Scars Solution

Scar Solution Ebook By Sean Lowry

This training system is developed by Sean Lowry a medical researcher and also a former scar sufferer. The Scar Solution book is actually an useful treatment available online that guides users on how to get clear skin without scars fast. Sean Lowry put her skills and knowledge as a medical researcher and scientist to good use, and in the process she came up with the scar solutions discussed in her aptly-titled The Scar Solution e-book. This is a scientifically designed, clinically proven, dermatologist approved and tested program. In this program scars have been classified into specific categories based on their cause. Remedies have been given accordingly systematically eliminate each type of scar effectively. This guide does provide information regarding total treatment of scars. It is based on scientific studies, research and experiments. It appears that this natural cure for removal of scars as already helped many the world over get rid of scars completely. However no two people are the same. Therefore what may work for one may not work for others. Read more...

The Scar Solution Natural Scar Removal Summary


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The very first point I want to make certain that The Scar Solution Natural Scar Removal definitely offers the greatest results.

As a whole, this manual contains everything you need to know about this subject. I would recommend it as a guide for beginners as well as experts and everyone in between.

Vt Related To Regions Of Scar

Scar Related Reentry

The most common cause of VT is reentry through regions of scar, most commonly an old MI (Fig. 4). Other scar-related VTs occur because of arrhythmogenic right ventricular dysplasia, sarcoidosis, Chagas' disease, and other nonischemic cardiomyopathies. Two features of ventricular scarring lead to reentrant VT (40-42). First, dense scarring creates regions of anatomic conduction block. Second, the scar is not comprised completely of dense fibrotic tissue, but also contains surviving myocyte bundles (43,44). Fibrosis between myocytes and myocyte bundles decreases cell-to-cell connections. The excitation wavefront propagates in a zig-zag manner from myocyte bundle to myocyte bundle, increasing the time for depolarization to procede through the region and thereby causing slow conduction (44). Circulation of an excitation wavefront around an area of block leads to reentry. With slow conduction, each cell in the circuit has sufficient time to recover after each depolarization. Most...

Problems And Emerging Solutions For Scarrelated Tachycardias

In some idiopathic and scar-related tachycardias the ablation target is not located on the endocardium, but is intramural or epicardial in location. In these cases, epicardial mapping can be attempted in one of two ways. Electrode catheters can be introduced into the cardiac venous system via the coronary sinus (CS). Small, 2 French multielectrode catheters are available that allow extensive epicardial mapping over regions of the left ventricle by canulating the branches of the CS and great cardiac vein (77). The utility of this method is being evaluated. A second approach developed by Sosa and colleagues involves percutaneous entry into the pericardial space in the manner used for pericardiocentesis, followed by insertion of an introducer and mapping catheter (73,78,79). Epicardial foci have been identified and ablated. The risk of damage to adjacent lung and epicardial coronary vessels requires further evaluation. This method cannot be employed in patients who have had prior cardiac...

Scarring Or Keloids

Scarring is not anticipated as a consequence of this procedure, but any procedure in which the surface of the skin is removed can heal with scarring. This usually occurs because of some secondary factor which interferes with healing, such as infection, irritation, scratching, or poor wound care. Scarring from infection, irritation or scratching, does blend and ordinarily disappears in a few months, but some scarring may be permanent if it occurs. Hypertrophic scars or keloids in susceptible people may suddenly appear. Most of these respond to injections or special creams. Some scarring could be permanent. Notify your physician if you have ever used Accutane as this can increase your risk for scarring.

Scarring in General

Most surgeons assume the patient understands that healing entails formation of scar. Unfortunately, it is seldom discussed in the preop-erative consultation. In plastic and reconstructive surgery, the appearance of the resulting scar can be the major genesis of dissatisfaction. It is imperative that the plastic surgeon obtains from the patient clear evidence of his or her comprehension that without scarring, there is no healing. The patient must be made to understand that healing qualities

The Standard Procedures

For all operations associated with large scars, follow-up treatment is very important. A compression dressing should be worn for approximately 4 weeks and follow-up treatment for the scar should be carried out with a silicone plaster. Scars resulting from brachioplasty, abdominoplasty, and thigh and buttock lifts in particular are often unpredictable and must be discussed in detail with the patient when the procedure is explained so that there is no disagreement later.

Thigh and Buttock Lift

The incision line in the buttock area should not extend beyond the lateral buttock fold, as otherwise there may be residual aesthetically displeasing scars, which often disturb patients more than hanging skin. With extremely slack skin in the area of the medial thigh, vertical tightening extending to the medial side of the knee can be performed in addition to horizontal tightening in the groin and buttock region. This allows extremely intense tightening of the entire medial thigh, but the residual scar should be drawn to the patient's attention and explained. The video shows the most frequently requested operation for horizontal thigh and buttock lifting. In contrast to brachioplasty, it is important that the thick cutaneous fatty flap be secured at two points to achieve a longer-lasting result and better scar formation, owing to gravity in the thigh area. The points for fixation are the periosteum of the pubic bone and the inguinal ligament. The extent of the resection is defined...

The Mediators Expressed by Mast Cells and Their Role in the Inflammatory Response

Mast cells have been incriminated in such diverse diseases as allergy, asthma, rheumatoid arthritis, atherosclerosis, interstitial cystitis, inflammatory bowel disease, progressive systemic sclerosis, chronic graft-vs-host disease, fibrotic diseases, sarcoidosis, asbestosis, ischemic heart disease, keloid scars, and malignancy (3). The mediators released by mast cells can independently and, in synergy with macrophage- and T-cell-derived cytokines, induce much of the inflammatory pathology observed in inflammation and serve to orchestrate a complex immune response. Histamine, LTB4, LTC4, PAF, and PGD2 may have multiple effects on inflammatory cell recruitment (eosinophils), smooth muscle hyperplasia, and vascular dilatation (80,81). Tryptase, chymase, and TNF-a from mast cells activate fibroblasts, leading to collagen deposition and fibrosis. Mast cell-derived TNF-a regulates NF-KB-dependent induction of endothelial adhesion molecule expression on endothelial cells in vivo (49). Mast...

Conclusions on carotid atherosclerosis

The incidence and fate of nascent atheromata are determined at all levels, even beyond the plaque itself, reflecting a profile of the whole patient, from genetics, cellular events, and blood biochemistry 70 , to patient diet and behavior. For example, the 'vulnerable patient' and the patient who is less or not vulnerable to a stroke may, theoretically, have identical plaques, but one patient is 'vulnerable' because his or her blood has a composition with a greater predisposition to clotting, when exposed thrombogenic factors within the plaque. As such, other non-imaging clinical tests, particularly serum analyses, will play a great role, in risk-stratifying patients with carotid atherosclerosis.

Tissue Remodeling Fibrosis

Tial fibrosis are greater than from control individuals (102), and patients with idiopathic interstitial pulmonary fibrosis show evidence of mast cell degranulation and elevated mast cell numbers (103). In the kidney tissue of patients with IgA nephropathy, mast cell numbers correlate with the degree of interstitial fibrosis and creatinine clearance. In these kidney tissues, mast cells express tryptase and bFGF (104), which may be partially responsible for the fibrosis observed. The mast cell appears to be the dominant source of bFGF in some patients with pulmonary fibrosis (105). Similarly, patients with pulmonary fibrosis associated with scleroderma show higher numbers of mast cells and quantities of histamine and tryptase in bronchoalveolar lavage fluid than patients with normal chest roentgenograms (106). Mast cells also are found in intimate contact with myofibroblasts in keloid scars, suggesting they may play a role in fibroblast activation and scar formation (107). Thus, it...

Theory Psychoanalysis in Context

The very real persecution suffered by the psychoanalytic movement in its infancy left a deep scar. From the outset, Freud saw psychoanalysis as a cause to be defended against attack and the analytic institutes that emerged could be seen to be the bastions of this defence (Kirsner, 1990). This had the unfortunate effect of also keeping at bay other perspectives and related fields of enquiry, fearing their evaluation, criticism and attack.

