Implication of the glycoxidation and lipoxidation reactions in the pathogenesis of dialysis-related amyloidosis (Review)

BACKGROUND: The term Marjolin ulcer is now synonymous with malignant transformation of chronic ulcers, sinus tracts, and burn scars. OBJECTIVE: To illustrate the importance of incisional or excisional biopsies in cases of suspected burn scar carcinoma. METHODS: Case report and review of the literature. RESULTS: Multiple punch biopsies were negative while a complete excision revealed the diagnosis of squamous cell carcinoma. CONCLUSION: Because of the focal nature of malignant change in burn scars, incisional or excisional biopsy should be performed.     

Beyond bloodletting

Marjolin's ulcer is a term used to describe squamous cell carcinomas which develop in chronic wounds. These carcinomas may also develop at the site of long-standing irritation, such as unstable burn scars. Development times for burn scar carcinomas of more than 30 years have been noted. This evaluation describes the treatment of 10 patients with burn scar carcinomas who have been treated using wide excision and closure of the defect with skin grafts or flaps, plus regional lymph node dissection if required. Results indicate a mean carcinoma development time of 26 years. Local recurrence occurred in only one patient.     

Multiple malignant melanoma and squamous-cell carcinoma in a burn scar

Malignant melanoma arising in a burn scar is very rare. Only 12 cases have been reported until now. We report a case of multiple malignant melanoma and squamous-cell carcinoma arising in the same burn scar. Reported cases of malignant melanoma arising in burn scars are also reviewed. Results of immunohistochemical studies and HLA typing of our patient and a review of previous cases suggest the aggressive behavior of malignant melanoma in burn scars.     

Cobalt 60 radiotherapy for treatment of squamous cell carcinoma of the nasal cavity and paranasal sinuses in three horses

Three adult horses underwent aggressive treatment of squamous cell carcinoma of the nasal cavity and paranasal sinuses, using course-fractionated cobalt 60 radiotherapy. Squamous cell carcinoma of the nasal cavity and paranasal sinuses is not commonly diagnosed in horses. Historically, horses with this type of neoplasm have not been treated or have undergone some form of surgery. The prognosis for long-term survival or cure has been poor. Long-term results of cobalt 60 radiotherapy were good to excellent and exceeded those usually reported for horses treated surgically. On the basis of these results, use of radiotherapy for these neoplasms is recommended.     

Pulsed dye laser treatment of hypertrophic burn scars

Hypertrophic burn scars are notoriously difficult to treat because of their extensive tissue involvement and tendency to worsen with hypertrophy and contracture formation. Various therapies have been advocated in the past, including surgical excision and grafting, dermabrasion, and corticosteroids, with distinct cosmetic limitations. The 585-nm pulsed dye laser has been shown previously to be effective in the treatment of a variety of traumatic and surgical scars with improvement in scar texture, color, and pliability with minimal side effects. Sixteen patients with 40 hypertrophic burn scars resulting from chemical peels, carbon dioxide laser procedures, and accidental thermal injury were treated with a 585-nm pulsed dye laser. Sequential photographic and clinical assessments were recorded in all patients. Histologic evaluations of skin punch biopsies before and after laser irradiation were performed when possible. Symptomatic improvement of scars was reported after one treatment. Decreased scar erythema with improved texture and pliability was observed after an average of 2.5 treatments. No correlation was found between scar duration, location, or etiology and response to treatment. Normal number of dermal fibroblasts with decreased sclerosis was observed on histologic examination of laser-irradiated scars. The 585-nm pulsed dye laser irradiation of hypertrophic burn scars can effectively improve scar pliability and texture and decrease erythema and associated symptoms yielding cosmetically and functionally acceptable clinical results.     

Topical silicone gel sheeting in the treatment of hypertrophic scars and keloids. A dermatologic experience

BACKGROUND: Topical silicone gel sheeting has been used successfully in the management of hypertrophic and keloid scars resulting from thermal burn wounds. METHODS: An open-labelled approach using the silicone gel sheets was performed using hypertrophic and keloid scars secondary to surgical procedures or traumatic insults. RESULTS: The silicone gel sheets resulted in moderate improvement in scar thickness, scar color and was noted to be effective to some degree in all tested. The material was easy to use and painless. CONCLUSION: Topical silicone gel sheeting is an effective method for the treatment of hypertrophic and keloid scars and may be considered useful in the treatment of these difficult cutaneous lesions.     

