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Tissue Necrosis (tissue + necrosis)
Selected AbstractsRegarding Extensive Tissue Necrosis Following High Concentration Sclerotherapy for Varicose VeinsDERMATOLOGIC SURGERY, Issue 11 2000David A. Fisher MD [source] Excitable Gap in Canine Fibrillating Ventricular Myocardium: Effect of Subacute and Chronic Myocardial InfarctionJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2001TARESH TANEJA M.D. Excitable Gap in Infarcted Canine Myocardium.Introduction: The existence of an excitable gap during ventricular fibrillation (VF) has been suggested in several prior studies. However, the effects of myocardial infarction on the presence and duration of an excitable gap during VF have not been evaluated. Methods and Results: Electrophysiologic study was performed in normal dogs and in dogs with subacute and chronic infarction. Experimental infarction was produced by left anterior descending coronary ligation. The excitable gap was determined indirectly using either evaluation of intrinsic wavefronts during VF or from the shortest activation interval at individual sites using recordings from a 112- electrode plaque sutured to the epicardial surface of the left ventricle. The excitable gap also was correlated to local electrophysiologic and anatomic properties. The excitable gap using the wavefront propagation method and shortest activation method was significantly longer in subacute infarction dogs (48 ± 17 msec and 37 ± 18 msec, respectively) and chronic infarction dogs (41 ± 14 msec and 35 ± 14 msec, respectively) than normal dogs (32 ± 13 msec and 30 ± 11 msec, respectively; P < 0.05 normal vs subacute and chronic infarction dogs in both methods). The excitable gap occupied approximately 30% and 27% of the VF cycle length in all three groups using the wavefront propagation and shortest activation method, respectively. The excitable gap correlated better with local ventricular refractoriness determined using the wavefront propagation method than with the shortest activation method, but not at all with refractoriness determined using extrastimulus testing. Tissue necrosis was noted in subacute infarction dogs and fibrosis in chronic infarction dogs, but the gap was not highly correlated with anatomic changes. Conclusion: During VF, an excitable gap exists in both normal and infarcted canine ventricular myocardium. It is significantly longer in the presence of infarction. These finding have implications for understanding the pathophysiology of VF and targeting antiarrhythmic therapies. [source] Late Results of Gelatin,Resorcin,Formalin Glue-aided Repair in Acute Type A Aortic DissectionARTIFICIAL ORGANS, Issue 12 2006Motomi Shiono Abstract:, Gelatin,resorcin,formalin (GRF) glue has been used to obliterate the false lumen of dissected aortas, resulting in reduced mortality. However, because of the cytotoxicity of formalin, the application of GRF remains controversial. In this study, a total of 138 consecutive patients with acute type A dissection since 1995, who underwent emergency graft replacement, were reviewed. The mean age was 65.5 years. The hospital mortality rate was 6.5%. In-hospital re-exploration rate and patency rate of the false lumen were 6.5% and 24.7%, respectively. The actuarial survival rates were 81.5% after 5 years and 54.8% after 10 years. Reoperation-free rates were 87.9% after 5 years and 72.3% after 10 years. Tissue necrosis or aneurismal degeneration was not demonstrated at reoperation. In conclusion, GRF glue demonstrats excellent tissue adhesion and hemostasis capability, and contributes to improve surgical results. [source] Bacteria associated with the rapid tissue necrosis of stony coralsENVIRONMENTAL MICROBIOLOGY, Issue 7 2007G. M. Luna Summary The rapid tissue necrosis (RTN) is a common disease of both wild and captive stony corals, which causes a fast tissue degradation (peeling) and death of the colony. Here we report the results of an investigation carried out on the stony coral Pocillopora damicornis, affected by an RTN-like disease. Total abundance of prokaryotes in tissue samples, determined by epifluorescence microscopy, was significantly higher in diseased than in healthy corals, as well as bacterial counts on MB2216 agar plates. Further experiments performed by fluorescent in situ hybridization using a 16S rDNA Vibrio -specific probe showed that vibrios were significantly more abundant in diseased than in healthy corals. Accordingly, bacterial counts on TCBS agar plates were higher in diseased than in healthy tissues. 