Phenol content, antioxidant and tyrosinase inhibitory activity of mangrove plants in Micronesia

OBJECTIVE@#To find out and compare the in vitro antioxidant and tyrosinase inhibitory activities of two species of mangrove plants.@*METHODS@#Mangrove samples were harvested at the shoreline on the island of Weno, Chuuk State in Micronesia. The phenol content, antioxidant activity (based on DPPH-free radical scavenging) and tyrosinase inhibitory activity in different tissues (leaves, barks and roots) of Rhizophora stylosa (R. stylosa) and Sonneratia alba (S. alba), collected from the island of Weno.@*RESULTS@#Total phenol content ranged from 4.87 to 11.96 mg per g of freeze dried samples. The highest antioxidant activity was observed in R. stylosa bark (85.5%). The highest tyrosinase inhibitory activity was found in S. alba bark. Also, total phenol content and antioxidant activity were higher in methanol extracts than in aqueous extracts.@*CONCLUSIONS@#Taken together, the results of this study proved that mangroves can be excellent sources of antioxidant compounds.

Use of mini-implants to avoid maxillary surgery for Class III mandibular prognathic patient: a long-term post-retention case / 대한치과교정학회지

Because of the potential morbidity and complications associated with surgical procedures, limiting the extent of orthognathic surgery is a desire for many orthodontic patients. An eighteen-year-old woman had a severe Class III malocclusion and required bi-maxillary surgery. By changing the patient's maxillary occlusal plane using orthodontic mini-implants, she was able to avoid the maxillary surgery; requiring only a mandibular setback surgery. To accurately predict the post-surgery outcome, we applied a new soft tissue prediction method. We were able to follow and report the long-term result of her combined orthodontic and orthognathic treatment. The changes to her occlusal plane continue to appear stable over 6 years later.

The Clinical Characteristics of Lower Lumbar Osteoporotic Compression Fractures Treated by Percutaneous Vertebroplasty : A Comparative Analysis of 120 Cases

OBJECTIVE: The purpose of this study is to provide accurate understanding of clinical presentations and surgical outcomes as well as to identify the unique characteristics of lower lumbar osteoporotic compression fracture (OCF). METHODS: Clinical data were collected from 120 patients who had L3, L4 or L5 percutaneous vertebroplasty (PVP) performed from 2008 to 2012 at the single institute. L4 or L5 PVP patients were classified into group 1 and group 2 was for L3 PVP patients. Medical records were retrospectively investigated at 1 month after PVP. Long term follow-up results were obtained at a median value of 22 months after PVP. RESULTS: 75% of the patients in group 1 were not associated with traumatic events, 71% presenting with leg radiating symptoms and 46% requiring an additional decompressive surgery, more often than those in group 2. These differences are statistically significant (p<0.05). The short term medical record review demonstrated that only 73% of patients in group 1 were ameliorated with regard to back motion pain, whereas those in group 2 reported 87.7% rates of amelioration in identical category (p<0.05). The long term follow up confirmed a significantly worse outcome in group 1, with only 55.7% of patients reporting amelioration in their pain or functional status, but 71.7% rate of amelioration in group 2. CONCLUSION: The OCFs at the L4 or L5 level have different clinical characteristics from those at upper levels of the lumbar spine.

Microsurgical Experience with Supraorbital Keyhole Operations on Anterior Circulation Aneurysms

OBJECTIVE: Conventional pterional approach is a commonly used neurosurgical technique for the treatment of cerebral aneurysms. However, this technique requires more extensive brain exposure than other key hole approaches and is sometimes associated with surgical traumatization or cosmetic problems. The aim of this study was to compare the postoperative outcome between pterional and supraorbital keyhole approaches in the patients with anterior circulation aneurysms. METHODS: The authors reviewed patients with anterior circulation aneurysms who underwent aneurysm clipping via pterional or supraorbital keyhole approach at a single institute over a period of 2 years. Ninety-eight patients harboring 108 aneurysms were included in this study. Various outcomes were recorded, which included clinical grade, cosmetic problems, patients' satisfaction and complications such as chewing discomfort, frontal muscle weakness, hyposmia, infection. RESULTS: The supraorbital approach exhibited a shorter operation time compared with the pterional approach. Complications such as chewing discomfort occurred less frequently in the supraorbital approach group. Moreover, the cosmetic outcome was significantly better in the supraorbital group than in the pterional group. CONCLUSION: The supraorbital keyhole approach reduced intra- and postoperative complications, including chewing discomfort and cosmetic disturbances, compared with the conventional pterional approach.

