Tubal Buccal Mucosa Graft without Anastomosis of the Proximal Urethra for Long Segment Posterior Urethral Defect Repair

A 31-year-old man was referred for further management of a urethral stricture. He was a victim of a traffic accident and his urethral injury was associated with a pelvic bone fracture. He had previously undergone a suprapubic cystostomy only owing to his unstable general condition at another hospital. After 3 months of urethral injury, direct urethral anastomosis was attempted, but the surgery failed. An additional 4 failed internal urethrotomies were performed before the patient visited Chungbuk National University Hospital. Preoperative images revealed complete posterior urethral disruption, and the defect length was 4 cm. We performed a buccal mucosa tubal graft without anastomosis of the proximal urethra for a long segment posterior urethral defect. The Foley catheter was removed 3 weeks after the operation and the patient was able to void successfully. After 8 months, he had normal voiding function without urinary incontinence.

Application of Mini-abdominoplasty after Conservative Excision of Extensive Cesarean Scar Endometriosis

Endometriosis is defined as the presence of functioning endometrial tissue outside the uterine cavity, and the standard treatment is extensive surgical excision. Cesarean scar endometriosis is a type of cutaneous endometriosis arising on or near a Cesarean section scar. A 44-year-old woman presented with a 9x6 cm sized dark-brown, stony-hard, irregular, lower abdominal mass of four years duration. The patient had a history of two Cesarean deliveries, 14 and 16 years ago. Suspecting endometriosis, we excised the tumor conservatively rather than extensively to prevent incisional hernia considering the benign nature of the tumor and the low possibility of recurrence because the patient's age was near menopause, along with simultaneous bilateral salpingo-oophorectomy that was performed in this case. On reconstruction, mini-abdominoplasty was adopted to avoid possible wound complications and cosmetic deformities. The patient was satisfied with the cosmetic results, and neither recurrence nor functional problems occurred during the 1-year follow-up period. Plastic surgeons should keep in mind the possibility of cutaneous endometriosis in an abdominal mass of a female of reproductive age with a previous history of pelvic or intra-abdominal surgery. An optimal result from oncological, functional, and cosmetic standpoints can be achieved with conservative excision followed by mini-abdominoplasty of extensive Cesarean scar endometriosis.

Squamous Cell Carcinoma and Basal Cell Carcinoma Simultaneously Arising in a Nevus Sebaceus: A Case Report

PURPOSE: Nevus sebaceus is a congenital hamartomatous lesion, typically involving head and neck. Various benign and malignant neoplasms can develop in association with nevus sebaceus. We report a case of simultaneous occurrence of squamous cell carcinoma and basal cell carcinoma in nevus sebaceus. METHODS: A 73-year-old man presented with erythematous to black verrucous nodules on the right subauricular area. The upper part was accompanied with inflammation and ulceration, and no specific findings suspicious for malignant degeneration were found in the lower part preoperatively. The mass was totally excised and the defect was directly closed. Lymph nodes were not involved on concomitant neck dissection. RESULTS: Histopathologic examination confirmed the presence of squamous cell carcinoma in the upper part and basal cell carcinoma in the lower part of a nevus sebaceus. Negative margins were achieved on resection. No clinical problems were found during the 3-month follow-up period. CONCLUSION: We experienced a rare case of simultaneous occurrence of squamous cell carcinoma and basal cell carcinoma within the same nevus sebaceus. Because patients with nevus sebaceus have risk of malignant changes, surgical excision and work-up for recurrence and metastasis should be considered in suspicious cases. And even in a totally asymptomatic case, the possibility of occult secondary cancer should be informed before surgery in aged patients.

The effects of midazolam administered postoperatively on emergence agitation in pediatric strabismus surgery / 대한마취과학회지

BACKGROUND: The present study tested the effect of midazolam administration after sevoflurane anesthesia against emergence agitation in children in the recovery phase. METHODS: A total of 60 children presenting for ophthalmic surgery under sevoflurane anesthesia were randomly placed in four groups from Group I to Group IV. Before the end of the surgery, we injected normal saline 2 ml in Group I and Group IV. We administered a 2-ml mixture of midazolam 0.025 mg/kg and midazolam 0.050 mg/kg to Group II and Group III respectively. Among the patients with agitation scores 4 or 5 in the peostanesthesia care unit (PACU), Group IV patients were intravenously given a 1-ml mixture of midazolam 0.025 mg/kg and normal saline up to 3 times. Agitation parameters, anesthesia recovery times, and the total administration amounts of midazolam were measured. RESULTS: Extubation time was significantly longer and maximum agitation scores higher in Group III than in Group I. The rate of the length of the period when the agitation score was 4 or 5 out of the length of stay in the PACU was significantly lower in Group II, Group III, and Group IV than in Group I. The length of stay in the PACU was significantly longer in Group III, and Group IV than in Group I. CONCLUSIONS: For pediatric patients under sevoflurane anesthesia, postoperative midazolam administration slightly prolonged the length of stay in the PACU. But it effectively reduced emergence agitation without any side effects.

