Acne Scars

BJOG. 2009 Jul; 116(8): 1069-78; discussion 1078-80Zwart JJ, Richters JM, Ory F, de Vries JI, Bloemenkamp KW, van Roosmalen JOBJECTIVE: To assess incidence of uterine rupture in scarred and unscarred uteri and its maternal and fetal complications in a nationwide design. DESIGN: Population-based cohort study. SETTING: All 98 maternity units in The Netherlands. POPULATION: All women delivering in The Netherlands between August 2004 and August 2006 (n = 371,021). METHODS: Women with uterine rupture were prospectively collected using a web-based notification system. Data from all pregnant women in The Netherlands during the study period were obtained from Dutch population-based registers. Results were stratified by uterine scar. MAIN OUTCOME MEASURES: Population-based incidences, severe maternal and neonatal morbidity and mortality, relative and absolute risk estimates. RESULTS: There were 210 cases of uterine rupture (5.9 per 10,000 pregnancies). Of these women, 183 (87.1%) had a uterine scar, incidences being 5.1 and 0.8 per 10,000 in women with and without uterine scar. No maternal deaths and 18 cases of perinatal death (8.7%) occurred. The overall absolute risk of uterine rupture was 1 in 1709. In univariate analysis, women with a prior caesarean, epidural anaesthesia, induction of labour (irrespective of agents used), pre- or post-term pregnancy, overweight, non-Western ethnic background and advanced age had an elevated risk of uterine rupture. The overall relative risk of induction of labour was 3.6 (95% confidence interval 2.7-4.8). CONCLUSION: The population-based incidence of uterine rupture in The Netherlands is comparable with other Western countries. Although much attention is paid to scar rupture associated with uterotonic agents, 13% of ruptures occurred in unscarred uteri and 72% occurred during spontaneous labour.

Invest Ophthalmol Vis Sci. 2009 Jun 10; Byström B, Carracedo S, Behndig AB, Gullberg D, Pedrosa-Domellof FPurpose: To examine the distribution of integrin alpha11 chain in the human cornea during fetal development and in normal and diseased adult human corneas. Methods: Six fetal corneas, 10-20 weeks of gestation (wg), and 18 adult corneas including 3 normal, 7 with keratoconus, 5 with pseudophakic bullous keratopathy (PBK), two with Fuchs' corneal dystrophy and one with a scar after previous deep lamellar keratoplasty (DLKP) were processed for immunohistochemistry with specific antibodies against integrin alpha11 chain, collagen I, IV and V and alpha-smooth muscle actin (alpha-SMA). The cellular source of alpha11 integrin chain was further investigated in cell cultures. Results: At 10-17 wg alpha11 integrin chain was predominantly present in the anterior corneal stroma. At 20 wg, in normal adult corneas and in Fuchs' dystrophy corneas there was weak staining in the stroma. The PBK corneas showed variable and weak staining, generally accentuated in the posterior stroma near the Descemet's membrane. In contrast, the anterior portion of the stroma in the keratoconus corneas was strongly stained in an irregular streaky pattern. Human corneal fibroblasts/myofibroblasts produced alpha11 integrin chain in culture. Cultures treated with TGF-beta showed higher content of both alpha-SMA and alpha11 integrin chain. Conclusions: The presence of alpha11 integrin chain during early corneal development and the enhanced expression in scarred keratoconus corneas indicates that this integrin chain likely plays an important role in collagen deposition during corneal development and in keratoconus with a scarring component and compromised basement membrane integrity.

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 May; 23(5): 534-7Wang Z, Song H, Deng H, Chen J, Zhang L, Li YOBJECTIVE: To analyze the causes and managing methods of long bone fracture nonunion after allogeneic bone transplantation. METHODS: From December 1995 to December 2000, 43 cases of postoperative nonunion of long bone fracture were treated. These cases included 31 males and 12 females at the age of 19-57 years (40 years on average). The locations were femur in 11 cases, tibia in 21 cases, humerus in 8 cases and forearm in 3 cases. Bone nonunion after allogeneic bone transplantation was caused by extensive soft tissue contusion and poor cover around bone fracture site in 6 cases, by incomplete debridement in 8 cases of osteomyelitis (including 6 without continual lavage and 4 only skin flap transfer), by secondary infection of wounds in 3 cases, by severe primary injury or secondary scar covering bone in 12 cases, instable internal fixation in 7 cases, and by earlier weight bearing in 7 cases. According to Weber classification, there were 4 cases of hypertrophic type and 39 cases of atrophic type. Basing on the type of nonunion, the methods such as refixation, bone retransplantation and transferring tissue flap were chosen to manage the cases. RESULTS: Incision healed by first intention in 37 cases, superficial infection occurred and cured after 2 weeks of dressing change in 5 cases, and sinus formed and cured after 2 months of dressing change and drainage in 1 case. All transferring tissue flap survived, and partial necrosis occurred at flap edge in 4 cases and cured after dressing change. All patients were followed up for 38-91 months with an average of 54.6 months. All the nonunion cases achieved bone union 5-11 months with an average of 7.6 months. But low extreme shorten monstrosity occured in 4 cases, malunion in 2 cases, functional limitation near joints in 7 cases, and rotational limitation of forearm in 1 case. CONCLUSION: Fracture nonunion after allogeneic bone transplantation mainly shows atrophic type with overall or partial absorption of the allograft bone. The preconditions to guarantee fracture nonunion healing include stability of fracture fixation, using transferring tissue flaps, controlling infection, and adequate bone transplantion.