DERMATOLOGIC SURGERY, Issue 1 2009
RAN HUO MD
BACKGROUND Conventional expansion inadequately restores damaged skin for patients with large areas of skin deficiency or who lack sources of normal skin. These patients require repeated skin expansions, but little is known about the outcomes of this procedure. OBJECTIVE To evaluate the microscopic changes and biomechanical properties of skin and soft tissue after repeated expansion. MATERIALS AND METHODS We prepared three groups of six pigs each: a conventional expansion group, a repeated expansion group, and a blank nonsurgical control group. We measured histology, ultrastructure, basic fibroblast growth factor (bFGF), stress,strain, stress relaxation, and stress strength. RESULTS Skin obtained after conventional expansion and repeated expansion was basically healthy, but the microscopic and biomechanical properties differed from those of nonexpanded skin, especially in the repeated expansion group. CONCLUSION Repeated skin expansion involves growth under stress, simultaneous injuries, and further repairs, with fibers showing more injury signs than cells. This article describes the microscopic changes and biomechanical properties that occur after repeated expansion. [source]

Hypertrophic Cranial Pachymeningitis Accompanied by Inflammation of the Nasopharygeal Soft Tissue

HEADACHE, Issue 8 2009
Hai-Tao Lu MD
No abstract is available for this article. [source]

Clear Cell Sarcoma of Soft Tissue with Cytogenetic and Molecular Analyses

JOURNAL OF CUTANEOUS PATHOLOGY, Issue 1 2006
C. Vejabhuti
A 7-year-old girl presented with pain and progressive swelling on the left plantar surface. Biopsy of a 2.5 cm mass demonstrated nests of large oval tumor cells with high nuclear-to-cytoplasm ratio, amphophilic to clear cytoplasm, prominent nucleoli, and brisk mitotic activity. Occasional cells showed spindled morphology. Infrequent melanin pigment was present. Melanocytic markers (HMB45, S-100) were diffusely positive. A diagnosis of clear cell sarcoma of soft tissue (CCSS) was made, and the tumor was re-excision with negative margins. 28 months later, a 1.0 cm pulmonary nodule was identified and showed CCSS. Cytogenetics demonstrated a complex karyotype (unbalanced translocation der(12;14)(p10;q10), additional chromosome 22 material of unknown origin). Although the CCSS translocation t(12;22)(q13;q12) was not identified, EWSR1 gene rearrangement was detected by fluorescence in situ hybridization (FISH). RT-PCR demonstrated an EWS-ATF1 fusion transcript, confirmed by direct sequencing. CCSS requires differentiation from malignant melanoma, due to overlapping clinical presentations, sites of involvement, histomorphology, immunocytochemical profiles, and ultrastructure. In many circumstances, definitive diagnosis is only possible with confirmation of the CCSS tumor-defining translocation. [source]

Pulmonary Zygomycosis in Solid Organ Transplant Recipients in the Current Era

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2009
H.-Y. Sun
Fifty-eight solid organ transplant recipients with zygomycosis were studied to assess the presentation, radiographic characteristics, risks for extra-pulmonary dissemination and mortality of pulmonary zygomycosis. Pulmonary zygomycosis was documented in 31 patients (53%) and developed a median of 5.5 months (interquartile range, 2,11 months) posttransplantation. In all, 74.2% (23/31) of the patients had zygomycosis limited to the lungs and 25.8% (8/31) had lung disease as part of disseminated zygomycosis; cutaneous/soft tissue (50%, 4/8) was the most common site of dissemination. Pulmonary disease presented most frequently as consolidation/mass lesions (29.0%), nodules (25.8%) and cavities (22.6%). Patients with disseminated disease were more likely to have Mycocladus corymbifer as the causative pathogen. The mortality rate at 90 days after the treatment was 45.2%. In summary, pulmonary zygomycosis is the most common manifestation in solid organ transplant recipients with zygomycosis, and disseminated disease often involves the cutaneous/soft tissue sites but not the brain. [source]

Inhomogeneous volumetric Laplacian deformation for rhinoplasty planning and simulation system

COMPUTER ANIMATION AND VIRTUAL WORLDS (PREV: JNL OF VISUALISATION & COMPUTER ANIMATION), Issue 3-4 2010
Sheng-hui Liao
Abstract This paper presents an intuitive rhinoplasty planning and simulation system, to provide high quality prediction of postoperative appearance, and design patient specific nose prosthesis automatically. The key component is a novel volumetric Laplacian deformation tool inspired by the state-of-the-art differential surface deformation techniques. Working on the volumetric domain and incorporating inhomogeneous material from CT data make the new approach suitable for soft tissue simulation. In particular, the system employs a special sketch contour driving deformation interface, which can provide realistic 3D rhinoplasty simulation with intuitive and straightforward 2D manipulation. When satisfied with the appearance, the change of soft tissue before and after simulation is utilized to generate the individual prosthesis model automatically. Clinical validation using post-operative CT data demonstrated that the system can provide prediction results of high quality. And the surgeons who used the system confirmed that this planning system is attractive and has potential for daily clinical practice. Copyright © 2010 John Wiley & Sons, Ltd. [source]