Ocular Manifestations

Diagnosis of uveitis is made by slit-lamp examination and is found in both eyes in 50 of cases. Moreover, uveitis is more frequent in UC patients with other EIM, such as joint and skin lesions. Uveitis needs prompt treatment to avoid scarring complications. The treatment of choice is topical corticos-teroids associated with systemic corticosteroids, aza-thioprine or cyclosporine. Colectomy has been

Post Treatment Surveillance

Although still largely investigational, endovas-cular treatment of carotid stenosis is becoming more accepted in recent years. A number of patients have received treatment with carotid angio-plasty without stenting. Evaluation of these patients is also similar to that of patients following carotid endarterectomy. Patients with prior carotid stent placement, however, present added problems. Safety considerations due to possible magnetic attraction of the intravascular stent must be considered. Most stents are not attracted in a magnetic field and therefore are generally safe to image. To be absolutely certain, since most often one is not aware of the exact stent type used, we generally limit MR imaging of post-stented patients for any reason to imaging only after the stent has been in place for a minimum of six weeks. This is to ensure that there is adequate scarring and endotheliaza-tion around the stent, which will help stabilize the

Physiological regulators

Above, I suggested that the correlation between scars and infection status in hantavirus and arenavirus host rodents means that aggression leads to infection. Recent evidence suggests, however, that the cause and effect relationship between aggression and infection may not be as simple as it appears. Klein et al. 23 showed

Effects of ang ii on vascular repair

Vascular fibrosis, an important component in the inflammatory-reparative process, involves accumulation of extracellular matrix proteins, particularly collagen and fibronectin, in the vascular media and contributes to structural remodeling and scar formation. Ang II is critically involved in fibrosis. In cultured VSMCs, fibroblasts and cardiac cells, Ang II stimulates profibrotic signaling pathways and stimulates production of vascular collagen and fibronectin (77,90-92). Systemic infusion of Ang II leads to cardiac,

The Dysmorphic Patient

Patients with dysmorphism are those obsessively preoccupied with real or imaginary defects. They may even take the mirror to point out a defect that has not been noted by the physician. In general, those defects are minor but are perceived by them to be disfiguring. The inability to deal with unavoidable scars is also a warning that dissatisfaction may arise after the cosmetic procedure. Some patients do have a real psychiatric or emotional disorder. Patients with borderline personality, obsessive-compulsive, and narcissistic disorders should be avoided.

Analysis of MCG Signal Morphology

When analyzing ST segment and T-wave amplitude after exercise in both MCG and BSPM in 24 CAD patients with specified ischemic regions and no previous myocardial scar, Hanninen et al. (2001) identified optimal MCG locations sensitive to ST depression and elevation as well as to the increase or decrease of the T-wave amplitude. These authors noted that the locations were dependent on the stenosed vessel region, that the T-wave changes could separate stenosed vessel regions as well as ST segment changes, and that the most informative sites were outside the 12-lead standard ECG. In a later study in 44 patients with ischemia documented by coronary angiography and exercise thallium scintigraphy, the same group was able to show a decrease in MCG ST amplitude, ST slope and T-wave amplitude under

QSwitched Alexandrite Laser 755 nm

Used in freehand mode, reproducibility is lacking and the thermal damage is somewhat unpredictable. The risk of scarring and pigmentary changes is therefore significant in the hands of inexperienced operators. In general, these CW lasers, when used by skilled operators, are effective in the treatment of epidermal pigmented lesions.

Spring And Bifurcate Ligaments

Talar Stress Fracture

Coronal FSE image demonstrates scarring of the deep fibers of the deltoid ligament and an ossific fragment abutting and causing mass effect on the medial talus. (Courtesy of Department of MRI, Hospital for Special Surgery, New York, NY.) Fig. 16. Coronal FSE image demonstrates scarring of the deep fibers of the deltoid ligament and an ossific fragment abutting and causing mass effect on the medial talus. (Courtesy of Department of MRI, Hospital for Special Surgery, New York, NY.)

Ileocolic Non Complicated Disease

The ideal patients who may benefit from laparoscopy are those undergoing elective ileocolic resection. These patients are young and often are attracted by the advantage of smaller abdominal scars 3 . The minimally invasive nature of the laparoscopic approach has a favourable impact, as patients undergoing this approach may require further surgery in the future. The outcomes of the randomised trial 2 and of several cohort comparison studies 4-8 , show that after laparoscopic ileocolic resection there is a shorter hospital stay, with a faster recovery of pulmonary function, possibly a reduced postoperative ileus and better cosmesis. Three reports conclude that the cost of laparoscopic resection is globally less than open resection 5,7,8 . Due to the less extensive intra-abdominal manipulation and consequent less adhesion formation, laparoscopy seems to have decreased long-term small-bowel obstruction non-related to recurrence 4 .

Consumer concerns about regulatory safeguards for medical devices

In racially and ethnically diverse countries such as the USA, the potential for racial and ethnic differences in responses to implanted medical devices has become an issue of concern among consumer groups. The NRC for Women & Families, the National Medical Association, and the Congressional Black Caucus of the US Congress have all expressed their concern that implant makers rarely include racial and ethnic minorities in their studies. Since individuals of African or Asian ancestry are more likely to have keloid scarring, and since individuals of African ancestry are more susceptible to autoimmune diseases, medical implants may be more risky for those groups. However, it is impossible to know whether this is the case if no studies have been done.

Orthopedic devices in the growing child

Adverse fracture sequelae may manifest as different types of growth disturbances, including premature partial closure of the growth plate, leading to angular deformity complete interruption of the growth plate, resulting in the affected leg being shorter than the other or, conversely, as the fracture heals there may be increased blood supply and overgrowth of the affectedbone. Femoral fractures pose a particular challenge when they occur in the school-aged child. Very different from young pre-school children who are treated with spica casts, school-aged children are not skeletally mature, need to be mobile, must attend school, and have higher risk for problems associated with prolonged bed rest. These factors have led to an increased use of internal and external fixation devices in this age group 36-38 . Rigid intramedullary nails inserted into growing young children may be used however, according to the results of a 1998 survey of pediatric orthopedists, avascular necrosis of the...

Discoid lupus erythematosus

Disease may be limited to the skin and assume the chronic discoid form, with scaling red plaques and follicular plugging. Healing of these lesions is associated with central scarring and atrophy. Although chronic discoid lupus erythematosus remains primarily cutaneous in the majority of patients, SLE will develop in a small percentage (about 5 ). Conversely, patients with SLE may have discoid lesions among the cutaneous manifestations of their disease. Certain types of skin lesions, such as those of subacute cutaneous lupus erythematosus, may reflect a specific immunogenetic predisposition.

Immune Deficiencies Associated With Phagocytosis

Recurrent infections are found in patients with chronic granulomatous disease (CGD). These individuals reveal an increased frequency of deep tissue infections and a failure to resolve inflammatory reactions mediated by neutrophils. Consequently, there is granuloma and scarring in tissue. Despite aggressive therapy, the disease is often fatal.

Reentrant Tachycardia

The two most common cardiac disorders associated with sustained monomorphic VT are CAD with prior MI (infarct-related VT) and nonischemic dilated cardiomyopathy. Evidence suggests that the underlying mechanism for sustained VT is reentry involving a fixed substrate consisting of normal myocardium interspersed with islands of poorly conducting fibrotic scar (7). The relatively constant revolution time around the circuit coupled with a fixed exit site results in a uniform tachycardia with a relatively stable rate. Predicting which survivors of MI will develop ventricular tachyarrhythmias is difficult, and risk stratification relies upon the identification of variables associated with increased risk. These variables include Data evaluating the effectiveness of ICD therapy on the primary prevention of patients with nonischemic dilated cardiomyopathy is scarce. Several trials are currently under investigation to answer this issue. The SCD-HEFT trial has been previously mentioned (33). The...

What Is The Risk Of Having Another Heart Attack

Scar tissue in the heart can be seen using ultrasound. The function of the heart and the ability of the heart arteries to deliver sufficient blood and oxygen to the muscle can be assessed with an exercise stress ECG. As a result of this test and exercise tests on a treadmill or bicycle, a coronary angiogram may be advised.

