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Sample records for myocardial scar extent

  1. Physiological Implications of Myocardial Scar Structure.

    PubMed

    Richardson, William J; Clarke, Samantha A; Quinn, T Alexander; Holmes, Jeffrey W

    2015-10-01

    Once myocardium dies during a heart attack, it is replaced by scar tissue over the course of several weeks. The size, location, composition, structure, and mechanical properties of the healing scar are all critical determinants of the fate of patients who survive the initial infarction. While the central importance of scar structure in determining pump function and remodeling has long been recognized, it has proven remarkably difficult to design therapies that improve heart function or limit remodeling by modifying scar structure. Many exciting new therapies are under development, but predicting their long-term effects requires a detailed understanding of how infarct scar forms, how its properties impact left ventricular function and remodeling, and how changes in scar structure and properties feed back to affect not only heart mechanics but also electrical conduction, reflex hemodynamic compensations, and the ongoing process of scar formation itself. In this article, we outline the scar formation process following a myocardial infarction, discuss interpretation of standard measures of heart function in the setting of a healing infarct, then present implications of infarct scar geometry and structure for both mechanical and electrical function of the heart and summarize experiences to date with therapeutic interventions that aim to modify scar geometry and structure. One important conclusion that emerges from the studies reviewed here is that computational modeling is an essential tool for integrating the wealth of information required to understand this complex system and predict the impact of novel therapies on scar healing, heart function, and remodeling following myocardial infarction. PMID:26426470

  2. High Sensitivity of Late Gadolinium Enhancement for Predicting Microscopic Myocardial Scarring in Biopsied Specimens in Hypertrophic Cardiomyopathy

    PubMed Central

    Konno, Tetsuo; Hayashi, Kenshi; Fujino, Noboru; Nagata, Yoji; Hodatsu, Akihiko; Masuta, Eiichi; Sakata, Kenji; Nakamura, Hiroyuki; Kawashiri, Masa-aki; Yamagishi, Masakazu

    2014-01-01

    Background Myocardial scarring can be assessed by cardiac magnetic resonance imaging with late gadolinium enhancement and by endomyocardial biopsy. However, accuracy of late gadolinium enhancement for predicting microscopic myocardial scarring in biopsied specimens remains unknown in hypertrophic cardiomyopathy. We investigated whether late gadolinium enhancement in the whole heart reflects microscopic myocardial scarring in the small biopsied specimens in hypertrophic cardiomyopathy. Methods and Results Twenty-one consecutive patients with hypertrophic cardiomyopathy who were examined both by cardiac magnetic resonance imaging and by endomyocardial biopsy were retrospectively studied. The right interventricular septum was the target site for endomyocardial biopsy in all patients. Late gadolinium enhancement in the ventricular septum had an excellent sensitivity (100%) with a low specificity (40%) for predicting microscopic myocardial scarring in biopsied specimens. The sensitivity of late gadolinium enhancement in the whole heart remained 100% with a specificity of 27% for predicting microscopic myocardial scarring in biopsied specimens. Quantitative assessments of fibrosis revealed that the extent of late gadolinium enhancement in the whole heart was the only independent variable related to the microscopic collagen fraction in biopsied specimens (β  =  0.59, 95% confident interval: 0.15 – 1.0, p  =  0.012). Conclusions Although there was a compromise in the specificity, the sensitivity of late gadolinium enhancement was excellent for prediction of microscopic myocardial scarring in hypertrophic cardiomyopathy. Moreover, the severity of late gadolinium enhancement was independently associated with the quantitative collagen fraction in biopsied specimens in hypertrophic cardiomyopathy. These findings indicate that late gadolinium enhancement can reflect both the presence and the extent of microscopic myocardial scarring in the small biopsied specimens in

  3. Monolayered mesenchymal stem cells repair scarred myocardium after myocardial infarction.

    PubMed

    Miyahara, Yoshinori; Nagaya, Noritoshi; Kataoka, Masaharu; Yanagawa, Bobby; Tanaka, Koichi; Hao, Hiroyuki; Ishino, Kozo; Ishida, Hideyuki; Shimizu, Tatsuya; Kangawa, Kenji; Sano, Shunji; Okano, Teruo; Kitamura, Soichiro; Mori, Hidezo

    2006-04-01

    Mesenchymal stem cells are multipotent cells that can differentiate into cardiomyocytes and vascular endothelial cells. Here we show, using cell sheet technology, that monolayered mesenchymal stem cells have multipotent and self-propagating properties after transplantation into infarcted rat hearts. We cultured adipose tissue-derived mesenchymal stem cells characterized by flow cytometry using temperature-responsive culture dishes. Four weeks after coronary ligation, we transplanted the monolayered mesenchymal stem cells onto the scarred myocardium. After transplantation, the engrafted sheet gradually grew to form a thick stratum that included newly formed vessels, undifferentiated cells and few cardiomyocytes. The mesenchymal stem cell sheet also acted through paracrine pathways to trigger angiogenesis. Unlike a fibroblast cell sheet, the monolayered mesenchymal stem cells reversed wall thinning in the scar area and improved cardiac function in rats with myocardial infarction. Thus, transplantation of monolayered mesenchymal stem cells may be a new therapeutic strategy for cardiac tissue regeneration. PMID:16582917

  4. Left ventricular volume during supine exercise: importance of myocardial scar in patients with coronary heart disease

    SciTech Connect

    Mann, D.L.; Scharf, J.; Ahnve, S.; Gilpin, E.

    1987-01-01

    Existing studies suggest that exercise-induced ischemia produces an increase in left ventricular end-diastolic volume; however, all of these studies have included patients with previous myocardial infarction. To test whether the end-diastolic volume response to exercise is related to the extent of myocardial scar, the results of gated radionuclide supine exercise tests performed on 130 subjects were reviewed. The patient group comprised 130 subjects were reviewed. The patient group comprised 130 men aged 35 to 65 years (mean +/- SD 52 +/- 5) with documented coronary heart disease. The extent of myocardial ischemia and scar formation was assessed by stress electrocardiography and thallium-201 scintigraphy. Patients were classified into three groups on the basis of left ventricular end-diastolic volume response at peak exercise: group 1 (n = 72) had an increase of end-diastolic volume greater than 10%, group 2 (n = 41) had a change in end-diastolic volume less than 10% and group 3 (n = 17) had a decrease in end-diastolic volume greater than 10% (n = 17). At rest there was no significant difference among groups in heart rate, systolic blood pressure, end-diastolic (EDVrest) or end-systolic volumes or ejection fraction (p greater than 0.05); however, at peak exercise the end-systolic volume response was significantly greater for group 1 (p less than 0.002).

  5. Vectorcardiographic identification of myocardial scar: a discriminative study with automatically processed vectorcardiographic information.

    PubMed

    Bizarro, R O; O'Brien, P C; Titus, J L; Smith, R E

    1978-07-01

    A multivariate discriminative procedure for the vectorcardiographic identification of ischemic myocardial scarring was performed utilizing data from 1,162 vectorcardiograms (VCGs) obtained in clinically normal subjects and 90 VCGs obtained from patients proved at autopsy to have ischemic myocardial scars. The VCGs from patients with myocardial scars were divided into two groups, a design group of 50 cases and an evaluation group of 40 cases. The best vectorcardiographic variables to discriminate the clinically normal group from the design group with scars were identified by stepwise linear discrimination. Sixteen vectorcardiographic variables were then used for discriminative analysis. This analysis correctly identified myocardial scars in 45 of the 50 VCGs in the design group (sensitivity 90%); among the 1,162 VCGs from clinically normal subjects, 32 were misidentified as myocardial scar (specificity 97.2). The sensitivity of these defining criteria was then tested in the 40 cases of myocardial scar in the evaluation group and found to be reproducible; 34 of the 40 cases of this group (85.0%) were correctly identified as having a myocardial scar. The multivariate discriminative criteria developed in this study had greater sensitivity and specificity than standard methods usually employed in electrocardiography and vectorcardiography. The criteria defined need to be evaluated in a large series that includes instances of cardiac pathology of nonischemic nature. PMID:357672

  6. Imaging myocardial scar and arrhythmic risk prediction--a role for the electrocardiogram?

    PubMed

    Strauss, David G; Wu, Katherine C

    2009-01-01

    Risk stratification for sudden cardiac death (SCD) has become increasingly important to identify candidates for implantable cardioverter-defibrillators (ICDs). Existing clinical guidelines to identify patients for ICDs focus on reduced left ventricular ejection fraction (LVEF); however, the average annual rate of appropriate ICD shocks is only 5.1% in this select group (LVEF myocardial scar after infarction and in nonischemic cardiomyopathies. Myocardial scar, particularly in the scar border zone, interrupts electrical conduction providing regions that support reentrant ventricular arrhythmias. Recent studies have shown that increased MRI scar in both prior infarction and nonischemic cardiomyopathy patients is associated with arrhythmogenesis, worsening heart failure, and cardiac mortality. This review will focus on the emerging role of MRI to quantify scar and predict arrhythmogenesis in patients with prior infarction and with nonischemic cardiomyopathies-including idiopathic, hypertrophic, Fabry's disease, myocarditis, Chagas' disease, and sarcoidosis. Furthermore, this review will discuss the potential role of the 12-lead electrocardiographic Selvester QRS scoring system to quantify myocardial scar and predict arrhythmogenesis in prior infarct and nonischemic cardiomyopathy patients. PMID:19185315

  7. Relation of brain natriuretic peptide level to extent of left ventricular scarring in patients with chronic heart failure secondary to ischemic cardiomyopathy.

    PubMed

    Aktas, Mehmet Kemal; Allen, Drew; Jaber, Wael A; Chuang, Hsuan-Hung; Taylor, David O; Yamani, Mohamad H

    2009-01-15

    Multiple factors influence brain natriuretic peptide (BNP) release in patients with heart failure. We hypothesized that extensive myocardial scarring could result in an attenuated BNP response. A total of 115 patients with New York Heart Association class III chronic heart failure and ischemic cardiomyopathy were evaluated for ischemia, hibernation, and myocardial scarring by dipyridamole-rubidium-positron emission tomographic scanning with fluorine-18, 2-fluoro-2-deoxyyglucose. Plasma BNP levels were determined within 2 weeks of the study. Left ventricular dimension and function were evaluated by echocardiography. Patients were categorized as having <33% myocardial scar (n=67) or>or=33% myocardial scar (n=48). BNP measurements were correlated with amount of myocardial scarring. Compared with patients with less scar, those with >or=33% scar had lower BNP levels (mean 317+/-364 vs 635+/-852 pg/ml, median 212 vs 357, p=0.016). Using multiple regression analysis, presence of scarring was associated with decreased BNP response (p=0.022). Further, patients with <33% scar in whom a higher BNP level was noted had more ischemia (51% vs 27%, p=0.01) and greater myocardial hibernation (22+/-14% vs 12+/-7%, p=0.02) compared with patients with >or=33% scar. In conclusion, in patients with chronic heart failure, a decreased BNP response indicated extensive myocardial scarring. PMID:19121444

  8. Computational Representations of Myocardial Infarct Scars and Implications for Arrhythmogenesis

    PubMed Central

    Connolly, Adam J.; Bishop, Martin J.

    2016-01-01

    Image-based computational modeling is becoming an increasingly used clinical tool to provide insight into the mechanisms of reentrant arrhythmias. In the context of ischemic heart disease, faithful representation of the electrophysiological properties of the infarct region within models is essential, due to the scars known for arrhythmic properties. Here, we review the different computational representations of the infarcted region, summarizing the experimental measurements upon which they are based. We then focus on the two most common representations of the scar core (complete insulator or electrically passive tissue) and perform simulations of electrical propagation around idealized infarct geometries. Our simulations highlight significant differences in action potential duration and focal effective refractory period (ERP) around the scar, driven by differences in electrotonic loading, depending on the choice of scar representation. Finally, a novel mechanism for arrhythmia induction, following a focal ectopic beat, is demonstrated, which relies on localized gradients in ERP directly caused by the electrotonic sink effects of the neighboring passive scar. PMID:27486348

  9. Platelet microparticle number is associated with the extent of myocardial damage in acute myocardial infarction

    PubMed Central

    Puspitawati, Ira; Gharini, Putrika Prastuti Ratna; Setianto, Budi Yuli

    2016-01-01

    Introduction Activated platelets generate microparticles. Increased platelet microparticles occur in acute myocardial infarction (AMI) and contribute to intracoronary thrombosis and subsequent myocardial injury. This study aimed to investigate the impact of platelet microparticles on intracoronary thrombosis by assessing the relationship between platelet microparticles and the extent of myocardial damage in AMI. Material and methods This was a cross sectional study. The subjects were patients with acute coronary syndrome (ACS). Forty-one consecutive subjects with ACS admitted to intensive cardiovascular care unit were enrolled. The clinical spectrum of ACS comprised AMI (n = 26), both ST-elevation AMI (STEMI) and non-ST-elevation AMI (NSTEMI), and unstable angina (n = 15). Platelet microparticles were isolated from peripheral venous blood and detected with anti-CD42b-PE by the flow cytometry method. The extent of myocardial damage was determined by measuring the peak level of serial cardiac enzymes within 24 h of admission. Results Subjects with AMI had a significantly higher number of platelet microparticles than those with unstable angina (4855 ±4509/µl vs. 2181 ±1923/µl respectively; p = 0.036). Subjects with STEMI had the highest number of platelet microparticles, but no significant difference was detected as compared to those with NSTEMI (5775 ±5680/µl vs. 3601 ±1632/µl). The number of platelet microparticles in AMI was positively associated with the extent of myocardial damage (peak CK-MB: r = 0.408, p = 0.019 and peak GOT: r = 0.384, p = 0.026). Conclusions The number of platelet microparticles was increased in AMI as compared to unstable angina and associated with the extent of myocardial damage. PMID:27279844

  10. Coupled agent-based and finite-element models for predicting scar structure following myocardial infarction.

    PubMed

    Rouillard, Andrew D; Holmes, Jeffrey W

    2014-08-01

    Following myocardial infarction, damaged muscle is gradually replaced by collagenous scar tissue. The structural and mechanical properties of the scar are critical determinants of heart function, as well as the risk of serious post-infarction complications such as infarct rupture, infarct expansion, and progression to dilated heart failure. A number of therapeutic approaches currently under development aim to alter infarct mechanics in order to reduce complications, such as implantation of mechanical restraint devices, polymer injection, and peri-infarct pacing. Because mechanical stimuli regulate scar remodeling, the long-term consequences of therapies that alter infarct mechanics must be carefully considered. Computational models have the potential to greatly improve our ability to understand and predict how such therapies alter heart structure, mechanics, and function over time. Toward this end, we developed a straightforward method for coupling an agent-based model of scar formation to a finite-element model of tissue mechanics, creating a multi-scale model that captures the dynamic interplay between mechanical loading, scar deformation, and scar material properties. The agent-based component of the coupled model predicts how fibroblasts integrate local chemical, structural, and mechanical cues as they deposit and remodel collagen, while the finite-element component predicts local mechanics at any time point given the current collagen fiber structure and applied loads. We used the coupled model to explore the balance between increasing stiffness due to collagen deposition and increasing wall stress due to infarct thinning and left ventricular dilation during the normal time course of healing in myocardial infarcts, as well as the negative feedback between strain anisotropy and the structural anisotropy it promotes in healing scar. The coupled model reproduced the observed evolution of both collagen fiber structure and regional deformation following coronary

  11. Assessment of Myocardial Scar; Comparison Between 18F-FDG PET, CMR and 99Tc-Sestamibi

    PubMed Central

    Crean, Andrew; Khan, Sadia N.; Davies, L. Ceri; Coulden, Richard; Dutka, David P.

    2009-01-01

    Objective: Patients with heart failure and ischaemic heart disease may obtain benefit from revascularisation if viable dysfunctional myocardium is present. Such patients have an increased operative risk, so it is important to ensure that viability is correctly identified. In this study, we have compared the utility of 3 imaging modalities to detect myocardial scar. Design: Prospective, descriptive study. Setting: Tertiary cardiac centre. Patients: 35 patients (29 male, average age 70 years) with coronary artery disease and symptoms of heart failure (>NYHA class II). Intervention: Assessment of myocardial scar by 99Tc-Sestamibi (MIBI), 18F-flurodeoxyglucose (FDG) and cardiac magnetic resonance (CMR). Outcome Measure: The presence or absence of scar using a 20-segment model. Results: More segments were identified as nonviable scar using MIBI than with FDG or CMR. FDG identified the least number of scar segments per patient (7.4 +/− 4.8 with MIBI vs. 4.9 +/− 4.2 with FDG vs. 5.8 +/− 5.0 with CMR, p = 0.0001 by ANOVA). The strongest agreement between modalities was in the anterior wall with the weakest agreement in the inferior wall. Overall, the agreement between modalities was moderate to good. Conclusion: There is considerable variation amongst these 3 techniques in identifying scarred myocardium in patients with coronary disease and heart failure. MIBI and CMR identify more scar than FDG. We recommend that MIBI is not used as the sole imaging modality in patients undergoing assessment of myocardial viability. PMID:20508767

  12. Paced QRS duration and myocardial scar amount: predictors of long-term outcome of right ventricular apical pacing.

    PubMed

    Lee, Seung-Ah; Cha, Myung-Jin; Cho, Youngjin; Oh, Il-Young; Choi, Eue-Keun; Oh, Seil

    2016-07-01

    Long-term right ventricular apical pacing (RVAP) is reportedly associated with heart failure (HF) development. However, the predictors of pacing-induced HF (PHF) remained unclear. We retrospectively enrolled 234 patients without structural heart disease who underwent a permanent pacemaker implantation with RVAP between 1982 and 2004. RVAP-induced HF was defined as left ventricular ejection fraction decrease >5 % with HF symptom without other HF development etiology. The QRS duration of a paced beat (pQRSd) and myocardial scar score were analyzed from each patient's 12-lead ECG. During a mean 15.6 years (range 3.3-30.0 years), 48 patients (20.5 %) patients developed RVAP-induced HF. The PHF group patients had a longer pQRSd (192.4 ± 13.5 vs. 175.7 ± 14.7 ms in non-PHF patients, p < 0.001) and a higher myocardial scar score (5.2 ± 1.9 vs. 2.7 ± 1.9, respectively p < 0.001). In multivariate Cox regression analysis, old age at implantation [Hazard ratio (HR) 1.62, 95 % confidential interval (CI) 1.22-2.16, p = 0.001], a longer pQRSd (HR 1.54, 95 % CI 1.15-2.05, p = 0.003), a higher myocardial scar score (HR 1.23, 95 % CI 1.03-1.49, p = 0.037), and a higher percentage of ventricular pacing (HR 1.31, 95 % CI 1.01-1.49, p = 0.010) were independent predictors of PHF. Based on the results of the receiver-operating characteristic (ROC) curve, the pQRSd cutoff was 185 ms (AUC 0.79, sensitivity 66.7 %, specificity 76.3 %) and myocardial scar score cutoff value was 4 (AUC 0.81, sensitivity 81.3 %, specificity 66.1 %). The pQRSd was positively correlated with scar score (r = 0.70, p < 0.001). pQRSd ≥185 ms and/or myocardial scar score ≥4 might be independent long-term prognostic markers of PHF. PMID:26142378

  13. Three‐dimensional myocardial scarring along myofibers after coronary ischemia–reperfusion revealed by computerized images of histological assays

    PubMed Central

    Katz, Monica Y.; Kusakari, Yoichiro; Aoyagi, Hiroko; Higa, Jason K.; Xiao, Chun‐Yang; Abdelkarim, Ahmed Z.; Marh, Karra; Aoyagi, Toshinori; Rosenzweig, Anthony; Lozanoff, Scott; Matsui, Takashi

    2014-01-01

    Abstract Adverse left ventricular (LV) remodeling after acute myocardial infarction is characterized by LV dilatation and development of a fibrotic scar, and is a critical factor for the prognosis of subsequent development of heart failure. Although myofiber organization is recognized as being important for preserving physiological cardiac function and structure, the anatomical features of injured myofibers during LV remodeling have not been fully defined. In a mouse model of ischemia–reperfusion (I/R) injury induced by left anterior descending coronary artery ligation, our previous histological assays demonstrated that broad fibrotic scarring extended from the initial infarct zone to the remote zone, and was clearly demarcated along midcircumferential myofibers. Additionally, no fibrosis was observed in longitudinal myofibers in the subendocardium and subepicardium. However, a histological analysis of tissue sections does not adequately indicate myofiber injury distribution throughout the entire heart. To address this, we investigated patterns of scar formation along myofibers using three‐dimensional (3D) images obtained from multiple tissue sections from mouse hearts subjected to I/R injury. The fibrotic scar area observed in the 3D images was consistent with the distribution of the midcircumferential myofibers. At the apex, the scar formation tracked along the myofibers in an incomplete C‐shaped ring that converged to a triangular shape toward the end. Our findings suggest that myocyte injury after transient coronary ligation extends along myofibers, rather than following the path of coronary arteries penetrating the myocardium. The injury pattern observed along myofibers after I/R injury could be used to predict prognoses for patients with myocardial infarction. PMID:25347856

  14. Scar revision

    PubMed Central

    Sharma, Mohit; Wakure, Abhijeet

    2013-01-01

    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. PMID:24516292

  15. Bortezomib-Induced Complete Heart Block and Myocardial Scar: The Potential Role of Cardiac Biomarkers in Monitoring Cardiotoxicity

    PubMed Central

    Diwadkar, Sachin; Patel, Aarti A.; Fradley, Michael G.

    2016-01-01

    Bortezomib is a proteasome inhibitor used to treat multiple myeloma and mantle cell lymphoma. Traditionally, bortezomib was thought to have little cardiovascular toxicity; however, there is increasing evidence that bortezomib can lead to cardiac complications including left ventricular dysfunction and atrioventricular block. We present the case of a 66-year-old man with multiple myeloma and persistent asymptomatic elevations of cardiac biomarkers who developed complete heart block and evidence of myocardial scar after his eighth cycle of bortezomib, requiring permanent pacemaker placement. In addition to discussing the cardiovascular complications of bortezomib therapy, we propose a potential role for biomarkers in the prediction and monitoring of bortezomib cardiotoxicity. PMID:26942019

  16. Expression of phospholipase D isozymes in scar and viable tissue in congestive heart failure due to myocardial infarction.

    PubMed

    Dent, Melissa R; Singal, Tushi; Dhalla, Naranjan S; Tappia, Paramjit S

    2004-01-01

    The phospholipase D (PLD) associated with the cardiac sarcolemmal (SL) membrane hydrolyses phosphatidylcholine to produce phosphatidic acid, an important phospholipid signaling molecule known to influence cardiac function. The present study was undertaken to examine PLD isozyme mRNA expression, protein contents and activities in congestive heart failure (CHF) subsequent to myocardial infarction (MI). MI was induced in rats by occlusion of the left anterior descending coronary artery. At 8 weeks after the surgical procedure, hemodynamic assessment revealed that these experimental rats were at a moderate stage of CHF. Semi-quantitative reverse transcriptase-polymerase chain reaction revealed that PLD1 and PLD2 mRNA amounts were unchanged in viable left ventricular (LV) tissue of the failing heart. Furthermore, this technique demonstrated the presence of PLD1 and PLD2 mRNA in the scar tissue. While SL PLD1 and PLD2 protein contents were elevated in the viable LV tissue of the failing heart, SL PLD1 activity was significantly decreased, whereas SL PLD2 activity was significantly increased. On the other hand, although PLD1 protein was undetectable, PLD2 protein and activity were detected in the scar tissue. Our findings suggest that differential changes in PLD isozymes may contribute to the pathophysiology of CHF and may also be involved in the processes of scar remodeling. PMID:15601581

  17. Intramyocardial injections of human mesenchymal stem cells following acute myocardial infarction modulate scar formation and improve left ventricular function.

    PubMed

    Otto Beitnes, Jan; Oie, Erik; Shahdadfar, Aboulghassem; Karlsen, Tommy; Müller, Regine M B; Aakhus, Svend; Reinholt, Finn P; Brinchmann, Jan E

    2012-01-01

    Cell therapy is a promising treatment modality to improve heart function in acute myocardial infarction. However, the mechanisms of action and the most suitable cell type have not been finally determined. We performed a study to compare the effects of mesenchymal stem cells (MSCs) harvested from different tissues on LV function and explore their effects on tissue structure by morphometry and histological staining for species and lineage relationship. MSCs from skeletal muscle (SM-MSCs) and adipose tissue (ADSCs) were injected in the myocardium of nude rats 1 week after myocardial infarction. After 4 weeks of observation, LVEF was significantly improved in the SM-MSCs group (39.1%) and in the ADSC group (39.6%), compared to the placebo group (31.0%, p < 0.001 for difference in change between groups). Infarct size was smaller after cell therapy (16.3% for SM-MSCs, 15.8% for ADSCs vs. 26.0% for placebo, p < 0.001), and the amount of highly vascularized granulation tissue in the border zone was significantly increased in both groups receiving MSCs (18.3% for SM-MSCs, 22.6% for ADSCs vs. 13.1% for placebo, p = 0.001). By in situ hybridization, moderate engraftment of transplanted cells was found, but no transdifferentiation to cardiomyocytes, endothelial cells, or smooth muscle cells was observed. We conclude that MSC injections lead to improved LVEF after AMI in rats predominantly by reduction of infarct size. After 4 weeks, we observed modulation of scar formation with significant increase in granulation tissue. Transdifferentiation of MSCs to cardiomyocytes or vascular cells did not contribute significantly in this process. MSCs from skeletal muscle and adipose tissue had similar effects. PMID:22410280

  18. CMR Quantification of Myocardial Scar Provides Additive Prognostic Information in Nonischemic Cardiomyopathy

    PubMed Central

    Neilan, Tomas G.; Coelho-Filho, Otavio R.; Danik, Stephan B.; Shah, Ravi V.; Dodson, John A.; Verdini, Daniel J.; Tokuda, Michifumi; Daly, Caroline A.; Tedrow, Usha B.; Stevenson, William G.; Jerosch-Herold, Michael; Ghoshhajra, Brian B.; Kwong, Raymond Y.

    2014-01-01

    OBJECTIVES This study sought to determine whether the extent of late gadolinium enhancement (LGE) can provide additive prognostic information in patients with a nonischemic dilated cardiomyopathy (NIDC) with an indication for implantable cardioverter-defibrillator (ICD) therapy for the primary prevention of sudden cardiac death (SCD). BACKGROUND Data suggest that the presence of LGE is a strong discriminator of events in patients with NIDC. Limited data exist on the role of LGE quantification. METHODS The extent of LGE and clinical follow-up were assessed in 162 patients with NIDC prior to ICD insertion for primary prevention of SCD. LGE extent was quantified using both the standard deviation–based (2-SD) method and the full-width half-maximum (FWHM) method. RESULTS We studied 162 patients with NIDC (65% male; mean age: 55 years; left ventricular ejection fraction [LVEF]: 26 ± 8%) and followed up for major adverse cardiac events (MACE), including cardiovascular death and appropriate ICD therapy, for a mean of 29 ± 18 months. Annual MACE rates were substantially higher in patients with LGE (24%) than in those without LGE (2%). By univariate association, the presence and the extent of LGE demonstrated the strongest associations with MACE (LGE presence, hazard ratio [HR]: 14.5 [95% confidence interval (CI): 6.1 to 32.6; p < 0.001]; LGE extent, HR: 1.15 per 1% increase in volume of LGE [95% CI: 1.12 to 1.18; p < 0.0001]). Multivariate analyses showed that LGE extent was the strongest predictor in the best overall model for MACE, and a 7-fold hazard was observed per 10% LGE extent after adjustments for patient age, sex, and LVEF (adjusted HR: 7.61; p < 0.0001). LGE quantitation by 2-SD and FWHM both demonstrated robust prognostic association, with the highest MACE rate observed in patients with LGE involving >6.1% of LV myocardium. CONCLUSIONS LGE extent may provide further risk stratification in patients with NIDC with a current indication for ICD implantation for

  19. Extent and severity of myocardial hypoperfusion as predictors of prognosis in patients with suspected coronary artery disease

    SciTech Connect

    Ladenheim, M.L.; Pollock, B.H.; Rozanski, A.; Berman, D.S.; Staniloff, H.M.; Forrester, J.S.; Diamond, G.A.

    1986-03-01

    The ability of exercise-induced myocardial hypoperfusion on thallium scintigraphy to predict coronary events was assessed in 1,689 patients with symptoms suggestive of coronary artery disease but without prior myocardial infarction or coronary artery bypass surgery. A total of 74 patients had a coronary event in the year after testing (12 cardiac deaths, 20 nonfatal infarctions and 42 referrals for bypass surgery more than 60 days after testing). Stepwise logistic regression identified only three independent predictors: the number of myocardial regions with reversible hypoperfusion (an index of the extent of hypoperfusion), the maximal magnitude of hypoperfusion (an index of the severity of hypoperfusion) and the achieved heart rate (an index of exercise performance). Both extent and severity were exponentially correlated with event rate (r greater than 0.97 and p less than 0.01 for each), whereas achieved heart rate was linearly correlated with event rate (r = 0.79 and p less than 0.05). On the basis of these data, a prognostic model was defined that employs extent and severity as stress-dependent orthogonal variables. Using this model, the predicted coronary event rate ranged over two orders of magnitude--from a low of 0.4% in patients able to exercise adequately without developing severe and extensive hypoperfusion at a low heart rate (less than 85% of their maximal predicted heart rate). Extent and severity of myocardial hypoperfusion, therefore, are important independent variables of prognosis in patients with suspected coronary artery disease.

  20. Extent of utilization of the Frank-Starling mechanism in conscious dogs. [preload effects on myocardial regulation

    NASA Technical Reports Server (NTRS)

    Boettcher, D. H.; Vatner, S. F.; Heyndrickx, G. R.; Braunwald, E.

    1978-01-01

    The left ventricular end-diastolic pressure-dimension relationships in conscious dogs were studied; the ventricle was stressed to its limit in terms of myocardial preload in order to assess the extent of use of the Frank-Starling mechanism under these conditions. The preload was increased through volume loading with saline infusions, the provocation of global myocardial ischemia by constriction of the left main coronary artery, and infusion of methoxamine. While left ventricular end-diastolic pressure increased substantially in the reclining conscious animals, the left ventricular end-diastolic diameter did not increase, suggesting a minimum role for the Frank-Starling mechanism in this case.

  1. Association Between Extent of Thiazolidinedione Exposure and Risk of Acute Myocardial Infarction

    PubMed Central

    Dore, David D.; Trivedi, Amal N.; Mor, Vincent; Lapane, Kate L.

    2016-01-01

    Study Objectives To determine if an association exists between thiazolidinedione (rosiglitazone or pioglitazone) exposure and acute myocardial infarction, and if the timing of drug initiation relative to the onset of myocardial infarction affected the frequency of the event. Design Nested, case-control study. Data Source Health care claims from California, Florida, New York, Ohio, and Illinois from the Medicaid Analytic Extract database for calendar years 2001–2002. Patients Of patients who received metformin plus a sulfonylurea during a defined eligibility period, we identified 2316 cases who had a primary discharge diagnosis of acute myocardial infarction and 9700 controls, who were defined by means of risk-set sampling. Measurements and Main Results We reviewed demographic and clinical characteristics of the cases and controls, and documented initiation of thiazolidinedione therapy. We noted the time of therapy initiation within 180 days of the index date (date of acute myocardial infarction for cases, same date for matched controls) and assessed any association between the start of thiazolidinedione therapy and acute myocardial infarction, relative to use of metformin plus a sulfonylurea. We performed secondary analyses using various time intervals between start of thiazolidinedione and onset of event (0–90 and 91–180 days before the index date). Applying conditional logistic regression, we obtained adjusted odds ratios (AORs) and 95% confidence intervals (CIs). After adjustment for confounding, starting rosiglitazone (AOR 1.00, 95% CI 0.72–1.39) or pioglitazone (AOR 1.04, 95% CI 0.74–1.45) therapy in the 180 days before the index date was not associated with acute myocardial infarction. Point estimates for rosiglitazone (AOR 1.29, 95% CI 0.85–1.94) and, less so, pioglitazone (AOR 1.15, 95% CI 0.73–1.81) in the 90 days before the index date suggested a small increase in the rate of acute myocardial infarction shortly after the start of these drugs

  2. Interactive visualization for scar transmurality in cardiac resynchronization therapy

    NASA Astrophysics Data System (ADS)

    Reiml, Sabrina; Toth, Daniel; Panayiotou, Maria; Fahn, Bernhard; Karim, Rashed; Behar, Jonathan M.; Rinaldi, Christopher A.; Razavi, Reza; Rhode, Kawal S.; Brost, Alexander; Mountney, Peter

    2016-03-01

    Heart failure is a serious disease affecting about 23 million people worldwide. Cardiac resynchronization therapy is used to treat patients suffering from symptomatic heart failure. However, 30% to 50% of patients have limited clinical benefit. One of the main causes is suboptimal placement of the left ventricular lead. Pacing in areas of myocardial scar correlates with poor clinical outcomes. Therefore precise knowledge of the individual patient's scar characteristics is critical for delivering tailored treatments capable of improving response rates. Current research methods for scar assessment either map information to an alternative non-anatomical coordinate system or they use the image coordinate system but lose critical information about scar extent and scar distribution. This paper proposes two interactive methods for visualizing relevant scar information. A 2-D slice based approach with a scar mask overlaid on a 16 segment heart model and a 3-D layered mesh visualization which allows physicians to scroll through layers of scar from endocardium to epicardium. These complementary methods enable physicians to evaluate scar location and transmurality during planning and guidance. Six physicians evaluated the proposed system by identifying target regions for lead placement. With the proposed method more target regions could be identified.

  3. Acne Scars

    MedlinePlus

    ... scars. Cryosurgery : This treatment freezes the scar tissue. Freezing the tissue causes it to die and gradually ... et al . “Which Type of Atrophic Acne Scar (Ice-pick, Boxcar, or Rolling) Responds to Nonablative Fractional ...