Severe periodontal damage by an ultrasonic endodontic device: a case report

DENTAL TRAUMATOLOGY, Issue 2 2007
John D. Walters
Abstract,,, Heat produced within a root canal during use of an ultrasonic instrument can be conducted through the dentin into periodontal ligament, bone and soft tissue. If severe in intensity or long in duration, it can induce damage to these tissues. This report describes a case in which an ultrasonic endodontic instrument apparently induced severe damage to alveolar bone, gingiva and nasal mucosa in a 42-year-old female. Overheating of a maxillary central incisor caused necrosis of soft tissue and bone on the facial and mesial aspects and triggered a protracted inflammatory response in the adjacent nasal cavity. To relieve the severe discomfort associated with this damage, the patient chose to have her maxillary incisors extracted and replaced by a removable partial denture. A defect in the soft tissue and bone was present at a follow-up visit 10 months after the extractions. While morbidity of this nature is rare, this case reinforces the need to maintain adequate cooling of ultrasonic instruments. [source]

Prevalence of oral trauma in children with bilateral clefts

DENTAL TRAUMATOLOGY, Issue 1 2005
Juliana Yassue Barbosa Da Silva
Abstract,,, The main object of this study is to analyze the prevalence of oral trauma in subjects with complete bilateral clefts, with anterior projection of the premaxilla. A total of 106 children aging 6 months to 9 years were analyzed. The caretakers answered a specific questionnaire, in order to report the presence or absence of trauma to the soft and/or hard tissues of the child's mouth. Whenever there was a history of trauma, the patients were submitted to clinical examination. The prevalence of oral trauma was 53%, being 91% of soft tissue lesions, 8.9% of avulsion, 7% of luxation and 1.8% of intrusion. For the males, the prevalence was 56% and for the females it was 47%, with no statistical significance. Regarding the following aspects:period of time spent with the parents and at school, and presence or absence of siblings, no statistical difference could be found. Among the traumatized individuals, 80% aged less than 3 years by the moment of the trauma, 89% suffered the trauma at home, 75% presented lesions in the soft tissue at the premaxilla, 16% in the maxillary incisors, and 8.9% presented lesions in both structures. It was noticed that 45% of the permanent incisors that succeeded the traumatized deciduous teeth presented alterations, being 48% of structure and 52% of structure and position. The prevalence of trauma in this sample was superior to that observed in the literature, without any positive associations between the evaluated aspects. These results suggest that the projection of the premaxilla brings about a higher risk of oral trauma around this area. [source]

Use of Intraoperative Botulinum Toxin in Facial Reconstruction

DERMATOLOGIC SURGERY, Issue 2 2009
TIMOTHY CORCORAN FLYNN MD
BACKGROUND Botulinum toxin is a potent neuromodulator that temporarily relaxes muscles and can improve wound healing. OBJECTIVE This retrospective analysis assessed the use of intraoperative botulinum toxin type A or B in patients undergoing surgical reconstruction after Mohs micrographic surgery for treatment of skin cancer. The primary effect of intradermal botulinum toxin on wound healing was also studied. METHODS & MATERIALS Charts of patients who received intraoperative botulinum toxin type A (n=9) or B (n=9) in conjunction with reconstructive surgery after Mohs micrographic surgery were reviewed. Three volunteers also underwent dermal injections of botulinum toxin type A followed by erbium laser resurfacing. RESULTS Outcomes did not differ in patients treated with botulinum toxin type A and type B. Patients had excellent apposition of wound edges and smooth skin overlying soft tissue; no significant complications were noted. Healing of erbium laser ablation did not differ between botulinum toxin type A,treated skin and control skin. CONCLUSIONS Administration of botulinum toxin type A or B after reconstruction after Mohs micrographic surgery aided wound healing; botulinum toxin type A and botulinum toxin type B were equally effective. Intradermal botulinum toxin type A demonstrated no primary effect on healing of erbium laser,resurfaced skin. [source]

A Microscopic and Biomechanical Study of Skin and Soft Tissue After Repeated Expansion

