Amount Of Scar Tissue Research Articles

Studying intramuscular fat deposition and muscle regeneration: insights from a comparative analysis of mouse strains, injury models, and sex differences

Intramuscular fat (IMAT) infiltration, pathological adipose tissue that accumulates between muscle fibers, is a shared hallmark in a diverse set of diseases including muscular dystrophies and diabetes, spinal cord and rotator cuff injuries, as well as sarcopenia. While the mouse has been an invaluable preclinical model to study skeletal muscle diseases, they are also resistant to IMAT formation. To better understand this pathological feature, an adequate pre-clinical model that recapitulates human disease is necessary. To address this gap, we conducted a comprehensive in-depth comparison between three widely used mouse strains: C57BL/6J, 129S1/SvlmJ and CD1. We evaluated the impact of strain, sex and injury type on IMAT formation, myofiber regeneration and fibrosis. We confirm and extend previous findings that a Glycerol (GLY) injury causes significantly more IMAT and fibrosis compared to Cardiotoxin (CTX). Additionally, females form more IMAT than males after a GLY injury, independent of strain. Of all strains, C57BL/6J mice, both females and males, are the most resistant to IMAT formation. In regard to injury-induced fibrosis, we found that the 129S strain formed the least amount of scar tissue. Surprisingly, C57BL/6J of both sexes demonstrated complete myofiber regeneration, while both CD1 and 129S1/SvlmJ strains still displayed smaller myofibers 21 days post injury. In addition, our data indicate that myofiber regeneration is negatively correlated with IMAT and fibrosis. Combined, our results demonstrate that careful consideration and exploration are needed to determine which injury type, mouse model/strain and sex to utilize as preclinical model especially for modeling IMAT formation.

(PM-06) A RARE CASE OF SCROTAL URETHROCUTANEOUS FISTULA SECONDARY TO EROSION OF PENILE PROSTHESIS CONNECTOR TUBING

Abstract Objective The scrotal urethrocutaneous fistula is an uncommon pathology which can lead to serious complications, such as infections, scrotal abscesses, or even Fournier’s gangrene. We present an unusual case of scrotal urethrocutaneous fistula secondary to erosion of a penile prosthesis tubing in a patient with a history of erectile dysfunction. Case presentation A 68-year-old patient with no previous comorbidities and a history of prostate adenocarcinoma that was treated with radical prostatectomy + lymphadenectomy, without the need for subsequent adjuvant therapy. He was diagnosed with erectile dysfunction after surgery, refractory to intracavernous therapy therefore required a 3-component penile implant placement procedure performed extra-institutionally. Two years after the surgery, he consulted with our institution for scrotal pain and urine leak from the scrotum during micturition. Physical examination shows extrusion of prosthesis tubes in the scrotal area with no signs of infection or exposure of the cylinders. The patient was hospitalized for management with antibiotics and to replace the penile implant. A retrograde urethrography with contrast medium was performed during surgery. Fluoroscopy showed a fistulous pathway between the penile urethra and the scrotum. No passage of the contrast to the corpora cavernosa was seen. The urethral lesion and fistula were identified and repaired. A malleable prosthesis was used, considering the amount of scar tissue. The patient had an adequate postoperative period. A urethral catheter and a cystotomy were used for six weeks. After catheter removal, a voiding cystogram was performed, finding no fistulas. The patient was followed for 11 months with no complications. Conclusion Although scrotal urethrocutaneous fistulas are an infrequent complication after penile prosthesis implantation, a timely diagnosis is essential for conservative treatment and to avoid life-threatening complications. Financing No conflict.