Pasteurized Tumoral Autograft for the Reconstruction of Monostotic Fibrous Dysplasia in Frontal Bone

PURPOSE: For the best possible aesthetic reconstruction after craniofacial bone tumor resection, pasteurization has been adopted to devitalize neoplastic cells while maintaining osteoinductive properties and mechanical strength. This case report aims to demonstrate a long-term follow-up result of a monostotic fibrous dysplasia in frontal bone which was reconstructed by pasteurized tumoral autograft in situ. METHODS: A 14-year-old girl presented with a hard, nontender, slowly growing mass of 6-year duration on her left supraorbital area. CT showed 5 x 4 x 3 cm sized well defined bony mass confined to frontal bone with heterogeneous density. Tumor was excised completely through bicoronal approach and reimplanted to its original site after pasteurization at 60feminineC for 30 minutes. The pathologic examination confirmed fibrous dysplasia. RESULTS: She revisited our clinic 5 years later after suffering some assault on her face. On CT examination, pasteurized tumoral autograft was incorporated to host bone except the fractured upper orbital rim without any evidence of recurrence. She has been satisfied with the result. CONCLUSION: Pasteurization offers a simple, reliable, cosmetic, economic, and durable reconstruction method for craniofacial skeletal tumor. It has advantages of both biologic incorporation ability and mechanical strength without risk of recurrence. So, it should be considered as one of the primary options in benign as well as resectable malignant tumors of craniofacial skeleton.

Tamoxifen Induced Corneal Opacity in Breast Cancer Patient

Since 1970's, Tamoxifen has been used as an antiestrogen agent for adjuvant hormonal therapy, targeting hormone receptor positive breast cancer. Tamoxifen has adverse side effects such as menopausal hot flush, vaginal discharge, irregular menses, thromboembolism, and uterine endometrial carcinoma. Tamoxifen has structure and side effects similar to amphiphilic cationic agents like chlorpromazine, thorazine, amiodarone, and chloroquine. With long period use in high dose, tamoxifen can cause ocular side effects such as retinal crystalline deposition, macular edema, whorl-like corneal opacities, posterior subcapsular lens opacities, optic neuritis, and affected EOG. Recently several reports showed that ocular side effect could happen even in low dose standard treatment. We experienced a case of keratopathy of corneal opacity without disorder of retina, lens, and optic nerve in low dose tamoxifen therapy for breast cancer.

Surgical Treatment of Cloverleaf Skull Deformity under the Concept of Comprehensive Cranioplasty

Cloverleaf skull deformity is not a syndrome or a disease, but one of the most severe forms of craniosynostosis which may or may not be associated with various syndromes such as achondroplasia, Crouzon's disease or Apert's syndrome. This deformity accompanies serious elevation of intracranial pressure which necessitates early surgical intervention to avoid death, mental retardation, and decreased visual acuity. Until recently, near total calvariectomy, staged anterior and posterior cranioplasty, and total calvarial remodelling using barrel stave osteotomy are used, but result in limited success only. High mortality and morbidity rates are related to multiple operations with long operation time in young age, difficulties in maintenance of patient position, and persistent deformity and bony defect. Therefore, the authors integrated various cranioplasty techniques originally developed for simple skull deformities and modified them according to the exact nature of the individual deformities under the unique original concept of 'Comprehensive Cranioplasty'. A fourteen week old male patient presented with trilobed skull shape, bony constriction band between the lobes, prominent forehead, flat occiput, and enlarged scalp veins. Three dimensional CT scan revealed premature fusion of total cranial sutures including metopic, sagittal, bilateral coronal, lambdoidal, and squamosal sutures. To release all the closed sutures and to correct the deformity in three dimensions, we adopted various cranioplasty techniques under the concept of comprehensive cranioplasty as follows; first, release of all cranial sutures by frontal craniotomy, bilateral temporal craniotomy, bilateral parasagittal strip craniectomy, and bilateral partial lambdoidal strip craniectomy, second, lengthening of skull anteroposterior dimension by fronto- orbital advancement and modified calvarial remodelling (infracture & outfracture), third, reduction of skull width by barrel stave osteotomy and bilateral parasagittal strip craniectomy, four, reduction of skull height by modified calvarial remodelling and split and transposition of craniotomized frontal bone segment, which also correct flat occiput and prominent forehead, respectively. All the operative procedures were performed under supine position. Without modified prone position, posterior cranium could be exposed to the inion level and it is sufficient to do the partial lambdoidal strip craniectomy and backcut osteotomy. We think modified prone position is not needed even in cases of posterior cranial deformity unless complete removal, ex vivo remodelling, and reattachment of occipital cranium are necessary. Eighteen months after the operation, the patient shows significant growth and improvement on both functional and aesthetic aspects despite persistent microcephalus, and insufficient reduction in cranial height and width. In summary, the authors experienced a quite satisfactory result both functionally and aesthetically in a complex cloverleaf skull deformity patient by combination and modification of previously developed various cranioplasty techniques according to the exact nature of the individual deformities under the concept of comprehensive cranioplasty.