Surgical Treatment of Ingrown Toenail without Matricectomy

DERMATOLOGIC SURGERY, Issue 1 2008
BERNARD NOËL MD
BACKGROUND Partial excision of the nail matrix (matricectomy) is generally considered necessary in the surgical treatment of ingrown toenail. Recurrences may occur, however, and poor cosmetic results are frequently observed. OBJECTIVE The objective is to present a new surgical procedure for ingrown toenail with complete preservation of the nail matrix. METHODS Twenty-three patients with ingrown toenail were included in this study. The surgical excision was performed 1 week after the completion of treatment of the initial infection. A large volume of soft tissue surrounding the nail plate was removed under local anesthesia. No matrix excision was performed. RESULTS Short-term results were excellent. No recurrences or severe complications were observed during the minimum 12-months follow-up period. Cosmetic results were remarkable. CONCLUSIONS Ingrown toenail results from the compression of the lateral nail folds on the nail plate. This study shows that ingrown toenail can be surgically treated without matricectomy. A large volume of soft tissue surrounding the nail plate should be removed to decompress the nail and reduce inflammation. Cosmetic results are excellent and superior to the classical Emmert plasty. Postoperative nail dystrophies and spicule formation are not observed. The main advantage of this surgical approach is the complete preservation of the anatomy and function of the nail to improve both therapeutic and cosmetic results. [source]

Effect of Cog Threads under Rat Skin

DERMATOLOGIC SURGERY, Issue 12 2005
Hyo Jook Jang MD
Background. The aging face loses the tensile strength of structural integrity. Cog threads have been used recently to tighten lax skin and soft tissue. Objective. A comparative study of the effects of cog, monofilament, and multifilament threads under rat skin. Methods. Each cog, monofilament, and multifilament thread was inserted under the facial skin of a cadaver and the panniculus carnosus of rat dorsal skin. The maximum holding strength (MHS) of the thread and the tearing strength of the skin around the thread were measured with a tensiometer. The thickness of the capsule around the thread and the myofibroblasts was observed histologically. Results. In the cadaver, the MHS of the cog thread was 190.7 ± 65.6 g. It was greater than that of the monofilament (22.4 ± 7.7 g) or multifilament (40.4 ± 19.7 g) thread. In the rat, the MHS of the cog thread was 95.1 ± 18.8 g. It was greater than that of the monofilament (4.3 ± 1.3 g) or multifilament (10.9 ± 2.1 g) thread in the second week. The thickness of the capsule around the cog thread was 93.0 ± 3.2 ,m. It was thicker than the monofilament thread's capsule, 39.2 ± 12.1 ,m, in the fourth week. The number of myofibroblasts presented significantly more in the cog (96.0 ± 72.4) than in the monofilament thread (4.3 ± 4.4). The rumpled in-between skin suspended by each of the three different threads returned to its original state in 2 weeks. Conclusion. The cog thread placed under the rat skin immediately pulled the skin and subcutaneous tissue. The myofibroblasts around the thread played a role in fibrous tissue contracture 4 weeks postinsertion of the thread. These findings could be the basis for clinical application. THIS STUDY WAS SUPPORTED BY A GRANT FROM THE KOREA HEALTH 21 R&D PROJECT, MINISTRY OF HEALTH AND WELFARE, REPUBLIC OF KOREA. [source]

Subungual Schwannoma: A Rare Location

DERMATOLOGIC SURGERY, Issue 5 2005
Sang Eun Moon MD
background. Schwannoma is a benign tumor of neural tissue and usually develops in deeper soft tissue. Cutaneous involvement is uncommon, and a subungual location is extremely rare. In fact, it has not been previously reported. objective. To present a case of subungual schwannoma. method. A 49-year-old man had a subungual tumor on his right thumb of 8 years duration. The lesion caused a mild stinging sensation in winter and grew slowly. The tumor was excised using a transungual approach. After closure, the wound was dressed with a trimmed original nail plate. results. The nail plate grew normally, and there was no recurrence 1 year postoperatively. conclusion. We describe a case of schwannoma that developed in the subungual area of a thumb. Although schwannoma rarely develops in this area, it should be considered in the differential diagnosis of subungual tumor. [source]

Diagnosing and treating diabetic foot infections

DIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue S1 2004
Benjamin A. Lipsky
Abstract Foot infections are a common, complex and costly complication of diabetes. We have made considerable progress in establishing consensus definitions for defining infection. Similarly, we have learned much about the appropriate ways to diagnose both soft tissue and bone infections. Accompanying these advances have been improvements in our knowledge of the proper approaches to antibiotic (and surgical) therapy for diabetic foot infections. Furthermore, investigators have explored the value of various adjunctive therapies, especially granulocyte colony stimulating factors and hyperbaric oxygen, for improving outcomes. This paper presents a summary of a minisymposium on infection of the diabetic foot that was held at the fourth International Symposium on the Diabetic Foot, in Noordwijkerhout, The Netherlands. Crown copyright 2004. Reproduced with the permission of Her Majesty's Stationery Office. Published by John Wiley & Sons, Ltd. [source]

Cytologic diagnosis of osseous lesions: A review with emphasis on the diagnosis of primary neoplasms of bone

