The Effect of Sphingosine-1-Phosphate in Survival of Grafted Fat Tissues

PURPOSE: Autologous fat grafting is a popular procedure for the correction of the soft tissue depression and deformity. But there are several issues required to be carefully considered in relation to this procedure, mainly about the unpredictability and the low survival rate of the grafted fat due to absorption and partial necrosis. Sphingosine-1-phosphate (S1P) is a lysophospholipid mediator that has been proposed to promote angiogenesis and to regulate the differentiation of adipose derived stromal cells (ASCs). In this study, we analyzed the viability of the grafted fat tissue mixed with S1P into each 12 nude mice (cann.cg-fox1nu/crlori) compared to the group of mice grafted fat tissue only. METHODS: Human aspirated fat was grafted subcutaneously into the backs of 8-week-old nude mice with or without S1P. Eight weeks later, the grafted fat was harvested and the weight and volume were checked. The fat was stained with hematoxylin-eosin and 4',6-diamidino-2-phenylindole. RESULTS: S1P group weighed significantly more than the control group (p=0.009), and the volume from the S1P group was considerably larger than that of the control group (p=0.004) either. In histological features, the surviving layer of the S1P group was thicker than the control group and microvasculature appeared to be prominent in the S1P group, especially in the outer layers. CONCLUSION: These findings suggest that S1P plays a vital role in the soft tissue augmentation, potentially providing a novel point of the control in adipose tissue for microfat graft.

Correction of High Fold without Skin Excision

PURPOSE: Double-eyelid operation is one of the most common cosmetic operations among Korean patients. In such operations, however, the complexity of and individual differences in the patients' anatomical structures may cause various complications, such as asymmetry, retraction of the eyelid, and the occurrence of a high fold. A high fold occurs frequently, and its correction is not very simple. Many methods have been developed to correct it, and among these, the operation involving the excision of the skin between the previous double-eyelid line and the new double-eyelid line is usually selected by plastic surgeons. In many cases, however, patients have insufficient eyelid skins for this operation. In this study, the authors introduce an operation procedure for high-fold correction that does not involve skin excision METHODS: From June 2005 to June 2009, 246 cases were treated with this procedure. After the incision of the new double-eyelid line, dissection was done between the previous scar tissue and the levator aponeurosis. Then the orbital septum, orbital fat or the retro-orbicularis oculi fat was slid down and sutured with a tarsal plate. Such sutures were repeated at four to five points, including the lateral and medial limbus, to prevent the reattachment of the previous scar and to create a new double-eyelid line at the end of the orbital septum. RESULTS: Most of the high-fold patients were satisfied with the procedure described above. Their previous scar was hidden under the new double-eyelid line after the operation. In the six cases, the scar was visible in the patients who had a very high and deep inner line. As such, scar revision was undertaken three months after the operation. It is known that scar revision is also required after an operation involving skin excision in the case of a very high inner-eyelid line. CONCLUSION: This method is an appropriate procedure for high-fold correction for patients who have insufficient upper-eyelid skin.

Experience and Analysis of Managing Deflated Mammary Bags

With the rising of augmentation mammaplasty, deflation of implant is increasing. So authors investigated and analyzed on patients who were treated due to deflation. Subjects were 15 patients(16 breasts) from September 1995 to March 2006. Authors had been investigated and analyzed the method of augmentation mammaplasty, types of breast implant, duration until deflation occurred, duration to reoperation, reoperation method and patient satisfaction. The follow-up period after reoperation was 33 months. The methods of augmentation mammaplasty were 13 patients(13 breasts) for transaxillary approach, 1 patient(1 breast) for inframammary approach and 1 patient(2 breasts) for periareolar approach. Location of implants was subpectoral plane. 2 patients(2 breasts) had silicone bag and 13 patients(14 breasts) had saline bag. The average time elapsed to deflation was 36 months. The elapsed time to reoperation were within 1 month(12 breasts), 4 months(1 breast), 6 months(1 breast), 7 months(1 breast) and 10 months(1 breast). The removal of mammary bag was performed only for 3 patients(3 breasts) and reaugmentation was performed for the rest of them, 12 patients(13 breasts). In reaugmentation, most of patients received the previous approach again. In case of reoperation, partial capsulectomy was performed. There were no patients of deflation. The patients had found good satisfaction in our management.

