Prevention of hypertrophic scars and keloids by the prophylactic use of topical silicone gel sheets following a surgical procedure in an office setting.

BACKGROUND: Topical silicone gel sheeting has been used for more than 20 years to help reduce the size of hypertrophic scars and keloids. Its clinical efficacy and safety is well established. OBJECTIVE: To determine whether topical silicone gel sheeting can be used to prevent hypertrophic scars and keloids from forming following dermatologic skin surgery. METHODS: Patients undergoing skin surgery were stratified into two groups: those with no history of abnormal scarring (low-risk group) and those with a history of abnormal scarring (high-risk group). Following the procedure, patients within each group were randomized to receive either routine postoperative care or topical silicone gel sheeting (48 hours after surgery). Patients were followed for 6 months. RESULTS: In the low-risk group, there were no statistical differences between individuals using routine postoperative care or using topical silicone gel sheets. In the high-risk group, there was a statistical difference (39% versus 71%) between patients who did not develop abnormal scars and used topical silicone gel sheeting and patients who developed abnormal scars after routine postoperative treatment. Those individuals having a scar revision procedure also showed a statistical difference if topical silicone gel sheeting was used following surgery. CONCLUSION: Topical silicone gel sheeting, with a 20-year history of satisfaction in dermatology, now appears to be useful in the prevention of hypertrophic scars and keloids in patients undergoing scar revision.

Nevus spilus successfully treated with an intense pulsed light source.

BACKGROUND: Nevus spilus is usually an acquired lesion that can present therapeutic dilemmas for clinicians. OBJECTIVE: Using an intense pulsed light source, a nevus spilus on the face of a 23-year-old woman was treated. METHODS: The intense pulsed light source, utilizing a 590 nanometer filter, was used to treat the nevus spilus. RESULTS: Four treatment sessions with the intense pulsed light successfully treated the nevus spilus, and it has remained clear at the 6-month follow-up. CONCLUSIONS: Nevus spilus is a difficult condition to treat; the intense pulsed light source should be considered in the armamentarium when treating this condition.

One-year follow-up using an intense pulsed light source for long-term hair removal.

BACKGROUND: The long-term removal of unwanted hair is a challenge for health care providers. Peer-reviewed scientific data for many of the hair removal laser systems is lacking. OBJECTIVE: This paper provides a chronicle of 24 of the 31 patients who participated in the original 3-month trial for hair removal utilizing an intense pulsed light source. METHODS: A total of 24 of the original 31 patients who took part in the one treatment, 3-month, intense pulsed light trial were examined again at 1 year following the treatment. RESULTS: Long-term epilation of 75% hair removal was found in this group of patients after 1 year with a single treatment. CONCLUSION: The intense pulsed light source is an effective method for providing long-term epilation of unwanted hair.

Long-term epilation using the EpiLight broad band, intense pulsed light hair removal system.

BACKGROUND: The long-term epilation of hair is the goal of several lasers and intense pulsed light systems. OBJECTIVE: The purpose of the study is to use the EpiLight Hair Removal System to assess long-term epilation and to assess its safety profile following a single treatment session. METHODS: Patients received a single treatment with the Epilight Hair Removal System after entering the patient's skin type, skin color, hair color, and hair density into the system's computer software. Treatment parameters include various wavelengths of light, pulse duration, pulse delay, and energy fluence. Thirty-seven subjects received a single treatment using one of four cut-off filters consisting of two to five pulses with energies of 34-55 J/cm2. RESULTS: The results of a single treatment show hair clearances occurring immediately and over a 12-week study period. Approximately 60% hair removal was noted at 12 weeks. CONCLUSIONS: The EpiLight Hair Removal System is an effective and safe method for long-term epilation of unwanted hair.

Olfactory epithelial organotypic slice cultures: a useful tool for investigating olfactory neural development.

An in vitro slice culture was established for investigating olfactory neural development. The olfactory epithelium was dissected from embryonic day 13 rats; 400 microns slices were cultured for 5 days in serum-free medium on Millicell-CM membranes coated with different substrates. The slices were grown in the absence of their appropriate target, the olfactory bulb, or CNS derived glia. The cultures mimic many features of in vivo development. Cells in the olfactory epithelium slices differentiate into neurons that express olfactory marker protein (OMP). OMP-positive cells have the characteristic morphology of olfactory receptor neurons: a short dendrite and a single thin axon. The slices support robust axon outgrowth. In single-label experiments, many axons expressed neural specific tubulin, growth-associated protein 43 and OMP. Axons appeared to grow equally well on membranes coated with type I rat tail collagen, laminin or fibronectin. The cultures exhibit organotypic polarity with an apical side rich in olfactory neurons and a basal side supporting axon outgrowth. Numerous cells migrate out of the slices, of which a small minority was identified as neurons based on the expression of neural specific tubulin and HuD, a nuclear antigen, expressed exclusively in differentiated neurons. Most of the migrating cells, however, were positive for glial fibrillary acidic protein and S-100, indicating that they are differentiated glia. A subpopulation of these glial cells also expressed low-affinity nerve growth factor receptors, indicating that they are olfactory Schwann cells. Both migrating neurons and glia were frequently associated with axons growing out of the slice. In some cases, axons extended in advance of migrating cells. This suggests that olfactory receptor neurons in organotypic cultures require neither a pre-established glial/neuronal cellular terrain nor any target tissue for successful axon outgrowth. Organotypic olfactory epithelial slice cultures may be useful for investigating cellular and molecular mechanisms that regulate early olfactory development and function.

