A Frontal Sinus Osteoma Presenting as Periorbital Cellulitis

Osteoma is the most common benign tumor of the paranasal sinuses and the frontal sinus is the most frequently involved site. Osteomas are slow growing osteoblastic lesions commonly seen in the outer table of the calvarium, the mandible, the frontal and ethmoid sinus, and occasionally in tubular bones. They are usually detected during the second to fifth decades of life, and reported ratio of male to female is 1.5:1 to 2:1. The symptoms of osteomas are usually developed as gradual growth. They are headaches, facial pain, proptosis, decreased visual acuity, chemosis, diplopia, epiphora, nonpulsating exophthalmus, and transient blindness. Posterior intracranial extension of a frontoethmoid osteoma may lead to brain abscess, intracranial mucocele, tension pneumocephalus. We experienced a 60-year-old male patient who came to the emergency room with acute and severe left periorbital swelling, red eye, and epiphora lasted for 10 days. In a plain radiographs and computerized tomographic scans, a 2.5 x 2.5 x 3.0 cm well marginated mass impressed by osteoma in frontoethmoidal sinus was detected. After the symptoms subsided by conservative treatment, total excision was made by bicoronal approach. Authors reported a frontoethmoidal osteoma presenting periorbital cellulitis without orbital mucocele, which is very rare symptom.

Axillary Contracture Due to Seroma with Fibrous Capsule Formation after mastectomy: A case report

No abstract available.

Prevention of reperfusion injury with CD18 monoclonal antibody and superoxide dismutase

Prolonged ischemia results in cellular necrosis and only prompt restoration of blood flow will prevent this type of injury. However, reperfusion itself can cause significant injury of previously ischemic tissue, i.e. "reperfusion injury'. This is an issue of concern in many areas of reconstructive surgery including free tissue transfer and replantation. Many factors have been implicated in the cause of reperfusion injury. Oxygen free radicals have enjoyed increasing popularity recently, but leukocytes had been thought to have a role only in the healing process that follows ischemic injury. Current studies in myocardium, liver and intestine have shown a dramatic increase in tissue leukocytes after ischemia-reperfusion and evidence implicating leukocytes in pathogenesis of ischemia-reperfusion injury has come from studies demonstrating significant injury reduction by depletion of circulating neutrophils. Therefore, increased neutrophil adhesiveness is a critical early step in the sequence of events leading to neutrophil-mediated injury. The purpose of this study is to evaluate the effect of CDl8 monoclonal antibody(CDl8 mAb), blocking antibody of neutrophil adherence, and superoxide dismutase (SOD), free radical scavenger, on reperfusion injury in rat epigastric island skin flap. The epigastric pedicle was occluded for six hours with ambient temperature at 22+/-1degrees C. The epigastric nerve was carefully dissected out and left intact to minimize autocannibalization. The flaps were sutured back down to their beds over interposed silicone sheets to prevent plasmatic imbibition. Fifteen minutes before reperfusion, the flaps were perfused with saline, CDl8 mAb(1 mg/kg), SOD(20,000 unit/kg) or CDl8 mAh/SOD(1 mg/kg + 20,000unit/kg). Percentage of flap survival was assessed by computerized planimetry on the seventh day. Tissue biopsies for myeloperoxidase(MPO) and malonyldialdehyde (MDA) were obtained at 24 hours after reperfusion. The results were as follows. 1. Percentage of flap survival was significantly increased in CDl8 mAb/SOD, CDl8 mAb and SOD groups in order, compared to the control(P < 0.05). Percentage of flap survival was significantly increased in CDl8 mAb group as compared with SOD group(p < 0.05). Percentage of flap survival significantly increased in CDl8 mAb/SOD group as compared with CDl8 mAb and SOD groups(p < 0.05) 2. MPO activity was significantly decreased in CDl8 mAb/SOD, CDl8 mAb and SOD groups(p < 0.01). MPO activity was significantly decreased in CDl8 mAb group as compared with SOD group. (p < 0.01). 3. MDA content was significantly decreased in CDl8 mAb/SOD, CDl8 mAb and SOD groups (p < 0.01), but the difference between CDl8 mAb and SOD groups was not significant. From those above results, we get to the conclusion that blocking neutrophil adherence and/or aggregation with monoclonal antibodies to CDl8 as compared with radical scavenger significantly ameliorates reperfusion injury. It is suggested that combination of modalities with antiadhesion therapy and radical scavenger may have a synergistic effect of improving flap survival and may be the optimal prevention of ischemiareperfusion injury.

