Clinical Experience of Cryptopenis

PURPOSE: By virtue of good nourishment, obese boys are increasing in Korea, which may result in prevalence of cryptopenis. As milieu of economy, culture, and society changes, increased attention to the external genitalia in children should encourage surgeon to do assertive treatment for cryptopenis. But various operative methods have been devised yet to need sophistication and revision. The author performed suprapubic lipectomy and operation according to the modification of the Johnston's principle. METHODS: The patient was 5 years old, 32kg, and 122cm. He had no pain or tenderness. The operation was done under general anesthesia. It was done with excision of suprapubic fat, cutting of retracted dartos fascia instead of removing the fascia around penile base, and anchoring of dermis and the cutting margin of the fascia to the underlying fascia such as Buck's fascia, tunica albuginea and rectus fascia at penile base. And then circumcision was performed. RESULTS:Postoperative complication was not observed. The clinical result of the operation was satisfactory to both surgeon and parents of the patient. CONCLUSION: Suprapubic lipectomy and anchoring of dermis and retracted cutting dartos fascia margin to the underlying fascia in all directions at the penile base through a single suprapubic incision provide this patient with complacency.

A Comparative Evaluation of Various Axillary Osmidrosis Treatment

Axillary osmidrosis caused by excessive secretion of apocrine glands, which causes an malodor and extreme social embarrassment. To remove the apocrine glands, various types of treatment methods for axillary osmidrosis have been introduced. They could be summarized as manual of instrumental subdermal shaving, ultrasonic assisted liposuction, Botox(R) injection, electrical probe, laser dessication, etc. Surgical removal of apocrine glands has been the favored treatment for the several decades, but such complications as long-term postoperative immobilization period, skin necrosis, hematoma, and visible scars have been frequent. Recently, for the purpose of reducing these complications, some operators have advocated other procedures such as axillary ultrasonic assisted liposuction, Botox(R) injection, laser dessication. From March 2002 to April 2003, we have corrected the axillary osmidrosis in 80 cases using the subdermal shaving(24 cases), ultrasonic assisted liposuction(20 cases), Botox(R) injection(10 cases), electrical probe(26 cases). Of these operation, manual dermal shaving had the lowest recurrence rate, but disadvantages of this procedure was 4-5cm axillary scar, moderate post operative complication, long immobilization period. Otherwise Ultrasonic assisted liposuction had many advantages which were simple operation technique, short operation time, early recovery of social activity, rare post operative complication, invisible scar, lower recurrence rate. In case of Botox(R) injection was also simple operation technique, but which was short term effect about 6 months so it was necessary to treat repetitive injection but relatively high recurrence rate in severe osmidrosis. In case of electrical probe was also simple operation technique, but which was vague treatment effect, need to repetitive operation and relatively high recurrence rate in severe osmidrosis. In comparative evaluation of these methods, ultrasonic assisted liposuction was considered better results to osmidrosis treatment than others method in many aspects.

Clinical Analysis of the 269 Cases of Free Flap

Free flap operations have been done for reconstruction or wound coverage as the aspect of both functional and structural problem solving. We have studied the 269 cases of free flap performed in Dong-A University Hospital from March 1990 to February 2002. In our study, the analysis was designed into 3 periods (1st stage: 1990-1994, 2nd stage: 1995-1999, 3rd stage: 2000-2002), and about age, donor site, application site, causative disease, success rate, morbidity, onset time of postoperative flap circulation insufficiency and its cause, etc. In our study, there was no difference in ratio of donor site, application site, and causative disease of free flap operation in each period, the LD free flap and TRAM free flap were the most common operation in the 269 cases of free flap operations. Recently thin perforator based free flaps were used more than myocutaneous or fasciocutaneous ones. Most of all postoperative flap circulation insufficiency were found within 48 hours after the operation, especially between 4 and 9 hours after the operation. The success rate of 3rd stage was 98.3% which was higher than 1st & 2nd stage (90.5% & 92.7%). This could be up to both the more intensive flap monitoring for example laser Doppler and the more rapid solution of poor circulation such as exploration or drainage of hematoma. These outcome can provide some information to plan and manage the free flap operations.

