1/77. Correction of the depressed, retracted, post-tracheostomy scar.Many methods have been developed for the correction of tracheal tug and scar depression. Early authors did well in correcting scar depression, but the correction of tracheal tug was more difficult. One method used to limit scarring is intralesional steroid injections. Repeated steroid injections inhibit healing, which could also limit skin-to-trachea adhesions. Carlson et al. were the first to advocate the use of an alloplastic barrier to prevent tracheal tug. Lyophilized dura has been used for several years by various surgical specialties. Microscopic studies have shown no host response; in fact, fibroblastic ingrowth is common. The use of alloplastic dura ensures that there is no contracture between the trachea and the skin, thus preventing tracheal tug. Alternatives to this method include soft-tissue procedures (as previously mentioned) to add bulk and then triamcinolone acetonide injections to prevent adherence and scarring. It is important to treat each case individually and to provide treatment that is best suited to the patient's needs. The method used in these case reports not only eliminates scar depression, but prevents tracheal tug as well.- - - - - - - - - - ranking = 1keywords = dura (Clic here for more details about this article) |
2/77. Annular vasculitis in association with sarcoidosis.We report a case of cutaneous vasculitis with annular features in association with sarcoidosis. A 36-year-old woman presented with fever, polyarthralgias, erythema nodosum, bilateral hilar lymphadenopathy, and induration of a long-standing scar on the face. In addition, she developed annular, erythematous, and purpuric patches over her thighs and buttocks that were histologically characterized by a small vessel leukocytoclastic vasculitis. The presence of circulating immune complexes in the early stages of sarcoidosis might be related to the occurrence of the vascular damage.- - - - - - - - - - ranking = 0.5keywords = dura (Clic here for more details about this article) |
3/77. Histologic features of lichen sclerosus et atrophicus in a surgical scar.A 76-year-old woman presented with a 7-mm, hard, pink nodule at the site of an appendectomy scar of more than 70 years' duration. The clinical impression at the time of biopsy was that of a keloid. Surprisingly, light microscopic examination revealed classic histologic features of late-stage lichen sclerosus et atrophicus (LSA) overlying a scar. elastic tissue stain highlighted the unusual presence of abundant nodules of elastin in the reticular dermis only.- - - - - - - - - - ranking = 0.5keywords = dura (Clic here for more details about this article) |
4/77. glioblastoma multiforme at the site of metal splinter injury: a coincidence? Case report.The authors report the case of a man who had suffered a penetrating metal splinter injury to the left frontal lobe at 18 years of age. Thirty-seven years later the patient developed a left-sided frontal tumor at the precise site of the meningocerebral scar and posttraumatic defect. Histological examination confirmed a glioblastoma multiforme adjacent to the dural scar and metal splinters. In addition, a chronic abscess from which propionibacterium acnes was isolated was found within the glioma tissue. The temporal and local association of metal splinter injury with chronic abscess, scar formation, and malignant glioma is highly suggestive of a causal relationship between trauma and the development of a malignant brain tumor.- - - - - - - - - - ranking = 0.5keywords = dura (Clic here for more details about this article) |
5/77. Protean manifestations of lipoid proteinosis in a 16-year-old boy.We report a 16-year-old Japanese male with lipoid proteinosis showing various skin manifestations. The patient was born to nonconsanguineous parents and none of his relatives was similarly affected. The patient suffered from a hoarse voice and refractory temporal epilepsy from early childhood. Computed tomography scanning of the brain showed bilateral calcification in the temporal lobes, a characteristic feature of lipoid proteinosis. On physical examination, various skin manifestations, including papules and haemorrhagic blisters, acne-like scars at sites of minor trauma or friction, and beads of small papules along the free margins of the eyelids were noted. A skin biopsy showed deposits of homogeneous hyaline-like material, positive on periodic acid-Schiff staining, throughout the dermis, particularly around small blood vessels. It is noteworthy that a range of characteristic skin lesions can be present in a patient with lipoid proteinosis even with mild systemic involvement.- - - - - - - - - - ranking = 1.8682296688274keywords = mater (Clic here for more details about this article) |
6/77. Excimer laser phototherapeutic keratectomy: indications, results and its role in the Indian scenario.PURPOSE: To report indications, technique, and results of excimer phototherapeutic keratectomy (PTK), and describe possible reasons for the small numbers of such procedures performed in a referral institute in india. methods: Retrospective review of case records of 10 patients (11 eyes) who underwent excimer PTK at our institute between February 1994 and September 1997. RESULTS: Corneal scars were the most common indication for treatment. Best-corrected visual acuity (BCVA) improved in 6 eyes (mean: 2 lines of Snellen acuity). All eyes had BCVA > or = 6/12 after treatment. None of the patients experienced loss of BCVA after treatment. Unaided visual acuity improved in 3 eyes and decreased in 2 eyes. Change in spherical equivalent refraction > or = 1 diopter occurred in 77.8% of eyes after treatment. Treating central corneal scars resulted in a significant hyperopic shift in refraction. CONCLUSIONS: Excimer PTK is a safe and effective procedure for the treatment of superficial corneal opacities. Post-treatment ametropia may require further correction with optical aids. Inappropriate referrals, deep corneal scars, and cost of the procedure could have contributed to the small numbers of PTK performed at our institute. Improved understanding of procedural strengths and limitations could lead to increased use of this procedure, with satisfying results in selected patients.- - - - - - - - - - ranking = 0.5keywords = dura (Clic here for more details about this article) |
