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PubMed2002

In situ repair of cyclobutane pyrimidine dimers in skin and melanocytic nevi of cutaneous melanoma patients.

The development of cutaneous malignant melanoma (CMM) and its precursor lesions, melanocytic nevi, has been linked to sun exposure. Cyclobutane pyrimidine dimers (CPDs) are the majority of DNA lesions induced by sun exposure. In our study, we investigated if CMM patients have impaired ability to repair CPDs in skin as well as in melanocytic nevi. The repair kinetics were followed up to 3 weeks after exposure to 40 mJ/cm(2) of solar simulating radiation. Altogether 12 CMM patients and 10 healthy controls were included in our study. Buttock skin biopsies were taken at 0 hr, 48 hr and 3 weeks after UV exposure, whereas melanocytic nevi and surrounding skin biopsies were taken only at 0 hr and 3 weeks. The CPD levels were measured by a (32)P-postlabeling method. The results showed that the repair rate of CPDs in neither the skin nor the nevi was significantly different between the CMM patients and the control group. For both groups, the repair rate of TT = C was faster than that for TT = T. The important finding is that about 10% of the initial TT = T damage remained unrepaired after 3 weeks, and was detectable in normal epidermis as well as in nevi of all subjects. We also found that the amount of TT = C and TT = T at 0 hr in nevi was significantly lower than that in surrounding skin (Wilcoxon rank sum test, p < 0.05).

Adult↗
PubMed2003

Prevalence and anatomical distribution of naevi in young Queensland children.

Sunlight is the principal environmental cause of melanoma and has also been implicated in the pathogenesis of melanocytic naevi. Epidemiological evidence indicates that childhood is a period during which melanocytes are susceptible to the effects of sunlight, yet little is known about the development of naevi in infancy. We conducted a survey of child-care centres to document the prevalence and anatomical distribution of melanocytic naevi among 193 young children aged 1-3 years in Brisbane, Australia (latitude 27 degrees S). Naevi were counted on all skin surfaces except for the scalp, buttocks and genitalia. Overall, almost 90% of children in the study sample had at least 1 naevus of any size, and more than 30% of children had 10 or more naevi. Total naevus counts ranged from 0 to 45 and were strongly determined by age. When taken together, naevus densities were highest on exposed body sites such as the face and limbs; however the density of large naevi (> or = 5 mm) was significantly higher on the trunk than on the face, neck and ears. These data support the concept that melanocytic neoplasia commences early in life and that naevus evolution is influenced by the anatomical site of the target cell.

Child, Preschool↗
PubMed1993

Site distribution of cutaneous melanoma in Queensland.

The age-adjusted incidence rates of cutaneous melanoma in Queensland in 1987 have been analysed for 16 anatomic sites, taking into account their surface areas. In men, the incidence of invasive melanoma on the ears, a chronically sun-exposed site, was extraordinarily high with annual rates of over 200 per 10(5) units of surface area in the Queensland population. Next highest rates of over 100 melanomas per 10(5) units were found on the face, neck, shoulders and back in men and the face and shoulders in women. Comparison with site-specific incidence rates in the same population 7 1/2 years previously showed that incidence of invasive disease had significantly increased for all these sites, though the largest relative increase in this period occurred on the forearm in both men and women. Melanoma was very rare on the buttocks of both sexes and on the scalp in women, sites which receive the least sun exposure. These findings are consistent with the theory that excessive total sun exposure plays a major role in the aetiology of cutaneous melanoma.

Adult↗
PubMed1995

Incidence of cutaneous childhood melanoma in Queensland, Australia.

The incidence of cutaneous melanoma in children aged 0-14 years was examined in Queensland, Australia. Details of notifications were collected from the population-based Australian Paediatric Cancer Registry. Between 1987 and 1994, the age-adjusted incidence rates of invasive cutaneous melanoma occurring in Queensland children were estimated at 8.5/million for males and 7.1/million for females. Incidence rates rose steeply in both sexes with increasing age, from less than 1/million in the 0-4 age group, to nearly 30/million in the 10-14 age group. To assess the uniformity of the anatomical distribution of lesions, relative tumour densities (RTDs) were calculated compared with the body as a whole. In both sexes, melanomas were most common on the trunk (RTD > 3), while lower limb lesions were less common (RTD < 0.6) and no melanomas were reported on the buttocks or external genitalia. Although not statistically significant, there was a tendency for truncal lesions in males to occur on the back, while in females, truncal melanomas were more evenly distributed across the chest, back and shoulders. No consistent relationship between latitude and melanoma incidence was observed, with higher rates reported in the subtropical than the tropical regions of Queensland. These are the first reported incidence rates of cutaneous melanoma in Australian children and are the highest ever reported in the world in this age group. Our findings provide baseline data from which to monitor changes in the occurrence of cutaneous melanoma in children.