A vision-based technique for objective assessment of burn scars

In this paper a method for the objective assessment of burn scars is proposed. The quantitative measures developed in this research provide an objective way to calculate elastic properties of burn scars relative to the surrounding areas. The approach combines range data and the mechanics and motion dynamics of human tissues. Active contours are employed to locate regions of interest and to find displacements of feature points using automatically established correspondences. Changes in strain distribution over time are evaluated. Given images at two time instances and their corresponding features, the finite element method is used to synthesize strain distributions of the underlying tissues. This results in a physically based framework for motion and strain analysis. Relative elasticity of the burn scar is then recovered using iterative descent search for the best nonlinear finite element model that approximates stretching behavior of the region containing the burn scar. The results from the skin elasticity experiments illustrate the ability to objectively detect differences in elasticity between normal and abnormal tissue. These estimated differences in elasticity are correlated against the subjective judgments of physicians that are presently the practice.     

A retroperitoneal abscess with cutaneous fistula developed after stercoral fistula operation: a case report

Sparing treatment of chronic purulent sinusitis in children is an urgent problem of rhinology. Usage of preparations of donor (parental, of the same group) autoleukomass and blood plasm which possess all the components of humoral and cellular immunity proved highly effective against chronic purulent sinusitis in children. The drawback of this method is the necessity of regular lavage of the sinuses after insertion of the leukomass and heparinized plasm. The use of donor serum (parental, of the same group) also produced a good effect in purulent sinusitis. The serum advantage over the leukomass or plasm is that it can be left in the sinuses until the next procedure.     

Childhood sarcoidosis presenting with hypercalcaemic crisis

Squamous cell carcinoma is a rare, but well documented complication of chronic osteomyelitis. Many authors have recommended amputation as the treatment of choice for locally invasive disease. Presented is a patient with squamous cell carcinoma arising in the draining sinus tract of chronic osteomyelitis of the lower extremity that was treated successfully with Mohs micrographic surgery (MMS). After ten year follow-up he remains tumor free and continues to enjoy use of his leg. We propose MMS as a therapeutic option to amputation for control of locally invasive disease.     

Free tissue transfer in the management of burns

Although the majority of burn wounds undergoing surgical treatment require only excision with split-skin grafting, the introduction of free microvascular tissue transfer has allowed for the preservation of otherwise unsalvageable deep burn injuries and the resurfacing of burn scars in areas with no available local tissue. A total of 1699 patients with burn injuries were admitted to the Burns Unit in Newcastle upon Tyne in the 5 years 1989-1993. During this period 604 patients (35.5 per cent) required surgical treatment of their burns. Of these patients 582 (96.4 per cent) underwent excision of their burns with split-skin grafting, 13 (2.1 per cent) of the patients required local flap cover and nine patients (1.5 per cent) had free tissue transfer. Free flap loss in this study was 22 per cent in burns patients as compared to only 3 per cent in patients undergoing microsurgical reconstruction for other reasons.     

Dynamic MRI using a surface coil in chronic cholecystitis and gallbladder carcinoma: radiologic and histopathologic correlation

PURPOSE: The purpose of this study was to determine whether dynamic MRI could differentiate gallbladder carcinoma from chronic cholecystitis. METHOD: The dynamic MR findings of 50 patients with pathologically proven chronic cholecystitis and 13 with gallbladder carcinomas were correlated with the pathological findings. RESULTS: In chronic cholecystitis with thickened wall, mucosa and muscle were shown in early images as smoothly delineated enhancement except in one case, and the subserosa with fibrosis was enhanced in late or delayed images. Unenhanced foci in the wall correlated with Rokitansky-Aschoff sinuses or mural stones. In carcinomas, all tumors showed irregularly delineated enhancement in early images. In late or delayed images, noncancerous portions were also enhanced. The outer margin of early enhancement correlated with the extension of the tumor. CONCLUSION: Dynamic MRI is useful for the differentiation of chronic cholecystitis from carcinoma and for the evaluation of its local extension.     

Molecular evidence for the involvement of alpha crystallin in the colouration/crosslinking of crystallins in age-related nuclear cataract

From August 1989 to January 1995 we performed multiple percutaneous longitudinal tenotomies under local anesthetic on 52 middle- and long-distance runners with unilateral Achilles tendinitis or peritendinitis that had failed conservative treatment. Forty-eight patients were reviewed at an average of 22.1 months (SD, 6.5) after surgery. Results were rated as excellent in 25 patients, good in 12, fair in 7, and poor in 4. Four patients developed subcutaneous hematomas. One patient developed a superficial infection at one of the incision sites, which was managed by oral antibiotics with full recovery. Three patients complained of over-sensitivity to the incisions; this was resolved by rubbing hand cream over the incisions several times a day. One patient developed hypertrophic painful scars on three of the five incisions, but corticosteroid injections yielded good functional and cosmetic results. Isometric strength and endurance of the gastrocsoleus complex was measured just before the procedure, and at 6 weeks and 6 months later. Both were within 10% of the normal contralateral limb by the 6th postoperative month. Percutaneous longitudinal tenotomy is simple, can be performed on an outpatient basis, requires minimal follow-up care, and, in our experience, has produced no significant complications. We use this procedure as the operative treatment of choice for cases of chronic tendinitis that have failed conservative treatment.     