Risk stratification using non-invasive liver stiffness surveillance and collagen proportionate areas

Unlike other organs in the human body, the liver is able to regenerate, replacing and repairing damaged tissue and leaving no scar tissue. However, when a liver is repeatedly damaged, liver fibrosis can occur and large amounts of scar tissue are formed. Scarring of the liver caused by long-term liver damage is called cirrhosis and this is a major cause of death around the world. It's important that liver fibrosis can be assessed in patients using non invasive methods, which are of course preferable to invasive methods. The goal of the research of Associate Professor Sheng-Hung Chen, Center for Digestive Medicine, China Medical University Hospital, Taiwan, is to help improve the effectiveness of treatments and outcomes for a range of diseases, including hepatitis. He is working to conduct risk stratification using non-invasive liver stiffness and collagen proportionate areas. Liver fibrosis monitoring over time is a critical issue and the development of non-invasive methods for liver fibrosis monitoring as well as other ways of understanding the condition of a patient's liver could facilitate the prognostics and save lives. Chen and the team are seeking to predict liver-related events over time by working on the concurrent kinetics in clinical aspects, paired or serial liver histology, blood test-based results and stiffness measurement.

Challenging Rhinoplasty for the Cleft Lip and Palate Patient.

Cleft lip and palate patients represent one of the most challenging groups of patients for septorhinoplasty, presenting as a complex surgical obstacle for even the most seasoned surgeons. These individuals have undergone several surgeries throughout their lives, resulting in a considerable amount of scar tissue, significant asymmetries and structural deficits. Key factors in successfully treating cleft lip and palate patients are the reconstruction of the absent/asymmetric cartilages and the replacement of bony structures. The use of autogenous rib cartilage allows the surgeon to create various grafts as well as fortify the soft tissue to resist persistent soft tissue deformities.

Determination of Myocardial Scar Tissue in Coronary Slow Flow Phenomenon and The Relationship Between Amount of Scar Tissue and Nt-ProBNP.

ResumoFundamentoA fisiopatologia e o prognóstico não estão claramente determinados nos pacientes com fenômeno do fluxo coronário lento (FCL). Esses pacientes apresentam várias condições clínicas, que variam desde quadro assintomático até internação hospitalar com morte cardíaca súbita.ObjetivosNosso objetivo foi avaliar os achados da ressonância magnética cardíaca (RMC) com o realce tardio pelo gadolínio (RTG), como um indicador de fibrose miocárdica. Também buscamos determinar a relação entre a presença de fibrose miocárdica e os níveis de NT-proBNP em pacientes com FCL na artéria coronária descendente anterior esquerda (DAE).MétodosAo todo, 35 pacientes, entre 31 e 75 anos de idade, foram incluídos. Os pacientes estudados (n=19) apresentaram artérias coronárias epicárdicas normais na angiografia, mas tinham FCL na DAE. O grupo controle de pacientes (n=16) apresentou artérias coronárias epicárdicas normais e níveis de escore TIMI normais na angiografia. Em ambos os grupos, os pacientes foram examinados com RMC para a detecção de presença de fibrose miocárdica. Além disso, níveis plasmáticos de NT-proBNP foram medidos. Valores de p < 0,05 foram considerados significativos.ResultadosA taxa de fibrose miocárdica foi significativamente maior na RMC para os pacientes com FCL (p=0.018). Uma quantidade variável de tecido cicatricial foi detectada no ápice ventricular esquerdo em 7 pacientes e nas regiões inferior e inferolateral em 3 pacientes. Não foram observadas diferenças nos níveis de NT-proBNP nos pacientes com FCL. Entretanto, os níveis de NT-proBNP foram maiores nos pacientes com FCL, que apresentaram fibrose miocárdica na RMC (p=0.022).ConclusõesEm suma, o RTG na RMC mostrou que a cicatriz miocárdica isquêmica pode estar presente nos pacientes com FCL. Esses resultados indicam que o FCL pode nem sempre ser inofensivo. (Arq Bras Cardiol. 2020; 114(3):540-551)

Inflammation as an orchestrator of cutaneous scar formation: a review of the literature.

