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Fulltext Versatility of the latissimus dorsi flap in upper limb salvage tumour surgery

Dorai AA, Halim AS, Zulmi W

Med J Malaysia, 2004 Dec;59 Suppl F:42-6.
PMID: 15941160

Reconstructive surgeons often encounter complex soft tissue and skeletal defects following oncological surgery. Soft tissue defects after wide resection in upper extremities posses a difficult challenge to find adequate tissue for reconstructing these defects. Paucity of local tissues dictates the requirement of loco-regional or distant flaps for these complex soft tissue defects which often exposes tendons, bones, nerves and joints. The latissimus dorsi muscle is a near ideal flap for the reconstruction because of the long neurovascular pedicle, ease of mobilization and its expendability. It can be rotated, with or without overlying skin, to cover soft tissue defects of the shoulder arm and elbow. Due to the large size of the muscle, it can be used to resurface the soft tissue defects and cover all major structures. Eleven consecutive cases were reviewed in which latissimus dorsi myocutaneous flap was used to reconstruct soft tissue defects of the upper limb following radical tumor resection. Flap survival was 100% with nominal donor site morbidity.

Matched MeSH terms: Neoplasms, Connective Tissue/pathology; Neoplasms, Connective Tissue/radiography; Neoplasms, Connective Tissue/surgery*
Fulltext Unusual branching pattern and termination of facial artery and its clinical implications for facial operations

Padur AA, Kumar N

J Vasc Bras, 2019 Jul 12;18:e20190021.
PMID: 31360158 DOI: 10.1590/1677-5449.190021

The facial artery is the main artery of the face and variations in its origin and its branching pattern have been documented. We report herein multiple facial artery branch variations in the face. A large posterior (premasseteric) branch originated from the left facial artery and coursed upwards behind the main trunk of the facial artery. This artery presented with a straight course and was closely related to the anterior border of the masseter. The branch then terminated by supplying the adjacent connective tissue below the parotid duct. It was also observed that the facial artery was very thick and tortuous and terminated as the superior labial artery. Knowledge of this variation is of great clinical significance in facial operations, especially for maxillofacial surgeons and plastic surgeons, because it forms the anatomical basis for the facial artery musculo-mucosal flap.

Matched MeSH terms: Connective Tissue
Toxic effects of Sapium baccatum (Ludai) extract in rats

Muhammad Taher, Nur Aizura Mat Alewi, Deny S, Zaitunnatakhin Zamli, Norazsida Ramli, Nurulwahida Saad

Sains Malaysiana, 2012;41:1423-1429.

Sapium baccatum is usually used as a timber in Malaysia. Its medicinal values are not well known and very little research has been conducted concerning the plant. Consequently, this study was conducted to observe toxicity effects of hexane extract of stem bark of S. baccatum. The toxicity effects were assessed through observation of physiological changes of the rats as well as through gross and histological examinations of its livers. The doses for the treated groups were given intraperitoneally for T2, T3 and T4 group which were given 100, 250 and 500 mg/kg, respectively. Meanwhile, control group (T1) was administered with 80% PEG 200 only. The observation period was 14 days. If the rat died, it was dissected and the liver was removed and examined. Some physiological effects observed include ataxia and hind-legs paralysis. The gross observations of the livers, growth of abnormal spots and connective tissues attachment to lobes of the livers were observed. The experiment was followed byhistopathological observation, which indicated the presence of abnormal hepatocytes with a distorted shape and undefined cell linings for T2 group. Results also indicated an increase in the distortion of hepatocytes, presence of massive cytoplasm and necrosis of hepatocytes for T3 and T4 groups. The results suggest that non polar extract of the stem bark of S. baccatum may promote toxic effects to the animals.

