Aortic elastic fiber degeneration during acute type a aortic dissection and reverse aortic remodeling.

BACKGROUND: Progression of proximal or distal aortic dilatation is defined as reverse aortic remodeling after surgery for acute type A aortic dissection (ATAAD) that may be dependent on aortic wall degeneration. METHODS: We investigated whether aortic wall degeneration is associated with reverse aortic remodeling leading to aortic reoperation after surgery for ATAAD. Altogether, 141 consecutive patients undergoing surgery for ATAAD at Tampere were evaluated. The resected ascending aortic wall at surgery was processed for 42 degenerative, atherosclerotic and inflammatory histological variables. Patients undergoing aortic reoperations (Redos) were compared with those without aortic reoperations (Controls) during a mean 4.9-year follow-up. RESULTS: Redos were younger than Controls (56 and 66 years, respectively, P < 0.001), and had less frequently previous cardiac surgery prior to ATAAD. Initial surgery encompassed replacement of the ascending aorta in the majority. There were 21 Redos in which one patient died during follow-up as compared with 51 deaths in Controls (log Rank P = 0.002). Histology of the aortic wall revealed increased elastic fiber fragmentation, loss, and disorganization in Redos as compared with Controls (2.1 ± 0.5 vs. 1.9 ± 0.5, Point score unit (PSU), P = 0.043 and 1.7 ± 0.8 vs. 1.2 ± 0.8, PSU, P = 0.016, respectively). Moderate atherosclerosis occurred less often in Redos vs. Controls (9.5% vs. 33%, PSU, P = 0.037, respectively). CONCLUSIONS: According to this exploratory study, histopathology reveals distinctive aortic wall degeneration during ATAAD. Reverse aortic remodeling after ATAAD is associated with the presence of ascending aortic wall elastic fiber fragmentation, loss and disorganization during ATAAD.

The role of ultrasound in front-of-neck access for cricothyroid membrane identification: A systematic review.

PURPOSE: Conventional palpation techniques for cricothyroid membrane (CTM) identification are inaccurate and unreliable. Ultrasound plays a multi-faceted role in airway management, however there is limited literature around its use for CTM identification prior to cricothyrotomies. This review sought to compare ultrasound to palpation in the general population, identify its indications in subjects with ill-defined neck anatomy, and determine its role in defining neck anatomy. METHODS: Two reviewers independently assessed titles, abstracts and full-text English articles through the Ovid Medline and EMBASE databases. Studies related to ultrasound for CTM assessment and/or cricothyrotomy in subjects older than 12 years were included. RESULTS: Fourteen studies were selected. Compared to palpation, ultrasound has greater accuracy, but longer CTM identification times in those with normal airway anatomy. Interestingly, ultrasound offers comparable times to palpation in patients with difficult airways. Ultrasound also helps define anatomical parameters in the neutral and extended neck positions thereby underscoring the importance of neck positioning during cricothyrotomies and confirming consensus-based incision recommendations set by the Difficult Airway Society. CONCLUSION: Ultrasound appears to be superior to palpation for CTM localization especially in those with difficult airway anatomy and objectively defines neck anatomy. Its pre-emptive use should be incorporated during difficult airway management.

Novel Histologic Finding: Adipose Tissue Is Prevalent Within Penile Tunica Albuginea and Corpora Cavernosa: An Anatomic Study of 63 Specimens and Considerations for Cancer Invasion.

Adipose tissue, along with arteries, veins, and peripheral nerves, is a normal constituent of mesenchymal tissues encasing the corpora cavernosa at the level of the penile shaft, variously designated as penile fascia or Bucks fascia. To our knowledge, the presence of fat has not been previously reported within the corpora cavernosa. One or 2 transversal histologic sections at the level of the surgical margin at the shaft of 63 consecutive partial penectomy specimens for squamous cell carcinoma were evaluated. From outer to inner tissues, 3 anatomic levels were identified: (1) outer fascia composed of a loose fibrovascular mesenchyme containing some nerve branches. Adipose tissue was present in the majority of the cases. (2) The tunica albuginea, a thick and dense fibroelastic band of tissue separating the outer fascia from the erectile tissues of the corpora cavernosa. Adipose tissue within the albuginea was present in 21 specimens (19%). (3) Erectile tissues of corpora cavernosa. Besides the typical erectile tissues, adipose tissue was present in 33 cases (52%). The fatty tissue was focal or multifocal and scant and peripherally located at the junction of the tunica albuginea with the corpora. In some cases, it was associated with small amounts of fibrous tissue, small vessels, and nerves. We are reporting the presence of adipose tissue in the tunica albuginea and the corpora cavernosa. It is possible that adipose tissue, along with small nutritional vessels and nerves perforates from the fascia, in which fat is usually present, through the tunica albuginea to reach the corpora. In a previous examination of the local routes of cancer spread, we found this pathway to be one of the mechanisms of cancer invading the penile corpora from the penile fascia.

