[Role of collateral circulation in the postinfarction cicatrix].
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Adult↗
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The use of betamethasone to manage the trapped penis following neonatal circumcision.
PURPOSE: The trapped penis results from cicatricial scar formation over the glans after circumcision. Management of this problem has been surgical either by incision of the cicatrix or formal surgical reconstruction. We report a series of neonates with trapped penises which were effectively managed primarily with topical steroid cream with operative intervention reserved for failed cases. MATERIALS AND METHODS: A retrospective study of 14 neonates who presented with a trapped penis treated with topical betamethasone cream was performed. Each child underwent topical application of 0.05% betamethasone 3 times daily for 3 weeks in conjunction with manual retraction that continued after the steroid course. The need for surgical intervention was assessed during and after the treatment period. RESULTS: All 14 boys were evaluated by the pediatric urologist within 4 weeks of circumcision. Each child had a trapped penis with a dense cicatrix of the residual foreskin distal to the glans. All parents were compliant with the regimen. There were no untoward effects of topical steroid application. Following therapy 11 boys (79%) demonstrated softening of the cicatrix with easy exposure of the glans in 2 and mild persistence of the cicatrix amenable to vertical relaxation incision in 2. The cicatrix persisted in 3 boys (14%) who required formal operative repair at ages 5 to 8 months. CONCLUSIONS: The combination of topical betamethasone and manual retraction is effective in managing the trapped penis. This combination may affect complete resolution of the condition in the majority of patients. Otherwise, this regimen may release the closing cicatrix and allow for simple incision of the constricting phimotic ring, thus reducing the need for formal surgical repair.
Administration, Topical↗
Termination of early pregnancy in the scarred uterus with mifepristone and misoprostol.
OBJECTIVE: To analyze the safety and possibility of terminating early pregnancy up to 49 days gestation after cesarean section with mifepristone and misoprostol. METHODS: One-hundred and ninety-two early pregnant women were recruited, of which, 35 cases with uterine cicatrix and 157 cases were no-uterine cicatrix as control group. All of them took 25 mg of mifepristone, b.i.d. for 3 days and 600 microg of misoprostol on the 4th day. RESULTS: Of the 35 cases with uterine cicatrix, 33 achieved complete abortion after medical abortion. The complete abortion rate was 94.29% (95% CI 81-99%) in the cicatrix group and 89.81% (95% CI 75-91%) in the control group. There were no obvious complications detected in the cicatrix group. CONCLUSION: For the termination of early pregnancy in scarred uterus, administration of mifepristone and misoprostol is safe and effective, and a further large series study needs be done to confirm its acceptability as a routine medication in such situations.
Abortifacient Agents↗
Effect of puromycin treatment on the regeneration of hemisected and transected rat spinal cord.
The effect of puromycin on spinal cord regeneration was studied following implantation into the site of spinal cord hemi- or transection of Gel-foam saturated with puromycin (1 mM) in a saline carrier, implantation of Gel-foam sponge saturated with saline (carrier control), or lesion alone (lesion control). The spinal cords of 107 rats were studied with light and electron microscopy 7, 14, 30, 60 and 90 days postoperative (DPO). Spinal cord hemisected animals developed a dense cicatrix at the site of lesion replete with connective tissue, blood vessles, and myelinated and unmyelinated nerve fibres which could be traced to peripheral sources. Rostrally at the C.N.S.--cicatrix interface, there were reactive neuroglial cells, occasional nerve fibres and finger-like projections of spinal cord (due to cavitation lesions) which contained neuroglia, axons and dendrites. Implantation of saline in Gel-foam resulted in the same morphology as in hemisected animals except for increased lesion size due to mechanical factors and decreased cicatrix density during the first 30 DPO. Puromycin treatment resulted in a cicatrix with initial decreased cell density but which contained a new class of nerve fibres at 30 DPO. These nerve fibres were oriented in a rostro-caudal direction, were unmyelinated, 0.1-0.2 micron in diameter and had expanded smooth endoplasmic reticulum. Some of these nerve fibres were degenerating at 30 DPO and all were absent by 60 DPO. The puromycin-treated spinal cord within 200 micron rostral to the basal lamina contained nerve terminal conglomerates, which resembled boutons, in fascicles from 30-90 DPO (duration of experiment). Hemisection of the spinal cord by crushing 1-1 1/2 segments rostral to the site of puromycin implantation at 30 DPO resulted in degeneration of these nerve fibres in the cicatrix as well as the degeneration of nerve terminal conglomerates just rostral to the basal lamina. The regenerative capacity of the spinal cord is discussed in relationship to these findings.