  4. Radial dyssynchrony assessed by cardiovascular magnetic resonance in relation to left ventricular function, myocardial scarring and QRS duration in patients with heart failure

    PubMed Central

    2009-01-01

    Background Intuitively, cardiac dyssynchrony is the inevitable result of myocardial injury. We hypothezised that radial dyssynchrony reflects left ventricular remodeling, myocardial scarring, QRS duration and impaired LV function and that, accordingly, it is detectable in all patients with heart failure. Methods 225 patients with heart failure, grouped according to QRS duration of <120 ms (A, n = 75), between 120-149 ms (B, n = 75) or ≥150 ms (C, n = 75), and 50 healthy controls underwent assessment of radial dyssynchrony using the cardiovascular magnetic resonance tissue synchronization index (CMR-TSI = SD of time to peak inward endocardial motion in up to 60 myocardial segments). Results Compared to 50 healthy controls (21.8 ± 6.3 ms [mean ± SD]), CMR-TSI was higher in A (74.8 ± 34.6 ms), B (92.4 ± 39.5 ms) and C (104.6 ± 45.6 ms) (all p < 0.0001). Adopting a cut-off CMR-TSI of 34.4 ms (21.8 plus 2xSD for controls) for the definition of dyssynchrony, it was present in 91% in A, 95% in B and 99% in C. Amongst patients in NYHA class III or IV, with a LVEF<35% and a QRS>120 ms, 99% had dyssynchrony. Amongst those with a QRS<120 ms, 91% had dyssynchrony. Across the study sample, CMR-TSI was related positively to left ventricular volumes (p < 0.0001) and inversely to LVEF (CMR-TSI = 178.3 e (-0.033 LVEF) ms, p < 0.0001). Conclusion Radial dyssynchrony is almost universal in patients with heart failure. This vies against the notion that a lack of response to CRT is related to a lack of dyssynchrony. PMID:19930713

  5. Correlations among copeptin, ischemia-modified albumin, and the extent of myocardial injury in patients with acute carbon monoxide poisoning.

    PubMed

    Li, J; Wang, J S; Xie, Z X; Wang, W Z; Wang, L; Ma, G Y; Li, Y Q; Wang, P

    2015-01-01

    This study evaluated the relationships among copeptin, ischemia-modified albumin (IMA), and extent of myocardial injury in patients with acute carbon monoxide poisoning (ACOP). A total of 110 patients with different degrees of ACOP were selected as the poisoning group, and 30 healthy individuals as the control group. The levels of troponin I (cTnI), IMA, and copeptin were detected. Based on the presence of complications, the patients were assigned to the complication (26 patients) or non-complication (84 patients) group. Levels of cTnI, IMA, and copeptin were compared among the control, complication, and non-complication groups. Compared with the control group, in the 2 h after admission, the IMA levels decreased and copeptin levels increased in the poisoning group; these changes were more significant in patients with severe ACOP than in those with mild ACOP, and the difference was statistically significant (P < 0.05). There were no differences in the IMA and copeptin levels between the groups 7 days after admission; the cTnI levels increased more significantly in patients with severe ACOP than in patients with mild and moderate ACOP, and the differences were statistically significant (P < 0.05). In the complication group, at 7 days after admission, the IMA levels decreased whereas the copeptin and cTnI levels were significantly higher than in the non-complication group, with a statistically significant difference (P < 0.05). IMA was negatively correlated with copeptin. IMA and copeptin detection is clinically useful in the early diagnosis and prognosis of ACOP-related myocardial injury and in guiding early clinical drug application. PMID:26345979

  6. Myocardial Scar Imaging by Standard Single-Energy and Dual-Energy Late Enhancement Computed Tomography: Comparison to Pathology and Electroanatomical Map in an Experimental Chronic Infarct Porcine Model

    PubMed Central

    Truong, Quynh A.; Thai, Wai-ee; Wai, Bryan; Cordaro, Kevin; Cheng, Teresa; Beaudoin, Jonathan; Xiong, Guanglei; Cheung, Jim W.; Altman, Robert; Min, James K.; Singh, Jagmeet P.; Barrett, Conor D.; Danik, Stephan

    2015-01-01

    Background Myocardial scar is a substrate for ventricular tachycardia and sudden cardiac death. Late enhancement computed tomography (CT) imaging can detect scar, but it remains unclear whether newer late enhancement dual-energy (LE-DECT) acquisition has benefit over standard single-energy late enhancement (LE-CT). Objective We aim to compare late enhancement CT using newer LE-DECT acquisition and single-energy LE-CT acquisitions to pathology and electroanatomical map (EAM) in an experimental chronic myocardial infarction (MI) porcine study. Methods In 8 chronic MI pigs (59±5 kg), we performed dual-source CT, EAM, and pathology. For CT imaging, we performed 3 acquisitions at 10 minutes post-contrast: LE-CT 80 kV, LE-CT 100 kV, and LE-DECT with two post-processing software settings. Results Of the sequences, LE-CT 100 kV provided the best contrast-to-noise ratio (all p≤0.03) and correlation to pathology for scar (ρ=0.88). While LE-DECT overestimated scar (both p=0.02), LE-CT images did not (both p=0.08). On a segment basis (n=136), all CT sequences had high specificity (87–93%) and modest sensitivity (50–67%), with LE-CT 100 kV having the highest specificity of 93% for scar detection compared to pathology and agreement with EAM (κ 0.69). Conclusions Standard single-energy LE-CT, particularly 100kV, matched better to pathology and EAM than dual-energy LE-DECT for scar detection. Larger human trials as well as more technical-based studies that optimize varying different energies with newer hardware and software are warranted. PMID:25977115

  7. Scarring alopecia.

    PubMed

    Newton, R C; Hebert, A A; Freese, T W; Solomon, A R

    1987-07-01

    The scarring alopecias are a diverse group of diseases characterized by the combination of follicular destruction and dermal scarring. In this article we divide scarring alopecias into three broad categories, pediatric diseases, perifollicular lymphocytic diseases, and folliculopustular diseases, and discuss selected entities from each category. PMID:3301117

  8. Diagnosis of acute myocardial infarction by indium-111 antimyosin antibodies and correlation with the traditional techniques for the evaluation of extent and localization

    SciTech Connect

    Volpini, M.; Giubbini, R.; Gei, P.; Cuccia, C.; Franzoni, P.; Riva, S.; Terzi, A.; Metra, M.; Bestagno, M.; Visioli, O.

    1989-01-01

    This clinical study evaluated the accuracy of planar myocardial scintigraphy with antimyosin monoclonal antibodies radiolabeled with indium-111 (AMA-Fab) in the detection and localization of acute myocardial infarction (AMI). Fifty-seven patients admitted for suspected AMI were studied; 17 patients underwent thrombolytic therapy with intravenous streptokinase and 11 had clinical signs of reperfusion; 9 had had a previous myocardial infarction. Fifty of 57 patients were discharged from the coronary care unit with a confirmed diagnosis of AMI. The AMA-Fab study results were positive for AMI in 49 patients (98%) and negative in 1 (2%). Among the 7 patients without AMI, 5 had unstable angina, 1 had Prinzmetal's variant angina and 1 had acute pancreatitis. AMA-Fab results were negative in 6 of 7 patients (85%) and positive in 1 (15%). Therefore, the sensitivity and specificity of AMA-Fab scintigraphy were 0.98 and 0.85, respectively. To assess accuracy in defining the extent and location of AMI, AMA-Fab results were compared with those of the electrocardiogram, echocardiogram, technetium-99m pyrophosphate myocardial scintigraphy and coronary angiography and left ventriculography. AMA-Fab scintigraphy showed a good concordance with the traditional techniques in the topographic definition of the infarcted regions. No uptake of AMA-Fab was seen in the regions of previous old infarcts. Ten healthy volunteers also underwent AMA-Fab scintigraphy. No evidence of myocardial tracer uptake was noted in them. No adverse reactions or side effects were noted after injection of AMA-Fab in any patient. It is concluded that planar myocardial scintigraphy with AMA-Fab is a reliable method for AMI detection and location.

  9. Relationship of ventricular arrhythmias to the angiographically and scintigraphically estimated extent of ventricular damage late after myocardial infarction

    SciTech Connect

    Huikuri, H.V.; Korhonen, U.R.; Linnaluoto, M.K.; Takkunen, J.T.

    1987-03-01

    In order to study the quantitative relationship of ventricular arrhythmias to myocardial damage and ischemia, 61 patients with a previous myocardial infarction (at least 6 months previously) were studied by 24-hour ambulatory ECG monitoring, cardiac catheterization, and thallium-201 scintigraphy. Thirty-five patients (57%) had no ectopic beats or only infrequent, unifocal ones and 26 patients (43%) had complex ventricular arrhythmias. Left ventricular function was lower in the latter, but the number of diseased vessels did not differ in the two groups. The reduction of thallium activity in the infarct area was more marked in patients with complex arrhythmias. Multiple thallium defects were not more common in arrhythmia patients, however. These data support the view that complex ventricular arrhythmias are more closely related to the severity of ventricular damage than the presence of myocardial ischemia remote to the area of previous infarction.

  10. Scar Tissue.

    PubMed

    McLean, Haydn J

    2015-12-01

    Scar tissue is associated with physical wounds and their mending, but it is also descriptive in portraying the emotional scarring that occurs following adversity, resulting in potential psychological morbidity. Provided the adversity is not severe, such challenges to adaptability may provoke Andrew Solomon's process of forging meaning and building identity. Perceiving an emotional constitution as analogous to the immune system provides a metaphor for appreciating the benefits of emotional challenges, which may provoke greater emotional resilience or posttraumatic growth. PMID:26631526

  11. [Comparison of vectorcardiography and echocardiography in the evaluation of the site and extent of necrosis in myocardial infarction without Q wave].

    PubMed

    Palmieri, M; Gotti, G; Zilio, G; Chiozza, R; Moratti, P; Della Mea, M T; Magris, R

    1990-04-01

    In order to improve the evaluation of the site and extent of the necrosis in acute myocardial infarction without Q wave (IMNQ), we used a multiparametric method taking into account the enzymatic values of the total CK, a score derived from Frank's VCG and a kinetic score of the VG segments estimated by echo-2D. The literature data have shown, according to the clinical and anatomical correlations, the frequency of the transmural lesions in the IMNQ cases and, on the contrary, of the lesions limited to the endocardial region and partially transmural in infarctions with new pathological Q waves. The heterogeneousness of the anatomo-pathological data can be explained by the mechanisms of the ischaemia, the site of the coronary occlusion, the presence or not of a spasm, the compensation by the collateral flux and eventually the effects of a treatment by fibrinolytic drugs. PMID:2369055

  12. Scar Wars: Preferences in Breast Surgery

    PubMed Central

    Murphy, Siun; Murphy, Stephen; Kelly, Jack L; Morrison, Colin M

    2015-01-01

    Background The uptake of breast reconstruction is ever increasing with procedures ranging from implant-based reconstructions to complex free tissue transfer. Little emphasis is placed on scarring when counseling patients yet they remain a significant source of morbidity and litigation. The aim of this study was to examine the scarring preferences of men and women in breast oncoplastic and reconstructive surgery. Methods Five hundred men and women were asked to fill out a four-page questionnaire in two large Irish centres. They were asked about their opinions on scarring post breast surgery and were also asked to rank the common scarring patterns in wide local excisions, oncoplastic procedures, breast reconstructions as well as donor sites. Results Fifty-eight percent of those surveyed did not feel scars were important post breast cancer surgery. 61% said that their partners' opinion of scars were important. The most preferred wide local excision scar was the lower lateral quadrant scar whilst the scars from the deep inferior epigastric artery perforator (DIEP) flap were most favoured. The superior gluteal artery perforator flap had the most preferred donor site while surprisingly, the DIEP had the least favourite donor site. Conclusions Scars are often overlooked when planning breast surgery yet the extent and position of the scar needs to be outlined to patients and it should play an important role in selecting a breast reconstruction option. This study highlights the need for further evaluation of patients' opinions regarding scar patterns. PMID:26430631

  13. Extent of Coronary and Myocardial Disease and Benefit from Surgical Revascularization in Patients with Ischemic Left Ventricular Dysfunction

    PubMed Central

    Panza, Julio A.; Velazquez, Eric J.; She, Lilin; Smith, Peter K.; Nicolau, José C.; Favaloro, Roberto R.; Gradinac, Sinisa; Chrzanowski, Lukasz; Prabhakaran, Dorairaj; Howlett, Jonathan G.; Jasinski, Marek; Hill, James A.; Szwed, Hanna; Larbalestier, Robert; Desvigne-Nickens, Patrice; Jones, Robert H.; Lee, Kerry L.; Rouleau, Jean L.

    2014-01-01

    Background Patients with ischemic left ventricular dysfunction have higher operative risk with CABG. However, those whose early risk is surpassed by subsequent survival benefit have not been identified. Objective To examine the impact of anatomic variables associated with poor prognosis on the effect of coronary artery bypass graft surgery (CABG) in ischemic cardiomyopathy. Methods All 1,212 patients in the STICH surgical revascularization trial were included. Patients had coronary artery disease (CAD), ejection fraction (EF) ≤35%, and were randomized to CABG plus medical therapy or optimal medical therapy alone (OMT). This study focused on 3 prognostic factors: presence of 3-vessel CAD; EF below the median (27%); and end-systolic volume index (ESVI) above the median (79 ml/m2). Patients were categorized as having 0–1 or 2–3 of these factors. Results Patients with 2–3 prognostic factors (n= 636) had reduced mortality with CABG, as compared to OMT (HR=0.71, 95% CI=0.56–0.89; p=0.004); CABG had no such effect in patients with 0–1 factors (HR=1.08, 95% CI=0.81–1.44; p=0.591). There was a significant interaction between the number of factors and the effect of CABG on mortality (p=0.022). Although 30-day risk with CABG was higher, a net beneficial effect of CABG over OMT was observed at >2years in patients with 2–3 factors (HR=0.53, 95% CI=0.37–0.75; p#x0003C;0.001), but not in those with 0–1 factors (HR=0.88, 95% CI=0.59–1.31; p=0.535). Conclusions Patients with more advanced ischemic cardiomyopathy receive greater benefit from CABG. This supports the indication for surgical revascularization in patients with more extensive CAD and worse myocardial dysfunction and remodeling. (ClinicalTrials.gov number, NCT00023595) PMID:25104523

  14. Facial Scar Revision: Understanding Facial Scar Treatment

    MedlinePlus

    ... Contact Us Trust your face to a facial plastic surgeon Facial Scar Revision Understanding Facial Scar Treatment ... face like the eyes or lips. A facial plastic surgeon has many options for treating and improving ...

  15. Contrast echocardiography in acute myocardial ischemia. III. An in vivo comparison of the extent of abnormal wall motion with the area at risk for necrosis.

    PubMed

    Kaul, S; Pandian, N G; Gillam, L D; Newell, J B; Okada, R D; Weyman, A E

    1986-02-01

    To define the in vivo relation between abnormal wall motion and the area at risk for necrosis after acute coronary occlusion, 11 open chest dogs were studied. Five dogs underwent left anterior descending coronary artery occlusion and six underwent left circumflex artery occlusion. Area at risk was defined at five short-axis levels (mitral valve, chordal, high and low papillary muscle and apex) using myocardial contrast echocardiography. Wall motion was measured in the cycles preceding injection of contrast medium. Two observers used two different methods to measure wall motion. In method A, end-diastolic to end-systolic fractional radial change for each of 32 endocardial targets was determined. The extent of abnormal wall motion was then calculated using three definitions of wall motion abnormality: akinesia/dyskinesia, fractional inward endocardial excursion of less than 10%, and fractional inward endocardial excursion of less than 20%. In method B, the information from the entire systolic contraction sequence was analyzed and correlated with a normal contraction pattern. The best linear correlation between area at risk (AR) and abnormal wall motion (AWM) was achieved using method B and expressed by the following linear regression: AWM = 0.92 AR + 3.0 (r = 0.92, p less than 0.0001, SEE = 1.7%). Of the three definitions of abnormality used in method A, the best correlation was achieved between area at risk and less than 10% inward endocardial excursion and was expressed by the following polynomial regression: AWM = -0.01 AR2 + 1.5 AR -0.14 (r = 0.92, p less than 0.001, SEE = 1.7%). These data demonstrate that there is a definite relation between area at risk and abnormal wall motion but that this relation varies depending on the method used to analyze wall motion. However, wall motion during acute ischemia is also influenced by the loading conditions of the heart. Because these may vary in a manner that is independent of the ischemic process, measurement of both

  16. Ventricular premature beats on Holter monitoring in patients admitted with chest pain, in whom acute myocardial infarction is not confirmed. The prognostic value and relationship to scars or ischemia on thallium-201 scintigraphy

    SciTech Connect

    Madsen, J.K.; Sorensen, J.N.; Kromann-Andersen, B.; Kjeldgaard, K.M.; Christoffersen, K.; van Duijvendijk, K.; Reiber, J.H.

    1987-05-01

    Ambulatory 24-h Holter monitoring was carried out in 198 patients who had been admitted because of suspected acute myocardial infarction (AMI) due to chest pain, but in whom AMI was not confirmed. During a follow-up period of 12-24 months (median 14 months) 16 cardiac events (i.e., nonfatal AMI or cardiac death) occurred. Ventricular premature beats (VPBs) were found in 65.2% of the patients, complex VPBs in 28.8%. Pairs of VPBs which were seen in 10.0% of the patients were the only important type of VPBs significantly related to an impaired prognosis. Thallium-201 scintigraphy was performed in 144 of the patients. VPBs were significantly related to scar formation (i.e., to permanent defects, but not to ischemia, specifically, to transient defects). It is concluded that ventricular arrhythmias in this patient category indicate presence of chronic ischemic heart disease, and that pairs of VPBs seem to identify patients at risk for cardiac events.

  17. Right ventricular dysfunction: an independent and incremental predictor of cardiac deaths late after acute myocardial infarction.

    PubMed

    Di Bella, Gianluca; Siciliano, Valeria; Aquaro, Giovanni D; De Marchi, Daniele; Rovai, Daniele; Carerj, Scipione; Molinaro, Sabrina; Lombardi, Massimo; Pingitore, Alessandro

    2015-02-01

    Prognostic implication of right ventricular dysfunction and infarction scar in the chronic phase of the myocardial infarction has been little analyzed. In 299 consecutive patients (age 63 ± 11 years) with >3 months old myocardial infarction, we quantified right and left ventricular volumes and ejection fractions by cine cardiac magnetic resonance, and right and left ventricular scar tissue by late gadolinium enhancement. During follow-up (median, 2.4 years) cardiac events (cardiac-related deaths or appropriate intra-cardiac defibrillator shocks) occurred in 21 patients. Right ventricular systolic dysfunction (ejection fraction lower the reference mean values-2 SD) was present in 67 patients (22 %), right ventricular late gadolinium enhancement was observed in 15 patients (5 %). After adjustment for left ventricular end-diastolic volume, wall motion score index, and global extent of late gadolinium enhancement, right ventricular dysfunction was an independent and incremental predictor of cardiac events (p = 0.0053), while right ventricular scar tissue extent was not. Right ventricular dysfunction is an independent and incremental predictor of cardiac events also in the chronic phase of the myocardial infarction. In these patients, right ventricular dysfunction does not necessarily mean right ventricular infarction scar, but likely reflects the effects of hemodynamic and biohumoral factors. PMID:25348657

  18. Treatment of acne scarring.

    PubMed

    Alam, M; Dover, J S

    Acne scarring is common but surprisingly difficult to treat. Scars can involve textural change in the superficial and deep dermis, and can also be associated with erythema, and less often, pigmentary change. In general, treatment of acne scarring is a multistep procedure. First, examination of the patient is necessary to classify the subtypes of scarring that are present. Then, the patient's primary concerns are elicited, and the patient is offered a menu of procedures that may address the various components of the scarring process. It is important to emphasize to the patient that acne scarring can be improved but never entirely reversed. PMID:17180246

  19. Scar revision - series (image)

    MedlinePlus

    ... entire body, and acts as a protective barrier. Scar tissue forms as skin heals after an injury ( ... heredity; and skin characteristics including color (pigmentation). No scar can be removed completely. The degree of improvement ...

  20. Relativistic Quantum Scars

    SciTech Connect

    Huang, Liang; Lai Yingcheng; Ferry, David K.; Goodnick, Stephen M.; Akis, Richard

    2009-07-31

    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.

  1. California Burn Scars

    Atmospheric Science Data Center

    2014-05-15

    article title:  Burn Scars Across Southern California     ... California between October 21 and November 18, 2003. Burn scars and vegetation changes wrought by the fires are illustrated in these ... Nov 18, 2003 Images:  California Burn Scars location:  United States region:  ...

  2. Post-burn scars and scar contractures

    PubMed Central

    Goel, Arun; Shrivastava, Prabhat

    2010-01-01

    The mortality and morbidity from burns have diminished tremendously over the last six to seven decades. However, these do not truly reflect whether the victim could go back to society as a useful person or not and lead a normal life because of the inevitable post-burn scars, contractures and other deformities which collectively have aesthetic and functional considerations. This article gives an overview of the post-burn scars and scar contractures, especially their prevention, minimisation and principles of management. PMID:21321660

  3. Laser Scar Management Technique

    PubMed Central

    Ohshiro, Toshio; Sasaki, Katsumi

    2013-01-01

    Background and Aims: Scars are common and cause functional problems and psychological morbidity. Recent advances in optical technologies have produced various laser systems capable of revising the appearance of scars from various etiologies to optimize their appearance. Methods: Laser treatment can commence as early as the time of the initial injury and as late as several years after the injury. Several optical technologies are currently available and combined laser/light treatments are required for treatment of scars. Since 2006, we have set up a scar management department in our clinic and more than 2000 patients have been treated by our combined laser irradiation techniques. Herein, we review several available light technologies for treatment of surgical, traumatic, and inflammatory scars, and discuss our combined laser treatment of scars, based upon our clinical experience. Results and Conclusions: Because scars have a variety of potential aetiologies and take a number of forms, no single approach can consistenty provide good scar treatment and management. The combination of laser and devices is essential, the choice of wavelength and approach being dictated by each patient as an individual. PMID:24511202

  4. SCAR-B AERONET

    Atmospheric Science Data Center

    2015-11-19

    ... SCAR-B Discipline:  Tropospheric Chemistry Field Campaigns Radiation Budget Aerosols ... Parameters:  Aerosol Optical Depth Precipitable Water Vapor Solar Irradiance Order Data:  ASDC Order ...

  5. Scar revision - series (image)

    MedlinePlus

    ... a year after a wound has healed. A keloid is an abnormal scar that is thicker, different ... creates a thick, puckered effect simulating a tumor. Keloids are removed at the point where it meets ...

  6. Keloid scar (image)

    MedlinePlus

    Keloids are an overgrowth of scar tissue at the site of a healed skin injury. They often create a thick, puckered effect simulating a tumor. Keloids may be reduced in size by freezing (cryotherapy), ...

  7. Primary scarring alopecias.

    PubMed

    Rigopoulos, Dimitrios; Stamatios, Gregoriou; Ioannides, Dimitrios

    2015-01-01

    Scarring alopecia or cicatricial alopecia results from follicular damage that is sufficient to cause the destruction and replacement of pilosebaceous structures by scar tissue. Primary scarring alopecias represent a group of disorders that primarily affect the hair follicles, as opposed to secondary scarring alopecias, which affect the dermis and secondarily cause follicular destruction. Inflammation may predominantly involve lymphocytes or neutrophils. Cicatricial alopecias that mainly involve lymphocytic inflammation include discoid lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia, central centrifugal alopecia, and pseudopelade (Brocq). Cicatricial alopecias that are due to predominantly neutrophilic inflammation include folliculitis decalvans, tufted folliculitis, and dissecting cellulitis of the scalp. Folliculitis keloidalis is a cicatricial alopecia with a mixed inflammatory infiltrate. PMID:26370646

  8. Probability mapping of scarred myocardium using texture and intensity features in CMR images

    PubMed Central

    2013-01-01

    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). PMID:24053280

  9. Incomplete Cesarean Scar Rupture

    PubMed Central

    Ahmadi, Firoozeh; Siahbazi, Shiva; Akhbari, Farnaz

    2013-01-01

    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. PMID:23926561

  10. Cardiac Magnetic Resonance Scar Imaging for Sudden Cardiac Death Risk Stratification in Patients with Non-Ischemic Cardiomyopathy

    PubMed Central

    Kim, Eun Kyoung; Chattranukulchai, Pairoj

    2015-01-01

    In patients with non-ischemic cardiomyopathy (NICM), risk stratification for sudden cardiac death (SCD) and selection of patients who would benefit from prophylactic implantable cardioverter-defibrillators remains challenging. We aim to discuss the evidence of cardiac magnetic resonance (CMR)-derived myocardial scar for the prediction of adverse cardiovascular outcomes in NICM. From the 15 studies analyzed, with a total of 2747 patients, the average prevalence of myocardial scar was 41%. In patients with myocardial scar, the risk for adverse cardiac events was more than 3-fold higher, and risk for arrhythmic events 5-fold higher, as compared to patients without scar. Based on the available observational, single center studies, CMR scar assessment may be a promising new tool for SCD risk stratification, which merits further investigation. PMID:26175568

  11. A Review of Scar Scales and Scar Measuring Devices

    PubMed Central

    Fearmonti, Regina; Bond, Jennifer; Erdmann, Detlev; Levinson, Howard

    2010-01-01

    Objective: Pathologic scarring affects millions of people worldwide. Quantitative and qualitative measurement modalities are needed to effectively evaluate and monitor treatments. Methods: This article reviews the literature on available tools and existent assessment scales used to subjectively and objectively characterize scar. Results: We describe the attributes and deficiencies of each tool and scale and highlight areas where further development is critical. Conclusion: An optimal, universal scar scoring system is needed in order to better characterize, understand and treat pathologic scarring. PMID:20596233

  12. Can Acne Scars Be Removed?

    MedlinePlus

    ... Can I Help a Friend Who Cuts? Can Acne Scars Be Removed? KidsHealth > For Teens > Can Acne ... eliminarse las marcas de acne? Different Types of Acne Scars from acne can seem like double punishment — ...

  13. Limitations of premature ventricular complex morphology in the diagnosis of myocardial infarction

    SciTech Connect

    Wahl, J.M.; Hakki, A.H.; Iskandrian, A.S.; Segal, B.L.

    1986-04-01

    To determine the diagnostic value of Q-waves (greater than or equal to 0.04 seconds duration) in premature ventricular complexes (PVC's) for the presence of myocardial scar, we examined 12-lead electrocardiograms and multiple lead rhythm strips obtained before and after exercise at the time of thallium-201 myocardial imaging in 970 patients. PVC's were found in 233 patients, 112 of whom had fixed thallium-201 perfusion defects indicative of myocardial scar. PVC's occurring during exercise were excluded from the analysis. Twenty-one patients had Q-wave PVC's in one or more electrocardiographic leads. Of those, 14 patients (67%) had myocardial scar in the suggested location. Myocardial scar was more common among patients with Q-wave PVC's than in patients without (67% vs. 36%, p less than 0.01). However, only 6 of 13 patients (46%) with Q-wave PVC's but no diagnostic sinus beats actually had myocardial scar. The remaining seven patients had Q-wave PVC's, no myocardial scar, and no evidence of myocardial ischemia suggested by angina during exercise, exercise electrocardiogram or thallium-201 imaging. We conclude that although Q-wave PVC's indicate the presence of myocardial scar in 67% of patients, they yield little or no additional diagnostic information to that obtained from the sinus beats

  14. Emerging Therapies for Scar Prevention

    PubMed Central

    Block, Lisa; Gosain, Ankush; King, Timothy W.

    2015-01-01

    Significance: There are ∼12 million traumatic lacerations treated in the United States emergency rooms each year, 250 million surgical incisions created worldwide every year, and 11 million burns severe enough to warrant medical treatment worldwide. In the United States, over $20 billion dollars per year are spent on the treatment and management of scars. Recent Advances: Investigations into the management of scar therapies over the last decade have advanced our understanding related to the care of cutaneous scars. Scar treatment methods are presented including topical, intralesional, and mechanical therapies in addition to cryotherapy, radiotherapy, and laser therapy. Critical Issues: Current treatment options for scars have significant limitations. This review presents the current and emerging therapies available for scar management and the scientific evidence for scar management is discussed. Future Directions: Based upon our new understanding of scar formation, innovative scar therapies are being developed. Additional research on the basic science of scar formation will lead to additional advances and novel therapies for the treatment of cutaneous scars. PMID:26487979

  15. Update on hypertrophic scar treatment.

    PubMed

    Rabello, Felipe Bettini; Souza, Cleyton Dias; Farina Júnior, Jayme Adriano

    2014-08-01

    Scar formation is a consequence of the wound healing process that occurs when body tissues are damaged by a physical injury. Hypertrophic scars and keloids are pathological scars resulting from abnormal responses to trauma and can be itchy and painful, causing serious functional and cosmetic disability. The current review will focus on the definition of hypertrophic scars, distinguishing them from keloids and on the various methods for treating hypertrophic scarring that have been described in the literature, including treatments with clearly proven efficiency and therapies with doubtful benefits. Numerous methods have been described for the treatment of abnormal scars, but to date, the optimal treatment method has not been established. This review will explore the differences between different types of nonsurgical management of hypertrophic scars, focusing on the indications, uses, mechanisms of action, associations and efficacies of the following therapies: silicone, pressure garments, onion extract, intralesional corticoid injections and bleomycin. PMID:25141117

  16. Update on hypertrophic scar treatment

    PubMed Central

    Rabello, Felipe Bettini; Souza, Cleyton Dias; Júnior, Jayme Adriano Farina

    2014-01-01

    Scar formation is a consequence of the wound healing process that occurs when body tissues are damaged by a physical injury. Hypertrophic scars and keloids are pathological scars resulting from abnormal responses to trauma and can be itchy and painful, causing serious functional and cosmetic disability. The current review will focus on the definition of hypertrophic scars, distinguishing them from keloids and on the various methods for treating hypertrophic scarring that have been described in the literature, including treatments with clearly proven efficiency and therapies with doubtful benefits. Numerous methods have been described for the treatment of abnormal scars, but to date, the optimal treatment method has not been established. This review will explore the differences between different types of nonsurgical management of hypertrophic scars, focusing on the indications, uses, mechanisms of action, associations and efficacies of the following therapies: silicone, pressure garments, onion extract, intralesional corticoid injections and bleomycin. PMID:25141117

  17. [Cesarean scar pregnancy].

    PubMed

    Matyszkiewicz, Anna; Jach, Robert; Nocuń, Agnieszka; Posadzka, Ewa; Huras, Hubert; Pityński, Kazimierz; Wolski, Hubert; Basta, Paweł

    2015-10-01

    Pregnancy in the uterine scare after previous caesarean section is the rarest type of ectopic pregnancy Due to the possibility of life-threatening complications, cesarean scar pregnancy (CSP) needs rapid and proper diagnosis and management. Hereby we present 3 cases of women with CSP, diagnosed and treated at the Department of Gynecology and Obstetrics of Jagiellonian University Medical College, in Krakow, in 2013, as well as literature review. PMID:26677591

  18. Cutaneous Scar Prevention and Management

    PubMed Central

    Al-Shaqsi, Sultan; Al-Bulushi, Taimoor

    2016-01-01

    Cutaneous scarring is common after trauma, surgery and infection and occurs when normal skin tissue is replaced by fibroblastic tissue during the healing process. The pathophysiology of scar formation is not yet fully understood, although the degree of tension across the wound edges and the speed of cell growth are believed to play central roles. Prevention of scars is essential and can be achieved by attention to surgical techniques and the use of measures to reduce cell growth. Grading and classifying scars is important to determine available treatment strategies. This article presents an overview of the current therapies available for the prevention and treatment of scars. It is intended to be a practical guide for surgeons and other health professionals involved with and interested in scar management. PMID:26909210

  19. Longitudinal burn scar quantification.

    PubMed

    Nedelec, Bernadette; Correa, José A; de Oliveira, Ana; LaSalle, Leo; Perrault, Isabelle

    2014-12-01

    Quantitative studies of the clinical recovery of burn scars are currently lacking. Previous reports validate the objective, precise, diagnostic capabilities of high-frequency ultrasound to measure thickness, the Cutometer(®) to measure pliability and the Mexameter(®) to measure erythema and pigmentation of scars. Thus, we prospectively quantified clinical characteristics of patient-matched, after burn hypertrophic scar (HSc), donor site scar (D) and normal skin (N) using these instruments. One investigator measured 3 sites (HSc, D, N) in 46 burn survivors at 3, 6, and 12 months after-burn. A mixed model regression analysis, adjusting p-values for multiplicity of testing, was used to compare means among sites and time points. Participants were 41.2±13.5 years old, 87% males, predominantly Caucasian, with an average of 19.5% body surface area burned. HSc thickness decreased significantly between 3 and 6, 6 and 12, and 3 and 12 months (all p<0.0001), but remained thicker than D and N skin (all p<0.0001). Pliability differed significantly between HSc, D and N sites at all time points (all p<0.0001), with HSc and D increasing between 3 and 12 months (p<0.05) but not reaching normal. HSc and D sites were significantly more erythematous than normal skin (p<0.05) at 3 and 6 months but D sites approached normal by 12 months. The only time points at which pigmentation significantly differed were the HSc and D sites at 6 months. Thickness, pliability, erythema and pigmentation of N skin remained similar over the 12 months. We found that post-burn HSc thickness, pliability and erythema differed significantly from D and N skin at 3, 6, and 12 months and does not return to normal by 12 months after-injury; however, significant improvements towards normal can be expected. Donor sites are redder than normal skin at 3 and 6 months but can be expected to return to normal by 12 months. Although the color of HSc and D sites change markedly with time these color changes are

  20. Dune Avalanche Scars

    NASA Technical Reports Server (NTRS)

    2004-01-01

    05 August 2004 This Mars Global Surveyor (MGS) Mars Orbiter Camera (MOC) image shows large, low albedo (dark) sand dunes in Kaiser Crater near 47.2oS, 340.4oW. The dunes are--ever so slowly--moving east to west (right to left) as sand avalanches down the steeper, slip face slopes of each. Avalanching sand in the Kaiser dune field has left deep scars on these slopes, suggesting that the sand is not loose but is instead weakly cemented. The image covers an area approximately 3 km (1.9 mi) wide and is illuminated by sunlight from the upper left.

  1. Laser treatment of hypertrophic scars

    NASA Astrophysics Data System (ADS)

    Dobrjakova, Olga B.; Gulev, Valerii S.

    2001-10-01

    For prophylaxis and treatment, the pulsed solid state neodymium yttrium-aluminum garnet laser was used. It has been shown that this kind of radiation inhibits the proliferative process and prevents the scar hyperfibrotization. In this paper author's reports about the development of the method for improving the scar quality using Nd:YAG laser are presented.

  2. Cutaneous Scarring: A Clinical Review

    PubMed Central

    Baker, Richard; Urso-Baiarda, Fulvio; Linge, Claire; Grobbelaar, Adriaan

    2009-01-01

    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. PMID:20585482

  3. 9 CFR 11.3 - Scar rule.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... WELFARE HORSE PROTECTION REGULATIONS § 11.3 Scar rule. The scar rule applies to all horses born on or after October 1, 1975. Horses subject to this rule that do not meet the following scar rule...

  4. 9 CFR 11.3 - Scar rule.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... WELFARE HORSE PROTECTION REGULATIONS § 11.3 Scar rule. The scar rule applies to all horses born on or after October 1, 1975. Horses subject to this rule that do not meet the following scar rule...

  5. 9 CFR 11.3 - Scar rule.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... WELFARE HORSE PROTECTION REGULATIONS § 11.3 Scar rule. The scar rule applies to all horses born on or after October 1, 1975. Horses subject to this rule that do not meet the following scar rule...