7/77. Bioartificial skin.The loss of skin has been one of the oldest, yet most frequent and costly problems in our health care system. To restore functional and esthetic integrity in patients with unstable or hypertrophic scars, in burn patients and after skin loss for hereditary, traumatic or oncological reasons, an armamentarium of reconstructive surgical procedures including autogenous, allogenous and xenogenous tissue transfer as well as implantation of alloplastic materials has been favored. For several decades there has been increasing interest focused on 'tissue engineering' of dermal, epidermal and full thickness skin substitutes by both biological and synthetic matrices. At our institution (Hannover Medical School), a collagen/glycosaminoglycan dermal regeneration matrix has been used for immediate dermal coverage after escharectomy in burn injuries as well as for dermal replacement in chronically unstable scars. This article gives an overview on the current state of the art in bioartificial skin as well as our personal experience with the collagen/glycosaminoglycan matrix for dermal replacement in different clinical situations.- - - - - - - - - - ranking = 1.8682296688274keywords = mater (Clic here for more details about this article) |
8/77. Malignancy in chronic ulcers and scars of the leg (Marjolin's ulcer): a study of 21 patients.OBJECTIVE: To study the imaging features of patients with chronic ulcers of the leg that were associated with malignancy. DESIGN AND patients: All patients who on biopsy were proven to have malignancy--the majority of which were squamous cell carcinoma-were included in a prospective study. Ulcers limited to the foot were excluded but ulcers of the leg which extended into the foot were included. amputation was performed in all but two patients, due to pain, bleeding or tissue necrosis. RESULTS: The etiology was multifactorial. The mean duration of the ulcers was 36 years including venous ulcers, extensive scarring of the leg secondary to infection, injury or burns. One ulcer was secondary to a snake bite. The remainder, usually in the upper part of the leg, had repeated episodes of blunt trauma or knife wounds, which were also complicated by infections which failed to heal or, if they healed, regularly recurred. Although arterial insufficiency was not primary in any patient, most were of advanced age and it may have been an element in some patients. Despite infection, osteomyelitis was present in only one patient. The essential features were bone destruction, soft tissue mass and periosteal reaction. The bone destruction was visible on the radiographs in all but one case. The soft tissue masses varied in size but in general were very large. The periosteal reaction varied in type but most commonly was lamellated. The classic undulating solid periosteal reaction of venous stasis was only occasionally present. The periosteal reaction was nonspecific in the majority of cases and did not aid in the diagnosis or etiology. MRI and CT studies were performed in six patients. These were helpful in defining the extent of bone destruction and periosteal reaction but were not essential in management. CONCLUSION: Chronic ulcer present for decades that then undergoes malignant change is a disease of developing countries where patients only consult physicians when they have developed complications such as pain, bleeding or tissue necrosis. Chronic ulcers may require to be biopsied at regular intervals as malignant change in these ulcers is directly related to their duration.- - - - - - - - - - ranking = 1keywords = dura (Clic here for more details about this article) |
9/77. C-shape extended transconjunctival approach for the exposure and osteotomy of traumatic orbitozygomaticomaxillary deformities.In the treatment of post-traumatic deformities of the orbitozygomaticomaxillary complex resulting from trauma, the most appropriate exposure must be used. The choice of exposures includes the bicoronal approach and the periorbital incisions. When the whole orbitozygomatic complex is malpositioned, the bicoronal approach is desirable; this can be combined with buccal and eyelid incisions. However, the bicoronal approach is complicated by a longer duration of operation time, post-surgical scars that tend to show, and potential damage to the temporal branch of the facial nerve. A new approach using a C-shape extended transconjunctival approach is possible to have one field of vision to osteotomize the frontozygomatic suture, the lateral orbital wall, inferior orbital rim, lateral maxillary buttress, and zygomatic arch. It takes less operating time and the post-surgical scars are shorter than the bicoronal approach.- - - - - - - - - - ranking = 0.5keywords = dura (Clic here for more details about this article) |
10/77. Bilateral linear scleroderma "en coup de sabre" associated with facial atrophy and neurological complications.BACKGROUND: Linear scleroderma "en coup de sabre" (LSCS) usually affects one side of the face and head in the frontoparietal area with band-like indurated skin lesions. The disease may be associated with facial hemiatrophy. Various ophthalmological and neurological abnormalities have been observed in patients with LSCS. We describe an unusual case of LSC. CASE PRESENTATION: A 23 year old woman presented bilateral LSCS and facial atrophy. The patient had epileptic seizures as well as oculomotor and facial nerve palsy on the left side which also had pronounced skin involvement. Clinical features of different stages of the disease are presented. CONCLUSIONS: The findings of the presented patient with bilateral LSCS and facial atrophy provide further evidence for a neurological etiology of the disease and may also indicate that classic progressive facial hemiatrophy (Parry-Romberg syndrome) and LSCS actually represent different spectra of the same disease.- - - - - - - - - - ranking = 0.5keywords = dura (Clic here for more details about this article) |
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