Animals↗
[Echographic and morphological parallels in the evaluation of the condition of the uterine scar].
Examinations of 86 women included echography, examination of the lower segment of the uterus during surgery, control manual examination of the postpartum uterus, and histologic examination of the tissues collected from the so-called cicatrix site. The authors claim that the criteria of the myometrial adequacy are the V-shaped lower segment of the uterus, at least 3-4 mm thick, continuous anterior contour of the uterus, the presence of a homogenous echostructure or a structure with small sites of elevated echogenicity. A balloon-shaped lower segment of the uterus and its thinness (less than 3 mm), no continuity in the uterine contour, predominance of elevated echogenicity incorporations in the echostructure of the cicatrix site indicate the inadequacy of the myometrium at the site of the transverse cicatrix in the lower segment of the uterus. The findings evidence that echography is a highly informative method for the diagnosis of the uterine cicatrix status and that echographic examinations should be widely used to choose the delivery mode for pregnant women with a history of abdominal delivery.
Adult↗
[Clinical significance of factors affecting the course of pregnancy and the status of newborn infants born to women with uterine scar].
Clinical, ultrasonic (fetoscopy, placentography, Doppler metry of uteroplacental and fetoplacental blood flow), and radioimmunological methods (measurement of follicle-stimulating and luteinizing hormones, estradiol, estriol, progesterone) were used to examine 98 pregnant with a cicatrix onto the uterus. The early neonatal period was studied thoroughly in some newborns. The acid-base balance, umbilical vascular blood gases, arterial blood oxygen saturation, heart rate, blood pressure, and body temperature were measured. Having no clear-cut negative action on the uteroplacental and fetoplacental blood flow, an inadequate cicatrix was found to be a risk factor for fetal hypotrophy. Due to lower adaptative possibilities, the newborns to mothers having a cicatrix onto the uterus should constitute a risk group for complications in the neonatal period. It is concluded that repeated elective cesarean section performed in the period close to delivery is one of the factors that lower perinatal mortality and morbidity of babies born to mothers with a cicatrix on the uterus.
Adult↗
[Leg ulcers and cancer. 6 case reports].
OBJECTIVE: It is estimated that 1 leg ulcer out of 300 is a carcinoma. In the literature ulceration of skin cancer is distinguished from chronic leg ulcers although this later category remains a subject of debate. We examined the clinical features of suspected malignant leg ulcers and discuss the notion of secondary malignant transformation of leg ulcers. PATIENTS AND METHODS: This study included patients attending the Vascular Clinic at the Saint-Joseph Hospital in Paris between 1991 and 1999 who were referred for leg ulcers and whose final diagnosis was cancerous ulceration. RESULTS: There were six patients, mean age 77 years who had squamous cell carcinomas (4 cases) and basocellular carcinomas (2 cases). We observed two distinct situations: leg carcinomas that ulcerated from onset (2 cases) and malignant transformation of a cicatrix, known as Marjolin's ulcer (4 cases). There were no cases of malignant transformation of chronic leg ulcers in this series. The clinical elements suggestive of a cancerous leg ulcer were the absence of a vascular etiology, the red, budding aspect of the ulcer with hard borders, and its development on a cicatrix. CONCLUSION: Malignant transformation of a vascular leg ulcer was not observed in our series, but has been reported in the literature although a critical analysis of reported data is only significant for squamous cell carcinoma. The frequency is probably overestimated. Our series enabled us to identify the clinical circumstances leading to an early diagnosis of carcinoma of the lower limbs. There are three essential criteria: analysis of the vascular status of the patient, the clinical characteristics of the leg ulcer, and its development on a cicatrix.