  6. 9 CFR 11.3 - Scar rule.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... WELFARE HORSE PROTECTION REGULATIONS § 11.3 Scar rule. The scar rule applies to all horses born on or after October 1, 1975. Horses subject to this rule that do not meet the following scar rule...

  7. 9 CFR 11.3 - Scar rule.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... WELFARE HORSE PROTECTION REGULATIONS § 11.3 Scar rule. The scar rule applies to all horses born on or after October 1, 1975. Horses subject to this rule that do not meet the following scar rule...

  8. Connexin43 contributes to electrotonic conduction across scar tissue in the intact heart

    NASA Astrophysics Data System (ADS)

    Mahoney, Vanessa M.; Mezzano, Valeria; Mirams, Gary R.; Maass, Karen; Li, Zhen; Cerrone, Marina; Vasquez, Carolina; Bapat, Aneesh; Delmar, Mario; Morley, Gregory E.

    2016-05-01

    Studies have demonstrated non-myocytes, including fibroblasts, can electrically couple to myocytes in culture. However, evidence demonstrating current can passively spread across scar tissue in the intact heart remains elusive. We hypothesize electrotonic conduction occurs across non-myocyte gaps in the heart and is partly mediated by Connexin43 (Cx43). We investigated whether non-myocytes in ventricular scar tissue are electrically connected to surrounding myocardial tissue in wild type and fibroblast-specific protein-1 driven conditional Cx43 knock-out mice (Cx43fsp1KO). Electrical coupling between the scar and uninjured myocardium was demonstrated by injecting current into the myocardium and recording depolarization in the scar through optical mapping. Coupling was significantly reduced in Cx43fsp1KO hearts. Voltage signals were recorded using microelectrodes from control scars but no signals were obtained from Cx43fsp1KO hearts. Recordings showed significantly decreased amplitude, depolarized resting membrane potential, increased duration and reduced upstroke velocity compared to surrounding myocytes, suggesting that the non-excitable cells in the scar closely follow myocyte action potentials. These results were further validated by mathematical simulations. Optical mapping demonstrated that current delivered within the scar could induce activation of the surrounding myocardium. These data demonstrate non-myocytes in the scar are electrically coupled to myocytes, and coupling depends on Cx43 expression.

  9. Connexin43 contributes to electrotonic conduction across scar tissue in the intact heart

    PubMed Central

    Mahoney, Vanessa M.; Mezzano, Valeria; Mirams, Gary R.; Maass, Karen; Li, Zhen; Cerrone, Marina; Vasquez, Carolina; Bapat, Aneesh; Delmar, Mario; Morley, Gregory E.

    2016-01-01

    Studies have demonstrated non-myocytes, including fibroblasts, can electrically couple to myocytes in culture. However, evidence demonstrating current can passively spread across scar tissue in the intact heart remains elusive. We hypothesize electrotonic conduction occurs across non-myocyte gaps in the heart and is partly mediated by Connexin43 (Cx43). We investigated whether non-myocytes in ventricular scar tissue are electrically connected to surrounding myocardial tissue in wild type and fibroblast-specific protein-1 driven conditional Cx43 knock-out mice (Cx43fsp1KO). Electrical coupling between the scar and uninjured myocardium was demonstrated by injecting current into the myocardium and recording depolarization in the scar through optical mapping. Coupling was significantly reduced in Cx43fsp1KO hearts. Voltage signals were recorded using microelectrodes from control scars but no signals were obtained from Cx43fsp1KO hearts. Recordings showed significantly decreased amplitude, depolarized resting membrane potential, increased duration and reduced upstroke velocity compared to surrounding myocytes, suggesting that the non-excitable cells in the scar closely follow myocyte action potentials. These results were further validated by mathematical simulations. Optical mapping demonstrated that current delivered within the scar could induce activation of the surrounding myocardium. These data demonstrate non-myocytes in the scar are electrically coupled to myocytes, and coupling depends on Cx43 expression. PMID:27244564

  10. Connexin43 contributes to electrotonic conduction across scar tissue in the intact heart.

    PubMed

    Mahoney, Vanessa M; Mezzano, Valeria; Mirams, Gary R; Maass, Karen; Li, Zhen; Cerrone, Marina; Vasquez, Carolina; Bapat, Aneesh; Delmar, Mario; Morley, Gregory E

    2016-01-01

    Studies have demonstrated non-myocytes, including fibroblasts, can electrically couple to myocytes in culture. However, evidence demonstrating current can passively spread across scar tissue in the intact heart remains elusive. We hypothesize electrotonic conduction occurs across non-myocyte gaps in the heart and is partly mediated by Connexin43 (Cx43). We investigated whether non-myocytes in ventricular scar tissue are electrically connected to surrounding myocardial tissue in wild type and fibroblast-specific protein-1 driven conditional Cx43 knock-out mice (Cx43fsp1KO). Electrical coupling between the scar and uninjured myocardium was demonstrated by injecting current into the myocardium and recording depolarization in the scar through optical mapping. Coupling was significantly reduced in Cx43fsp1KO hearts. Voltage signals were recorded using microelectrodes from control scars but no signals were obtained from Cx43fsp1KO hearts. Recordings showed significantly decreased amplitude, depolarized resting membrane potential, increased duration and reduced upstroke velocity compared to surrounding myocytes, suggesting that the non-excitable cells in the scar closely follow myocyte action potentials. These results were further validated by mathematical simulations. Optical mapping demonstrated that current delivered within the scar could induce activation of the surrounding myocardium. These data demonstrate non-myocytes in the scar are electrically coupled to myocytes, and coupling depends on Cx43 expression. PMID:27244564

  11. Topical treatments for hypertrophic scars.

    PubMed

    Zurada, Joanna M; Kriegel, David; Davis, Ira C

    2006-12-01

    Hypertrophic scars represent an abnormal, exaggerated healing response after skin injury. In addition to cosmetic concern, scars may cause pain, pruritus, contractures, and other functional impairments. Therapeutic modalities include topical medications, intralesional corticosteroids, laser therapy, and cryosurgery. Topical therapies, in particular, have become increasingly popular because of their ease of use, comfort, noninvasiveness, and relatively low cost. This review will discuss the properties and effectiveness of these agents, including pressure therapy, silicone gel sheeting and ointment, polyurethane dressing, onion extract, imiquimod 5% cream, and vitamins A and E in the prevention and treatment of hypertrophic scars. PMID:17097399

  12. Semi-automated scar detection in delayed enhanced cardiac magnetic resonance images

    NASA Astrophysics Data System (ADS)

    Morisi, Rita; Donini, Bruno; Lanconelli, Nico; Rosengarden, James; Morgan, John; Harden, Stephen; Curzen, Nick

    2015-06-01

    Late enhancement cardiac magnetic resonance images (MRI) has the ability to precisely delineate myocardial scars. We present a semi-automated method for detecting scars in cardiac MRI. This model has the potential to improve routine clinical practice since quantification is not currently offered due to time constraints. A first segmentation step was developed for extracting the target regions for potential scar and determining pre-candidate objects. Pattern recognition methods are then applied to the segmented images in order to detect the position of the myocardial scar. The database of late gadolinium enhancement (LE) cardiac MR images consists of 111 blocks of images acquired from 63 patients at the University Hospital Southampton NHS Foundation Trust (UK). At least one scar was present for each patient, and all the scars were manually annotated by an expert. A group of images (around one third of the entire set) was used for training the system which was subsequently tested on all the remaining images. Four different classifiers were trained (Support Vector Machine (SVM), k-nearest neighbor (KNN), Bayesian and feed-forward neural network) and their performance was evaluated by using Free response Receiver Operating Characteristic (FROC) analysis. Feature selection was implemented for analyzing the importance of the various features. The segmentation method proposed allowed the region affected by the scar to be extracted correctly in 96% of the blocks of images. The SVM was shown to be the best classifier for our task, and our system reached an overall sensitivity of 80% with less than 7 false positives per patient. The method we present provides an effective tool for detection of scars on cardiac MRI. This may be of value in clinical practice by permitting routine reporting of scar quantification.

  13. [The scars of Andy Warhol].

    PubMed

    Scholz, A

    1996-02-01

    The biographical and artistic documents describing to the attempted assassination of the artist Andy Warhol are reviewed. The visible scars are interpreted as symbols of the damaged integrity of the skin. PMID:8868460

  14. [Dermatological laser- and light treatments of scars].

    PubMed

    Karmisholt, Katrine; Borch, Jakob E; Omland, Silje Haukali; Hædersdal, Merete

    2016-08-01

    Many patients struggle with tender, rigid and erythematous scars. Various modalities are used to treat cutaneous scars and in recent years, laser treatments are emerging as promising procedures. This article describes laser systems used for scar treatment according to scar type, evaluates the highest available level of evidence from randomized controlled trials (RCTs) and introduces a guideline for laser treatment of scars. Twelve RCTs documented effect on acne, burn and surgical scars. It is recommended that laser- and light-based treatments are considered according to the scar type. PMID:27507028

  15. Fillers for the improvement in acne scars

    PubMed Central

    Wollina, Uwe; Goldman, Alberto

    2015-01-01

    Acne is a common inflammatory disease. Scarring is an unwanted end point of acne. Both atrophic and hypertrophic scar types occur. Soft-tissue augmentation aims to improve atrophic scars. In this review, we will focus on the use of dermal fillers for acne scar improvement. Therefore, various filler types are characterized, and available data on their use in acne scar improvement are analyzed. PMID:26491364

  16. How reliable is myocardial imaging in the diagnosis of acute myocardial infarction

    SciTech Connect

    Willerson, J.T.

    1983-01-01

    Myocardial scintigraphic techniques available presently allow a sensitive and relatively specific diagnosis of acute myocardial infarction when they are used correctly, although every technique has definite limitations. Small myocardial infarcts (less than 3 gm.) may be missed, and there are temporal limitations in the usefulness of the scintigraphic techniques. The development of tomographic methodology that may be used with single-photon radionuclide emitters (including technetium and /sup 201/Tl will allow the detection of relatively small abnormalities in myocardial perfusion and regions of myocardial infarction and will help to provide a more objective interpretation of the myocardial scintigrams. The use of overlay techniques allowing simultaneous assessment of myocardial perfusion, infarct-avid imaging, and radionuclide ventriculograms will provide insight into the relevant aspects of the extent of myocardial damage, the relationship of damage to myocardial perfusion, and the functional impact of myocardial infarction on ventricular performance.

  17. Target-seeking antifibrotic compound enhances wound healing and suppresses scar formation in mice.

    PubMed

    Järvinen, Tero A H; Ruoslahti, Erkki

    2010-12-14

    Permanent scars form upon healing of tissue injuries such as those caused by ischemia (myocardial infarction, stroke), trauma, surgery, and inflammation. Current options in reducing scar formation are limited to local intervention. We have designed a systemically administered, target-seeking biotherapeutic for scar prevention. It consists of a vascular targeting peptide that specifically recognizes angiogenic blood vessels and extravasates into sites of injury, fused with a therapeutic molecule, decorin. Decorin prevents tissue fibrosis and promotes tissue regeneration by inhibiting TGF-β activity and by other regulatory activities. The decorin-targeting peptide fusion protein had substantially increased neutralizing activity against TGF-β1 in vitro compared with untargeted decorin. In vivo, the fusion protein selectively accumulated in wounds, and promoted wound healing and suppressed scar formation at doses where nontargeted decorin was inactive. These results show that selective targeting yields a tissue-healing and scar-reducing compound with enhanced specificity and potency. This approach may help make reducing scar formation by systemic drug delivery a feasible option for surgery and for the treatment of pathological processes in which scar formation is a problem. PMID:21106754

  18. Scar remodeling after strabismus surgery.

    PubMed Central

    Ludwig, I H

    1999-01-01

    PURPOSE: Patients with overcorrected strabismus (and several patients with undercorrection after extraocular muscle resection) underwent exploration of previously operated muscles, with the intention of advancing their tendons to prevent the need for surgery on additional muscles. Unexpectedly, it was found that, in many cases, an elongated scar segment of variable length was interposed between the muscle and its insertion site on the sclera. Laboratory investigations were carried out to elucidate the underlying mechanism(s) and to create an animal model of the disorder. METHODS: Lengthened scars were repaired on 198 muscles during 134 procedures performed on 123 patients. The scars consisted of amorphous connective tissue interposed between the globe and normal tendon. Repair was accomplished by excision of the scar and reattachment of the muscle to sclera, using absorbable sutures in 64 cases and nonabsorbable sutures in 70 cases. Histopathologic examination was performed on 82 clinical specimens, and tissue culture studies were performed on 7 specimens. To develop an animal model, 10 New Zealand white rabbits underwent bilateral superior rectus resection. Half of the eyes received sub-Tenon's injections of collagenase over the operative site during weeks 2, 3, 5, and 6 postoperatively; the other half received saline solution injections on the same schedule. At 10 weeks, half the sites were studied histologically, and the other half underwent collagen creep analysis. In a second study, the use of absorbable versus nonabsorbable sutures was compared in the rabbit model. RESULTS: In the clinical cases, the mean length of the elongated scar segments was 4.2 mm. A total of 105 of the 134 repair procedures were judged successful. Thirty-one procedures resulted in recurrence of the original overcorrection; 7 of these had documented restretches. Factors that distinguished patients with stretched scars from patients with classic slipped muscles included minimal or no

  19. Multimodal management of atrophic acne scarring in the aging face.

    PubMed

    O'Daniel, T Gerald

    2011-12-01

    Atrophic facial acne scarring is a widely prevalent condition that can have a negative impact on a patient's quality of life. The appearance of these scars is often worsened by the normal effects of aging. A number of options are available for the treatment of acne scarring, including chemical peeling, dermabrasion, ablative or nonablative laser resurfacing, dermal fillers, and surgical techniques such as subcision or punch excision. Depending on the type and extent of scarring, a multimodal approach is generally necessary to provide satisfactory results. Resurfacing techniques correct surface irregularities, long-lasting dermal fillers address the volume loss resulting from acne, and sub-superficial musculoaponeurotic system (SMAS) face-lift procedures counter the soft tissue laxity and ptosis associated with aging. This article briefly reviews the evolution of individual approaches to treating atrophic acne scarring, followed by case examples illustrating results that can be achieved using a multimodal approach. Representative cases from patients in their 30s, 40s, and 50s are presented. In the author's clinical practice, multimodal approaches incorporating fractionated laser, injectable poly-L: -lactic acid, and sub-SMAS face-lift procedures have achieved optimal aesthetic outcomes, high patient satisfaction, and durability of aesthetic effect over time. PMID:21491169

  20. Burns, hypertrophic scar and galactorrhea.

    PubMed

    Karimi, Hamid; Nourizad, Samad; Momeni, Mahnoush; Rahbar, Hosein; Momeni, Mazdak; Farhadi, Khosro

    2013-07-01

    An 18-year-old woman was admitted to Motahari Burn Center suffering from 30% burns. Treatment modalities were carried out for the patient and she was discharged after 20 days. Three to four months later she developed hypertrophic scar on her chest and upper limbs. At the same time she developed galactorrhea in both breasts and had a disturbed menstrual cycle four months post-burn. On investigation, we found hyperprolactinemia and no other reasons for the high level of prolactin were detected.She received treatment for both the hypertrophic scar and the severe itching she was experiencing. After seven months, her prolactin level had decreased but had not returned to the normal level. It seems that refractory hypertrophic scar is related to the high level of prolactin in burns patients. PMID:23456048

  1. Cardiovascular magnetic resonance of myocardial edema using a short inversion time inversion recovery (STIR) black-blood technique: Diagnostic accuracy of visual and semi-quantitative assessment

    PubMed Central

    2012-01-01

    Background The short inversion time inversion recovery (STIR) black-blood technique has been used to visualize myocardial edema, and thus to differentiate acute from chronic myocardial lesions. However, some cardiovascular magnetic resonance (CMR) groups have reported variable image quality, and hence the diagnostic value of STIR in routine clinical practice has been put into question. The aim of our study was to analyze image quality and diagnostic performance of STIR using a set of pulse sequence parameters dedicated to edema detection, and to discuss possible factors that influence image quality. We hypothesized that STIR imaging is an accurate and robust way of detecting myocardial edema in non-selected patients with acute myocardial infarction. Methods Forty-six consecutive patients with acute myocardial infarction underwent CMR (day 4.5, +/- 1.6) including STIR for the assessment of myocardial edema and late gadolinium enhancement (LGE) for quantification of myocardial necrosis. Thirty of these patients underwent a follow-up CMR at approximately six months (195 +/- 39 days). Both STIR and LGE images were evaluated separately on a segmental basis for image quality as well as for presence and extent of myocardial hyper-intensity, with both visual and semi-quantitative (threshold-based) analysis. LGE was used as a reference standard for localization and extent of myocardial necrosis (acute) or scar (chronic). Results Image quality of STIR images was rated as diagnostic in 99.5% of cases. At the acute stage, the sensitivity and specificity of STIR to detect infarcted segments on visual assessment was 95% and 78% respectively, and on semi-quantitative assessment was 99% and 83%, respectively. STIR differentiated acutely from chronically infarcted segments with a sensitivity of 95% by both methods and with a specificity of 99% by visual assessment and 97% by semi-quantitative assessment. The extent of hyper-intense areas on acute STIR images was 85% larger than

  2. Modified Dovetail-Plasty in Scar Revision

    PubMed Central

    Oh, Suk Joon; Yang, Jihoon; Kim, Seon Gyu; Jung, Sung Won; Koh, Sung Hoon

    2014-01-01

    Abstract Scar revision is one of the fundamental techniques in the field of plastic and reconstructive surgery. Local flaps, such as a Z-plasty, W-plasty, or geometric broken-line closure, have been used for scar revision. Camouflaging a scar during scar revision for marginal scars from skin grafts and flaps, trapdoor scars, and linear scars is difficult. We describe our experience with the use of modified dovetail-plasty for scar revision in these difficult areas. Our study group consisted of 28 cases among 22 patients (9 males and 13 females) with a mean age of 33.6 years (range, 6–61 years). The conspicuous scars were located on the face (50%) and extremities (50%). The authors designed Y-shaped incision lines to relax the skin tension lines on one side of the excision line and trapezoid incision lines on the other side. There were 16 follow-up operations performed over 6 months after the initial operation among a total of 22 patients. There were scar depressions (2 patients) and a hypertrophic scar (1 patient) at the interval area between the dovetail flaps. A diffuse hypertrophic scar occurred in 1 patient with a dorsal foot scar. The overall success rates of the procedure as assessed by the surgeons were as follows: excellent (75%), good (12.4%), fair (6.3%), and poor (6.3%). This new local flap can achieve an inconspicuous scar using a blurred scar line and reducing tension. The authors recommend a modified dovetail-plasty for the revision of trapdoor scars and scars under excessive tension. PMID:24577307

  3. The Electrophysiologic Cardiac Ventricular Substrate in Patients after Myocardial Infarction: Noninvasive Characterization with ECG Imaging (ECGI)

    PubMed Central

    Cuculich, Phillip S.; Zhang, Junjie; Wang, Yong; Desouza, Kavit A.; Vijayakumar, Ramya; Woodard, Pamela K.; Rudy, Yoram

    2012-01-01

    Objectives To noninvasively image the electophysiologic substrate of human ventricles after myocardial infarction and define its characteristics. Background Ventricular infarct border zone is characterized by abnormal cellular electrophsyiology and altered structural architecture and is a key contributor to arrhythmogenesis. The ability to noninvasively image its electrical characteristics could contribute to understanding of mechanisms and to risk-stratification for ventricular arrhythmia. Methods Electrocardiographic Imaging (ECGI), a noninvasive functional electrophysiologic imaging modality, was performed during sinus rhythm in 24 subjects with infarct-related myocardial scar. The abnormal electrophysiologic substrate on the epicardial aspect of the scar was identified and its location, size, and morphology were compared to the anatomic scar imaged by other noninvasive modalities. Results ECGI constructs epicardial electrograms which have characteristics of reduced amplitude (low voltage) and fractionation. ECGI co-localizes the epicardial electrical scar to the anatomic scar with a high degree of accuracy (sensitivity 89%, specificity 85%). In nearly all subjects, sinus rhythm activation patterns were affected by the presence of myocardial scar. Late potentials could be identified and were almost always within ventricular scar. Conclusions ECGI accurately identifies areas of anatomic scar and complements standard anatomic imaging by providing scar - related electrophysiologic characteristics of low voltages, altered sinus rhythm activation, electrogram fragmentation and presence of late potentials. PMID:22018301

  4. Answers to Common Questions about Scars

    MedlinePlus

    ... Donation Volunteer Efforts Answers to Common Questions About Scars skip to submenu Parents & Individuals Information for Parents & Individuals Answers to Common Questions About Scars To download the PDF version of this factsheet, ...

  5. Stimulated infrared thermography applied to differentiate scar tissue from peri-scar tissue: a preliminary study.

    PubMed

    Riquet, Damien; Houel, Nicolas; Bodnar, Jean-Luc

    2016-08-01

    Every human injury leads to a scar formation. The healing process leads to the formation of new tissue: the scar, which is different from the original tissue. This process is influenced by mechanical strength and the local vasculature is modified. The purpose of this study is to show that there are various temperatures between the scar and the peri-scar area associated with the healing process that can be estimated using the thermal infrared camera. In the study, 12 scars were stimulated by cold. Several changes of temperature were observed between scar and peri-scar area for 10 min. Scars appeared significantly colder with a Wilcoxon test (p = 0.01). Results showed that stimulated infrared thermography can be used to monitor the temperature difference between the scar and peri-scar tissue. PMID:27270169

  6. Does Transendocardial Injection of Mesenchymal Stem Cells Improve Myocardial Function Locally or Globally? An Analysis From the POSEIDON Randomized Trial

    PubMed Central

    Suncion, Viky Y.; Ghersin, Eduard; Fishman, Joel E.; Zambrano, Juan Pablo; Karantalis, Vasileios; Mandel, Nicole; Nelson, Katarina H; Gerstenblith, Gary; Velazquez, Darcy L. DiFede; Breton, Elayne; Sitammagari, Kranthi; Schulman, Ivonne H.; N.Taldone, Sabrina; Williams, Adam R.; Sanina, Cristina; Johnston, Peter V.; Brinker, Jeffrey; Altman, Peter; Mushtaq, Muzammil; Trachtenberg, Barry; Mendizabal, Adam M.; Tracy, Melissa; Da Silva, Jose; McNiece, Ian K.; Lardo, Alberto C.; George, Richard T.; Hare, Joshua M.; Heldman, Alan W.

    2014-01-01

    Rationale Transendocardial Stem Cell Injection (TESI) with mesenchymal stem cells improves remodeling in chronic ischemic cardiomyopathy, but the impact of the injection site remains unknown. Objective To address whether TESI exerts its effects at the site of injection only or also in remote areas, we hypothesized that segmental myocardial scar and segmental ejection fraction improve to a greater extent in injected than in non-injected segments. Methods and Results Biplane ventriculographic and endocardial tracings were recorded. TESI was guided to 10 sites in infarct-border zones. Sites were mapped according to the 17-myocardial segment model. As a result, 510 segments were analyzed in 30 patients before and 13-months after TESI. Segmental early enhancement defect (SEED, a measure of scar size) was reduced by TESI in both injected (−43.7±4.4%, n=95, p<0.01) and non-injected segments (−25.1±7.8%, n=148, p<0.001; between group comparison p<0.05). Conversely, segmental ejection fraction (SEF, a measure of contractility) improved in injected scar segments (19.9±3.3 to 26.3±3.5%, p=0.003) but not in non-injected scar segments (21.3±2.6 to 23.5±3.2%, p=0.20, between group comparison p<0.05). In the subgroup of scar segments with baseline SEF<20%, the SEF improvement was even greater in injected segments (12.1±1.2% to 19.9±2.7%, n=18, p=0.003) vs. non-injected segments (13.3±1.3% to 16.1±2.1%, n=15, p=0.05; between group comparison p<0.05). Conclusions These findings illustrate a dichotomy in regional responses to TESI. Although scar reduction was evident at the site of TESI and remotely, ventricular functional responses occurred preferentially at the sites of TESI. Furthermore, improvement was greatest when segmental left ventricular dysfunction was severe. PMID:24449819

  7. Two dimensional unstable scar statistics.

    SciTech Connect

    Warne, Larry Kevin; Jorgenson, Roy Eberhardt; Kotulski, Joseph Daniel; Lee, Kelvin S. H. (ITT Industries/AES Los Angeles, CA)

    2006-12-01

    This report examines the localization of time harmonic high frequency modal fields in two dimensional cavities along periodic paths between opposing sides of the cavity. The cases where these orbits lead to unstable localized modes are known as scars. This paper examines the enhancements for these unstable orbits when the opposing mirrors are both convex and concave. In the latter case the construction includes the treatment of interior foci.

  8. Possibilities of scar treatment after thoracic surgery.

    PubMed

    Maragakis, M; Willital, G H; Michel, G; Görtelmeyer, R

    1995-01-01

    During a ten year observation period it was found that scar formation after thoracic surgery is influenced by various factors: metabolism, operative technique and factors of a general nature. On the basis of these findings, a study was carried out to investigate the effect of the scar-specific Contractubex gel (Merz+Co., D-Frankfurt/Main), containing 10% onion extract, 50 U sodium heparin per g of gel and 1% allantoin, in the treatment of children who underwent thoracic surgery and to evaluate its effect on scar development. Before and during the six-month treatment period, both macromorphology and scar colour were assessed; furthermore, a global evaluation of the therapeutic result was made. Additionally, the scars were characterized after a six-month treatment-free follow-up period. The results of 38 Contractubex-treated and 27 untreated patients were compared. In the treated scars, the global evaluation of the therapeutic result was better than in the untreated scars. In the Contractubex group, the rating was "good" and "very good" in 84% of cases, as compared to 59% of the untreated cases. In the treated group, the increase in scar size was markedly lower than in the untreated patients. The treated scars showed a tendency towards quicker paling than the untreated scars. In the treated group, the conversion of primary physiological scars to unphysiological scars (hypertrophic or keloidal scars) was less frequent than in the untreated group. The tolerability of the product was very good in 37 of the 38 treated patients, and good in one patient. All scar-specific effects of Contractubex continued to persist after the end of treatment. PMID:8846750

  9. Systemic Effects of Electromagnetic Fields in Patients with Myocardial Infarction

    NASA Astrophysics Data System (ADS)

    Cañedo-Dorantes, L.; Valle, L.; Uruchurtu, E.; Medel, A.; García-Mayen, F.; Serrano-Luna, G.

    2003-09-01

    Healing of acute myocardial infarction (AMI) is associated with inflammatory response, which promotes healing and scar formation. Activation of a local inflammatory response in patients with sequel of AMI could have an important role to enhance angiogenesis and regeneration of hibernating myocardial tissue. Chronic arterial leg ulcers have a similar etiology, and healing has been promoted by exposure to extremely low frequency electromagnetic fields (ELF). We report the evolution of three AMI patients with sequel of AMI that were exposed to ELF.

  10. Myocardial imaging artifacts caused by mitral valve annulus calcification

    SciTech Connect

    Wagoner, L.E.; Movahed, A.; Reeves, W.C. )

    1991-02-01

    Knowledge of imaging artifact of myocardial perfusion studies with thallium-201 is critical for improving the diagnostic accuracy of coronary artery disease. Three patients are described who underwent exercise or pharmacologic stress thallium-201 imaging studies and had a moderate, fixed myocardial perfusion defect (scar) involving the posterolateral and inferoposterior walls of the left ventricle. This was an imaging artifact caused by a heavily calcified mitral valve annulus.

  11. Pulmonary scar carcinoma. A clinicopathologic analysis

    SciTech Connect

    Bakris, G.L.; Mulopulos, G.P.; Korchik, R.; Ezdinli, E.Z.; Ro, J.; Yoon, B.H.

    1983-08-01

    To delineate differences between scar and non-scar pulmonary carcinoma, the charts, autopsy protocols and chest roentgenograms of 80 male patients (autopsied) between 1975 and 1980, were reviewed. Nineteen patients (24%) had documented scar carcinomas. The comparison revealed scar carcinomas to possess certain distinctive features: A higher histologic distribution of adenocarcinoma (58% versus 15% in non-scars) and the frequent presentation (53%) with only nonpulmonary symptoms and signs related to metastasis. In scar carcinomas both bronchoscopy and sputum cytology were ineffective as initial diagnostic tools since chest findings were absent or minimal. Chest x-ray was negative in 9 of the 19 patients with scar cancer and remained negative until death in seven. In 10 of 19 instances, pulmonary scar carcinomas presented with only nonpulmonary symptoms and showed a tendency to metastasize while clinically undetectable. The differences noted between scar and non-scar carcinomas of the lung appear to depend on the peripheral location of these tumors and not on the adenocarcinoma histology.

  12. Scars

    MedlinePlus

    ... Non-ablative Laser Rejuvenation Non-invasive Body Contouring Treatments Skin Cancer Skin Cancer Information Free Skin Cancer Screenings Skin ... Non-ablative Laser Rejuvenation Non-invasive Body Contouring Treatments Skin Cancer Skin Cancer Information Free Skin Cancer Screenings Skin ...

  13. Acne Scars: Pathogenesis, Classification and Treatment

    PubMed Central

    Fabbrocini, Gabriella; Annunziata, M. C.; D'Arco, V.; De Vita, V.; Lodi, G.; Mauriello, M. C.; Pastore, F.; Monfrecola, G.

    2010-01-01

    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. PMID:20981308

  14. A Case of Multiple Spontaneous Keloid Scars

    PubMed Central

    Jfri, Abdulhadi; Rajeh, Nawal; Karkashan, Eman

    2015-01-01

    Keloid scars result from an abnormal healing response to cutaneous injury or inflammation that extends beyond the borders of the original wound. Spontaneous keloid scars forming in the absence of any previous trauma or surgical procedure are rare. Certain syndromes have been associated with this phenomenon, and few reports have discussed the evidence of single spontaneous keloid scar, which raises the question whether they are really spontaneous. Here, we present a 27-year-old mentally retarded single female with orbital hypertelorism, broad nasal bridge, repaired cleft lip and high-arched palate who presented with progressive multiple spontaneous keloid scars in different parts of her body which were confirmed histologically by the presence of typical keloidal collagen. This report supports the fact that keloid scars can appear spontaneously and are possibly linked to a genetic factor. Furthermore, it describes a new presentation of spontaneous keloid scars in the form of multiple large lesions in different sites of the body. PMID:26351423

  15. Myocardial ischaemia in infancy and childhood

    PubMed Central

    Berry, C. L.

    1967-01-01

    Examination of 135 consecutive necropsy specimens has shown that ischaemic myocardial injury is not uncommon in infancy and childhood. The extent of the myocardial change has been assessed by a technique of staining with acid fuchsin, first described by Selye (1958). The significance of the findings is discussed. Images PMID:4163355

  16. Spinal osteotomy in the presence of massive lumbar epidural scarring.

    PubMed

    Arlet, Vincent

    2015-01-01

    The combination of Massive epidural scarring and spinal deformity represents the ultimate challenge for the spinal deformity surgeon. This is observed more and more as the population is aging and the number of spine surgery is increasing. In assessing the patient with spinal deformity and epidural scarring, one should carry out a thorough medical work up including Dexa scan, comorbidities, and in most cases a Myelo-CT scan that will identify the extent of the previous fusion, the fixed or semi-rigid nature of the deformity with complete anterior fusion or only bone bridges, the evaluation of the previous instrumentation (if present) with possible screw misplacement, or halo around the screws, the extent of the previous laminectomy, the spinal stenosis and possible arachnoiditis and or meningocele. Once the requirement of deformity correction has been established with specific attention to the pelvic incidence and amount of lordosis required two basic choices can be made. The first one is to perform the spine realignment outside the massive epidural scarring whether this will be performed through simple posterior osteotomies, TLIF combined with Smith-Petersen osteotomies or Pedicle subtraction osteotomies. One should not forget about all the possibilities of an anterior or lateral approach to the spine that can also judiciously realign the spine at the level or at distance of the massive epidural scarring. These anterior realignments have to be supplemented with posterior fixation and or osteotomies. The other alternative is to perform the spine osteotomy at the level of the massive epidural scarring preferably at the junction of normal dura and epidural scar. Working around the dura that will require to be thinned down before the osteotomy is performed represents another challenge where incidental durotomies are not infrequent. During the closing of the osteotomy the dura may not be as giving as a normal dura and too aggressive closure of the osteotomy may not be

  17. [Surgical controversy. Limiting postoperative scarring].