Static-electric field induction by a silicone cushion for the treatment of hypertrophic and keloid scars

Silicone gel and silicone occlusive sheeting are widely used at present for the treatment of hypertrophic and keloid scars, without any scientific explanation as to their mode of action. In a recent paper the possibility was raised that static electricity generated by friction-activated silicone sheeting could be the reason for this effect, and that it can, with time, cause involution of hypertrophic and keloid scars. The objective of this study was to test this hypothesis and to observe whether a continuous and also an increased negatively charged static-electric field will shorten the treatment period. A device to implement these requirements gradually evolved over a 5-year period. A number of prototypes were tested until the final product was attained. Some of the patients in this study were treated initially with a silicone sponge inserted in the cushion. Later this version was changed to the final design described herein. A silicone cushion was developed with the purpose of increasing a negative static-electric charge to accelerate the regression process. The cushion is custom-made using a silicone occlusive sheeting envelope of 0.75-mm thickness, which does not deteriorate with use, and is partially filled with high viscosity silicone oil. Its edges are sealed, and its size is designed to extend a little beyond the scarred area. Static electricity readings, generated by activating the cushion by pumping action with the fingers, stretching or deforming the cushion, are invariably much higher when compared with those obtained with silicone occlusive sheeting and silicone gel sheeting. The interaction between the negatively charged ions of the cushion and the ionic charges of the tissue fluids may be the critical factor in achieving hypertrophic and keloid scars involution. Of the 30 patients enrolled in the study, 3 patients dropped out. Treatment with the silicone cushions yielded 63.3 percent cessation of itching and burning followed by pallor and flattening of the scar, some markedly so, over a few weeks to 6-month period. An additional 26.6 percent had their scars resolved in up to 12 months of treatment. Good contact of the cushion over the scar has been shown to be important in this clinical trial, and much creativity is needed for making elastic strap bindings that ensure this contact. The clinical trials extended over a 12-month period. Ten patients (33.3 percent) who had recalcitrant scars with little response to the use of the silicone cushion were given intralesional corticosteroid injections, in addition to the continued use of the cushion, resulting in a fairly rapid resolution of these scars over a period of months to a year.     

Prevalence and age-specific incidence of burns in Ghanaian children

The incidence of burns in developing countries is not precisely known due to unavailability or incompleteness of death registration and disease reporting. In this study, we determined prevalence and age-specific incidence of burns in children 0-5 years in the Ashanti region of Ghana using burn scars as proxy. We used a community-based, multi-site survey to identify children who had scars as evidence of previous burns. A scar prevalence of 6 per cent was found. No sex differences were found. However, significant differences were found among age groups, with children aged 18-23 months having the highest incidence (57.4 per 1000 person-years). There was evidence of focal occurrence of childhood burns in certain districts, and a higher prevalence in rural areas. We conclude that childhood burns are a significant health problem in Ghana, especially among rural residents and the very young, and recommend that interventions be developed to control them.     

The use of silicone occlusive sheeting (Sil-K) and silicone occlusive gel (Epiderm) in the prevention of hypertrophic scar formation

The development of hypertrophic scars and keloids is an unsolved problem in the process of wound healing. For this reason, a successful treatment to prevent excessive scar formation still has not been found. Over the last decade, however, a promising new treatment has been introduced. Silicone materials have proved to reduce the amount of scar tissue and are believed even to prevent hypertrophic scar and keloid formation. In this study, the prophylactic effect of a silicone occlusive sheeting (Sil-K, Degania, Israel) and a silicone occlusive gel (Epiderm, Inamed B.V., The Netherlands) was investigated in a bilateral breast-reduction scar model in which the nontreated scars were supported by nonocclusive Micropore (3M, The Netherlands). The inframammary scars of 129 female patients with a mean age of 31 years ( 14 to 69 years) were studied up to 1 year after the operation. The width and height were measured, and B-scan ultrasound, laser-Doppler flowmetry, and color measurements were used as objective indicators to distinguish between normal and exuberant scars. Three months following the operation, 64.3 percent of the patients developed a hypertrophic scar, which was reduced to 56.6 percent after 6 months and down to 35.3 percent after 1 year. No keloids were seen. Patients with an easily tanning skin, nonsmokers, and patients with an allergy showed more hypertrophic scar formation. Neither Sil-K, used in 68 patients, nor Epiderm, used in 61 patients, could prevent the formation of hypertrophic scars. If both groups were taken together, the scars treated with silicone materials even developed significantly more hypertrophy compared with the Micropore-applicated scars.     

