Laser treatment of scars and keloids – How we do it

The existence of scars may present considerable problems for patients. As well as being sometimes disfiguring and having an influence on a person's perception of him or herself, hypertrophic scars and keloids can often also cause pruritus, dysesthesia and pain, and can form strictures.

Since the first attempts to influence hypertrophic scars and keloids with lasers, many refinements in the technology and improved laser treatment techniques have taken place. Flashlamp-pumped dye lasers and near infrared (NIR) lasers are the most frequently used lasers for hypertrophic scar treatment, whereas CO₂ and Er:YAG lasers are preferred to diminish atrophic scars. Non-ablative skin remodeling may be used for minor changes.

Lasers and other intensive light sources can also play a role in prevention of scars, and new strategies for acne treatment are on the horizon.     

Ductus venosus shunting in marmoset and baboon fetuses.

OBJECTIVES: The increased shunting of blood through the ductus venosus (DV) during stress situations is an important mechanism that ensures fetal survival. Although primate fetuses may serve to study the function of this important venous shunt, the rate of DV shunting has not been determined in non-human primates under normal conditions. METHODS: DV shunting was measured in 11 marmoset (eight mothers) and eight singleton baboon fetuses in mid and late gestation using Doppler ultrasound. RESULTS: DV shunting in marmosets was 39 +/- 20% (mean +/- SD) and 28 +/- 8% in baboon fetuses. Umbilical vein (UV) blood volume rate increased significantly in baboons with gestational age (GA) (UV flow volume = -111.8 + 1.6*GA; r = 0.94, P < 0.05) and slightly in marmosets (UV flow volume = -10.37 + 0.13*GA; r = 0.42, P > 0.05). Both UV diameter (r = 0.84) and the time-averaged mean UV flow velocity in baboons depended on GA (r = 0.8, P < 0.05). Distinct pulsation was found in marmoset fetuses in the UV (pulsatility index (PI) = 1.3 +/- 0.9) and the DV (PI = 1.9 +/- 1.2) with zero blood flow velocity during atrial contraction. CONCLUSIONS: A high level of pulsation is observed in the UV in marmoset fetuses. DV shunting in marmosets is higher than in baboon fetuses.     

Diagnostic contribution of endomyocardial biopsy in suspected latent cardiomyopathy

Twenty-eight patients with suspected diagnosis of latent cardiomyopathy are reported. In all patients left ventricular endomyocardial biopsy (five or more specimens) was performed after noninvasive and invasive investigations. The indication to investigate invasively arose from clinical symptoms in combination with uncertain ECG disturbances. Coronary heart disease, latent myocarditis and latent cardiomyopathy were to be excluded. Hemodynamic parameters proved to be normal or borderline at rest. Angiocardiography and coronary angiography revealed no pathological findings. But in all cases the histological results of endomyocardial biopsy were characterized by pathological criteria as follows: inflammatory myocardial process, narrowing or obliterating diseases of intramural small arteries, exogenous-toxic myocardial disturbances, idiopathic cardiomyopathy, endomyocardial fibrosis with endocardial thrombus and infiltrations of eosinophiles. Four cases are demonstrated as examples.     

Long-term study of patients with severe forms of Sj?gren syndrome and/or myoepithelial sialadenitis

It is well known that the incidence of malignant lymphomas (non-Hodgkin type) is increased in patients with Sj?gren's syndrome. The occurrence of malignant diseases was retrospectively studied in 62 patients. In the course of the disease two patients developed a non-Hodgkin lymphoma, one patient developed a transitional-cell carcinoma located in the nasopharynx and three patients developed a squamous-cell carcinoma located in the salivary glands. The large quantity of epithelial carcinomas seems to be remarkable, especially compared with the number of non-Hodgkin lymphomas. It might be possible that early surgical treatment of persistent or progressive swelling of the salivary glands helps to prevent the occurrence of malignant lymphoma in patients with known myoepithelial sialadenitis.     

Synovectomy of the knee in juvenile chronic arthritis. A retrospective, consecutive follow-up study

We report 60 synovectomies of the knee in 51 children with juvenile chronic arthritis. Synovitis had been present for an average of 5 years and the average age at operation was 13 years. Results were evaluated in terms of pain, knee movement, relapse of synovitis and radiological change during a follow-up averaging 7.5 years. The relief of pain was rewarding and there was a slight postoperative gain in range of knee movement in most cases. The older the patient at onset of disease, the greater the risk of pain during follow-up. Progressive joint destruction was more common in younger patients, those with systemic or polyarticular disease, and those with highly active disease at the time of operation. Recurrence of synovitis was more frequent in patients who had their operation in a phase of high disease activity; this occurred most often in patients with polyarticular disease.     

Infantile hypertrophic pyloric stenosis: myopathic type

Summary Smooth muscle cell biopsies obtained at pyloromyotomy from 37 children with infantile hypertrophic pyloric stenosis (IHPS) were studied by light and electron microscopy and compared with 6 autopsy control cases without any clinical evidence of this disorder. In cases with IHPS an apparently irregular increase in the number of smooth muscle cells by mitosis was accompanied by an increase of the endoplasmic reticulum, proliferation of mitochondria and regressive changes, such as shrinkage, swelling, necrosis and apoptosis of smooth muscle cells. Other alterations, seen in some but not all cases consisted of large numbers of unusual dense granules some of which were clearly associated with actin filaments and, therefore, regarded as derivatives of the normally occurring dense bodies. Furthermore, intermyofibrillar and subsarcolemmal glycogen accumulations, various nuclear abnormalities and pleomorphic membranous cytoplasmic or nuclear bodies occurred. While smooth muscle cell abnormalities predominated in some cases of IHPS, in others there were more severe axonal changes in the myenteric plexus. It is suggested, therefore, that a primarily myogenic type of IHPS can be distinguished from a predominantly neurogenic type.Supported in part by a grant from the Deutsche Forschungsgemeinschaft (Di 386/1-1)Presented in part at the 33. Jahrestagung der Deutschen Gesellschaft für Neuroanatomie und Neuropathologie, Bielefeld, West Germany, October 12–15, 1988, and at the meeting of the Arbeitsgemeinschaft Rheinisch-Westfälischer Pathologen, Essen, West Germany, April 22, 1989     

Nephrotoxicity and myelotoxicity of antineoplastic Pt(II) and Pt(IV) coordination compounds in rats

In comparison with cis-DDP four new platinum (II) and platinum (IV) complexes were evaluated for their acute nephrotoxic and myelotoxic potency in male rats following i.v. administration of maximum tolerated doses on 5 consecutive days. Parameters for nephrotoxicity determined on day 6, 13 and 22 after the first administration of the drugs included blood, urea nitrogen, serum creatinine, urine volume, urinary glucose and tubule cell excretion. Parameters for myelotoxicity determined on the same days included leucocytes, platelets, hemoglobin and hematocrit. Cis-DDP was found to be the most nephrotoxic compound. The myelotoxicity of the new platinum complexes appeared to be similar to that of cis-DDP with exception of trans-ODDP.