    PubMed

    Lachkar, Y

    2005-06-01

    Postoperative follow-up of glaucoma surgery must be rigorous and carried out over the long term. Data acquired on the make-up of the filtering bleb justifies using postoperative anti-inflammatory drugs, even if the eye is clinically quiet. When using antimetabolites, the risk factors for failure must be well known and either 5-fluorouracile or mitomycin should be chosen depending on the level of risk of scarring. Their use in needle revision must be adapted case by case. anti-TGF-beta-2 antibody, currently being investigated, may prove advantageous in the very near future. PMID:16208245

  18. Scar Revision Surgery: The Patient's Perspective

    PubMed Central

    Allan, Anna Y; Butler, Daniel P; Cussons, Paul D

    2015-01-01

    Background Insufficient satisfaction outcome literature exists to assist consultations for scar revision surgery; such outcomes should reflect the patient's perspective. The aim of this study was to prospectively investigate scar revision patient satisfaction outcomes, according to specified patient-selection criteria. Methods Patients (250) were randomly selected for telephone contacting regarding scar revisions undertaken between 2007-2011. Visual analogue scores were obtained for scars pre- and post-revision surgery. Surgery selection criteria were; 'presence' of sufficient time for scar maturation prior to revision, technical issues during or wound complications from the initial procedure that contributed to poor scarring, and 'absence' of site-specific or patient factors that negatively influence outcomes. Patient demographics, scar pathogenesis (elective vs. trauma), underlying issue (functional/symptomatic vs. cosmetic) and revision surgery details were also collected with the added use of a real-time, hospital database. Results Telephone contacting was achieved for 211 patients (214 scar revisions). Satisfaction outcomes were '2% worse, 16% no change, and 82% better'; a distribution maintained between body sites and despite whether surgery was functional/symptomatic vs. cosmetic. Better outcomes were reported by patients who sustained traumatic scars vs. those who sustained scars by elective procedures (91.80% vs. 77.78%, P=0.016) and by females vs. males (85.52% vs. 75.36%, P<0.05), particularly in the elective group where males (36.17%) were more likely to report no change or worse outcomes versus females (16.04%) (P<0.01). Conclusions Successful scar revision outcomes may be achieved using careful patient selection. This study provides useful information for referring general practitioners, and patient-surgeon consultations, when planning scar revision. PMID:26618120

  19. Remote sensing and hydrological modeling of burn scars

    NASA Astrophysics Data System (ADS)

    Miller, Mary Ellen

    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

  20. Effective Treatments of Atrophic Acne Scars

    PubMed Central

    Zhou, Bingrong

    2015-01-01

    Atrophic scarring is often an unfortunate and permanent complication of acne vulgaris. It has high prevalence, significant impact on quality of life, and therapeutic challenge for dermatologists. The treatment of atrophic acne scars varies depending on the types of acne scars and the limitations of the treatment modalities in their ability to improve scars. Therefore, many options are available for the treatment of acne scarring, including chemical peeling, dermabrasion, laser treatment, punch techniques, fat transplantation, other tissue augmenting agents, needling, subcision, and combined therapy. Various modalities have been used to treat scars, but limited efficacy and problematic side effects have restricted their application. In order to optimally treat a patient’s scar, we need to consider which treatment offers the most satisfactory result. There are also promising procedures in the future, such as stem cell therapy. In this article, the authors review the different treatment options of atrophic acne scars. This may be useful for selecting the best therapeutic strategy, whether it be single or combined therapy, in the treatment of atrophic acne scars while reducing or avoiding the side effects and complications. PMID:26029333

  1. The cost of post-burn scarring.

    PubMed

    Mirastschijski, U; Sander, J T; Zier, U; Rennekampff, H O; Weyand, B; Vogt, P M

    2015-09-30

    Deep burns lead to scarring and contractures for which there is little or no published data on treatment costs. The purpose of this study was to fill this gap by analysing treatment costs for burn sequelae. To do this, German-DRG for in-patient treatment was collected from the Burn Centre Lower Saxony. DRG-related T95.-coding served as a tool for burn-associated sequelae. Data on scar occurrence, plastic-reconstructive surgery and sick leave were collected by a questionnaire. The findings showed that 44.6% patients reported post-burn scarring and 31% needed surgical intervention. The expected risk for readmission was significantly higher (p=0.0002) with scars compared to without. Significantly higher costs for pressure garments were noted for scarred patients (p=0.04). No differences were found for ointments, silicone dressings or pain medication. Treatment costs for patients with scars were 5.6 times higher compared with no scar assessed by G-DRG. No differences were stated subsuming multiple readmissions for post-burn treatment per individual. Significantly higher costs (p=0.03) were noted for patients with burn sequelae other than scars with regard to individual readmissions. It has been revealed that treatment of scars causes higher costs than for other burn sequelae because of multiple surgical interventions. To reduce post-burn scarring and costs, specialized burn centres provide optimal and state-of-the-art treatment. As well as this, more emphasis should be laid on promoting research for the development of novel anti-scarring therapies. PMID:27279810

  2. Myocardial Bridge

    MedlinePlus

    ... artery. See also on this site: Ask a Texas Heart Institute Doctor: Search "myocardial bridge" Updated August ... comments. Terms of Use and Privacy Policy © Copyright Texas Heart Institute All rights reserved.

  3. Prevalence and predictors of mechanical dyssynchrony as defined by phase analysis in patients with left ventricular dysfunction undergoing gated SPECT myocardial perfusion imaging

    PubMed Central

    Samad, Zainab; Atchley, Allen E.; Trimble, Mark A.; Sun, Jie-Lena; Shaw, Linda K.; Pagnanelli, Robert; Chen, Ji; Garcia, Ernest V.; Iskandrian, Ami E.; Velazquez, Eric J.; Borges-Neto, Salvador

    2011-01-01

    Background A novel method to quantify dyssynchrony using phase analysis of single-photon emission computed tomography (SPECT) myocardial perfusion imaging has been developed. We sought to determine the prevalence of SPECT-derived mechanical dyssynchrony, and we report clinical variables which predict mechanical dyssynchrony in patients with left ventricular dysfunction. Methods We used a count-based Fourier analysis method to convert the regional myocardial counts from discrete frames per cardiac cycle into a continuous thickening function which allows resolution of the phase of the onset of myocardial contraction. The standard deviation of left ventricular phases (Phase SD) describes the regional phase dispersion as a measure of dyssynchrony. Significant dyssynchrony was defined as Phase SD ≥ 43°. 260 patients with left ventricular ejection fraction ≤35% were examined. Results The prevalence of mechanical dyssynchrony in the entire cohort of patients studied was 52%. Univariate predictors of Phase SD were age (P = .03), black race (P = .0005), QRS duration, EF, EDV, summed stress score (SSS), and summed rest score (SRS) (all P = <.0001). Black race, male gender, QRS EF, and SRS were independent predictors of SPECT-based mechanical dyssynchrony. Conclusions Significant SPECT-based mechanical dyssynchrony is relatively common among patients with left ventricular dysfunction. In a population of patients with predominantly ischemic heart disease referred for SPECT, a reduced EF, increasing QRS duration, severity and extent of myocardial scar on SPECT imaging are independent predictors of mechanical dyssynchrony and may serve to identify patients for dyssynchrony screening. PMID:21082299

  4. Cardiac MRI evaluation of myocardial disease.

    PubMed

    Captur, Gabriella; Manisty, Charlotte; Moon, James C

    2016-09-15

    Cardiovascular magnetic resonance (CMR) is a key imaging technique for cardiac phenotyping with a major clinical role. It can assess advanced aspects of cardiac structure and function, scar burden and other myocardial tissue characteristics but there is new information that can now be derived. This can fill many of the gaps in our knowledge with the potential to change thinking, disease classifications and definitions as well as patient care. Established techniques such as the late gadolinium enhancement technique are now embedded in clinical care. New techniques are coming through. Myocardial tissue characterisation techniques, particularly myocardial mapping can precisely measure tissue magnetisation-T1, T2, T2* and also the extracellular volume. These change in disease. Key biological pathways are now open for scrutiny including focal fibrosis (scar) and diffuse fibrosis, inflammation, metabolism and infiltration. Other new areas to engage in where major insights are growing include detailed assessments of myocardial mechanics and performance, spectroscopy and hyperpolarised CMR. In spite of the advances, challenges remain, particularly surrounding utilisation, technical development to improve accuracy, reproducibility and deliverability, and the role of multidisciplinary research to understand the detailed pathological basis of the MR signal changes. Collectively, these new developments are galvanising CMR uptake and having a major translational impact on healthcare globally and it is steadily becoming key imaging tool. PMID:27354273

  5. Prevention and treatment of excessive dermal scarring.

    PubMed Central

    Roseborough, Ingrid E.; Grevious, Mark A.; Lee, Raphael C.

    2004-01-01

    Today, wound management to avoid excessive scar formation is increasingly important, especially in populations with Fitzpatrick 3 or higher skin pigmentation. Medical science and industrial development are devoting more effort toward understanding and offering better therapy to control scars. However, advances in scar management have been hampered by the confusing or ambiguous terminology. There is no consensus on what amount of post-traumatic skin scar formation is "normal" and what should be considered "hypertrophic". In the World Health Organization's ICD-9, there is no diagnostic code for hypertrophic scar--only keloid is listed. Yet, the medical and scientific literature distinguishes them as different conditions. Our experience suggests that the diagnosis of keloid disease is greatly over-rendered. For black patients, an elevated scar seems, by default, diagnosed as keloid by most. This confusion results in inappropriate management of scar formation, and occasionally contributes to decision making related to elective or cosmetic surgery. Given that patients are expecting better outcomes from wound care today than in the past, this review article attempts to capture the essential biological factors related to wound scar production and discusses treatment options and indications used by the authors. Images Figure 1 Figure 2 Figure 3 PMID:14746360

  6. Preprocedural magnetic resonance imaging for image-guided catheter ablation of scar-related ventricular tachycardia.

    PubMed

    Tao, Qian; Piers, Sebastiaan R D; Lamb, Hildo J; Zeppenfeld, Katja; van der Geest, Rob J

    2015-02-01

    To present and validate a highly automated MRI analysis workflow for image-guided catheter ablation of scar-related ventricular tachycardia (VT) ablation procedures. A cohort of 15 post-infarction patients underwent MRI prior to VT ablation. The MRI study included a black-blood turbo spin echo sequence for visualizing the aortic root and ostium of the left main (LM) coronary artery, and a 3D late gadolinium enhanced sequence for visualizing the LV anatomy and myocardial scar substrate. Semi-automated segmentation of the LV, aortic root and ostium of LM was performed, followed by fully automated segmentation of myocardial scar. All segmented structures were aligned using an automated image registration algorithm to remove inter-scan displacement. MRI was integrated at the beginning of the procedure after mapping a single LM point. The integration performance was compared to that of the traditional iterative closest point (ICP) method. The proposed method required a single LM mapping point only, compared to 255 ± 43 points with the ICP method. The single-point method achieved a mean point-to-surface distance of 4.9 ± 1.5 mm on the LV surface and 5.1 ± 1.7 mm on the aorta surface (ICP: 3.7 ± 0.8 and 9.2 ± 7.2 mm, P < 0.05). The Cohen's kappa coefficient between the MRI-defined and EAM-defined scar was 0.36 ± 0.16 for the presented method, significantly higher than that of ICP method (0.23 ± 0.21, P = 0.03), indicating more accurate scar substrate localization during integration. This study demonstrated the feasibility of preprocedural MRI integration into the VT ablation procedure, with highly automated image analysis workflow and minimal mapping effort. PMID:25341408

  7. Solanidine and tomatidine trigger scar pruritus.

    PubMed

    Alonso, Pedro E; Rioja, Luis F

    2016-05-01

    Scar pruritus is frequently encountered in clinical practice (particularly in burn patients) owing to its poorly known pathogenesis and difficult treatment. In previous work, we demonstrated the usefulness of a diet excluding edible solanaceae (viz., potatoes, tomatoes, peppers and aubergines) in patients with antihistamine-resistant scar pruritus. We hypothesized that alkaloids in solanaceae (particularly their secondary metabolites or aglycones) might be the actual pruritogens. In order to test this hypothesis, we conducted a single-blind prospective study on patients responding favourably to a solanaceae-free diet whose scar pruritus could be ascribed to one of the four foods. The study involved applying the aglycones solanidine and tomatidine to each scar and checking whether, and which, had a pruritogenic effect. A total of 18 patients (90%) responded by developing pruritus; also, the triggering aglycone coincided with that prevailing in the pruritogenic food. We concluded that solanaceae aglycones are directly involved in the pathogenesis of scar pruritus. PMID:26777454

  8. Assessment of myocardial viability.

    PubMed

    Travin, Mark I; Bergmann, Steven R

    2005-01-01

    The prevalence of left ventricular (LV) dysfunction and resultant congestive heart failure is increasing. Patients with this condition are at high risk for cardiac death and usually have significant limitations in their lifestyles. Although there have been advances in medical therapy resulting in improved survival and well being, the best and most definitive therapy, when appropriate, is revascularization. In the setting of coronary artery disease, accounting for approximately two thirds of cases of congestive heart failure, LV dysfunction often is not the result of irreversible scar but rather caused by impairment in function and energy use of still viable-myocytes, with the opportunity for improved function if coronary blood flow is restored. Patients with LV dysfunction who have viable myocardium are the patients at highest risk because of the potential for ischemia but at the same time benefit most from revascularization. It is important to identify viable myocardium in these patients, and radionuclide myocardial scintigraphy is an excellent tool for this. Single-photon emission computed tomography perfusion scintigraphy, whether using thallium-201, Tc-99m sestamibi, or Tc-99m tetrofosmin, in stress and/or rest protocols, has consistently been shown to be an effective modality for identifying myocardial viability and guiding appropriate management. Metabolic imaging with positron emission tomography radiotracers frequently adds additional information and is a powerful tool for predicting which patients will have an improved outcome from revascularization, including some patients referred instead for cardiac transplantation. Other noninvasive modalities, such as stress echocardiography, also facilitate the assessment of myocardial viability, but there are advantages and disadvantages compared with the nuclear techniques. Nuclear imaging appears to require fewer viable cells for detection, resulting in a higher sensitivity but a lower specificity than stress

  9. Computational modeling of acute myocardial infarction.

    PubMed

    Sáez, P; Kuhl, E

    2016-01-01

    Myocardial infarction, commonly known as heart attack, is caused by reduced blood supply and damages the heart muscle because of a lack of oxygen. Myocardial infarction initiates a cascade of biochemical and mechanical events. In the early stages, cardiomyocytes death, wall thinning, collagen degradation, and ventricular dilation are the immediate consequences of myocardial infarction. In the later stages, collagenous scar formation in the infarcted zone and hypertrophy of the non-infarcted zone are auto-regulatory mechanisms to partly correct for these events. Here we propose a computational model for the short-term adaptation after myocardial infarction using the continuum theory of multiplicative growth. Our model captures the effects of cell death initiating wall thinning, and collagen degradation initiating ventricular dilation. Our simulations agree well with clinical observations in early myocardial infarction. They represent a first step toward simulating the progression of myocardial infarction with the ultimate goal to predict the propensity toward heart failure as a function of infarct intensity, location, and size. PMID:26583449

  10. Microneedling Therapy for Atrophic Acne Scars

    PubMed Central

    Barakat, Manal; Awad, Sherif; Medhat, Walid; El-Fakahany, Hasan; Farag, Hanna

    2015-01-01

    Objective: Treatment of acne scarring is always a challenge. Microneedling therapy or percutaneous collagen induction is a new addition to the treatment modalities for such scars and has been reported to be simple and effective in atrophic acne scar treatment. The aim of this study is to evaluate the clinical effect and objectively quantify the histological changes of acne scarring in response to skin microneedling. Design: A prospective clinical study. Participants: Ten patients with different types of atrophic acne scars were subjected to three months of skin microneedling treatment (six sessions at two-week intervals). Measurements: Patients were photographed, and skin biopsies were obtained at baseline as well as one and three months from the start of treatment. Histometry for epidermal thickness and quantitative evaluation of total elastin; newly synthesized tropoelastin; collagen types I, III, and VII; and newly synthesized collagen were performed for all biopsies. Results: Compared to the baseline, patients’ evaluations revealed noticeable clinical improvement in atrophic post-acne scars in response to skin microneedling. There was a statistically significant increase (p<0.05) in the mean of collagen types I, III, and VII and newly synthesized collagen, while total elastin was significantly decreased (p<0.05) after the end of treatment. Conclusions: Multiple minimally invasive sessions of skin microneedling are an effective treatment for post-acne atrophic scars as it stimulates the repair processes with the advantage of being a relatively risk-free, in-office procedure with minimal patient recovery time. PMID:26203319

  11. Quantifying Asymmetry and Scar Quality of Children With Repaired Cleft Lip and Palate Using Symnose 2.

    PubMed

    Pigott, Ronald W; Pigott, Brian B

    2016-05-01

    The Symnose semiautomated assessment of outcome of the appearance of the repaired cleft lip and nose was developed to measure asymmetry. Symnose 2 has been further developed to include quantification of the extent of scar color, intensity, and contour and midline dehiscence, underexpressed in the measurement of asymmetry. PMID:26295699

  12. Phase and Texture Characterizations of Scar Collagen Second-Harmonic Generation Images Varied with Scar Duration.

    PubMed

    Chen, Guannan; Liu, Yao; Zhu, Xiaoqin; Huang, Zufang; Cai, Jianyong; Chen, Rong; Xiong, Shuyuan; Zeng, Haishan

    2015-08-01

    This work developed a phase congruency algorithm combined with texture analysis to quantitatively characterize collagen morphology in second-harmonic generation (SHG) images from human scars. The extracted phase and texture parameters of the SHG images quantified collagen directionality, homogeneity, and coarseness in scars and varied with scar duration. Phase parameters showed an increasing tendency of the mean of phase congruency with scar duration, indicating that collagen fibers are better oriented over time. Texture parameters calculated from local difference local binary pattern (LD-LBP) and Haar wavelet transform, demonstrated that the LD-LBP variance decreased and the energy of all subimages increased with scar duration. It implied that collagen has a more regular pattern and becomes coarser with scar duration. In addition, the random forest regression was used to predict scar duration, demonstrating reliable performance of the extracted phase and texture parameters in characterizing collagen morphology in scar SHG images. Results indicate that the extracted parameters using the proposed method can be used as quantitative indicators to monitor scar progression with time and can help understand the mechanism of scar progression. PMID:26036282

  13. Analysis of Frequency of Use of Different Scar Assessment Scales Based on the Scar Condition and Treatment Method

    PubMed Central

    Bae, Seong Hwan

    2014-01-01

    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. PMID:24665417

  14. Scar State on Time-evolving Wavepacket

    NASA Astrophysics Data System (ADS)

    Tomiya, Mitsuyoshi; Tsuyuki, Hiroyoshi; Kawamura, Kentaro; Sakamoto, Shoichi; Heller, Eric J.

    2015-09-01

    The scar-like enhancement is found in the accumulation of the time-evolving wavepacket in stadium billiard. It appears close to unstable periodic orbits, when the wavepackets are launched along the orbits. The enhancement is essentially due to the same mechanism of the well-known scar states in stationary eigenstates. The weighted spectral function reveals that the enhancement is the pileup of contributions from scar states on the same periodic orbit. The availavility of the weighted spectrum to the semiclassical approximation is also disscussed.

  15. The evidence for natural therapeutics as potential anti-scarring agents in burn-related scarring.

    PubMed

    Mehta, M; Branford, O A; Rolfe, K J

    2016-01-01

    Though survival rate following severe thermal injuries has improved, the incidence and treatment of scarring have not improved at the same speed. This review discusses the formation of scars and in particular the formation of hypertrophic scars. Further, though there is as yet no gold standard treatment for the prevention or treatment of scarring, a brief overview is included. A number of natural therapeutics have shown beneficial effects both in vivo and in vitro with the potential of becoming clinical therapeutics in the future. These natural therapeutics include both plant-based products such as resveratrol, quercetin and epigallocatechin gallate as examples and includes the non-plant-based therapeutic honey. The review also includes potential mechanism of action for the therapeutics, any recorded adverse events and current administration of the therapeutics used. This review discusses a number of potential 'treatments' that may reduce or even prevent scarring particularly hypertrophic scarring, which is associated with thermal injuries without compromising wound repair. PMID:27574685

  16. [Coronary artery disease, myocardial perfusion and ventricular function in Q-wave and non-Q-wave myocardial infarcts].

    PubMed

    Macieira-Coelho, E; Garcia-Alves, M; da Costa, B; Cantinho, G; Pedro, P; Dionisio, I; Gouveia, A; de Padua, F

    1997-04-01

    Controversy remains in considering non-Q wave myocardial infarction (NQMI) a distinct pathophysiological entity of Q wave myocardial infarction (QMI). In order to analyze the severity of coronary artery disease, extension of myocardial scar or myocardial ischemia and ventricular function, 78 consecutive patients with QMI and 32 with NQMI, mean age 55.4 +/- 8.5, not submitted to thrombolytic therapy, were studied. Coronary angiography, exercise thallium scintigraphy and radionuclide ventriculography were performed in all at least within 3 months of a prior myocardial infarction. In the present study the occurrence of QMI was significantly more frequent in older patients than NQMI. There was no prevalence of occlusion either in the right, left circumflex or left anterior descending coronary arteries in both groups. Ejection fraction, degree of occlusion and presence of collateral circulation showed an equal prevalence in QMI and NQMI patients. A higher incidence of multivessel disease was found in NQMI that had less necrosis than QMI patients. The prevalence of exercise induced thallium-201 redistribution defects within the infarct zone was substantially higher and involved more scar segments in NQMI patients. Physiological and clinical consequences of coronary thrombosis depends on the size and the number of diseased arteries, the approach the pathophysiologic consequences of coronary disease in terms of fractal structure has been suggested. A pronounced heterogeneity in regional myocardial blood flow in a fractal branching arterial network may be responsible for the pathophysiologic differences of coronary thrombosis between Q-wave and non Q-wave infarction. PMID:9341032

  17. An idiosyncratic history of burn scars.

    PubMed

    Petro, Jane A

    2015-03-01

    The history of burn scars can best be found in military medical history. The care of wounded soldiers documented in the Illiad reflected the trauma of the weapons of war, arrow, spear, sword, and ax. The introduction of gunpowder in the 14th century, increasingly sophisticated explosives, and in modern times, petroleum-driven vehicles, including airplanes, created a new subset of wounds requiring attention and post-survival scars challenging the quality of survival. This article selects from among a myriad of examples of modern military treatments as they relate to those survivors. Larrey, with Napolean's Grand Army, Sir Harold Gilles during and following World War I, and the Boston area preparation and response to the Cocoanut Grove Fire in 1942 are the principle topics examined. Recent modern interventions, related to the survival of horrific blast and burn injuries, with modern wound care and scar manipulation techniques provide context to the current ability to modify healing and scars. PMID:25922950

  18. Proceedings of the SCAR Conference, Part 1

    NASA Technical Reports Server (NTRS)

    1976-01-01

    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.

  19. SCAR-B UWC131A

    Atmospheric Science Data Center

    2015-11-19

    ... SCAR-B Discipline:  Tropospheric Chemistry Field Campaigns Radiation Budget Aerosols ... Droplet Concentration Effective Droplet Radius Liquid Water Content Nitrogen Oxides Ozone (O3) Particle Number Concentration ...

  20. The semiclassical limit of scar intensities

    NASA Astrophysics Data System (ADS)

    Vergini, Eduardo G.

    2015-04-01

    By using a simple statistical model we find the distribution of scar intensities surviving the semiclassical limit. The obtained distribution is verified in a wide energy range of the quantum Bunimovich stadium billiard.

  1. SCAR-A Data and Information

    Atmospheric Science Data Center

    2015-11-19

    ... (SCAR-A) data include physical and chemical components of the Earth's surface, the atmosphere and the radiation field collected in the eastern part of the United States with an emphasis in air pollution. Discipline:  ...

  2. Do postsurgical interventions optimize ultimate scar cosmesis.

    PubMed

    Viera, M H; Amini, S; Konda, S; Berman, B

    2009-06-01

    Keloids and other scars are different manifestations of the normal wound healing process. If located in visible areas, scars may have a psychological impact that could affect the quality of life of the scar-bearing population. Good preoperatory planning including hiding incisions in natural anatomical landmarks or placing them parallel to relaxed skin tension lines are among the techniques used to improve the cosmesis of scars. Once a prominent or noticeable scar has developed, multiple therapeutic modalities can be applied including surgical excision, although high recurrence rates precludes its use as monotherapy. Several advanced surgical correction techniques including Z-plasty and W-plasty may be useful in repositioning scars. Other modalities that have been reported to improve scar cosmesis include cryosurgery, radiotherapy, lasers, and skin substitute grafts. Adjuvant postsurgical treatment modalities have reduced dramatically the recurrence rates associated with the removal of the scar. In this review of the literature the authors discuss evidence based data related to the abovementioned modalities and other topical and intralesional therapies including occlusion, compression, silicone, corticosteroids, interferons, imiquimod, resiquimod, tacrolimus, 5-fluorouracil, retinoids, as well as the role of several over-the-counter agents such as onion extract, vitamin E and the combination of hydrocortisone, vitamin E and silicone. Finally, they address newer modalities including vascular endothelial growth factor inhibitor, transforming growth factor-3, interleukin-10, mannose-6-phosphate, UVA-1, narrowband UVB, intense pulsed light and photodynamic therapy. Ultimately, the decision of choosing the most appropriate postexcisional management treatment should be taken by physicians on a case-by-case basis in order to obtain the best cosmetically acceptable results. PMID:19528906

  3. Frequency of placenta previa in previously scarred and non scarred uterus

    PubMed Central

    Majeed, Tayyaba; Waheed, Fatima; Mahmood, Zahid; Saba, Kanwal; Mahmood, Hamis; Bukhari, Mulazim Hussain

    2015-01-01

    Objective: To determine the frequency of placenta Previa in patients coming to a tertiary care unit with previously scarred and non-scarred uterus. Methods: A descriptive cross sectional study was carried on 114 cases who underwent caesarean sections (37 cases out of 645 cases with non scarred uterus and 77 cases from 721 cases with scarred uterus) in the department of obstetrics and gynecology Lady Willingdon Hospital from January 2008– December 2011. Results: Most patients (47.36%) were between 26-30 years age group, presented with gestational age between 36-40 weeks (70.17%), were mostly G2-4, while frequency of placenta Previa in non-scarred uterus was 32.45% (37 cases), and frequency in previously scarred uterus was 67.54% (77 cases). Major degree Previa was found in 88 cases (77.19%). There were 5.70% cases of placenta Previa from non-scarred uteruses and 10.67% cases of placenta Previa (10.67%) from already scarred uteruses. Stratification revealed a higher trend of the morbidity with the increase in number of previous caesarean sections. Conclusion: A significantly higher frequency of placenta Previa was found among patients coming to a tertiary care hospital with previously scarred uterus. PMID:26101491

  4. [Mortality of myocardial infarction].

    PubMed

    Bonnefoy, E; Kirkorian, G

    2011-12-01

    Coronary disease is a major cause of death and disability. From 1975 to 2000, coronary mortality was reduced by half. Better treatments and reduction of risk factors are the main causes. This phenomenon is observed in most developed countries, but mortality from coronary heart disease continues to increase in developing countries. In-hospital mortality of ST elevation myocardial infarction (STEMI) is in the range of 7 to 10% in registries. In infarction without ST segment elevation (NSTEMI), in-hospital mortality is around 5%. More recent studies found a similar in-hospital mortality for STEMI and NSTEMI. Because of patient selection and monitoring, mortality in clinical trials is much lower. After adjustment for the extent of coronary disease, age, risk factors, history of myocardial infarction, the excess mortality observed in women is fading. Many clinical, biological and laboratory parameters are associated with mortality in myocardial infarction. They refer to the immediate risk of death (ventricular rhythm disturbances, shock…), the extent of infarction (number of leads with ST elevation on the ECG, release of biomarkers, ejection fraction…), the presence of heart failure, the failure of reperfusion and the patient's baseline risk (age, renal function…). Risk scores, and more specifically the GRACE risk score, synthesize these different markers to predict the risk of death in a given patient. However, their use for the treatment of myocardial only concerns NSTEMI. Only a limited number of mechanical or pharmacological interventions reduces mortality of heart attack. The main benefits are observed with reperfusion by thrombolysis or primary angioplasty in STEMI, aspirin, heparin, beta-blockers, angiotensin converting enzyme inhibitors. Some medications such as bivalirudin and fondaparinux reduce mortality by decreasing the incidence of hemorrhagic complications. The guidelines classify interventions according to their benefit and especially their ability

  5. Drought and Burn Scars in Southeastern Australia

    NASA Technical Reports Server (NTRS)

    2003-01-01

    More than 2 million acres were consumed by hundreds of fires between December 2002 and February 2003 in southeastern Australia's national parks, forests, foothills and city suburbs. These images were acquired on February 14, 2002 (left) and February 17, 2003 (right) by the Multi-angle Imaging SpectroRadiometer (MISR) instrument onboard NASA's Terra satellite. The year 2002 was one of Australia's hottest and driest on record, and the acreage burnt during the summer 2002-2003 fire season in Victoria, the Australian Capital Territory and southern New South Wales, is the largest since 1938-1939, when more than 3 million acres were scorched.

    The extent of the burnt area and the dry conditions as of February 2003 are indicated by these contrasting false-color views. Both image panels display data from the near-infrared, red and blue spectral bands of MISR's downward-viewing (nadir) camera, as red, green and blue, respectively. This display technique causes healthy vegetation to appear red and burnt areas to show as dark brown. The data displayed from the two dates were processed identically to preserve relative brightness variations. Vegetation changes related to the dry conditions (not related to the brown burn scars) are also indicated in the February 2003 panel, where many previously red areas exhibit instead the pale yellow-brown of the underlying soils and geology. Significant reduction in the surface area of several large and important water bodies are also apparent. The diminished extent of Lake Hume (along the left-hand edge) in the later date provides a good example.

    The Multi-angle Imaging SpectroRadiometer observes the daylit Earth continuously and every 9 days views the entire globe between 82 degrees north and 82 degrees south latitude. These data products were generated from a portion of the imagery acquired during Terra orbits 14999 and 16858. The panels cover an area of about 208 kilometers x 286 kilometers, and utilize data from blocks 118 to

  6. Effectiveness of Onion Extract Gel on Surgical Scars in Asians

    PubMed Central

    Chanprapaph, Kumutnart; Tanrattanakorn, Somsak; Wattanakrai, Penpun; Wongkitisophon, Pranee; Vachiramon, Vasanop

    2012-01-01

    Background. Onion extracts have been shown in vitro to accelerate wound healing. Results from clinical studies on surgical scars in Caucasians were disappointing. The aim of this study is to evaluate the effectiveness of onion extract gel in improving the cosmetic and symptoms of surgical scars in Asians. Patients/Methods. Twenty Asians who had new Pfannenstiel's cesarean section scars were recruited in this prospective double-blinded, split-scar study. Each side was randomly assigned treatment with onion extract gel or placebo at 7 days after surgery. The product was applied three times daily for 12 weeks. Subjects were evaluated at baseline and 4th and 12th weeks. Scar redness was assessed by calorimeter, scar height and pliability were assessed by blinded investigators, and scar symptoms and overall cosmetic improvement were assessed by subjects. Results. Sixteen subjects completed the study. A statistically significant difference between two sides of scar in terms of scar height and scar symptoms was found. There was no statistically significant difference in scar redness, scar pliability, and overall cosmetic appearance between two sides. Conclusions. The early use of topical 12% onion extract gel on Pfannenstiel's cesarean section scar in Asians resulted in the improvement of scar height and scar symptoms. PMID:22924037

  7. Digital representation of oil and natural gas well pad scars in southwest Wyoming: 2012 update

    USGS Publications Warehouse

    Garman, Steven L.; McBeth, Jamie L.

    2015-01-01

    The recent proliferation of oil and natural gas energy development in the Greater Green River Basin of southwest Wyoming has accentuated the need to understand wildlife responses to this development. The location and extent of surface disturbance that is created by oil and natural gas well pad scars are key pieces of information used to assess the effects of energy infrastructure on wildlife populations and habitat. A digital database of oil and natural gas pad scars had previously been generated from 1-meter (m) National Agriculture Imagery Program imagery (NAIP) acquired in 2009 for a 7.7-million hectare (ha) (19,026,700 acres) region of southwest Wyoming. Scars included the pad area where wellheads, pumps, and storage facilities reside and the surrounding area that was scraped and denuded of vegetation during the establishment of the pad. Scars containing tanks, compressors, the storage of oil and gas related equipment, and produced-water ponds were also collected on occasion. This report updates the digital database for the five counties of southwest Wyoming (Carbon, Lincoln, Sublette, Sweetwater, Uinta) within the Wyoming Landscape Conservation Initiative (WLCI) study area and for a limited portion of Fremont, Natrona, and Albany Counties using 2012 1-m NAIP imagery and 2012 oil and natural gas well permit information. This report adds pad scars created since 2009, and updates attributes of all pad scars using the 2012 well permit information. These attributes include the origination year of the pad scar, the number of active and inactive wells on or near each pad scar in 2012, and the overall status of the pad scar (active or inactive). The new 2012 database contains 17,404 pad scars of which 15,532 are attributed as oil and natural gas well pads. Digital data are stored as shapefiles projected to the Universal Transverse Mercator (zones 12 and 13) coordinate system. These data are available from the U.S. Geological Survey (USGS) at http://dx.doi.org/10

  8. Inflammatory markers in ST-elevation acute myocardial infarction.

    PubMed

    Seropian, Ignacio M; Sonnino, Chiara; Van Tassell, Benjamin W; Biasucci, Luigi M; Abbate, Antonio

    2016-08-01

    After acute myocardial infarction, ventricular remodeling is characterized by changes at the molecular, structural, geometrical and functional level that determine progression to heart failure. Inflammation plays a key role in wound healing and scar formation, affecting ventricular remodeling. Several, rather different, components of the inflammatory response were studied as biomarkers in ST-elevation acute myocardial infarction. Widely available and inexpensive tests, such as leukocyte count at admission, as well as more sophisticated immunoassays provide powerful predictors of adverse outcome in patients with ST-elevation acute myocardial infarction. We review the value of inflammatory markers in ST-elevation acute myocardial infarction and their association with ventricular remodeling, heart failure and sudden death. In conclusion, the use of these biomarkers may identify subjects at greater risk of adverse events and perhaps provide an insight into the mechanisms of disease progression. PMID:25681486

  9. Reflectance confocal microscopy for scarring and non-scarring alopecia real-time assessment.

    PubMed

    Ardigò, Marco; Agozzino, Marina; Franceschini, Chiara; Donadio, Carlo; Abraham, Leonardo Spagnol; Barbieri, Luca; Sperduti, Isabella; Berardesca, Enzo; González, Salvador

    2016-07-01

    Clinical management of alopecia represents one of the major issues in dermatology. Scalp biopsies are not easily accepted because of the high bleeding and sensitive anatomical area. Trichoscopy is routinely used for diagnosis of alopecia, but in several cases lack to provide sufficient information on the status of the disease. Recently, reflectance confocal microscopy demonstrated its usefulness for the evaluation of several inflammatory skin condition and preliminary reports about alopecia have been proposed in the literature. The aim was to identify the confocal features characterizing scarring and non-scarring alopecia. Reflectance confocal microscopy from 86 patients affected by scarring (28 lichen planopilaris and 9 lupus erythematosus) and non-scarring alopecia (30 androgenic alopecia and 19 alopecia areata), were retrospectively, blinded evaluated. Good concordance between different readers on the confocal criteria has been assessed. Statistical significant features, specific for scarring alopecia and non-scarring alopecia have been identified. In this study, data on reflectance confocal microscopy features useful for the differential diagnosis between scarring and non-scarring alopecia have been identified. Further studies focusing on the use of this non-invasive technique in the therapeutic follow-up and distinction of sub-entities of alopecia are still required. PMID:27225248

  10. Usefulness of MRI to Differentiate Between Temporary and Long-Term Coronary Artery Occlusion in a Minimally Invasive Model of Experimental Myocardial Infarction

    SciTech Connect

    Abegunewardene, Nico Vosseler, Markus; Gori, Tommaso; Hoffmann, Nico; Schmidt, Kai-Helge; Becker, Dietmar; Kreitner, Karl-Friedrich; Petersen, Steffen E.; Schreiber, Laura M.; Horstick, Georg; Muenzel, Thomas

    2009-09-15

    The surgical technique employed to determine an experimental ischemic damage is a major factor in the subsequent process of myocardial scar development. We set out to establish a minimally invasive porcine model of myocardial infarction using cardiac contrast-enhanced magnetic resonance imaging (ce-MRI) as the basic diagnostic tool. Twenty-seven domestic pigs were randomized to either temporary or permanent occlusion of the left anterior descending artery (LAD). Temporary occlusion was achieved by inflation of a percutaneous balloon in the left anterior descending artery directly beyond the second diagonal branch. Occlusion was maintained for 30 or 45 min, followed by reperfusion. Permanent occlusion was achieved via thrombin injection. Thirteen animals died peri- or postinterventionally due to arrhythmias. Fourteen animals survived the 30-min ischemia (four animals; group 1), the 45-min ischemia (six animals; group 2), or the permanent occlusion (4 animals; group 3). Coronary angiography and ce-MRI were performed 8 weeks after coronary occlusion to document the coronary flow grade and the size of myocardial scar tissue. The LAD was patent in all animals in groups 1 and 2, with normal TIMI flow; in group 3 animals, the LAD was totally occluded. Fibrosis of the left ventricle in group 1 (4.9 {+-} 4.4%; p = 0.008) and group 2 (9.4 {+-} 2.9%; p = 0.05) was significantly lower than in group 3 (14.5 {+-} 3.9%). Wall thickness of the ischemic area was significantly lower in group 3 versus group 1 and group 2 (2.9 {+-} 0.3, 5.9 {+-} 0.7, and 6.1 {+-} 0.7 mm; p = 0.005). The extent of late enhancement of the left ventricle was also significantly higher in group 3 (16.9 {+-} 2.1%) compared to group 1 (5.3 {+-} 5.4%; p = 0.003) and group 2 (9.7 {+-} 3.4%, p = 0.013). In conclusion, the present model of minimally invasive infarction coupled with ce-MRI may represent a useful alternative to the open chest model for studies of myocardial infarction and scar development.