DIAGNOSTIC CYTOPATHOLOGY, Issue 4 2009
Lester J. Layfield M.D.
Abstract Fine-needle aspiration has been utilized as the initial diagnostic technique at a large number of body sites for over three quarters of a century. As early as the 1930s, fine-needle aspiration (FNA) was used to investigate lesions of the musculoskeletal system. In many early reports, FNA was most frequently and successfully used for the diagnosis of metastatic disease to bone. Less emphasis was placed on its utility for the investigation of primary neoplasms of bone and soft tissue. Current utilization of FNA continues to de-emphasize its application to the diagnosis of primary lesions of the musculoskeletal system. Recent advances in imaging techniques, immunohistochemistry, and molecular diagnostics along with an increasing familiarity among pathologists with the cytologic appearance of primary osseous tumors has led to reevaluation of the technique for investigation of these tumors. The diagnostic accuracy of FNA along with its relatively low cost and high degree of safety makes it a desirable technique for the investigation of primary lesions of the musculoskeletal system. This article reviews issues of diagnostic accuracy, optimal practice procedures, and benefits of the technique including cost reduction. The article will review criteria for selection of appropriate tissue targets for FNA to reduce the number of unsatisfactory specimens. Cytomorphologic features of the more common primary neoplasms of bone will be summarized along with recommendations for the utilization of immunohistochemistry and molecular diagnostics in the work-up of primary neoplasms of bone. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc. [source]

Fine-needle aspiration of soft tissue leiomyosarcoma: An analysis of the most common cytologic findings and the value of ancillary techniques

DIAGNOSTIC CYTOPATHOLOGY, Issue 9 2006
Henryk A. Domanski M.D., Ph.D.
Abstract This study aims to determine the diagnostic accuracy of fine-needle aspiration cytology (FNAC) of primary leiomyosarcoma (LMS) of soft tissue and to review diagnostic criteria and adjunctive methods, which can contribute to a confident diagnosis. We evaluated the preoperative FNAC in 89 patients with primary LMS for the following: cytomorphology and correspondence of FNA to histological features of excised tumors and clinical data. In addition, the utility of adjunctive techniques was analyzed and other spindle-cell lesions in the differential diagnoses were discussed. An unequivocal, malignant diagnosis was rendered by FNAC in 78 cases; 74 tumors were diagnosed as sarcoma, of which 31 as LMS or suspicion of LMS. In addition, three smears were labeled as malignant tumor, one as carcinoma metastasis, and three as neurilemmoma. Seven aspirates were inconclusive and one insufficient. On reevaluation, the diagnostic smears in most cases contained tumor cell fascicles with an admixture of dispersed cells or stripped nuclei. The most common cells were spindle cells with elongated, blunt-ended, segmented or fusiform nuclei, and round/polygonal cells, often with rounded or indented nuclei. In addition, 51 cases showed pleomorphic, often multinucleated cells. Osteoclasts, intranuclear vacuoles, and mitoses occurred in 14, 47, and 27 cases, respectively. Thus, most high-grade LMSs have cytologic features that allow diagnosis of sarcoma. Ancillary studies can confirm the diagnosis of LMS and help in the correct interpretation of predominant spindle-cell or epitheloid-cell smears resembling neurilemoma or carcinoma, respectively. Diagn. Cytopathol. 2006;34:597,604. © 2006 Wiley,Liss, Inc. [source]

Detection of a subset of CD30+ anaplastic large cell lymphoma by interphase fluorescence in situ hybridization

DIAGNOSTIC CYTOPATHOLOGY, Issue 2 2003
Hyung Ju C. Shin M.D.
Abstract T/null-cell anaplastic large cell lymphoma (ALCL) is a morphologically and clinically heterogeneous group of non-Hodgkin's lymphoma; to date several morphologic variants have been described on histologic specimens. However, the cytologic features of these variants in the fine-needle aspiration (FNA) specimens have not been well evaluated. The t(2;5)(p23;q35) has been identified in a subset of T/null-ALCL and is known to be associated with a favorable prognosis. We reviewed the cytomorphologic characteristics in 24 FNA specimens of ALCL. In all cases, the diagnosis was confirmed on histologic specimens, and immunohistochemical studies for anaplastic lymphoma kinase (ALK) protein expression were performed on the aspirates. The presence of ALK breakpoints were evaluated in nine cases, using a DNA break-apart probe on chromosome 2 covering the ALK gene by fluorescence in situ hybridization (FISH) techniques. Two hundred cells per case were examined. The results were expressed as the percentage of cells containing more than two signals of chromosome 2 to the total number of cells counted. FNA sites included lymph nodes (20), lung (2), breast (1), and soft tissue (1). The median age of the patients was 56 yr (range, 17,75 yr). Twenty cases had systemic involvement; in four cases, skin was the primary site with secondary involvement of the lymph nodes. All cases were CD30+ by immunohistochemistry; 20 were of T-cell phenotype and 4 were null cell type. The cytologic evaluation revealed typical anaplastic morphology (common type) with many "hallmark cells" in 16 (67%) cases. Other morphologic variants identified were small cell pattern in five cases, monomorphic pattern in two cases, and lymphohistiocytic pattern in one case. FISH studies showed that six (66.7%) of nine cases had at least two signals of chromosome 2, consistent with ALK breakpoints. With careful cytomorphologic evaluation in conjunction with appropriate immunohistochemical studies, a diagnosis of ALCL can be confidently made in the FNA specimens in the cellular aspirates and its morphologic variants also can be recognized. Furthermore, the FNA specimen is suitable in detecting ALK breakpoints by FISH study, permitting rapid identification of a subset of patients with ALCL, who may have a favorable prognosis. Using a commercially available probe, detection of ALK breakpoints in the FNA specimens is simple and can be a useful diagnostic adjunct in cases where distinction from other lymphomas or lymphoid lesions is morphologically difficult. Diagn. Cytopathol. 2003;29:61,66. © 2003 Wiley-Liss, Inc. [source]