16S rDNA sequencing identified as Vibrio colonies from diseased tissues only. Cultivated vibrios were dominated by a single ribotype, which displayed 99% of similarity with Vibrio harveyi strain LB4. Bacterial ribotype richness, assessed by terminal-restriction fragment length polymorphism analysis of the 16S rDNA, was significantly higher in diseased than in healthy corals. Using an in silico software, we estimated that a single terminal restriction fragment, putatively assigned to a Vibrio sp., accounted for >,15% and < 5% of the total bacterial assemblage, in diseased and healthy corals respectively. These results let us hypothesize that the RTN in stony corals can be an infectious disease associated to the presence of Vibrio harveyi. However, further studies are needed to validate the microbial origin of this pathology. [source] Interactions between surface proteins of Streptococcus pyogenes and coagulation factors modulate clotting of human plasmaJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 2 2003H. Herwald Summary., Invasive and toxic infections caused by Streptococcus pyogenes are connected with high morbidity and mortality. Typical symptoms of these infections are hypotension, edema formation, tissue necrosis, and bleeding disorders. Here we report that components of the coagulation system including fibrinogen, factors V, XI, and XII, and H-kininogen, are assembled at the surface of S. pyogenes through specific interactions with bacterial surface proteins. In plasma environment, absorption of fibrinogen by S. pyogenes causes a hypocoagulatory state resulting in prolonged clotting times and impaired fibrin network formation. Moreover, the binding of coagulation factors and the subsequent activation of the coagulation system at the bacterial surface lead to the formation of a fibrin network covering S. pyogenes bacteria adhering to epithelial cells. The results suggest that interactions between S. pyogenes and components of the coagulation system contribute to some of the symptoms seen in severe infections caused by this important human pathogen. [source] Preliminary results of interstitial motexafin lutetium-mediated PDT for prostate cancerLASERS IN SURGERY AND MEDICINE, Issue 5 2006K.L. Du MD Abstract Background and Objectives Interstitial photodynamic therapy (PDT) is an emerging modality for the treatment of solid organ disease. Our group at the University of Pennsylvania has performed extensive studies that demonstrate the feasibility of interstitial PDT for prostate cancer. Our preclinical and clinical experience is herein detailed. Study Design/Materials and Methods We have treated 16 canines in preclinical studies, and 16 human subjects in a Phase I study, using motexafin lutetium-mediated PDT for recurrent prostate adenocarcinoma. Dosimetry of light fluence, drug level and oxygen distribution for these patients were performed. Results We demonstrate the safe and comprehensive treatment of the prostate using PDT. However, there is significant variability in the dose distribution and the subsequent tissue necrosis throughout the prostate. Conclusions PDT is an attractive option for the treatment of prostate adenocarcinoma. However, the observed variation in PDT dose distribution translates into uncertain therapeutic reproducibility. Our future focus will be on the development of an integrated system that is able to both detect and compensate for dose variations in real-time, in order to deliver a consistent overall PDT dose distribution. Lasers Surg. Med. 38:427,434, 2006. © 2006 Wiley-Liss, Inc. [source] Complementary (secondary) metabolites in a soft coral: sex-specific variability, inter-clonal variability, and competitionMARINE ECOLOGY, Issue 3 2006Beatriz Fleury Abstract Sex-specific interactions involving competition for space between the dioecious alcyonacean soft coral Sarcophyton glaucum and the scleractinian coral Acropora robusta were assessed experimentally on Bald Rock, central region of the Great Barrier Reef. To examine this, plus inter-clonal responses, one male colony of S. glaucum, known to produce sarcophytoxide as its predominant complementary (secondary) metabolite, was sectioned, producing 10 clones. The same was done for a female colony. These two sets of clones were then relocated to grids and placed in contact with Acropora clones. Relocated and non-relocated controls were also