Duplicate Patient Information

Although one tries to achieve symmetry before the intervention by precisely drawing the areas of skin that are to be removed, after the operation there may still be small differences between the sides. If this is very unsightly, it is possible to compensate by making a small extra intervention under local anesthesia without a need to admit the patient. During the first few weeks after the operation, the scars frequently move cau-dally.

Mechanisms of Epidermal Repair in Embryos

The different mechanisms of healing in adult and embryonic epidermis raise many problems that call for mathematical modelling. Perhaps the most important aspect of embryonic wound healing is that they heal without scarring, and not only epithelial wounds. An understanding of how the processes differ could have far-reaching implications for clinical wound management (see, for example, Martin 1997). Fetal surgery is a high-stakes field, has many attractions and dangers and is highly controversial with many complex ethical issues. It has already been used to treat spina bifida (since 1998) and this is only the beginning. There are many advocates for treating nonlethal conditions such as facial deformities and other defects. We have already mentioned the potential for cleft palate repair in Chapter 4. The review article by Longaker and Adzick (1991) and their edited book of contributed articles specifically on fetal wound healing (Adzick and Longaker 1991) is a good place to start. The...

Chronic Inflammation Develops When Antigen Persists

Chronically activated macrophages also stimulate fibroblast proliferation and collagen production. A type of scar tissue develops at sites of chronic inflammation by a process called fibrosis, a wound-healing reaction that can interfere with normal tissue function. Chronic inflammation may also lead to formation of a granuloma, a tumor-like mass consisting of a central area of activated macrophages surrounded by activated lymphocytes. The center of the granuloma often contains multinucleated giant cells formed by the fusion of activated macrophages. These giant cells typically are surrounded by large modified macrophages that resemble epithelial cells and therefore are called epithelioid cells.

Fieldwork and Laboratory Studies

Simple observation is enhanced by manipulating the subjects in various ways. Individual animals can be marked, or in some cases they can be identified by natural color patterns, scars, or other marks. These marked individuals can be followed, and their behavior and interactions with other individuals observed. Radios and radioactive tracer elements are sometimes implanted in individuals, and these individuals are followed in the field. Much can be learned about a species' social behavior by following the locations of such tagged animals. In addition, they are more readily locatable for direct observation.

Alternative Surgical Techniques

The external approach is best done using a seagull-shaped incision to reduce the likelihood of the scar webbing. Having found and diathermied the angular vein and dissecting down on to the periosteum, the anterior lacrimal crest should be found and then a sub-periosteal dissection done posteriorly, staying on the bone of the medial part of the orbit. This will stop orbital fat prolapsing and getting in the way, so it is important to stay in the right plane. It is often surprising to those who are not familiar with the procedure how far back the anterior ethmoid artery is. It can be seen approximately 2.4 cm from the anterior lacrimal crest as what looks like a firm attachment of the orbital periosteum, but in fact it is simply where the anterior eth-moidal artery is going through the periosteum, tenting it as it goes into the anterior ethmoid foramen. The periosteum is mobilized to expose enough of the artery to allow it to be clipped or diathermied.


A dose of 67 MBq (1.8 mCi) 99mTc-nanocolloid in a volume of 0.30 mL was injected intradermally divided over two doses on either side of the biopsy scar. The first lymphoscintigraphy study showed two sentinel nodes in the left axilla (Fig. 8). Imaging was repeated 2 weeks later on the day before the operation.

Concluding Remarks on Wound Healing

Although we have said it before (Murray et al. 1998) it bears repeating to ask why we use mathematics to study something so complicated and badly understood as wound healing. We argue that mathematics must be used if we hope to truly convert an understanding of the underlying mechanisms into a predictive science. Mathematics is required to bridge the gap between the level on which most of our knowledge is accumulating (cellular and below) and the macroscopic level of the scar itself which is of primary concern to the surgeon and the patient. A mathematical approach allows one to explore the logic of wound healing. Even if the mechanisms were well understood and they certainly are not at this stage mathematics would be required to explore the consequences of manipulating the various parameters associated with any particular wound management scenario. The number of options that are fast becoming available to wound managers will become overwhelming unless we can find a way to simulate...

Diseases of the genitourinary system N00N99

Adenomyosis N80.1 Endometriosis of ovary N80.2 Endometriosis of fallopian tube N80.3 Endometriosis of pelvic peritoneum N80.4 Endometriosis of rectovaginal septum and vagina N80.5 Endometriosis of intestine N80.6 Endometriosis in cutaneous scar N80.8 Other endometriosis N80.9 Endometriosis, unspecified

Strategies to Limit Remodeling

For a long time, infarct scar had been considered an inert tissue. However, utilizing molecular and cellular biologic technologies, we know that infarct scar is composed of biologically active components such as myofibroblasts with contractile behavior and the capacity of producing type I collagen (90). This activity contributes to the formation of fibrous tissue in noninfarcted myocardium. ACE inhibition or angiotensin 1 receptor antagonism has proven effective in attenuating this metabolic activity. In the early phase postinfarction, which encompasses the first several days, there is evidence from randomized trials that improvement in loading conditions, either with intravenous (IV) nitroglycerin (91) or with ACE inhibitors, may reduce infarct expansion. However, the data with iv nitroglycerin remain controversial, and the acute impact of early ACE inhibition on LV vol appears small. By contrast, long-term ACE inhibition has demonstrated remarkable benefits in postinfarct patients,...

The Importance of Muscle

The most common heart problems are caused by reduction or blockage of the blood supply to the heart muscle. Reduced blood supply usually is the cause of a reduced oxygen supply. The insufficient oxygen supply weakens the heart-muscle cells, causing the condition of ischemia. Complete interruption of the blood supply to an area of cardiac muscle tissue usually results in necrosis (death) of the affected muscle cells the condition is referred to as myocardial infarction. The dead muscle cells do not regenerate but are replaced by scar tissue, which is not contractile. This results in decreased pumping efficiency by the heart. De

Postoperative Care and Complications

Complications of ablative resurfacing can include prolonged erythema, contact dermatitis, acne, infection, pigmentary changes, and scarring (Lewis and Alster 1996 Nanni and Alster 1998 Sriprachya-Anunt 1997). Postoperative erythema typically improves with time it is most pronounced during the first week and steadily subsides over the next few weeks. Prolonged erythema and or pruritus result from contact dermatitis, infection, or thermal damage. Allergic and irritant contact dermatitis occurs more commonly in newly resurfaced skin and likely relates to the increased density of Langerhans cells, which is noted in areas of perturbed epidermis. Thus, anything that comes into contact with the skin can trigger a reaction as the disrupted epidermis more readily attracts the dendritic cells to potential sites of antigen invasion. The most likely contactants are sources of perfumes or dyes such as those found in fabric softener dryer sheets or detergents. Patients should be forewarned to elimi...

In Patients With Diabetes

The cellular and molecular mechanisms of systolic failure specifically related to ischemia are multiple, and include necrosis, apoptosis, reversible proteo-lytic damage to calcium cycling, and contractile proteins and perhaps phenotypic changes in these same proteins. In addition, a variety of mechanisms are generic to dilated cardiomyopathy, both ischemic and nonischemic, such as downregula-tion of calcium cycling proteins, alterations in protein kinase A and C activity, and neurohumoral and cytokine-mediated adverse effects on the myocardium. Ischemia causes diastolic failure mediated by some of the same phenomena (e.g., impaired function or damage to calcium cycling proteins), and also by virtue of scar formation following infarction. In addition, because they often do not have

Introduction Definition of Pulmonary Hypertension

Pulmonary hypertension (PH) is an important clinical complication in approximately 30 of interstitial and other non-neoplastic lung diseases in humans. The mean pulmonary artery pressures are between 25 and 45 mmHg and this elevation can compromise right heart function. The underlying mechanisms of PH in these conditions probably relates to pathologic vessel remodeling associated with progressive alveolar hypoxia and or peripheral vessel destruction from inflammation and or scarring. In contrast, a small fraction of patients with severe pulmonary hypertension in whom the pulmonary artery pressures are in excess of 40 mmHg are at risk life threatening right ventricular failure.

