise mechanisms involved are unclear at present, but appear to be distinct from blockade of atrial alpha 1-adrenoceptors or L-type Ca2+ channels.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7901775
Le Grand, B; Marty, A; Vieu, S; Talmant, J M; John, G W
The implantation of a pregnancy within the scar of a previous cesarean delivery is the rarest of ectopic pregnancy locations. If it is diagnosed early, treatment options are capable of preserving the uterus and subsequent fertility. However, a delay in either diagnosis or treatment can lead to uterine rupture, hysterectomy, and significant maternal morbidity. (Am J Obstet Gynecol 2002;187:302-4.)
Donald L. Fylstra; Toya Pound-Chang; M. Grant Miller; Amy Cooper; Kathryn M. Miller
Existing remote sensing-based Burnt scar mapping methodologies are mainly based on medium spatial resolution sensors. These methodologies cannot accurately detect burnt areas smaller than 200 ha. However, smaller burnt areas can represent a significant number of the total burnt areas. They play an important ecological roll, and also have relevant socio-economic consequences. Within this framework, a new methodology for burnt
Fernando Sedano; Pieter Kempeneers; Jan Kucera; Jesus San Miguel-Ayanz
Damage to the central nervous system (CNS) results in a glial reaction, leading eventually to the formation of a glial scar. In this environment, axon regeneration fails, and remyelination may also be unsuccessful. The glial reaction to injury recruits microglia, oligodendrocyte precursors, meningeal cells, astrocytes and stem cells. Damaged CNS also contains oligodendrocytes and myelin debris. Most of these cell
James W Fawcett; Richard. A Asher
Flood scars, abundant along rivers of heavily forested northern British Columbia, provide records of flood occurrence and magnitude in a region with few and relatively short gaging records. Log transport during floods is episodic and occurs almost immediately preceding and during peak stage. Impact wounds form during this transport stage. Many of these logs are sequestered in bankside vegetation where
Allen S. Gottesfeld
The external ear is a location with high risk of keloid scar formation. Its incidence is growing since general use of piercings and performance of plastic surgery of the external ear. The external ear keloid can be a devasting process for adolescent population which is worried about their appearance. Our aim is to attract attention about the risk of keloid scars of the external ear, reviewing our experience. After dismissing radiotherapy, corticoid infiltration and surgical removal are the most used options, with a high recurrence risk. We have reviewed traumatic, surgical and piercing wounds of the external ear, with a subsequent keloid formation treated in our outpatient clinic, collecting data about wound etiology, treatment and results. During the last 10 years we have found 11 keloid scars, 2 of them improved with topical corticosteroid. Treatment has been surgical in 9 cases, 4 of them with skin graft: 5 recovered and 4 recurred; 2 of them were reoperated. 2 of them were treated with intralesional corticosteroid solely, one recovered and the other one had improved. Treatment management of keloid scars is complex and there isn't a procedure with superior results than the others. Risk of complication must be explained within adolescent population. PMID:24783642
Bejarano Serrano, M; Parri Ferrandis, F J; García Smith, N I; Martínez-Herrada, S; Manzanares Quintela, A; Albert Cazalla, A
Nineteen cultivars of apricot (Prunus armeniaca) were distinguished using random amplified polymorphic DNA (RAPD) markers. One decamer out of 44 used was useful to differentiate cultivars of the Campania Region from those of Northern Italy, North America and Greece. A sequence characterized amplified region (SCAR) marker was obtained. The results provide a protocol to fingerprint DNA of apricots as an
Loredana Mariniello; Maria Grazia Sommella; Angela Sorrentino; Marcello Forlani; Raffaele Porta
Boiler tubes in a fossil-fuelled power station are subjected to erosion and corrosion that caused the tubes to become locally thinned or scarred. To avoid unscheduled tube failures and hence prevent large financial loss due to boiler shut-down and tube repairs, it is important to estimate boiler tube lives. Boiler tube lives are very sensitive to tube temperature. This paper
Implantation of a pregnancy into the scar of a prior cesarean is an uncommon type of ectopic pregnancy. The incidence of cesarean scar pregnancy is thought to be one in 1800-2216 pregnancies. The increase in the incidence of cesarean scar pregnancy is thought to be a consequence of the increasing rates of cesarean delivery. The natural history of cesarean scar pregnancy is unknown. However, if such a pregnancy is allowed to continue, uterine scar rupture with hemorrhage and possible hysterectomy seem likely. Two early diagnosed cesarean scar pregnancies were treated with hysteroscopy and suction curettage removal. One required intramuscular methotrexate to resolve a persistent cesarean scar ectopic pregnancy. It would seem reasonable that simple suction evacuation would frequently leave chorionic villi imbedded within the cesarean scar, as the pregnancy is not within the endometrial cavity. PMID:24320609
Fylstra, Donald L
The quantum eigenstates of a strongly chaotic system (hyperbolic octagon) are studied with special emphasis on the scar phenomenon. The dynamics of a localized wavepacket is discussed which travels along a short periodic orbit yielding a test for the scar...
R. Aurich F. Steiner
Genetic linkage studies have linked congenital contractural arachnodactyly (CCA), a usually mild heritable connective-tissue disorder, to FBN2, the fibrillin gene on chromosome 5. Recently, FBN2 mutations in two patients with CCA have been described. Here we report an A-->T transversion at the -2 position of the consensus acceptor splice site, resulting in the missplicing of exon 34, a calcium-binding epidermal growth factor-like repeat in fibrillin-2 in a mother and daughter with CCA. Significantly, the mother exhibited a classic CCA phenotype with arachnodactyly, joint contractures, and abnormal pinnae, whereas her daughter exhibited a markedly more severe CCA phenotype, which included cardiovascular and gastrointestinal anomalies that led to death in infancy. Analysis of cloned fibroblasts showed that the mother is a somatic mosaic for the exon 34 missplicing mutation, whereas all the daughter's cells harbored the mutation. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6
Wang, M.; Clericuzio, C. L.; Godfrey, M.
Genetic linkage studies have linked congenital contractural arachnodactyly (CCA), a usually mild heritable connective-tissue disorder, to FBN2, the fibrillin gene on chromosome 5. Recently, FBN2 mutations in two patients with CCA have been described. Here we report an A-->T transversion at the -2 position of the consensus acceptor splice site, resulting in the missplicing of exon 34, a calcium-binding epidermal growth factor-like repeat in fibrillin-2 in a mother and daughter with CCA. Significantly, the mother exhibited a classic CCA phenotype with arachnodactyly, joint contractures, and abnormal pinnae, whereas her daughter exhibited a markedly more severe CCA phenotype, which included cardiovascular and gastrointestinal anomalies that led to death in infancy. Analysis of cloned fibroblasts showed that the mother is a somatic mosaic for the exon 34 missplicing mutation, whereas all the daughter's cells harbored the mutation. PMID:8900230
Wang, M; Clericuzio, C L; Godfrey, M
Using area under the contracture curve to quantitate contractures, the diffusion coefficient of calcium ions within the frog toe muscle during washout in a calcium-free solution and subsequent recovery after reintroduction of calcium to the bathing solution was calculated to be about 2 x 10-6 cm2/sec. The diffusion coefficient measured during washout was found to be independent of temperature or initial calcium ion concentration. During recovery it was found to decrease if the temperature was lowered. This was likely due to the repolarization occurring after the depolarizing effect of the calcium-free solution. The relation between contracture area and [Ca]o was found to be useful over a wider range than that between maximum tension and [Ca]o. The normalized contracture areas were larger at lower calcium concentrations if the contractures were produced with cold potassium solutions or if NO3 replaced Cl in the bathing solutions. Decreasing the potassium concentration of the contracture solution to 50 mM from 115 mM did not change the relation between [Ca]o and the normalized area. If the K concentration of the bathing solution was increased, the areas were decreased at lower concentrations of Ca.
Milligan, J. V.