monitored. High levels of tissue necrosis were observed in the hard coral under contact conditions with both the male and female clones after 20 days. The development of a protective polysaccharide layer in the alcyonacean was also observed. Differences observed in the concentrations of complementary metabolites within the two different S. glaucum colonies were related to sex. Both under competition and non-competition conditions, females exhibited significantly higher concentrations of sarcophytoxide than males, and this increased with time. Fatty ester concentration was also higher in females than males, varying significantly through time, and falling dramatically just after spawning. Fatty ester concentrations decreased linearly through time in the male clones. When involved in competition for space, females possessed higher concentrations of fatty esters than males, both at the site of contact and in non-contact sites, again, decreasing after spawning. No significant changes in sarcophytoxide levels were noted in the parental colonies, but such changes were observed in fatty esters, with the female producing higher concentrations until after spawning. The use of these two variates in the form of a ratio (sarcophytoxide concentration:fatty ester concentration) yielded a variable Rho (,) which was a more sensitive indicator of biochemical change than either of its components alone. These two sets of compounds appeared to have a negative association through time and varied highly significantly between sexes. The diterpene sarcophytoxide may be considered an allelopathic or stress metabolite, while the lipids act as energy storage metabolites. [source] Ischemic preconditioning of free muscle flaps: An experimental studyMICROSURGERY, Issue 7 2005Claudiu F. Marian M.D. The aim of this study was to apply the hypothesis of ischemic preconditioning (IP) on free skeletal muscle (rat thigh flap). Five groups of Sprague-Dawley rats (n = 6) were used. In group A (control group), standard free autologous flap transfers were performed. Flaps in groups B and C underwent 4 and 6 h, respectively, of ischemia before transfer. In groups D and E, muscle flaps were preconditioned (3 × 10 min ischemia interrupted by 10 min of reperfusion, clip applied on the dissected artery of the flap) and subjected to 4 and 6 h, respectively, of ischemia before transfer. After 48 h of reperfusion, the muscle flaps were evaluated macroscopically as well as by histological and immunohystochemical staining. In group A, the viability was 100%, whereas in groups D and E the viability was 83.3% and 100%, respectively. Groups B and C had undergone macroscopically parceled to total necrosis, further confirmed by histological findings (fragmentation and disappearance of muscle striations, combined with tissue necrosis and intravascular thrombosis). The beneficial effect of IP demonstrated in the heart, liver, and small bowel extends to skeletal muscle, which can be used in free-flap transfers, if the transfer includes a long period of predictable ischemia. © 2005 Wiley-Liss, Inc. Microsurgery 25:524,531, 2005. [source] Clinical characteristics of children with snakebite poisioning and management of complications in the pediatric intensive care unitPEDIATRICS INTERNATIONAL, Issue 6 2005Gonca Ozay AbstractBackground:,Venomous snakebite is an emergency condition with high morbidity and mortality in childhood. Nearly all venomous snakes in Turkey are members of the Viperidae family and show poisonous local and hematotoxic effects. Methods:,A total of 77 children (mean age 9.9 ± 2.9 years; age range 3,14 years) with venomous snakebites were investigated. General characteristics of the children, species of the snakes, localization of the bite, clinical and laboratory findings, treatment approaches, complications and prognosis were evaluated. Results:,The male to female ratio was 1.4. Ninety-one per cent of cases were from rural areas. Most of the bites were seen in May and June. Mean duration between snakebites and admissions to our department was 13 ± 6.5 h. According to a clinical grading score, 57.1% of patients presented to us as grade II. Mean leukocyte count, aspartate aminotransferase, lactate dehydrogenase, creatinine phosphokinase and protrombin time levels were above the normal ranges and mean activated partial tromboplastin time was below the normal range. Platelet counts inversely correlated with the grading score and duration of hospitalization. The