Body Image And Physical Rehabilitation

Disfigurement is never pleasant, and in this age of body-building, facelifts, breast implants, and bikinis, the slightest imperfection or scarring can make a patient feel like the Phantom of the Opera. If the patient has a religious background, this can be a powerful resource, and I emphasize that the real self is still there, and they can learn to forgive anyone who doesn't know that fact and looks askance. Patients without spiritual resources need to be approached with a more Ericksonian technique, utilizing whatever ego strengths are available. Physical rehabilitation requires determination to stretch out contractures, ignoring or modifying perceptions of itching and irritation in scars, and overcoming heat intolerance (Wakeman, 1988). Above all, one must persevere in physical therapy until maximal improvement is attained. Physicians tend to leave this to the physiotherapist so completely that it is almost like abandoning the patient. Hypnotic suggestions directed at these problems...

Multiple Failed Anti Reflux Operations

Another indication for esophagectomy for GERD is a history of multiple failed attempts at anti-reflux surgery. Compromise of esophageal blood supply occurs each time the esophagus and stomach are dissected to enable performance of a fundoplication. In addition, accumulated scar tissue as well as anatomic deformities caused by prior operations increase the risk of injury to the vagus nerves and the vagal plexus during dissection. The cumulative effect of these injuries results in loss of peristaltic function (pump function) leading to dysphagia and ineffective esophageal clearance of gastric refluxate. Several reports indicate that satisfactory results after fundoplication surgery occur in only 50-60 of patients who have had two or more prior fundoplications.22-24 The assessment of esophageal function is more important than merely counting the number of prior operations to determine optimal surgical therapy. Such assessment typically includes endoscopy, manometry, esophageal transit...

The Origin of Sex Differentiation

In the male, the genital tubercle will become the tip of the penis, and the innermost urogenital folds will fuse together to form the body of the penis the scar of this joining may be seen on the underside of the penis. This fusion closes off the urogenital groove and encloses the male's urethra within the tubelike penis. The outer pair of ridges

Concluding remarks

In 2004 the Scientific Committee on Antarctic Research (SCAR), fully aware of the problems inherent to climate change, launched the 8-year international programme Evolution and Biodiversity in the Antarctic the Response of Life to Change'' (EBA). It integrates research across a wide variety of fields, from functional genomics and molecular systematics to ecosystem science and modelling, and draws on and contributes information to a wide rage of related fields, such as climate modelling and tectonics. Its major intention is to provide a platform for interactions amongst disciplines and researchers that are essential to understand the role of biodiversity in the Earth System and its responses to change, by offering the Antarctic context, and establishing crosslinks with the Arctic, enhancing our ability to achieve a sustainable future for all life. EBA will provide SCAR and the international scientific community with the best possible estimate of the consequences for the Antarctic of...

What About Angioplasty And Surgery

It used to be thought that women did not recover as well as men after angioplasty or coronary artery surgery, but this is no longer thought to be true. Women may recover slower than men after angioplasty and coronary heart surgery, and this may be because they are unfit. In some cases, the results of angioplasty and coronary artery surgery are not as good as in men because women's heart arteries are smaller and technically more difficult to treat. Some women (and men) are left with an unsightly scar down the front of their chest and their leg (where the vein used for the bypass is taken) after a heart operation.

Mangs Spacelift Introduction

The name spacelift was chosen by the author and protected by patent (no. 30323891) as appropriately purified and centrifugated, recycled fat droplets are injected into the entire face, as in a honeycomb, using microinjections. The fat particles break down but, as a result of the contact with vessels (because they are not injected in large quantities in a bolus dose), they are able to form their own fibroblasts and the catabo-lized fat cells are augmented with fibroblasts and elastin fibers. Virtually no scars are formed and the face stabilizes as a result of the procedure. Naturally, injections can be made beneath other wrinkles in the forehead and nasolabial area using a conventional fat injection technique. Lipo-transfer is also recommended for lip augmentation.

Assessment of the safety and effectiveness of intervertebral disc replacement

Perioperative complications vary according to the surgeon's experience. One study that looked at complication rates according to the surgeon's experience found that the most experienced surgeon's complication rate (2.2 ) was statistically different from that of less experienced surgeons (10.7 ) 79 . Possible gastrointestinal injuries include peritoneal or intestinal tears leading to bowel perforation, peritoneal scarring, and adhesions. Genitourinary complications such as retrograde ejaculation, incontinence, or ureter damage might occur. Peripheral nerve damage, spinal cord injuries, dural tear, epidural hematoma, or herniated nucleus pulposus may occur 80 . Postoperative complications include deep vein thrombosis, pulmonary embolus and infection. Late complications may include pain and leg edema.

The patients right of access

Drawings may be helpful, particularly of the abdomen (see Figs 5.9 and 5.10, p. 164) to illustrate the position of tenderness, masses or scars. They are also useful for recording the site and size of superficial injuries or ulcers. A sample case record is shown on the following pages with explanatory notes alongside each section in turn.

Intramuscular Central Tendon Injury

Thus, the most significant injuries were rectus femoris central tendon injures greater than 13 cm in length or greater than 15 cross-sectional area resulting in rehabilitation intervals of 32.7 to 35.3 days. These injuries were termed acute bullseye lesions because of MR appearance. Peripheral injures less than 15 of cross-sectional area had the smallest rehabilitation interval of zero days in three cases. One hypothesis for longer rehabilitation times for healing central tendon injuries is that scar tissue from the healing process predisposes to discordant contraction of deep and superficial fibers resulting in chronic irritation and prolonged healing.

Mediastinoscopy Case Study

Physical examination was unremarkable except for a thoracotomy scar in the left hemithorax, decreased breath sounds, and dullness to percussion of the left base. There was no hemoptysis. Radio-nucleotide bone scan showed increased activity in the left upper posterior hemithorax. Chest and upper abdomen CT scan showed findings compatible with recurrent sarcoma of the left hemithorax. Abnormal mediastinal nodes were evident. Thoracentesis was attempted but did not yield fluid. L.E. was scheduled for a left thoracoscopy, mediastinoscopy, and biopsy.

Conventional and Videolaparoscopic Treatment

As regards colorectal surgery, the laparoscopic approach was initially used to treat benign diseases or in palliative operations because of the fear of neoplasm implantation on the scars of trocar accesses however, despite its progressive diffusion and satisfactory employment in the oncology field, its use is still not completely accepted. The need to remove large and voluminous specimen from the abdomen has led to the use of videolaparoscopic-assisted techniques (VDLA), meaning short service incisions to carry out this part of the operation. Some problems still remain a major technical complexity (difficult manoeuvres to be performed on delicate organs such as the colon, ileum and relative mesentery without the help of stereoscopic vision and tactile sensibility) and a long learning curve 31,32 , so that at present most major colorectal surgery is still performed using the traditional approach, whereas the laparoscopic technique is employed at specialised centres. However,...

Entrapment Neuropathies of the Shoulder and Elbow in the Athlete

Entrapment neuropathy secondary to nerve compression by mechanical or dynamic forces may be a cause of upper extremity pain and weakness in the athlete. Anatomically narrow passages predispose individual nerves to entrapment neuropathies. Dynamic changes within these narrow tunnels during repetitive athletic activity can produce further compression of a nerve with only minimal anatomic variation 1 . Nerve compression may also be produced by space-occupying lesions such as tumors, cysts, inflammatory processes or by post-traumatic conditions such as hematoma, myositis ossificans, and scar formation. Other causes for nerve compression are associated with hormonal alterations and systemic diseases, such as pregnancy, oral contraceptive ingestion, diabetes mellitus, and hypothyroidism. MRI is also useful in identifying the cause for entrapment. Osseous abnormalities such as bony spurs, fracture fragments, and callous can easily be identified. Mass occupying lesions such as tumors,...

Human Papilloma Virus

There are no guidelines regarding which treatment to use first. Treatment of EGWs should be guided by patient preference and the patient's ability to follow directions, number and location of warts, and clinical expertise (2). Experts suggest that treatment should be changed or the patient referred to a specialist when three treatment sessions have resulted in no improvement, if there is incomplete clearance after six treatment sessions or when continued treatment extends beyond manufacturer's recommendations (2,30). Clinicians must monitor patient progress and avoid overtreatment. Most experts agree that combining modalities on a single wart does not increase efficacy (2). All wart treatments may cause mild local irritation, ulceration, or erosion. Ablative modalities can result in hypopigmentation, hyperpegmentation, or hypertophic scars. Pregnancy and immunodeficiency are associated with larger or more numerous EGWs (30). There are reports of immunocompromised patients having EGWs...