  11. Automatic classification of scar tissue in late gadolinium enhancement cardiac MRI for the assessment of left-atrial wall injury after radiofrequency ablation

    NASA Astrophysics Data System (ADS)

    Perry, Daniel; Morris, Alan; Burgon, Nathan; McGann, Christopher; MacLeod, Robert; Cates, Joshua

    2012-03-01

    Radiofrequency ablation is a promising procedure for treating atrial fibrillation (AF) that relies on accurate lesion delivery in the left atrial (LA) wall for success. Late Gadolinium Enhancement MRI (LGE MRI) at three months post-ablation has proven effective for noninvasive assessment of the location and extent of scar formation, which are important factors for predicting patient outcome and planning of redo ablation procedures. We have developed an algorithm for automatic classification in LGE MRI of scar tissue in the LA wall and have evaluated accuracy and consistency compared to manual scar classifications by expert observers. Our approach clusters voxels based on normalized intensity and was chosen through a systematic comparison of the performance of multivariate clustering on many combinations of image texture. Algorithm performance was determined by overlap with ground truth, using multiple overlap measures, and the accuracy of the estimation of the total amount of scar in the LA. Ground truth was determined using the STAPLE algorithm, which produces a probabilistic estimate of the true scar classification from multiple expert manual segmentations. Evaluation of the ground truth data set was based on both inter- and intra-observer agreement, with variation among expert classifiers indicating the difficulty of scar classification for a given a dataset. Our proposed automatic scar classification algorithm performs well for both scar localization and estimation of scar volume: for ground truth datasets considered easy, variability from the ground truth was low; for those considered difficult, variability from ground truth was on par with the variability across experts.

  12. Evaluating evidence for atrophic scarring treatment modalities

    PubMed Central

    McGrouther, Duncan; Chakrabarty, Kaushik

    2014-01-01

    Summary Introduction Atrophic scars cause significant patient morbidity. Whilst there is evidence to guide treatment, there does not appear to be a systematic review to analyse the efficacy of treatment options. Objectives To retrieve all evidence relating to atrophic scar treatment and evaluate using the Clinical Evidence GRADE score in order to allow clinicians to make evidence-based treatment choices. Method Searches were performed in Medline, EMBASE, CINHL and Cochrane to identify all English studies published evaluating treatment of atrophic scars on adults excluding journal letters. Each study was allocated a GRADE score based on type of study, quality, dose response, consistency of results and significance of results. The end score allowed categorisation of evidence into high, moderate, low or very low quality. Results A total of 41 studies were retrieved from searches including randomised controlled trials, observational studies, retrospective analyses and case reports of which 7% were allocated a high-quality score, 10% a moderate score, 7% a low score and 75% a very low score. Treatment modalities included ablative laser therapy, non-ablative laser therapy, autologous fat transfer, dermabrasion, chemical peels, injectables, subcision, tretinoin iontophoresis and combination therapy. Conclusion There is a paucity of good-quality clinical evidence evaluating treatment modalities for atrophic scarring. Evidence supports efficacy of laser, surgery and peel therapy. Further biomolecular research is required to identify targeted treatment options and more randomised controlled trials would make the evidence base for atrophic scar treatment more robust. PMID:25352991

  13. Fraxelated radiofrequency device for acne scars

    NASA Astrophysics Data System (ADS)

    Rao, Babar K.; Khokher, Sairah

    2012-09-01

    Acne scars can be improved with various treatments such as topical creams, chemical peels, dermal fillers, microdermabrasion, laser, and radiofrequency devices. Some of these treatments especially lasers and deep chemical peels can have significant side effects such as post inflammatory hyperpigmentation in darker skin types. Fraxelated RF Laser devices have been reported to have lower incidence of side effects in all skin phototypes. Nine patients between ages 18 and 35 of various skin phototypes were selected from a private practice and treated with a RF fraxelated device (E-matrix) for acne scars. Outcomes were measured by physician observation, subjective feedback received by patients, and comparison of before and after photographs. In this small group of patients with various skin phototypes, fraxelated radiofrequency device improved acne scars with minimal side effects and downtime.

  14. Pingo scars in the Mission Valley, northwest Montana -- Implications for paleoclimate and the Flathead lobe of the Cordilleran ice sheet

    SciTech Connect

    Levish, D.R.; Klinger, R.E.; Ostenaa, D.A. )

    1993-04-01

    More than 2,000 closed depressions on the floor of the Mission Valley have previously been interpreted as kettles from a late Wisconsin advance of the Flathead lobe of the Cordilleran ice sheet. However, these depressions are encircled by low ridges or ramparts, a distinguishing characteristic of collapsed pingos and pingo scars in areas of active and former permafrost. The morphology of these ramparts, their internal structure, and the complex crosscutting patterns of depressions and ramparts, demonstrate that these closed depressions in the Mission Valley are pingo scars. The pingo scars commonly occur in clusters. Often annular ramparts are truncated by other ramparts and smaller pingo scars are superimposed on larger ones. The scars range in diameter from 20 to 400 m; have circular, oval, and composite shapes; and have ramparts that range in height from 1 to 10 m. South of Ronan, Montana, the density of pingo scars is as high as 50--60/km[sup 2], and pingo scars are associated with relic frost mounds and thermokarst features. A 30-m-long trench excavated across the rampart of a pingo scar exposed laminated silt and clay of glacial Lake Missoula. Upturned beds, recumbent folds, and minor thrust faults record the outward displacement of material during pingo growth. Normal faults cut these compressional features and indicate extension during later pingo collapse. The pingo scars formed in glacial Lake Missoula sediment of the Mission Valley constrain the southern extent of the late Wisconsin advance of the Flathead lobe and document the existence of permafrost following the most recent draining of glacial lake Missoula.

  15. Modifications in vertical scar breast reduction.

    PubMed

    Beer, G M; Morgenthaler, W; Spicher, I; Meyer, V E

    2001-06-01

    The use of vertical-scar breast reduction techniques is only slowly increasing, even though they have been advocated by Lassus and Lejour and are requested by patients. Possible reasons why surgeons are reluctant to use these techniques are that they are said to be more difficult to learn, they require considerable experience and intuition, and their applicability is confined to small breasts. Several surgeons have developed modifications, combining vertical-scar breast reduction techniques with details of the familiar inverted-T-scar technique. We present a procedure involving two further modifications of the vertical-scar breast reduction technique: first, a standardised, geometrical preoperative drawing from our superior-pedicle T technique, with the aim of establishing a reproducible method of reduction requiring no particular intuitive touch, and, second, the addition of a periareolar skin resection, to give the breast the desired round shape. Between September 1998 and December 1999 we used this technique in a prospective series of 52 patients. The median resection weight was 450 g. The maximal postoperative follow-up was 15 months. There were no acute postoperative complications necessitating reoperation. The late complication rate was within the expected range for such procedures (seven patients, 13.5%) and included vertical-scar widening, areolar distortion, residual wrinkles due to incomplete shrinkage of the undermined skin in the inferior pole and asymmetry of the breast. This procedure enables us to offer patients with moderate to marked hypertrophy a reproducible versatile vertical breast reduction technique. The technique is easy to teach and easy to learn, especially for those who are familiar with the superior pedicle inverted-T-scar technique. PMID:11355991

  16. Inflammation and cutaneous nervous system involvement in hypertrophic scarring

    PubMed Central

    Li, Shao-hua; Yang, Heng-lian; Xiao, Hu; Wang, Yi-bing; Wang, De-chang; Huo, Ran

    2015-01-01

    This study aimed to use a mouse model of hypertrophic scarring by mechanical loading on the dorsum of mice to determine whether the nervous system of the skin and inflammation participates in hypertrophic scarring. Results of hematoxylin-eosin and immunohistochemical staining demonstrated that inflammation contributed to the formation of a hypertrophic scar and increased the nerve density in scar tissue.Western blot assay verified that interleukin-13 expression was increased in scar tissue. These findings suggest that inflammation and the cutaneous nervous system play a role in hypertrophic scar formation. PMID:26692869

  17. Downscaling of inundation extents

    NASA Astrophysics Data System (ADS)

    Aires, Filipe; Prigent, Catherine; Papa, Fabrice

    2014-05-01

    The Global Inundation Extent from Multi-Satellite (GIEMS) provides multi-year monthly variations of the global surface water extent at about 25 kmx25 km resolution, from 1993 to 2007. It is derived from multiple satellite observations. Its spatial resolution is usually compatible with climate model outputs and with global land surface model grids but is clearly not adequate for local applications that require the characterization of small individual water bodies. There is today a strong demand for high-resolution inundation extent datasets, for a large variety of applications such as water management, regional hydrological modeling, or for the analysis of mosquitos-related diseases. This paper present three approaches to do downscale GIEMS: The first one is based on a image-processing technique using neighborhood constraints. The third approach uses a PCA representation to perform an algebraic inversion. The PCA-representation is also very convenient to perform temporal and spatial interpolation of complexe inundation fields. The third downscaling method uses topography information from Hydroshed Digital Elevation Model (DEM). Information such as the elevation, distance to river and flow accumulation are used to define a ``flood ability index'' that is used by the downscaling. Three basins will be considered for illustrative purposes: Amazon, Niger and Mekong. Aires, F., F. Papa, C. Prigent, J.-F. Cretaux and M. Berge-Nguyen, Characterization and downscaling of the inundation extent over the Inner Niger delta using a multi-wavelength retrievals and Modis data, J. of Hydrometeorology, in press, 2014. Aires, F., F. Papa and C. Prigent, A long-term, high-resolution wetland dataset over the Amazon basin, downscaled from a multi-wavelength retrieval using SAR, J. of Hydrometeorology, 14, 594-6007, 2013. Prigent, C., F. Papa, F. Aires, C. Jimenez, W.B. Rossow, and E. Matthews. Changes in land surface water dynamics since the 1990s and relation to population pressure

  18. LAD-Ligation: A Murine Model of Myocardial Infarction

    PubMed Central

    Kolk, Mandy V.V.; Meyberg, Danja; Deuse, Tobias; Tang-Quan, Karis R.; Robbins, Robert C.; Reichenspurner, Hermann; Schrepfer, Sonja

    2009-01-01

    Research models of infarction and myocardial ischemia are essential to investigate the acute and chronic pathobiological and pathophysiological processes in myocardial ischemia and to develop and optimize future treatment. Two different methods of creating myocardial ischemia are performed in laboratory rodents. The first method is to create cryo infarction, a fast but inaccurate technique, where a cryo-pen is applied on the surface of the heart (1-3). Using this method the scientist can not guarantee that the cryo-scar leads to ischemia, also a vast myocardial injury is created that shows pathophysiological side effects that are not related to myocardial infarction. The second method is the permanent ligation of the left anterior descending artery (LAD). Here the LAD is ligated with one single stitch, forming an ischemia that can be seen almost immediately. By closing the LAD, no further blood flow is permitted in that area, while the surrounding myocardial tissue is nearly not affected. This surgical procedure imitates the pathobiological and pathophysiological aspects occurring in infarction-related myocardial ischemia. The method introduced in this video demonstrates the surgical procedure of a mouse infarction model by ligating the LAD. This model is convenient for pathobiological and pathophysiological as well as immunobiological studies on cardiac infarction. The shown technique provides high accuracy and correlates well with histological sections. PMID:19829290

  19. Incidence of acute myocardial infarction in patients with exercise-induced silent myocardial ischemia

    SciTech Connect

    Assey, M.E.; Walters, G.L.; Hendrix, G.H.; Carabello, B.A.; Usher, B.W.; Spann, J.F. Jr.

    1987-03-01

    Fifty-five patients with angiographically proved coronary artery disease (CAD) underwent Bruce protocol exercise stress testing with thallium-201 imaging. Twenty-seven patients (group I) showed myocardial hypoperfusion without angina pectoris during stress, which normalized at rest, and 28 patients (group II) had a similar pattern of reversible myocardial hypoperfusion but also had angina during stress. Patients were followed for at least 30 months. Six patients in group I had an acute myocardial infarction (AMI), 3 of whom died, and only 1 patient in group II had an AMI (p = 0.05), and did not die. Silent myocardial ischemia uncovered during exercise stress thallium testing may predispose to subsequent AMI. The presence of silent myocardial ischemia identified in this manner is of prognostic value, independent of angiographic variables such as extent of CAD and left ventricular ejection fraction.

  20. [Autologous Fat Grafting in Scar Revision].

    PubMed

    Yu, Pan-xi; Cai, Jing-long

    2016-04-01

    Regenerative medicine is an emerging discipline. Adipose tissue is a rich source of fat cells and mesenchymal stem cells, and autologous fat grafting has increasingly been applied in plastic surgeries and dermatological treatments. This paper reviews the latest advances in autologous fat grafting in scar revision. PMID:27181904

  1. Will stem cells bring hope to pathological skin scar treatment?

    PubMed

    Li, Qiankun; Zhang, Cuiping; Fu, Xiaobing

    2016-08-01

    Pathological skin scars, such as keloids, aesthetically and psychosocially affect patients. The quest for scar reduction and the increasing recognition of patient satisfaction has led to the continued exploration of scar treatment. Stem cells are a promising source for tissue repair and regeneration. The multi-potency and secretory functions of these cells could offer possible treatments for pathological scars and have been examined in recent studies. Here, we analyze the factors that influence the formation of pathological skin scars, summarize recent research on pathological scar treatment with stem cells and elaborate on the possible mechanisms of this treatment. Additionally, other effects of stem cell treatments are also presented while evaluating potential side effects of stem cell-based pathological scar treatments. Thus, this review may provide meaningful guidance in the clinic for scar treatments with stem cells. PMID:27293205

  2. Thallium-201 myocardial scintigraphy in acute myocardial infarction and ischemia

    SciTech Connect

    Wackers, F.J.

    1982-04-01

    Thallium-201 scintigraphy provides a sensitive and reliable method of detecting acute myocardial infarction and ischemia when imaging is performed with understanding of the temporal characteristics and accuracy of the technique. The results of scintigraphy are related to the time interval between onset of symptoms and time of imaging. During the first 6 hr after chest pain almost all patients with acute myocardial infarction and approximately 50% of the patients with unstable angina will demonstrate /sup 201/TI pefusion defects. Delayed imaging at 2-4 hr will permit distinction between ischemia and infarction. In patients with acute myocardial infarction, the size of the perfusion defect accurately reflects the extent of the infarcted and/or jeopardized myocardium, which may be used for prognostic stratification. In view of the characteristics of /sup 201/TI scintigraphy, the most practical application of this technique is in patients in whom myocardial infarction has to be ruled out, and for early recognition of patients at high risk for complications.

  3. Effect of lipopolysaccharide on the biological characteristics of human skin fibroblasts and hypertrophic scar tissue formation.

    PubMed

    Yang, Hongming; Hu, Chao; Li, Fengyu; Liang, Liming; Liu, Lingying

    2013-06-01

    Burn injury-mediated destruction of the skin barrier normally induces microbial invasion, in turn leading to the development of systemic infection and occasional septic shock by the release of endotoxins. The objective of this work was to study the influence of lipopolysaccharide (LPS) on the biological characteristics of normal skin fibroblasts and to elucidate the influence of LPS in the initial stage of skin wound healing. Twenty patients with hypertrophic scar in proliferative stage were selected randomly and primary cultures were established from fibroblasts derived from their hypertrophic scar tissue and normal skin. Normal skin fibroblasts of passage 3 were stimulated with different concentrations of LPS. LPS stimulated the proliferation and collagen synthesis of fibroblasts within a certain extent of concentrations (0.005-0.5 μg/mL) (P < 0.05), whereas at a concentration of 1 μg/mL inhibited the proliferation and collagen synthesis of fibroblasts (P < 0.05). Collagen synthesis by normal skin fibroblasts after LPS stimulation mimicked those derived from hypertrophic scar tissue. LPS of 0.1 μg/mL had significant effect on normal skin fibroblasts-continuous passage of these fibroblasts resulted in ultrastructural pattern similar to fibroblasts derived from hypertrophic scar tissue, and the findings was substantiated by hematoxylin and eosin staining and immunohistochemistry detection of proliferation cell nuclear antigen, type I procollagen and α-smooth muscle actin. Our results suggest that LPS might convert normal skin fibroblasts to hypertrophic scar tissue fibroblasts and participate in the formation of hypertrophic scar; hence, appropriate concentration of LPS may have no effect or be beneficial to skin wound healing, whereas excessive concentration of LPS may delay the time of wound healing. PMID:23653386

  4. Type 1 procollagen as a marker of severity of scarring after sternotomy: effects of topical corticosteroids.

    PubMed Central

    Riaz, Y; Cook, H T; Wangoo, A; Glenville, B; Shaw, R J

    1994-01-01

    AIMS--To determine whether the abundance of newly formed collagen in healing surgical wounds correlated with scar severity, and whether topical application of steroid cream reduced new collagen formation in patients who have undergone median sternotomy. METHODS--Thirty three patients six weeks after sternotomy, and 12 controls were studied. Scars were photographed, and biopsy specimens from scars at sites treated or untreated with topical corticosteroids (clobetasol proprionate 0.5%) were examined using immunohistochemical staining for type 1 procollagen (PCP 1) and transforming growth factor beta (TGF-beta), and in situ hybridisation for type 1 procollagen messenger RNA (mRNA). RESULTS--The degree of hypertrophy of the scar and the abundance of PCP 1 immunostaining were ranked independently, blind, and a correlation between these two variables was observed (r = 0.604, p < 0.001). The PCP 1 immunostaining was accompanied by a great abundance of PCP 1 mRNA and only a slight increase in TGF-beta immunostaining, when compared with normal skin or mature scars. Following the application of topical corticosteroids, for either 48 hours or twice daily for seven days, there was no reduction in PCP 1 immunostaining nor the abundance of PCP 1 mRNA. CONCLUSIONS--These data suggest that the extent of new collagen formation as assessed by PCP 1 immunohistochemistry may be a useful marker of the exuberance of the scarring process following sternotomy, and that topical corticosteroids are ineffective in reducing this component of the fibrotic response. Images PMID:7962602

  5. A nude mouse model of hypertrophic scar shows morphologic and histologic characteristics of human hypertrophic scar.

    PubMed

    Momtazi, Moein; Kwan, Peter; Ding, Jie; Anderson, Colin C; Honardoust, Dariush; Goekjian, Serge; Tredget, Edward E

    2013-01-01

    Hypertrophic scar (HSc) is a fibroproliferative disorder that occurs following deep dermal injury. Lack of a relevant animal model is one barrier toward better understanding its pathophysiology. Our objective is to demonstrate that grafting split-thickness human skin onto nude mice results in survival of engrafted human skin and murine scars that are morphologically, histologically, and immunohistochemically consistent with human HSc. Twenty nude mice were xenografted with split-thickness human skin. Animals were euthanized at 30, 60, 120, and 180 days postoperatively. Eighteen controls were autografted with full-thickness nude mouse skin and euthanized at 30 and 60 days postoperatively. Scar biopsies were harvested at each time point. Blinded scar assessment was performed using a modified Manchester Scar Scale. Histologic analysis included hematoxylin and eosin, Masson's trichrome, toluidine blue, and picrosirius red staining. Immunohistochemistry included anti-human human leukocyte antigen-ABC, α-smooth muscle actin, decorin, and biglycan staining. Xenografted mice developed red, shiny, elevated scars similar to human HSc and supported by blinded scar assessment. Autograft controls appeared morphologically and histologically similar to normal skin. Xenografts survived up to 180 days and showed increased thickness, loss of hair follicles, adnexal structures and rete pegs, hypercellularity, whorled collagen fibers parallel to the surface, myofibroblasts, decreased decorin and increased biglycan expression, and increased mast cell density. Grafting split-thickness human skin onto nude mice results in persistent scars that show morphologic, histologic, and immunohistochemical consistency with human HSc. Therefore, this model provides a promising technique to study HSc formation and to test novel treatment options. PMID:23126488

  6. The Use of Silicone Adhesives for Scar Reduction

    PubMed Central

    Bleasdale, Benjamin; Finnegan, Simon; Murray, Kathyryn; Kelly, Sean; Percival, Steven L.

    2015-01-01

    Significance: This article discusses the history and developments of silicone gel sheeting (SGS) scar therapy. Furthermore, we review a breadth of literature to gain an insight into how and why topical silicone gels remain the favored treatment of medical experts in scar management. We also analyze an ever increasing number of alternative therapies claiming to provide enhanced scar reduction performance. Recent Advances: Topical silicone gel treatments seem to remain the first point of clinical recommendation in scar management. SGS has been used in scar therapy for over 30 years, during which its efficacy has been the subject of numerous clinical evaluations. Critical Issues: While the exact mechanisms by which SGS improves hypertrophic scars, keloid development and recovery are yet to be fully agreed upon, its ability to do so remains largely undisputed at present. However, there still is ongoing deliberation over the exact mechanism of action of silicone in improving a scar. At present it is likely that through occlusion of the scar site and hydration of the wound bed, the overactivity of scar-related cells is suppressed, and their activity normalized. Future Direction: The clinical support of topical silicone gel products, relative to all alternative scar therapies, is considered the internationally recommended first-line form of scar management, and favored by consensus among healthcare professionals. However, there still remains the need for further clinical evidence and a better understanding of the mechanism behind the benefit of silicone gel for use in the prevention of abnormal scarring. PMID:26155385

  7. Scar formation and revision after the removal of orthodontic miniscrews

    PubMed Central

    Choi, Yoon Jeong; Lee, Dong-Won; Kim, Kyung-Ho

    2015-01-01

    Many clinicians expect complete healing after the removal of temporary anchorage devices, but clinical examination may reveal scar-like tissue. This report presents the typical features of scarring detected after the removal of miniscrews, and the clinical outcome of scar revision along with its pathologic features. PMID:26023543

  8. A Rat Excised Larynx Model of Vocal Fold Scar

    ERIC Educational Resources Information Center

    Welham, Nathan V.; Montequin, Douglas W.; Tateya, Ichiro; Tateya, Tomoko; Choi, Seong Hee; Bless, Diane M.

    2009-01-01

    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…

  9. Combination Therapy in the Management of Atrophic Acne Scars

    PubMed Central

    Garg, Shilpa; Baveja, Sukriti

    2014-01-01

    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. PMID:24761094

  10. Analysis of healing after myocardial infarction using polarized light microscopy.

    PubMed Central

    Whittaker, P.; Boughner, D. R.; Kloner, R. A.

    1989-01-01

    To better understand the healing process after permanent coronary artery occlusion in a canine model, the authors used polarized light microscopy. At 6 weeks after occlusion the scar collagen was mainly type I. Some regions of the scar contained a fiber lattice which appeared to be type III collagen. Collagen orientation was measured using a universal stage; subepicardial collagen was obliquely aligned (-14.0 +/- 3.5 degrees), midmyocardial collagen circumferentially aligned (1.4 +/- 0.4 degrees) and subendocardial collagen obliquely aligned (12.7 +/- 2.1 degrees). The molecular organization of scar collagen increased from 1 to 6 weeks after occlusion. Muscle cell disarray, similar to that in hypertrophic cardiomyopathy, was seen in the viable muscle adjacent to the scar. Such abnormal organization extended as far as 1 cm from the edge of the scar. The ability of polarized light microscopy to assess these different parameters from histologic sections demonstrates that it is a useful adjunct to other methods commonly used to study myocardial healing. Images p[889]-a Figure 7 Figure 1 p883-a Figure 6 PMID:2705508

  11. Prognostic Significance of Imaging Myocardial Sympathetic Innervation.

    PubMed

    Malhotra, Saurabh; Fernandez, Stanley F; Fallavollita, James A; Canty, John M

    2015-08-01

    There has been a longstanding interest in understanding whether the presence of inhomogeneity in myocardial sympathetic innervation can predict patients at risk of sudden cardiac arrest from lethal ventricular arrhythmias. The advent of radiolabeled norepinephrine analogs has allowed this to be imaged in patients with ischemic and non-ischemic cardiomyopathy using single, photon emission computed tomography (SPECT) and positron emission tomography (PET). Several observational studies have demonstrated that globally elevated myocardial sympathetic tone (as reflected by reduced myocardial norepinephrine analog uptake) can predict composite cardiac end-points including total cardiovascular mortality. More recent studies have indicated that quantifying the extent of regional denervation can predict the risk of lethal ventricular arrhythmias and sudden cardiac death. This review will summarize our current understanding of the prognostic significance of altered myocardial sympathetic innervation. PMID:26087899

  12. PET: Is myocardial flow quantification a clinical reality?

    PubMed

    Saraste, Antti; Kajander, Sami; Han, Chunlei; Nesterov, Sergey V; Knuuti, Juhani

    2012-10-01

    Positron emission tomography (PET) enables quantitative measurements of myocardial blood flow (MBF) and myocardial flow reserve (MFR). Recent developments and improved availability of PET technology have resulted in growing interest in translation of quantitative flow analysis from mainly a research tool to routine clinical practice. Quantitative PET measurements of absolute MBF and MFR have potential to improve accuracy of myocardial perfusion imaging in diagnosis of multivessel coronary artery disease as well as definition of the extent and functional importance of stenoses. This article reviews recent advances and experience in the quantitative myocardial perfusion imaging together with issues that need to be resolved for quantitative analysis to become clinical reality. PMID:22733534

  13. Intracoronary Cardiosphere-Derived Cells After Myocardial Infarction

    PubMed Central

    Malliaras, Konstantinos; Makkar, Raj R.; Smith, Rachel R.; Cheng, Ke; Wu, Edwin; Bonow, Robert O.; Marbán, Linda; Mendizabal, Adam; Cingolani, Eugenio; Johnston, Peter V.; Gerstenblith, Gary; Schuleri, Karl H.; Lardo, Albert C.; Marbán, Eduardo

    2013-01-01

    Objectives This study sought to report full 1-year results, detailed magnetic resonance imaging analysis, and determinants of efficacy in the prospective, randomized, controlled CADUCEUS (CArdiosphere-Derived aUtologous stem CElls to reverse ventricUlar dySfunction) trial. Background Cardiosphere-derived cells (CDCs) exerted regenerative effects at 6 months in the CADUCEUS trial. Complete results at the final 1-year endpoint are unknown. Methods Autologous CDCs (12.5 to 25 × 106) grown from endomyocardial biopsy specimens were infused via the intracoronary route in 17 patients with left ventricular dysfunction 1.5 to 3 months after myocardial infarction (MI) (plus 1 infused off-protocol 14 months post-MI). Eight patients were followed as routine-care control patients. Results In 13.4 months of follow-up, safety endpoints were equivalent between groups. At 1 year, magnetic resonance imaging revealed that CDC-treated patients had smaller scar size compared with control patients. Scar mass decreased and viable mass increased in CDC-treated patients but not in control patients. The single patient infused 14 months post-MI responded similarly. CDC therapy led to improved regional function of infarcted segments compared with control patients. Scar shrinkage correlated with an increase in viability and with improvement in regional function. Scar reduction correlated with baseline scar size but not with a history of temporally remote MI or time from MI to infusion. The changes in left ventricular ejection fraction in CDC-treated subjects were consistent with the natural relationship between scar size and ejection fraction post-MI. Conclusions Intracoronary administration of autologous CDCs did not raise significant safety concerns. Preliminary indications of bioactivity include decreased scar size, increased viable myocardium, and improved regional function of infarcted myocardium at 1 year post-treatment. These results, which are consistent with therapeutic regeneration

  14. Biology and principles of scar management and burn reconstruction.

    PubMed

    Tredget, Edward E; Levi, Benjamin; Donelan, Matthias B

    2014-08-01

    Hypertrophic scarring is extremely common and is the source of most morbidity related to burns. The biology of hypertrophic healing is complex and poorly understood. Multiple host and injury factors contribute, but protracted healing of partial thickness injury is a common theme. Hypertrophic scarring and heterotopic ossification may share some basic causes involving marrow-derived cells. Several traditional clinical interventions exist to modify hypertrophic scar. All have limited efficacy. Laser interventions for scar modification show promise, but as yet do not provide a definitive solution. Their efficacy is only seen when used as part of a multimodality scar management program. PMID:25085089

  15. CARDIOVASCULAR MAGNETIC RESONANCE IMAGING IN DELIVERING AND EVALUATING THE EFFICACY OF HEPATOCYTE GROWTH FACTOR GENE IN CHRONIC INFARCT SCAR

    PubMed Central

    Saeed, Maythem; Saloner, David; Do, Loi; Wilson, Mark; Martin, Alastair

    2012-01-01

    Background In open-chest model of acute infarct, epicardial delivery of hepatocyte growth factor (HGF) gene improved LV function. This study was designed to test 1) the efficacy of HGF gene in infarct scar delivered under MR guidance and 2) the potential of multiple MR sequences in assessing the effects of pCK-HGF (treatment) and pCK-LacZ (control) genes on myocardial structure and function. Methods and Materials Swine (6 per group) were subjected to myocardial infarct, under X-ray fluoroscopy, developed LV remodelling at 5weeks. Multiple clinical MR imaging sequences were performed before delivery of gene (at 5 weeks after infarction) and 5 weeks after delivery of gene. Under MR-guidance, the active endovascular catheter was introduced into LV to transendocardially deliver 3.96×1011 viral copies of pCK-HGF or pCK-LacZ in the border and core of the infarct scar. Histological evaluation of the infarct scar was performed 5 weeks after delivery of gene. Results At 5weeks after infarction, there was no significant difference in measured cardiovascular MR parameters between the groups. PCK-HGF gene caused significant improvement in the following parameters (P<0.05 for these parameters): 3D strain (radial, circumferential, and longitudinal) , perfusion (maximum upslope, peak signal intensity, and time to peak) compared with control pCK-LacZ at 5 weeks after delivery of the genes. The ejection fraction was higher in pCK-HGF treated (43±1%) than pCK-LacZ control (37±1%, P<0.05). These changes are associated with a decrease in infarct scar size (11.3±2.0% in pCK-LacZ control and 6.7±1.3%, in pCK-HGF treated, P<0.01) and transmurality in 4 out of 5 infarct scar segments (P<0.05) on DE-MR imaging. Microscopic study confirmed the increase in capillary (P<0.05), and arteriole (P<0.05) density of infarct scar in pCK-HGF treated compared with pCK-LacZ control animals. Conclusions HGF gene delivered under MR-guidance into infarct scar ameliorated global function, 3D strain

  16. Suppressed inflammatory gene expression during human hypertrophic scar compared to normotrophic scar formation.

    PubMed

    van den Broek, Lenie J; van der Veer, Willem M; de Jong, Etty H; Gibbs, Susan; Niessen, Frank B

    2015-08-01

    Hypertrophic scar formation is a result of adverse cutaneous wound healing. The pathogenesis of hypertrophic scar formation is still poorly understood. A problem next to the lack of suitable animal models is that often normal skin is compared to hypertrophic scar (HTscar) and not to normotrophic scar (NTscar) tissue. Another drawback is that often only one time period after wounding is studied, while scar formation is a dynamic process over a period of several months. In this study, we compared the expression of genes involved in inflammation, angiogenesis and extracellular matrix (ECM) formation and also macrophage infiltration in biopsies obtained before and up to 52 weeks after standard surgery in five patients who developed HTscar and six patients who developed NTscar. It was found that HTscar formation coincided with a prolonged decreased expression of inflammatory genes (TNFα, IL-1α, IL-1RN, CCL2, CCL3, CXCL2, CXCR2, C3 and IL-10) and an extended increased expression of ECM-related genes (PLAU, Col3A1, TGFβ3). This coincided with a delayed but prolonged infiltration of macrophages (type 2) in HTscar tissue compared to NTscar tissue. These findings were supported by immunohistochemical localization of proteins coding for select genes named above. Our study emphasizes that human cutaneous wound healing is a dynamic process that is needed to be studied over a period of time rather than a single point of time. Taken together, our results suggest innate immune stimulatory therapies may be a better option for improving scar quality than the currently used anti-inflammatory scar therapies. PMID:25939875

  17. Current options for the treatment of pathological scarring.

    PubMed

    Poetschke, Julian; Gauglitz, Gerd G

    2016-05-01

    Scarring is the consequence of surgery, trauma or different skin diseases. Apart from fresh, immature scars,that transform into mature scars over the course of would healing and that do not require further treatment,linear hypertrophic scars, widespread hypertrophic scars, keloids and atrophic scars exist. Symptoms like pruritusand pain, stigmatization as well as functional and aesthetic impairments that are very disturbing for the affected patients can bethe basis for the desire for treatment. Today, a multitude of options for the treatment and prevention of scars exists. Topical agents based on silicone or onion extract, intralesional injections of cristalline glucocorticoids (oftentimes in combinationwith cryotherapy) or 5-Fluorouracil as well as ablative and nonablative laser treatment are used. Current guidelines summarize the multitude of available treatment options and the currently available datafor the treating physicians, allowing them to make clear therapy recommendations for every single scar type. Relieving patients of their discomfort and doing their aesthetic demands justice is thus possible. Apart from scar prevention becoming more and more important, the increased use of modernlaser treatment options constitutes a key point in clinical scar treatment. At the same time the attention is turned to evaluating current therapeutic options with the help of contemporary study designs so as to graduallyimprove the level of evidence in scar treatment. PMID:27119465

  18. Granuloma annulare in herpes zoster scars.

    PubMed

    Ohata, C; Shirabe, H; Takagi, K; Kawatsu, T

    2000-03-01

    A 54-year-old Japanese female developed granuloma annulare twice in herpes zoster scars. Soon after the second event, she developed ulcerative colitis, which was well controlled by sulfonamides and corticosteroid suppository. She had no history of diabetes mellitus. There was no recurrence of granuloma annulare by June of 1999. Granuloma annulare might have contributed to the complications of ulcerative colitis, although this had not been noticed before. PMID:10774142

  19. Umbilical scarring in hatchling American alligators

    USGS Publications Warehouse

    Wiebe, J.J.; Sepulveda, M.S.; Buckland, J.E.; Anderson, S.R.; Gross, T.S.