Proliferation of elastic fibres in idiopathic pulmonary fibrosis: a whole-slide image analysis and comparison with pleuroparenchymal fibroelastosis.

AIMS: We occasionally encounter patients with idiopathic pulmonary fibrosis (IPF) who have similar imaging patterns to those of pleuroparenchymal fibroelastosis (PPFE) in the upper lung fields but are not diagnosed as having PPFE clinically. The aim of this study is to identify the clinicopathological features and intrapulmonary distribution of elastic fibres and collagen fibres in these patients. METHODS AND RESULTS: We retrospectively reviewed the medical records of patients with a clinical diagnosis of IPF, and selected consecutive patients who underwent autopsy or pneumonectomy for lung transplantation. Patients with histologically confirmed PPFE were also reviewed for comparison. We quantified the collagen fibres and elastic fibres in each lobe as a percentage of the non-aerated lung area (collagen fibre score and elastic fibre score, respectively) in histological specimens by using whole-slide image analysis, and compared these scores between IPF and PPFE patients. In a total of 55 patients (IPF, 48; PPFE, 7), there were no significant differences in the collagen fibre scores between IPF and PPFE patients. The elastic fibre scores in the upper lobe in PPFE patients were significantly higher than those in IPF patients (23.5 versus 10.3, P = 0.005). However, it is of note that, in 12 of 48 IPF patients, the elastic fibre scores of the upper lobes were above the first quartile of those in PPFE patients. CONCLUSIONS: IPF occasionally shows intense elastosis in the upper lobes, and such cases are histologically indistinguishable from PPFE. There seem to be histologically borderline cases between PPFE and IPF.

Estudo da relação entre as fibras elásticas cutâneas e a ptose mamária em pacientes submetidas à cirurgia de implante mamário / Study of the relationship between cutaneous elastic fibers and breast ptosis in patients undergoing breast implant surgery

Introdução: Diferentes técnicas e abordagens para a introdução de implantes mamários já foram descritas. Entretanto, estes mesmos estudos não levam em conta a natureza das propriedades cutâneas e suas consequências. A presença de ptose e alterações nas fibras elásticas cutâneas pode interferir na contratilidade, elasticidade, resiliência da pele e, consequentemente, no resultado da cirurgia de implantes para aumento mamário. Métodos: Por meio de um estudo transversal retrospectivo, foram avaliados os registros em prontuário médico de pacientes submetidas ao procedimento de implante de aumento mamário no período entre abril de 2011 a abril de 2013. Dados sobre o grau de falência das fibras elásticas e ptose mamária foram coletados e para todas as análises estatísticas foi considerado um valor de p de 0,05. Resultados: Das 70 pacientes elegíveis, a média de idade foi 33,2 ± 9,3 anos. A ausência de falência das fibras elásticas cutâneas estava presente em 44,2% da amostra. Para os níveis 1 (discreta), 2 (moderada) e 3 (acentuada), constatou-se as prevalências 12,8%, 24,4% e 18,5%, respectivamente. A ptose e a falência das fibras elásticas apresentaram correlação de r = 0,67 e p < 0,001. Conclusões: O estudo dos elementos de ptose mamária e fibras elásticas cutâneas permitiu avaliar os seus variados graus de apresentação. Sugere-se a proposta de estudos prospectivos para o melhor entendimento da relação causal entre falência das fibras elásticas e ptose mamária.