Case 2 Merkels Cell Carcinoma

A 34-yeor-old woman was examined at another hospital with a 3 X 4 cm tumor in the right thigh. The tumor was attached to the skin and had developed in the scar of o cut that she suffered 22 years earlier. Physical examination revealed no other abnormalities. Excision with a narrow margin was performed. Pathological evaluation revealed a neuroendocrine tumor of the skin (Merkel's cell carcinoma) that involved the excision margin. A computed tomography scan of the chest

Medical Terminology Case Studies - Skin


K.B., a 32-year-old fitness instructor, had noticed a tiny hard lump at the base of her left nostril while cleansing her face. The lesion had been present for about 2 months when she consulted a dermatologist. She had recently moved north from Florida, where she had worked as a lifeguard. She thought the lump might have been triggered by the regular tanning salon sessions she had used to retain her tan because it did not resemble the acne pustules, blackheads, or resulting scars of her adolescent years. Although dermabrasion had removed the obvious acne scars and left several areas of dense skin, this lump was brown-pigmented and different. K.B. was afraid it might be a malignant melanoma. On examination, the dermatologist noted a small pearly-white nodule at the lower portion of the left ala (outer flared portion of the nostril). There were no other lesions on her face or neck. Raised, thickened scar Scar ____trix

Establishing Pneumoperitoneum

Gas Insufflation Laparoscopic Surgery

Pneumoperitoneum is most often established using a Veress needle. The needle is usually inserted at the site where the primary cannula for the laparoscope will be placed. Our preference is a vertical infra-umbilical incision because it overlies the location where the skin, fascia, and parietal peritoneum converge and fuse. If the patient has had prior abdominal surgery, we generally avoid the old incision scars and enter from a remote site in the upper abdomen.

External Form Of A Woody Twig

Stipules Buds Bud Scales Scars

There often (but not always) is a terminal bud present at the tip of each twig. A terminal bud usually resembles an axillary bud, although it is often a little larger. Unlike axillary buds, terminal buds do not become separate branches, but, instead, the meristems within them normally produce tissues that make the twig grow longer during the growing season. The bud scales of a terminal bud leave tiny scars around the twig when they fall off in the spring. Counting the number of groups of bud scale scars on a twig can tell one how old the twig is. Sometimes other scars of different origin also occur on a twig. These scars come from a leaf that has stipules at the base of the petiole. Stipules are paired, often somewhat leaflike, appendages that may remain throughout the life of the leaf. In some plants, they fall off as the buds expand in the spring, leaving tiny stipule scars. The stipule scars may resemble a fine line encircling the twig, or they may be very inconspicuous small scars...

Treatment Of Relapse Of Juvenile Angiofibroma

Sphenopalatine Artery

Recurrent persistent juvenile angiofibromas in two different patients. CT after contrast administration, axial plane (a) endoscopic view (b) enhanced VIBE sequence in sagittal and coronal planes (c,d). a A thin plaque of non-enhancing scar tissue is detected at the level of sphenopalatine foramen (white arrow). The submucosal relapse (black arrows) has its epicenter at the pterygoid root level where the medullary bone is replaced by the enhanced juvenile angiofibroma (asterisk). Erosion of pterygoid bony boundaries is seen (arrowheads). The encircled area corresponds to the endoscopic view (b), which does not show any abnormality. c,d In a different patient, a relapsing juvenile angiofibroma is detected 2 years after endonasal surgery (arrows) located submucosally within residual sphenoid sinus floor Fig. 8.39a-d. Recurrent persistent juvenile angiofibromas in two different patients. CT after contrast administration, axial plane (a) endoscopic view (b) enhanced VIBE...

Early Nonsurgical Therapy

How Insert Mousseau Barbin Tube

Nitinol self-expanding mesh stents are useful for temporary palliation of benign strictures, but the resultant surrounding tissue inflammation can lead to additional scarring if the stent is left in place too long. Figure 2.4. Nitinol self-expanding mesh stents are useful for temporary palliation of benign strictures, but the resultant surrounding tissue inflammation can lead to additional scarring if the stent is left in place too long.

Posteromedial Impingement

Occasionally after a severe ankle sprain, a thick, confluent scar persists between the medial wall of the talus and the posterior margin of the medial malleolus, causing persistent pain and localized tenderness, particularly with plantar flexion and inversion 43 . Development of this symptomatic local scarring has been referred to as posteromedial impingement, and is thought to result from the deep posterior deltoid ligament being crushed between the talus and the medial malleolus at ankle sprain 43 .

Suprapubic Transvesical Prostatectomy

Prostate Arterial Supply

A sterile marking pen is then used to delineate the line of intended incision. With respect to the latter, a transverse (Pfannenstiel) or lower midline incision may be used depending on the need for adjunctive procedures (i.e., diverticulectomy, concomitant inguinal hernia repair), the patient's body habitus, and the presence of previous surgical scars. If a transverse approach is chosen, the incision should be placed approximately two finger-breadths above the pubic symphysis in a suitable skin crease. Care must be taken to avoid extending the transverse incision too far laterally to decrease the risk of postoperative hernia. Awareness of potential injury to the underlying inferior epigastric vessels is important. We prefer the transverse approach whenever feasible given the superior cosmetic quality of the healed incision. The remainder of this discourse will be predicated on that operative approach.

Where Are Seeds Developed In Figure 8.1


The concave side of an ordinary kidney bean (a dicot) has a small white scar called the hilum. The hilum marks the point at which the ovule was attached to the ovary wall. A tiny pore called the micropyle is located right next to the hilum. If this bean is placed in water for an hour or two, it may swell enough to split the seed coat. Once the seed coat is removed, the two halves, called cotyledons, can be distinguished (Fig. 8.28). The cotyledons, which have a tiny immature plantlet along one edge between them, are food-storage organs that also function as the first seed leaves of the seedling plant. The cotyledons and the tiny, rudimentary bean plant to which they are attached constitute the embryo. Some seeds (e.g., those of grasses and all other monocots) have only one cotyledon. seed must first be viable (capable of germinating). Many seeds for various reasons (e.g., death of the embryo within) are not viable, and all lose their viability after varying periods of time. Many seeds...

Abnormal findings

Enlarged Liver Causes

Pink to brown or black, and haemangiomas (Campbell de Morgan spots) are so common that they could be considered normal changes. The presence of striae requires explanation. Any abnormality of the skin should be noted, including surgical scars, and the nature of the surgery undertaken should be identified. Laparoscopic incisions are usually immediately below the umbilicus and may be difficult to see. The common sites of surgical incisions are shown in Table 5.26 and illustrated in Figure 5.7. Other transverse incisions are used for access to the aorta, kidneys, adrenals, ureters, sympathetic chain or stoma closures. The common types of stoma arc illustrated in Figure 5.8. The effluent from a colostomy is solid with a faecal odour in an ileostomy there is a fluid, odourless effluent.

Open Laparotomy for Reoperative Fundoplication

Floppy Fundoplication

A partial posterior, or Toupet, fundoplication is indicated for patients who have inadequate esophageal motility. Patients with dysphagia from a fundoplication that is too tight may also benefit from a partial fundoplication if it is not possible to create a total fundoplication that is floppy secondary to scarring or ischemia. Although some authors recommend liberal use of a Toupet fundoplication, there are higher failure rates with a Toupet compared with a Nissen fundoplication.16,17 The Toupet is performed by wrapping the fundus posteriorly and securing the fundus to the esophagus and crura bilaterally. Two sutures are placed from the fundus to the crus on the right, and four fundus to esophagus sutures are placed, two on each side. Sutures along the esophagus are placed 1cm apart to create a 2-cm fundoplication (Figure 11.4).