Adolescent↗
PubMed2004

Water-friendly virtual reality pain control during wound care.

Recent research suggests that entering an immersive virtual environment can serve as a powerful nonpharmacologic analgesic for severe burn pain. The present case study describes an attempt to use water-friendly virtual reality (VR) technology with a burn patient undergoing wound care in a hydrotherapy tub. The patient was a 40-year-old male with 19% total body surface area deep flame/flash burns to his legs, neck, back, and buttocks. The virtual reality treatment decreased the patient's sensory and affective pain ratings and decreased the amount of time spent thinking about his pain during wound care. We believe that VR analgesia works by drawing attention away from the wound care, leaving less attention available to process incoming pain signals. The water-friendly VR helmet dramatically increases the number of patients with severe burns that could potentially be treated with VR (see http://www.vrpain.com).

Adult↗
PubMed2003

Effect of radiation and cell implantation on wound healing in a rat model.

BACKGROUND AND OBJECTIVES: Having shown that intra-dermal injection of fibroblasts decreases the effect of radiation on healing of superficial wounds, we now test the effect of fibroblasts and syngeneic marrow stromal cells on irradiated deep and superficial wounds. METHODS: Wistar rats received bilateral buttock irradiation followed by partial excision of the gluteus muscle bilaterally. In Protocol 1, one irradiated wound was treated with 1.2 x 10(7) autologous cells injected intra-dermally. In Protocol 2, the experimental side was treated with a fibrin and autologous cell implant (1.2 x 10(7) cells). Twenty-one days later, wound mechanical characteristics were tested. In Protocol 3, the effect of pooled marrow stromal cells on healing of superficial irradiated wounds in Lewis rats was similarly tested. RESULTS: The fibrin-fibroblast implant (Protocol 2) had no effect on wound mechanics. Superficial injection of fibroblasts (Protocol 1) significantly improved wound breaking strength when compared to the control group (mean +/- SEM, breaking strength: treated 504.6 +/- 37.0 g vs. control 353.4 +/- 35.2 g, P = 0.005). The dermal injection of marrow stromal cells also resulted in marked increases in breaking strength (mean +/- SEM, breaking strength: treated 338.5 +/- 39.9 g vs. control 187.1 +/- 12.0 g, P < 0.01). In both Protocols 1 and 3, ultimate tensile strength and toughness were increased in the side receiving cell transplantation. CONCLUSIONS: Cell implantation holds promise for decreasing the effect of radiation on healing of irradiated wounds.

Animals↗
PubMed2002

Evaluation of pulse-duration on purpuric threshold using extended pulse pulsed dye laser (cynosure V-star).

BACKGROUND AND OBJECTIVES: Pulsed dye lasers (PDL) with extended pulse-durations create new opportunities in the treatment of vascular lesions. Development of extended pulse methods requires understanding of tissue effects of extended pulse-durations. We evaluated tissue effects of extended pulse-duration PDL (EPDL) with cooling. Effects of increasing pulse-duration, fluence, and multiple passes were evaluated to determine purpuric threshold and delayed purpuric response. STUDY DESIGN/PATIENTS AND METHODS: Ten patients were treated with EPDL and air-cooling on normal buttocks skin. Exposure pulse-durations of 0.5, 2, 20, and 40 milliseconds and increasing fluences 3-20 J/cm(2), pulse-duration dependent. Exposures were evaluated 0.5, 1, and 24 or 48 hours determining purpuric threshold and side effects. RESULTS: Immediate purpuric threshold increased from 6.2 to 8, 10.4, and 13.8 J/cm(2) at pulse-durations of 0.5, 2, 20, and 40 milliseconds, respectively. Purpuric threshold dropped after 24 hours to 5.2, 7.1, 9.3, and 11.9 J/cm(2), respectively. Multi-pass treatment lowered purpuric threshold by 1 J/cm(2). EPDL purpura resolved in less time than traditional PDL. No side effects were noted. CONCLUSIONS: EPDL exhibits increasing purpuric threshold with increasing pulse-durations, and risk of delayed onset of purpura.

Drug Administration Schedule↗
PubMed2006

Non-ablative 1,450-nm diode laser treatment of striae distensae.