Inflammation is a key phase in the cutaneous wound repair process. The activation of inflammatory cells is critical for preventing infection in contaminated wounds and results in the release of an array of mediators, some of which stimulate the activity of keratinocytes, endothelial cells, and fibroblasts to aid in the repair process. However, there is an abundance of data suggesting that the strength of the inflammatory response early in the healing process correlates directly with the amount of scar tissue that will eventually form. This review will summarize the literature related to inflammation and cutaneous scar formation, highlight recent discoveries, and discuss potential treatment modalities that target inflammation to minimize scarring.

Bone marrow-derived mesenchymal stromal cell treatment in patients with ischaemic heart failure: final 4-year follow-up of the MSC-HF trial.

The study assessed 4-year outcomes of intramyocardial injections of autologous bone marrow-derived mesenchymal stromal cells (MSCs) in patients with ischaemic heart failure. The MSC-HF trial was a randomized, double-blind, placebo-controlled trial. Patients were randomized 2:1 to intramyocardial injections of MSCs or placebo. The primary endpoint was change in left ventricular end-systolic volume (LVESV), measured by magnetic resonance imaging or computed tomography. Sixty patients aged 30-80 years with ischaemic heart failure, New York Heart Association class II-III, left ventricular ejection fraction (LVEF) <45% and no further treatment options were randomized. Patients were followed clinically for 12 months and in addition 4-year data of hospitalizations and survival were retrieved. After 12 months, LVESV was significantly reduced in the MSC group and not in the placebo group, with difference between groups of 17.0± 16.2mL (95% confidence interval 8.3-25.7, P= 0.0002). There were also significant improvements in LVEF of 6.2% (P< 0.0001), stroke volume of 16.1mL (P< 0.0001) and myocardial mass (P= 0.009) between groups. A significant dose-response effect was also observed. Moreover, a significant reduction in the amount of scar tissue and quality of life score in the MSC group but not in the placebo group was observed. After 4 years, there were significantly fewer hospitalizations for angina in the MSC group and otherwise no differences in hospitalizations or survival. No side effects were identified. Intramyocardial injections of autologous bone marrow-derived MSCs improved myocardial function and myocardial mass in patients with ischaemic heart failure.

Cardiac Magnetic Resonance Imaging used for Evaluation of Adipose-Derived Stromal Cell Therapy in Patients with Chronic Ischemic Heart Disease

Adipose-derived stromal cell (ASC) therapy is currently investigated as a new treatment option for patients with ischemic heart disease (IHD). The aim of this study was to evaluate the effect of ASC therapy in patients with chronic IHD measuring myocardial perfusion and cardiac function using cardiac magnetic resonance imaging (CMRI). Patients were included in MyStromalCell trial, a phase II, randomized, double-blinded, placebo-controlled study investigated the effect of ASCs in patients with chronic IHD with preserved left ventricular ejection fraction (LVEF). In total, 41 of 60 patients underwent cine, late enhancement, rest and stress imaging with CMRI. There was a non-significant difference between stress and rest values in maximal signal intensity, a measure of myocardial perfusion, from baseline to follow-up comparing placebo with ASC group (–52.52 ± 88.61 and 3.05 ± 63.17, p = 0.061, respectively). LVEF, myocardial mass, stroke volume, left ventricle end-diastolic volume and end-systolic volume changed non-significantly (–0.5 ± 4.7%, –3.5 ± 13.1 g, –0.7 ± 8.6 mL, 1.9 ± 25.1 mL and 2.6 ± 16.5 mL, respectively) in the placebo group and in the ASC group (0.7 ± 8.6%, 0.9 ± 10.8 g, –0.3 ± 26.1 mL, –3.0 ± 31.5 mL and –2.7 ± 20.4 mL, respectively) from baseline to 6 months follow-up. The amount of scar tissue was unchanged in the placebo group by 0.0 ± 1.6 g, p = 1.0 and in the ASC group with –0.3 ± 2.3 g, p = 0.540. There was no difference between the groups. There was a non-significant trend toward increased myocardial perfusion but no significant changes in functional parameters or amount of scar tissue in patients treated with ASCs compared with patients allocated into the placebo group.