Relation between metal concentration in water and metal content of marine mussels (Mytilus galloprovincialis): Impact of physiology,

ENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 7 2008
Stellio Casas
Abstract The present study constitutes an in situ investigation of metal kinetics within soft tissue of mussels (Mytilus gallo-provincialis), which solves the problem of the decoupling of the effect of animal physiology and metal bioavailability in water. Field experiments were conducted to measure uptake and elimination kinetics for four metals (Hg, Pb, Cd, and Cu) in three Mediterranean sites with different contamination and nutritive levels. At each site, metal concentrations were monitored in soft tissues of mussels and in the surrounding waters. The experimental conditions were completely characterized: Lazaret Bay (located between Nice and Marseille, France) is a hot spot for Hg (6.3 ng/L) and Pb (163 ng/L) concentrations and is an oligotrophic, stable site; Bages Lagoon (located to the west of Montpellier, France) is particularly contaminated by Cd (1.5 ng/L) and Cu (1.5,g/L) and is a mesotrophic site where variability of trophic and physicochemical parameters is significant; and Port-Cros Island (located in the Hyeres National Park, France) is considered to be a reference site. Those kinetics permit us to decouple physiological, chemical, and environmental interactions. After normalizing mussel metal content for similar physiological conditions, application of the local weighted regression (LOWESS) statistical treatment shows a parallelism between the time trends of metal concentrations in the bivalve and metal concentrations in water. The results enabled us to obtain in situ kinetic parameters and realistic bioaccumulation factors. Their logarithmic values were 4.6 for Hg, 4.3 for Pb, 4.9 for Cd, and 3.9 for Cu. The importance of physiological processes such as spawning is discussed as a factor influencing the bioaccumulation factor. This information may be useful in refining monitoring tools for risk assessment and, more generally, in environmental management strategies. [source]

Kinetic uptake of bioavailable cadmium, selenium, and zinc by Daphnia magna

ENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 11 2002
Ri-Qing Yu
Abstract Kinetic uptake of Cd, Se(IV), and Zn by Daphnia magna from the dissolved phase was determined using radiotracer techniques in moderately hard water. The metal influx rate and distribution in the soft tissue and the exoskeleton of the daphnids as influenced by metal concentration, inorganic ligands including pH, Ca2+ and SO42,, and body size were quantified. When the metal concentrations were <180 nM for Cd and <769 nM for Zn, the concentration factor in daphnids increased linearly within the 12 h of exposure. At a higher concentration, apparent steady state was reached after 3 h of exposure. Cadmium and Zn distribution in the soft tissues was not affected by the total ambient concentrations, whereas Se distribution in the soft tissue decreased by 7 to 10% with increasing Se concentration from 16 to 643 nM. A linear positive power relationship was found between the influx rates of the metals and the ambient concentrations. The concentration factor for Se, however, decreased significantly with increasing Se concentration in water. The influx rate of metals was inversely related to the body size in a power function. When the pH in ambient water increased from 5.0 to 7.0, the influx rate of Cd, Se, and Zn increased by 2.9, 16.6, and 4.1 times, respectively. The influx rates of Cd, Se, and Zn decreased by 6.9, 8.7, and 4.4 times, respectively, with an increase in Ca2+ concentration from 0.6 to 5.1 mM. In contrast, the uptake rates of all three metals were not significantly affected by the SO42, concentration. The majority of accumulated Se was distributed in the soft tissues after 12 h of exposure, whereas Cd and Zn were about evenly distributed in the soft tissue and exoskeleton. Any changes in pH, Ca2+, and SO42, concentrations did not apparently affect their distributions in the daphnids. Our study provides important kinetic data necessary for delineating the exposure routes and for further development of the biotic ligand model in Daphnia. Using a bioenergetic-based kinetic model, we showed that the dissolved uptake is dominant for Zn accumulation (>50%). For Cd and Se, dietary exposure is dominant when the bioconcentration factors of these metals in phytoplankton are at the high end. [source]

Osseous abnormalities associated with collateral desmopathy of the distal interphalangeal joint.