Venous drainage of the inferolateral temporal lobe in relationship to transtemporal/transtentorial approaches to the cranial base

OBJECTIVE: Intimate to the application of lateral transtemporal approaches to the cranial base are the identification, manipulation, and/or the sacrifice of the venous anatomy of the inferolateral temporal lobe and the superior petrosal sinus and the transection of the tentorium. This study demonstrates the relationship and variability of the venous drainage of the lateral and inferior surfaces of the temporal lobe. METHODS: Twenty-one specially prepared, injected cadaver specimens yielded 40 temporal lobes for examination. The venous systems in these specimens were traced from their origins on the temporal lobe (venous drainage complexes) to the transverse/petrosal sinuses, and the geometry of these venous complexes (venous configuration) was noted. The measurements of each complex's entry to the sinuses were noted. RESULTS: Four distinct venous drainage complexes were identified: 1) the lateral complex, 2) the anteroinferior complex, 3) the medial-inferior complex, and 4) the posteroinferior complex. Three basic venous configurations were found: 1) the candelabra of veins uniting to form one large draining vein, 2) multiple independent draining veins, and 3) venous lakes running in the tentorium before entering the sinuses. The lateral complex, incorporating the classic "vein of Labbé," was present in 100% of the specimens. However, in the majority of cases, it did not represent the dominant venous drainage of the lateral and inferior surfaces of the temporal lobe. CONCLUSION: An understanding of the complexity and diversity of the venous drainage complexes and their configurations is necessary to avoid venous complications during lateral cranial base surgery.     

Sinus aspergillosis after an endodontic treatment. Presentation of a clinical case

Aspergillosis is an opportunistic deep mycosis that occurs in immunocompromised patients, often in the paranasal sinuses. However, it sometimes occurs in healthy subjects, producing symptoms similar to those of a chronic sinusitis that is unresponsive to conventional treatment. A possible entry point for Aspergillus is the oroantral communication originated by perforation of the dental root cavity during root canal of a molar with penetration of material. We report the clinical case of a patient with symptoms of chronic sinusitis who was diagnosed as sinus aspergillosis after radiological and histological study. The origin may have been a third upper molar in which a root canal was performed.     

Use of the scalp as a donor site for large burn wound coverage: review of 150 patients

The characteristics of rapid wound healing and multiple harvest capacity make the scalp an important donor site when dealing with large and deep burn wounds. This paper reports the results of a retrospective analysis of 150 patients treated for large burn wounds. The findings indicated that bleeding during graft skin harvest could be limited to 50 ml by intradermal injection of epinephrine (1:2,000,000), high-concentration epinephrine-soaked gauze compression (1:20,000), and temporary porcine skin coverage. Use of a scalp graft also carried a low risk of complications, with only four (2.7%) major complications including three cases (2.0%) of visible alopecia and one case (0.7%) of hair transplantation. There were no hypertrophic scars, even in the patient who had the largest number (11) of repeat harvests.     

MR imaging and MR angiography in the diagnosis of dural arteriovenous fistulas

Intracranial DAVFs are most commonly found in the cavernous, transverse, and sigmoid sinuses. MR imaging and MR angiography can be used to screen for these lesions and determine if there is cortical venous drainage. Conventional angiography still has a major role in screening and is mandatory prior to any therapy. Spinal DAVFs are uncommon lesions seen predominantly in older men. The diagnosis can be suspected with MR imaging if a large draining vein is seen in association with swelling and enhancement of the conus and increased signal on T2-weighted images. MR angiography shows some promise in identifying the vascular anatomy of these lesions.     

Epidural hematomas in the posterior cranial fossa

A review of 89 cases of posterior fossa epidural hematoma (PFEDH) is presented. The mortality rate was 17.9%. In 44 cases (49.4%) there were associated intracranial hematomas. In 30 cases the hematoma was localized within the boundary of the foramen magnum and the transverse and sigmoid sinuses ("pure" PFEDH). In 59 cases the hematoma extended beyond the sinuses to the occipital area ("mixed" PFEDH). In the pure PFEDHs, the bleeder could be identified in only six cases and in five cases the source was a bleeding transverse sinus. The bleeders disclosed in the mixed PFEDHs were a torn transverse sinus in 28 cases, a meningeal artery in three cases, and a bony fracture in three cases. The possibility of a PFEDH should be kept in mind when evaluating patients who have suffered an occipital blow resulting in a frontal or temporal hematoma. In our series, patients with the pure PFEDHs with no associated intracranial hematomas had the best prognoses. Nine patients developed a PFEDH after surgery for a supratentorial hematoma. In 14 cases the PFEDH was treated at the subacute or chronic stage. All but one patient survived with a good recovery. Children generally had better prognoses.