Vascular Marks Research Articles

Walking on water: subchondral vascular physiology explains how joints work and why they become osteoarthritic.

This review of bone perfusion introduces a new field of joint physiology, important in understanding osteoarthritis. Intraosseous pressure (IOP) reflects conditions at the needle tip rather than being a constant for the whole bone. Measurements of IOP in vitro and in vivo, with and without proximal vascular occlusion confirm that cancellous bone is perfused at normal physiological pressures. Alternate proximal vascular occlusion may be used to give a perfusion range or bandwidth at the needle tip more useful than a single IOP measure. Bone fat is essentially liquid at body temperature. Subchondral tissues are relatively delicate but are micro-flexible. They tolerate huge pressures with loading. Collectively, the subchondral tissues transmit load mainly by hydraulic pressure to the trabeculae and cortical shaft. Normal MRI scans demonstrate subchondral vascular marks which are lost in early osteoarthritis. Histological studies confirm the presence of those marks and possible subcortical choke valves which support hydraulic pressure load transmission. Osteoarthritis appears to be at least partly a vasculo-mechanical disease. Understanding subchondral vascular physiology will be key to better MRI classification and prevention, control, prognosis and treatment of osteoarthritis and other bone diseases.

Management of asymptomatic cutaneous lumbosacral findings in newborns: a neurosurgical perspective.

The purpose of this study was to find areas of agreement among pediatric neurosurgeons with respect to the clinical management of asymptomatic newborns with a variety of lumbosacral skin findings. An electronic survey containing 18 clinical images and brief vignettes was sent to pediatric neurosurgeons within the American Academy of Pediatrics Section of Neurological Surgery (AAP SONS). In total, 38% (n = 21) of AAP SONS members submitted complete responses to the survey. Respondents were asked if they would advise routine care, watchful waiting, imaging, or subspecialty consultation for each clinical case. Responses were categorized into two groups: 1) watchful waiting and/or routine care, or 2) imaging and/or subspecialty consultation. Consensus was categorized as good (> 90% of responses in the same group), modest (70%-90%), and poor (< 70%). Demographic information, local factors impacting management, and experiences with local referral patterns were also collected. Among the pediatric neurosurgeons within the AAP SONS network, the authors found high levels (> 90%) of agreement that subcutaneous lipomas, faun tail nevi, large skin tags, and deep/atypical lumbosacral dimples in asymptomatic newborns should prompt an imaging study. Similarly, the authors found high agreement that simple coccygeal dimples do not need imaging. The management of some types of lumbosacral vascular marks and gluteal crease deviations had poor agreement (< 70%). When imaging was recommended, there was preference for spinal MRI in most cases (67%). Pediatric neurosurgeons generally agree that imaging of the spine is indicated for asymptomatic newborns with subcutaneous lipomas, faun tail nevi, large skin tags, or deep/atypical lumbar dimples (deep or atypical appearing). They also agree that imaging is unnecessary for infants with simple coccygeal dimples. There was a notable lack of consensus on the appropriate management of certain gluteal cleft deviations and cutaneous vascular marks.

A Review of RPPVSM based Skin Identification Techniques

In recent times, most work on suspect detection, medical science and meteorology has been committed towards image processing. This paper deals with several biometric characteristics, including face recognition, finger knuckle, RPPVSM, vein pattern, and fingerprint. RPPVSM differs from the birthmark, because it is genetic but RPPVSM can be genetic or obtained. The two main parts of RPPVSM are detection and Matching. A duplicate evidence therefore creates a vein pattern unlikely. In contexts in which images of evidence may display non-facial body sections of offenders or criminals such as child sexual assault or conflict, relatively permanent Pigmented or Vascular Skin Marks (RPPVSM) have recently been adopted as biometric recognition attribute. In certain cases, Face Detection is hard to recognize individuals because adequate facial details are not sufficient. The recognition of manual RPPVSM is exhausting and time - intensive.