EQUINE VETERINARY JOURNAL, Issue 8 2009
Part 2: Treatment, outcome
Summary Reasons for performing study: There are currently few long-term follow-up data relating to recovery from injury of a collateral ligament (CL) of the distal interphalangeal (DIP) joint and limited information about the effect of associated osseous injury on prognosis. Objectives: To describe long-term follow-up results for horses with CL injury, with and without associated osseous injury; and to determine the effect of extracorporeal shock wave therapy (ECSWT) or radial pressure wave therapy (RPWT) on outcome. Hypotheses: Prognosis for return to performance for horses with CL-related osseous injury would be worse than for horses with CL injury alone. Methods: Magnetic resonance images from 313 feet of 289 horses with foot pain and a definitive diagnosis of collateral desmopathy of the DIP joint were analysed retrospectively for presence of osseous abnormality associated with the ligament origin or insertion and the middle and distal phalanges. Horses were assigned to groups according to the combination of their injuries. Type of treatment was recorded and follow-up information obtained. Thirty-two horses with additional sources of lameness were excluded from analysis of outcome. Results: Follow-up data were available for 182 horses, 55 of which had follow-up information for up to 2 years after presentation. Twenty-seven percent of horses with CL injury alone and 34% of horses with CL related osseous injury returned to their previous performance level. Prognosis for a combination of injuries to multiple soft tissue and osseous structures within the hoof capsule was substantially worse. There was no effect of ECSWT or RPWT on outcome. Conclusions: The presence of mild to moderate CL related osseous injury does not appear to influence prognosis compared with CL injury alone. Clinical relevance: Further studies of a larger number of horses are necessary in order to ascertain if specific types of osseous pathology influence return to performance levels. [source]

The role of calcimimetics in the treatment of hyperparathyroidism

EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 12 2007
R. P. Wüthrich
Abstract Calcimimetics reduce serum levels of parathyroid hormone (PTH) and calcium, with a leftward shift in the set-point for calcium-regulated PTH secretion. The aim of this publication is to review the data available for calcimimetics in primary, secondary and tertiary hyperparathyroidism (HPT). Parathyroidectomy (PTX) is currently the only curative treatment for primary HPT, and recommended for patients with moderate-to-severe disease, as defined by a 2002 National Institute's of Health summary statement. In general, patients with primary HPT not meeting these surgical criteria, as well as those with contraindication or refusal for surgery, are monitored for signs and symptoms of primary HPT. There are currently no non-surgical therapies approved for use in primary HPT, although bisphosphonates are used in some patients, in an effort to control serum calcium levels. Calcimimetics decrease PTH and calcium levels and are a potential alternative for patients contraindicated for PTX, or who have failed previous PTX and have recurrent primary HPT. Secondary HPT develops early in chronic kidney disease and is present virtually in all patients with end-stage renal disease (ESRD). Secondary HPT is a progressive disease and is associated with several systemic complications, including renal osteodystrophy, soft tissue and vascular calcifications, and adverse cardiovascular outcomes. In ESRD patients, calcimimetics were shown to simultaneously reduce PTH, calcium, phosphate and calcium × phosphate product. In addition, observational analyses of use of calcimimetics in the ESRD population have shown a reduction of important clinical outcomes. In renal allograft recipients with tertiary HPT and hypercalcaemia, calcimimetics are a promising treatment option to control the parameters of calcium phosphate metabolism and may be a valid alternative to PTX. Based on its unique mechanism of action, the calcimimetic cinacalcet may play a role in the medical treatment of primary and tertiary forms of HPT, in addition to the registered indication for the treatment of secondary HPT. [source]

Detection of a t(1;22)(q23;q12) translocation leading to an EWSR1-PBX1 fusion gene in a myoepithelioma

GENES, CHROMOSOMES AND CANCER, Issue 7 2008
Petter Brandal
Chromosome banding as well as molecular cytogenetic methods are of great help in the diagnosis of mesenchymal tumors. Myoepithelial neoplasms of soft tissue including myoepitheliomas, mixed tumors, and parachordomas are diagnoses that have been increasingly recognized the last few years. It is still debated which neoplasms should be included in these morphologically heterogeneous entities, and the boundaries between them are not clear-cut. The pathogenetic mechanisms behind myoepithelial tumors are unknown. Only five parachordomas and one mixed tumor have previously been karyotyped, and nothing is known about their molecular genetic characteristics. We present a mesenchymal tumor classified as a myoepithelioma that had a balanced translocation t(1;22)(q23;q12) as the sole karyotypic change. A novel EWSR1-PBX1 fusion gene consisting of exons 1,8 of the 5,-end of EWSR1 and exons 5,9 of the 3,-end of PBX1 was shown to result from the translocation. Both genes are known to be targeted also by other neoplasia-specific translocations, PBX1 in acute lymphoblastic leukemia and EWSR1 in several solid tumors, most of which are malignant. Based on the structure of the novel fusion gene detected, its transforming mechanism is thought to be the same as for other fusion genes involving EWSR1 or PBX1. © 2008 Wiley-Liss, Inc. [source]

ALK probe rearrangement in a t(2;11;2)(p23;p15;q31) translocation found in a prenatal myofibroblastic fibrous lesion: Toward a molecular definition of an inflammatory myofibroblastic tumor family?