Aged↗
Nasopharyngeal cicatrices in horses: 47 cases (1972-1985).
Nasopharyngeal cicatrices were observed endoscopically in 47 horses examined because of abnormal respiratory noises and/or exercise intolerance. A review of these cases revealed a correlation between cicatrization and age, sex, and the presence of other upper airway abnormalities. The age of affected horses ranged from 6 to 21 years, with a mean age of 12.7 +/- 7.8 (+/- 2 SD) years. Females were affected 2.7 times more frequently than males. Abnormalities commonly observed with a nasopharyngeal cicatrix included chondritis of the arytenoid cartilage, epiglottic deformity, and deformity of the guttural pouch openings. The nasopharyngeal cicatrix was responsible for respiratory obstruction in only 3 horses. Treatment for the cicatrix was not performed on any horse in this series. Generalized nasopharyngeal and laryngeal inflammation were postulated as causes of the cicatrices and associated abnormalities.
Age Factors↗
Immediate and long-term phantom breast syndrome after mastectomy: incidence, clinical characteristics and relationship to pre-mastectomy breast pain.
Phantom breast syndrome (PBS) following mastectomy has already been reported by other authors. The temporal course, character and extent of these phenomena, however, have not yet been elucidated. In a prospective study, we investigated the incidence, clinical picture and the temporal course of PBS. One hundred and twenty women who, during a 1 year period, embarked consecutively on post-operative control or treatment at the department, were interviewed by a standard questionnaire 3 weeks after the operation. One year later 110 patients were interviewed again. The median age at the first interview was 54 years (Q1 = 45 years; Q3 = 62 years). The incidence of PBS was 25.8% at the first interview and 24.5% at the second. The incidence of phantom pain and non-painful phantom sensations was 13.3% and 15.0%, respectively, 3 weeks after mastectomy and 12.7% and 11.8%, respectively after 1 year. We found significant relationships between pre-operative pain and PBS, but no significant relation between age and the occurrence of PBS. Neither post-operative sequelae nor cancer treatment including radiotherapy seemed to affect the occurrence of PBS. Exteroceptive-like pain emerged as the most predominant type of pain from both interviews. At the time of the first interview, 35.0% of the patients experienced cicatrix pain which was clearly distinguishable from phantom pain; after 1 year, 22.7% of the patients had persistent cicatrix pain. The present incidence of PBS is close to the incidence reported by others. Persistent phantom pain may, however, be more common than usually expected. Also persistence of cicatrix pain seems to be more common than generally expected.
Breast Neoplasms↗
[Studies of implantation traces in rats. III. Histological examination].
We carried out a histological examination of the implantation traces in delivered rats. The implantation traces could be identified more than 500 days after delivery on the mesometrial side as black and brown spots. The implantation traces were recognizable as a cicatrix remaining in the parametrium, mesometrial triangle, which was formed by repair of injury caused by placental desquamation. In this area, metrial gland cells which were laid down through pregnancy were recognized for about two months after delivery. The implantation traces consisted of cicatrix tissue associated with collagen production and hemosiderin. It was possible to distinguish old and new traces by the size of the siderophile cells and by the degree of hemosiderin present. It was also possible to discriminate new traces as yellowish-brown areas, covered with a yellowish-white mass of degenerated metrial gland, in cleared uteri stained with 2% NaOH solution. Siderophile cells on the implantation traces were derived from giant cells which persisted around the peripheral region of the placental desquamation site, and these giant cells were considered to be identifiable with metrial gland cells. It was considered that formation of the cicatrix is essentially the same in abortion, stillbirth and normal delivery. However, it was found that the implantation traces had different histological appearances depending on the degree of injury to the endometrium and myometrium and time of placental desquamation. The iron content of the implantation traces corresponded quantitatively with the hemosiderin observed in the histological investigations. The iron content decreased rapidly up to 21 days after delivery, decreasing gradually thereafter. The iron in the implantation traces could, however, be analyzed quantitatively by atomic absorption spectroscopy until day 365 after delivery.