Matched MeSH terms: Connective Tissue
Therapeutic effects of connective tissue manipulation on wound healing and bacterial colonization count among patients with diabetic foot ulcer

Joseph LH, Paungmali A, Dixon J, Holey L, Naicker AS, Htwe O

J Bodyw Mov Ther, 2016 Jul;20(3):650-6.
PMID: 27634091 DOI: 10.1016/j.jbmt.2016.01.010

This study investigated the therapeutic effects of connective tissue manipulation (CTM) in diabetic foot ulcer (DFU). A total of 20 participants (10 in CTM group and 10 in conventional treatment group (CG)) with DFU underwent the conventional DFU treatment. In addition, the CTM group received CTM twice per week for 6 weeks. The percentage wound area reduction (PWAR) and bacterial colonization count (BCC) in log10 colony-forming units (CFU) per ml wound fluid was evaluated at baseline and six weeks. Results showed a significant change in PWAR in CTM (p

Matched MeSH terms: Connective Tissue/physiology*
Fulltext The structure of Calcareous Rings in Stichopus hermanni Semper and Holothuria atra Jaeger

Hawa Ismail, Ng, S.K., Hing, H.L., Normalawati Shamsudin, Ridzwan Hashim

Jurnal Sains Kesihatan Malaysia, 2004;2(2):47-52.
MyJurnal

The calcareous rings of two species of local sea cucumbers, Stichopus hermanni Semper and Holothuria atra Jaeger, were located, dissected, exposed and recorded. The calcareous rings of both species each composed of ten plates knit together by connective tissues. The radial plate of H. atra was a square with a notch at the anterior part whereas in S. hermanni it was squarish consisting of 4 ridges in the anterior part with a notch at the posterior part. The interradial plates of both species were smaller than the radial plates. A ridge was present at the anterior part of the interradial plate in H. atra. In S. hermanii, the ridge at the anterior part of the interradial was thin and prominent. Under the scanning electron microscope the calcareous rings from the two species exhibited a mosaic of small, numerous spicules bound to each other.

Matched MeSH terms: Connective Tissue
Fulltext The possible potential therapeutic targets for drug induced gingival overgrowth

Subramani T, Rathnavelu V, Alitheen NB

Mediators Inflamm, 2013;2013:639468.
PMID: 23690667 DOI: 10.1155/2013/639468

Gingival overgrowth is a side effect of certain medications. The most fibrotic drug-induced lesions develop in response to therapy with phenytoin, the least fibrotic lesions are caused by cyclosporin A, and the intermediate fibrosis occurs in nifedipine-induced gingival overgrowth. Fibrosis is one of the largest groups of diseases for which there is no therapy but is believed to occur because of a persistent tissue repair program. During connective tissue repair, activated gingival fibroblasts synthesize and remodel newly created extracellular matrix. Proteins such as transforming growth factor (TGF), endothelin-1 (ET-1), angiotensin II (Ang II), connective tissue growth factor (CCN2/CTGF), insulin-like growth factor (IGF), and platelet-derived growth factor (PDGF) appear to act in a network that contributes to the development of gingival fibrosis. Since inflammation is the prerequisite for gingival overgrowth, mast cells and its protease enzymes also play a vital role in the pathogenesis of gingival fibrosis. Drugs targeting these proteins are currently under consideration as antifibrotic treatments. This review summarizes recent observations concerning the contribution of TGF-β, CTGF, IGF, PDGF, ET-1, Ang II, and mast cell chymase and tryptase enzymes to fibroblast activation in gingival fibrosis and the potential utility of agents blocking these proteins in affecting the outcome of drug-induced gingival overgrowth.

Matched MeSH terms: Connective Tissue Growth Factor/metabolism
The effects of betel-nut chewing on the buccal mucosa: a histological study

Lee KW, Chin CT

Br. J. Cancer, 1970 Sep;24(3):433-41.
PMID: 5475751

Sixty-two "leukoplakias" from the cheeks of betel-nut chewers in West Malaysia were studied histologically. Ten biopsies were from non-tobacco betel-nut chewers. An amorphous von Kossa positive layer was seen on the keratin surface in 42 specimens. Tobacco did not appear essential for its formation, and it appeared to be significantly associated with parakeratosis. Its possible significance as a cuticle-like layer prolonging contact between carcinogens and the mucosa is discussed.Parakeratosis appeared to be the most common form of cornification seen, and the mitotic activity in parakeratinized leukoplakias appeared to be significantly greater than orthokeratinized leukoplakias.Comparison with studies on other population samples using different quids suggested that severe histological changes were more likely to be seen when tobacoo-containing quids were chewed as compared to non-tobacco-containing quids.An attempt to correlate the histological changes seen with the clinical habit in leukoplakias from chewers using tobacco-containing quids suggested that epithelial atrophy appeared to be significantly related to the duration of the habit but not to the "intensity" of the habit.