Benign Brachial Plexus Nerve Sheath Tumor: Schwannoma: A Case Report

Benign peripheral nerve sheath tumors arising from the brachial plexus are rare, in general have a good prognosis. And the most common tumor arising from peripheral nerves is the schwannoma(also called neurilemoma or neurinoma). Malig- nant transformation is extremely rare. The tumors are composed of Schwann cells which support the peripheral nerve fibers, and are neuroectodermal in origin. We will present a case of brachial plexus schwannoma with surgical excision of anterior supraclavicular approach.

Infranuchal Infrafloccular Approach to the More Vulnerable Segments of the Facial Nerve in Microvascular Decompressions for the Hemifacial Spasm

OBJECTIVE: We investigated the locations of compressing vessels in hemifacial spasm. To approach compression sites, we described and evaluated the efficacy of the infranuchal infrafloccular (INIF) approach. METHODS: A retrospective review of 31 consecutive patients who underwent microvascular decompression (MVD) through INIF with a minimum follow-up of 1 year was performed. Along the intracranial facial nerve, we classified the compression sites into the transitional zone (TRZ), the central nervous system (CNS) segment and the peripheral nervous system (PNS) segment. The INIF approach was used to inspect the CNS segment and the TRZ. Subdural patch graft technique was used in order to achieve watertight dural closure. The cranioplasty was performed using polymethylmethacrylate. The outcome and procedure-related morbidities were evaluated. RESULTS: Twenty-nine patients (93%) showed complete disappearance of spasm. In two patients, the spasm was resolved gradually in 2 and 4 weeks, respectively. Late recurrence was noted in one patient (3%). The TRZ has been identified as the only compression site in 19 cases (61.3%), both the TRZ and CNS segment in 11 (35.5%) and the CNS segment only in 1 (3.2%). There was no patient having a compressing vessel in the PNS segment. Infection as a result of cerebrospinal fluid leak occurred in one patient (3%). Delayed transient facial weakness occurred in one patient. CONCLUSION: The TRZ and the CNS segment were more vulnerable area to the compression of vessels. We suggest that surgical avenue with the INIF approach provides early identification of this area.c

Studies on the Proper Storage Period and Change of -20 degrees C Cryopreserved Adipocyte

The use of autologous fat grafts has questionable clinical value due to unreliable grafts survival. For the purpose of improved graft survival, re-implantation of cryopreserved adipocytes is developed. The purpose of study is to analyze the changes of freeze-preserved adipocytes and to find out efficient long-term storage period. After centrifugation of aspirated abdominal tissues, 10ml of packed adipocytes were freezed at -20 degrees C (n=70). For 6 months, each 10 frozen samples were taken and analyzed at 1 month interval. Significant volume changes were observed in cryopreservation for 3 months (p < 0.05). The profiles of total lipid and FFA were not changed and no significant difference in saturated fatty acid ratio with gas chromatography. No histologic changes were observed, independent of the freezing period with H & E stain. The reduction of mitochondrial enzymatic activity was observed independent of time interval but activity of mitochondrial dehydrogenase was reduced less than 50% in XTT assay. On the basis of these data, -20 degrees C freezing for 6 months has no adverse effect to adipocytes, but frigile adipocytes, damaged cell membrane during harvest procedure, were disrupted within 1month and the maximum volume reduction were followed less than 3 months. These results demonstrate that tissue preparation cells with no cell membrane damage have the greatest viability level and cryopreservation less than 3 months has great volume effect.