Introduction: Different techniques and approaches have already been described for the introduction of breast implants. However, these same studies do not take into account the nature of the cutaneous properties and its consequences. The presence of ptosis and degeneration of the elastic fibers can interfere in the contractility, elasticity, resilience of the skin and, consequently, the outcome of implant surgery for breast augmentation. Methods: A cross-sectional retrospective study was performed, with evaluation of the medical records of patients undergoing breast augmentation implant procedure from April 2011 to April 2013. Data on the degree of degeneration of the elastic fibers and breast ptosis were collected and a p value of 0.05 was considered for all statistical analyses. Results: Of the 70 eligible patients, the mean age was 33.2 ± 9.3 years. An absence of degeneration of the elastic fibers was present in 44.2% of the sample. A prevalence of 12.8%, 24.4% and 18.5% was found for level 1 (mild), 2 (moderate) and 3 (severe) ptosis, respectively. The correlation between ptosis and the degeneration of the elastic fibers was r = 0.67, p < 0.001. Conclusions: The study of the elements of breast ptosis and cutaneous elastic fibers enabled the evaluation of their varying degrees of presentation. Prospective studies are suggested for a better understanding of the causal relationship between the degeneration of the elastic fibers and breast ptosis.

Comparative Histopathological Analysis of Mitral Valves in Barlow Disease and Fibroelastic Deficiency.

Whether Barlow disease (BD) and fibroelastic deficiency (FED), the main causes of mitral valve prolapse (MVP), should be considered 2 distinct diseases remains unknown. Mitral valves from patients who required surgery for severe mitral regurgitation due to degenerative nonsyndromic MVP were analyzed. Intraoperative diagnosis of BD or FED was based on leaflet redundancy and thickness, number of segments involved, and annular dimension. The removed medial scallop of the posterior leaflet and attached chordae were used for histopathological and immunohistological assessment. Histologically, compared to normal controls (n = 3), BD (n = 14), and FED (n = 9) leaflets demonstrated an altered architecture and increased thickness. Leaflet thickness was greater and chordae thickness lower in BD than FED (P < 0.0001). In BD, increased thickness was owing to spongiosa expansion (proteoglycan accumulation) and intimal thickening on fibrosa and atrialis; in FED, local thickening was predominant on the fibrosa side, with accumulation of proteoglycan-like material around the chordae. Collagen accumulation was observed in FED leaflets and chords and decreased in BD. Fragmented elastin fibers were present in BD and FED; elastin decreased in BD but increased in FED leaflets and around chordae. Activated myofibroblasts accumulate in both diseased leaflets and chords, but more abundantly in FED chordae (P < 0.0001), independently of age, suggesting a role of these cells in chordal rupture. There were more CD34-positive cells in BD leaflets and in FED chordae (P < 0.01). In BD leaflets (but not chordae) proliferative Ki67-positive cells were more abundant (P < 0.01) and matrix metalloproteinase 2 levels were increased (P < 0.01) indicating tissue remodeling. Upregulation of transforming growth factor beta and pERK signaling pathways was evident in both diseases but more prominent in FED leaflets (continued on next page)(P < 0.001), with pERK upregulation in FED chordae (P < 0.0001). Most cellular and signaling markers were negligible in control valves. Quantitative immunohistopathological analyses demonstrated distinct changes between BD and FED valves: predominant matrix degradation in BD and increased profibrotic signaling pathways in FED, indicating that BD and FED are 2 different entities. These results may pave the way for genetic studies of MVP and development of preventive drug therapies.

Segmental disruption of the internal elastic lamina as a potential pathogenetic mechanism of a true posttraumatic femoral artery aneurysm, years after single blunt trauma.

We present an unusual case of a true posttraumatic aneurysm of the superficial femoral artery (SFAA) 7 years after a motorcycle accident including blunt trauma to the thigh. Surgical reconstruction was accomplished without any complications by aneurysm resection and interposition of an autologous reversed saphenous vein. Histopathological examination revealed a true aneurysm with segmental disruption and fragmentation of the internal elastic lamina (IEL) in van Gieson's stain. This is a first-time finding in context with SFAA and may represent the pathogenetic explanation for the rare formation of posttraumatic true aneurysms.

The viscoelastic properties of the SMAS and its clinical translation: firm support for the high-SMAS rhytidectomy.