Follow Up Study of the Zygoma Complex Fracture Patients along the Inclusion of Coronary Incision as the Approaches

Zygoma complex has important roles as the contour, and buttreses in the bony skeleton of the midface. Many surgical approaches to the zygoma complex fractures have been discovered, such as the coronal approach, Gillies' approach and the intraoral approach. 387 patients of zygoma complex fracture from March 1990 to March 2001 in Department of Plastic & Reconstructive Surgery, Dong-A University Hospital were studied retrospectively about deformity of facial contour, enophthalmos, scar etc., divided into two groups, operated with and without coronary approach. The postoperative complications were researched through the charts, X-ray findings and clinical photographs. The coronary approach was used mostly in the case of the severe displacement of fractured bony fragments or neurosurgical emergency(traumatic subdural hematoma, ect.). The group with the coronary approach had higher rate of scar, hypoesthesia and anesthesia than the group without the coronary approach but the coronary approach was thought to be useful considering mostly used in severe zygoma bone fractures and its lower rate of deformity than the group without one, nevertheless there was no statistical significance about the facial deformity between the former(2.6%) and the latter(7.3%). We supposed that these outcome help us to choose more suitable approach in zygoma complex fracture operation.

Application of Digital Infrared Thermographic Imaging(DITI) to the Evaluation of Blood Supply of Lower Abdominal Flap in Rabbit

The monitoring method of the flap for detecting the compromise of vascular circulation has been developed in order to prevent flap loss in the microsurgery. The ideal flap monitor for the flaps would show the vascularity and circulation state of the flap, any time, any place easily. The concept that the skin temperature is up to the vascularity under the skin, rendered to apply IR(infrared) thermometer as quantitative analysis and IRIS-2000 (digital infrared thermographic imaging: DITI) as geographic analysis to the several kinds of flap in 15 New Zealand white rabbits. The IR thermometer showed that the nearer to the pedicle, the higher temperature quantitatively. The DITI scan showed to us like below. The nearer to the pedicle, the higher temperature color in DITI scan image. The DITI scan image of myocutaneous flap had higher temperature color than that of fasciocutaneous flap. In case of cut down of one side vascular pedicle, the DITI scan image of the pedicle-cut-down side showed lower temperature color than the opposite side. So, the better blood supply in the area of the flap, the higher temperature as color image in DITI scan. We supposed that the DITI would help to estimate the circulation of the flap as its color image, based on skin temperature.

The Two Flap Palatoplasty by Bardach Compared with the Other Methods in Cleft Palate

The purpose of palatoplasty in cleft palate patient is to close the palatal defect completely and create an adequately functioning velopharyngeal mechanism for normal speech production, and to form normal growth of maxilla. Authors tried to analyze postoperative result in two-flap palatoplasty by Bardach' method in terms of operation time, fistula incidence, speech production. The postoperative analysis was done retrospectively in 131 consecutive nonsyndromic patients with cleft palate repaired by a single operator. The patients suffered from complete cleft palate (99 cases) and incomplete cleft palate (32 cases). The complete cleft palate patients were repaired by Wardill-Kilner method (53 cases) and Bardach method (46 cases). All incomplete cleft palate patient were repaired by Furlow method (32 cases). The age of patients who had cleft repair was 8 to 18 months. Mean age was 11.7 months and mean follow- up period was 21 months. Mean operation time was similar in patients with Wardill-Kilner method, Furlow method, Bardach method. The fistula rate of Bardach method was lower than other methods. Hypernasality test and articulation test were done by speech evaluation table which was consisted of 29 different words. We ascertained the truth of adequate speech production in patients with Bardach method as a results of our study. The 2 flap palatoplasty by Bardach method is not a difficult method compared with other methods. And it can be suggested to close the cleft palate with minimal or no exposure of palatal bone and reduce the fistula incidence. In addition, it can provide adequate production of speech in cleft palate patients.