Cellular forms and functions of brain microglia.

Consistent with the recent characterization of microglial cells as macrophages, an overall picture for the unique function of these cells in CNS tissue has developed. The microglia are derived from blood monocytes that migrate into the tissue during fetal development and subsequently remain after complete formation of the blood-brain barrier. These monocytes give rise to the ramified microglia of adult tissue through the developmental intermediate of amoeboid microglia. Ramified microglia appear uniquely adapted in contrast to other tissue macrophages based on their stability or lack of turnover and mitotic capability. The ramified cells, while usually downregulated, can convert into active macrophages termed reactive microglia; this conversion appears to occur nonspecifically in response to any injury. Further, reactive microglial cells can fuse to form giant multinucleated cells during viral infections. Each microglia cell form possesses a characteristic morphology and differing functional state with regard to macrophage activity. In their role as tissue macrophages, microglia are involved in immune responses, tissue transplantation, and AIDS dementia complex, as well as many other neurological mechanisms and diseases.

The oral health in different groups of adults with mental handicaps attending Birmingham (UK) adult training centres.

The policies of normalisation and integration into the community of people with mental handicap have significant implications for dental care. Before dental services can be planned, the extent of the problem needs to be identified. A total of 382 people with mental handicap living in the community and attending day centres was examined; 52 of these people were edentulous. The mean age of the dentate adults was 30.9 years and the mean DMFT was 9.59. This was low in comparison with data available from national studies but when component parts of the DMF were evaluated it was apparent that far less restorative care had been received by the adults with mental handicap. There were also significant differences in the mean DMFT between mentally handicapped people who had additional handicaps; the mean DMFT for people with Down's syndrome was 10.95, whilst those mentally handicapped people who also had epilepsy had a mean DMFT of 11.19. The oral hygiene and periodontal condition was also poor and there were significant differences between the sub-groups. However, despite people with Down's syndrome having lower levels of plaque, they showed evidence of greater periodontal destruction. When resources are allocated, consideration should be given to raising the oral health of adults with mental handicap up to at least the same level as that of the rest of the population.

Correlation of manual dexterity and comprehension with oral hygiene and periodontal status in mentally handicapped adults.

Although there is relatively little information concerning the oral health of handicapped adults there is increasing evidence to suggest that their oral condition, particularly periodontal health, is poor. The present investigation involved assessment of 382 handicapped patients attending four different Adult Training Centres in Birmingham. The caries status, oral hygiene, and periodontal conditions were evaluated and the Community Periodontal Index of Treatment Need (CPITN) was calculated. In order to assess the manual dexterity and the comprehension of the trainees a standard test was devised. This consisted of timing each participant in carrying out simple instructions to pick up and position certain common objects. The results indicated high levels of plaque, calculus, and bleeding with a mean CPITN of 7.43. The mean time taken for the manual dexterity and comprehension test was 23.9 seconds with a range from 10 to 80 seconds, S.E.+/- 1.33. This compares with results from 34 "normal" adults of a mean time of 8.2 seconds +/- 1.8 with a range of 6 to 12 seconds. There was no significant correlation between the Manual Dexterity and Comprehension scores and the periodontal indices in the handicapped adults.

Size and development of the dentition in endocrine deficiency.

Two case reports are presented of boys, who were found to have pituitary and thyroid dysfunction respectively. This was treated in childhood with replacement therapy. These deficiences are known to affect normal skeletal and dental development, but the cases described also showed marked effects on the dental tissues themselves with severe microdontia and abnormalities of crown and root form.

Occlusal changes from primary to permanent dentitions.

A longitudinal study was undertaken to assess the persistence of occlusal features of the primary dentition at five years into the permanent dentition at 12 years. It was found that although there was a broad measure of predictability there was variation in detail which made forecasting unreliable in the individual patient. Generally speaking, incisal overjet and overbite changed very little between the two dentitions, but those changes which occurred were in both directions, and the direction of change could not be predicted. The sagittal relationships of the dental arch were also relatively stable, but where change occurred it tended to be in a Class II direction, with the mandibular arch becoming more retroposed in relation to the maxillary arch. The prediction of crowding of the permanent dentition from a simple count of spaces in the primary dentition, while generally reliable, was not accurate in every individual patient.

Dental study of handicapped children attending special schools in Birmingham, UK.

The prevalence of dental caries, the levels of oral hygiene and the periodontal treatment requirements were assessed in 3562 handicapped children and 1344 randomly selected normal children attending schools in Birmingham, UK. The effect of different types of handicapping condition on these parameters was also evaluated. This investigation showed that there were few differences in caries prevalence when comparing handicapped children with children attending normal schools. However, the provision of dental care showed significant differences, with the handicapped children receiving less restorative treatment. There were also significantly poorer levels of oral hygiene and a greater prevalence of periodontal disease in the handicapped children attending special schools. The type of handicapping condition had a significant effect on the periodontal problems observed; those children with mental retardation having the poorest levels of oral hygiene and the greatest periodontal treatment requirements.