GENES, CHROMOSOMES AND CANCER, Issue 1 2001
Nicolas Sirvent
A prenatal tumor located in the lumbar paravertebral area was discovered during a routine ultrasound examination at 32 weeks of pregnancy and surgically removed at 4 months of life. The histopathological diagnosis was first suggested to be an infantile desmoid fibromatosis. The tumor karyotype showed a three-way translocation involving both chromosomes 2 and a chromosome 11, t(2;11;2)(p23;p15;q31). Fluorescence in situ hybridization with a probe flanking the ALK gene at 2p23 demonstrated a rearrangement, as previously described in inflammatory myofibroblastic tumors (IMTs). In light of the genetic analysis, the histopathological diagnosis was revised to IMT, although inflammatory cells were scarce. IMTs are pseudosarcomatous inflammatory lesions that primarily occur in the soft tissue and viscera of children and young adults. Our report describes for the first time the occurrence of IMT during prenatal life. The ALK rearrangement may represent the molecular definition of a subgroup of mesenchymal tumors, not always with complete morphological features of IMT, similar to the model of EWS rearrangement in the Ewing sarcoma family of tumors. © 2001 Wiley-Liss, Inc. [source]

The Spectrum of Myositis Ossiticans in Haemophilia

HAEMOPHILIA, Issue 2 2004
G. V. Massey
Summary., Myositis ossificans (MO) refers to non-neoplastic heterotopic soft tissue ossification that can have several aetiologies. Broadly it can be classified into three categories based on aetiology [1]. MO traumatica, the most common form occurs secondary to acute or chronic trauma. MO can also be associated with neurological disorders and in rare cases is congenital. The latter (progressive MO) is a genetic disorder in which congenital osseous abnormalities are associated with progressive soft tissue calcification. Despite an increased tendency to soft tissue bleeds, MO has been rarely reported in haemophilia. We treated three adolescents with haemophilia and MO of varying degrees of severity and outcome. [source]

Outcome of sinonasal melanoma: Clinical experience and review of the literature,

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2010
Thomas N. Roth MD
Abstract Background. Primary sinonasal malignant melanoma (SNMM) is a rare clinical entity. There is neither a classification nor a staging system nor an evidence-based treatment concept established. Our objective was to find potential risk factors predicting the outcome. Methods. Twenty-five patients with histologically confirmed SNMM were consecutively included and retrospectively analyzed. Staging methods were nasal endoscopy, CT, MRI, and positron emission tomography (PET) scan. Patients were selected for a curative or palliative concept. All patients had postoperative follow-up with control-MRI at 3 and 6 months. Restaging was performed when local recurrence occurred. Results. Nineteen patients underwent primary surgery with curative intention; in 16 cases with tumor free margins. Thirteen patients (68%) had transnasal endoscopic surgery, 4 lateral rhinotomy, and 2 transfacial approach with orbital exenteration. Six patients (32%) had palliative therapy and 7 patients (37%) had adjuvant radiotherapy. Despite radical operations, 6 patients (37%) showed local recurrence and 8 patients (50%) developed distant metastasis. In 2 patients with incomplete surgery, regional metastasis was noted. The median disease-free interval was 18 months, and the median overall survival rate was 23 months. Conclusion. SNMMs of the ethmoid and maxillary sinuses have a worse prognosis than other localizations in the nasal cavity; infiltration into the skull base, orbit, or facial soft tissue correlates with a very poor outcome corresponding to the palliative situations. Furthermore, local recurrence insinuates aggressive disease with short survival rate. A main difference from its cutaneous counterpart seems to be a primary tendency to hematogenic spread. Further research is needed to confirm these findings. © 2010 Wiley Periodicals, Inc. Head Neck, 2010 [source]

Myopericytoma of the oral cavity

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 6 2007
Vivekanand Datta MD
Abstract Background. Myopericytoma is a rare mesenchymal neoplasm of pericytic cells demonstrating myoid differentiation. The lesion typically arises within the subcutaneous tissue of the extremities. We report a case that, to the best of our knowledge, is the first case of myopericytoma involving the soft tissue of the oral cavity. Methods. A 36-year-old woman had a 5-mm sessile, whitish-pink, firm tongue nodule. The patient underwent excisional biopsy, and histopathologic examination as well as immunohistochemical analysis were performed. Results. The differential diagnosis by histologic analysis included solitary fibrous tumor, myofibroma, glomus tumor, and myopericytoma. The results of immunohistochemical analysis, when combined with the histologic features, led to a diagnosis of myopericytoma. Conclusions. Applying strict morphologic criteria and appropriately selective immunohistochemical markers will help to distinguish myopericytoma in the oral cavity. © 2007 Wiley Periodicals, Inc. Head Neck, 2007 [source]