most common complication that occurred during the treatment was tissue necrosis (13%). The mean hospital stay time was 6.3 ± 6 days. Three children with disseminated intravascular coagulation died. Fasciotomies were performed to seven (9.1%) children due to compartment syndrome. Of 10 children with tissue necrosis, three (3.9%) had finger amputation and seven (9.1%) had toe amputation. Higher grading score on admission, platelet count below 120 000/mm3, AST over 50 IU/L and existence of evident ecchymosis were found as significant risk factors for development of serious complications by logistic regression analysis. Conclusions:,Snakebite poisoning is an emergency medical condition that is particularly important in childhood. The envenomations are still considerable public health problems with a high morbidity and mortality in rural areas of Turkey. [source] External Beam Radiation Followed by Planned Neck Dissection and Brachytherapy for Base of Tongue Squamous Cell Carcinoma,THE LARYNGOSCOPE, Issue 10 2000David M. Kaylie MD Abstract Background Surgical resection of tongue base cancer can leave the patient with significant functional deficits. Other therapies, such as external beam radiation followed by neck dissection and radiation implants, have shown equal tumor control with good functional outcome. Methods Between March 1991 and July 1999, 12 patients at Oregon Health Sciences University, the Portland Veterans Administration Medical Center and West Virginia University School of Medicine Hospital were treated with external beam radiation followed by neck dissection and Ir192 implants. Two patients had T1 disease, two had T2, five patients had T3 tumors, and three had T4 tumors. Six had N2a necks, three had N2b necks, and three had N2c. Follow-up ranged from 13 months to 8 years. Results After external beam radiation, five patients had complete response and seven had partial response in the neck without complications. One patient underwent a unilateral radical neck dissection, eight had unilateral selective neck dissections involving levels I to IV, and three had dissections involving levels I to III. One of the five patients who had a complete clinical response in the neck had pathologically positive nodes. One patient had a pulmonary embolus that was treated and had no permanent sequelae. There were three complications from brachytherapy. Two patients had soft tissue necrosis at the primary site and one patient had radionecrosis of the mandible. All healed without further therapy. One patient had persistent disease and underwent a partial glossectomy but died of local disease. Distant metastasis developed in two patients. All others show no evidence of disease and are able to eat a normal diet by mouth. Conclusion This combination of therapies should be considered when treating tongue base cancer. [source] IMPACT OF BLOOD FLOW OCCLUSION ON LIVER NECROSIS FOLLOWING THERMAL ABLATIONANZ JOURNAL OF SURGERY, Issue 1-2 2006Mehrdad Nikfarjam Background: Laser, radiofrequency and microwave are common techniques for local destruction of liver tumours by thermal ablation. The main limitation of thermal ablation treatment is the volume of necrosis that can be achieved. Blood flow occlusion is commonly advocated as an adjunct to thermal ablation to increase the volume of tissue necrosis based on macroscopic and histological assessment of immediate or direct thermal injury. This study examines the impact of blood flow occlusion on direct and indirect laser induced thermal liver injury in a murine model using histochemical methods to assess tissue vitality. Methods: Thermal ablation produced by neodymium yttrium-aluminium-garnet laser (wavelength 1064 nm) was applied to the liver of inbred male CBA strain mice at 2 W for 50 s (100 J). Treatment was performed with and without temporary portal vein and hepatic artery blood flow occlusion. Animals were killed upon completion of the procedure to assess direct thermal injury or at 24, 48 and 72 h to assess the progression of tissue damage. The maximum diameter of necrosis was assessed by vital staining for nicotinamide adenine dinucleotide (NADH) diaphorase. Microvascular changes were assessed by laser Doppler flowmetry, confocal in vivo microscopy and scanning electron microscopy. Results: The direct thermal injury (mean SE) assessed by NADH diaphorase staining was significantly greater following thermal ablation treatment without blood flow occlusion than with blood flow