Acne Scars

Ultrasound Obstet Gynecol. 2009 Jun 4; Vikhareva Osser O, Jokubkiene L, Valentin LOBJECTIVES: To determine the ability to correctly identify Cesarean section scars, to estimate the prevalence of defective scars, and to determine the size and location of scar defects by transvaginal ultrasound imaging. METHODS: Two hundred and eighty-seven women underwent transvaginal ultrasound examination 6-9 months after delivery: 108 had undergone one Cesarean section, 43 had had two Cesarean sections, 11 had undergone at least three Cesarean sections, and 125 were primiparae who had delivered vaginally. The ultrasound examiner was blinded to the obstetric history until all scans had been evaluated. RESULTS: None of the 125 vaginally delivered women had a visible scar in the uterus, whereas all women who had undergone Cesarean section had at least one visible scar. Median myometrial thickness at the level of the isthmus was 11.6 mm in women who had only been delivered vaginally, and 8.3 mm, 6.7 mm and 4.7 mm in women who had undergone one, two and at least three Cesarean sections, respectively (P < 0.001). Scar defects were seen in 61% (66/108), 81% (35/43) and 100% (11/11) of the women who had undergone one, two and at least three Cesarean sections (P = 0.002); at least one defect was classified as large by the ultrasound examiner in 14% (15/108), 23% (10/43) and 45% (5/11) (P = 0.027), and at least one total defect was seen in 6% (7/108), 7% (3/43) and 18% (2/11) (P = 0.336). In women who had undergone one Cesarean section, the median distance between an intact scar and the internal cervical os was 4.6 (range, 0-19) mm, and that between a deficient scar and the internal cervical os was 0 (range, 0-26) mm (P < 0.001). CONCLUSIONS: Cesarean section scars can be detected reliably by ultrasound imaging. Myometrial thickness at the level of the isthmus uteri decreases with the number of Cesarean sections and the frequency of large scar defects increases. Scars with defects are located lower in the uterus than intact scars. Copyright (c) 2009 ISUOG. Published by John Wiley & Sons, Ltd.

J Laparoendosc Adv Surg Tech A. 2009 Jun 2; Riquelme M, Aranda A, Riquelme-Q MAbstract Background: There have been descriptions of several techniques for congenital inguinal hernia (CIH) repair in the pediatric population by doing high ligation of the sac, without a definitive advantage over the open procedure. High recurrence rates have been reported with using these minimally invasive techniques in which the patent processus vaginalis has been ligated and left in place completely or partially. Methods: With approval of the ethics committee, a proper informed consent was obtained. During July 2003 to April 2008, we performed the inguinal hernia repair on 91 patients (76 males and 15 females), using a laparasocopic technique in which we completely resected the patent processus vaginalis and the parietal peritoneum surrounding the internal inguinal ring. This allowed the peritoneal scar tissue to close the area of the ring. Also, this scarring occurs in the extent of the inguinal canal where the dissection took place, therefore causing the same peritoneal scarring and sealing of the inguinal floor. In this series, a purse string was done only in the cases with an internal ring wider than 10 mm. Results: There were no conversions. Operative time was in the range of 35-72 minutes (average, 40). Close follow-up in the clinic has been 5 months to 4 years without a single recurrence. In 4 cases, 3 months later, we did a laparoscopic evaluation of the contralateral side due to associated cryptorchidism, in which we were able to confirm a complete closure of the interior inguinal ring. Two small hematomas were followed until they were gone, without further need for intervention. Discussion: No recurrences have been observed. We conclude that laparoscopic repair of CIH is feasible using this technique of complete resection of the processus vaginalis and surrounding parietal peritoneum. This series does not conclude on the need for the internal ring to be closed when found to be wider than 10 mm.

J Am Coll Surg. 2009 Jun; 208(6): 1045-50Yoshikawa K, Hiki N, Fukunaga T, Tokunaga M, Yamamoto Y, Miki A, Ogawa K, Higashijima J, Ohyama S, Seto Y, Shimada M, Yamaguchi TBACKGROUND: Selected cases of clinical mucosal gastric cancer can be treated endoscopically. But mucosal gastric cancer, which has a higher incidence of lymph node metastasis, should be treated by gastrectomy with lymph node dissection. Laparoscopy-assisted gastrectomy is usually indicated for the surgical treatment of mucosal gastric cancer. STUDY DESIGN: From April 2005 to December 2007, 148 consecutive patients with clinical mucosal gastric cancer who underwent laparoscopy-assisted gastrectomy were investigated to clarify the clinicopathologic findings in this patient group. RESULTS: Of the patients who underwent gastrectomy, 93 (63%) had tumors>20 mm in diameter and 92 (62%) had undifferentiated cancer. The frequency of lymph node metastasis was 8% (12 patients). One patient had second-compartment lymph node metastasis (station 8a). In patients with lymph node metastasis, 11 (92%) had an ulcer scar and 11 (92%) had undifferentiated tumors. None of the patients met the criteria for extended endoscopic submucosal dissection. CONCLUSIONS: The incidence of lymph node metastasis in patients with mucosal gastric cancer in whom gastrectomy is indicated is higher than reported previously. More careful consideration is needed for the possibility of lymph node metastasis in this era of endoscopic submucosal dissection.

Neth Heart J. 2009 May; 17(5): 199-207Chamuleau SA, Vrijsen KR, Rokosh DG, Tang XL, Piek JJ, Bolli RMyocardial infarction results in loss of cardiomyocytes, scar formation, ventricular remodelling, and eventually heart failure. In recent years, cell therapy has emerged as a potential new strategy for patients with ischaemic heart disease. This includes embryonic and bone marrow derived stem cells. Recent clinical studies showed ostensibly conflicting results of intracoronary infusion of autologous bone marrow derived stem cells in patients with acute or chronic myocardial infarction. Anyway, these results have stimulated additional clinical and pre-clinical studies to further enhance the beneficial effects of stem cell therapy. Recently, the existence of cardiac stem cells that reside in the heart itself was demonstrated. Their discovery has sparked intense hope for myocardial regeneration with cells that are obtained from the heart itself and are thereby inherently programmed to reconstitute cardiac tissue. These cells can be detected by several surface markers (e.g. c-kit, Sca-1, MDR1, Isl-1). Both in vitro and in vivo differentiation into cardiomyocytes, endothelial cells and vascular smooth muscle cells has been demonstrated, and animal studies showed promising results on improvement of left ventricular function. This review will discuss current views regarding the feasibility of cardiac repair, and focus on the potential role of the resident cardiac stem and progenitor cells. (Neth Heart J 2009;17:199-207.).