Matched MeSH terms: Connective Tissue/pathology
Squamous odontogenic tumor of the mandible: a case report demonstrating immunoexpression of Notch1, 3, 4, Jagged1 and Delta1

Siar CH, Nakano K, Ng KH, Tomida M, Nagatsuka H, Kawakami T

Eur J Med Res, 2010 Apr 08;15(4):180-4.
PMID: 20554499

BACKGROUND: Squamous odontogenic tumor (SOT) is a rare benign odontogenic epithelial neoplasm. A slow-growing painless expansive swelling is the common presenting symptom. Histopathologically, SOT can be easily misdiagnosed as an acanthomatous ameloblastoma. Although Notch receptors and ligands have been shown to play a role in cell fate decisions in ameloblastomas, the role of these cell signaling molecules in SOT is unknown.
CASE REPORT: This paper describes a case of SOT affecting the anterior mandible of a 10-year-old Indian female. The patient was treated by local surgical excision and there has been no follow-up clinical record of recurrence 5 years after primary treatment. Histo?pathological examination revealed a solid, locally-infiltrative neoplasm composed of bland-looking squamatoid islands scattered in a mature fibrous connective tissue stroma and the diagnosis was SOT. Immunohistochemical evaluation showed positive reactivity of varying intensity in the neoplastic epithelial cells for Notch1, Notch3, Notch4, and their ligands Jagged1 and Delta1. Expression patterns showed considerable overlap. No immunoreactivity was detected for Notch2 and Jagged2.
CONCLUSIONS: Present findings suggest that Notch receptors and their ligands play differential roles in the cytodifferentiation of SOT.

Matched MeSH terms: Connective Tissue/pathology
Fulltext Spontaneous biceps tendon rupture in a patient with mixed connective tissue disease

Ong SG

Malays Fam Physician, 2013;8(3):31-3.
PMID: 25893055 MyJurnal

Tendon rupture is a rare complication that occurs in patients receiving corticosteroid therapy. We report a case of a middle-aged man with mixed connective tissue disease who presented with spontaneous biceps tendon rupture 5 weeks after initiation of high-dose corticosteroid therapy. Musculoskeletal ultrasonography was performed at the clinic and helped to confirm the diagnosis. It is a new imaging modality that is increasingly used in rheumatology clinics in Malaysia as it serves as an extension to physical examination. Musculoskeletal ultrasonography is preferred by patients as it is noninvasive, does not involve ionising radiation, painless, relatively inexpensive and can be performed readily at the clinic.
KEYWORDS: corticosteroid; musculoskeletal ultrasonography; tendon rupture

Matched MeSH terms: Mixed Connective Tissue Disease*
Fulltext Spontaneous Conventional Osteosarcoma Transformation of a Chondroblastoma: A Case Report and Literature Review

Narhari P, Haseeb A, Lee S, Singh VA

Indian J Orthop, 2018 2 9;52(1):87-90.
PMID: 29416176 DOI: 10.4103/ortho.IJOrtho_495_17

Chondroblastomas are a primary benign cartilaginous tumor that accounts for approximately 1% of all benign bone tumors. Primarily they are treated by curettage. The patient presented 4 years after a successfully treated chondroblastoma (curettage and Bone cement). Wide resection of the proximal tibia with endoprosthesis replacement was done. Lung CT showed multiple lung metastasis and despite starting chemotherapy, he succumbed to the disease. We discuss regarding the possibilities of "aggressive" chondroblastoma and more recently termed chondroblastoma-like osteosarcoma which is a separate entity from chondroblastoma. Aggressiveness in chondroblastoma can be 1 of 3 types as follows: 1. benign chondroblastoma with lung metastasis. 2. malignant chondroblastoma. 3. subsequent malignant transformation of benign chondroblastoma. We have attempted to review the literature and describe the "aggressive" chondroblastoma and chondroblastoma-like osteosarcoma in this report.