Prostatic epithelial cells and their high expressions of CKIP-1 affect the TGF-\u03b21 expression levels which might reduce the scar formation in remodeling stage at prostatic urethral wounds after wound repair

ObjectiveThere are less scar formations in some wounds after wound repair. Our earlier study had shown that the amount of collagen fibers in canine prostatic urethra wound were less than in bladder neck wound after 2-μm laser resection of the prostate (TmLRP) and partial bladder neck mucosa at 4 weeks. The purpose of this study was to observe the amount of scar tissue and characterize the probable causes of “less scar healing” in prostatic urethra wound.MethodsA total of 12 healthy adult male crossbred canines underwent resection of prostate and partial bladder neck mucosa using 2-μm laser. The prostatic urethra and bladder neck wound specimens were harvested at 3, 4, 8 and 12 weeks after operation, respectively. The histopathologic characteristics were observed by hematoxylin and eosin(HE)staining, and the expression of transforming growth factor-β1 (TGF-β1) and casein kinase-2 interacting protein-1 (CKIP-1) were examined by immunohistochemistry in prostatic urethra and bladder neck wound, respectively. Overexpressed CKIP-1 human prostate epithelial cells (BPH-1 cells) were established and the expression of TGF-β1 was detected by Western blotting. Furthermore, a non-contact co-culture system of BPH-1 cells and human fibroblast (HFF-1) cells was used to observe the effects of BPH-1 cell and their high CKIP-1 levels on the expression of TGF-β1 in HFF-1 in vitro.ResultsThe histology showed that there were a large number of prostatic epithelium and a small amount of scar tissue in prostatic urethra wound, while no epithelial cells and more scar tissue in bladder neck wound at 4, 8 and 12 weeks after repair. There were a higher expression level of TGF-β1 in prostate epithelial cells and fibroblasts and a lower expression level of CKIP-1 in prostate epithelial cells at 3 weeks after surgery in prostatic urethral wound. Compared to week 3, the TGF-β1 expression decreased both in prostate epithelial cells and fibroblasts at 4, 8 and 12 weeks in prostatic urethral wound (p < 0.05 or p < 0.01). The CKIP-1 expression increased in prostate epithelial cells at 4, 8 and 12 weeks compared to 3 weeks in prostatic urethra wound (p < 0.01). A higher TGF-β1 expression level of fibroblasts was observed in bladder neck wound at 3 weeks. And there was no significant change in the expression of TGF-β1 of fibroblasts in 3, 4, 8 and 12 weeks after operation in bladder neck wound. Both the prostate urethra and bladder neck wound fibroblasts showed weak expression of CKIP-1 and there was no significant change in 3, 4, 8 and 12 weeks. The vitro experiments showed that the TGF-β1 expression in BPH-1 cells with CKIP-1 overexpression decreased 25% compared with control group (p < 0.05). Furthermore, the expression of TGF-β1 in HFF-1 cells of co-cultured group decreased by 20% compared with Control group (p < 0.05); the expression of TGF-β1 in HFF-1 cells of overexpression co-culture group were reduced by 15% compared with co-cultured group (p < 0.01).ConclusionsA large number of prostate epithelial cells in prostatic urethra wound may be one of the causes of less formation of scar tissue after repair. The prostate epithelial cells might reduce expression level of TGF-β1 by raising CKIP-1 expression and inhibit expression of TGF-β1 in peripheral fibroblasts at remodeling stage to reduce the excessive proliferation of fibrous cells and the excessive scar formation.

The prevention effect of poly (L-glutamic acid)/chitosan on spinal epidural fibrosis and peridural adhesion in the post-laminectomy rabbit model.