BACKGROUND: The superficial musculoaponeurotic system (SMAS) has inherent viscoelastic properties, although the optimal tension levels to minimize tissue relaxation have not been defined. This study evaluated the viscoelastic properties of the SMAS within the biomechanical parameters of the high-SMAS rhytidectomy. METHODS: Patients (n = 30) underwent a high-SMAS face lift performed by the senior author (F.E.B.) with intraoperative tension at the superior (preauricular) and inferior (mastoid) points of SMAS fixation sequentially measured with a tensiometer. Fresh samples of lateral, preparotid SMAS were then harvested and evaluated ex vivo for bursting strength, stress relaxation, and creep. RESULTS: The force applied to the superior, preauricular SMAS intraoperatively (7.21 ± 0.87 N) was significantly lower than that of the inferior mastoid point of fixation (9.59 ± 1.8 N) (p < 0.001). The bursting force of the SMAS was 55.7 N, with the average bursting pressure of 224.97 PSI. The in vivo force applied to the SMAS was found to be only 15 percent of its total bursting strength. The deformational load of the high-SMAS face lift caused only a 14 percent creep in the tissue ex vivo. CONCLUSIONS: The in vivo tension in a high-SMAS face lift is predictable, with the force applied to the mastoid point being significantly greater than that of the superior preauricular point. This intraoperative force is only a fraction of the tissue's inherent bursting strength, contributing to the minimal stress relaxation and creep observed in this study. These biomechanical properties likely contribute to the effective and long-lasting correction of facial aging with the high-SMAS technique. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

White fibrous papulosis of the neck.

A 56-year-old white man with multiple, discrete nonfollicular papules on the neck is presented. Clinical and histopathologic features were compatible with the entity of white fibrous papulosis of the neck (WFPN). Pseudoxanthoma elasticum-like papillary dermal elastolysis (PXE-PDE) and WFPN are further clinicopathologic patterns of intrinsic aging. Clinically, WFPN is characterized by isolated, whitish papules, whereas those of PXE-PDE are yellowish and often coalesce to form "cobblestone" plaques. Our case showed clearly marginated whitish papules. The major histopathologic feature of WFPN is superficial dermal fibrosis with scant elastolysis; in PXE-PDE, there is papillary dermal elastolysis but no sign of fibrosis. No recurrence was performed in the 3 years' follow-up in our case. Surgical treatment may be considered in such cases with well-circumscribed lesions.

Elastofibromatous changes and hyperelastosis of the oral mucosa.

Three cases of abnormalities of elastic fibers, two of them on the floor of the mouth and one on the lingual alveolar mucosa, close to the floor of the mouth, in a patient with history of homolateral squamous cell carcinoma of the floor of the mouth, are presented. Comparison with elastofibromatous changes and elastofibromas are made and their possible pathogenesis is discussed. It is suggested that increased awareness may facilitate recognition of such lesions as they can be easily overlooked, especially when they do not present as discrete tumors or they are associated with other "more significant" pathologic processes.

Soft-tissue balancing during total knee arthroplasty in the varus knee.

Soft-tissue balancing during total knee arthroplasty is an important step in optimizing the mechanical balance of the knee joint. Soft-tissue contractures that result from varus coronal plane deformity can pose a difficult problem, and the surgeon should have a standard procedure for managing such situations in the operating room. Balance may be assessed intraoperatively with the use of spacer blocks, laminar spreaders, and tensioning devices as well as by placement of trial components. Techniques used to balance the varus knee during primary total knee arthroplasty include femoral component rotation, osteophyte resection, soft-tissue release, and bone resection. Flexion and extension gap balancing is crucial for long-term success and patient satisfaction.

Elastofibroma dorsi: estudio retrospectivo de seis casos / Retrospective analysis of 6 cases of elastofibroma dorsi

El elastofibroma dorsi es una lesión benigna de tejido fibroelástico, a menudo bilateral, localizada frecuentemente en la región subescapular, más común en mujeres de edad media y ancianas. La patogénesis es desconocida, y se ha sugerido que se trate de un proceso reactivo, degenerativo o neoplásico. Presentamos un estudio retrospectivo de los hallazgos observados en seis pacientes con elastofibroma dorsi. El elastofibroma debe plantearse en el diagnóstico diferencial de tumoraciones subcutáneas de localización escapular, ya que es una lesión benigna que sólo requiere tratamiento quirúrgico cuando es sintomático o muy grande. Técnicas no invasivas, como la ecografía, tomografía computarizada y especialmente la resonancia magnética pueden ser suficientes para orientar el diagnóstico, con estrecha correlación entre el cuadro histológico y las imágenes radiológicas específicas evitando biopsias y cirugías innecesarias (AU)

Elastofibroma dorsi is a benign lesion of fibroelastic tissue. It often presents bilaterally, is frequently localized to the subscapular region, and is more common in middle-aged and elderly women. The pathogenesis is still unclear but it has been suggested to involve reactive, degenerative, or neoplastic processes. We present a retrospective study of the findings from 6 patients with elastofibroma dorsi. Elastofibroma should be included in the differential diagnosis of subcutaneous scapular tumors, as it is a benign lesion that only requires surgery when associated with symptoms or the lesion is extensive. Noninvasive techniques such as ultrasonography, computed tomography, and, above all, magnetic resonance imaging, may be sufficient to guide diagnosis. The results of histology and imaging are closely correlated, so the need for unnecessary biopsy and surgery may beavoided (AU)

Elastic fiber depletion in the supporting ligaments of the gastroesophageal junction: a structural basis for the development of hiatal hernia.