We present a modification to the widely used lead hand retraction system that allows for improved surgical access to a digit with a severe flexor contracture. A simple construct using surgical adhesive tape and a silk suture can be made and applied to the digit and lead hand. Our technique is simple and inexpensive to use, and we recommend its use to improve surgical access without causing unnecessary trauma to the digit. PMID:20961699
Jain, Sameer; Anwar, Mohammed Umair; Majumder, Sanjib
Arthrolysis and dynamic splinting have been used in the treatment of elbow contractures, but there is no standardised protocol for treatment of severe contractures with an arc of flexion < 30 degrees . We present our results of radical arthrolysis with twin incisions with the use of a monolateral hinged fixator to treat very severe extra-articular contracture of the elbow. This retrospective study included 26 patients (15 males and 11 females) with a mean age of 30 years (12 to 60). The mean duration of stiffness was 9.1 months (5.4 to 18) with mean follow-up of 5.2 years (3.5 to 9.4). The mean pre-operative arc of movement was 15.6 degrees (0 degrees to 30 degrees ), with mean pre-operative flexion of 64.1 degrees (30 degrees to 120 degrees ) and mean pre-operative extension of 52.1 degrees (10 degrees to 90 degrees ). Post-operatively the mean arc improved to 102.4 degrees (60 degrees to 135 degrees ), the mean flexion improved to 119.1 degrees (90 degrees to 140 degrees ) and mean extension improved to 16.8 degrees (0 degrees to 30 degrees ) (p < 0.001). The Mayo elbow score improved from a mean of 45 (30 to 65) to 89 (75 to 100) points, and 13 had excellent, nine had good, three had fair and one had a poor result. We had one case of severe instability and one wound dehiscence which responded well to treatment. One case had deep infection with poor results which responded well to treatment. Our findings indicate that this method is very effective in the treatment of severe elbow contracture; however, a randomised controlled study is necessary for further evaluation. PMID:20044685
Kulkarni, G S; Kulkarni, V S; Shyam, A K; Kulkarni, R M; Kulkarni, M G; Nayak, P
The “hook finger”, with both proximal interphalangeal (PIP) and distal interphalangeal (DIP) joint flexion contractures, often after multiple previous operations, is difficult to treat. This paper reports the results of 50 fingers in 49 patients in which the TATA (T?no-Arthrolyse Totale Ant?rieure) salvage procedure, described by Saffar in 1978, was carried out. Thirty-seven of 50 (74%) of these fingers had
P. LOREA; J. MEDINA HENRIQUEZ; R. NAVARRO; P. LEGAILLARD; G. FOUCHER
Reports on results of a teacher's experiment in book burning as a lesson accompanying the teaching of Ray Bradbury's "Fahrenheit 451." Discusses student reactions and the purpose of or justification for the experimental lesson. (TB)
... infection in the mouth acid reflux poorly-fitting dentures or allergies to denture materials anxiety and depression. In some people, burning ... to check for oral candidiasis allergy testing for denture materials, certain foods, or other substances that may ...
The synthesis of type I and III collagens in cultured skin fibroblasts from normal skin, normal scar, hypertrophic scar, and keloids was examined. The ratio of type I/III collagen was significantly elevated in keloids compared to that in the other groups. When mRNA steady-state levels coding for alpha 1(I) procollagen were determined, it was apparent that this increase in the type I/III collagen ratio in keloids was paralleled by a specific increase in alpha 1(I) procollagen mRNA. This specific increase in alpha 1(I) procollagen mRNA in keloids was the result of increased gene expression because the transcription rate of the alpha 1(I) procollagen gene was significantly elevated in keloids, as determined by nuclear runoff transcription. The rate of transcription of the alpha 1(I) procollagen gene was also elevated in hypertrophic scars, although no concomitant increase in alpha 1(I) procollagen mRNA levels or alteration in the type I/III collagen ratio was observed. These data indicate that the rate of gene transcription of alpha 1(I) procollagen is increased in both hypertrophic scars and keloids, but only keloids exhibit increased steady-state levels of alpha 1(I) procollagen mRNA and concurrent increases in type I collagen. These results suggest that at least two distinct mechanisms, one pretranscriptional and one post-transcriptional, regulate type I collagen synthesis. It is possible, therefore, that in keloids, neither mechanism functions efficiently to down-regulate type I collagen. In hypertrophic scars, however, the post-transcriptional mechanisms are able to decrease elevated levels of mRNA coding for alpha 1(I) procollagen that result from increased transcription of the alpha 1(I) procollagen gene. PMID:8412102
Friedman, D W; Boyd, C D; Mackenzie, J W; Norton, P; Olson, R M; Deak, S B
Developed by Professor Matthew Weinstein of Kent State University, Books2burn translates text files into a series of audio files, which may then subsequently be converted to mp3's or other formats. This program will be a great boon to scholars and the general public alike, as the application allows for the easy transfer and replication of potentially large and problematic files into a number of audio formats. Books2burn is compatible with all systems running Mac OS X.
Congenital contractural arachnodactyly (Beals syndrome) is a rare autosomal dominantly inherited connective tissue disorder characterized by flexion contractures, arachnodactyly, crumpled ears, and mild muscular hypoplasia. Here, a father and son with congenital contractural arachnodactyly features were identified. After sequencing 15 exons (22 to 36) of the FBN2 gene, a novel mutation (C1425Y) was found in exon 33. This de novo mutation presented first in the father and was transmitted to his son, but not in the other 14 unaffected family members and 365 normal people. The C1425Y mutation occurs at the 19th cbEGF domain. Cysteines in this cbEGF domain are rather conserved in species, from human down to ascidian. The cbEGF12-13 in human FBN1 was employed as the template to perform homology modeling of cbEGF18-19 of human FBN2 protein. The mutation has also been evaluated by further prediction tools, for example, SIFT, Blosum62, biochemical Yu's matrice, and UMD-Predictor tool. In all analysis, the mutation is predicted to be pathogenic. Thus, the structure destabilization by C1425Y might be the cause of the disorder. PMID:19473076
Chen, Ying; Lei, Yun-Ping; Zheng, Hong-Xiang; Wang, Wei; Cheng, Hong-Bo; Zhang, Jing; Wang, Hong-Yan; Jin, Li; Li, Hong
Ball lightning is a rare physical phenomenon, which is not yet completely explained. It is similar to lightning but with different, peculiar characteristics. It can be considered a mix of fire and electricity, concentrated in a fireball with a diameter of 20-cm that most commonly appears suddenly, even in indoor conditions, during a thunderstorm. It moves quickly for several meters, can change direction, and ultimately disappears. During a great storm, a 28-year-old man and his 5-year-old daughter sustained burn wounds after ball lightning came from the outdoors through a chimney. These two patients demonstrated signs of fire and electrical injuries. The father, who lost consciousness, sustained superficial second-degree burn wounds bilaterally on the zygomatic area and deep second-degree burn wounds on his right hand (total body surface area, 4%). His daughter demonstrated superficial second-degree burn wounds on the left part of the face and deep second-degree and third-degree burn wounds (total body surface area, 30%) on the left neck, both upper arms, and the back. In this article, the authors report the first two cases of burn injuries resulting from ball lightning contact indoors. The literature on this rare phenomenon is reviewed to elucidate the nature of ball lightning. Emphasis is placed on the nature of injuries after ball lightning contact, the therapy used, and the long-term complications. PMID:12792547
Selvaggi, Gennaro; Monstrey, Stan; von Heimburg, Dennis; Hamdi, Mustapha; Van Landuyt, Koen; Blondeel, Phillip
The molecular mechanisms behind the pathogenesis of post-burn hypertrophic scar (HS) remain unclear. Here, we investigate the role of interleukin-6 (IL-6) trans-signaling-STAT3 pathway in HS fibroblasts (HSF) derived from burned-induced HS skin. HSF showed increased Tyr 705 STAT3 phosphorylation over normal fibroblast (NF) after IL-6•IL-6R? stimulation by immunoassays. The endogenous STAT3 target gene, SOCS3, was upregulated in HSF and showed increased STAT3 binding on its promoter relative to NF in Chromatin Immunoprecipitation assay. We observed that the cell surface signaling transducer glycoprotein 130 is upregulated in HSF using Q-RT-PCR and flow cytometry. The production of excessive extracellular matrix (ECM), including the expression of alpha2 (1) procollagen (Col1A2) and fibronectin 1 (FN) were seen in HSFs. A STAT3 peptide inhibitor abrogated FN and Col1A2 gene expression in HSF indicating involvement of STAT3 in ECM production. The cellular proliferation markers Cyclin D1, Bcl-Xl and c-Myc were also upregulated in HSF and knockdown of STAT3 by siRNA attenuated c-Myc expression indicating the essential role of STAT3 in fibroblast proliferation. Taken together, our results suggest that the IL-6-trans-signaling-STAT3 pathway may play an integral role in HS pathogenesis and disruption of this pathway could be a potential therapeutic strategy for the treatment of burn-induced HS.