Prevention of reperfusion injury with CD18 monoclonal antibody and superoxide dismutase

Prolonged ischemia results in cellular necrosis and only prompt restoration of blood flow will prevent this type of injury. However, reperfusion itself can cause significant injury of previously ischemic tissue, i.e. "reperfusion injury'. This is an issue of concern in many areas of reconstructive surgery including free tissue transfer and replantation. Many factors have been implicated in the cause of reperfusion injury. Oxygen free radicals have enjoyed increasing popularity recently, but leukocytes had been thought to have a role only in the healing process that follows ischemic injury. Current studies in myocardium, liver and intestine have shown a dramatic increase in tissue leukocytes after ischemia-reperfusion and evidence implicating leukocytes in pathogenesis of ischemia-reperfusion injury has come from studies demonstrating significant injury reduction by depletion of circulating neutrophils. Therefore, increased neutrophil adhesiveness is a critical early step in the sequence of events leading to neutrophil-mediated injury. The purpose of this study is to evaluate the effect of CDl8 monoclonal antibody(CDl8 mAb), blocking antibody of neutrophil adherence, and superoxide dismutase (SOD), free radical scavenger, on reperfusion injury in rat epigastric island skin flap. The epigastric pedicle was occluded for six hours with ambient temperature at 22+/-1degrees C. The epigastric nerve was carefully dissected out and left intact to minimize autocannibalization. The flaps were sutured back down to their beds over interposed silicone sheets to prevent plasmatic imbibition. Fifteen minutes before reperfusion, the flaps were perfused with saline, CDl8 mAb(1 mg/kg), SOD(20,000 unit/kg) or CDl8 mAh/SOD(1 mg/kg + 20,000unit/kg). Percentage of flap survival was assessed by computerized planimetry on the seventh day. Tissue biopsies for myeloperoxidase(MPO) and malonyldialdehyde (MDA) were obtained at 24 hours after reperfusion. The results were as follows. 1. Percentage of flap survival was significantly increased in CDl8 mAb/SOD, CDl8 mAb and SOD groups in order, compared to the control(P < 0.05). Percentage of flap survival was significantly increased in CDl8 mAb group as compared with SOD group(p < 0.05). Percentage of flap survival significantly increased in CDl8 mAb/SOD group as compared with CDl8 mAb and SOD groups(p < 0.05) 2. MPO activity was significantly decreased in CDl8 mAb/SOD, CDl8 mAb and SOD groups(p < 0.01). MPO activity was significantly decreased in CDl8 mAb group as compared with SOD group. (p < 0.01). 3. MDA content was significantly decreased in CDl8 mAb/SOD, CDl8 mAb and SOD groups (p < 0.01), but the difference between CDl8 mAb and SOD groups was not significant. From those above results, we get to the conclusion that blocking neutrophil adherence and/or aggregation with monoclonal antibodies to CDl8 as compared with radical scavenger significantly ameliorates reperfusion injury. It is suggested that combination of modalities with antiadhesion therapy and radical scavenger may have a synergistic effect of improving flap survival and may be the optimal prevention of ischemiareperfusion injury.

Surgical treatment of livedo vasculitis

Livedo vasculitis is thought to be a thrombogenic disorder that is related to the autoimmune disease. It clinically shows purplish mottling and recurrent painful ulcers in the lower extremities, leaving atrophie blanche after healing of the ulcers. Histopathologic finding are thrombotic occlusion in the mid-dermal vessels without necrotizing vasculitis. The therapeutic approach has largely been made by the use of drugs that stimulate endogenous fibrinolytic activitiy, that inhibit thrombus formation, or that cause vasodilation, but surgical intervention by excision and skin graftion has rarely been reported as a primary treatment.In our experience, two patients with livedo vasculitis, who had been unresponsive to various medications, were treated with wide excision and several times of skin grafting. And they experienced complete healing without recurrence.

Augmentation rhinoplasty in Patients with Traumatic nasal Deformities

Nasal dorsal suppor may be weakened or lost during the corrective rhinoplasty procedures such as resection of dorsal deviation, osteotomies and reposition of deviated nasal bones, and incision, fracture, resection or scoring of the dorsal septal strut especially in the small flat noses. Partial or total augmentation of the nasal dorsum has an important role in the correction of asymmetry and restoration of aesthetic balance in the considerable amount of traumatic nasal deformities. We reviewed medical records, pre- and postoperative photographs of 53 patients with traumatic nasal deformities, which had been corrected by augmentation rhinoplasties. The majority of the patients were male (70%), ages of twenties and thirties (79%), injection by automobile accident, fist blows, and sports activities (76%), and were operated more than 3 years after injury (74%). Types of deformities were deviation only (47%), depression only (23%), deviation and depression (19%), deviation and hump (8%), and depression and widening (6%). At least two corrective procedures were needed in the deviated deformities and one procedure in the depressed deformities. Materials for augmentation were silicone implants in 55% and autogenous tissues in 45%. In terms of postoperative complications, displacement and/or absorption were observed in 6 of 24 (25%) autogenous augmentations and displacement and/or swelling in 8 of 29 (27.6%) silicone augmentations.