Upper tibial MRI vascular marks lost in early knee osteoarthritis

BackgroundWe describe upper tibial radiating vascular marks on MRI scans. They are lost in early osteoarthritis (OA).MethodsA literature search revealed no previous description of upper tibial MRI radial vascular marks. Fifty-six consecutive patients with anteroposterior knee X-rays and an axial PD_SPAIR MRI scan of the same knee within 1 year were studied. Their mean age was 53.1 years (range 22–85) with 27 males and 29 females. The medial and lateral compartments of each knee were scored for osteoarthritis using the Kellgren-Lawrence (K-L) classification. Marks on the MRI scans were counted by layer and quadrant position.ResultsRadial vascular marks were present in the first axial upper tibial subchondral slice, peaked between 6 and 10 mm depth and were absent by 16 mm depth. There was no association with age, left or right knee, BMI, or weight. There was more K-L graded OA medially and more vascular marks laterally. There was an inverse correlation between the number of marks and early grades of osteoarthritis medially (p < 0.001) and laterally (p < 0.002).ConclusionWe demonstrate previously undescribed subchondral vascular marks on axial MRI scans of the tibia and their inverse correlation with the presence and severity of early knee osteoarthritis. Our work offers a new insight into the possible vascular aetiology of osteoarthritis and potentially a means of earlier diagnosis and a therapeutic target.

Relatively Permanent Pigmented or Vascular Skin Marks for Identification: A Pilot Reliability Study.

In child sexual exploitation offenses, the collected evidence images often show the skin of nonfacial body parts of the criminals and victims. For identification in this scenario, "relatively permanent pigmented or vascular skin marks," abbreviated as RPPVSM, were recently introduced as the basis for a novel biometric trait. This pilot study evaluated the interexaminer variability of RPPVSM identification. Four dermatology physicians were recruited to examine RPPVSM from 75 skin images collected from a total of 51 Caucasian and Asian subjects. The images were separated into 50 reference ("suspect") images and 25 evaluation ("evidence") images. The examiners were asked to perform identification by annotating RPPVSM in each of the 25 evaluation images and matching them with the reference images. The rate of misidentification was 0% while the mean rate at which examiners failed to find a match was 6%, indicating the potential of dermatology physicians performing the role of RPPVSM examiners.

On Criminal Identification in Color Skin Images Using Skin Marks (RPPVSM) and Fusion With Inferred Vein Patterns

Relatively Permanent Pigmented or Vascular Skin Marks (RPPVSM) were recently introduced as a biometric trait for identification in the cases in which the evidence images show only the nonfacial body parts of the criminals or victims, such as in child sexual abuse and riots. As manual RPPVSM identification is tiring and time-consuming, an automated RPPVSM identification system is proposed in this paper. The system comprises skin segmentation, RPPVSM detection, and RPPVSM matching algorithms. The system was evaluated on 1,200 back images collected from 283 Asian and Caucasian subjects in varying pose and viewpoint conditions. The system achieved rank-1 and rank-10 identification accuracies of 76.79% and 88.97%, respectively, higher than the identification accuracies given by existing skin mark detection methods previously proposed for face recognition systems. To handle identification with limited numbers of RPPVSM, a fusion scheme with inferred vein patterns is also proposed. The fusion was evaluated on 2,360 images of chests, forearms, and thighs collected mostly from Asian subjects, who tend to have fewer RPPVSM than Caucasian subjects. The results show that the fusion improves vein identification in all body parts with improvement rates varying between 2% and 5% depending on the number of RPPVSM detected. To the best of our knowledge, this is the first work on automated identification in color skin images based on nonfacial skin marks and fusion with inferred vein patterns in forensic settings.