Matched MeSH terms: Neoplasms, Connective Tissue
Fulltext Septic arthritis in rheumatology: review of five cases

Muhayidina AD, Said MS

J Clin Med Res, 2009 Aug;1(3):173-7.
PMID: 22493652 DOI: 10.4021/jocmr2009.08.1254

This report illustrates five cases of patients admitted to medical ward in HUKM, diagnosed and treated as septic arthritis over the course of two months. Their age ranged from 32 to 67 years old with one patient had history of monoarticular pain and the other four had polyarticular pain. Two of these patients had pre-existing joint disease, namely gouty arthritis and rheumatoid arthritis, and another patient with background history of mixed connective tissue disease on long term steroid therapy. The diagnosis of septic arthritis was made mainly from clinical assessment, supported by synovial fluid assessment and blood investigations. All patients received minimum of two weeks intravenous antibiotic followed by one month course of antibiotic. All of them had arthrocentesis for diagnostic and therapeutic purposes and two had laparoscopic arthroscopy with wash out done.

Matched MeSH terms: Mixed Connective Tissue Disease
Fulltext Root coverage of a wide anterior mucogingival defect with epithelial embossed connective tissue graft and its evaluation using root coverage esthetic scores

Rath A, Fernandes BA, Sidhu P, Ramamurthy P

J Indian Soc Periodontol, 2018 2 15;21(3):245-248.
PMID: 29440795 DOI: 10.4103/jisp.jisp_221_17

New and innovative surgical techniques are necessary to help the clinician ensure the best results and satisfy patient's expectations. One such periodontal problem that has been challenging to the dental practitioners and impacts the oral health quality of life of patients has been gingival recession. When present anteriorly where esthetics is a major concern, patient centric parameters too become paramount. Root coverage esthetic score (RES) evaluation helps to keep the patient outcomes in mind. This case reports the successful treatment of a wide anterior mucogingival defect using epithelial embossed connective tissue graft which was evaluated for the first time using RES.

Matched MeSH terms: Connective Tissue
Root Coverage of Palatal Recession Using Epithelial Embossed Connective Tissue: A Case Report

Rath A, Fernandes B, R PH, Varma S, Pavuluri AK

J Int Acad Periodontol, 2017 Jan 02;19(1):10-14.
PMID: 31473707

Labial and buccal gingival recession is a common finding in the adult population, which can occur due to various factors. When present, it can lead to an unesthetic appearance and can cause hypersensitivity. However, very limited literature is available regarding the incidence of palatal gingival recession. Many times it goes unnoticed during routine clinical examinations. Although there are no esthetic concerns in these regions, recession can cause sensitivity and pose a technical challenge in surgical correction because of poor accessibility and visibility. This case reports the treatment of a single palatal recession defect using an epithelial embossed connective tissue graft. The 12-month follow-up of the case showed significant root coverage (93.6%) and decreased sensitivity. The advantage of the harvested graft was that the connective tissue was not exposed, as it was tucked into the underlying flap, and the mucosal contour was maintained.

Matched MeSH terms: Connective Tissue
Fulltext Role of amino acid arginine for broiler production: A review

M. J. Khatun, T.C. Loh, H.L. Foo, M.K.I. Khan

Journal of Engineering and Science Research, 2018;2(3):1-6.
MyJurnal

Amino acids are known as anabolic factors that are essential for formation of muscle by stimulating protein synthesis while inhibiting proteolysis, and they are significant component for the synthesis of various nitrogenous compounds. There are 20 amino acids are essential to require in cell for formation of body protein of which about 10 amino acids, which cannot be synthesized by the birds are termed essential. Among the essential amino acid arginine one of the essential amino acids for chickens because, like other birds, they are unable to obtain Arginine from endogenous sources due to the absence of most of the enzymes involved in the urea cycle. This amino acid involved in synthesis of proline, hydroxyl proline and polyamines which are essential for connective tissue synthesis as well as increased growth of chicken. Moreover, L-arginine (L-Arg) is effective for reducing fat deposition in broiler. Moreover, it decrease heat stress increase meat quality and increase immune response of broiler. This re-view presents the recent advances in the relevance of the inclusion of excess L-Arginine in broiler ration to growth, fat deposition and immune response in broiler.