Clinical Comparative Study of Continuous Method and Internal Perforating Method for Nasal Lateral Osteotomy

Recently many studies have demonstrated that perforating method of lateral nasal osteotomy causes less edema and echymosis than those of continuous method of lateral nasal osteotomy. For lessening the damage of nasal mucosa, authors performed continuous nasal lateral osteotomy(NLO) with an aid of silastic strip insertion into the subperiosteal pocket on the medial side of nose along the line of osteotomy. NLO was performed in 5 patients for correction of bony abnormality. In each patient, internal perforating NLO was performed on one side of nasal bone using 2-mm straight osteotome and protected continuous NLO was performed on the other side using 4-mm curved guided osteotome. The condition of nasal mucosa was checked using endoscopy immediately after the procedure. On postoperative days 2, 7, 14, and 21 the degrees of ecchymosis and edema of each side evaluated using clinical photos(Canon EOS 300D). Mild edema and ecchymosis were observed in both sides on postoperative days 2, 7, 14, there were no significant differences between right side and left side. This study confirmed that concerning postoperative ecchymosis and edema there were no significant differences between in protected continuous NLO and in perforating NLO. We conclude that whatever the technique of NLO, the degrees of post operative edema and ecchymosis may depends on the degree of nasal soft tissue trauma.

An Analysis of Frontal Photographs Using "Balanced and Proportional Measurement"

In the morphologic study on the face, it is very important fact that one must analyze not only anomalous structures but also proportional problems of face. Authors analyzed photographs in frontal views of Korean and Western famous female entertainers, which was secondary and supplementary analysis after "BAPA (Balanced Angular Profile Analysis)" This was also a preliminary study for developing a new computerized program of facial analysis. Authors extracted 56 famous female entertainers' photographs (30 Koreans, 26 Westerns) from Internet websites. When performing sampling procedures, authors made strict criteria for selection of photographs in frontal view. We executed 20 proportional measures and 4 angular measures for the analysis. Statistical analysis using SAS program (Version 8.1. USA), was performed. Data from each group(Korean versus Western) were presented to show the means, ranges, P and F values, and standard deviations of each measurement. In addition, the Student t-test(with significance level set to P=0.05) was performed to compare the two groups. Significant between-group proportional differences(P<0.05) were found for middle face height, brow height, interpupil width, eye fissure width, nasal height, interala width, upper lip height, and mandible height but no significant racial differences were found in terms of several proportions and all of the angular measures. If automated computer program is developed based on our data, we can use our data for useful tools for the first consultation process, and suggest that appropriate and harmonious aesthetic operations should be considered reflecting these differences.

Lipoabdominoplasty with Litmited Central Undermining

The classic abdominoplasty still provides the best results, despite many advances in abdominoplasty techniques. Performing liposuction and at the same time abdominoplasty is associated with a relatively high incidence of complication especially in patients with wide undermining of the abdominal flap. So, when performing the liposuction and abdominoplasty at the same time, cautious suctioning with small cannulas in the upper abdominal flap is recommended. Most perform liposuction and abdominoplasty separately, with 6-month interval between procedures to avoid involvement of the blood vessel. In 1992, Illouz published a technique of abdominoplasty without undermining that was used in obese patients with pendulous abdomens in which an enbloc resection followed by superior lipoplasty and limited plication of abdominal recti muscle. Authors present a new surgical approach to the aesthetic treatment of the abdominal region, especially upper abdomen, which uses the principles of liposuction and the traditional abdominoplasty with limited central undermining flap. Lipoplasty proceeds from the region above the umbilicus to the flank and the skin is resected as in classical abdominoplasty, but a thinner fatty layer with its connective tissue is preserved. The limited central undermining is done for the correction of diastasis recti in upper abdomen. Authors suggest that lipoabdominoplasty with limited central undermining may be appropriate technique to enhances the upper abdominal contour with fewer complications.

DuoDERM EXTRA THIN(TM) Dressing Modified by Multiple Incisions

In reconstruction of the skin defect, partial thickness skin graft (STSG) is common procedure in plastic and reconstructive surgery. Even if the graft is taken successfully, the texture of the donor site can be an aesthetic problem to the patient and the surgeon. Nowadays, occlusive dressings have been recommended for better results and accelerated healing of the donor site. Although hydrocolloid dressing is one of the popular occlusive dressings, its application is limited to the wounds that have mild to moderate discharge because of its absorption capacity. We modified the DuoDERM EXTRA THIN(TM) with multiple incisions to drain the massive discharge in acute stage in STSG donor dressing from January 2003 to May 2003. During the surgery, the half of the donor site was covered with the modified DuoDERM and the other half with original one as a control study. Dressing was changed after the 2nd day of operation. As bloody exudates were drained through the incisions areas, blood clot was less attached on experimental groups than control. Epithelialization was faster in modified dressing and skin surface was more even than the control. We are reporting the advantage of making multiple incisions on DuoDERM EXTRA THIN(TM) for dressing of the partial thickness skin graft donor site.