Animals↗
[Surgical treatment of epilepsy with electrocorticography monitoring].
From January 1983 to April 1988, 40 cases of epilepsy were treated surgically. There were 15 cases of posttraumatic cicatrix, 5 cases of grade I astrocytoma, 9 cases of diffuse gliosis, 4 cases of vascular malformation, 1 case of calcification and cicatrix of temporal lobe, 2 cases of microglia malformation, 1 case of brain atrophy complicating ganglioneuroma, 2 cases of localized brain atrophy, 1 case of post-hematoma cicatrix. The end results were seizures subsided in 26, and reduction of the seriousness in 8. No mortality in this series. Follow-up study showed 85% of these patients with effectiveness. The indication of surgery, utilizing of electrocorticography, excision of epileptogenic focus are discussed.
Adolescent↗
Management of postblepharoplasty lower eyelid retraction with hard palate grafts and lateral tarsal strip.
Lower eyelid malposition is the most common long-term complication following transcutaneous lower eyelid blepharoplasty. The malposition may include rounding of the lateral canthal angle, lower eyelid retraction with inferior scleral show, or frank ectropion. The result is cosmetically unacceptable and may be associated with tearing, irritation, and other exposure keratitis symptoms. Multiple factors, including lower eyelid laxity, shortage of skin, and scarring of the middle lamella, may be responsible for this malposition. A systematic examination of the lower eyelid, as presented, helps to assess the degree to which each of these factors is responsible for the malposition. Patients with the most severe degree of lower eyelid malposition generally have middle lamella scarring. If this abnormality is not addressed, lower eyelid procedures aimed at correcting the malposition are doomed to failure. In the presence of significant middle lamella scarring, a spacer is required to provide vertical height and stiffness to support the lower eyelid following release of the cicatrix. A systematic approach aimed at addressing the underlying abnormalities was developed. In patients with significant middle lamella scarring, hard palate mucosa grafts were used as spacers in 29 eyelids (17 patients). A lateral canthotomy and transconjunctival incision allow access to the scarring in the lower eyelid retractors and septum. After careful release of all cicatrix, a hard palate mucosa graft is inserted between the lower border of the tarsal plate and the recessed conjunctiva, lower eyelid retractors, and septum. Horizontal lower eyelid laxity, when present, is corrected by performing a lateral tarsal strip. Most patients do not have a true deficiency of the anterior lamella (skin and orbicularis oculi muscle). When a moderate amount of anterior lamella deficiency is present with significant scarring of the middle lamella, the technique we describe allows correction of the lower eyelid malposition without a skin graft. After a follow-up interval of 6 to 30 months (mean 14 months), excellent results were obtained in all eyelids. Complications included corneal abrasions in two eyes before routine use of bandage cornea contact lenses at the end of surgery and a secondary bleed from the roof of the mouth in one patient. Palate mucosa closely resembles tarsus and provides excellent vertical support to the eyelid. It is stiff enough to maintain eyelid contour without causing a cosmetically unacceptable bump. Tissue can be obtained with ease. The technique, as described, addresses the underlying causes of lower eyelid malposition and gives excellent functional and cosmetic results.
Adult↗
Surgical repair of an esophageal stricture in a horse.
An esophageal stricture was diagnosed in a 9-month-old quarterhorse by esophagoscopy and positive pressure contrast esophagography. Medical management and two attempts at surgical intervention were unsuccessful. The initial surgical technique used was a linear esophagotomy, mucosal resection and anastomosis, and closure of the muscular tunic, which resulted in a more severe stricture. The second surgical procedure was interruption of the stricture cicatrix by a single linear esophagotomy and primary closure of only the esophageal muscular tunic. This technique resulted in an increased lumen diameter, but failed to adequately resolve the stricture. Successful resolution of the stricture with return to a normal diet was achieved by a two stage repair using formation of an esophagostomy to stabilize the esophagus, followed by fenestration of the mucosal-submucosal cicatrix. Six months postoperatively, the horse was asymptomatic on a normal diet.
Anastomosis, Surgical↗
Volume injection adhesiotomy.