Matched MeSH terms: Connective Tissue
Recent advances in the use of animal-sourced gelatine as natural polymers for food, cosmetics and pharmaceutical applications

Mohd Shakrie Palan Abdullah, Mohamed Ibrahim Noordin, Syed Ibrahim Mohd Ismail, Nur Murnisa Mustapha, Malina Jasamai, Ahmad Fuad Shamsuddin, et al.

Sains Malaysiana, 2018;47:323-336.

Gelatine is used as an excipient for various pharmaceutical dosage forms, such as capsule shells (both hard and soft),
tablets, suspensions, emulsions and injections (e.g. plasma expanders). It is also broadly used in various industries
such as food and cosmetics. Gelatine is a biopolymer obtained from discarded or unused materials of bovine, porcine,
ovine, poultry and marine industrial farms. The discarded materials can be the skin, tendons, cartilages, bones and
connective tissues. Gelatine sourced from animals is relatively easy and inexpensive to produce. The potential needs of
gelatine cannot be overemphasised. Rising demands, health concerns and religious issues have heightened the need for
alternative sources of gelatine. This review presents the various industrial uses of gelatine and the latest developments
in producing gelatine from various sources.

Matched MeSH terms: Connective Tissue
Fulltext Pyoderma gangrenosum and cobalamin deficiency in systemic lupus erythematosus: a rare but non fortuitous association

Teoh SC, Sim CY, Chuah SL, Kok V, Teh CL

BMC Rheumatol, 2021 Mar 03;5(1):7.
PMID: 33653418 DOI: 10.1186/s41927-021-00177-4

BACKGROUND: Pyoderma gangrenosum (PG) is an uncommon, idiopathic, ulcerative neutrophilic dermatosis. In many cases, PG is associated with a wide variety of different disorders but SLE in association with PG is relatively uncommon. In this article we present the case of a middle aged patient with PG as the initial clinical presentation of SLE. We also provide a brief review of cobalamin deficiency which occurred in our patient and evidence-based management options.
CASE PRESENTATION: A 35 years old man presented with a 5 month history of debilitating painful lower limb and scrotal ulcers. This was associated with polyarthralgia and morning stiffness involving both hands. He also complained of swallowing difficulties. He had unintentional weight loss of 10 kg and fatigue. Physical examination revealed alopecia, multiple cervical lymphadenopathies, bilateral parotid gland enlargement and atrophic glossitis. There was Raynaud's phenomenon noted over both hands and generalised hyper-pigmented fragile skin. Laboratory results disclosed anaemia, leukopenia, hyponatraemia and hypocortisolism. Detailed anaemic workup revealed low serum ferritin and cobalamin level. The autoimmune screen showed positive ANA, anti SmD1, anti SS-A/Ro 52, anti SSA/Ro 60, anti U1-snRNP with low complement levels. Upper gastrointestinal endoscopy with biopsies confirmed atrophic gastritis and duodenitis. Intrinsic factor antibodies and anti-tissue transglutaminase IgA were all negative. Punch biopsies of the leg ulcer showed neutrophilic dermatosis consistent with pyoderma gangrenosum. Based on the clinical findings and positive immunologic studies, he was diagnosed as systemic lupus erythematosus. His general condition improved substantially with commencement of corticosteroids, immunosuppressants and vitamin supplements.
CONCLUSIONS: We report a case of PG as the first manifestation of SLE which was treated successfully with immunosuppressants and vitamin supplements. Our report highlighted the need to consider connective tissue diseases such as SLE in a patient presenting with PG in order for appropriate treatment to be instituted thereby achieving a good outcome.