SVC Syndrome Caused by Leiomyosarcoma of SVC: A Case Report / 대한흉부외과학회지

Among the causes of SVC syndrome,intraluminal tumor,especially the leiomyosarcoma is very rare.We report a 39 year old female patient who had been suffering from headache and facial edema for 6 weeks before admission.On physical examination,facial edema and venous engorgement on upper extermities and upper chast wall were showed.The chest CT scan and SVC cavogram showed a long intraluminal mass lesion resulting in a near total obstruction of the SVC.Surgery was performed through median sternotomy.For complete resection of the tumor and thrombus,we used partial and total CPB.The follow up SVC cavogram revealed no abnormality 14 months after the operation.

Treatment of Blepharoptosis Using Variable Operative Techniques

No abstract available.

The Effective Treatment Method of Hyaluronidase and Triamcinolone Acetonide on Extravasation of Calcium Gluconate in Rabbit

When the skin and soft tissue necrosis occurs due to extravasation of intravenously administrated biological active materials and drugs, no specific mode of treatment modality is known except for supportive management or debridement and skin graft. This experiment was designed to determine the effective dosage of hyaluronidase and triamcinolone acetonide on the extravasation necrosis caused by calcium gluconate and to establish the optimal time of administration of the antidotes. Initially 0.4 ml of 10% calcium gluconate was injected subcutaneously into the rabbit back. Study I was designed to observe the skin change in 8 groups including control group with no treatment and treated groups with normal saline, saline with hyaluronidase(dosage: 150, 300, 600 unit), saline with triamcinolone acetonide(1 mg, 2 mg), and 150 unit hyaluronidase and 1 mg triamcinolone acetonide (all in volume 0.2 ml, treatment delay: immediate, 15-minutes, 30-minutes, 1-hour, 3-hours delay). The sizes of skin necrosis and induration were measured and compared between each group. Study II was designed to examine the histologic findings of the skin and evaluate the effect of hyaluronidase and triamcinolone acetonide on tissue damage. The sizes of induration and necrosis are smaller in all treated groups than non-treated group and the statistically significant protective effect on reducing the size of necrosis was found in groups treated with the drugs within 15 minutes to 30 minutes(p < 0.05). The most effective protection was obtained by the immediate injection of 150 unit dosage of hyaluronidase with 1 mg triamcinolone acetonide. This study suggests that intralesional injection of hyaluronidase and triamcinolone acetonide within half hour delay for the treatment of extravasation necrosis of calcium gluconate is the most effective, probably due to their diffusion, antiinflammatory effect and role in facilitating the resorption of calcium in the tissue.

Anatomic and Histologic Changes of the Testis after Long-Term Estrogen Exposure in Transsexuals / 대한남성과학회지

PURPOSE: To investigate the anatomic and histologic changes of testis as a result of long-term estrogen exposure on male MATERIALS AND METHODS: Fourteen testes were harvested from 14 consecutive male-to-female transsexuals who had sex reassignment operation in Dong-A University Hospital from March 1991 to March 1997. Age at inception of estrogen therapy was 16 years to 24 years. The duration of estrogen therapy was 2-12 years (mean 7.4 years). The dose and method of estrogen treatment regimen was variable, but about 20 mg (intravenous) monthly during first year. Sperm analysis, volume of testis and histologic change of testis were compared to the duration of estrogen therapy. RESULTS: The mean volume of semen was 1.8 ml(0.5~3 ml), and oligozoospermia, azoospermia or asthenospermia were observed in 12 cases (85.7%) by means of sperm analysis. The mean volume of testis was 17.3 ml(15~23ml). In light microscopic examination of the testis, near-normal histologic finding was noted in 3 cases(21.4%), spermatocytic arrest in 8 cases(57.2%) and geminal cell aplasia in 3 cases (21.4%). CONCLUSION: As the duration of estrogen therapy was longer, there was a tendency that volume of semen, sperm count and motility were reduced and the histologic change of seminiferous tubules was severe. It was considered that the negative feedback of estrogen on hypothalamic-pituitary-gonadal axis, the down regulation of estrogen receptors and the direct effect of estrogen might produce the adverse effect on male reproductive system by testicular change with maturation arrest, germ cell aplasia, end-stage testis and peritubular fibrosis and reduced fertility after long-term estrogen exposure.