BACKGROUND AND OBJECTIVES: Striae distensae are dermal scars with flattening and atrophy of the epidermis. Successful treatment of these stretch marks has been disappointing. The non-ablative 1,450-nm diode laser has been shown to improve atrophic scars and may be expected to improve striae. As yet, no study has been published to document the effects of this laser on striae. Our aim is to evaluate the efficacy of the 1,450-nm diode laser in the treatment of striae rubra and striae alba in Asian patients with skin types 4-6. STUDY DESIGN/MATERIALS AND METHODS: Striae on one half of the body in 11 patients were treated with the 1,450-nm diode laser with cryogen cooling spray with the other half serving as a control. The following parameters were used: 6 mm spot size and dynamic cooling device (DCD) for 40 milliseconds to protect the epidermis. Patients were randomly assigned to receive either 4, 8, or 12 J/cm2. A total of three treatments were given at 6-week intervals. The following sites were treated: abdomen, arms, back, buttocks, and thighs. Two patients had striae rubra and nine striae alba. Clinical photographs were taken before and after each treatment and analysis was undertaken through photographic evaluation by non-treating physicians. RESULTS: At 2 months after the last treatment, no patients showed any noticeable improvement in the striae on the treated side compared to baseline and to the control areas. Side effects were limited to transient erythema and postinflammatory hyperpigmentation (PIH), which occurred in seven (64%) patients. CONCLUSIONS: The non-ablative 1,450-nm diode laser is not useful in the treatment of striae in patients with skin types 4, 5, and 6.

Adult↗
PubMed2006

A single center, randomized, comparative, prospective clinical study to determine the efficacy of the VelaSmooth system versus the Triactive system for the treatment of cellulite.

BACKGROUND AND OBJECTIVES: One area of cosmetic concern for women of all races is the unsightly appearance of cellulite in the buttocks area and lower extremities. Two modern technological advances claim to improve cellulite and provide reproducible results, TriActive and VelaSmooth. The TriActive laser is intended to reduce the appearance of cellulite through the combination of low-energy diode laser, contact cooling, suction, and massage. The VelaSmooth is based on a combination of two different ranges of electromagnetic energy: infrared light and radio frequency (RF) combined with mechanical manipulation of the skin. This single center study was designed to evaluate the efficacy of the VelaSmooth versus TriActive in the reduction of the appearance of cellulite. STUDY DESIGN/MATERIALS AND METHODS: Twenty female patients were treated twice a week for 6 weeks with the randomization of TriActive on one side and VelaSmooth on the other side. Patients were evaluated with photographs and circumferential thigh measurements before treatment and after the final treatment. RESULTS: Although there was improvement in the reduction of cellulite for each device individually, there was no significant difference between VelaSmooth or TriActive devices in the following categories: reduction of thigh circumference, photographic evaluation, and perceived change in before and after photographic grading. There was a statistically significant increase in the incidence of post-treatment bruising with the VelaSmooth compared to TriActive. CONCLUSIONS: In conclusion, both the TriActive and VelaSmooth provide improvement of cellulite. When comparing differences in efficacy, the average mean percent change calculated was roughly the same for both treatments and showed no statistical difference.

Adipose Tissue↗
PubMed1997

Lower body impedance for the evaluation of venovenous bypass flow.

Inferior vena cava (IVC) clamping during liver transplantation causes venous congestion in the splanchnic and IVC beds. A venovenous bypass relieves congestion and improves cardiac output (CO), but the bypass flow required for adequate drainage of the vascular beds is controversial. In this study we evaluated the bypass flow necessary to compensate for the IVC clamping. Lower body impedance (BI) is inversely related to tissue fluid content and was used to reflect congestion. A venovenous bypass was successfully applied to 59 of 62 patients. BI was measured across the left buttock and related to bypass flow, CO, bypass flow ratio (bypass flow/CO before IVC clamping; n = 62), and right femoral venous pressure (n = 8). The bypass flow was 1.7 (0.0-3.0) L.min-1 (median and range). BI decreased (delta BI; -2.2 [-10.3-1.1)] omega) as the femoral venous pressure increased (29 [21-49] mm Hg; r = -0.81; P < .05), and the femoral venous pressure correlated inversely to bypass flow (r = -0.35; P < .01). The change in CO at IVC clamping (delta CO; -2.3 [-6.3-1.6] L.min-1) related to bypass flow ratio (0.25 [0-0.51]; r = 0.57, P < .01), whereas delta BI related only minimally to bypass flow or bypass flow ratio (r = 0.37; P < .05). In conclusion the median bypass flow of 1.7 L.min-1 was too small to prevent fluid accumulation in the lower caval region, and extrapolation of data suggests that bypass flow should have approached 3.5 L.min-1 or 50% of CO in order to prevent fluid accumulation in the lower caval region. However the minimal correlation between lower BI and bypass flow indicates that bypass flow per se is not the only determinant of lower body fluid accumulation.