    2004-01-01

    Umbilical scarring is the presence of excess scar tissue deposited between abdominal dermal layers at the site of yolk sac absorption in hatchling American alligators (Alligator mississippiensis). The presence of this dermal condition plays a key evaluatory role in the overall quality and subsequent value for various commercial leather products. Despite the prevalent nature of this condition, currently the industry has no standardized protocols for its quantification. The objectives of this study were to examine the relationship between hatchling weight and age and incidence of umbilical scarring and to develop a quantifiable and reproducible technique to measure this dermal condition in hatchling American alligators. Thirty eggs from each of nine clutches were incubated in two separate incubators at different facilities and hatchling umbilical scarring was measured at 2 and 10 days of age using digital calipers. Umbilical area was calculated by multiplying umbilical length times umbilical width. There was a significant effect of both age and clutch on umbilical area (overall decline of 64%) by 10 days post-hatch. However, only five of the nine clutches utilized expressed a noticeable decline in the size of this dermal condition (range 67-74%). We had hypothesized that larger hatchlings would have larger umbilical areas and a slower rate of improvement in this condition during the first few days post-hatch. The differences in umbilical area and percent decline with age across clutches, however, were not associated with differences in initial hatchling weights. Within clutches and time periods, hatchling weight had no significant effect on the size and/or rate of decline of this condition. ?? 2004 Published by Elsevier B.V.

  20. Caesarean scar ectopic pregnancy: a case report

    PubMed Central

    Edwards, Hazel; Heggs, Karen; White, Donna

    2013-01-01

    This case study discusses a recent diagnosis of a rare form of ectopic pregnancy within a Caesarean section scar. Evidence indicates that the prevalence of this form of ectopic pregnancy is escalating due to the increasing number of Caesarean sections performed. As ultrasound plays a major role in diagnosing this rare life-threatening condition, we recommend key points for practitioners to consider for meticulous assessment and accurate diagnosis. PMID:27433207

  1. Scars of symmetries in quantum chaos

    SciTech Connect

    Delande, D.; Gay, J.C.

    1987-10-19

    The hydrogen atom in a magnetic field is a classically chaotic Hamiltonian system. The energy-level fluctuations have been shown recently to obey a random-matrix model. Here we go beyond the statistical analysis by studying the destruction of the low-field dynamical symmetries. We especially establish the existence of scars of symmetries in the chaotic regime. The symmetry properties are no longer associated with one given level, but fractalized onto clusters of levels, generating a long-range order.

  2. Optimizing benefit from CRT: role of speckle tracking echocardiography, the importance of LV lead position and scar.

    PubMed

    Kydd, Anna C; McCormick, Liam M; Dutka, David P

    2012-09-01

    Cardiac resynchronization therapy is demonstrated to be effective in patients with advanced heart failure. Correcting mechanical dyssynchrony is proposed as the predominant mechanism of response. Achieving optimum left ventricular lead position, at the site of maximal mechanical dyssynchrony but away from transmural scar, is identified as one of the main determinants of both symptomatic and prognostic benefit. Strategies employing multimodality cardiac imaging techniques have been used to identify this optimal pacing site, in addition to any potential anatomical limitations to successful implantation. Speckle tracking echocardiography offers prospective lead targeting, incorporating pathophysiological determinants of cardiac resynchronization therapy response. This review considers the key factors in defining optimum left ventricular lead location, emphasizing the role of myocardial scar. The use of speckle tracking echocardiography and the potential for this technique to be incorporated into routine practice to guide the implant strategy in an individual patient is discussed. PMID:23116079

  3. SPARC mediates early extracellular matrix remodeling following myocardial infarction

    PubMed Central

    McCurdy, Sarah M.; Dai, Qiuxia; Zhang, Jianhua; Zamilpa, Rogelio; Ramirez, Trevi A.; Dayah, Tariq; Nguyen, Nguyen; Jin, Yu-Fang; Bradshaw, Amy D.

    2011-01-01

    Secreted protein, acidic, and rich in cysteine (SPARC) is a matricellular protein that functions in the extracellular processing of newly synthesized collagen. Collagen deposition to form a scar is a key event following a myocardial infarction (MI). Because the roles of SPARC in the early post-MI setting have not been defined, we examined age-matched wild-type (WT; n=22) and SPARC-deficient (null; n=25) mice at day 3 post-MI. Day 0 WT (n=28) and null (n=20) mice served as controls. Infarct size was 52 ± 2% for WT and 47 ± 2% for SPARC null (P=NS), indicating that the MI injury was comparable in the two groups. By echocardiography, WT mice increased end-diastolic volumes from 45 ± 2 to 83 ± 5 μl (P < 0.05). SPARC null mice also increased end-diastolic volumes but to a lesser extent than WT (39 ± 3 to 63 ± 5 μl; P < 0.05 vs. day 0 controls and vs. WT day 3 MI). Ejection fraction fell post-MI in WT mice from 57 ± 2 to 19 ± 1%. The decrease in ejection fraction was attenuated in the absence of SPARC (65 ± 2 to 28 ± 2%). Fibroblasts isolated from SPARC null left ventricle (LV) showed differences in the expression of 22 genes encoding extracellular matrix and adhesion molecule genes, including fibronectin, connective tissue growth factor (CTGF; CCN2), matrix metalloproteinase-3 (MMP-3), and tissue inhibitor of metalloproteinase-2 (TIMP-2). The change in fibroblast gene expression levels was mirrored in tissue protein extracts for fibronectin, CTGF, and MMP-3 but not TIMP-2. Combined, the results of this study indicate that SPARC deletion preserves LV function at day 3 post-MI but may be detrimental for the long-term response due to impaired fibroblast activation. PMID:21602472

  4. Tomoscintigraphic assessment of myocardial metabolic heterogenity

    SciTech Connect

    Roesler, H.; Hess, T.; Weiss, M.; Noelpp, U.; Mueller, G.; Hoeflin, F.; Kinser, J.

    1983-04-01

    I-123-omega-heptadecanoic acid (HDA) was evaluated for myocardial scanning in 59 healthy volunteers and 133 patients, using a 7-pinhole collimator. Early (uptake) and late (retention) images were compared visually. Regional HDA elimination was also followed semiquantitatively based on the calculation of a retention-over-uptake ratio, R(phi), derived from the maximal counts/pixel in 60 midventricular slice sectors. The healthy heart concentrated HDA homogeneously in all segments with no difference between early and late images. The minimal R(phi), taken as representative of that myocardium with the best function, was unchanged after maximal ergometer stress and with dipyramidole-induced hyperperfusion. A circumscribed decreased HDA uptake is the clear-cut criterion for an abnormal finding. HDA tomography of the myocardium had an 86% sensitivity for myocardial infarcts (MIs) up to 4 wk old, and 83% for myocardial scars (MSs). Comparing early and late tomograms, we find a cool-warm sequence more often with acute and subacute MIs. A cool-cool or a cold-cold sequence dominated with MSs. HDA tomoscintigraphy cannot replace TI-201 for the evaluation of regional coronary reserve in coronary heart disease.

  5. Relationship between myocardial bridging and coronary arteriosclerosis.

    PubMed

    Sun, Jian Ling; Huang, Wei Min; Guo, Ji Hong; Li, Xiao Ying; Ma, Xian Lin; Wang, Chong Yu

    2013-04-01

    The objective of the study was to explore the prevalence and characteristics of myocardial bridging in patients who underwent coronary angiography and to also evaluate the correlation between bridged coronary segments and atherosclerosis. For this purpose, clinical materials of 1,500 patients who had received coronary angiography were retrospectively analyzed. The location and length of the myocardial bridge were recorded as well as the extent and location of coronary artery stenosis was described. Segments proximal and distal to the bridging were evaluated for coronary arteriosclerosis as were the remaining coronary segments. We found that myocardial bridging was present in 179 (11.9 %) patients. Bridges were frequently (84.9 %) localized in the mid-distal segment of the left anterior descending (LAD) artery. Myocardial bridging was not considered a significant risk factor for coronary atherosclerosis (odds ratio 0.58) compared with traditional cardiovascular risk factors. The incidence of coronary arteriosclerosis in the distal segments was significantly less affected than the proximal segments (P < 0.01). It was, therefore, concluded that myocardial bridging frequently localized in the mid-distal segment of the LAD artery. The presence of myocardial bridging promotes proximal atherosclerosis but it is not an additional risk factor for coronary atherosclerosis. PMID:23076634

  6. Myocardial imaging. Coxsackie myocarditis

    SciTech Connect

    Wells, R.G.; Ruskin, J.A.; Sty, J.R.

    1986-09-01

    A 3-week-old male neonate with heart failure associated with Coxsackie virus infection was imaged with Tc-99m PYP and TI-201. The abnormal imaging pattern suggested myocardial infarction. Autopsy findings indicated that the cause was myocardial necrosis secondary to an acute inflammatory process. Causes of abnormal myocardial uptake of Tc-99m PYP in pediatrics include infarction, myocarditis, cardiomyopathy, bacterial endocarditis, and trauma. Myocardial imaging cannot provide a specific cause diagnosis. Causes of myocardial infarction in pediatrics are listed in Table 1.

  7. [Quantitative evaluation of acute myocardial infarction by In-111 antimyosin Fab myocardial imaging].

    PubMed

    Naruse, H; Morita, M; Itano, M; Yamamoto, J; Kawamoto, H; Fukutake, N; Ohyanagi, M; Iwasaki, T; Fukuchi, M

    1991-11-01

    For quantitative evaluation of acute myocardial infarction, In-111 antimyosin Fab myocardial imaging (InAM) was performed in 17 patients with myocardial infarction who underwent Tl-201 (TL) and Tc-99m pyrophosphate (PYP) myocardial imaging in acute phase. For calculating the infarct size, voxel counter method was used for analysis in PYP and InAM, and extent and severity score were used on bull's-eye polar map in TL. The most appropriate cut-off level ranged from 65 to 80% by the fundamental experiment using cardiac phantom. The cut-off level of 0.70 (InAM) and 0.65 (PYP) were used for clinical application of voxel counter analysis. The infarct size calculated by InAM and PYP was compared with wall motion abnormality index by echocardiography (WMAI), TL extent score, TL severity score, peak CK and sigma CK. Infarct size by InAM showed the following correlations with other indices. PYP: r = 0.26 (ns), TL extent score: r = 0.72 (p less than 0.01), TL severity score: r = 0.65 (p less than 0.05), WMAI: r = 0.69 (p less than 0.05). The infarct size by PYP did not show any correlations with these indices. Therefore, the infarct size by InAM showed better correlations with TL and WMAI than that of PYP. So InAM was considered superior to PYP for quantitative evaluation of acute myocardial infarction. PMID:1770642

  8. Scar Management in the Pediatric and Adolescent Populations.

    PubMed

    Krakowski, Andrew C; Totri, Christine R; Donelan, Matthias B; Shumaker, Peter R

    2016-02-01

    For most children and adolescents who have developed symptomatic scars, cosmetic concerns are only a portion of the motivation that drives them and their caregivers to obtain treatment. In addition to the potential for cosmetic disfigurement, scars may be associated with a number of physical comorbidities including hypertrichosis, dyshidrosis, tenderness/pain, pruritus, dysesthesias, and functional impairments such as contractures, all of which may be compounded by psychosocial factors. Although a plethora of options for treating scars exists, specific management guidelines for the pediatric and adolescent populations do not, and evidence must be extrapolated from adult studies. New modalities such as the scar team approach, autologous fat transfer, and ablative fractional laser resurfacing suggest a promising future for children who suffer symptomatically from their scars. In this state-of-the-art review, we summarize cutting-edge scar treatment strategies as they relate to the pediatric and adolescent populations. PMID:26743819

  9. Analysis of state of vehicular scars on Arctic Tundra, Alaska

    NASA Technical Reports Server (NTRS)

    Lathram, E. H.

    1974-01-01

    Identification on ERTS images of severe vehicular scars in the northern Alaska tundra suggests that, if such scars are of an intensity or have spread to a dimension such that they can be resolved by ERTS sensors (20 meters), they can be identified and their state monitored by the use of ERTS images. Field review of the state of vehicular scars in the Umiat area indicates that all are revegetating at varying rates and are approaching a stable state.

  10. [Scarring linear IgA dermatosis in the adult].

    PubMed

    Kurz, K; Mahrle, G

    1986-10-15

    A 54-year-old woman had a six-months history of a scarring blistering disease with clinical signs of dermatitis herpetiformis and bullous pemphigoid. Direct immunofluorescence examination showed homogeneously linear deposits of IgA along the dermo-epidermal junction. Electron microscopic studies revealed blistering above and beneath the lamina densa. Referring to this new case of a scarring linear IgA disease we discuss some other forms of scarring bullous diseases in adults. PMID:3541412

  11. Role of the lesion scar in the response to damage and repair of the central nervous system.

    PubMed

    Kawano, Hitoshi; Kimura-Kuroda, Junko; Komuta, Yukari; Yoshioka, Nozomu; Li, Hong Peng; Kawamura, Koki; Li, Ying; Raisman, Geoffrey

    2012-07-01

    Traumatic damage to the central nervous system (CNS) destroys the blood-brain barrier (BBB) and provokes the invasion of hematogenous cells into the neural tissue. Invading leukocytes, macrophages and lymphocytes secrete various cytokines that induce an inflammatory reaction in the injured CNS and result in local neural degeneration, formation of a cystic cavity and activation of glial cells around the lesion site. As a consequence of these processes, two types of scarring tissue are formed in the lesion site. One is a glial scar that consists in reactive astrocytes, reactive microglia and glial precursor cells. The other is a fibrotic scar formed by fibroblasts, which have invaded the lesion site from adjacent meningeal and perivascular cells. At the interface, the reactive astrocytes and the fibroblasts interact to form an organized tissue, the glia limitans. The astrocytic reaction has a protective role by reconstituting the BBB, preventing neuronal degeneration and limiting the spread of damage. While much attention has been paid to the inhibitory effects of the astrocytic component of the scars on axon regeneration, this review will cover a number of recent studies in which manipulations of the fibroblastic component of the scar by reagents, such as blockers of collagen synthesis have been found to be beneficial for axon regeneration. To what extent these changes in the fibroblasts act via subsequent downstream actions on the astrocytes remains for future investigation. PMID:22362507

  12. Repair of acne scars with Dermicol-P35.

    PubMed

    Smith, Kevin C

    2009-01-01

    Acne vulgaris is a prevalent skin condition that can cause disfiguring residual scarring. While the complete removal of acne scars is unlikely, several treatments exist that can improve the appearance of acne scars. Dermal fillers offer a simple, nonsurgical corrective procedure that can provide improved skin texture. Dermicol-P35 (Evolence [Ortho Dermatologics, Skillman, NJ]) is a new, highly purified, ribose cross-linked, porcine collagen-based dermal filler that has demonstrated low immunogenicity and results that persist for at least 12 months. This article presents the aesthetic results of a male patient treated with Dermicol-P35 for severe facial acne scars. PMID:19577176

  13. CNS Injury, Glial Scars, and Inflammation

    PubMed Central

    Fitch, Michael T.; Silver, Jerry

    2008-01-01

    Spinal cord and brain injuries lead to complex cellular and molecular interactions within the central nervous system in an attempt to repair the initial tissue damage. Many studies have illustrated the importance of the glial cell response to injury, and the influences of inflammation and wound healing processes on the overall morbidity and permanent disability that result. The abortive attempts of neuronal regeneration after spinal cord injury are influenced by inflammatory cell activation, reactive astrogliosis and the production of both growth promoting and inhibitory extracellular molecules. Despite the historical perspective that the glial scar was a mechanical barrier to regeneration, inhibitory molecules in the forming scar and methods to overcome them have suggested molecular modification strategies to allow neuronal growth and functional regeneration. Unlike myelin associated inhibitory molecules, which remain at largely static levels before and after central nervous system trauma, inhibitory extracellular matrix molecules are dramatically upregulated during the inflammatory stages after injury providing a window of opportunity for the delivery of candidate therapeutic interventions. While high dose methylprednisolone steroid therapy alone has not proved to be the solution to this difficult clinical problem, other strategies for modulating inflammation and changing the make up of inhibitory molecules in the extracellular matrix are providing robust evidence that rehabilitation after spinal cord and brain injury has the potential to significantly change the outcome for what was once thought to be permanent disability. PMID:17617407

  14. Recognition of Fibrotic Infarct Density by the Pattern of Local Systolic-Diastolic Myocardial Electrical Impedance

    PubMed Central

    Amorós-Figueras, Gerard; Jorge, Esther; García-Sánchez, Tomás; Bragós, Ramón; Rosell-Ferrer, Javier; Cinca, Juan

    2016-01-01

    Myocardial electrical impedance is a biophysical property of the heart that is influenced by the intrinsic structural characteristics of the tissue. Therefore, the structural derangements elicited in a chronic myocardial infarction should cause specific changes in the local systolic-diastolic myocardial impedance, but this is not known. This study aimed to characterize the local changes of systolic-diastolic myocardial impedance in a healed myocardial infarction model. Six pigs were successfully submitted to 150 min of left anterior descending (LAD) coronary artery occlusion followed by reperfusion. 4 weeks later, myocardial impedance spectroscopy (1–1000 kHz) was measured at different infarction sites. The electrocardiogram, left ventricular (LV) pressure, LV dP/dt, and aortic blood flow (ABF) were also recorded. A total of 59 LV tissue samples were obtained and histopathological studies were performed to quantify the percentage of fibrosis. Samples were categorized as normal myocardium (<10% fibrosis), heterogeneous scar (10–50%) and dense scar (>50%). Resistivity of normal myocardium depicted phasic changes during the cardiac cycle and its amplitude markedly decreased in dense scar (18 ± 2 Ω·cm vs. 10 ± 1 Ω·cm, at 41 kHz; P < 0.001, respectively). The mean phasic resistivity decreased progressively from normal to heterogeneous and dense scar regions (285 ± 10 Ω·cm, 225 ± 25 Ω·cm, and 162 ± 6 Ω·cm, at 41 kHz; P < 0.001 respectively). Moreover, myocardial resistivity and phase angle correlated significantly with the degree of local fibrosis (resistivity: r = 0.86 at 1 kHz, P < 0.001; phase angle: r = 0.84 at 41 kHz, P < 0.001). Myocardial infarcted regions with greater fibrotic content show lower mean impedance values and more depressed systolic-diastolic dynamic impedance changes. In conclusion, this study reveals that differences in the degree of myocardial fibrosis can be detected in vivo by local measurement of phasic systolic

  15. Preoperative prediction of reversible myocardial asynergy by postexercise radionuclide ventriculography

    SciTech Connect

    Rozanski, A.; Berman, D.; Gray, R.; Diamond, G.; Raymond, M.; Prause, J.; Maddahi, J.; Swan, H.J.; Matloff, J.

    1982-07-22

    Myocardial asynergy is sometimes reversed by coronary bypass, and a noninvasive method of predicting which assess are reversible would be desirable. To assess whether changes in myocardial wall motion observed immediately after exercise can differentiate reversible from nonreversible myocardial asynergy, we evaluated 53 patients by radionuclide ventriculography before and after exercise and again at rest after coronary bypass surgery. Preoperative improvement in wall motion immediately after exercise was highly predictive of the surgical outcome (average chance-corrected agreement, 91 per cent). At surgery the asynergic segments that had improved after exercise were free of grossly apparent epicardial scarring. The accuracy of these predictions for postoperative improvement was significantly greater (P less than 0.01) than that of analysis of Q waves on resting electrocardiography (average chance-corrected agreement, 40 per cent). In contrast, preoperative changes in left ventricular ejection fraction after exercise were not predictive of postoperative resting ejection fraction. We conclude that postexercise radionuclide ventriculography can be used to identify reversible resting myocardial asynergy. This test should prove effective in predicting which patients with myocardial asynergy are most likely to benefit from aortocoronary revascularization.

  16. Nd:YAG Laser Treatment of Keloids and Hypertrophic Scars

    PubMed Central

    Akaishi, Satoshi; Koike, Sachiko; Dohi, Teruyuki; Kobe, Kyoko; Hyakusoku, Hiko; Ogawa, Rei

    2012-01-01

    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 μs 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. PMID:22259645

  17. Molecular Imaging of Healing After Myocardial Infarction

    PubMed Central

    Naresh, Nivedita K; Ben-Mordechai, Tamar; Leor, Jonathan

    2011-01-01

    The progression from acute myocardial infarction (MI) to heart failure continues to be a major cause of morbidity and mortality. Potential new therapies for improved infarct healing such as stem cells, gene therapy, and tissue engineering are being investigated. Noninvasive imaging plays a central role in the evaluation of MI and infarct healing, both clinically and in preclinical research. Traditionally, imaging has been used to assess cardiac structure, function, perfusion, and viability. However, new imaging methods can be used to assess biological processes at the cellular and molecular level. We review molecular imaging techniques for evaluating the biology of infarct healing and repair. Specifically, we cover recent advances in imaging the various phases of MI and infarct healing such as apoptosis, inflammation, angiogenesis, extracellular matrix deposition, and scar formation. Significant progress has been made in preclinical molecular imaging, and future challenges include translation of these methods to clinical practice. PMID:21869911

  18. Pathological observation of acute myocardial infarction in Chinese miniswine

    PubMed Central

    Wang, Chuang; Wang, Shao-Xin; Dong, Ping-Shuan; Wang, Li-Ping; Duan, Na-Na; Wang, Yan-Yu; Wang, Ke; Li, Zhuan-Zhen; Wei, Li-Juan; Meng, Ya-Li; Cheng, Jian-Xin

    2015-01-01

    The acute myocardial infarction (AMI) model in Chinese miniswine was built by percutaneous coronary artery occlusion. Pathological observation of AMI was performed, and the expression of tumor necrosis factor alpha (TNF-α) in the infarct sites was detected at different days after modeling in Chinese miniswine. The experimental findings may be used as the basis for blood flow reconstruction and intervention after AMI. Seven experimental Chinese miniswine were subjected to general anesthesia and Seldinger right femoral artery puncture. After coronary angiography, the gelfoam was injected via the microtube to occlude the obtuse marginal branch (OM branch). At 1 d, 3 d, 5 d, 7 d, 10 d, 14 d and 17 d after modeling, hetatoxylin-eosin (HE) staining was performed to observe the pathological changes and to detect the expression of TNF-α in the myocardial tissues. Cytoplasmic acidophilia of the necrotic myocardial tissues at 1 d after modeling was enhanced, and cytoplasmic granules were formed; at 3 d, the margins of the necrotic myocardial tissues were infiltrated by a large number of inflammatory cells; at 5 d, the nuclei of the necrotic myocardial cells were fragmented; at 7 d, extensive granulation tissues were formed at the margin of the necrotic myocardial tissues; at 10 d, part of the granulation tissues were replaced by fibrous scar tissues; at 14-17 d, all granulation tissues were replaced by fibrous scar tissues. Immunohistochemical detection indicated that no TNF-α expression in normal myocardial tissues. The TNF-α expression was first detected at 3 d in the necrotic myocardial tissues and then increased at 5 d and 7 d. After reaching the peak at 10 d, the expression began to decrease at 14 d and the decrease continued at 17 d. Coronary angiography showed the disappearance of blood flow at the distal end of OM branch occluded by gelfoam, indicating that AMI model was constructed successfully. The repair of the infarcted myocardium began at 10-17 d after

  19. Fractional Carbon Dioxide Laser in Treatment of Acne Scars

    PubMed Central

    Petrov, Andrej; Pljakovska, Vesna

    2016-01-01

    BACKGROUND: Scars appear as a result of skin damage during the process of the skin healing. There are two types of acne scars, depending on whether there is a loss or accumulation of collagen: atrophic and hypertrophic. In 80-90% it comes to scars with loss of collagen compared to smaller number of hypertrophic scars and keloids. AIM: The aim of the study was to determine efficiency and safety of fractional carbon dioxide laser in the treatment of acne scars. MATERIAL AND METHODS: The study was carried out in Acibadem Sistina Clinical Hospital, Skopje at the Department of Dermatovenerology, with a total of 40 patients treated with fractional carbon dioxide laser (Lutronic eCO2). The study included patients with residual acne scars of a different type. RESULTS: Comedogenic and papular acne in our material were proportionately presented in 50% of cases, while the other half were the more severe clinical forms of acne - pustular inflammatory acne and nodulocystic acne that leave residual lesions in the form of second, third and fourth grade of scars. CONCLUSION: The experiences of our work confirm the world experiences that the best result with this method is achieved in dotted ice pick or V-shaped acne scars. PMID:27275326

  20. Topical modalities for treatment and prevention of postsurgical hypertrophic scars.

    PubMed

    Foo, Chong Wee; Tristani-Firouzi, Payam

    2011-08-01

    There is no universally accepted treatment regimen and no evidence-based literature to guide management of hypertrophic scars. This article summarizes the existing literature regarding topical treatments such as silicone gel sheeting and ointment, onion extract, vitamin E, pressure garment therapy, massage therapy, and topical imiquimod 5% cream in the management of hypertrophic scars. PMID:21856542

  1. Regenerative healing, scar-free healing and scar formation across the species: current concepts and future perspectives.

    PubMed

    Ud-Din, Sara; Volk, Susan W; Bayat, Ardeshir

    2014-09-01

    All species have evolved mechanisms of repair to restore tissue function following injury. Skin scarring is an inevitable and permanent endpoint for many postnatal organisms except for non-amniote vertebrates such as amphibians, which are capable of tissue regeneration. Furthermore, mammalian foetuses through mid-gestation are capable of rapid wound repair in the absence of scar formation. Notably, excessive cutaneous scar formation, such as hypertrophic and keloid scars, is a species limited clinical entity as it occurs only in humans, although wounds on the distal limbs of horses are also prone to heal with fibroproliferative pathology known as equine exuberant granulation tissue. Currently, there are no reliable treatment options to eradicate or prevent scarring in humans and vertebrates. The limited number of vertebrate models for either hypertrophic or keloid scarring has been an impediment to mechanistic studies of these diseases and the development of therapies. In this viewpoint essay, we highlight the current concepts of regenerative, scar-free and scar-forming healing compared across a number of species and speculate on areas for future research. Furthermore, in-depth investigative research into the mechanisms of scarless repair may allow for the development of improved animal models and novel targets for scar prevention. As the ability to heal in both a scarless manner and propensity for healing with excessive scar formation is highly species dependent, understanding similarities and differences in healing across species as it relates to the regenerative process may hold the key to improve scarring and guide translational wound-healing studies. PMID:24863070

  2. Idiopathic calcified myocardial mass

    PubMed Central

    Patterson, David; Gibson, Derek; Gomes, Ricardo; McDonald, Lawson; Olsen, Eckhardt; Parker, John; Ross, Donald

    1974-01-01

    Patterson, D., Gibson, D., Gomes, R., McDonald, L., Olsen, E., Parker, J., and Ross, D. (1974).Thorax,29, 589-594. Idiopathic calcified myocardial mass. Myocardial calcification can be subdivided into three groups—metastatic, dystrophic or an extension inwards from the pericardium. This case in which the calcified myocardial mass was initially delineated by radiography and by echocardiography and subsequently removed does not fit into any subdivision and has been termed idiopathic. Images PMID:4279467

  3. [Myocardial responses to ischemia].

    PubMed

    Borisenko, V G; Gubareva, E A; Kade, A Kh

    2010-01-01

    The paper details the types of a myocardial response to impaired blood flow, such as myocardial stunning, hibernation, ischemic preconditioning, warm-up phenomenon, ischemic postconditioning, remodeling, and infarction. According to the pathogenesis, the authors identify several types of myocardial dysfunction in transient ischemic attack--uptake, delivery; and a mixed one. It is concluded the myocardial response to damage depends on a combination of influencing factors, a number of pathophysiological processes starting in the acute phase of ischemia achieve its peak in the late period. PMID:20564927

  4. T1 Mapping in Characterizing Myocardial Disease: A Comprehensive Review.

    PubMed

    Puntmann, Valentina O; Peker, Elif; Chandrashekhar, Y; Nagel, Eike

    2016-07-01

    Cardiovascular magnetic resonance provides insights into myocardial structure and function noninvasively, with high diagnostic accuracy and without ionizing radiation. Myocardial tissue characterization in particular gives cardiovascular magnetic resonance a prime role among all the noninvasive cardiovascular investigations. Late gadolinium enhancement imaging is an established method for visualizing replacement scar, providing diagnostic and prognostic information in a variety of cardiac conditions. Late gadolinium enhancement, however, relies on the regional segregation of tissue characteristics to generate the imaging contrast. Thus, myocardial pathology that is diffuse in nature and affecting the myocardium in a rather uniform and global distribution is not well visualized with late gadolinium enhancement. Examples include diffuse myocardial inflammation, fibrosis, hypertrophy, and infiltration. T1 mapping is a novel technique allowing to diagnose these diffuse conditions by measurement of T1 values, which directly correspond to variation in intrinsic myocardial tissue properties. In addition to providing clinically meaningful indices, T1-mapping measurements also allow for an estimation of extracellular space by calculation of extracellular volume fraction. Multiple lines of evidence suggest a central role for T1 mapping in detection of diffuse myocardial disease in early disease stages and complements late gadolinium enhancement in visualization of the regional changes in common advanced myocardial disease. As a quantifiable measure, it may allow grading of disease activity, monitoring progress, and guiding treatment, potentially as a fast contrast-free clinical application. We present an overview of clinically relevant technical aspects of acquisition and processing, and the current state of art and evidence, supporting its clinical use. PMID:27390332

  5. Old-scar mass and changing surgical perspective: Sarcoidosis

    PubMed Central

    Aktimur, Recep; Aktimur, Sude Hatun; Çolak, Elif; Alıcı, Ömer; Demirağ, Mehmet Derya

    2015-01-01

    Sarcoidosis is a systemic inflammatory disease of an unknown etiology. Skin is involved in 25% of all cases, and 29% of them present as a scar sarcoidosis. Asymptomatic old-scar masses are generally regarded as a foreign body reaction by surgeons and often result in excisional biopsy. We describe a case of a patient who developed sarcoidosis in a 34-year-old appendectomy scar and adjacent inguinal lymph nodes without any local or systemic symptom and radiologic finding. Surgeons should not underestimate the importance of such lesions as a simple condition. Scar sarcoidosis may resolve spontaneously, or the treatment with some topical agents is effective. Furthermore, scar sarcoidosis may be the initial manifestation of systemic sarcoidosis. PMID:25931946

  6. Burn Scar Near the Hanford Nuclear Reservation

    NASA Technical Reports Server (NTRS)

    2002-01-01

    This Multi-angle Imaging Spectroradiometer (MISR) image pair shows 'before and after' views of the area around the Hanford Nuclear Reservation near Richland, Washington. On June 27, 2000, a fire in the dry sagebrush was sparked by an automobile crash. The flames were fanned by hot summer winds. By the day after the accident, about 100,000 acres had burned, and the fire's spread forced the closure of highways and loss of homes. These images were obtained by MISR's vertical-viewing (nadir) camera. Compare the area just above and to the right of the line of cumulus clouds in the May 15 image with the same area imaged on August 3. The darkened burn scar measures approximately 35 kilometers across. The Columbia River is seen wending its way around Hanford. Image courtesy NASA/GSFC/JPL, MISR Science Team

  7. The molecular basis of hypertrophic scars.

    PubMed

    Zhu, Zhensen; Ding, Jie; Tredget, Edward E

    2016-01-01

    Hypertrophic scars (HTS) are caused by dermal injuries such as trauma and burns to the deep dermis, which are red, raised, itchy and painful. They can cause cosmetic disfigurement or contractures if craniofacial areas or mobile region of the skin are affected. Abnormal wound healing with more extracellular matrix deposition than degradation will result in HTS formation. This review will introduce the physiology of wound healing, dermal HTS formation, treatment and difference with keloids in the skin, and it also review the current advance of molecular basis of HTS including the involvement of cytokines, growth factors, and macrophages via chemokine pathway, to bring insights for future prevention and treatment of HTS. PMID:27574672

  8. Cardioprotective Properties of Aerobic and Resistance Training Against Myocardial Infarction.

    PubMed

    Barboza, C A; Souza, G I H; Oliveira, J C M F; Silva, L M; Mostarda, C T; Dourado, P M M; Oyama, L M; Lira, F S; Irigoyen, M C; Rodrigues, B

    2016-06-01

    We evaluated the effects of aerobic and resistance exercise training on ventricular morphometry and function, physical capacity, autonomic function, as well as on ventricular inflammatory status in trained rats prior to myocardial infarction. Male Wistar rats were divided into the following groups: sedentary+Sham, sedentary+myocardial infarction, aerobic trained+myocardial infarction, and resistance trained+myocardial infarction. Sham and myocardial infarction were performed after training periods. In the days following the surgeries, evaluations were performed. Aerobic training prevents aerobic (to a greater extent) and resistance capacity impairments, ventricular dysfunction, baroreflex sensitivity and autonomic disorders (vagal tonus decrease and sympathetic tonus increase) triggered by myocardial infarction. Resistance training was able to prevent negative changes to aerobic and resistance capacity (to a greater extent) but not to ventricular dysfunction, and it prevented cardiovascular sympathetic increments. Additionally, both types of training reduced left ventricle inflammatory cytokine concentration. Our results suggest that aerobic and, for the first time, dynamic resistance training were able to reduce sympathetic tonus to the heart and vessels, as well as preventing the increase in pro-inflammatory cytokine concentrations in the left ventricle of trained groups. These data emphasizes the positive effects of aerobic and dynamic resistance training on the prevention of the negative changes triggered by myocardial infarction. PMID:26928914

  9. Radiation-induced pulmonary fibrosis resolves spontaneously if dense scars are not formed

    SciTech Connect

    Pickrell, J.A.; Diel, J.H.; Slauson, D.O.; Halliwell, W.H.; Mauderly, J.L.

    1983-02-01

    The relation of static compliance of excised lungs to collagen accumulation and histologic fibrosis was examined in Syrian hamsters inhaling sufficient /sup 238/PuO2 particles to achieve initial lung burdens of 50 or 100 nCi. Control animals were exposed to nonradioactive aerosols. Irradiated lungs from hamsters at both dose levels had compliance reduced to the same extent at point of maximal reduction. However, collagen accumulation was more closely related to /sup 238/Pu exposure level than the compliance measurements. Histologic examination revealed both diffuse alveolar thickening and some dense fibrous scars, the former predominating at lower dose levels. Hamsters exposed to 50 nCi /sup 238/PuO2 showed normal collagen content and static lung compliance with minimal histologic fibrosis 288 days after exposure. In contrast, hamsters exposed to 100 nCi had significant pulmonary fibrosis at that time and the highest incidence of dense scars at any time period. Such findings are consistent with a stiffening of lung parenchyma. They suggest that the diffuse interstitial fibrosis developed by this injury resolves spontaneously; dense fibrous scars, however, do not.