Myoepithelioma of the soft tissue of the head and neck: a case report and review of the literature

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2004
Antonio Galvao Neto MD
Abstract Background. Extraglandular myoepitheliomas are neoplasms that seldom occur in the soft tissue of the head and neck region. Misdiagnosis of these neoplasms as more aggressive tumors can lead to unnecessary treatment. Methods. We describe a myoepithelioma of cervical soft tissue. The histopathology of the tumor, its immunophenotype, its differential diagnosis, and a review of the literature are presented. Results. Histopathologically, the tumor was composed of epithelioid cells with eosinophilic cytoplasm and eccentric nuclei arranged in cords and files. On immunohistochemical analysis, the cells expressed cytokeratin 14, calponin, glial fibrillary acid protein, and p63 and showed focal positivity for S-100 protein. Together, these markers identified the cells as myoepithelial type. A literature review identified only five cases of myoepithelioma in the soft tissue of the head and neck region in which detailed clinical information was provided. Conclusions. Myoepitheliomas can have cells with variable morphology arranged in different histologic patterns. Immunohistochemical analysis is crucial for unequivocal diagnosis when myoepitheliomas occur in extraglandular locations. © 2004 Wiley Periodicals, Inc. Head Neck26: 470,473, 2004 [source]

High-Strength Hydrogels with Integrated Functions of H-bonding and Thermoresponsive Surface-Mediated Reverse Transfection and Cell Detachment

ADVANCED MATERIALS, Issue 24 2010
Lei Tang
The construction of a high-strength hydrogel with integrated functions by photo-initiated copolymerization of temperature-sensitive and hydrogen-bonding monomers is described. The hydrogen-bonding and thermoresponsive surface of hydrogels offers a multifunctional platform, where reverse gene transfection and gene-modified cell detachment can be achieved for the potential use in the regeneration and replacement of soft tissue. [source]

A meshless Total Lagrangian explicit dynamics algorithm for surgical simulation

INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING, Issue 8 2010
Ashley Horton
Abstract A method is presented for computing deformation of very soft tissue. The method is motivated by the need for simple, automatic model creation for real-time simulation. The method is meshless in the sense that deformation is calculated at nodes that are not part of an element mesh. Node placement is almost arbitrary. Fully geometrically nonlinear Total Lagrangian formulation is used. Geometric integration is performed over a regular background grid that does not conform to the simulation geometry. Explicit time integration is used via the central difference method. As an example the simple but fully nonlinear Neo-Hookean material model is employed. The results are compared with a finite element simulation to verify the usefulness of the method. Copyright © 2010 John Wiley & Sons, Ltd. [source]

How Nature Modulates a Fiber's Mechanical Properties: Mechanically Distinct Fibers Drawn from Natural Mesogenic Block Copolymer Variants

ADVANCED MATERIALS, Issue 4 2009
Matthew J. Harrington
Mussel byssal threads are functionally graded biological fibers adapted for tethering the soft tissue of the organism (,1 MPa) to hard surfaces !(25 GPa) in the rocky seashore. A stiffness gradient mitigates contact deformation and is defined by an incrementally regulated distribution of two protein block copolymer variants with stiff and pliable domains, respectively. [source]

New malignancies following childhood cancer in the United States, 1973,2002

INTERNATIONAL JOURNAL OF CANCER, Issue 10 2007
Peter D. Inskip
Abstract The objectives of our study were to quantify risks for developing new malignancies among childhood cancer survivors, identify links between particular types of first and subsequent cancer, and evaluate the possible role of treatment. A cohort of 25,965 2-month survivors of childhood cancer diagnosed in the U.S. during 1973,2002 was identified and followed through SEER cancer registries. Observed-to-expected ratios (O/E) were calculated, and Poisson regression was used to compare risks among treatment groups. Childhood cancer survivors were at nearly 6-fold risk of developing a new cancer relative to the general population (O/E = 5.9, 95% CI: 5.4,6.5). Most common were subsequent primary cancers of the female breast, central nervous system, bone, thyroid gland and soft tissue, as well as cutaneous melanoma and acute non-lymphocytic leukemia (ANLL). The greatest risks of subsequent cancers occurred among patients diagnosed previously with Hodgkin lymphoma (HL), Ewing sarcoma, primitive neuroectodermal tumor, or retinoblastoma. Risk of subsequent solid cancers was higher among persons whose initial treatment for childhood cancer included radiotherapy, whereas the excess of subsequent ANLL was strongly related to chemotherapy. The O/E for subsequent ANLL increased with increasing calendar year of initial cancer diagnosis among survivors of cancers other than HL, most likely due to increasing use of leukemogenic drugs for solid cancers and non-Hodgkin lymphoma. Childhood cancer survivors are at markedly increased risk of developing a variety of new cancers relative to the general population, but the magnitude of excess risk and specific types of second cancer vary widely by type of first cancer. © 2007 Wiley-Liss, Inc. [source]