Ray, Sutapa; Ju, Xiaoxi; Sun, Hong; Finnerty, Celeste C; Herndon, David N; Brasier, Allan R
Congenital poikiloderma is characterized by a combination of mottled pigmentation, telangiectasia, and epidermal atrophy in the first few months of life. We have previously described a South African European-descent family affected by a rare autosomal-dominant form of hereditary fibrosing poikiloderma accompanied by tendon contracture, myopathy, and pulmonary fibrosis. Here, we report the identification of causative mutations in FAM111B by whole-exome sequencing. In total, three FAM111B missense mutations were identified in five kindreds of different ethnic backgrounds. The mutation segregated with the disease in one large pedigree, and mutations were de novo in two other pedigrees. All three mutations were absent from public databases and were not observed on Sanger sequencing of 388 ethnically matched control subjects. The three single-nucleotide mutations code for amino acid changes that are clustered within a putative trypsin-like cysteine/serine peptidase domain of FAM111B. These findings provide evidence of the involvement of FAM111B in congenital poikiloderma and multisystem fibrosis.
Mercier, Sandra; Kury, Sebastien; Shaboodien, Gasnat; Houniet, Darren T.; Khumalo, Nonhlanhla P.; Bou-Hanna, Chantal; Bodak, Nathalie; Cormier-Daire, Valerie; David, Albert; Faivre, Laurence; Figarella-Branger, Dominique; Gherardi, Romain K.; Glen, Elise; Hamel, Antoine; Laboisse, Christian; Le Caignec, Cedric; Lindenbaum, Pierre; Magot, Armelle; Munnich, Arnold; Mussini, Jean-Marie; Pillay, Komala; Rahman, Thahira; Redon, Richard; Salort-Campana, Emmanuelle; Santibanez-Koref, Mauro; Thauvin, Christel; Barbarot, Sebastien; Keavney, Bernard; Bezieau, Stephane; Mayosi, Bongani M.
Background Gluteal muscle contracture (GMC) is a clinical syndrome due to multiple etiologies in which hip movements may be severely limited. The aim of this study was to propose a detailed classification of GMC and evaluate the statistical association between outcomes of different management and patient conditions. Methods One hundred fifty-eight patients, who were treated between January 1995 and December 2004, were reviewed at a mean duration of follow-up of 4.8 years. Statistical analyses were performed using X2 and Fisher's exact tests. Results Non-operative management (NOM), as a primary treatment, was effective in 19 of 49 patients (38.8%), while operative management was effective in all 129 patients, with an excellence rating of 83.7% (108/129). The outcome of NOM in level I patients was significantly higher than in level II and III patients (P < 0.05). The results of NOM and operative management in the child group were better than the adolescent group (P < 0.05). Complications in level III were more than in level II. Conclusion NOM was more effective in level I patients than in level II and III patients. Operative management was effective in patients at all levels, with no statistical differences between levels or types. We recommend NOM as primary treatment for level I patients and operative management for level II and III patients. Either NOM or operative management should be carried out as early as possible.
Zhao, Chen-Guang; He, Xi-Jing; Lu, Bin; Li, Hao-Peng; Wang, Dong; Zhu, Zhen-Zhong
Scars after facial trauma or surgery can be a source of distress for patients, and facial plastic surgeons are frequently called upon to help manage them. Although no technique can remove a scar, numerous treatment modalities have been developed to improve facial scar appearance with varying levels of invasiveness. This article reviews techniques that camouflage scars without surgical intervention. Topical scar treatments, camouflage cosmetics, use of hairstyling and glasses, and facial prosthetics are discussed. In addition, professional counseling is provided on selection and application of topical cosmetics for use as part of an office practice. PMID:21856536
Sidle, Douglas M; Decker, Jennifer R
Background The relationship between radial scars and breast cancer is unclear, as the results of different studies are inconsistent. We aim to solve the controversy and assess the breast cancer risk of radial scars. Methods Case-control or cohort studies about radial scars and breast cancer risk published in PubMed, Web of Science and the Cochrane Library from 2000 to 2013 were searched. Heterogeneity for the eligible data was assessed and a pooled odds ratio (OR) with 95% confidence interval (CI) was calculated. Results Five observational studies involving 2521 cases and 20290 controls were included in our study. From pooled analysis, radial scars were found to have a 1.33 fold increased risk of breast cancer, but which was not significant (P?=?0.138). Sample size contributed to heterogeneity. In subgroup analysis, the results pooled from studies with sample size >2000 show that presence of radial scars was associated with 1.6 times breast cancer risk compared to absence of radial scars. Radial scars increased the risk of breast cancer among women with proliferative disease without atypia, but no significant association between radial scars and carcinoma was noted among women with atypical hyperplasia. Conclusions Radial scars tend to be associated with an increased breast cancer risk. Radial scars should be considered among women with proliferative disease without atypia, while atypical hyperplasia is still the primary concern among women with both radial scars and atypical hyperplasia.
Zhong, Shanliang; Chen, Weixian; Hu, Qing; Ma, Tengfei; Zhang, Jun; Zhang, Xiaohui; Tang, Jinhai; Zhao, Jianhua
Endometriosis is an ectopic occurrence of tissue morphologically and functionally resembling endometrial tissue in regions outside the uterine cavity. Although scar endometriosis after surgery has been shown to be most common among all the extrapelvic forms of endometriosis, endometriosis after bladder exstrophy surgery has not been reported, and here we present the first known case. A 26-year-old woman with a history of bladder exstrophy was aware of a painful induration at the operative scar located in the left lower abdominal wall, and presented at our hospital. Although the symptoms resolved, recurring exacerbation was observed after 9 months. Abdominal magnetic resonance imaging showed a heterogeneous mass 16 mm in diameter in the left abdominal wall with high signal intensity on T1W1 and T2W1 images. She underwent excisional biopsy of the lesion under general anesthesia. Histopathology confirmed the diagnosis of endometriosis. Eighteen months after surgery, she was well and free from recurrence.
Kitajima, Takahito; Inoue, Mikihiro; Uchida, Keiichi; Otake, Kohei; Kusunoki, Masato
Endometriosis is an ectopic occurrence of tissue morphologically and functionally resembling endometrial tissue in regions outside the uterine cavity. Although scar endometriosis after surgery has been shown to be most common among all the extrapelvic forms of endometriosis, endometriosis after bladder exstrophy surgery has not been reported, and here we present the first known case. A 26-year-old woman with a history of bladder exstrophy was aware of a painful induration at the operative scar located in the left lower abdominal wall, and presented at our hospital. Although the symptoms resolved, recurring exacerbation was observed after 9 months. Abdominal magnetic resonance imaging showed a heterogeneous mass 16 mm in diameter in the left abdominal wall with high signal intensity on T1W1 and T2W1 images. She underwent excisional biopsy of the lesion under general anesthesia. Histopathology confirmed the diagnosis of endometriosis. Eighteen months after surgery, she was well and free from recurrence. PMID:23701150
Kitajima, Takahito; Inoue, Mikihiro; Uchida, Keiichi; Otake, Kohei; Kusunoki, Masato
Primary choriocarcinoma of the uterine cervix is an extremely rare disease. The clinical diagnosis of cervical choriocarcinoma is difficult, because of its rarity and being non-specific abnormal vaginal bleeding the most common symptom. In the present report, the authors present a case of cervical choriocarcinoma, which was initially misdiagnosed as a cesarean section scar ectopic pregnancy. Remission of cervical choriocarcinoma was accomplished with the combination of hysterectomy and chemotherapy. PMID:24497867
Sorbi, Flavia; Sisti, Giovanni; Pieralli, Annalisa; Di Tommaso, Mariarosaria; Livi, Lorenzo; Buccoliero, Anna Maria; Fambrini, Massimiliano
\\u000a Fully ablative carbon dioxide (CO2) laser resurfacing is the traditional gold standard for the treatment of moderate-to-severe\\u000a rhytides and acne scars. It offers the most dramatic results but can have extensive downtime of 2 or more weeks. The Erbium:YAG\\u000a laser, Erbium:YSGG laser, and plasma skin regeneration were developed to improve photoaging and textural abnormalities without\\u000a the prolonged recovery time of
Melissa A. Bogle; Geeta Yadav; Kenneth A. Arndt; Jeffrey S. Dover
A new disease, the slippery scar, was investigated in cultivated bags of Auricularia polytricha. This fungus was isolated from the infected mycelia of cultivated bags. Based on morphological observation, rDNA-internal transcribed spacer and 18S sequence analysis, this pathogen was identified as the Ascomycete Scytalidium lignicola. According to Koch's Postulation, the pathogenicity of S. lignicola to the mycelia of A. polytricha was confirmed. The parasitism of this fungus on mushroom mycelia in China has not been reported before.