occlusion (3.3 (0.4) mm vs 2.9 (0.3) mm; P = 0.005). Tissue disruption, cracking and vacuolization was more pronounced adjacent to the fibre insertion site in the group treated with thermal ablation combined with blood flow occlusion. There was an equivalent increase in the extent of injury following therapy in both groups that reached a peak at 48 h. The maximum diameter of necrosis in the thermal ablation alone group at 48 h was significantly greater than the thermal ablation combined with blood flow occlusion group (5.8 (0.4) mm vs 5.3 (0.3) mm; P = 0.011). The patterns of microvascular injury were similar in both groups, varying in extent. Conclusion: Temporary blood flow inflow occlusion appears to decrease the extent of initial injury measured by vital staining techniques and does not alter the time sequence of progressive tissue injury following thermal ablation therapy. [source] A Novel Low Temperature Transcutaneous Energy Transfer System Suitable for High Power Implantable Medical Devices: Performance and Validation in SheepARTIFICIAL ORGANS, Issue 5 2010Thushari D. Dissanayake Abstract Transcutaneous energy transfer (TET) systems use magnetic fields to transfer power across the skin without direct electrical connectivity. This offers the prospect of lifetime operation and overcomes risk of infection associated with wires passing through the skin. Previous attempts at this technology have not proved suitable due to poor efficiency, large size, or tissue damage. We have developed a novel approach utilizing frequency control that allows for wide tolerance in the alignment between internal and external coils for coupling variations of 10 to 20 mm, and relatively small size (50 mm diameter, 5 mm thickness). Using a sheep experimental model, the secondary coil was implanted under the skin in six sheep, and the system was operated to deliver a stable power output to a 15 W load continuously over 4 weeks. The maximum surface temperature of the secondary coil increased by a mean value of 3.4 ± 0.4°C (±SEM). The highest absolute mean temperature was 38.3°C. The mean temperature rise 20 mm from the secondary coil was 0.8 ± 0.1°C. The efficiency of the system exceeded 80% across a wide range of coil orientations. Histological analysis revealed no evidence of tissue necrosis or damage after four weeks of operation. We conclude that this technology is able to offer robust transfer of power to implantable devices without excess heating causing tissue damage. [source] Intraprostatic ethanol chemoablation via transurethral and transperineal injectionBJU INTERNATIONAL, Issue 1 2003M.K. Plante OBJECTIVES To further assess the safety and feasibility of prostatic chemoablation with ethanol and to address previous concerns associated with transperineal injection using a canine model. MATERIALS AND METHODS The study included 25 dogs; normal saline or 98% dehydrated ethanol were injected into the prostate using both routes, at volumes of 25,50% of the total prostate volume. The prostate and adjacent structures were examined grossly and histopathologically after the dogs were killed humanely at 4 h, 7 days and 12 weeks after injection. RESULTS Transperineal injection resulted in tissue necrosis in all prostates and significant extraprostatic necrosis in two of three animals treated. With transurethral injection, the control groups showed minimal change, whereas the group injected with ethanol resulted in lesions with variable necrosis and location. CONCLUSIONS Intraprostatic chemoablation is possible with ethanol injection both transperineally and transurethrally. Transperineal ethanol injections were associated with more extraprostatic necrosis. Transurethral injections resulted in larger amounts of necrosis in the prostatic parenchyma with minimal extraprostatic effects. However, the extent of prostatic necrosis/ablation was inconsistent and further research is warranted. [source] Technical characterization of an ultrasound source for noninvasive thermoablation by high-intensity focused ultrasoundBJU INTERNATIONAL, Issue 3 2002K.U. Köhrmann Objective,To develop a generator for high-intensity focused ultrasound (HIFU, a method of delivering ultrasonic energy with resultant heat and tissue destruction to a tight focus at a selected depth within the body), designed for extracorporeal coupling to allow various parenchymal organs to be treated. Material and methods,The ultrasound generated by a cylindrical piezo-ceramic element