Spinal epidural fibrosis and adhesion are implicated as one of the key factors of failed back surgery syndrome, which may cause dura mater compression or peridural tethering, resulting in persistent backache and leg pain. Various materials or drugs have been used to inhibit formation of epidural fibrosis and reduce the compressive effect on neural structures. Nevertheless, the effects are not satisfied. In this study, we investigated the prevention effect of poly (L-glutamic acid)/chitosan (PLGA/CS) barrier on epidural fibrosis developing post-laminectomy in a rabbit model. Sixteen rabbits were divided randomly into two equal groups: group A (experimental group, n = 8) and group B (non-treatment group, n = 8). In both groups, total L5-6 laminectomy was performed; further both ligamentum flavum and epidural fat were removed gently. In experimental group, the laminectomy sites were treated with PLGA/CS barriers, while no additional treatment was received in non-treatment group. At 1, 12 and 24 weeks post-surgery, the animals were subjected to magnetic resonance imaging (MRI) evaluation. Following last MRI examination, all rabbits were sacrificed and their spinal columns were totally removed for further macroscopic and histological evaluation. MRI showed that rabbits treated with PLGA/CS barrier at 12 and 24 weeks post-surgery had less epidural fibrosis or scar tissue, peridural adhesion, foreign body reaction and low pressure of spinal cord in comparison with the non-treatment group. In consistence with the radiographic results, macroscopic analysis and histological examination showed that the amount of scar tissue and the extent of epidural adhesion decreased significantly in experimental groups. Concerning the fibroblast density evaluated, the scores were significantly lower in experimental group compared with those in non-treatment group. The results of our study demonstrate that PLGA/CS barrier is effective in inhibiting epidural fibrosis and peridural adhesions in post-laminectomy rabbit model.

Improvement in Cardiac Function following Transplantation of Human Umbilical Cord Matrix-Derived Mesenchymal Cells

Objectives: Human umbilical cord mesenchymal cells (hUCM) can be easily obtained and processed in a laboratory. These cells may be considered as a suitable source in the repair of heart failure diseases. We, therefore, examined whether these cells may contribute to heart regeneration following an acute experimental myocardial infarction (MI). Methods: MI-induced animals received 5 × 10⁶ hUCM cells, 5 × 10⁶ 5-azacytidine-treated cells (dhUCM), or PBS alone, subepicardially. A group of animals with MI and no other former intervention served as controls. dhUCM cells were assessed for F-actin, myogenin and troponin-I expression. Results: dhUCM cells appeared as binucleated cells with extensive cytoplasmic processes. These differentiated cells were F-actin and myogenin positive. Thirty days after LAD ligation, left ventricular ejection fraction and the percentage of fractional shortening improved significantly in cell-receiving animals. In addition, the amount of scar tissue was significantly reduced in hUCM and dhUCM groups compared to MI group (p < 0.05). These parameters were comparable between hUCM and dhUCM groups. Histopathological evaluations revealed that some engrafted cells adjacent to and remote from the MI area expressed troponin-I, F-actin and connexin43. Conclusion: These findings demonstrated the potential therapeutic use of either differentiated or undifferentiated hUCM cells in treatment of heart failure conditions.

Effect of Amniotic Membrane to Reduce Postlaminectomy Epidural Adhesion on a Rat Model

Epidural fibrosis and adhesion are the main reasons for post-laminectomy sustained pain and functional disability. In this study, the authors investigate the effect of irradiated freeze-dried human amniotic membrane on reducing epidural adhesion after laminectomy on a rat model. A total of 20 rats were divided into two groups. The group A did not receive human amniotic membrane implantation after laminectomy and group B underwent human amniotic membrane implantation after laminectomy. Gross and microscopic findings were evaluated and compared at postoperative 1, 3 and 8 weeks. The amount of scar tissue and tenacity were reduced grossly in group of rats with human amniotic membrane implantation (group B). On a microscopic evaluation, there were less inflammatory cell infiltration and fibroblast proliferation in group B. This experimental study shows that implantation of irradiated freeze-dried human amniotic membrane reduce epidural fibrosis and adhesion after spinal laminectomy in a rat model.