Correction of Sunken Upper Eyelids Using Incisional Double Eyelidplasty and Autologous Microfat Grafting into Orbital Septum

Sunken upper eyelids are one of the common and complicated problems that occur with an aging process or after double eyelidplasty. Autologous microfat grafting is a technique that has frequently been used for sunken eyelids. The traditional blind method of microfat grafting has a some complications. Therefore, we performed the open method with incisional double eyelidplasty. Between June, 2005 and February, 2008, we performed incisional double eyelidplasty and autologous microfat grafting into orbital septum in 63 patients(124 cases) with sunken upper eyelids. The fat was harvested from periumbilical regionand centrifuged at 3000 rpm for 3 minutes. After the middle fat layer was obtained by 1cc syringe, we made skin incision and separated orbital septum(inner layer) and levator aponeurosis. And then, we injected the microfat into orbital septum with 0.9 mm blunt cannula. At this time, one of the important things was to make the patient gaze upward during the fat injection. All the patients were satisfied, except 5 cases which were 3 cases of undercorrection and 2 cases of asymmetry. Surgical revision was required for only the above 5 cases(4%). Patients with some transient complications of ptosis (13 cases), overcorrection(4 cases) and nodular appearance(2 cases) were self-improved. We found that the method using incisional double eyelidplasty and autologous microfat grafting into orbital septum has many advantages which include less traumatic, less complication rate, less absorption rate of fat. and less burden of patients.

A Case of Spinal Cord Ependymoma resulting in Superficial Siderosis

A 63-year-old woman developed left leg weakness, bilateral sensorineural hearing loss and headache. Brain MRI showed a hypointense rim on the surfaces of the cerebellum, brainstem, and cerebral cortex indicating superficial siderosis. Further examination showed an intramedullary ependymoma at the level of T12-L2. We report a patient with a spinal cord ependymoma resulting in superficial siderosis of the central nervous system.

Ataxic Variant of Guillain-Barre Syndrome Associated with Anti-GD1b Ig G Antibody

It is known that anti GD1b antibody bind to the cerebellar granular layer or spinocerebellar Ia fiber. We recently encountered a patient of Guillain Barr syndrome (GBS) showing marked cerebellar ataxia and relatively mild quadriparesis but completely intact extraocular eye movement. Markedly high IgG anti GD1b antibody titer was identified from the patient's serum. The nerve conduction study showed reduction of compound muscle action potential without evidence of perpheral nerve demyelination. We report an ataxic variat of GBS associated with anti GD1b IgG antibody.

Selective Neurectomy of Medial Gastrocnemius Muscle for the Calf Reduction

No abstract available.

A Case of Huge Sized Kimura's Disease

Kimura's disease is a rare chronic inflammatory condition characterized by proliferation of vascular endothelial cells, lymphoid infiltration, and mixed inflammatory cells infiltrated with numerous eosinophils. That was known in Western literature as angiolymphoid hyperplasia with eosinophilia and many reports have used the terms synonymously. But the histological features between the 2 disorders have been proved to be distinctive and the 2 terms should not be used synonymously. A case of huge sized(24x12x10cm) Kimura's disease, the patient was 20-year-old male who has painless soft mass on his right cheek. Preoperatively, proteinuria(2+), serum eosinophilia(27.7%), increased serum Ig E(above 2500 IU) were noted in laboratory tests. Histologically, mixed inflammatory cells infiltrated with numerous eosinophils and reactive lymphoid follicles with germinal center were observed, and the proliferation of typical high endothelial venules was observed, also. He was treated by surgical excision of mass, systemic steroid therapy, and focal radiotherapy. During the follow-up of 3 years, the lesion was not recurred and no proteinuria, decreased serum eosinophilia and serum Ig E were noted in laboratory test. We experienced the treatment of huge sized Kimura's disease without recurrence and a case is presented with the review of literature.

A Comparative Study of Nerve Regeneration on End-to-Side and End-to-End Neurorrhaphy in Rats

The surgical methods of injured peripheral nerve were limited to end-to-end neurorrhaphy, nerve graft, neurotization, etc. Recently, Several studies were executed about end-to-side neurorrhaphy in peripheral nerve injury. The purpose of this study is to investigate the axonal regeneration of end-to-side neurorrhaphy in rats, as alternative surgical method for peripheral nerve injury comparing with the state of normal, denervated, and end-to-end neurorrhaphy. Sixty female Sprague-Dawley rats were divided into four groups; group I as normal control group, group II as denervated control group, group III as end-to-end neurorrhaphy group, group IV as end-to-side neurorrhaphy group. At postoperative 4, 8, 12, 16, 20 and 24 week, nerve regeneration was assessed through electrophysiologic and histological studies. The results obtained were as follows: 1. In electrophysiologic test, the mean amplitude was higher in normal control group(group I) than either in end-to-end neurorrhaphy group(group III) or in end- to- side neurorrhaphy group(group IV)(p < 0.05). But there is no significant difference between group III and group IV. 2. The mean number of regenerating myelinated nerve fibers was higher in group I than either in group III or in group IV(p < 0.05). But there is no significant difference between group III and group IV, except at postoperative 16 week. 3. The mean number of motor end-plates at postoperative 24 week was 20.5 in group III and 18.2 in group IV, but there is no significant difference between group III and group IV. In conclusion, end-to-side neurorrhaphy through an epineural window could induce distal nerve regeneration by collateral sprouting of main peripheral nerve and positively reflected in functional improvement of the target muscle.