The effect of confined burning explosive abutting nonburning explosive in a variety of one-dimensional geometries has been studied by numerical simulation, demonstrating the effects of confinement, burning rate, and shock sensitivity. The model includes porous bed burning, compressible solids and gases, shock-induced decomposition with possible transition to detonation, and constant velocity ignition waves. Two-phase flow, gas relative to solid, is not allowed. Because the shock sensitivity of an explosive changes with explosive density and because such experimental data is rarely available over a range of densities, a method for the calculation of the density effect on the initial-shock-pressure, distance-to-detonation (wedge test) measure of shock sensitivity is given. The calculation uses the invariance with density of the shock particle velocity as a function of time to detonation, and the experimental data at some high density.
Phenol burns and intoxications are life-threatening injuries. Roughly 50 per cent of all reported cases have a fatal outcome. Only a small number of cases have been reported with high serum concentrations after phenol burns who survived. In our own experience a patient with 20.5 per cent total body surface area deep partial skin thickness phenol burns and serum concentrations of 17,400 micrograms/litre survived after immediate and repeated treatment of the scalds with polyethylene glycol (PEG) and silver sulphadiazine. A literature review of experiences with phenol intoxications reveals the advantages of PEG application. Questions on the need for enforced diuresis and haemodialysis as well as the initial treatment procedures are discussed. Advantages of different solutions for local therapy are reported. PMID:8148075
Horch, R; Spilker, G; Stark, G B
Excessive scarring in the form of keloids and hypertrophic scars continues to be a clinical problem for some patients. The lack of an animal model for such scarring has been an obstacle to studying the cellular and molecular biology of these entities. Previous observations made by the authors that some surgical scars in the rabbit ear remain raised for months after wounding prompted us to investigate whether the rabbit ear might provide a model by which to study excessive dermal scarring. After establishing the model in preliminary study, 40 excisional wounds, 6 mm in diameter, were created over the ventral surface of rabbit ears. Elevated scars were treated with either intralesional triamcinolone acetonide or saline at day 16 postwounding. On day 22, 25 scar wounds were used for thorough histomorphometric analysis, 15 wounds were eliminated prior to analysis because of invagination of epithelial tissue, which made analysis difficult. Total area of scar and Hypertrophic Index, a ratio comparing scar prominence with the thickness of adjacent unwounded tissue, were measured for 25 (62 percent) of the resulting scars. Both total area of scar and Hypertrophic Index were found to be significantly decreased in the steroid-treated group (p < 0.02 and < 0.03, respectively). In a chronic form of this model, in which larger excisions were taken, an excessive accumulation of both new collagen and cartilage over 9 months was observed. An animal model for excessive dermal scarring that allows quantitation of scar formation and, at an early stage, can be modulated in a predictable way with intralesional corticosteroid treatment is presented. This model may parallel hypertrophic scarring in humans and thus might provide a tool by which to study its pathophysiology and objectively evaluate therapeutic modalities. PMID:9283567
Morris, D E; Wu, L; Zhao, L L; Bolton, L; Roth, S I; Ladin, D A; Mustoe, T A
Burning mouth syndrome (BMS) is a chronic condition that is characterized by burning symptoms of the oral mucosa without obvious clinical examination findings. This syndrome has complex characteristics, but its cause remains largely enigmatic, making treatment and management of patients with BMS difficult. Despite not being accompanied by evident organic changes, BMS can significantly reduce the quality of life for such patients. Therefore, it is incumbent on dental professionals to diagnose and manage patients with BMS as a part of comprehensive care. PMID:23809306
Thoppay, Jaisri R; De Rossi, Scott S; Ciarrocca, Katharine N
ABSTRACT Purpose: While contemporary management of contractures (a common secondary problem of acquired brain injury that can be difficult to treat) includes passive stretch, recent evidence indicates that this intervention may not be effective. This may be because clinical trials have not provided a sufficient dose or have not combined passive stretch with other treatments. The purpose of this case report is to describe a programme of intensive passive stretch combined with motor training administered over a 1.5-year period to treat severe knee contractures. Method: Five months after traumatic brain injury, an adolescent client with severe contractures in multiple joints underwent an intensive stretch programme for his knee contractures, including serial casting and splinting, which was administered for 10 months in conjunction with a motor training programme administered for 1.5 years. Results: The client regained full extension range in his knees and progressed from being totally dependent to walking short distances with assistance; these effects were maintained at follow-up 5.5 years after injury. Conclusion: The use of a high dose of passive stretch in conjunction with motor training may be an option to consider for correcting severe contractures following acquired brain injury.
Harvey, Lisa A.; Moseley, Anne M.
Purpose: While contemporary management of contractures (a common secondary problem of acquired brain injury that can be difficult to treat) includes passive stretch, recent evidence indicates that this intervention may not be effective. This may be because clinical trials have not provided a sufficient dose or have not combined passive stretch with other treatments. The purpose of this case report is to describe a programme of intensive passive stretch combined with motor training administered over a 1.5-year period to treat severe knee contractures. Method: Five months after traumatic brain injury, an adolescent client with severe contractures in multiple joints underwent an intensive stretch programme for his knee contractures, including serial casting and splinting, which was administered for 10 months in conjunction with a motor training programme administered for 1.5 years. Results: The client regained full extension range in his knees and progressed from being totally dependent to walking short distances with assistance; these effects were maintained at follow-up 5.5 years after injury. Conclusion: The use of a high dose of passive stretch in conjunction with motor training may be an option to consider for correcting severe contractures following acquired brain injury. PMID:24403690
Leung, Joan; Harvey, Lisa A; Moseley, Anne M
The clinical and pathologic features of sixty-four cases of infection of the heart in 3,064 burned patients are reviewed. In the majority of the cases, the heart became involved as part of a generalized septicemia with a portal of entry through either the...
A. M. Munster B. A. Pruitt F. C. DiVincenti F. D. Foley
A process is provided for burning refuse containing polyvinyl chloride without the consequent production of phosgene. The refuse is carbonized in a rotary furnace at temperatures below 1200 degrees F., especially 700 degrees F., in an oxygen deficient atmosphere. A burnable gas containing the carbonized refuse is drawn from the furnace by an air jet wherein same is mixed with
When conducting a trial burn, it is necessary to make a number of measurements in order to adequately define the performance of the incinerator. n addition to flue gas emissions for particulate matter, HCl, and selected organics, it is also necessary to measure selected organics ...
An air tight wood burning stove (10) for heating a designated space comprises a housing (12) having an access opening (50) in the front wall (14) thereof and at least one glass panel (64) containing door (54, 56) hingedly mounted on the front wall for closing the opening (50). A latching mechanism (60) on the door (54, 56) engages with
In this activity, learners burn a peanut, which produces a flame that can be used to boil away water and count the calories contained in the peanut. Learners use a formula to calculate the calories in a peanut and then differentiate between food calories and physicist calories as well as calories and joules.
Characteristics of aluminum combustion are summarized in an overview of the subject, focusing on the burning time of individual particles. Combustion data from over ten different sources with almost 400 datum points have been cataloged and correlated. Available models have also been used to evaluate combustion trends with key environmental parameters. The fundamental concepts that control aluminum combustion are discussed,
M. W. Beckstead
Discusses the use of CDs (Compact Disks) for backing up data as an alternative to using floppy disks and explains how to burn, or record, a CD. Topics include differences between CD-R (CD-Recordable) and CD-RW (CD-Rewritable); advantages of CD-R and CD-RW; selecting a CD burner; technology trends; and care of CDs. (LRW)
Background The myocardium exhibits heterogeneous nature due to scarring after Myocardial Infarction (MI). In Cardiac Magnetic Resonance (CMR) imaging, Late Gadolinium (LG) contrast agent enhances the intensity of scarred area in the myocardium. Methods In this paper, we propose a probability mapping technique using Texture and Intensity features to describe heterogeneous nature of the scarred myocardium in Cardiac Magnetic Resonance (CMR) images after Myocardial Infarction (MI). Scarred tissue and non-scarred tissue are represented with high and low probabilities, respectively. Intermediate values possibly indicate areas where the scarred and healthy tissues are interwoven. The probability map of scarred myocardium is calculated by using a probability function based on Bayes rule. Any set of features can be used in the probability function. Results In the present study, we demonstrate the use of two different types of features. One is based on the mean intensity of pixel and the other on underlying texture information of the scarred and non-scarred myocardium. Examples of probability maps computed using the mean intensity of pixel and the underlying texture information are presented. We hypothesize that the probability mapping of myocardium offers alternate visualization, possibly showing the details with physiological significance difficult to detect visually in the original CMR image. Conclusion The probability mapping obtained from the two features provides a way to define different cardiac segments which offer a way to identify areas in the myocardium of diagnostic importance (like core and border areas in scarred myocardium).