BACKGROUND: The position of the gastroesophageal junction is maintained by a complex of fibroelastic ligaments. The purpose of this study was to characterize and compare the histology of these ligaments in patients with gastroesophageal reflux disease (GERD) and hiatal hernia (HH) versus GERD alone, with emphasis on the elastin morphology. STUDY DESIGN: Thirteen patients were examined at the time of laparoscopic fundoplication for symptomatic GERD; nine had no significant HH and four had large diaphragmatic hernias (GERD/HH). Tissue biopsies were obtained from the gastrohepatic ligament (GHL, n=5 and n=3, GERD and GERD/HH, respectively), the phrenoesophageal ligament (n=7 and n=4, respectively), and the gastrophrenic ligament (n=6 and n=4, respectively). Sections of fixed tissue were stained with hematoxylin and eosin, Masson's trichrome, and resorcin-fuchsin for analysis of elastic fibers by light microscopy, and elastin area was quantified and expressed as a percentage of the imaged tissue. RESULTS: Elastin and collagen fibers were prominent in all ligaments in patients with GERD alone. In patients with GERD/HH, there was fragmentation and distortion of elastin in the phrenoesophageal ligament and gastrohepatic ligament, and to a lesser degree, in the gastrophrenic ligament. Compared with patients with GERD alone, the presence of hiatal hernia was associated with a reduction in elastin area by more than 50% in the phrenoesophageal ligament ([mean +/- SEM] 31.0%+/-3.3% versus 15.1%+/-1.3%, p < 0.01) and gastrohepatic ligament (26.9% +/- 0.5% versus 12.5%+/-0.1%, p < 0.008). There was no decrease with respect to elastin in the gastrophrenic ligament. CONCLUSIONS: The periesophageal ligaments in patients with GERD are characterized by prominent elastic fibers. In contrast, GERD/HH is associated with depletion of elastic fibers in two of three ligaments supporting the gastroesophageal junction. Elastic fiber depletion in the periesophageal ligaments thereby provides a structural basis for the development of HH. It remains unclear if this represents a primary (etiologic) alteration or if it is a secondary phenomenon.

Elastic tissue damage in cephalic acquired cutis laxa.

Cutis laxa is a rare condition characterized by diminished elastic tissue. We report the histological changes from a 22-year-old male patient, who presented since 4 years hanging and inelastic facial skin, giving him an older appearance. The palpebral, preauricular and submandibular skin obtained after a facelift were examined. Conventional light microscopy with hematoxylin-eosin staining showed perivascular lymphocytic infiltrates and crossed-over collagen fibers. With Weigert staining, a lessening of elastic fibers with fragmentation, shortening and clumping was seen. The oxytalanic fibers in the papillary dermis were also affected, ranging from absence or reduction to flattening with clumping of the fibers, giving an irregular contour to the basal membrane zone. These findings were more intense in the palpebral skin. Transmission electronic microscopy showed reduction of the elastic fibers, a granular degeneration of the elastic tissue was found and collagen fibers were normal. Similar to light microscopy, at the ultrastructural level, the basal membrane has an irregular contour.

Primary pulmonary valve papillary fibroelastoma.

Papillary fibroelastoma (PFE) is a rare and benign cardiac tumor typically found on the valvular endocardium. In most cases, PFE is identified incidentally on echocardiography or during cardiac surgery. The patient was a 73-year-old man who had been treated for hepatocellular carcinoma for 5 years. On echocardiography, a 2.5-cm diameter mass was detected in the pulmonary trunk just above the pulmonary valve. Through a transpulmonary arterial approach with cardiopulmonary bypass, the mass identified on the commissure of the right and posterior pulmonary cusp was surgically excised together with the attached endocardium. Despite the benign histology of PFE, lethal embolic events such as stroke, myocardial infarction, and pulmonary embolism are reported in some cases. To prevent such complications, tumor identification and surgical excision are essential.