Visualization of transcoronary ablation of septal hypertrophy in patients with hypertrophic obstructive cardiomyopathy: a comparison between cardiac MRI, invasive measurements and echocardiography

ObjectiveHypertrophic obstructive cardiomyopathy (HOCM) is treated by surgical myectomy or transcoronary ablation of septal hypertrophy (TASH). The aim of this study was to visualize the feasibility, success and short-term results of TASH on the basis of cardiac MRI (CMR) in comparison with cardiac catheterization and echocardiography.MethodsIn this in vivo study, nine patients with HOCM were treated with TASH. Patients were evaluated by transthoracic echocardiography, invasive cardiac angiography and CMR. Follow-up examinations were carried out after 1, 3 and 12 months. MR imaging was performed on a 1.5-T scanner. All images were processed using the semiautomatic Argus software and were evaluated by an attending thoracic radiologist and cardiologist.ResultsThe echocardiographic pressure gradient (at rest) was 69.3 ± 15.3 mmHg before and 22.1 ± 5.7 mmHg after TASH (P < 0.01, n = 9). The flux acceleration over the aortic valve examined (V max) was 5.1 ± 0.6 m/s before and 3.4 ± 0.3 m/s after the TASH procedure (P < 0.05). Also, there was a decrease of septum thickness from 22.0 ± 1.2 to 20.2 ± 1.0 mm (P < 0.05) after 6 ± 3 weeks. The invasively assessed pressure gradient at rest was reduced from 63.7 ± 15.2 to 21.2 ± 11.1 mmHg (P < 0.01) and the post-extrasystolic gradient was reduced from 138.9 ± 12.7 to 45.6 ± 16.5 mmHg (P < 0.01). All differences as well as the quantity of injected ethanol were plotted against the size or amount of scar tissue as assessed in the MRI. There was a statistically significant correlation between the post-extrasystolic gradient decrease and the amount of scar tissue (P = 0.03, r 2 = 0.5). In addition, the correlation between the quantity of ethanol and scar tissue area was highly significant (P < 0.01, r 2 = 0.6), whereas the values for the gradient deviation (P = 0.10, r 2 = 0.34), ΔV max (P = 0.12, r 2 = 0.31), as well as the gradient at rest (P = 0.27, r 2 = 0.17) were not significant.ConclusionTASH was consistently effective in reducing the gradient in all patients with HOCM. In contrast to the variables investigated by echocardiography, the invasively measured post-extrasystolic gradient correlated much better with the amount of scar tissue as assessed by CMR. We conclude that the optimal modality to visualize the TASH effect seems to be a combination of CMR and the invasive identification of the post-extrasystolic gradient.

Efficacy of human adipose tissue-derived stem cells in cardiac muscle repair in an experimental acute myocardial infarction model using nude rats (Crl:NIH-Fox1RNU)

This study was designed to compare the efficacy of intraventricular (IV), intramyocardial (IM) or combined IV and IM injections of human adipose tissue-derived stem cells (hADSCs) administered either immediately, 5, or 10 days after induction of acute myocardial infarction (AMI) in a nude rat model. Acute myocardial infarction was induced in 99, adult (250–350 g BW), male nude rats strain Crl:NIH-Fox1RNU. Rats received either no cells (group I, n = 15) or 2 million, hADSCs as follows: group II (n = 19) IV injection immediately after AMI; group III (n = 18) IV injection 5 days after AMI; group IV (n = 15) IV injection 5 days and IM injection 10 days after AMI; group V (n = 17) IV injection immediately after AMI and IM injection 10 days after AMI and group VI (n = 15) IM injection 10 days after AMI. Tissue sections from hearts were studied using H&E and immunohistochemistry. In the control group, there was a tendency toward granulation tissue formation, active phagocytosis, and variable angiogenesis when evaluated at 10 days, early fibrosis when evaluated at 30 days, and established fibrosis when evaluated at 60 days. However, hADSC-treated groups showed a tendency toward cardiomyocyte regeneration and prominent angiogenesis when evaluated at 10 days and smaller infarction size when evaluated at 30 and 60 days. The present study showed a significantly decreased amount of scar tissue following myocardial infarction and enhanced regenerative capacity of myocardial cells following a single, intraventricular injection of 2 million hADSCs immediately after AMI.