Osteoplastic Flap Sinusotomy

Osteoplastic Flap Procedure

This operation is currently considered the gold standard whenever an external approach to the frontal sinus is required after failure of previous endonasal procedures or when the disease cannot be adequately reached transnasally. The anterior wall of the frontal sinus may be exposed through a coronal incision, which is carried out far posteriorly to be hidden by the hair line, or a butterfly or seagull incision, which is performed along the superior border of the eyebrows (Fig. 5.19). Our preference is for coronal incision, since the latter may leave the patient with a visible scar and some numbness of the forehead. Soft tissue dissection is then carried along the plane between the galea and

Granulomatous Reactions

If there is no response after approximately eight injections over a 2-month period, 5-flu-oruracil (50 mg ml) can be added to the steroid (triamcinolonactenoid 1 mg ml). As for all other interventions, the efficacy of the addition of 5-fluoruracil is based on a case series in patients with hypertrophic scars and expert opinion (see Table 6.2 Fitzpatrick 1999). A further case report suggests that oral 200-600 mg allopurinol per day given over 16 weeks should be helpful. However, this particular patient was also treated with topical steroids and the results have never been confirmed by another paper (Reisberger et al. 2003). Based on the nature of these granuloma-tous reactions a livelong therapy - with remissions lasting several months - might be necessary in some patients.

Botulinum Toxin and Fillers

Depressor Nasi Resection

Of both muscles often produces imperfect results and may cause a distorted frown line. BoNT-A is the optimal solution to treat this area, and fillers may be needed as complementary treatment (see Fig. 5.2 and 5.4 see Chap. 5). This is the case when the wrinkle is very deep some wrinkles are so deep that they seem to be scars, and thus unsolvable. In these cases, direct excision or sub-cision should be considered. Horizontal lines in the forehead are due to excessive movement of the frontalis. BoNT-A is usually the single method needed in this area. Depending on the skin thickness and dermal injury, however, fillers may also be needed. After the effects of BoNT-A are complete, fillers can be injected into the remain

Treatment of Intraocular Retinoblastoma

Local therapy is used to eradicate local disease after reduction of the tumor volume by chemotherapy and may include cryotherapy, green laser, infrared laser, and or radioactive plaque. The goal of local therapy is to achieve a type I regression pattern with calcification or type IV with flat chorioretinal scars, or avascular, linear, white gliosis.

Varicellazoster Virus

Although perinatal infection is uncommon because most mothers are immune, intrauterine VZV infection may result in fetal varicella syndrome (low birth weight, cutaneous scarring, limb hypoplasia, microencephaly, cortical atrophy, chorioretinitis) if the infection occurs during the first half of the pregnancy. The incidence of fetal varicella syndrome with VZV infection in wk 1-12 is 0.4 and in wk 13-20, 2 (40,41). Varicella infection of the mother 5 d before to 2 d after delivery may result in severe varicella in 17-30 of newborns with a 31 risk of death if untreated. Passive immunization with varicella immune globulin (VZIG) is effective in reducing mortality.

Transsphenoidal Surgery

Mayfield Horseshoe Headrest

For the majority of pituitary tumors, some form of transsphenoidal surgery is the most appropriate route (3-4). Usually this is a standard microsurgical submu-cosal transseptal transsphenoidal procedure. There are many virtues of the transsphenoidal approach. Most importantly, it is the least traumatic route of surgical access to the sella, providing excellent visualization of the pituitary gland and adjacent pathology. The lack of visible scars, lower morbidity and mortality as compared with transcranial procedures, the necessity of only a brief hospital stay, the relatively brief recuperative period, and the overall safety of the procedure add to the procedure's appeal.

Consent For Levulan Photodynamic Treatment

Anticipated side effects of Levulan treatment include discomfort, burning, swelling, blistering, scarring, redness and possible skin peeling, especially in any areas of sun damaged skin and pre-cancers of the skin, as well as lightening or darkening of skin tone and spots, and possible hair removal. The peeling may last many days, and the redness for several weeks if I have an exuberant response to treatment.

Ultrasonographic Assessment of Perianal Crohns Disease

Eas Defect Ultrasound

The major problems while investigating primary tracts with EAUS occur because of the structure alterations of the anal canal and perianal muscles and tissues, which can overstage the fistula, or poor definition of the tract when filled with inflammatory tissue, which can downstage the fistula. Differentiation between granulated tracts and scars is sometimes difficult. Straight tracts are easily identified, but smaller and oblique tracts are more difficult to image. Secondary tracts, when present, are related to the main one and are classified as intersphincteric, transsphincteric, suprasphincteric or extrasphinc-

Evaluation of Suspected Immunodeficiency

Dihydrorhodamine Test

Thus, the clinical history and presentation should direct the immunologic evaluation and it is necessary to consider HIV infection in the differential diagnosis with appropriate questions during the history and laboratory testing. There are now more than 120 genetically linked immune disorders, so a careful family history is also extremely important (Notarangelo et al. 2006). Finally, the physical examination may provide clues regarding specific primary immunodeficiencies (e.g., typical facies in the hyper-IgE Job syndrome and scars from abscess drainage sites) and secondary immune disorders (e.g., oral hairy leukoplakia or Kaposi's sarcoma in HIV infection).

Peculiar Aspects of Gastroenteric Extra Colonic Manifestations of FAP

As already mentioned, even desmoid tumours are problematic in treating FAP 25, 26 . Intra-abdomi-nal desmoid tumours may significantly affect the choice of surgical treatment or, if they develop during the postoperative stage, they are extremely difficult to treat and results are often unsatisfactory. Abdominal-wall desmoid tumours are less aggressive and easier to treat, and therefore can be entirely removed 27 . In our experience, parietal desmoid tumours appear in four out of five cases after surgery at the site of surgical scarring. This aspect led us to think that long incisions and trauma on the muscles could support the subsequent development of abdominal-wall desmoids. Regarding this hypothesis, we are evaluating the impact that small scars such as the ones we have with the VDL approach, could have in determining desmoid development. Up to now only one of the patients operated on with the VDL approach has developed a desmoid tumour where the former protection ileostomy was.

The Stem Of Flowering Olant

Types Grapes And Their Names

Some berries are derived from flowers with inferior ovaries so that other parts of the flower also contribute to the flesh. They can usually be distinguished by the remnants of flower parts or their scars that persist at the tip. Examples of such berries include gooseberries, blueberries, cranberries, pomegranates, and bananas. Because fruit development in the cultivated banana is parthenocarpic, there are no seeds. Several other species of banana produce an abundance of seeds.

Epidemiology of contact lens ulcers and public policy

Infectious, the disease is clinically referred to as 'microbial keratitis' (MK). Infectious corneal ulcers are more serious than sterile ulcers, and usually cause significant scarring of the cornea. Corneal scarring opacifies the normally clear corneal tissue this can lead to visual impairment or blindness when the resulting opacity covers the pupil.

Anterolateral Impingement

Prominent Scar Tissue Medial Gutter

Occasionally patients may develop symptoms of anterolateral impingement after one or more ankle inversion injuries 30,31 . Chronic ankle pain, particularly with dorsiflexion, is the predominant symptom 31,32 . Thickening of the anterior talofibular ligament, scar formation, and synovial hypertrophy in the anterolateral gutter are seen at imaging (Fig. 13) 33,34 . Treatment is typically physical therapy with nonsteroidal anti-inflammatory medications Fig. 13. A 37-year-old male with continued pain 5 months after ankle inversion injury. Sagittal STIR and axial FSE images demonstrate prominent scar and synovial hypertrophy in the anterolateral gutter. Anterolateral impingement. Fig. 13. A 37-year-old male with continued pain 5 months after ankle inversion injury. Sagittal STIR and axial FSE images demonstrate prominent scar and synovial hypertrophy in the anterolateral gutter. Anterolateral impingement.

Current Limitations Possible Solutions and Enhancement Technologies

Microtechnology now allows the electrodes to be miniaturised, and their active surface can be enlarged by laser treatment. Coating of the electrodes with growth factors appears to improve the electrical contact to the neural structures, and conductive tarnish with nanoparticles reduces the breakdown of electrodes by living tissue. Neurons cultured on nanofibres develop neurite extensions and the artificial material counteract astrocytic scar formation, at the same time (McKenzie et al. 2004 Webster 2004). Also, neural cells can be grown onto silicon chips, contact them, and promote fibre growth connecting the implant to the nervous system.