Elastofibroma dorsi has distinct cytomorphologic features, making diagnostic surgical biopsy unnecessary: cytomorphologic study with clinical, radiologic, and electron microscopic correlations.

Elastofibroma dorsi (EFD) is a relatively rare soft tissue mass, probably of reactive nature. The lesion is typically located near the inferior margin of the scapula or between the inferior part of scapula and the chest wall in elderly women. Although location of the tumor together with the age/sex of the patients and radiologic findings is often suggestive of the diagnosis, tissue examination has been considered necessary to confirm the diagnosis. Although the histologic features of EFD are well known, there are only four single case reports of the cytologic findings in the English language literature. We describe the cytologic features of EFD in five patients with correlations to clinical, radiologic, histologic, and electron microscopic findings. The current study suggests that the fine-needle aspiration (FNA) features are highly diagnostic, permitting a firm diagnosis of EFD in a typical clinical setting and eliminating the need for preoperative histologic examination.

Asymmetric medial degeneration of the intrapericardial aorta in aortic valve disease.

BACKGROUND: A geometrical and functional asymmetry in the normal aortic root has been recently demonstrated. Whether the distribution of medial degeneration (MD) within the wall of the dilated ascending aorta in adult patients reflects such asymmetry, still has to be assessed. METHODS: Nineteen patients with fibrocalcific aortic valve disease and dilatation of the intrapericardial aorta, without clinical signs and familiar history of primary elastic connective tissue disorders, underwent surgery. Biopsies (57 specimens) were taken in each patient from three areas of the ascending aortic wall distal to the three sinuses of Valsalva. MD lesions found at histology in each specimen were classified in three degrees. Comparisons were made between the three sites as to distribution of the three degrees and between one site and the other two as to incidence of the highest degree. RESULTS: A mild degree of MD was found in 26 specimens (45.6%), moderate in 14 (24.6%), severe in 17 (29.8%). The distribution of the three degrees of MD changes was significantly different between one of the three studied wall areas and the other two (P<0.001): a significantly greater incidence of the highest degree of involvement in the aortic wall distal to the non-coronary sinus than in the wall areas corresponding to the coronary sinuses was found (P<0.001). CONCLUSIONS: MD lesions in dilated intrapericardial aorta are more severe in the wall area distal to the non-coronary sinus, likely due to haemodynamic stress asymmetry.

Benign pseudotumorous lesion (fibroangiomyomatous hyperplasia with elastosis) in the gallbladder.

We describe a rare case of a benign pseudotumorous lesion (fibroangiomyomatous hyperplasia with elastosis) in the gallbladder in a 44-year-old Japanese woman, and discuss the rarity of elastosis in the gallbladder. To our knowledge, this case may be the first report of a pseudotumorous lesion of the gallbladder with elastosis in Japan.

Comparison of the 585 nm pulse dye laser and the short pulsed CO2 laser in the treatment of striae distensae in skin types IV and VI.

BACKGROUND: Striae distensae, or stretch marks, are a very common cosmetic problem. The successful management of stretch marks has long been a source of frustration and curiosity for both the clinician and the researcher. Recent studies suggest lasers may have a role in their management. As yet, no study has reported on the effects of either of these lasers in the treatment of stretch marks on persons with skin types 4 to 6. OBJECTIVE: To assess the efficacy of short pulsed CO2 laser and pulsed dye laser for the treatment of stretch marks in skin types 4, 5, and 6. METHODS: Four patients were initially enrolled in the study. All were female with abdominal stretch marks, present for a range of 8 to 19 years. The patients had skin types ranging from 4 to 6. The test area consisted of a stretch mark long enough to be divided into three contiguous 2 cm sections, labeled A, B, and C. Section A served as the short pulsed CO2 test site, section B served as a control, while section C served as the 585 nm pulsed dye site. Patients were seen for evaluation after 1 week, then every 4 weeks for a total of 20 weeks. Patients were evaluated subjectively by the investigators, and the patients' own self-evaluation was reported as well. RESULTS: Following the 585 nm pulse dye laser, at 20 week follow-up patients with type 4 skin showed no improvement, while type 6 skin showed hyperpigmentation. The short pulsed CO2 test site showed persistent erythema in type 4 skin and marked hyperpigmentation in type 6 skin. CONCLUSIONS: For patients with types 4, 5, and 6 skin, laser treatment of striae should be avoided or used with great caution.