Enveloping bioabsorbable polyglycolide membrane and immobilization in achilles tendon repair: A comparative experimental study on rabbits

Using qualitative and histoquantitative methods, we investigated the effect of immobilization versus nonimmobilization on the biodegradation process, implant-tissue interaction, and scar formation after enveloping a rejoined rabbit Achilles tendon with a self-reinforced polyglycolide (SR-PGA) membrane. The soleus and gastrocnemius tendons of the right hind legs of 40 rabbits were transected. After suturing the ends, the seam was enveloped with the bioabsorbable membrane. Twenty ankles were immobilized with cast, 20 remained nonimmobilized. All nonoperated left ankles served as intact controls. During the follow-up of 3, 6, 12, and 24 weeks, scar formation, tissue response, and membrane biodegradation were studied histologically and histomorphometrically. The amount of scar tissue, highest at 3 weeks, gradually approached intact controls. SR-PGA degradation in both cast and noncast specimens was near complete by 24 weeks. Signs of an inflammatory process were most prominent at 3 weeks and diminished gradually by 24 weeks. No significant difference between cast and noncast specimens was noted at any time point regarding the amount of scar tissue, degradation process of PGA, or intensity of inflammatory reaction. In the present experimental setting, cast immobilization influenced neither scar formation nor speed of degradation during reunion of transected Achilles tendon ends as compared with nonimmobilization. No differences in the reunion process of the tendon ends were seen between the immobilized and nonimmobilized groups. Moreover, inflammatory cells were similar in both groups and reflected a transient tissue reaction to the membrane. Within the follow-up, the seam area (cross-sectional) approached that of intact controls.

Osseous Lesion of the Calcaneus Following the Use of Shock Wave Therapy in a Horse

An 8-year-old Dutch warmblood gelding was presented with a mechanical lameness (2/10) because of the presence of a soft tissue injury on the top of the right tuber calcanei. Plain radiographs of the tarsus demonstrated the presence of soft tissue swelling caudal to the right tuber calcanei, without osseous involvement, and ultrasonography revealed excessive scar tissue within and around the superficial digital flexor tendon. Extra-corporeal shock wave therapy was applied on the right hock to decrease the amount of scar tissue. One month after the therapy the lameness was greater (3/10) and a marginal increase in the size of the swelling was found. Periosteal new bone formation associated with an ill-defined radiolucent area and two bony fragments were detected radiographically at the caudo-proximal aspect of the right tuber calcanei. A blister containing oil of croton, camphor, pine and thyme, turpentine and cantharides was applied on the right calcaneus. Twenty days after blister application, the size of the swelling had been reduced by 50% and the degree of lameness had also been decreased (1/10). On clinical re-evaluation 6 months after treatment, the degree of lameness was stable (1/10) and flexion test of the limb was negative.