Common abnormalities

Much can be learned by inspecting the pre-cordium. Chest deformities including pectus excavatum (posterior displacement of the lower sternum) can affect the rest of the examination. A midline sternotomy scar usually indicates previous coronary bypass surgery, or valve replacement. A left submammary scar is usually the result of a mitral valvotomy.

Clinical Correlates

Amputation Penis

Occasionally, tears in the amnion result in amniotic bands that may encircle part of the fetus, particularly the limbs and digits. Amputations, ring constrictions, and other abnormalities, including craniofacial deformations, may result (Fig. 6.16). Origin of the bands is probably from infection or toxic insults that involve either the fetus, fetal membranes, or both. Bands then form from the amnion, like scar tissue, constricting fetal structures.

Space Occupying Lesion Aberrant Nerve

Carpal Tunnel Syndrome Mri Bowing Ratio

In wrist flexion, in asymptomatic individuals, the median nerve moves radially and posteriorly and becomes interposed between the flexor tendons 75 . The median nerve is more likely to remain adjacent to the flexor retinaculum during wrist flexion in patients who have carpal tunnel syndrome. This lack of motion of the median nerve may predispose it to compression and subsequent carpal tunnel syndrome. Other theories proposed to account for carpal tunnel syndrome include repeated compression of the median nerve with subsequent ischemia, subendoneurial edema, synovitis, and eventual fibrosis, as well as reduced gliding and tethering of the nerve due to scar tissue 76 . persistent carpal tunnel syndrome after surgical release. Scar tissue engulfing the nerve, adhesions, persistent tenosynovitis, and incomplete release of the ret-inaculum may be identified. MRI findings of Guyon's canal include increased size and increased signal in the nerve and its branches, best appreciated on axial MR...

Reproductive technologies help solve problems of infertility

There are many reasons why a man and woman may not be able to have children. The man's rate of sperm production may be low, or his sperm may lack motility. The mucus in the woman's reproductive tract may be thick and not conducive to sperm reaching the oviducts. Structural problems may also exist, such as blockage of the oviducts by scar tissue or by endometriosis, a proliferation of endometrial cells outside of the uterus. In some cases, treatment with powerful chemicals to cure cancer damages the ability of the go-nads to produce gametes.

Critical Size of a Pacemaker

Pacemaker Action Potential

An ectopic focus is a collection of cells other than the SA node or AV node that are normally not oscillatory but that for some reason (for example, increased extracellular potassium) become self-oscillatory and manage to entrain the surrounding tissue into a rapid beat. In some situations, particularly in people with scar tissue resulting from a previous heart attack, the appearance of an ectopic focus may be life-threatening.

The pharynx and buccal mucosa

Aphthous Stomatitis

This is characterised by ulcers on the inner sides of the lips, the edges of the tongue, the insides of the cheek or on the palate. Initially small vesicles form, which quickly burst, leaving shallow ulcers usually surrounded by a red margin. Such ulcers can cause intense discomfort. They may heal quickly in a day or two. or they may progress into deep indurated ulcers which heal slowly (Fig. 2.37 and may leave a small scar. The lesions tend to occur in crops a patient may be free from ulcers tor months only to relapse. The cause is obscure. They arc often seen in patients with ulcerative colitis.

Laser Resurfacing and Fillers

Oral Commisures

Some patients who cannot schedule the required recovery time may find fillers a nice method for improving the appearance of wrinkles and scars until the time is appropriate for laser resurfacing. Fillers must be seen as the primary therapy when the deep dermis is compromised. In contrast, laser resurfacing is the first method to be used for superficial rhytides and sun damage. For complex scars, both methods should be used, even though the results are not long lasting. If any resurfacing method reaches the deep dermis, scar tissue may result. Fillers injected too superficially into rhytides may result in nodule formation and cause irregularities in the skin. When full-face resurfacing is performed, laser resurfacing of the nasolabial fold may decrease its depth if it was a superficial crease, because it tightens the skin from both the cheek and upper lip. Aggressive therapy may result in scar tissue formation. Patients with deep nasolabial folds may benefit from combination therapy...

Rupture Of The Patellar Tendon

Patella Tendon Rupture Tka

To be referred a case for allograft reconstruction that has had several prior attempts at repair. Because the skin may be adherent or there may be multiple scars, soft tissue expanders have been shown to be helpful, and should be considered.12 This is also important because the tibial tubercle allograft does add bulk to the proximal tibia making closure difficult.

Trachoma Lymphogranuloma venereum

Trachoma is a follicular keratoconjunctivitis. The disease occurs in all climatic zones, although it is more frequent in warmer, less-developed countries. It is estimated that 400 million people carry this chronic infection and that it has caused blindness in six million. The pathogen is transmitted by direct contact and indirectly via objects in daily use. Left untreated, the initially acute inflammation can develop a chronic course lasting months or years and leading to formation of a corneal scar, which can then cause blindness. The laboratory diagnostics procedure involves detection of C. trachomatis in conjunctival smears using direct immunofluorescence microscopy. The fluoro-chrome-marked monoclonal antibodies are directed against the MOMP (major outer membrane protein) of C. trachomatis. The pathogen can also Inclusion conjunctivitis. This is an acute, purulent papillary conjunctivitis that may affect neonates, children, and adults (swimming-pool conjunctivitis). Newborn...

Personal Laser Technique

Erbium Laser Day After

The first CO2 ablative laser pass is performed mainly to remove the epidermis and feather peripherally to minimize any demarcation with surrounding nontreated skin. The second laser pass, and, if used, a third pass is for heat deposition to promote tightening. Finally, the erbium laser (in the ablation mode) can be used to remove superficial thermal necrosis for further sculpting of deeper rhytides and or acne scars. The second CO2 laser pass is performed at a density of 4-5 depending on the tightening needed and the risk for the area. The upper eyelids and the central face are typically treated at densities of 5, whereas mid cheeks and some lower eyelids may be treated with densities of 4. Delivered energies are also decreased towards the periphery. A second pass is rarely done on the lateral cheeks unless acne scarring is present. A third pass may be done on acne scars and in perioral and glabellar regions to deliver additional heat to enhance tightening. When using the EMLA topical...

Lymphomatoid Papulosis in Children

Lymphomatoid papulosis (LyP) is a clinically benign skin disorder characterized by chronic and recurrent self-healing papulonodular lesions. This disorder occurs rarely in children. The sites of lesions include the limbs and or trunk. The eruption recurs episodically, often ulcerates, and heals spontaneously in 3-8 weeks, leaving an atrophic scar occasionally. LyP results from a clonal T-cell proliferation, which may explain its evolution or coexistence with Hodgkin disease, mycosis fungoides, or anaplastic large cell lymphoma (ALCL).

Long Term Complications

Because TURP includes the removal of tissue at the bladder neck that encompasses smooth muscle of the internal sphincter, stress urinary incontinence can result if care is not taken to protect the external urethral sphincter complex. As described earlier, critical in avoiding injury to this sphincteric complex is the identification of the verumontanum and the resection of prostate tissue only proximal to this landmark. Stress urinary incontinence should be uncommon after TURP when the procedure is performed correctly, with an incidence well below 1 . Risk factors for postoperative stress incontinence include prostatic scarring from prior prostate surgery, radiation, and prostate cancer, all of which have the potential to obscure the verumontanum, making resection more difficult and increasing the likelihood of injury to the external sphincter. In fact, patients with a history of advanced prostate cancer who require TURP for relief of obstructive symptoms have an approx 20 risk for the...

Lasers in Dermatology

Image Skin Cross Section Colour

Radiation from the argon ion laser is strongly absorbed by hemoglobin and melanin as already illustrated in Fig. 2.4. This laser is thus predestined for superficial treatments of highly vascularized skin. Apfelberg et al. (1978) and Apfelberg et al. (1979a) investigated laser-induced effects on various abnormalities of the skin. The most frequent indications for the application of argon ion lasers are given by port wine stains (naevi flammei). Earlier methods of treating these malformations - e.g. cryotherapy, X-ray, or chemical treatment - had failed, and patients were advised to accept their misery. The idea of removing port wine stains with argon ion lasers has led to the most significant progress of lasers in dermatology so far. The treatment itself requires a lot of patience, since several sessions are necessary over a period of up to a few years. The faster the treatment is to come to an end, the higher is the probability for the occurrence of scarring. However, patient patients...