A Comparison of Permanent Expander-Implant in Immediate and Delayed Breast Reconstruction after Modified Radical Mastectomy

Breast reconstruction is considered as the best choice to improve the quality of life for the mastectomy patient. Recent trends in breast reconstruction have transitioned toward the skin-sparing type of mastectomy and immediate reconstruction using autologous tissue or expander-implant. Immediate prosthetic breast reconstruction is a relatively simple, quick procedure without donor site morbidity. Tissue expansion also has become the most important method for postmastectomy breast reconstruction. However, well-defined inframammary fold and ptosis are difficult to achieve with this technique. Improvements in implant technology have seen the evolution of shaped, fixed-volume implants and permanent expanders. The aim of the present study was to assess outcome after immediate breast reconstruction using the Sebbin permanent expander implant and delayed breast reconstruction with the same expander- implant. A total of 25 consecutive patients were studied over a 7-year period; 18 patients had immediate expander-implant placement, and 7 patients had delayed expander-implant. Postoperative photograph assessment by 20-observer and patients' telephone-questionnaire were evaluated using double blind method. Expander implants used in immediate breast reconstruction are associated with high levels of patient and surgeon satisfaction. Natural breast form can be achieved during this single operation with a low incidence of complications.

The Applications of Vaccum Assisted Closure(V.A.C.) for the Treatment of Chronic Wounds with Extrinsic Factors

Vacuum Assisted Closure (V.A.C.) has been reported to speed up the healing of various chronic wounds including pressure sores, stasis ulcers, cutaneous gastrointestinal fistula, hardware exposure almost due to intrinsic factors. We applied V.A.C. for the treatment of the nonhealing wounds with impaired healing mechanism due to extrinsic factors. The extrinsic factors of our cases were systemic factors that have local effects on the wound healing response, including diabetes mellitus, systemic steroid administration, chemotherapy and end stage renal disease. A total of ten patients whose wound failed conservative management over 2 weeks were successfully treated by V.A.C. therapy. The healthy granulation tissue was formed and the wounds were closed by skin graft or delayed closure. In theses cases, the positive effect of V.A.C may be the local compensation of extrinsically deviated cellular environment by dressing foam structure, continuous drainage of inhibitory wound fluid and sufficient blood supply required for inflammatory response and cell proliferation. Our results demonstrate the usefulness of V.A.C. as an adjunct in management of chronic wounds with other extrinsic factors as well as diabetes mellitus.

Combined Facial Rejuvenation Using Endoscopic Face Lift and Laser Resurfacing

Facial aging is a complex process of gravity-induced soft tissue ptosis and photoaging. In the standpoint of ideal rejuvenation, face lifting combined with laser resurfacing offers significant improvement in aesthetic outcome unachievable by either procedure alone and has many advantages. Neverthless, the simultaneous combination has never been popularized due to the non-specific thermal effects of the laser and risks of skin necrosis in Korea. This report documents the safety and effectivness of combined procedures when using systematic consideration and modified techniques in orientals. This study included 26 Fitzpatrick type III, IV orientals who didn't complaint lower face aging. A dramatic rejuvenation in soft tissue reposition and skin quality was produced in combined endoscopic forehead and midface lift with laser resurfacing cases. The standard forehead lift using endoscopic subperiosteal deep plane seldom interfere flap resurfacing. An endoscopic subperiosteal and subcutaneous midface lift repositions the midface tissue effectively without preauricular incision. Newer variable pulse Er:YAG lasers allow precise ablation and coagulation separately. The minimal excessive thermal injury from variable Er:YAG lasers, modified techniques for flap and skin care program would make it possible to safely perform laser resurfacing with surgical facial rejuvenations on non smokers. There were no incidents of persistent erythema or pigmentation abnormality, scar, full thickness flap necrosis. By following the considerations suggested in this report, the combination of controlled skin resurfacing with face lifting may be safe and effective in orientals.