The Individuality of Relatively Permanent Pigmented or Vascular Skin Marks (RPPVSM) in Independently and Uniformly Distributed Patterns

With recent advances in multimedia technology, the involvement of digital images/videos in crimes has been increasing significantly. Identification of individuals in these images/videos can be challenging. For example, in cases of child sexual abuse, child pornography, and masked gunmen, the faces of criminals or victims are often hidden or covered and only some body parts (e.g., back, thigh, and arm) can be observed from the digital evidence. Although tattoos and scars can be used for identification in some cases, they are neither universal nor unique. We propose a group of skin marks named Relatively Permanent Pigmented or Vascular Skin Marks (RPPVSM) as a biometric trait for forensic identification. To support the scientific underpinnings of using RPPVSM patterns as a novel biometric trait, the individuality was studied. RPPVSM on the backs of 269 male subjects were examined. We found that RPPVSM in middle to low density patterns tend to form an independent and uniform distribution, while RPPVSM in high density patterns tend to form clusters. We present in this paper an individuality model for the independently and uniformly distributed RPPVSM patterns. When compared to the empirical results, this model fits the empirical distribution very well. Finally, the predicted error rates for verification and identification are reported.

The potential of capillary birthmarks as a significant marker for capillary malformation–arteriovenous malformation syndrome in children who had nontraumatic cerebral hemorrhage

Background/Purpose Capillary malformation–arteriovenous malformation (CM-AVM) is a new autosomal dominant disorder with cutaneous capillary malformations (CM) and high-flow cerebral arteriovenous malformations (AVM). Patients may have Parkes-Weber syndrome. This study determined if cutaneous CM are a significant indicator of CM-AVM in children with cerebral bleeds. Methods Children with cerebral AVMs between 1991 and 2009 were reviewed. A family history of brain hemorrhage, AVMs, or cutaneous birthmarks was elicited. Patients and siblings were examined for CM and a family tree recorded. A brief questionnaire determined the family's opinion regarding screening for this syndrome. Results Of 30 families, 1 family had Parkes-Weber syndrome. In 3 families, both patient and relatives had CM. In 9 families, patients had no CM, but relatives had them. One family had hereditary hemorrhagic telangiectasia. From the survey, 80% of families would be concerned about vascular marks, and 87% of families would allow screening for cerebral AVMs. Conclusion A family history of vascular marks may predict families at risk of having a cerebral AVM with hemorrhage. Most families would agree to screening. However, family history and physical examination alone do not confirm CM-AVM but form a useful screening tool to identify families needing further investigations with genetic testing and/or magnetic resonance imaging.

The Presentation and Management of Hemangiomas

After studying this article, the participant should be able to: (1) Define what is meant by either a classic (infantile) or atypical hemangioma and understand the natural history of each. (2) Identify the common phenotypic, histologic, and radiographic findings of a hemangioma. (3) Know the potential complications associated with hemangiomas. (4) Outline the options available to treat a hemangioma. Hemangiomas represent the most common tumors of infancy. These lesions maintain unique patterns of growth, sequelae, and therapeutic modalities from other vascular birthmarks. Until recently, however, classification schemes based on historical phenotypic observations often complicated diagnosis and proper medical management. Mulliken and Glowacki redefined the identification of these lesions by correlating clinical, histological, and autoradiographical data from a series of patients with vascular marks. A formal classification was officially adopted by the International Society for the Study of Vascular Anomalies in 1996 to structure a clinically relevant classification system. Under the adopted parameters, hemangiomas are classified as a subset of vascular tumors and delineated from vascular malformations. Generally, a hemangioma experiences a phase of rapid growth and expansion followed by slow, but steady, regression. The life cycle can be divided into the proliferating phase, involuting phase, and involuted phase, with each distinct in its time course and histological, radiographic, and molecular findings. Rarely, hemangiomas with an atypical presentation arise, and the clinician must be aware of their existence to avoid incorrect intervention and to prepare for possible life-threatening sequelae. The frequency of vascular marks in the general population makes it likely that a plastic surgeon will be involved in treatment of an affected patient at some point in his or her career. The goal of this article is to distinguish hemangiomas from other vascular marks by highlighting their presentation, possible complications, and common treatment modalities to aid diagnosis and therapeutic planning for this common vascular tumor.