Adult↗
PubMed1994

In vivo EPR studies of the metabolic fate of nitrosobenzene in the mouse.

We report the first demonstration of EPR spectroscopy to study free radical reactions in live mice and excised muscle tissue resulting from the metabolism of nitrosobenzene. A broad three-line EPR spectrum (aN = 11.6 G) appeared in the buttocks region of a mouse place in an L-band loop gap resonator after intramuscular or intraperitoneal injection of 0.2 mmol/kg nitrosobenzene. The signal intensity reached a maximum at 20 to 30 min and remained constant well beyond 2 h. If muscle tissue was dosed with nitrosobenzene and excised within 5 min, a similar three-line X-band EPR spectrum was obtained which was preceded by the rapid growth and subsequent decay of an EPR spectrum identical with that of the phenylhydronitroxide radical, which was presumably generated from reactions between nitrosobenzene and reducing agents in the blood or tissue such as NADH or ascorbic acid. A model system containing nitrosobenzene and unsaturated fatty acids (olive oil or animal fat) yielded an identical three-line spectrum resulting from radical adducts of nitrosobenzene across the double bond. Overall, these results suggest that the most probable mechanism in vivo was nitrosobenzene covalently adding ("binding") to polyunsaturated fatty acid clusters in fat or membranes.

Animals↗
PubMed2003

Evaluation and treatment of low back pain: an evidence-based approach to clinical care.

Low back pain is a common reason for patient visits to a health care provider. For most patients, low back symptoms are nonspecific, meaning that the pain is localized to the back or buttocks and is due to a presumed musculoligamentous process. For patients with radicular leg symptoms, a precise etiology is more commonly identified. The history and physical examination usually provide clues to the uncommon but potentially serious causes of low back pain, as well as to those patients at risk for prolonged recovery. Diagnostic testing should not be a routine part of the initial evaluation, but used selectively based upon the history, examination, and initial treatment response. For patients without significant neurological impairment, initial treatments should include activity modification, nonnarcotic analgesics, and education. For patients whose symptoms are not improving over 2 to 4 weeks, referral for physical treatments is appropriate. A variety of therapeutic options of limited or unproven benefit are available for patients with radicular leg symptoms or chronic low back pain. Patients with radicular pain and little or no neurological findings should receive conservative treatment, but elective surgery is appropriate for those with nerve root compression who are unresponsive to conservative therapy.

Evidence-Based Medicine↗
PubMedDate not supplied

"Snapping bottom": subluxation of the tendon of the long head of the biceps femoris muscle.

Subluxation of the tendon of origin of the long head of the biceps femoris muscle (or snapping bottom) is a rare, previously unreported degeneration of the tendinous attachments of the muscle at the ischial tuberosity. It occurs in a patient who wears out this attachment through a lifetime of hyperflexion hip movements, such as are required in bending to reach the floor. The snapping of the tendon across its point of origin causes pain and swelling in the buttock. In the older nonathlete, if conservative measures fail, the treatment of choice is simple tenotomy. The condition should not be confused with weaver's bottom (ischiogluteal bursitis), even though it may be a cause for that bursitis.

Aged↗
PubMed2005

Localization of the urge to void in patients with painful bladder syndrome.

AIMS: Our aim was to describe the location of urinary urgency or bladder discomfort in patients with painful bladder syndrome (PBS) and controls. METHODS: Patients with symptomatic diagnoses of PBS, overactive bladder (OAB) syndrome, stress urinary incontinence (SUI), and asymptomatic controls were asked to indicate the location of their urinary urge/urgency/discomfort on a body map. RESULTS: We present results for 30 PBS patients, 25 OAB patients, 15 SUI patients, and 15 asymptomatic controls. In asymptomatic subjects and those with SUI, the urge to void was localized to the suprapubic region only. More than half (53%) of patients with PBS and a minority (20%) of those with OAB localized their urinary urgency/discomfort to both suprapubic and vulvar/urethral locations. Some patients with PBS also localized their urinary discomfort to other body sites including low back, upper and lateral buttocks, lower abdomen, and upper thighs. CONCLUSIONS: In most patients with PBS and some with OAB, complaints of bladder discomfort or urgency may refer to sensations that are localized at sites other than suprapubic. The etiology of widespread sensation may include an expansion of dermatomes of referral of bladder sensation, and/or the presence of associated somatic abnormalities.

Adult↗
PubMed2005

Pain experienced by electric-powered chair users: a pilot exploration using pain drawings.