Comparison of Titanium Micro Mesh(R) with Titanium Mesh Screen 1.3(R) in the Reconstruction of Medial Orbital wall Fracture

The aim of the surgical reconstruction of medial orbital wall fracture is to restore the three-dimensional shape and size of the orbital cavity. Many different autologous and alloplastic implants have been used for the reconstruction of medial orbital wall fracture. Recently, titanium mesh has been reported of its advantage over other various implants. As the advantage of the Titanium Mesh Screen(R) in orbital reconstruction was reported in our previous report1, this study is focused on the comparison of the two different types of titanium mesh screen through our experiences. From March 1998 to February 2003, 18 cases of medial orbital wall fracture were surgically repaired. Nine cases were repaired with Titanium Micro Mesh(R)(Stryker Leibinger, USA) and 9 cases with Titanium Mesh screen 1.3(R)(Marthys, USA). Through our experiences, shaping of the Titanium Micro Mesh(R) was as easy as Titanium Mesh Screen 1.3(R). the Titanium Micro Mesh(R) has some advantages over Titanium Mesh Screen 1.3(R); (1) Titanium Micro Mesh(R) was more easily inserted than the Titanium Mesh Screen 1.3(R). (2) The insertion failure by crumbling was less frequent in Titanium Micro Mesh(R) than in Titanium Mesh Screen 1.3(R). (3) Fixation of Titanium Micro Mesh(R) was more secure than that of Titanium Mesh Screen(R). So we are reporting the superiority of the Titanium Micro Mesh(R) to Titanium Mesh Screen 1.3(R) in the reconstruction of medial orbital wall fracture.

A Case of Kimura Disease on Parotid Gland

Kimura disease(KD) is a chronic inflammatory disorder of unknown etiology and results from an abnormal proliferation of lymphoid follicles and vascular endothelium and rarely has been reported in Korea. Clinical findings of Kimura disease include solitary or multiple, firm, subcutaneous nodules, which usually are located on the head or neck but parotid region is the most common site. The clinical course of the disease is chronic, with lesions frequently persisting or recurring despite treatment. The prognosis for KD is good, with no potential for malignant transformation. Our case is a 45-years-old man who had huge mass on left cheek which had slowly grown since about 10 years before. We planned to perform superficial parotidectomy but the mass was poorly demarcated due to extensive fibrosis and adhesion and had easy bleeding tendency. After frozen biopsy, we performed tumor debulking operation followed by cyclosporin therapy by the dose of 2.5 mg/Kg/day. The lesion was almostly cleared successfully after 3 months later. We report important aspects of clinical findings, histologic features, and therapeutic options of the rare case of KD with review of the previous articles.

Repair of Medial Orbital Wall Fracture

From March 1997 to August 2001, Titanium mesh screen 1.0 (SYNTHES(R)) were applied to the repair of 29 medial orbital fractures; 18 patients with orbital inferior wall fracture, 16 patients with nasal bone fracture and 6 patients with pure medial wall fracture. Clinically, the periorbital ecchymosis and subconjunctival hemorrage were sensitive indications of orbital wall fracture. Even though there are no sign of diplopia or enophthalmos, in cases of simple nasal bone fracture with periorbital ecchymosis and subconjunctival hemorage, the evaluations of medial orbital wall fracture were strongly recommended because the medial orbital wall fractures occurred frequently combined with simple nasal bone fractures. Titanium mesh screen 1.0 was used as onlay implant to fit the anatomical shape on the fracture portion needed to be reconstructed and 1.3mm microscrews (SYNTHES(R)) were used to fix titanium mesh screen. The patients were followed up for 18 months with no significant enophthalmos or diplopia.