is focused at a depth of 10 cm using a parabolic reflector with a diameter of 10 cm. A diagnostic B-mode ultrasonographic transducer is integrated into the source to allow the focus to be located in the target area. The field distribution of the sound pressure was measured in degassed water using a needle hydrophone. An ultrasound-force balance was used to determine the acoustic power. These measurements allowed the spatially averaged sound intensity to be calculated. The morphology and extent of tissue necrosis induced by HIFU was examined on an ex-vivo kidney model. Results,The two-dimensional field distribution resulted in an approximately ellipsoidal focus of 32×4 mm (, 6 dB). The spatially maximum averaged sound intensity was 8591 W/cm2 at an electrical power of 400 W. The lesion caused to the ex-vivo kidney at this maximum generator power with a pulse duration of 2 s was a clearly delineated ellipsoidal coagulation necrosis up to 8.8×2.3 mm (length×width) and with central liquefied necrosis of 7.9×1.9 mm. Conclusion,This newly developed ultrasound generator with a focal length of 10 cm can induce clear necrosis in parenchymal tissue. Because of its specific configuration and the available power range of the ultrasound generator, there is potential for therapeutic noninvasive ablation of tissue deep within a patient's body. [source] Evaluation of tumor response after locoregional therapies in hepatocellular carcinoma,CANCER, Issue 3 2009Are response evaluation criteria in solid tumors reliable? Abstract BACKGROUND: Evaluation of response to treatment is a key aspect in cancer therapy. Response Evaluation Criteria in Solid Tumors (RECIST) are used in most oncology trials, but those criteria evaluate only unidimensional tumor measurements and disregard the extent of necrosis, which is the target of all effective locoregional therapies. Therefore, the European Association for the Study of the Liver (EASL) guidelines recommended that assessment of tumor response should incorporate the reduction in viable tumor burden. The current report provides an assessment of the agreement/concordance between both RECIST and the EASL guidelines for the evaluation of response to therapy. METHODS: The authors evaluated a cohort of 55 patients within prospective studies, including 24 patients with hepatocellular carcinoma who underwent transarterial chemoembolization (TACE) with drug eluting beads (DEB-TACE) and 31 patients who underwent percutaneous ablation (percutaneous ethanol injection [PEI]/radiofrequency [RF]). Triphasic helical computed tomography scans were performed at baseline, at 1 month, and at 3 months after procedure, and 2 independent radiologists evaluated tumor response. RESULTS: Evaluating response according to RECIST criteria, no patients achieved a complete response (CR), 21.8% of patients achieved a partial response (PR) (none in the PEI/RF group), 47.3% of patients had stable disease (SD), and 30.9% of patients had progressive disease (PD). When response was evaluated according to the EASL guidelines, 54.5% of patients achieved a CR, 27.3% of patients achieved a PR, 3.6% of patients had SD, and 14.5% had PD. The , coefficient was 0.193 (95% confidence interval, 0.0893-0.2967; P < .0001). CONCLUSIONS: RECIST missed all CRs and underestimated the extent of partial tumor response because of tissue necrosis, wrongly assessing the therapeutic efficacy of locoregional therapies. This evaluation should incorporate the reduction in viable tumor burden as recognized by nonenhanced areas on dynamic imaging studies. Cancer, 2009. © 2008 American Cancer Society. [source] Granulomatous pyoderma gangrenosum: two unusual cases showing necrotizing granulomatous inflammationCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 8 2000Hyang-Joon Park We present two cases of pyoderma gangrenosum (PG) with unusual histopathological findings. The main histopathological feature of PG is usually massive neutrophilic infiltration; the neutrophil is thus the cytologic hallmark of PG. The occurrence of vasculitis is controversial. In our patients, in contrast, biopsy specimens revealed extensive granulomatous inflammation with massive tissue necrosis throughout the entire dermis and subcutaneous tissue and vascular involvement simulating many other granulomatous diseases. However, there was no evidence of systemic disease. Our cases may therefore represent a histopathologically distinct subset of PG. [source] | ||||||||||||||||||||||