AIM To investigate and compare the cytopathological and clinical effects of amniotic membrane transplantation (AMT) and oral mucosal membrane transplantation (OMMT) in socket contraction. METHODS Twelve patients who could not be fitted with ocular prosthesis due to socket contracture were included in this study. Seven patients underwent AMT and 5 patients underwent OMMT. Thirteen patients who had healthy sockets were included as control group. Depth of inferior fornix, degree of inflammation, extent of the socket contracture and socket volume were measured in the preoperative period and at sixth and twelfth weeks postoperatively. Impression cytology of conjunctival fornices and tear transforming growth factor beta-1 (TGF?1) levels were determined. RESULTS In the AMT group, socket volume and lower fornix depth values were significantly higher (P=0.030 and P=0.004 respectively) and inflammation levels and impression cytology stages (P=0.037 and P=0.022 respectively) were significantly lower in postoperative period compared to preoperative period. In the OMMT group, no statistical differences were found in terms of clinical parameters, inflammation levels and impression cytology stages of preoperative versus postoperative values. Preoperative tear TGF?1 levels were higher in AMT and OMMT groups compared to the control group (25.5 ng/mL, 26.3 ng/mL and 21.7 ng/mL respectively). Decreased tear TGF?1 levels were observed in both the AMT and OMMT groups postoperatively (median decrease value=2.1 ng/mL and 2.7 ng/mL respectively). CONCLUSION AMT is associated with postoperative improvement in inferior fornix depth, socket volume, inflammation and impression cytology levels and may be a more proper alternative method than OMMT in the management of socket contracture.
Kurtul, Bengi Ece; Erdener, Ugur; Mocan, Mehmet Cem; Irkec, Murat; Orhan, Mehmet
The instrument measures accurately the burning rate of solid propellant rocket motors. This is accomplished by use of light-transmitting rods of different lengths embedded in a propellant grain and transmitting light energy during burning of the grain to ...
J. E. Fitzgerald N. C. Allen
Burning Mouth Syndrome (BMS) is a chronic disorder that predominately affects middle-aged women in the postmenopausal period. The condition is distinguished by burning symptoms of the oral mucosa and the absence of any clinical signs. The etiology of BMS is complex and it includes a variety of factors. Local, systemic and psychological factors such as stress, anxiety and depression are listed among the possible causes of BMS. BMS may sometimes be classified as BMS Type I, II or III. Although this syndrome is not accompanied by evident organic alterations and it does not present health risks, it can significantly reduce the patient's quality of life. This study analyzes the available literature related to BMS, and makes special reference to its therapeutic management. The pages that follow will also discuss the diagnostic criteria that should be respected, etiological factors, and clinical aspects. We used the PubMed database and searched it by using the keywords "burning mouth syndrome", "BMS and review", and "burning mouth and review", in the title or abstract of the publication. BMS treatment usually steers towards the management of the symptoms; however, the specific local factors that could play a significant role in worsening the oral burning sensation should be eradicated. The most widely accepted treatment options that show variable results include tricyclic antidepressants, benzodiazepines and antipsychotic drugs; nevertheless there are other therapies that can also be carried out. Professionals that work in the field of dentistry should formulate standardized symptomatic and diagnostic criteria in order to more easily identify the most effective and reliable strategies in BMS treatment through multidisciplinary research. PMID:24984658
Spanemberg, Juliana Cassol; Rodríguez de Rivera Campillo, Eugenia; Salas, Enric Jané; López López, José
Six methods for measuring the shortwave absorption and\\/or black carbon (BC) content of aerosols from biomass burning were compared during the Smoke, Clouds, and Radiation-Brazil (SCAR-B) experiment. The methods were the optical extinction cell (OEC), integrating plate (IP), optical reflectance (OR), particle soot\\/absorption photometer (PSAP), thermal evolution (TE), and remote sensing (RS). Comparisons were made for individual smoke plumes and
Jeffrey S. Reid; Peter V. Hobbs; Catherine Liousse; J. Vanderlei Martins; Ray E. Weiss; Thomas F. Eck
The Burn Data Coordinating Center (BDCC) began collecting data in 1994 and is currently the largest burn database in the country. Pediatric burn data was added in 1998. The BMS database contains over 2,800 cases supporting clinical research and research on outcomes including empl...
Summary Burn patterns differ across the whole world and not only in relation to lack of education, overcrowding, and poverty. Cultures, habits, traditions, psychiatric illness, and epilepsy are strongly correlated to burn patterns. However, burns may also occur because of specific religious beliefs and activities, social events and festivals, traditional medical practices, occupational activities, and war.
Almoghrabi, A.; Abu Shaban, N.
This poster shows how prescribed burns operate, using careful planning and preparation to start a fire that will renew habitat without threatening ecosystems or homes. This image describes the steps required to prepare a prescribed burn, how fire crews set up for the burn, and how the wind is used to help control the fire.
Forestry, Florida D.; Smokeybear.com
Chemical burn is a rare complication of topical polyvinylpyrrolidone-iodine (PVP-I), commonly called povidone-iodine (trade name Betadine, Purdue, Stamford, NJ). This adverse reaction occurred on the buttocks of an eight-year-old male after undergoing a laparoscopic appendectomy involving antiseptic skin preparation using a 10% PVP-I solution. This case is consistent with previous reports in which a chemical burn develops when PVP-I does not adequately dry, pools beneath a dependent body part during surgery, or is placed under an occlusive device. Symptoms develop immediately to one day after surgery. The proposed mechanism is irritation from iodine coupled with maceration, pressure and friction. While patients typically heal without significant scarring, the burn subjects the patient to unnecessary pain, prolongs hospitalization and increases the risk for infection. Physicians should be aware of this complication and therefore take preventative measures. These include allowing PVP-I to completely dry, preventing dripping and pooling and avoiding occlusion. PMID:21455553
Rees, Adam; Sherrod, Quyn; Young, Lorraine
The ecological effects of forest fires burning with high severity are long-lived and have the greatest impact on vegetation successional trajectories, as compared to low-to-moderate severity fires. The primary drivers of high severity fire are unclear, but it has been hypothesized that wind-driven, large fire-growth days play a significant role, particularly on large fires in forested ecosystems. Here, we examined the relative proportion of classified burn severity for individual daily areas burned that occurred during 42 large forest fires in central Idaho and western Montana from 2005 to 2007 and 2011. Using infrared perimeter data for wildfires with five or more consecutive days of mapped perimeters, we delineated 2697 individual daily areas burned from which we calculated the proportions of each of three burn severity classes (high, moderate, and low) using the differenced normalized burn ratio as mapped for large fires by the Monitoring Trends in Burn Severity project. We found that the proportion of high burn severity was weakly correlated (Kendall ? = 0.299) with size of daily area burned (DAB). Burn severity was highly variable, even for the largest (95th percentile) in DAB, suggesting that other variables than fire extent influence the ecological effects of fires. We suggest that these results do not support the prioritization of large runs during fire rehabilitation efforts, since the underlying assumption in this prioritization is a positive relationship between severity and area burned in a day.
Birch, Donovan S.; Morgan, Penelope; Kolden, Crystal A.; Hudak, Andrew T.; Smith, Alistair M. S.
The development of effective, non-toxic (local and systemic) methods for the rapid chemical (enzymatic and non-enzymatic) debridement of third degree burns would dramatically reduce the morbidity and mortality of severely burned patients. Sepsis is still the major cause of death of patients with extensive deep burns. The removal of the devitalized tissue, without damage to unburned skin or skin only partially injured by burning, and in ways which would permit immediate (or very prompt) skin grafting, would lessen substantially the problems of sepsis, speed convalescence and the return of these individuals to society as effective human beings, and would decrease deaths. The usefulness and limitations of surgical excision for patients with extensive third degree burns are discussed. Chemical debridement lends itself to complementary use with surgical excision and has the potential advantage over surgical excision in not requiring anesthesia or a formal surgical operation. The authors' work with the chemical debridement of burns, in particular the use of Bromelain, indicates that this approach will likely achieve clinical usefulness. The experimental studies indicate that rapid controlled debridement, with minimal local and systemic toxicity, is possible, and that effective chemotherapeutic agents may be combined with the Bromelain without either interfering with the actions of the other. The authors believe that rapid (hours) debridement accomplished by the combined use of chemical debriding and chemotherapeutic agents will obviate the possibility of any increase in infection, caused by the use of chemical agents for debridement, as reported for Paraenzyme21 and Travase.39,48 It is possible that the short term use of systemic antibiotics begun just before and continued during, and for a short time after, the rapid chemical debridement may prove useful for the prevention of infection, as appears to be the case for abdominal operations of the clean-contaminated and contaminated types. ImagesFigs. 1a-c.Fig. 1b.Fig. 1c.Fig. 2.Fig. 3.Fig. 4.Fig. 5.Fig. 6.Fig. 7.Fig. 8.Fig. 9a.Fig. 9B.Fig. 10.Fig. 11.Figs. 12a-c.Fig. 12b.Fig. 12c.Figs. 14a-c.Fig. 14b.Fig. 14c.Figs. 15a-c.Fig. 15b.Fig. 15c.
