We have examined the effects of various solutions (SDS, DMSO, NaCl) on the swelling and mechanical properties of arterial elastin. Our results indicate that SDS-swollen elastin is stiffer, stronger, and appears to fail at smaller extensions than water-swollen elastin. In order to determine if these changes in mechanical properties are due to swelling changes or to a specific effect of SDS bound to the elastin network, we studied the effect of DMSO on the mechanical properties of elastin. DMSO swells elastin to the same extent as 0.1 M SDS, but DMSO is uncharged and probably does not interact directly with the elastin protein. The data for DMSO-swollen elastin corrected for swelling changes are virtually identical to those of water-swollen elastin but significantly different from those of SDS-swollen elastin. Thus, there is apparently a specific SDS effect, and this effect probably arises from the high negative charge density due to bound SDS. Lastly, studies of changes induced by sodium chloride concentrations in the physiological range indicate that there is no significant change in stiffness, strength, or extensibility due to increased NaCl levels.
Umbilical endometriosis infrequently presents to the plastic surgeon. As such, the diagnosis is difficult to make because it is often overlooked. The current report presents a 35-year-old nulligravid woman with a six-month history of a firm, cyclically swelling lesion in her umbilical region. None of the signs characteristic of pelvic endometriosis except dysmenorrhea and a one-year history of infertility were present. Biopsy of the lesion revealed umbilical endometriosis (grade IV), and laparoscopy uncovered extensive disease. Monopolar cautery with coagulating current umbilical excision and reconstruction with a purse-string suture was used. The results underscore the importance of a broad differential diagnosis for an umbilical lesion in a middle-age woman. They also highlight the importance of early recognition and appropriate surgical intervention to minimize morbidity and mortality associated with umbilical endometriosis.
Children who receive radiation for malignant tumors in the orbital area frequently develop widespread craniofacial deformities. These affect the skull, orbit, maxilla, and mandible. When these patients seek treatment at a later age, they require careful assessment using cephalometrics and three-dimensional imaging. It is recommended that the four levels of skeletal deformity be corrected in a single procedure, that is frontotemporal expansion with repositioning of the skull base area, orbital expansion and repositioning together with maxillary and mandibular surgery. Bone grafts should be inlay rather than onlay and soft tissue should be supplied by free-tissue transfer. This counteracts any residual ischemia related to the previous radiation therapy. The second surgical stage is designed to reconstruct the socket and the eyelids to allow more satisfactory rehabilitation with an ocular prosthesis. In patients who have a globe present, the usual enophthalmos can be corrected by repositioning of the eye as part of the first procedure by reducing the anteroposterior dimensions of the socket. In bilateral cases, the deformity is hourglass in nature and requires correction in the frontal and temporal area with lateral displacement of the orbits. A bimaxillary procedure is also indicated. It is emphasized that to formulate a satisfactory operative plan an in-depth three-dimensional analysis of the deformity is mandatory.
Bullous pilomatricoma has rarely been described. A common pathological feature in this type of pilomatricoma is the presence of dilated lymphatics. Bullous morphea associated with dermal lymphatic dilation has also been described. In both bullous pilomatricoma and morphea, it is possible that individual pathological features of the lesion lead to obstruction and congestion of the dermal lymphatics thereby inducing enough dilation and edema to form a dermal bulla.
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