Freezing Therapy for Relief of Vasospasm on Microvascular Anastomosis with Damaged Endothelium: An Experimental and Clinical Application

The histologically confirmed endothelial damage, which appears as a normal vessel under the operative microscope, may lead to thrombus formation or vasospasm, and ultimately result in the anastomotic failure. Vascular freezing has been reported to be an effective method of relieving spasm. This study examined if the freezing therapy could safely relieve the vasospasm accompanying microvascular anastomosis of vessels, which had histologically confirmed endothelial damage, but with no other harmful effects. In the experimental model, Microvascular anastomoses of the femoral arteries(n = 80) of 40 Sprague-Dawley rats were performed after producing crush injuries on both femoral arteries with energy to cause vasospasm and histologically confirmed endothelial damage. Freezing was achieved with ethyl chloride for 4 seconds before the anastomosis and the vascular spasm was disappeared immediately after freezing and maintained its expansion for 2,10 and 30 days after the operation. No significant difference was observed in the patency rates of the crush-freezing group and the crush group (p > 0.05). In the clinical model, a case was presented in which ethyl chloride in vivo freezing was used to relieve a refractory spasm in the recpient vessels of free latissimus dorsi muscle transfer in a soft tissue defect of dorsum of foot. The spasm was relieved and the flap survived. This study found that the vascular freezing relieved the spasm in the microvascular repair, which was accompanied by histologically confirmed endothelial damaged vessels, and that no harmful effects of vascular freezing were observed when the technique was used to prevent or elieve vascular spasm in case of microvascular repair.

A Scanning Electron Microscopic Study about Crush Injured Vasospasm after Freezing Therapy

The histologically confirmed endothelial damage (HCED) may lead to vasospasm, which increases the failure rate of microvascular anastomosis. Recently, vascular freezing has been reported to be the most effective and lasting method of alleviating or preventing vessel constriction in virgin microvessels. We question whether the application of freezing designed to relieve vasospasm is possible in microvessels accompanying with underlying acute endothelial damages without any harmful effects. We produced an experimental model with histologically confirmed endothelial damage and vasospasm in Sprague-Dawley rat. In crush injury group(group I, n = 15), the determined crushing load (0.07 J) was applied to femoral artery. In crush injury-freezing group(group II, n = 15), crushed arteries was frozen with ethyl chloride at 30 minutes after applying the crush injury. Gross and scanning electron microscopic appearances were inspected in both experimental groups on the 2nd, 14th and 30th day after the operation. In group I, vasospasm around the crushed segments were continued but in group II, the vasospasm disappeared immediately after vascular freezing, maintained its expansion even at postoperative 2, 14 and 30 days. On scanning electron microscopic examination, endothelium in group II showed slightly slower regeneration velocity but near complete regeneration was achieved at postoperative day 30. Regenerated endothelial cell in group II was more atypically shaped but arranged longitudinally at postoperative day 30. In conclusion, freezing with ethyl chloride could be a useful tool to reliably revert vasospasm without inducing thrombus even in acute endothelial damaged vessels after crush injury.

The Experimantal Studey of Delayed Wound Healing on Full-Thickness Skin Defects in Diabetic Rats

Wound healing was a natural process proceeded by connective tissue deposition, epithelialization, and wound contracture. Streptozotocin-induced diabetes mellitus was known to impair wound healing. However, the extend of delayed wound healing was not evaluate objectively in the diabetic rats. Therefore, we studied the extend of delayed wound healing(epithelialization and wound contracture) and histologic difference between diabetic and control rats. Twenty adult Sprague-Dawley rats(200-250 gm) were used as experimental animals(Diabetes: 10 rats, control: 10 rats). The wounds(2 x 2 cm, sized) were made on the back of the rats by excision through the panniculus carnosus. The areas of both wounds in relation to original wound areas (operative day) were serially measured at 0, 1,2, 3, 4, 5 weeks postoperatively. In addition, we performed histological examination of biopsy taken at 0, 1,2, 3, 4, 5weeks postoperatively. The difference in the mean area ratio between two groups was then compared using Kruskal Wallis test(SAS Program). Results were as follows: At postoperative 1 week, there was a significant difference(p < 0.05) in degree of epithelialization between the two groups, 1) After postoperative 2 weeks, there was a significant difference(p<0.05) in degree of wound contracture between the two groups. 2) In the diabetic group, the collagen fibers were smaller and poor organized than control group. Conclusion was that delay of epithelialization early and delay of wound contracture late in wound healing, were important roles in diabetic wound problem.