Levenson, Stanley M.; Kan, Dorinne; Gruber, Charles; Crowley, Leo V.; Lent, Richard; Watford, Alvin; Seifter, Eli
Background Dupuytren's disease is a fibro-proliferative disorder affecting ~3-5% of the UK population. Current surgical treatments for Dupuytren's contracture (DC) include fasciectomy and fasciotomy. We assessed the clinical management of DC in England over a 5-year period; associated NHS costs were assessed for a 1-year period. Methods Hospital Episode Statistics were extracted from April 2003 to March 2008 for patients with Palmar Fascial Fibromatosis (ICD10 = M720) and DC-related procedures. Variables included demographics, OPCS, patient status and physician specialty. To estimate 2010-2011 costs, HRG4 codes and the National Schedule of Tariff 2010-11-NHS Trusts were applied to the 2007-2008 period. Results Over 5 years, 75,157 DC admissions were recorded; 64,506 were analyzed. Mean admissions per year were 12,901 and stable. Day cases increased from 42% (2003-2004) to 62% (2007-2008). The percent of patients having two or more admissions per year increased from 5.5% in 2003-2004 to 26.1% in 2007-2008. Between 2003 and 2007, 91% of procedures were Fasciectomy. Revision of Fasciectomy and Fasciotomy each accounted for ~4%; Amputation for 1%. In 2007, classification was extended to identify Digital Fasciectomy, its Revision and Dermofasciectomy. In 2007-2008, admissions were: 70% Palmar Fasciectomy, 16% Digital Fasciectomy, 1.3% Other Fasciectomy, 4.4% Revision of Palmar Fasciectomy, 1.3% Revision of Digital Fasciectomy, 3.8% Division of Palmar Fascia, 2.6% Dermofasciectomy and 1.1% Amputation. 79% of cases were overseen by trauma and orthopaedic surgeons, 19% by plastic surgeons. Mean (±SD) inpatient hospital length of stay was 1.5 (±1.4) days in 2003-2004 and 1.0 (±1.3) days in 2007-2008. Total estimated costs for 1 year (2010-2011) were £41,576,141. Per-patient costs were £2,885 (day case) and £3,534 (inpatient). Costs ranged from £2,736 (day-case Fasciectomy) to £9,210 (day-case Revision Digital). Conclusions Between 2003 and 2008, fasciectomy was the most common surgical procedure for DC in England. While procedure rates and physician specialties varied little, there was a reversal in surgical venue: inpatient operations decreased as day-case procedures increased. The change is likely due to economic trends and changes to the healthcare system. Estimated costs for 2010-2011 varied by procedure type and patient status. These findings can be used to understand clinical management of DC and guide healthcare policy.
Purpose Description and evaluation of the sonographic changes at the site of the myomectomy and follow-up of the healing process.\\u000a \\u000a \\u000a \\u000a Methods Twelve patients with intramural fibroids underwent myomectomy. Pre- and postoperative ultrasound examinations included measurements\\u000a of uterine volume and the largest diameters of the largest fibroid and the myomectomy scar.\\u000a \\u000a \\u000a \\u000a Results The mean uterine preoperative volume was 773 cm3 (range 271–1,343) (SD 285). It
Ronnie Tepper; Yoram Beyth; Zvi Klein; Rami Aviram
Objectives/Hypothesis In vitro modeling of cell-matrix interactions that occur during human vocal fold scarring is uncommon, as primary human vocal fold scar fibroblast cell lines are difficult to acquire. The purpose of this study was to characterize morphologic features, growth kinetics, contractile properties, ?-smooth muscle actin (?-SMA) protein expression and gene expression profile of human vocal fold fibroblasts derived from scar (sVFF) relative to normal vocal fold fibroblasts (nVFF). Study Design In vitro. Methods We successfully cultured human vocal fold fibroblasts from tissue explants of scarred vocal folds from a 56-year-old female and compared these to normal fibroblast cells from a 59-year-old female. Growth and proliferation were assessed by daily cell counts and morphology was compared at 60% confluence for 5 days. Gel contraction assays were evaluated after seeding cells within a collagen matrix. Alpha-SMA was measured using western blotting and immunocytochemistry (ICC). Quantitative RT-PCR was used to assess differential extracellular matrix gene expression between the two cell types. Results sVFF were morphologically indistinguishable from nVFF. sVFF maintained significantly lower proliferation rates relative to nVFF on days 3-6 (day 3: p = 0.0138, days 4, 5, and 6: p < 0.0001). There were no significant differences in contractile properties between the two cell types at any time point (0h: p = 0.70, 24h: p = 0.79, 48h: p = 0.58). ICC and western blot analyses revealed increased expression of ?-SMA in sVFF as compared with nVFF at passages 4 and 5, but not at passage 6 (passage 4: p = 0.006, passage 5: p = 0.0015, passage 6 = 0.8860). Analysis of 84 extracellular matrix genes using qRT-PCR revealed differential expression of 15 genes (p < 0.01). Conclusions nVFF and sVFF displayed differences in proliferation rates, ?-SMA expression, and gene expression, whereas no differences were observed in contractile properties or morphology. Further investigation with a larger sample size is necessary to confirm these findings.
Jette, Marie E.; Hayer, Supriya D.; Thibeault, Susan L.
It has long been hoped that cesarean hysterotomy scar imaging data could predict obstetric complications in subsequent pregnancies with sufficient precision to be used for clinical decision-making. Although large visualized defects in nonpregnant uteri, and thinning of the lower uterine segment late in subsequent pregnancies, may be associated with increased risk of uterine rupture, the paucity of available clinical correlation data still preclude any clinical utility. There is an ongoing need for prospective adequately powered registries that include clinical factors related to the previous cesarean deliveries that can inform subsequent practice decisions. PMID:23090468
Burning mouth syndrome (glossalgia) is manifested by oral pin and tingling sensations, numbness and even burning and severe pains, more frequently in the tongue. Unpleasant sensations may involve the anterior two thirds of the tongue or be extended to the front part of the hard palate and the mucous membrane of the lower lip. This condition is characterized by "mirror" and "food dominant" symptoms, disordered salivation, dysgeusia, or psychological disorders. The disease shows a chronic course. Its etiology may be multifactorial. There are no universally accepted diagnostic criteria; the diagnosis of glossalgia is made to rule out all other causes. A thorough examination should be conducted to establish a differential diagnosis. Glossalgia occurs primarily in middle-aged and elderly people. Women get sick much more frequently than men of the same age. Glossalgia remains difficult to treat. Continuous symptomatic treatment and follow-up help relieve its symptoms. PMID:24757710
A case involving a five-month-old girl brought to the emergency department with burns over her abdomen is described. The child was reported to have spilled two small bottles of beauty nail adhesive on her clothes while her mother was preparing dinner. After undressing the infant, the mother discovered several lesions on the child's abdomen and quickly sought medical attention. Given the unusual circumstances of the presentation, the child was hospitalized for both treatment and supervision. The beauty nail adhesive contained cyanoacrylate. In addition to its well-appreciated adhesive capacity, cyanoacrylate, in the presence of cotton or other tissues, is known to produce an exothermic reaction that may cause burns. Cyanoacrylate-based products, due to their possible adverse effects, should be kept away from children as advised. Odd injuries should always raise concerns about the possibility of inflicted injury. PMID:24421671
Bélanger, Richard E; Marcotte, Marie-Eve; Bégin, François
A case involving a five-month-old girl brought to the emergency department with burns over her abdomen is described. The child was reported to have spilled two small bottles of beauty nail adhesive on her clothes while her mother was preparing dinner. After undressing the infant, the mother discovered several lesions on the child’s abdomen and quickly sought medical attention. Given the unusual circumstances of the presentation, the child was hospitalized for both treatment and supervision. The beauty nail adhesive contained cyanoacrylate. In addition to its well-appreciated adhesive capacity, cyanoacrylate, in the presence of cotton or other tissues, is known to produce an exothermic reaction that may cause burns. Cyanoacrylate-based products, due to their possible adverse effects, should be kept away from children as advised. Odd injuries should always raise concerns about the possibility of inflicted injury.