The authors present a modified method for treating painful cicatrix nerve entrapments. A series of three high-volume injections of local anesthetic, steroid, and hyaluronidase are used to perform percutaneous adhesiotomies and extraneural fibrosis decompression. If special attention is given to the tissue plane level in performing the sequential injections, circumferential neural trunk decompression or cicatrix adhesiotomy can be obtained. The procedure may decrease or eliminate pain sufficiently to circumvent surgical intervention.
Cicatrix↗
[Percutaneous autogenous bone marrow grafting for repairing bone defect: an experimental study in rabbits].
OBJECTIVE: To observe osteogenesis of percutaneous autogenous bone marrow into cicatrix of bone defect. METHODS: 18 rabbits were used to observe the osteogenesis of percutaneous autogenous bone marrow into cicatrix of bone defect. A 1 cm bone defect model was made in each side of the radius. And 2 ml autogenous bone marrow was injected in the right radial bone defect after 6 weeks, and 2 ml peripheral blood in the left side. The animals were sacrificed in 1, 2, 3, 4, 12 weeks after injection. Bone formation was studied with histologic technique, X-ray examination and Ca-P quantitative estimates. RESULTS: After 1 week of injection, a big shadow of softtissue was found around the bone defect in the right side(bone marrow). Histologically a lot of new cartilage like tissues were found. In the left side(peripheral blood), no change was seen. After 4 weeks of injection, many of new bone-like shadows were observed around the defect by X-ray examination in the right side. The defect was smaller(average 1.5 mm) and bone formation was found. But in the left side, no signs for osteogenesis were noted. In 12 weeks defect was smaller(average 1 mm). Histologic sections proved well-developed bone tissue. In the left side, no bone formation found. CONCLUSION: Autogenous bone marrow can induce osteogenesis in cicatric bone defect, whereas no osteogenesis is found in the peripheral blood injection side.
Animals↗
[Effectiveness of BCG vaccination in children in relation to genetic and social factors].
The social status, genetic parameters, somatic and infectious diseases have been studied in BCG--vaccinated children who presented a postvaccinal cicatrix and in those in whom it did not form. Children having a postvaccinal cicatrix were found to belong mainly to the muscular type of constitution, while those without it--to the thoracic type. It was shown that a one--time positive tuberculin reaction to the Mantoux test with 2 TU (infiltrate of 6-7 mm) is associated with somatic and infectious pathology. This reaction can be considered to be para--allergy within 4 months after the disease.
Age Factors↗
[The effect of the conditions for connective tissue formation during posttraumatic skin regeneration in rats on the adhesive properties of the epidermal cells].
A cicatrix formed in the process of posttraumatic skin regeneration is characterized by a higher cell adhesion power in the upper, and, especially, in the middle epidermis stratum. The cell adhesion power indices in these strata, and cell mitotic activity of basal epidermis stratum near the cicatrix depend on conditions of connective tissue formation in the wound defect. The effect of physiological solution and trypsin on the wound process results in a moderate rising of intercellular contact strength and in decreasing in the number of dividing basal stratum cells, while addition of ronidase solution results in a sharp rising of the corneous scale adhesion strength, and in establishing the straight correlation between this index and the speed of epidermocyte production.
Animals↗
[Surgical treatment of post-burn cicatricial deformities of the anterior surface of the thorax].
Operations were carried out on 11 patients with postburn keloidal cicatrix of the anterior chest wall the area of which ranged from 27 to 240 cm2. To, correct the deformity, extensive mobilization of the skin-fat layers of the axillae, subclavicular, region' anterior surface of the shoulder joints, and lateral surfaces of the chest is conducted. After excision of the cicatrix the layers are transposed to the wound and the skin covering is restored. Peripheral necrosis occurred in two patients but did not influence the outcome of the plastic procedures. Tailoring flaps from the mobilized layers causes a poorer cosmetic effect. Study of the results in follow-up periods of 2 to 18 months showed a good esthetic outcome in all patients, which allows the method to be recommended for the management of cicatricial deformities of the anterior chest surface.
Adipose Tissue↗