흰쥐에서의 카르복시메칠셀룰로오스나트륨과 겔란검 혼합겔의 유착방지 효과

The aim of the present study was to investigate the efficacy of a mixed gel formulation composed of sodium carboxymethyl cellulose and gellan gum (Na-CMC gel) for the prevention of adhesions after laminectomy. The anti-adhesive effect of the Na-CMC gel was tested in a controlled randomized study using an animal model of lumbar laminectomy. The animals (60 female Sprague-Dawley rats) were randomly allocated into two treatment groups to receive the Na-CMC gel on the injured area or no gel (control). The incidence of adhesions and their grade were blindly evaluated at 4, 8 and 12 weeks after surgery. The amount of scar tissue and tenacity were grossly reduced by the Na-CMC gel at postoperative 4, 8, and 12 weeks. The mean adhesion scores were 0.75, 1.25, and 1.38 at 4, 8, and 12 weeks in the gel-treated group, respectively. No significant inflammatory reaction was observed and the healing of wound was not affected by the Na-CMC gel. The Na-CMC gel reduced the amount of scar formation and tenacity in rat laminectomy model without affecting the healing of operation wound and other complications. Therefore, the Na-CMC gel may be the potential to prevent postsurgical adhesions in clinical state.

Effect of hyperbaric oxygen on the ligament healing process in rats.

Animal experiments were done to investigate whether administration of hyperbaric oxygen promotes scar tissue formation, increases expression of the Type I procollagen gene, and improves the tensile properties of healing ligament. In 76 Sprague-Dawley rats, a 2-mm segment of the medial collateral ligament was removed. Thirty-eight rats were exposed to hyperbaric oxygen at 2.5 atmospheres absolute for 2 hours 5 days per week (Group H), whereas the remaining rats were exposed to room air (Group C). The animals were sacrificed at 3, 7, 14, and 28 days postoperatively. In situ hybridization histochemistry was done to examine the Type I procollagen gene expression in healing ligaments in 40 rats, whereas a tensile failure test was done in the remaining rats. The amount of scar tissue was greater in Group H than in Group C. Type I procollagen gene expression at 7 or 14 days was significantly greater in Group H than in Group C. The ultimate load and stiffness in Group H were significantly greater than in Group C at 14 days. Administration of hyperbaric oxygen promotes scar tissue formation and increases Type I procollagen gene expression in healing ligaments. These effects are associated with the improvement of their tensile properties.

Fixing a broken heart with bone

The use of bone marrow-derived stem cells from matched donors to reconstitute the immune system in patients with certain types of leukemia is now standard practice, and there is great interest in using stem cells to treat other human diseases. This approach received a major boost with the demonstration by Donald Orlic (New York Medical College, NY, USA) and colleagues that bone marrow stem cells delivered locally into an infarcted heart resulted in myocardial regeneration and a recovery in cardiac function in a mouse model of coronary heart disease. Stem cells from the bone marrow appeared to differentiate into cardiomyocytes, smooth muscle cells and endothelial cells, demonstrating the multipotent nature of the bone marrow cells used. Importantly, the infarct size was reduced, limiting the amount of scar tissue remaining. This study raises the possibility that heart-attack victims could be treated with stem cells from their own bone marrow, thus eliminating concerns about stem-cell rejection. Nature (2001) 410, 701–705. LON

The Batista procedure: fact, fiction and its role in the management of heart failure.

End-stage heart failure is associated with high rates of mortality. Obviously, heart transplantation is the ultimate surgical intervention for its treatment. However, this surgical option is severely limited by immunosuppressive drug morbidity and inadequate donor organ availability. Partial left ventriculectomy, the so called Batista procedure, has been proposed for the treatment of dilated cardiomyopathy and other end-stage heart failure. Although initial reports lacked significant information on the safety and efficacy of this procedure, overall clinical impression from the reports is that the operation may serve as a relatively inexpensive bridge to transplantation especially in the patients with idiopathic dilated cardiomyopathy. In order to select an exact procedure to resect appropriate amount of scar tissue, dobutamine echocardiographic study, intraoperative volume reduction test using cardiopulmonary bypass, positron emission tomography, or magnetic resonance imaging scans can be used. To avoid the late deterioration related to the development of significant mitral valve regurgitation, definitive mitral valve repair or replacement at the time of the partial left ventriculectomy may be advised. Further study is required to determine the procedure's exact role in the treatment of congestive heart failure. This would have to be a multicenter, randomized, and long-term follow-up study.