Belanger, Richard E; Marcotte, Marie-Eve; Begin, Francois
A finite universe naturally supports chaotic classical motion. An ordered fractal emerges from the chaotic dynamics which we characterize in full for a compact two-dimensional octagon. In the classical-to-quantum transition, the underlying fractal can persist in the form of scars, ridges of enhanced amplitude in the semiclassical wavefunction. Although the scarring is weak on the octagon, we suggest possible subtle implications of fractals and scars in a finite universe.
Levin, Janna; Barrow, John D.
Burning Magnesium: this is a resource in the collection "General Chemistry Multimedia Problems". In this problem we will look at the reactions of two elements with oxygen in air. We will begin by observing the reaction of magnesium metal with oxygen when the metal is heated in air. General Chemistry Multimedia Problems ask students questions about experiments they see presented using videos and images. The questions asked apply concepts from different parts of an introductory course, encouraging students to decompartmentalize the material.
Burning of solid crystalline hydroxylammonium nitrate (HAN) and its water solutions is studied in a constant-pressure bomb\\u000a within the pressure range from 0.1 to 36 MPa. Abnormally high pressure exponents are found to be typical of combustion of\\u000a the crystalline substance, its ?9-mole\\/liter water solution, and a solution containing ethanolamine nitrate as a fuel: for\\u000a pressures below ?10 MPa, the
B. N. Kondrikov; V. É. Annikov; V. Yu. Egorshev; L. T. De Luca
1. Following a 5 min in vitro exposure to morphine (1.3 x 10(-7) M), U-50,488H (2.5 x 10(-8) M) and deltorphin (1.6 x 10(-8)-6.5 x 10(-9) M), the rabbit isolated jejunum exhibited a precipitated contracture after the addition of naloxone (2.75 x 10(-7) M). 2. The precipitated responses to U-50,488H and deltorphin but not to morphine were reproducible in the same tissue. 3. The precipitated contractures were blocked completely by tetrodotoxin (3 x 10(-7) M), partially by atropine (1.5 x 10(-7) M) and not affected by hexamethonium (1.4 x 10(-5) M). 4. Naloxone administration (2.75 x 10(-7) M) before the agonist prevented the development of the adaptive response to morphine and U-50,488H but not to deltorphin. 5. The selective antagonists norbinaltorphimine (2.7 x 10(-8)-2.7 x 10(-9) M) and naltrindole (1.1 x 10(-7) M) prevented the adaptive response development only to the respective agonists. 6. The opioid agonists partially inhibited the spontaneous activity of the tissue. This study has shown that independent activation of mu-, kappa- and delta-opioid receptors can induce dependence in this isolated tissue. Rabbit jejunum is a suitable tissue for studying the acute effects of opioids on the adaptative processes determined by their administration.
Valeri, P.; Morrone, L. A.; Romanelli, L.
There is not much level 1 evidence based literature to guide management of hypertrophic scars and keloids despite an array of therapeutic modalities at disposal. Intralesional (i/l) triamcinolone injections have remained a gold standard in non surgical management. Sporadic reports on use of i/l verapamil suggest its efficacy. Since verapamil has not found sufficient mention as an effective alternative modality, it was decided to undertake a randomized study which could also address some additional clinical parameters. A randomized, parallel group and observer blinded comparison with 40 patients (48 scars) was carried out to compare the effects of i/l triamcinolone (T) (22 scars) and verapamil injections (V) (26 scars). 1.5ml was the maximum indicative volume decided in the study protocol for both the drugs (triamcinolone @40mg/ml and verapamil @ 2.5mg/ml). Patients included were aged between 15-60 years with scars ranging between 0.5-5cm (but total area roughly <6cm(2)), and scars under 2 years duration. Patients with keloidal diathesis were excluded. Injections were scheduled every three weeks until complete flattening of the scar or eight sessions, which ever came earlier. No concomitant therapies like massage, silicone gel or pressure garments were used. Scar evaluation at each stage was done by serial photographic records as well as by Vancouver Scar Scale (VSS). Comparative survival analysis between the two drugs was done using Kaplan Meier curves, and VSS scores were analyzed using Wilcoxon test and log rank test. Mean zero VSS scores were achieved with treatments in respect of scar height (T-12 weeks, V-21 weeks), vascularity (T-15 weeks, V-18 weeks) and pliability (T-15 weeks, V-21 weeks). The improvement in scar vascularity and pliability kept pace with decrease in scar height, in both the groups. There was not much difference in the rate of change of scar pigmentation with either drug but almost 60% patients in both the groups regained normal pigmentation. Our study adds to evidence of verapamil's capability in flattening the raised scars. With an extremely low cost and fewer adverse effects it deserves better positioning in the wide armamentarium against hypertrophic scars. It also offers several therapeutic possibilities to alternate with triamcinolone or be used simultaneously in larger (or multiple) scars. PMID:24182692
Ahuja, Rajeev B; Chatterjee, Pallab
Limb lengthening aims to reduce limb length discrepancy, improve cosmesis, and permit more functional mobility. Scarring, however, is a major concern of patients. In this study 25 patients (27 lengthening sites) were assessed; 6 sites were lengthened with Orthofix and 21 sites with Ilizarov. Altogether, 452 pin tract scars were assessed. The mean scar length was 11.5 mm in the Ilizarov group (n=415) and 54.1 mm in the Orthofix group (n=37). The mean scar width was 5.6 mm in the Ilizarov group and 11.5 mm in the Orthofix group. The mean patient satisfaction was 7.3 in the Orthofix group and 5.5 in the Ilizarov group. The mean Vancouver score was 0.66 in the Ilizarov group and 3.1 in the Orthofix group. The scars were shorter and cosmetically better in the Ilizarov group, but patients were more satisfied in the Orthofix group because there were fewer scars. Patients were also more satisfied with the thigh scars than with the leg scars because clothing can easily cover the thigh scars. PMID:15502574
Karlen, Law Ka Pui; Yinusa, Wahab; Yan, Lam Shuk; Wang, Kwan Wing; Hoi, Li Yun; John, Leong Chi Yan
Hypertrophic scarring is a common proliferative disorder of dermal fibroblasts characterized by collagen overproduction and excessive deposition of extracellular matrix (ECM). There is no consensus about the best therapeutics to produce complete and permanent improvement of scars with few side effects. To investigate the therapeutic effects of oleanolic acid (OA) on hypertrophic scars and explore the possible mechanism of action involved, a rabbit ear model with hypertrophic scars was established. OA (2.5%, 5%, and 10%) was given once daily to the scars for 28 consecutive days. As a result, OA significantly alleviated formed hypertrophic scars on rabbit ears. The levels of TGF-?(1), MMP-1, TIMP-1, and collagens I and III were notably decreased, and the number of apoptosis cells and mRNA expression of MMP-2, caspase-3, and caspase-9 were markedly increased in the scar tissue. The scar elevation index (SEI) was also evidently reduced. Histological findings exhibited significant amelioration of the collagen tissue. These results suggest that OA has the favorable curative effects on formed hypertrophic scars in the rabbit ear model, and the possible mechanism of action is that OA decreases HSFs proliferation and increases HSFs apoptosis by reduction of P311 gene expression and TGF-?(1) production, inhibition of TIMP-1 secretion, enhancement of MMP-2 activity, and subsequently facilitation of degradation of collagen types I and III. PMID:23326292
Zhang, Hong; Zhang, Yan; Jiang, Yi-Ping; Zhang, Lan-Ke; Peng, Cheng; He, Kun; Rahman, Khalid; Qin, Lu-Ping
Hypertrophic scarring is a common proliferative disorder of dermal fibroblasts characterized by collagen overproduction and excessive deposition of extracellular matrix (ECM). There is no consensus about the best therapeutics to produce complete and permanent improvement of scars with few side effects. To investigate the therapeutic effects of oleanolic acid (OA) on hypertrophic scars and explore the possible mechanism of action involved, a rabbit ear model with hypertrophic scars was established. OA (2.5%, 5%, and 10%) was given once daily to the scars for 28 consecutive days. As a result, OA significantly alleviated formed hypertrophic scars on rabbit ears. The levels of TGF-?1, MMP-1, TIMP-1, and collagens I and III were notably decreased, and the number of apoptosis cells and mRNA expression of MMP-2, caspase-3, and caspase-9 were markedly increased in the scar tissue. The scar elevation index (SEI) was also evidently reduced. Histological findings exhibited significant amelioration of the collagen tissue. These results suggest that OA has the favorable curative effects on formed hypertrophic scars in the rabbit ear model, and the possible mechanism of action is that OA decreases HSFs proliferation and increases HSFs apoptosis by reduction of P311 gene expression and TGF-?1 production, inhibition of TIMP-1 secretion, enhancement of MMP-2 activity, and subsequently facilitation of degradation of collagen types I and III.