Intense Pulsed Light Treatment of 1,000 Consecutive Patients with Facial Vascular Marks

Facial teleangectasias or vascular marks often represent a very cosmetically detracting problem for the affected patient, who tries to cover the lesions by camouflage strategies. This study describes the response of these vascular lesions after an intense pulsed light source was used on 1,000 consecutive patients. Between October 1998 and April 2005, 1,000 consecutive patients with various skin types (Fitzpatrick I to IV) were treated with Photoderm VL. The average age of the patients was 47.1 years. These patients were subjected to a mean of 2.16 treatments (range, 1-9), then followed up 48 h, 72 h, 1 week, 3 weeks, and 1 month after each treatment. All the patients were followed up 2 months after the last treatment, and the percentage of clearance was assessed by comparison of pre- and posttreatment photographs. The patients also answered a questionnaire in which they expressed personal satisfaction. The final physicians-nurse evaluation also was recorded on the same form. Most of the patients (89.70%) experienced a clearance of 75% to 100%. The results appear to be correlated with operator experience, but not with lesion size, age, or skin type. Minimal adverse side effects occurred for 14.6% of the patients, but only for 6.76% of the treatments. The intense pulsed light source Photoderm VL can be considered a fast, safe, and effective treatment for facial teleangectasias or vascular marks.

Vascular Remodeling Marks Tumors That Recur During Chronic Suppression of Angiogenesis

The potential for avoiding acquired resistance to therapy has been proposed as one compelling theoretical advantage of antiangiogenic therapy based on the normal genetic status of the target vasculature. However, previous work has demonstrated that tumors may resume growth after initial inhibition if antiangiogenic blockade is continued for an extended period. The mechanisms of this recurrent growth are unclear. In these studies, we characterized molecular changes in vasculature during apparent resumption of xenograft growth after initial inhibition by vascular endothelial growth factor blockade, "metronome" topotecan chemotherapy, and combined agents in a xenograft murine model of human Wilms' tumor. Tumors that grew during antiangiogenic blockade developed as viable clusters surrounding strikingly remodeled vessels. These vessels displayed significant increases in diameter and active proliferation of vascular mural cells and expressed platelet-derived growth factor-B, a factor that functions to enhance vascular integrity via stromal cell recruitment. In addition, remodeled vessels were marked by expression of ephrinB2, required for proper assembly of stromal cells into vasculature. Thus, enhanced vascular stability appears to characterize tumor vessel response to chronic antiangiogenesis, features that potentially support increased perfusion and recurrent tumor growth.

Surgical treatment of hemangiomas of the nose.

The approach to a rapidly growing vascular tumor is determined by a number of objective and subjective factors. As a rule, treatment of a hemangioma in an infant is usually delayed, in the expectation that involution will be complete. While most hemangiomas are harmless vascular marks, some may grow to become large, infiltrating masses. Local factors that influence treatment decision making include volume, ulceration, secondary infection, and bleeding of the tumor. Hemangiomas situated on the nose are distinguished from other locations by a few but important aspects and may demand a more aggressive position from the surgeon. An important consideration is the potential for aplasia of the delicate nasal cartilages that are undergoing development, due to the mass effect of the tumor. Nasal tip hemangiomas are slow to regress, and contour deformities result from the fibrofatty tissue that invariably remains even after total involution. More importantly, hemangiomas of the nasal region are particularly prone to causing great social distress to the parents, who will request prompt treatment for such a visible, deforming lesion. A definite solution that ensures removal of affected tissue and preservation of anatomy seems to be the best treatment for these tumors. In this article, the experience of the senior author (IP) in treating hemangiomas located on the nose is reviewed. The elliptical midline incision over the nasal dorsum described in the text was developed to address three important aspects: an expedient procedure to treat a highly disfiguring disease; an open access to allow for complete resection and, at the same time, allow for the correction of underlying cartilaginous disruption; and placement of a scar in an anatomic location proven to be very satisfactory aesthetically, permitting access for secondary procedures for better definition of nasal contour. Careful patient selection for this surgical procedure is emphasized.