  10. Morphological and immunochemical differences between keloid and hypertrophic scar.

    PubMed Central

    Ehrlich, H. P.; Desmoulière, A.; Diegelmann, R. F.; Cohen, I. K.; Compton, C. C.; Garner, W. L.; Kapanci, Y.; Gabbiani, G.

    1994-01-01

    There are two types of excessive scarring, keloid and hypertrophic scar. Contrary to hypertrophic scars, keloids do not regress with time, are difficult to revise surgically, and do not provoke scar contractures. These two lesions require different therapeutic approaches but are often confused because of an apparent lack of morphological differences. We have investigated the collagen organization and the possible presence of alpha-smooth muscle (SM) actin-expressing myofibroblasts in these conditions. Keloids contain large, thick collagen fibers composed of numerous fibrils closely packed together. In contrast hypertrophic scars exhibit modular structures in which fibroblastic cells, small vessels, and fine, randomly organized collagen fibers are present. We confirm that such nodular structures are always present in hypertrophic scar and rarely in keloid. Furthermore, only nodules of hypertrophic scars contain alpha-SM actin-expressing myofibroblasts. Electron microscopic examination supports the above-mentioned differences in collagen organization and in fibroblastic features and shows the presence of an amorphous extracellular material surrounding fibroblastic cells in keloid. The presence in hypertrophic scar myofibroblasts of alpha-SM actin, the actin isoform typical of vascular SM cells, may represent an important element in the pathogenesis of contraction. Interestingly, when placed in culture fibroblasts from hypertrophic scars and keloid express similar amounts of alpha-SM actin, suggesting that local microenvironmental factors influence in vivo the expression of this protein. Thus several morphological and immunohistochemical differences exist between hypertrophic scar and keloid that are useful for the biological and pathological characterization of the two lesions. Images Figure 1 Figure 2 Figure 3 Figure 4 PMID:8030742

  11. Dependence of light fluence on treated depth with photosensitization reaction shortly after photosensitizer injection in rabbit myocardial tissue in vivo

    NASA Astrophysics Data System (ADS)

    Suenari, T.; Matsuo, H.; Ito, A.; Miyoshi, S.; Arai, T.

    2010-02-01

    We investigated experimentally dependence of light fluence on treated depth with photosensitization reaction shortly after photosensitizer injection in rabbit myocardial tissue in vivo. In this particular photosensitization reaction scheme, the photosensitizer accumulation characteristics for target region are not available. Meanwhile, the photosensitizer dose and hospitalization period under restricted light circumstance might be reduced. Since both photosensitizer and oxygen supply are governed by blood flow, this photosensitization reaction is influenced significantly by blood flow variation in particular blood vessel occlusion. We employed the myocardial tissue to keep tissue blood flow during the photosensitization reaction because vessel blood flow speed in myocardial tissue is fast to resist vascular occlusion. Surgically exposed rabbits myocardial tissues were irradiated with the light fluence ranging 25-100 J/cm2 by a 663 nm diode laser 30 min after the injection of 2 mg/kg water soluble chlorin photosensitizer, Talaporfin sodium. Two weeks after the irradiation, the rabbits were sacrificed and the histological specimens of the irradiated area were made to measure scar layer thickness. The scar layer tissue thickness of 0.2-3.0 mm was observed microscopically by the light fluence ranging 25-100 J/cm2. The scarring threshold in the deposit light fluence was estimated to 15-25 J/cm3 based on the above mentioned relation assuming constant and uniform myocardial effective attenuation coefficient of 0.72 mm-1. The estimated scarring threshold in the deposit light fluence was lower than the threshold of conventional PDT. Large variation of the estimated threshold value might be attributed to unconsidered PDT parameter such as flow rate inhomogeneity in the myocardial tissue. These results suggested that the photosensitization reaction investigated in this study would be available to apply arrhythmia therapy such as atrial fibrillation.

  12. Hypertrophic scar model in the rabbit ear: a reproducible model for studying scar tissue behavior with new observations on silicone gel sheeting for scar reduction.

    PubMed

    Kloeters, Oliver; Tandara, Andrea; Mustoe, Thomas A

    2007-01-01

    Hypertrophic scarring poses a clinically relevant problem as it can be cosmetically disfiguring and functionally debilitating. A lack of animal models has hindered an understanding of the pathogenesis and development of new treatment strategies therefore has largely been empiric. Our group has developed a unique hypertrophic scar (HS) model in the rabbit ear. The model has been reproducible, quantifiable, and measurable over a time period of 1 month. We describe the development as well as the reliability and responsiveness of this model to different therapeutic agents, such as TGF-beta blockade, silicone occlusion, and application of collagen-synthesis inhibitors. Moreover, it has given insights into the mechanism of action of silicone sheeting occlusive treatment and ultimately suggests that the epidermis plays a critical role in the development of HS. Additionally, we will present new data supporting the importance of the epidermis and further clarify the mechanism of action of silicone sheeting. When a semi-occlusive polyurethane film was left in place for an additional time period, scar formation was reduced. HSs of this model covered with silicone sheets and five layers of Tegaderm showed a significant scar reduction by 80% compared with wounds with only one layer of Tegaderm. The HS model in the rabbit ear is a highly reliable, responsive, and practical model for studying scar tissue behavior. Furthermore, our data suggest that the degree and the duration of occlusion are most important for reducing scar tissue formation. PMID:17727466

  13. Use of Patient and Observer Scar Assessment Scale for evaluation of facial scars treated with self-drying silicone gel.

    PubMed

    Bianchi, Francesca A; Roccia, Fabio; Fiorini, Paola; Berrone, Sid

    2010-05-01

    In this prospective study, we used the Patient and Observer Scar Assessment Scale (POSAS) to evaluate the outcome of the healing process of posttraumatic and surgical facial scars that were treated with self-drying silicone gel, by both the patient and the observer. In our division, the application of base cream and massage represents the standard management of facial scars after suture removal. In the current study, 15 patients (7 men and 8 women) with facial scars were treated with self-drying silicone gel that was applied without massage, and 15 patients (8 men and 7 women) were treated with base cream and massage. Both groups underwent a clinical evaluation of facial scars by POSAS at the time of suture removal (T0) and after 2 months of treatment (T1). The patient rated scar pain, itch, color, stiffness, thickness, and surface (Patient Scale), and the observer rated scar vascularity, pigmentation, thickness, relief, pliability, and surface area (Observer Scale [OS]). The Patient Scale reported the greatest improvement in the items color, stiffness, and thickness. Itch was the only item that worsened in the group self-drying silicone gel. The OS primarily reported an improvement in the items vascularization, pigmentation, and pliability. The only item in the OS that underwent no change from T0 to T1 was surface area. The POSAS revealed satisfactory healing of posttraumatic and surgical facial scars that were treated with self-drying silicone gel. PMID:20485035

  14. Myocardial perfusion abnormalities in asymptomatic patients with systemic lupus erythematosus

    SciTech Connect

    Hosenpud, J.D.; Montanaro, A.; Hart, M.V.; Haines, J.E.; Specht, H.D.; Bennett, R.M.; Kloster, F.E.

    1984-08-01

    Accelerated coronary artery disease and myocardial infarction in young patients with systemic lupus erythematosus is well documented; however, the prevalence of coronary involvement is unknown. Accordingly, 26 patients with systemic lupus were selected irrespective of previous cardiac history to undergo exercise thallium-201 cardiac scintigraphy. Segmental perfusion abnormalities were present in 10 of the 26 studies (38.5 percent). Five patients had reversible defects suggesting ischemia, four patients had persistent defects consistent with scar, and one patient had both reversible and persistent defects in two areas. There was no correlation between positive thallium results and duration of disease, amount of corticosteroid treatment, major organ system involvement or age. Only a history of pericarditis appeared to be associated with positive thallium-201 results (p less than 0.05). It is concluded that segmental myocardial perfusion abnormalities are common in patients with systemic lupus erythematosus. Whether this reflects large-vessel coronary disease or small-vessel abnormalities remains to be determined.

  15. Can intense endurance exercise cause myocardial damage and fibrosis?

    PubMed

    La Gerche, Andre

    2013-01-01

    There has been long-standing debate as to whether intense endurance exercise provokes acute myocardial damage and whether cardiac remodeling associated with long-standing endurance training is entirely physiological. Despite the lack of concrete evidence on either side, the potential for serious clinical consequences, including life-threatening arrhythmias, elevates the importance of the debate. Studies have taught us that elite athletes enjoy excellent health, and athletic animal models consistently show up-regulation of molecular pathways, which are free of fibrosis and entirely different from those induced through pathological cardiac loading. On the other hand, extreme exercise has been associated with biochemical and functional evidence of acute damage, and some recent imaging techniques raise the possibility of small areas of myocardial scar. Moreover, some arrhythmias appear to be more prevalent amongst endurance athletes. Only large prospective trials will enable us to really assess the health benefits and risks of regular intense endurance sports. PMID:23478555

  16. Multimodality imaging in the assessment of myocardial viability

    PubMed Central

    Partington, Sara L.; Kwong, Raymond Y.

    2014-01-01

    The prevalence of heart failure due to coronary artery disease continues to increase, and it portends a worse prognosis than non-ischemic cardiomyopathy. Revascularization improves prognosis in these high-risk patients who have evidence of viability; therefore, optimal assessment of myocardial viability remains essential. Multiple imaging modalities exist for differentiating viable myocardium from scar in territories with contractile dysfunction. Given the multiple modalities available, choosing the best modality for a specific patient can be a daunting task. In this review, the physiology of myocardial hibernation and stunning will be reviewed. All the current methods available for assessing viability including echocardiography, cardiac magnetic resonance imaging, nuclear imaging with single photon emission tomography and positron emission tomography imaging and cardiac computed tomography will be reviewed. The effectiveness of the various techniques will be compared, and the limitations of the current literature will be discussed. PMID:21069458

  17. Astrocyte scar formation aids central nervous system axon regeneration.

    PubMed

    Anderson, Mark A; Burda, Joshua E; Ren, Yilong; Ao, Yan; O'Shea, Timothy M; Kawaguchi, Riki; Coppola, Giovanni; Khakh, Baljit S; Deming, Timothy J; Sofroniew, Michael V

    2016-04-14

    Transected axons fail to regrow in the mature central nervous system. Astrocytic scars are widely regarded as causal in this failure. Here, using three genetically targeted loss-of-function manipulations in adult mice, we show that preventing astrocyte scar formation, attenuating scar-forming astrocytes, or ablating chronic astrocytic scars all failed to result in spontaneous regrowth of transected corticospinal, sensory or serotonergic axons through severe spinal cord injury (SCI) lesions. By contrast, sustained local delivery via hydrogel depots of required axon-specific growth factors not present in SCI lesions, plus growth-activating priming injuries, stimulated robust, laminin-dependent sensory axon regrowth past scar-forming astrocytes and inhibitory molecules in SCI lesions. Preventing astrocytic scar formation significantly reduced this stimulated axon regrowth. RNA sequencing revealed that astrocytes and non-astrocyte cells in SCI lesions express multiple axon-growth-supporting molecules. Our findings show that contrary to the prevailing dogma, astrocyte scar formation aids rather than prevents central nervous system axon regeneration. PMID:27027288

  18. Current concepts related to hypertrophic scarring in burn injuries.

    PubMed

    Chiang, Ryan S; Borovikova, Anna A; King, Kassandra; Banyard, Derek A; Lalezari, Shadi; Toranto, Jason D; Paydar, Keyianoosh Z; Wirth, Garrett A; Evans, Gregory R D; Widgerow, Alan D

    2016-05-01

    Scarring following burn injury and its accompanying aesthetic and functional sequelae still pose major challenges. Hypertrophic scarring (HTS) can greatly impact patients' quality of life related to appearance, pain, pruritus and even loss of function of the injured body region. The identification of molecular events occurring in the evolution of the burn scar has increased our knowledge; however, this information has not yet translated into effective treatment modalities. Although many of the pathophysiologic pathways that bring about exaggerated scarring have been identified, certain nuances in burn scar formation are starting to be recognized. These include the effects of neurogenic inflammation, mechanotransduction, and the unique interactions of burn wound fluid with fat tissue in the deeper dermal layers, all of which may influence scarring outcome. Tension on the healing scar, pruritus, and pain all induce signaling pathways that ultimately result in increased collagen formation and myofibroblast phenotypic changes. Exposure of the fat domes in the deep dermis is associated with increased HTS, possibly on the basis of altered interaction of adipose-derived stem cells and the deep burn exudate. These pathophysiologic patterns related to stem cell-cytokine interactions, mechanotransduction, and neurogenic inflammation can provide new avenues of exploration for possible therapeutic interventions. PMID:27027596

  19. Development of new renal scars: a collaborative study.

    PubMed Central

    Smellie, J M; Ransley, P G; Normand, I C; Prescod, N; Edwards, D

    1985-01-01

    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 four children were aged 5 or over when scarring occurred. Urinary infection occurred in all the children. Diagnosis and effective treatment were delayed in 45 of them; 58 suffered further urinary infections between the baseline intravenous urogram and the first showing new scarring. Vesicoureteric reflux was seen in 67 of the children. Investigation and treatment varied widely, and few children received long term prophylaxis. Social problems interfered with the management of 22 children. Early diagnosis, prompt effective treatment, investigation, and long term supervision of children with urinary infection are essential if renal scarring is to be reduced; those over the age of 5 are still vulnerable. PMID:3924325

  20. Modeling fibrosis using fibroblasts isolated from scarred rat vocal folds.

    PubMed

    Kishimoto, Yo; Kishimoto, Ayami Ohno; Ye, Shuyun; Kendziorski, Christina; Welham, Nathan V

    2016-07-01

    Following injury, pathologically activated vocal fold fibroblasts (VFFs) can engage in disordered extracellular matrix (ECM) remodeling, leading to VF fibrosis and impaired voice function. Given the importance of scar VFFs to phenotypically appropriate in vitro modeling of VF fibrosis, we pursued detailed characterization of scar VFFs obtained from surgically injured rat VF mucosae, compared with those obtained from experimentally naïve, age-matched tissue. Scar VFFs initially exhibited a myofibroblast phenotype characterized by increased proliferation, increased Col1a1 transcription and collagen, type I synthesis, increased Acta2 transcription and α-smooth muscle actin synthesis, and enhanced contractile function. These features were most distinct at passage 1 (P1); we observed a coalescence of the scar and naïve VFF phenotypes at later passages. An empirical Bayes statistical analysis of the P1 cell transcriptome identified 421 genes that were differentially expressed by scar, compared with naïve, VFFs. These genes were primarily associated with the wound response, ECM regulation, and cell proliferation. Follow-up comparison of P1 scar VFFs and their in vivo tissue source showed substantial transcriptomic differences. Finally, P1 scar VFFs responded to treatment with hepatocyte growth factor and transforming growth factor-β3, two biologics with reported therapeutic value. Despite the practical limitations inherent to working with early passage cells, this experimental model is easily implemented in any suitably equipped laboratory and has the potential to improve the applicability of preclinical VF fibrosis research. PMID:27111284

  1. Medicinal Plants for the Treatment of Hypertrophic Scars

    PubMed Central

    Ye, Qi; Wang, Su-Juan; Chen, Jian-Yu; Xin, Hai-Liang; Zhang, Hong

    2015-01-01

    Hypertrophic scar is a complication of wound healing and has a high recurrence rate which can lead to significant abnormity in aesthetics and functions. To date, no ideal treatment method has been established. Meanwhile, the underlying mechanism of hypertrophic scarring has not been clearly defined. Although a large amount of scientific research has been reported on the use of medicinal plants as a natural source of treatment for hypertrophic scarring, it is currently scattered across a wide range of publications. Therefore, a systematic summary and knowledge for future prospects are necessary to facilitate further medicinal plant research for their potential use as antihypertrophic scar agents. A bibliographic investigation was accomplished by focusing on medicinal plants which have been scientifically tested in vitro and/or in vivo and proved as potential agents for the treatment of hypertrophic scars. Although the chemical components and mechanisms of action of medicinal plants with antihypertrophic scarring potential have been investigated, many others remain unknown. More investigations and clinical trials are necessary to make use of these medical plants reasonably and phytotherapy is a promising therapeutic approach against hypertrophic scars. PMID:25861351

  2. Activated keratinocytes in the epidermis of hypertrophic scars.

    PubMed Central

    Machesney, M.; Tidman, N.; Waseem, A.; Kirby, L.; Leigh, I.

    1998-01-01

    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 PMID:9588880

  3. Microneedling Therapy in Atrophic Facial Scars: An Objective Assessment

    PubMed Central

    Majid, Imran

    2009-01-01

    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. PMID:20300368

  4. External rhinoplasty for the Arabian nose: a columellar scar analysis.

    PubMed

    Foda, Hossam M T

    2004-01-01

    This study aimed to evaluate columellar scar problems after external rhinoplasty in the Arabian population, and to analyze the technical factors that help prevent such problems and maximize the scar cosmesis. The investigation was conducted in university and private practice settings of the author in Alexandria, Egypt. A total of 600 Arab patients who underwent external rhinoplasty were included in the study. All the patients underwent surgery using the external rhinoplasty approach, in which bilateral alar marginal incisions were connected by an inverted V-shaped transcolumellar incision. At completion of the procedure, a two-layer closure of the columellar incision was performed. At a minimum of 1 year postoperatively, the columellar scar was evaluated subjectively by means of a patient questionnaire, and objectively by clinical examination and comparison of the close-up pre- and postoperative basal view photographs. Objectively, anything less than a barely visible, leveled, thin, linear scar was considered unsatisfactory. Subjectively, 95.5% of the patients rated the scar as unnoticeable, 3% as noticeable but acceptable, and 1.5% as unacceptable. Objectively, the scar was unsatisfactory in 7% of the cases. This was because of scar widening with or without depression (5%), hyperpigmentation (1.5%), and columellar rim notching (0.5%). The use of a deep 6/0 polydioxanon (PDS) suture significantly decreased the incidence of scar widening (p < 0.005).The columellar incision can be used safely in the Arab population regardless of their thick, dark, and oily skin. Technical factors that contributed to the favorable outcome of the columellar scar included proper planning of location and design of the incision used, precise execution, meticulous multilayered closure, and good postoperative care. PMID:15666046

  5. [Differential approach to the use of drug ultraphonophoresis for scars].

    PubMed

    Gerasimenko, M Iu; Zenger, V G; Iusova, Zh Iu

    2002-01-01

    A differential approach to administration of drug ultraphonophoresis (gel contractubex, collitin, elastolitin) in scarry deformations is proposed. The analysis of 82 treatment outcomes has shown that early after trauma (on day 6-12) it is more beneficial to use ultraphonophoresis (UPP) of heparin-containing compounds improving blood rheology, e.g. lidase. This prevents development of pathological scars. Later, when the scar tissues has already formed, more effective is UPP of enzyme medicines with fibrinolytic properties (collitin, elastolitin). Differentiated choice of UPP in scar therapy reduces the time of rehabilitation considerably. PMID:12132225

  6. Cardiac fibrosis in myocardial infarction-from repair and remodeling to regeneration.

    PubMed

    Talman, Virpi; Ruskoaho, Heikki

    2016-09-01

    Ischemic cell death during a myocardial infarction leads to a multiphase reparative response in which the damaged tissue is replaced with a fibrotic scar produced by fibroblasts and myofibroblasts. This also induces geometrical, biomechanical, and biochemical changes in the uninjured ventricular wall eliciting a reactive remodeling process that includes interstitial and perivascular fibrosis. Although the initial reparative fibrosis is crucial for preventing rupture of the ventricular wall, an exaggerated fibrotic response and reactive fibrosis outside the injured area are detrimental as they lead to progressive impairment of cardiac function and eventually to heart failure. In this review, we summarize current knowledge of the mechanisms of both reparative and reactive cardiac fibrosis in response to myocardial infarction, discuss the potential of inducing cardiac regeneration through direct reprogramming of fibroblasts and myofibroblasts into cardiomyocytes, and review the currently available and potential future therapeutic strategies to inhibit cardiac fibrosis. Graphical abstract Reparative response following a myocardial infarction. Hypoxia-induced cardiomyocyte death leads to the activation of myofibroblasts and a reparative fibrotic response in the injured area. Right top In adult mammals, the fibrotic scar formed at the infarcted area is permanent and promotes reactive fibrosis in the uninjured myocardium. Right bottom In teleost fish and newts and in embryonic and neonatal mammals, the initial formation of a fibrotic scar is followed by regeneration of the cardiac muscle tissue. Induction of post-infarction cardiac regeneration in adult mammals is currently the target of intensive research and drug discovery attempts. PMID:27324127

  7. Analysis of hypertrophic and normal scar gene expression with cDNA microarrays.

    PubMed

    Tsou, R; Cole, J K; Nathens, A B; Isik, F F; Heimbach, D M; Engrav, L H; Gibran, N S

    2000-01-01

    Hypertrophic scar is one form of abnormal wound healing. Previous studies have suggested that hypertrophic scar formation results from altered gene expression of extracellular matrix molecules. A broadscale evaluation of gene expression in hypertrophic scars has not been reported. To better understand abnormalities in hypertrophic scar gene expression, we compared messenger RNA expression in hypertrophic scars, normal scars, and uninjured skin with the use of complementary (c)DNA microarrays. Total RNA was extracted from freshly excised human hypertrophic scars, normal scars, or uninjured skin and reverse transcribed into cDNA with the incorporation of [33P] deoxycytidine triphosphate. The resulting radioactive cDNA probes were hybridized onto cDNA microarrays of 4000 genes. Hybridization signals were normalized and analyzed. In the comparison of tissue samples, mean intensities were calculated for each gene within each group (hypertrophic scars, normal scars, and uninjured skin). Ratios of the mean intensities of hypertrophic scars to normal scars, hypertrophic scars to uninjured skin, and normal scars to uninjured skin were generated. A ratio that was greater than 1 indicated upregulation of any particular gene and a ratio that was less than 1 indicated downregulation of any particular gene. Our data indicated that 142 genes were overexpressed and 50 genes were underexpressed in normal scars compared with uninjured skin, 107 genes were overexpressed and 71 were underexpressed in hypertrophic scars compared with uninjured skin, and 44 genes were overexpressed and 124 were underexpressed in hypertrophic scars compared with normal scars. Our analysis of collagen, growth factor, and metalloproteinase gene expression confirmed that our molecular data were consistent with published biochemical and clinical observations of normal scars and hypertrophic scars. cDNA microarray analysis provides a powerful tool for the investigation of differential gene expression in

  8. MISR Views a Fire-Scarred Landscape

    NASA Technical Reports Server (NTRS)

    2000-01-01

    This MISR image pair shows 'before and after' views of the area around the Hanford Nuclear Reservation near Richland, Washington. On June 27, 2000, a fire in the dry sagebrush was sparked by an automobile crash. The flames were fanned by hot summer winds. By the day after the accident, about 100,000 acres had burned, and the fire's spread forced the closure of highways and loss of homes.

    These images, from Terra orbits 2176 and 3341, were obtained by MISR's vertical-viewing (nadir) camera. Compare the area just above and to the right of the line of cumulus clouds in the May 15 image with the same area imaged on August 3. The darkened burn scar measures approximately 35 kilometers across. The Columbia River is seen wending its way around the area, and the Snake River branches off to the right.

    According to Idaho's National Interagency Fire Center, the US has been experiencing the worst fire season since 1996.

    MISR was built and is managed by NASA's Jet Propulsion Laboratory, Pasadena, CA, for NASA's Office of Earth Science, Washington, DC. The Terra satellite is managed by NASA's Goddard Space Flight Center, Greenbelt, MD. JPL is a division of the California Institute of Technology.

  9. Scarring, stem cells, scaffolds and skin repair.

    PubMed

    Markeson, Daniel; Pleat, Jonathon M; Sharpe, Justin R; Harris, Adrian L; Seifalian, Alexander M; Watt, Suzanne M

    2015-06-01

    The treatment of full thickness skin loss, which can be extensive in the case of large burns, continues to represent a challenging clinical entity. This is due to an on-going inability to produce a suitable tissue engineered substrate that can satisfactorily replicate the epidermal and dermal in vivo niches to fulfil both aesthetic and functional demands. The current gold standard treatment of autologous skin grafting is inadequate because of poor textural durability, scarring and associated contracture, and because of a paucity of donor sites in larger burns. Tissue engineering has seen exponential growth in recent years with a number of 'off-the-shelf' dermal and epidermal substitutes now available. Each has its own limitations. In this review, we examine normal wound repair in relation to stem/progenitor cells that are intimately involved in this process within the dermal niche. Endothelial precursors, in particular, are examined closely and their phenotype, morphology and enrichment from multiple sources are described in an attempt to provide some clarity regarding the controversy surrounding their classification and role in vasculogenesis. We also review the role of the next generation of cellularized scaffolds and smart biomaterials that attempt to improve the revascularisation of artificial grafts, the rate of wound healing and the final cosmetic and functional outcome. PMID:24668923

  10. Extensive Burn Scars in Russia's Amur Region

    NASA Technical Reports Server (NTRS)

    2002-01-01

    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

  11. Detecting Moorland Wildfire Scars and their Persistence in the Landscape using Synthetic Aperture Radar (SAR) in the Peak District National Park, UK

    NASA Astrophysics Data System (ADS)

    Millin-chalabi, G. R.; McMorrow, J.; Agnew, C.

    2012-12-01

    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

  12. Caesarean section scar ectopic pregnancy following postcoital contraception.

    PubMed

    Fabunmi, Laura; Perks, Nigel

    2002-07-01

    This is believed to be the first reported case of an ectopic pregnancy following failed progestogen-only emergency contraception. The ectopic pregnancy was at the site of a previous caesarean section scar and was managed conservatively. PMID:16259837

  13. Effects of scars on crystalline shell pressure stability

    NASA Astrophysics Data System (ADS)

    Wan, Duanduan; Sknepnek, Rastko; Bowick, Mark

    2014-03-01

    Thomson problem is the prototypical example of a crystal on a sphere. For high number of particles in the ground state of the Thomson problem one finds scars - freely-terminating grain boundary arrays of dislocations. Here we analyze how scars affect the mechanical stability of a spherical crystalline shell, like a viral capsid, under external hydrostatic pressure. We use elastic continuum theory to model the shell. Its energy contains both stretching and bending energies. Furthermore, using Monte Carlo simulations, we compare how shells with and without scars deform under external pressure in a quasi-static process. We find that presence of scars always lowers the critical pressure at which the shell collapses. We acknowledge support from Soft Matter Program, Syracuse University.

  14. 15. Newfound Gap parking area with construction scar looking W. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    15. Newfound Gap parking area with construction scar looking W. - Great Smoky Mountains National Park Roads & Bridges, Newfound Gap Road, Between Gatlinburg, TN & Cherokee, NC, Gatlinburg, Sevier County, TN

  15. Semiclassical calculation of scars for a smooth potential

    SciTech Connect

    Provost, D.; Baranger, M. )

    1993-08-02

    Bogomolny's formula for energy-smoothed scars is applied to a nonspecific, nonscalable Hamiltonian, a two-dimensional anharmonic oscillator. The semiclassical theory reproduces well the exact quantal results over a large spatial and energy range.

  16. Anatomopathological findings in scars: comparative study between different specimens.

    PubMed

    Munteanu, Andrada Despina; Bedereag, Ştefan Iulian; NiŢescu, Cristian; Florescu, Ioan Petre

    2015-01-01

    In spite of the remarkable progress science and medicine have experienced, many facts concerning healing processes and pathological scars are still unknown or incompletely explained. This paper is part of a larger study (research for a PhD thesis) concerning new approaches in the prevention and treatment of pathological post-burn scars. We present and analyze the cases of some patients who developed abnormal scars in order to understand and point out the characteristics, that different types of pathological scars have in common and how we can differentiate them. Knowing what issue to address is the key to any successful therapy. Thus, the information we obtained will help us in applying more appropriate and efficient methods of treatment and in our further research: comparing the efficiency of newer therapies to that of older ones. PMID:25826518

  17. Transient myocardial ischaemia after acute myocardial infarction.

    PubMed Central

    Currie, P; Saltissi, S

    1990-01-01

    The prevalence and characteristics of transient myocardial ischaemia were studied in 203 patients with recent acute myocardial infarction by both early (6.4 days) and late (38 days) ambulatory monitoring of the ST segment. Transient ST segment depression was much commoner during late (32% patients) than early (14%) monitoring. Most transient ischaemia (greater than 85% episodes) was silent and 80% of patients had only silent episodes. During late monitoring painful ST depression was accompanied by greater ST depression and tended to occur at a higher heart rate. Late transient ischaemia showed a diurnal distribution, occurred at a higher initial heart rate, and was more often accompanied by a further increase in heart rate than early ischaemia. Thus in the first 2 months after myocardial infarction transient ischaemia became increasingly common and more closely associated with increased myocardial oxygen demand. Because transient ischaemic episodes during early and late ambulatory monitoring have dissimilar characteristics they may also have different pathophysiologies and prognostic implications. PMID:2245108

  18. Laser treatment of acne, psoriasis, leukoderma, and scars.

    PubMed

    Railan, Divya; Alster, Tina S

    2008-12-01

    Lasers frequently are used by dermatologists for their multiple aesthetic applications, but they also can be used to treat a variety of medical dermatology conditions. Conditions such as acne vulgaris, psoriasis, and vitiligo can all be successfully treated with laser, thereby providing the patient with additional therapeutic options. Lasers have also been used for years to improve the appearance of scars. The newer fractionated lasers have been especially effective in enhancing the clinical outcomes of scar revision. PMID:19150300

  19. Quantitative measurement of hypertrophic scar: interrater reliability and concurrent validity.

    PubMed

    Nedelec, Bernadette; Correa, José A; Rachelska, Grazyna; Armour, Alexis; LaSalle, Léo

    2008-01-01

    Research into the pathophysiology and treatment of hypertrophic scar (HSc) remains limited by the heterogeneity of scar and the imprecision with which its severity is measured. The objective of this study was to test the interrater reliability and concurrent validity of the Cutometer measurement of elasticity, the Mexameter measurement of erythema and pigmentation, and total thickness measure of the DermaScan C relative to the modified Vancouver Scar Scale (mVSS) in patient-matched normal skin, normal scar, and HSc. Three independent investigators evaluated 128 sites (severe HSc, moderate or mild HSc, donor site, and normal skin) on 32 burn survivors using all of the above measurement tools. The intraclass correlation coefficient, which was used to measure interrater reliability, reflects the inherent amount of error in the measure and is considered acceptable when it is >0.75. Interrater reliability of the totals of the height, pliability, and vascularity subscales of the mVSS fell below the acceptable limit ( congruent with0.50). The individual subscales of the mVSS fell well below the acceptable level (< or =0.3). The Cutometer reading of elasticity provided acceptable reliability (>0.89) for each study site with the exception of severe scar. Mexameter and DermaScan C reliability measurements were acceptable for all sites (>0.82). Concurrent validity correlations with the mVSS were significant except for the comparison of the mVSS pliability subscale and the Cutometer maximum deformation measure comparison in severe scar. In conclusion, the Mexameter and DermaScan C measurements of scar color and thickness of all sites, as well as the Cutometer measurement of elasticity in all but the most severe scars shows high interrater reliability. Their significant concurrent validity with the mVSS confirms that these tools are measuring the same traits as the mVSS, and in a more objective way. PMID:18388576

  20. Perennial plate tectonics with lasting mantle lithosphere scars

    NASA Astrophysics Data System (ADS)

    Heron, P.; Pysklywec, R. N.; Stephenson, R.

    2015-12-01

    Although the conventional theory of plate tectonics can explain non-rigid behaviour at plate boundaries, it cannot adequately explain the processes involved in deformation and seismicity within plate interiors. Here, we consider that the pre-existing deformation or "scarring" within the mantle lithosphere may have a very long lived presence that could incorporate deformation of the plate interior and plate boundary. Mantle lithosphere scars from continent-continent collisions could generate virtual plate boundaries that remain over long timescales, producing "perennial" plate tectonics. Local geophysical studies can map the crustal environment well, and global whole mantle tomography models are rapidly improving, yet high-resolution images of the mantle lithosphere are often not available in regions where scarring may be present. Where mantle lithosphere heterogeneities have been observed (usually interpreted simply as subduction scars), the same attention has not been afforded to them as, for example, re-activation of faults within the Earth's crust. In idealized numerical simulations, we compare how relic scarring at varying depths in the lithosphere affects patterns of deformation. High-resolution thermal-mechanical numerical experiments explore continental lithospheric deformation featuring a weakened crust and mantle lithosphere scars. Our models show that deep lithospheric scars can control the tectonic evolution of a region over shallow geological features, indicating the importance of mantle lithosphere heterogeneities. The Altyn Tagh Fault (ATF) in central China is an example of an ancient continental collision zone that undergoes periodic deformation during times of regional compression. We suggest that the ATF may be a locale where a long-lasting mantle lithosphere scar can control the subsequent crustal evolution and deformation, with ancient plate boundaries having a "perennial" plate tectonic presence.

  1. Frequent PIK3CA mutations in radial scars.

    PubMed

    Wolters, Katie L; Ang, Daphne; Warrick, Andrea; Beadling, Carol; Corless, Christopher L; Troxell, Megan L

    2013-12-01

    Radial scars are breast lesions of uncertain pathogenesis that are associated with a 2-fold increased risk of breast cancer compared with that in controls. Activating point mutations in PIK3CA are found in 25% to 30% of invasive breast cancers; however, they have not previously been investigated in radial scars. We sought to evaluate radial scars for known activating point mutations commonly seen in invasive breast cancer. Sixteen surgical cases containing 22 radial scars were identified from pathology archives. Lesional tissue was macrodissected from unstained paraffin sections; genomic DNA was then extracted and screened for a panel of known hotspot mutations using polymerase chain reaction and mass spectroscopy analysis. Of the 22 radial scars, 14 (63.6%) had PIK3CA mutations (10 with H1047R mutations, 2 G1049R mutations, 1 E542K, 1 E545K). The remaining 8 lesions were wild type for all of the screened genes. Of the radial scars without epithelial atypia, 9/16 (56.3%) had PIK3CA mutations; furthermore, 5/6 (83.3%) radial scars with atypia had mutations detected. In this study, the frequency of PIK3CA mutations was notably higher than the 25% to 30% mutation frequency of invasive breast cancer. This finding raises interesting questions as to the role of PIK3CA mutations in breast cancer development. Additional larger studies are indicated to confirm and extend these observations in understanding the pathogenesis of radial scars and their relationship to breast cancer. PMID:24193002

  2. Suppression of scarring in peripheral nerve implants by drug elution

    NASA Astrophysics Data System (ADS)

    FitzGerald, James J.