Matched MeSH terms: Connective Tissue Diseases
Fulltext Protective Role of Phyllanthus niruri Extract against Thioacetamide-Induced Liver Cirrhosis in Rat Model

Amin ZA, Bilgen M, Alshawsh MA, Ali HM, Hadi AH, Abdulla MA

Evid Based Complement Alternat Med, 2012;2012:241583.
PMID: 22649471 DOI: 10.1155/2012/241583

A preclinical study was performed to determine if the extract from Phyllanthus niruri (PN) plays a protective role against liver cirrhosis induced by thioacetamide (TAA) in rats. Initially, acute toxicity was tested and the results showed that the extract was benign when applied to healthy rats. Next, the therapeutic effect of the extract was investigated using five groups of rats: control, TAA, silymarin, and PN high dose and low dose groups. Significant differences were observed between the TAA group and the other groups regarding body and liver weights, liver biochemical parameters, total antioxidant capacity, lipid peroxidation, and oxidative stress enzyme levels. Gross visualization indicated coarse granules on the surface of the hepatotoxic rats' livers, in contrast to the smoother surface in the livers of the silymarin and PN-treated rats. Histopathological analysis revealed necrosis, lymphocytes infiltration in the centrilobular region, and fibrous connective tissue proliferation in the livers of the hepatotoxic rats. But, the livers of the treated rats had comparatively minimal inflammation and normal lobular architecture. Silymarin and PN treatments effectively restored these measurements closer to their normal levels. Progression of liver cirrhosis induced by TAA in rats can be intervened using the PN extract and these effects are comparable to those of silymarin.

Matched MeSH terms: Connective Tissue
Primary biliary cirrhosis and auto immune hepatitis overlap syndrome mimicking cholangiocarcinoma

Adel A, Zamri Z, Azlanuddin A, Bong JJ

Clin Ter, 2013;164(6):e493-5.
PMID: 24424229 DOI: 10.7417/CT.2013.1643

Primary Biliary Cirrhosis (PBC) and Auto Immune Hepatitis (AIH) are autoimmune diseases of the liver which highlighted with slow destructive process of intra hepatic small bile ducts. As a result of these damages cholestasis and over the time tissue damage will happen, which leads to scarring, fibrosis and finally cirrhosis. Some patients may present with clinical and biochemical features of both conditions, which is called "Overlap syndrome". Here we are reporting a case of PBC-AIH overlap syndrome that primarily diagnosed as gallbladder carcinoma and went under operation and finally histological examination revealed to be PBC.

Matched MeSH terms: Connective Tissue Diseases
Peripheral ameloblastoma with clear cell differentiation

Ng KH, Siar CH

Oral Surg. Oral Med. Oral Pathol., 1990 Aug;70(2):210-3.
PMID: 2290651

This report details a case of mandibular peripheral ameloblastoma having a clear cell component. The latter consisted of ovoid cells with vacuolated or clear cytoplasm and vesicular or pyknotic nuclei that may be disposed as discrete clusters or show direct transition from typical acanthomatous areas. Comparison of this lesion with other odontogenic and nonodontogenic tumors that contain clear cells is discussed in the context of the differential diagnosis.

Matched MeSH terms: Connective Tissue/pathology
Peri-implant soft tissue integration of immediately loaded implants in the posterior macaque mandible: a histomorphometric study

Siar CH, Toh CG, Romanos G, Swaminathan D, Ong AH, Yaacob H, et al.

J. Periodontol., 2003 May;74(5):571-8.
PMID: 12816287

Today, one critical goal in implant placement is the achievement of optimal soft tissue integration. Reports thus far have demonstrated successful soft tissue preservation in delayed loaded implants placed in anterior jaws. The aim of this study was to histomorphometrically examine the soft tissues around immediately loaded implants placed in the macaque posterior mandible.

Matched MeSH terms: Connective Tissue/pathology

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