BACKGROUND AND PURPOSE: Many wheelchair users experience pain or discomfort, and little is known about its severity or nature. The present study explored the feasibility of using visual analogue scales and pain drawings to assess the intensity and distribution of pain in users of electric-powered indoor and outdoor wheelchairs, and its changes over time. METHOD: Five electric-powered indoor and outdoor chair (EPIOC) users, mean age 62 years (range 43-84 years) completed pain drawings and visual analogue scales two-hourly during one day. RESULTS: Pain intensity increased throughout the day in all users. It was most severe in the neck, back and buttocks. Pain drawings gave visual impact to the extent of the pain. CONCLUSIONS: Visual analogue scales and pain drawings may be useful in assessing pain experienced by EPIOC users, which may be severe and appears to increase in severity and distribution during the day.

Adult↗
PubMed1988

Breast reconstruction after mastectomy.

The goal of breast reconstruction is to reconstruct breasts which meet the patient's expectations both psychologically and aesthetically, while adhering to the principles of sound oncological management. Breast reconstruction is usually started around 3 to 9 mos after mastectomy. The simplest method of reconstruction uses tissue available after mastectomy and a silicone implant. The recent advances with tissue expansion of the skin of the mastectomy site can permit reconstruction without the use of a flap. The latissimus dorsi flap from the back is a useful source of muscle and skin and the transverse rectus abdominus musculocutaneous flap provides tissue from the lower abdomen enabling breast reconstruction without the use of a silicone implant. Fat and skin from the buttocks may be used in a microsurgical transfer technique. Prophylactic mastectomy and immediate breast reconstruction are still controversial, but are options for the woman who is worried about the development of breast cancer. The reconstruction of the nipple and areola is only done after reconstructed breast symmetry is ascertained.

Adult↗
PubMed1994

In vivo ovine flap model to evaluate surgical infection and tissue necrosis.

Although the inciting causes and the end results of soft tissue infection are well described, we have not achieved a quantitative methodistic description of the sequence of events in between. The following study presents an isolated in vivo model which will allow specific manipulations and quantifications of the events of integumentary infection. Pedicle flaps were raised on the buttock of the adult range ewe and it was multiply inoculated with Staphylococcus aureus, and followed for 96 hr. This pedicle contains not only a well-defined artery, vein, and nerve, but also a well-developed efferent lymphatic vessel. In addition, the distal portion of the flap is primarily supplied by a musculocutaneous arterial perforator, making the distal flap a watershed area. Anatomic, radiologic, and vital stain injection studies confirmed these results. The sheep model was found to be superior to the pig model both in terms of its anatomy (the addition of an efferent lymphatic vessel) as well as the disposition of the sheep which was more compliant than that of the pig. We believe that this flap will allow multiple manipulations and provide an in vivo isolated system to study the pathobiology of soft tissue infection.

Animals↗
PubMed2001

Adipose fat quality vs. quantity: relationships with children's serum lipid levels.

BACKGROUND: There is a controversy as to the relative importance of obesity vs quality of dietary fat in the prediction of serum lipoproteins in children. A reason for this is an apparent lack of studies implementing biomarkers of long-term dietary fat intake among children. The objective of the present study was to assess the relative contribution of degree of obesity, fat centrality, and quality of adipose tissue fat in the prediction of serum lipids in 12-year-old children. METHODS: Pupils came from 40 schools randomly selected among 541 primary schools in three different provinces of the island of Crete. One thousand forty-six pupils were examined at age 6. At age 9, a representative sample from the original cohort (n = 579) was randomly selected for reevaluation. At the age of 12, a representative sample of 831 pupils was reexamined. At ages 6, 9, and 12, serum lipid measures were obtained from 941, 458, and 791 children, respectively. At age 12, data were obtained on pupils' anthropometry, serum lipids, dietary intake, physical fitness, and physical activity. Adipose tissue fatty acid data were obtained from a subsample of 194 children at age 12. RESULTS: Regression analyses indicated that children's serum triglycerides related positively to body mass index and waist-hip ratio (WHR). Serum HDL-C related negatively to WHR and positively to endurance run test, an index of physical fitness. Dietary fatty acids, assessed by a single administration of 3-day weighed-food records, did not relate to serum lipids. However, serum HDL-C related negatively to sum of adipose polyunsaturated fatty acids, a measure of long-term polyunsaturated fat intake. CONCLUSIONS: It appears that obesity and fat centrality are stronger predictors of children's serum lipids than the quality of long-term dietary fat intake or adipose tissue fatty acid composition. It is possible that this finding may relate to the particular subcutaneous depot studied. It is suggested that future studies study abdominal rather than buttock adipose tissue fatty acid composition in relation to children's serum lipid levels.

Adipose Tissue↗