    2016-04-01

    Objective. Medical implants made of non-biological materials provoke a chronic inflammatory response, resulting in the deposition of a collagenous scar tissue (ST) layer on their surface, that gradually thickens over time. This is a critical problem for neural interfaces. Scar build-up on electrodes results in a progressive decline in signal level because the scar tissue gradually separates axons away from the recording contacts. In regenerative sieves and microchannel electrodes, progressive scar deposition will constrict and may eventually choke off the sieve hole or channel lumen. Interface designs need to address this issue if they are to be fit for long term use. This study examines a novel method of inhibiting the formation and thickening of the fibrous scar. Approach. Research to date has mainly focused on methods of preventing stimulation of the foreign body response by implant surface modification. In this paper a pharmacological approach using drug elution to suppress chronic inflammation is introduced. Microchannel implants made of silicone doped with the steroid drug dexamethasone were implanted in the rat sciatic nerve for periods of up to a year. Tissue from within the microchannels was compared to that from control devices that did not release any drug. Main results. In the drug eluting implants the scar layer was significantly thinner at all timepoints, and unlike the controls it did not continue to thicken after 6 months. Control implants supported axon regeneration well initially, but axon counts fell rapidly at later timepoints as scar thickened. Axon counts in drug eluting devices were initially much lower, but increased rather than declined and by one year were significantly higher than in controls. Significance. Drug elution offers a potential long term solution to the problem of performance degradation due to scarring around neural implants.

  3. The Importance of Mast Cells in Dermal Scarring

    PubMed Central

    Wilgus, Traci A.; Wulff, Brian C.

    2014-01-01

    Significance: Mast cells are resident inflammatory cells present in high numbers in the skin. They are one of the first cell types to respond to damage and they do so by quickly releasing a variety of preformed mediators that are stored within mast cell granules. Mast cells are not only active early on, where they help induce inflammation, but they also stimulate the proliferation of several important cell types and influence the production and remodeling of collagen. Recent Advances: Recent studies have highlighted the importance of mast cells in determining the amount of scar tissue that forms as a result of the repair process. Mast cells are found in low numbers and in a less activated state in scarless wounds, whereas high numbers of activated mast cells are associated with scarring and fibrosis. Furthermore, animals that lack mast cells or have been treated with degranulation inhibitors or drugs that block the activity of mast cell proteases have been shown to heal with reduced scar tissue. Critical Issues: Despite evidence suggesting that mast cells regulate scar tissue development, the entire range of mast cell activities during wound repair and scar formation has not been completely characterized. In addition, the potential therapeutic benefits of targeting mast cells clinically have yet to be fully explored. Future Directions: More studies are needed to determine whether inhibiting mast cell activation and blocking the function of mast cell mediators are viable options to prevent or reduce the appearance of scars. PMID:24757590

  4. Keloids and Hypertrophic Scars: Update and Future Directions

    PubMed Central

    Huang, Chenyu; Murphy, George F.; Akaishi, Satoshi

    2013-01-01

    Summary: The development of cutaneous pathological scars, namely, hypertrophic scars (HSs) and keloids, involves complex pathways, and the exact mechanisms by which they are initiated, evolved, and regulated remain to be fully elucidated. The generally held concepts that keloids and HSs represent “aberrant wound healing” or that they are “characterized by hyalinized collagen bundles” have done little to promote their accurate clinicopathological classification or to stimulate research into the specific causes of these scars and effective preventative therapies. To overcome this barrier, we review here the most recent findings regarding the pathology and pathogenesis of keloids and HSs. The aberrations of HSs and keloids in terms of the inflammation, proliferation, and remodeling phases of the wound healing process are described. In particular, the significant roles that the extracellular matrix and the epidermal and dermal layers of skin play in scar pathogenesis are examined. Finally, the current hypotheses of pathological scar etiology that should be tested by basic and clinical investigators are detailed. Therapies that have been found to be effective are described, including several that evolved directly from the aforementioned etiology hypotheses. A better understanding of pathological scar etiology and manifestations will improve the clinical and histopathological classification and treatment of these important lesions. PMID:25289219

  5. Management of keloids and hypertrophic scars: current and emerging options

    PubMed Central

    Gauglitz, Gerd G

    2013-01-01

    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. PMID:23637546

  6. How Infants Encode Spatial Extent

    ERIC Educational Resources Information Center

    Duffy, Sean; Huttenlocher, Janellen; Levine, Susan; Duffy, Renee

    2005-01-01

    This study explores how infants encode an object's spatial extent. We habituated 6.5-month-old infants to a dowel inside a container and then tested whether they dishabituate to a change in absolute size when the relation between dowel and container is held constant (by altering the size of both container and dowel) and when the relation changes…

  7. Scar prevention by laser-assisted scar healing (LASH) using thermal post-conditioning

    NASA Astrophysics Data System (ADS)

    Gossé, Alban; Iarmarcovai, Gwen; Capon, Alexandre; Cornil, Alain; Mordon, Serge

    2009-02-01

    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).

  8. Cesarean Scar Pregnancy Managed with Conservative Treatment.

    PubMed

    Boza, Aysen; Boza, Barıs; Api, Murat

    2016-09-01

    Cesarean scar pregnancy (CSP) is a rare, but life-threatening type of ectopic pregnancy. An exact and early diagnosis of CSP is very important for prognosis. The aim of the present study was to describe 4 women with CSP and discuss their clinical presentations, diagnoses, and various management options along with the published literature. Four women with a suspicion of CSP or cervical pregnancy were referred to our hospital between August 2013 and January 2014. All the patients were counseled about medical management options. After the treatment, serum beta human chorionic gonadotropin (ß-hCG) levels were followed weekly until they reached <5 mIU/mL. All the patients were diagnosed at the first trimester, with the average gestational age of 6.4±0.9 weeks. Treatment was systemic methotrexate (MTX) treatment in 3 of the 4 women, requiring no further intervention. The remaining 1 woman was treated with an intragestational administration of MTX. The mean time passed until ß-hCG reached <5 mIU/mL was 10.2±2.9 (range, 8-14) weeks, and the mean time passed until the gestational sac resolved was 21.5±3.5 (range, 18-25) weeks. Based on this limited number of case-series experience, it seems that CSP should be treated conservatively even if there are visible fetal cardiac activity, fetal poles, large gestational sacs, and high initial ß-hCG levels. Although the complete remission of the lesion takes a relatively long time, medical management via a noninvasive approach and follow-up should be tried as the first choice of therapy. PMID:27582596

  9. Cesarean Scar Pregnancy Managed with Conservative Treatment

    PubMed Central

    Boza, Aysen; Boza, Barıs; Api, Murat

    2016-01-01

    Cesarean scar pregnancy (CSP) is a rare, but life-threatening type of ectopic pregnancy. An exact and early diagnosis of CSP is very important for prognosis. The aim of the present study was to describe 4 women with CSP and discuss their clinical presentations, diagnoses, and various management options along with the published literature. Four women with a suspicion of CSP or cervical pregnancy were referred to our hospital between August 2013 and January 2014. All the patients were counseled about medical management options. After the treatment, serum beta human chorionic gonadotropin (ß-hCG) levels were followed weekly until they reached <5 mIU/mL. All the patients were diagnosed at the first trimester, with the average gestational age of 6.4±0.9 weeks. Treatment was systemic methotrexate (MTX) treatment in 3 of the 4 women, requiring no further intervention. The remaining 1 woman was treated with an intragestational administration of MTX. The mean time passed until ß-hCG reached <5 mIU/mL was 10.2±2.9 (range, 8–14) weeks, and the mean time passed until the gestational sac resolved was 21.5±3.5 (range, 18–25) weeks. Based on this limited number of case-series experience, it seems that CSP should be treated conservatively even if there are visible fetal cardiac activity, fetal poles, large gestational sacs, and high initial ß-hCG levels. Although the complete remission of the lesion takes a relatively long time, medical management via a noninvasive approach and follow-up should be tried as the first choice of therapy. PMID:27582596

  10. Effects of Noscarna™ on hypertrophic scarring in the rabbit ear model: histopathological aspects.

    PubMed

    Lee, Dong Won; Ku, Sae Kwang; Cho, Hyuk Jun; Kim, Jeong Hwan; Hiep, Tran Tuan; Han, Sang Duk; Kim, Bo Gyun; Kang, Min Kyung; Do, Eui Seon; Jun, Joon Ho; Jang, Sun Woo; Son, Mi-Won; Sohn, Young Taek; Choi, Han-Gon; Yong, Chul Soon; Kim, Jong Oh

    2012-11-01

    In this study, we evaluated the effects of silicone-based gel on the healing of hypertrophic scars in the rabbit ear model. After 4-week application of silicone-based gel containing allantoin, dexpanthenol and heparin (Noscarna™) to scars in a rabbit ear model of hypertrophic scarring, significant improvements in hypertrophic scar healing and a great loss of skin pigment were observed compared to the non-treated control, base or silicone control-treated scars. Furthermore, histological analysis of Noscarna™-treated scars revealed a significant reduction in scar elevation index (SEI), anterior skin and epithelial thicknesses, inflammatory cells, vessels, collagen disorganization and fibroblasts compared to all control hypertrophic scars. Furthermore, Noscarna™ showed more favorable effects on hypertrophic scars than a commercial product, Contractubex®. Therefore, these results clearly demonstrated that the newly developed silicone-based gel, Noscarna™, could be a promising formulation as an effective therapeutic agent for hypertrophic scars. PMID:23212642

  11. Myocardial infarction and marijuana.

    PubMed

    Charles, R; Holt, S; Kirkham, N

    1979-04-01

    Myocardial infarction in the virtual absence of risk factors occurred in a 25-year old man shortly after smoking a cigarette containing marijuana. Subsequent coronary arteriography was normal. PMID:466984

  12. Experimental myocardial infarction

    PubMed Central

    Kumar, Raj; Joison, Julio; Gilmour, David P.; Molokhia, Farouk A.; Pegg, C. A. S.; Hood, William B.

    1971-01-01

    The hemodynamic effects of tachycardia induced by atrial pacing were investigated in left ventricular failure of acute and healing experimental myocardial infarction in 20 intact, conscious dogs. Myocardial infarction was produced by gradual inflation of a balloon cuff device implanted around the left anterior descending coronary artery 10-15 days prior to the study. 1 hr after acute myocardial infarction, atrial pacing at a rate of 180 beats/min decreased left ventricular end-diastolic pressure from 19 to 8 mm Hg and left atrial pressure from 17 to 12 mm Hg, without change in cardiac output. In the healing phase of myocardial infarction 1 wk later, atrial pacing decreased left ventricular end-diastolic pressure from 17 to 9 mm Hg and increased the cardiac output by 37%. This was accompanied by evidence of peripheral vasodilation. In two dogs with healing anterior wall myocardial infarction, left ventricular failure was enhanced by partial occlusion of the circumflex coronary artery. Both the dogs developed pulmonary edema. Pacing improved left ventricular performance and relieved pulmonary edema in both animals. In six animals propranolol was given after acute infarction, and left ventricular function deteriorated further. However the pacing-induced augmentation of cardiac function was unaltered and, hence, is not mediated by sympathetics. The results show that the spontaneous heart rate in left ventricular failure of experimental canine myocardial infarction may be less than optimal and that maximal cardiac function may be achieved at higher heart rates. Images PMID:4395910

  13. Scar prevention and remodeling: a review of the medical, surgical, topical and light treatment approaches.

    PubMed

    Kerwin, Leonard Y; El Tal, Abdel Kader; Stiff, Mark A; Fakhouri, Tarek M

    2014-08-01

    Cosmetic, functional, and structural sequelae of scarring are innumerable, and measures exist to optimize and ultimately minimize these sequelae. To evaluate the innumerable methods available to decrease the cosmetic, functional, and structural repercussions of scarring, pubMed search of the English literature with key words scar, scar revision, scar prevention, scar treatment, scar remodeling, cicatrix, cicatrix treatment, and cicatrix remodeling was done. Original articles and reviews were examined and included. Seventy-nine manuscripts were reviewed. Techniques, comparisons, and results were reviewed and tabulated. Overall, though topical modalities are easier to use and are usually more attractive to the patient, the surgical approaches still prove to be superior and more reliable. However, advances in topical medications for scar modification are on the rise and a change towards medical treatment of scars may emerge as the next best approach. Comparison studies of the innumerable specific modalities for scar revision and prevention are impossible. Standardization of techniques is lacking. Scarring, the body's natural response to a wound, can create many adverse effects. At this point, the practice of sound, surgical fundamentals still trump the most advanced preventative methods and revision techniques. Advances in medical approaches are available, however, to assist the scarring process, which even the most advanced surgical fundamentals will ultimately lead to. Whether through newer topical therapies, light treatment, or classical surgical intervention, our treatment armamentarium of scars has expanded and will allow us to maximize scar prevention and to minimize scar morbidity. PMID:24697346

  14. Thallium-201 myocardial imaging in young adults with anomalous left coronary artery arising from the pulmonary artery

    SciTech Connect

    Moodie, D.S.; Cook, S.A.; Gill, C.C.; Napoli, C.A.

    1980-11-01

    Anomalous origin of the left coronary artery from the pulmonary artery (Bland-Garland-White syndrome) may produce myocardial ischemia, infarction, and frequently death in infancy. Some patients, however, develop satisfactory coronary artery collaterals and are relatively asymptomatic into adulthood. Very little is known about their myocardial perfusion patterns. We studied three young adults with this condition using stress thallium-201 myocardial imaging. Electrocardiograms in two patients demonstrated old arterolateral myocardial infarctions. Preoperative stress exercise tests were positive in all three patients. Marked perfusion abnormalities were found in the proximal anterolateral wall in all patients, and one patient also had a posterolateral defect. Postoperatively, all stress tests returned to normal. Thallium imaging demonstrated improvement in ischemic areas, but old scars persisted.

  15. New perspectives on the role of cardiac magnetic resonance imaging to evaluate myocardial salvage and myocardial hemorrhage after acute reperfused ST-elevation myocardial infarction.

    PubMed

    Mangion, Kenneth; Corcoran, David; Carrick, David; Berry, Colin

    2016-07-01

    Cardiac magnetic resonance (CMR) imaging enables the assessment of left ventricular function and pathology. In addition to established contrast-enhanced methods for the assessment of infarct size and microvascular obstruction, other infarct pathologies, such as myocardial edema and myocardial hemorrhage, can be identified using innovative CMR techniques. The initial extent of myocardial edema revealed by T2-weighted CMR has to be stable for edema to be taken as a retrospective marker of the area-at-risk, which is used to calculate myocardial salvage. The timing of edema assessment is important and should be focused within 2 - 7 days post-reperfusion. Some recent investigations have called into question the diagnostic validity of edema imaging after acute STEMI. Considering the results of these studies, as well as results from our own laboratory, we conclude that the time-course of edema post-STEMI is unimodal, not bimodal. Myocardial hemorrhage is the final consequence of severe vascular injury and a progressive and prognostically important complication early post-MI. Myocardial hemorrhage is a therapeutic target to limit reperfusion injury and infarct size post-STEMI. PMID:27043975

  16. Postmastectomy radiotherapy with integrated scar boost using helical tomotherapy

    SciTech Connect

    Rong Yi; Yadav, Poonam; Welsh, James S.; Fahner, Tasha; Paliwal, Bhudatt

    2012-10-01

    The purpose of this study was to evaluate helical tomotherapy dosimetry in postmastectomy patients undergoing treatment for chest wall and positive nodal regions with simultaneous integrated boost (SIB) in the scar region using strip bolus. Six postmastectomy patients were scanned with a 5-mm-thick strip bolus covering the scar planning target volume (PTV) plus 2-cm margin. For all 6 cases, the chest wall received a total cumulative dose of 49.3-50.4 Gy with daily fraction size of 1.7-2.0 Gy. Total dose to the scar PTV was prescribed to 58.0-60.2 Gy at 2.0-2.5 Gy per fraction. The supraclavicular PTV and mammary nodal PTV received 1.7-1.9 dose per fraction. Two plans (with and without bolus) were generated for all 6 cases. To generate no-bolus plans, strip bolus was contoured and overrode to air density before planning. The setup reproducibility and delivered dose accuracy were evaluated for all 6 cases. Dose-volume histograms were used to evaluate dose-volume coverage of targets and critical structures. We observed reduced air cavities with the strip bolus setup compared with what we normally see with the full bolus. The thermoluminescence dosimeters (TLD) in vivo dosimetry confirmed accurate dose delivery beneath the bolus. The verification plans performed on the first day megavoltage computed tomography (MVCT) image verified that the daily setup and overall dose delivery was within 2% accuracy compared with the planned dose. The hotspot of the scar PTV in no-bolus plans was 111.4% of the prescribed dose averaged over 6 cases compared with 106.6% with strip bolus. With a strip bolus only covering the postmastectomy scar region, we observed increased dose uniformity to the scar PTV, higher setup reproducibility, and accurate dose delivered beneath the bolus. This study demonstrates the feasibility of using a strip bolus over the scar using tomotherapy for SIB dosimetry in postmastectomy treatments.

  17. Myocardial stunning in hypertrophic cardiomyopathy: recovery predicted by single photon emission computed tomographic thallium-201 scintigraphy

    SciTech Connect

    Fine, D.G.; Clements, I.P.; Callahan, M.J.

    1989-05-01

    A young woman with hypertrophic cardiomyopathy confirmed by echocardiography and cardiac catheterization presented with chest pain and features of a large left ventricular aneurysm. The initial diagnosis was myocardial ischemia with either an evolving or an ancient myocardial infarction. Subsequently, verapamil therapy was associated with complete resolution of the extensive left ventricular wall motion abnormalities, normalization of left ventricular ejection fraction and a minimal myocardial infarction. Normal thallium uptake on single photon emission computed tomographic scintigraphy early in the hospital course predicted myocardial viability in the region of the aneurysm. Thus, orally administered verapamil may reverse spontaneous extensive myocardial ischemia in hypertrophic cardiomyopathy and possibly limit the extent of myocardial infarction in such circumstances.

  18. Myocardial Noncompaction Presenting With Myocardial Bridge

    PubMed Central

    Shen, Yuechun; Li, Xinchun; Lu, Dongfeng; Xiao, Aiyi; Li, Jun

    2015-01-01

    Abstract Myocardial noncompaction, namly isolated noncompaction of the left ventricular myocardium (NVM), is a rare congenital disease. It can be either seen in the absence of other cardiac anomalies, or associated with other congenital cardiac defects, mostly stenotic lesions of the left ventricular outflow tract. A myocardial bridge (MB) is thought being associated with coronary heart disease, such as coronary spasm, arrhythmia, and so on. The significance of MB in association with other congenital cardiac conditions is unknown. We report a novel case who was presented NVM and MB. A 34-year-old man complained of chest prickling-like pain and dizzy for 1 year. His blood pressure was 110/70 mm Hg. Echocardiograph revealed increased trabeculations below the level of papillary muscle of left ventricle (LV); deep intertrabecular recesses in the endocardial wall of LV particularly in apex free wall; and LV ejection fraction of 57%. A coronary computerized tomography scan showed that part, 38.9 cm, of left descending artery tunnel was surrounding by cardiac muscles rather than resting on top of the myocardium. The therapeutics interventions included lifestyle cares, agents of anti-ischemia and improvement myocardial cell metabolism. The patient was followed up for 2.6 years, and his general condition was stable. This case indicates that NVM can be developed with MB, and the complete diagnosis of NVM and MB should be made by different image studies. PMID:26356695

  19. A Rat Excised Larynx Model of Vocal Fold Scar

    PubMed Central

    Welham, Nathan V.; Montequin, Douglas W.; Tateya, Ichiro; Tateya, Tomoko; Hee Choi, Seong; Bless, Diane M.

    2008-01-01

    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 one of four experimental groups: Chronic vocal fold scar, chronic vocal fold scar treated with 100 ng basic fibroblast growth factor (bFGF), chronic vocal fold scar treated with saline (sham treatment), and unscarred untreated control. Following tissue harvest, histological and immunohistochemical data were collected to confirm extracellular matrix alteration in the chronic scar group, and acoustic, aerodynamic and high speed digital imaging data were collected using an excised larynx setup in all groups. Phonation threshold pressure (Pth), glottal resistance (Rg), glottal efficiency (Eg), vibratory amplitude and vibratory area were employed as dependent variables. Results Chronically scarred vocal folds were characterized by elevated collagen I and III and reduced hyaluronic acid abundance. Phonation was achieved and data were collected from all control and bFGF treated larynges, however phonation was not achieved with 3 of 6 chronically scarred and 1 of 6 saline treated larynges. Compared to control, the chronic scar group was characterized by elevated Pth, reduced Eg, and intra-larynx vibratory amplitude and area asymmetry. The bFGF group was characterized by Pth below control group levels, Eg comparable to control, and vocal fold vibratory amplitude and area symmetry comparable to control. The sham group was characterized by Pth comparable to control, Eg superior to control, and vocal fold vibratory amplitude and area symmetry comparable to control. Conclusions The excised larynx model reported here demonstrated robust deterioration across phonatory indices under the scar condition and sensitivity to treatment induced change under the bFGF condition. The improvement observed under the sham condition may reflect

  20. Hypertrophic scars and keloids in surgery: current concepts.

    PubMed

    Song, Colin

    2014-09-01

    Hypertrophic scars and keloids remain a challenge in surgery. We appreciate that our understanding of the process at cellular and molecular level, profound as it is, when it comes to the clinical evidence much is left to be desired. Although the bench to bedside conundrum remains, the science of translational research calls for an even higher level of cooperation between the scientist and the clinician for the impetus to succeed.The clinicians alerted us to the possible theories in the pathogenesis of keloid formation, inter alia, the ischemia theory, mast cell theory, immune theory, transforming growth factor β interaction, mechanical theory, and the melanocyte stimulating hormone theory. All of the above presupposed a stimulus that would result in an uncontrolled upregulation of collagen and extracellular matrix expression in the pathogenesis of the keloid. This bedside to bench initiative, as in true science, realized more ponderables than possibilities.By the same token, research into the epidermal-mesenchymal signaling, molecular biology, genomics, and stem cell research holds much promise in the bench top arena. To assess efficacy, many scar assessment scores exist in the literature. The clinical measurement of scar maturity can aid in determining end points for therapeutics. Tissue oxygen tension and color assessment of scars by standardized photography proved to be useful.In surgery, the use of dermal substitutes holds some promise as we surmise that quality scars that arise from dermal elements, molecular and enzyme behavior, and balance. Although a systematic review shows some benefit for earlier closure and healing of wounds, no such review exists at this point in time for the use of dermal substitutes in scars.Adipose-derived stem cell, as it pertains to scars, will hopefully realize the potential of skin regeneration rather than by repair in which we are familiar with as well as the undesirable scarring as a result of healing through the inflammatory

  1. Sympathetic stimulation increases dispersion of repolarization in humans with myocardial infarction

    PubMed Central

    Vaseghi, Marmar; Lux, Robert L.; Mahajan, Aman

    2012-01-01

    The sympathetic nervous system is thought to play a key role in genesis and maintenance of ventricular arrhythmias. The myocardial effect of sympathetic stimulation on myocardial repolarization in humans is poorly understood. The purpose of this study was to evaluate the effects of direct and reflex sympathetic stimulation on ventricular repolarization in patients with postinfarct cardiomyopathy (ICM). The effects of direct sympathetic stimulation were assessed using isoproterenol, while those of reflex sympathetic stimulation were assessed with nitroprusside infusion in ICM patients (n = 5). Five patients without cardiomyopathy were also studied. Local repolarization was measured from intracardiac electrograms that were used to calculate the activation recovery interval (ARI), a surrogate of action potential duration. Isoproterenol significantly increased heterogeneity in repolarization in patients with ICM; the decrease in ARI from baseline was 72.9 ± 9.1 ms in more viable regions, 64.5 ± 8.9 ms in the scar, and 54.9 ± 9.1 ms in border zones (P = 0.0002 and 0.014 comparing normal and scar to border zones, respectively). In response to nitroprusside, the ARI at the border zones decreased significantly more than either scar or surrounding viable myocardium, which showed an increase in ARI (P = 0.014 and 0.08 comparing normal tissue and scar to border zones, respectively). Furthermore, isoproterenol increased ARI dispersion by 70%, while nitroprusside increased ARI dispersion by 230% when ICM patients were compared to those with structurally normal hearts (P = 0.0015 and P < 0.001, respectively). In humans, both direct and reflex sympathetic stimulations increase regional differences in repolarization. The normal tissue surrounding the scar appears denervated. Dispersion of ARI in response to sympathetic stimulation is significantly increased in patients with ICM. PMID:22345568

  2. Closure of supporting cell scar formations requires dynamic actin mechanisms.

    PubMed

    Hordichok, Andrew J; Steyger, Peter S

    2007-10-01

    In many vertebrate inner ear sensory epithelia, dying sensory hair cells are extruded, and the apices of surrounding supporting cells converge to re-seal the epithelial barrier between the electrochemically-distinct endolymph and perilymph. These cellular mechanisms remain poorly understood. Dynamic microtubular mechanisms have been proposed for hair cell extrusion; while contractile actomyosin-based mechanisms are required for cellular extrusion and closure in epithelial monolayers. The hypothesis that cytoskeletal mechanisms are required for hair cell extrusion and supporting cell scar formation was tested using bullfrog saccules incubated with gentamicin (6h), and allowed to recover (18h). Explants were then fixed, labeled for actin and cytokeratins, and viewed with confocal microscopy. To block dynamic cytoskeletal processes, disruption agents for microtubules (colchicine, paclitaxel) myosin (Y-27632, ML-9) or actin (cytochalasin D, latrunculin A) were added during treatment and recovery. Microtubule disruption agents had no effect on hair cell extrusion or supporting cell scar formation. Myosin disruption agents appeared to slow down scar formation but not hair cell extrusion. Actin disruption agents blocked scar formation, and largely prevented hair cell extrusion. These data suggest that actin-based cytoskeletal processes are required for hair cell extrusion and supporting cell scar formation in bullfrog saccules. PMID:17716843

  3. Regulation of scar formation by vascular endothelial growth factor

    PubMed Central

    Wilgus, Traci A.; Ferreira, Ahalia M.; Oberyszyn, Tatiana M.; Bergdall, Valerie K.; DiPietro, Luisa A.

    2009-01-01

    Vascular endothelial growth factor (VEGF-A) is known for its effects on endothelial cells and as a positive mediator of angiogenesis. VEGF is thought to promote the repair of cutaneous wounds due to its pro-angiogenic properties, but its ability to regulate other aspects of wound repair, such as the generation of scar tissue has not been well studied. We examined the role of VEGF in scar tissue production utilizing models of scarless and fibrotic repair. Scarless fetal wounds had lower levels of VEGF and were less vascular than fibrotic fetal wounds, and the scarless phenotype could be converted to a scar-forming phenotype by adding exogenous VEGF. Similarly, neutralization of VEGF reduced vascularity and decreased scar formation in adult wounds. These results show that VEGF levels have a strong influence on scar tissue formation. Our data suggest that VEGF may not simply function as a mediator of wound angiogenesis, but instead may play a more diverse role in the wound repair process. PMID:18427552

  4. Sarcoidosis presenting as non-scarring non-scalp alopecia.

    PubMed

    Dan, Luke; Relic, John

    2016-08-01

    In this article we describe a 39-year-old man who presented with non-scarring non-scalp alopecia of his limbs as the initial presentation of sarcoidosis. Alopecia is a rare cutaneous manifestation of sarcoidosis. A literature review has found only one other example of sarcoidosis presenting as non-scarring non-scalp alopecia in an area other than the scalp in a patient who was otherwise asymptomatic. Several reported cases have described scarring alopecia of the scalp, which is the area of skin most commonly affected by sarcoidosis. There has been one documented case of sarcoidosis manifesting as total body non-scarring alopecia in a patient who had systemic symptoms of sarcoidosis. Other cases have presented rare cutaneous manifestations of sarcoidosis but in all these cases several other organ systems have been involved, and the patient has had systemic symptoms on presentation or the cutaneous presentation did not include non-scalp non-scarring alopecia. PMID:25823524

  5. Scar tissue orientation in unsutured and sutured corneal wound healing.

    PubMed Central

    Melles, G R; Binder, P S; Beekhuis, W H; Wijdh, R H; Moore, M N; Anderson, J A; SundarRaj, N

    1995-01-01

    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 PMID:7547789

  6. Ultrasonographic Evaluation of Uterine Scar Niche before and after Laparoscopic Surgical Repair: A Case Report

    PubMed Central

    Drouin, Olivier; Bergeron, Tessa; Beaudry, Ariane; Demers, Suzanne; Roberge, Stéphanie; Bujold, Emmanuel

    2014-01-01

    Context Uterine scar defects or scar niche are relatively common after cesarean delivery. An association has been observed between the severity of scar defect, also known as isthmocele, some gynecologic symptoms, and the risk of uterine scar dehiscence at the next delivery. It has been suggested that surgical repair of scar defect could improve the gynecological symptoms, but it remains unclear whether such surgery mends the uterine scar itself. Case Report We report the case of a woman with uterine scar defect in whom laparoscopic repair significantly improved the gynecological symptoms without affecting the uterine scar, evaluated by hysterosonography. Conclusion This case highlights the significant dearth of knowledge surrounding the diagnosis, consequences, and benefits of surgical repair of uterine scar defect after cesarean. PMID:25452883

  7. Ultrasonographic Evaluation of Uterine Scar Niche before and after Laparoscopic Surgical Repair: A Case Report.

    PubMed

    Drouin, Olivier; Bergeron, Tessa; Beaudry, Ariane; Demers, Suzanne; Roberge, Stéphanie; Bujold, Emmanuel

    2014-11-01

    Context Uterine scar defects or scar niche are relatively common after cesarean delivery. An association has been observed between the severity of scar defect, also known as isthmocele, some gynecologic symptoms, and the risk of uterine scar dehiscence at the next delivery. It has been suggested that surgical repair of scar defect could improve the gynecological symptoms, but it remains unclear whether such surgery mends the uterine scar itself. Case Report We report the case of a woman with uterine scar defect in whom laparoscopic repair significantly improved the gynecological symptoms without affecting the uterine scar, evaluated by hysterosonography. Conclusion This case highlights the significant dearth of knowledge surrounding the diagnosis, consequences, and benefits of surgical repair of uterine scar defect after cesarean. PMID:25452883

  8. Pseudopod growth and evolution during cell movement is controlled through SCAR/WAVE dephosphorylation

    PubMed Central

    Ura, Seiji; Pollitt, Alice Y.; Veltman, Douwe M.; Morrice, Nicholas A.; Machesky, Laura M.; Insall, Robert H.

    2016-01-01

    Background SCAR/WAVE is a principal regulator of pseudopod growth in crawling cells. It exists in a stable pentameric complex, which is regulated at multiple levels that are only beginning to be understood. SCAR/WAVE is phosphorylated at multiple sites, but how this affects its biological activity is unclear. Here we show that dephosphorylation of Dictyostelium SCAR controls normal pseudopod dynamics. Results We demonstrate that the C-terminal acidic domain of most Dictyostelium SCAR is basally phosphorylated at four serine residues. A small amount of singly phosphorylated SCAR is also found. SCAR phosphorylation site mutants cannot replace SCAR’s role in the pseudopod cycle, though they rescue cell size and growth. Unphosphorylatable SCAR is hyperactive – excessive recruitment to the front gives large pseudopods that fail to bifurcate because they continually grow forwards. Conversely, phosphomimetic SCAR is weakly active, causing frequent small, disorganised pseudopods. Even in its regulatory complex, SCAR is normally held inactive by an interaction between the phosphorylated acidic and basic domains. Loss of basic residues complementary to the acidic phosphosites yields a hyperactive protein similar to unphosphorylatable SCAR. Conclusions Regulated dephosphorylation of a fraction of the cellular SCAR pool is a key step in SCAR activation during pseudopod growth. Phosphorylation increases autoinhibition of the intact complex. Dephosphorylation weakens this interaction and facilitates SCAR activation, but also destabilizes the protein. We show that SCAR is specifically dephosphorylated in pseudopods, increasing activation by Rac and lipids and supporting positive feedback of pseudopod growth. PMID:22386315

  9. Computer-based assessment of left ventricular regional ejection fraction in patients after myocardial infarction

    NASA Astrophysics Data System (ADS)

    Teo, S.-K.; Su, Y.; Tan, R. S.; Zhong, L.

    2014-03-01

    After myocardial infarction (MI), the left ventricle (LV) undergoes progressive remodeling which adversely affects heart function and may lead to development of heart failure. There is an escalating need to accurately depict the LV remodeling process for disease surveillance and monitoring of therapeutic efficacy. Current practice of using ejection fraction to quantitate LV function is less than ideal as it obscures regional variation and anomaly. Therefore, we sought to (i) develop a quantitative method to assess LV regional ejection fraction (REF) using a 16-segment method, and (ii) evaluate the effectiveness of REF in discriminating 10 patients 1-3 months after MI and 9 normal control (sex- and agematched) based on cardiac magnetic resonance (CMR) imaging. Late gadolinium enhancement (LGE) CMR scans were also acquired for the MI patients to assess scar extent. We observed that the REF at the basal, mid-cavity and apical regions for the patient group is significantly lower as compared to the control group (P < 0.001 using a 2-tail student t-test). In addition, we correlated the patient REF over these regions with their corresponding LGE score in terms of 4 categories - High LGE, Low LGE, Border and Remote. We observed that the median REF decreases with increasing severity of infarction. The results suggest that REF could potentially be used as a discriminator for MI and employed to measure myocardium homogeneity with respect to degree of infarction. The computational performance per data sample took approximately 25 sec, which demonstrates its clinical potential as a real-time cardiac assessment tool.

  10. [Prehospital thrombolytic therapy in acute myocardial infarction].

    PubMed

    Carlsson, J; Schuster, H P; Tebbe, U

    1997-10-01

    The extent of myocardial damage occurring during acute myocardial infarction is time dependent, and there is abundant evidence from most clinical trials that mortality reduction is greatest in patients treated early with thrombolytic agents, although beneficial effects have been shown with treatment initiated up to 12 h after onset of symptoms. All studies on prehospital thrombolysis have conclusively shown the practicability and safety of patient selection and administration of the thrombolytic agent. The accuracy of diagnosis in the prehospital setting was comparable to trials of in-hospital thrombolysis, e.g., in the Myocardial Infarction Triage and Intervention Project (MITI) 98% of the patients enrolled had subsequent evidence of acute myocardial infarction. With regard to time savings, all randomized studies showed positive results. The smallest time gain was observed in the MITI trial: prehospital-treated patients received thrombolytic therapy an average of 33 min earlier than those treated in hospital. In the European Myocardial Infarction Project (EMIP) the difference in time between prehospital and hospital treatment was a median of 55 min. However, none of these trials was able to show a significant short-term mortality difference between the two groups. Only a meta analysis of five randomized studies with a combined median time gain of about 60 min showed a significant 17% reduction in short-term mortality for patients who received thrombolytic therapy in the prehospital phase. In the Grampian Region Early Anistreplase Trial (GREAT), a study performed in a more rural area than other studies, the time gain by prehospital initiation of thrombolysis was a median of 130 min. GREAT was the only study to date reporting a significant mortality benefit for prehospital-treated patients after 3 months and 1 year. In conclusion, prehospital thrombolysis is feasible and safe. Patients with acute myocardial infarction can be correctly identified and treated with