Zhang, Hong; Zhang, Yan; Jiang, Yi-Ping; Zhang, Lan-Ke; Peng, Cheng; He, Kun; Rahman, Khalid; Qin, Lu-Ping
Here, we report the case of a 55-year-old man with reactivation of old cutaneous scars associated with a febrile illness, episcleritis, polyarthralgias, erythema nodosum and hilar adenopathy. High-resolution computed tomography (HRCT) revealed right paratracheal, bilateral hilar, and subcarinal lymphadenopathy without any nodular densities in both lung fields. A scar biopsy revealed multiple noncaseating granulomas and confirmed the diagnosis of sarcoidosis. A short course of oral steroids led to regression of systemic symptoms, and the scars returned to baseline size. This patient represented a rare case of simultaneous Löfgren's syndrome and scar sarcoidosis. PMID:23533907
Vardhan Reddy Munagala, Vishnu; Tomar, Vaishali; Aggarwal, Amita
Hypertrophic scar (HS) is a cutaneous fibrotic disorder characterized by persistent inflammation, excessive proliferation of fibroblasts, and abundant accumulation of extracellular matrix (ECM) proteins. Pleiotrophin (PTN) is a highly conserved and secreted ECM-associated protein that belongs to a novel family of heparin-binding cytokines with multiple biological functions. The aim of this study was to detect and compare the expression and localization of PTN in HS tissues and normal skin tissues. Surgically removed HS tissue samples and site-matched normal skin specimens were obtained from 18 patients during the scar excision and reconstructive surgery. Semi-quantitative RT-PCR, Western blot analysis and immunohistochemistry were used to determine PTN gene expression and localization in skin tissues. Compared with the normal skin tissues, PTN was highly expressed at both mRNA and protein levels in HS tissues (P < 0.01). In immunohistochemical staining, PTN protein was localized in the cells of both epidermis and dermis in skin tissues, and there were increased staining intensity of PTN in HS tissues than in normal skin samples. In conclusion, elevated expression of PTN is likely to be involved in the pathogenesis of HS. Further studies are still required to elucidate the exact role of PTN in HS formation. PMID:23054143
Zhang, Qian; Tao, Kai; Huang, Wei; Tian, Yaguang; Liu, Xiaoyan
Regulation of cellular functions during dermal repair following injury is complex and critically dependent on the interaction of cells with the surrounding extracellular matrix (ECM). The ECM comprises various families of macromolecules that form the structural scaffold of the tissue, but also carry distinct biological activities. After injury to the skin, the defect is filled by a provisional matrix that is invaded by inflammatory cells, sprouting blood vessels and fibroblasts. In a later phase, the wound contracts, the tissue is replaced by mature connective tissue produced by activated fibroblasts, and a scar is formed. All cells involved communicate directly with the ECM by integrins and other matrix receptors. These transmit signals and induce adaptive responses to the environment by the embedded cells. The ECM or proteolytic fragments of individual ECM constituents exert defined biological activities influencing cell survival, differentiation of myofibroblasts, ECM synthesis and turnover, wound angiogenesis and scar remodeling. Extensive crosstalk exists between ECM and growth factors, and between growth factors and integrins. ECM-cell contact also enables direct transmission of mechanical tension, which then modulates many activities of all cellular players. Understanding this complex interplay is important to provide a basis for designing effective wound therapy and for strategic interference with mechanisms that have gone out of control in fibrotic conditions.
Miniabdominoplasty with umbilical free float has received little attention in the literature in 15 years and has been criticized for an abnormally low umbilicus. We hypothesized the umbilicus in women presenting for abdominal contouring is positioned higher than ideal and thus may benefit from lowering. In addition, we felt modifications of the original umbilical float technique would improve aesthetic results. A retrospective review identified 60 patients aged 34 to 56 who had abdominoplasty with umbilical fascial transection and inferior positioning. Technical modifications included low placement of a full transverse abdominal scar, abdominal flap undermining to the rib cage, more inferior umbilical repositioning, flank liposuction, and plication of diastasis recti from xiphoid to pubis. Patients did not have enough excess skin to allow traditional abdominoplasty without a high-transverse or vertical midline scar. No umbilical or incisional skin necrosis occurred. To assess optimal umbilical position, plastic surgeons were asked to draw the ideal position on pre- and postoperative photographs from 5 patients. The mean ideal umbilical position was 2.2 cm lower than the actual position (P < 0.01) in preoperative photographs and was close to the true position in postoperative photographs. In conclusion, lower abdominoplasty with inferior umbilical positioning is an excellent choice for the middle age, postpartum woman with excess abdominal skin and full length diastasis recti but a normal body mass index. PMID:20395799
Colwell, Amy S; Kpodzo, Dzifa; Gallico, G Gregory
An acoustic emission (AE) method is being used to measure the burning rate of solid propellant strands. This method has a precision of 0.5% and excellent burning rate correlation with both subscale and large rocket motors. The AE procedure burns the sample under water and measures the burning rate from the acoustic output. The acoustic signal provides a continuous readout during testing, which allows complete data analysis rather than the start-stop clockwires used by the conventional method. The AE method helps eliminate such problems as inhibiting the sample, pressure increase and temperature rise, during testing.
Christensen, W. N.
The seasonally burned cerrados of Brazil are the largest savanna-type ecosystem of South America and their contribution to the global atmospheric nitrous oxide (N20) budget is unknown. Four types of fire-scarred cerrado along a vegetation gradient from grassland to forest were investigated during the wet season of 1992/93. The effect of fire and subsequent water additions on epiodic emissions of N2O and the associated profile dynamic of soil/gas phase N2O concentrations were studied for several months. Additionally, the effect on episodic emissions of N2O of nitrate and glucose additions to a cerrado soil after fire and the associated profile dynamic of soil/gas phase N2O mixing ratios were determined. Finally, N2O episodic emissions in cerrado converted to corn, soybean, and pasture fields were investigated during one growing/wet season. Results showed N2O consumption/emission for the four fire-scared savanna ecosystems, for nitrogen and carbon fertilization, and for agriculture/pasture ranging from -0.3 to +0.7, 1.8 to 9.1, and 0.5 to 3.7 g N2O-N ha(exp -1) d(exp -1), respectively. During the wet season the cerrado biome does not appear to be a major source of N2O to the troposphere, even following fire events. However, the results of this study suggest that conversion of the cerrado to high input agriculture, with liming and fertilization, can increase N2O emissions more than ten fold.
Nobre, A. D.; Crill, P. M.; Harriss, R. C.
Thermonuclear X-ray bursts result from unstable nuclear burning of the material accreted on neutron stars in some low mass X-ray binaries (LMXBs). Theory predicts that close to the boundary of stability oscillatory burning can occur. This marginally stable regime has so far been identified in only a small number of sources. We present Rossi X-ray Timing Explorer (RXTE) observations of the bursting, high- inclination LMXB 4U 1323-619 that reveal for the first time in this source the signature of marginally stable burning. The source was observed during two successive RXTE orbits for approximately 5 ksec beginning at 10:14:01 UTC on March 28, 2011. Significant mHz quasi- periodic oscillations (QPO) at a frequency of 8.1 mHz are detected for approximately 1600 s from the beginning of the observation until the occurrence of a thermonuclear X-ray burst at 10:42:22 UTC. The mHz oscillations are not detected following the X-ray burst. The average fractional rms amplitude of the mHz QPOs is 6.4% (3 - 20 keV), and the amplitude increases to about 8% below 10 keV.This phenomenology is strikingly similar to that seen in the LMXB 4U 1636-53. Indeed, the frequency of the mHz QPOs in 4U 1323-619 prior to the X-ray burst is very similar to the transition frequency between mHz QPO and bursts found in 4U 1636-53 by Altamirano et al. (2008). These results strongly suggest that the observed QPOs in 4U 1323-619 are, like those in 4U 1636-53, due to marginally stable nuclear burning. We also explore the dependence of the energy spectrum on the oscillation phase, and we place the present observations within the context of the spectral evolution of the accretion-powered flux from the source.
Strohmayer, Tod E.; Altamirano, D.
The purpose of this study was to evaluate a minimally invasive subscapularis-preserving arthroscopic release of capsule in the treatment of internal rotation contracture of the shoulder due to Erb's palsy. We performed our procedure (subscapularis-preserving arthroscopic release of capsule) in 10 paediatric shoulders with an average age of 20.2 months and followed them for an average period of 41.5 months. All the patients were assessed clinically and radiologically preoperatively and postoperatively at regular intervals. The Mallet scoring system was used for analysing the results. The average gain in passive external rotation was 50°. The active internal rotation was preserved in all the cases. With the mid-term follow-up, there was