Ocular Cicatricial Pemphigoid

OCP is a chronic progressive inflammatory disease that causes bilateral progressive subconjunctival fibrosis eventuating in a blind scarred eye in untreated cases. It is characterized by autoantibodies, most commonly IgG, that bind to corneal epithelial basement membrane zone (BMZ) autoantigens, namely 4 protein of the a6 4 integrin 21 and epiligrin 22 . The autoantibody Progression of subepithelial conjunctival fibrosis in OCP leads to the formation of symblepharon (fibrotic bands between palpebral and bulbar conjunctiva) and ankyloblepharon (fusion of the lower eyelid to the bulbar conjunctiva) resulting in restriction of ocular mobility. Scarring also causes trichiasis and distichiasis due to alterations in eyelash follicle orientation, and this together with severe dry eye due to scar-induced blockage of tear gland openings causes damage to the corneal epithelium. Advanced OCP is hence accompanied by blinding keratopathy, corneal neovascularization, pseudopterygium formation, and...

Mario Muto Cosma Andreula and Marco Leonardi

The short-term success rate after surgery for lumbosacral disc her-niation is estimated at 95 , with a 2 to 6 incidence of true recurrence of herniation. The success rate drops to 80 over time owing to the onset of symptoms linked to failed back surgery syndrome (FBSS), a condition characterized by recurrence of disc herniation and or hypertrophic scarring with severe symptoms in 20 of patients.4-5 The failures after back surgery have stimulated research into new techniques to improve patient outcome. At the same time, advances in percutaneous techniques by interventional procedures chemodiscoly-sis with chymopapain, aspiration of the nucleus according to Onik (see Chapter 8), intradiscal electrothermal annuloplasty (IDET), discectomy laser, nucleoplasty, etc.) have minimized the invasive nature of surgery and have avoided complications such as scarring and infection associated with open surgery. eliminate the risk of postoperative scarring that has been associated with surgery....

Robust Techniques For Enhancement Of Microcalcifications In Digital Mammography

Microcalcifications Mammography

Normal, non-fat breast tissue is water dense and appears light. Fatty tissue is practically radio-transparent and appears very dark in a mammogram. The dynamic range in mammography is large, since there are large variations in breast anatomy. Individual breast appearance is influenced by the volume of a woman's breast tissue and fat, her age, a history of previous pregnancies and lactation, her heredity, the quality and elasticity of her breast skin, and the influence of hormones. Normal anatomy on a mammogram will image differently depending on a woman's weight, age, presence of surgical scars and presence of superficial or sub-muscular implants, as well as the amount of fatty tissue in her breasts.

Blue Dye Mapping The Concept

Sentinel Node Scan Pictures

Two blue dyes are in common use for lymphatic mapping and sentinel lymphade-nectomy. The more satisfactory agent is probably patent blue dye, but this is not currently available in the United States, where isosulfan blue is normally used. The blue dye is injected intradermally at several points around the melanoma if it remains in situ, or on either side of the central part of the biopsy scar if excision-biopsy has been performed previously (Fig. 2). Great care must be taken to ensure that the injection is truly intradermal and not subcutaneous, to avoid the possibility of mapping a lymphatic pathway leading to a node that is not the true sentinel node draining the melanoma site on the skin. If lymphatic mapping using either blue dye or a radiolabeled colloid is attempted after a wide local excision of the primary melanoma, inaccurate sentinel node identification is even more likely to occur. This is because there is evidence that the originally existing lymphatic pathways draining...

The Autoimmune Pulmonary Fibrosis Model

Intravenous transfer of TGF-p2-treated 2,4,6-trinitrobenzene sulfonic acid-pulsed APCs to experimental mice even 1 day after pulmonary challenge reduced the collagen deposition and subsequent scarring in the interstitium of the lung. As in ACAID, ADT-HIPIF mice treated with tolerogenic APCs developed antigen-specific CD8 + Treg cells that suppressed the efferent response by regulating the presensitized T effector cells.

Mangs Fish Mouth Technique

In appropriate cases, i. e., when the folds of skin do not extend a long way into the elbow region, a variation of the incision, without extension beyond the cranial third of the upper arm, can be successful. With this incision not only vertical tightening in the upper arm area is achieved, but also tangential tightening in the axilla. The advantage of this incision is that the scar is barely visible, and skin folds in the axilla and upper third of the upper arm can be eliminated very effectively. The scar can hardly be seen at all when sleeveless clothes are worn.

Surgical Implantation Technique

Attention is then turned to the lower quadrant of the abdomen, where a 10 cm incision is made down to the underlying subcutaneous fat layer. A subcutaneous pocket large enough to admit the particular pump being used is then fashioned. Generally, if all four fingers can be admitted to the metacarpal phalangeal joints in the pocket, it is large enough. The upper side of the incision is undermined roughly as the width of the pump, or about 2.5 cm, to allow closure without tension. The eccentric location of the pocket allows the pump to be placed so that the refill port is clear of the incisional scar and easier to locate. An ideal pocket is one that will allow placement of the pump without difficulty but is tight enough to aid in preventing pump rotation. The depth of the pocket below the skin is critical for programmable pumps. A depth greater than 2.5 cm may not allow reliable telemetry. In fashioning the pocket, meticulous hemostasis is important to avoid a postoperative hematoma. At...

Treatment Of Cervical

One of the disadvantages of LLETZ is that it is relatively expensive when compared to cryosurgery, which involves application of a liquid nitrogen cooled probe to the surface of the cervix (88-90). The probe is typically applied twice for 2-3-min applications and leads to necrosis of the frozen areas. The advantages of this method are its low cost, easy applicability in many different clinical settings, low morbidity, and treatment of the entire exocervix. Although reepithelialization of the cervix occurs within 2-3 mo, one of the disadvantages is that scarring may reduce the value of subsequent cytology and colposcopy, especially if the procedure leads to the recession of the squamocolumnar junction into the endocervix. The procedure has a higher failure rate than LLETZ and it cannot be used if a woman has an inadequate colposcopy, positive endocervical curettage, or especially large lesions. In this case, the treatment of choice is LLETZ. Laser conization using a CO2 laser is...

Mesenteric Fibromatosis

Mesenteric Fibromatosis

Tc scan revealing a large and invasive desmoid mass arising within the abdominal wall. b Lateral view of the abdomen showing a protruding desmoid mass along the scar of the previous prophylactic colectomy. c Desmoid mass specimen. Fig. 1a. Tc scan revealing a large and invasive desmoid mass arising within the abdominal wall. b Lateral view of the abdomen showing a protruding desmoid mass along the scar of the previous prophylactic colectomy. c Desmoid mass specimen.

Submental Liposuction

Submental Liposuction

After the operation a compression dressing is worn for approximately 1 week so that the submental skin that has been detached in the neck area can adapt after liposuction to the areas where fat has been removed. Just by tunneling with the 2 mm cannula, scar contractions occur, which result in a tightening effect.

Identification of Canine Cardiac Mast Cells in Paraffin Embedded Tissue

Mast Cell Avidin Fitc

Identification of mast cells in canine hearts. (A) Staining with FITC-conju-gated avidin identifies mast cells as intensely fluorescent cells packed with granules. (B) In canine infarcts mast cells accumulate in the scar (i) but not in noninfarcted areas (c) (1 h occlusion 7 d reperfusion). (C) Tryptase histochemistry identifies mast cells as red brown granular cells. (D) Mast cell degranulation in the infarcted myocardium is demonstrated using FITC-avidin staining. Fig. 2. Identification of mast cells in canine hearts. (A) Staining with FITC-conju-gated avidin identifies mast cells as intensely fluorescent cells packed with granules. (B) In canine infarcts mast cells accumulate in the scar (i) but not in noninfarcted areas (c) (1 h occlusion 7 d reperfusion). (C) Tryptase histochemistry identifies mast cells as red brown granular cells. (D) Mast cell degranulation in the infarcted myocardium is demonstrated using FITC-avidin staining.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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