The Effect of Curcumin and Human Adipose-derived Stromal Cells on Wound Healing of Lewis Rats

PURPOSE: On this study, we investigated the effects of curcumin and adipose-derived stromal cells(ADSCs) in wound healing process, especially in the aspect of synergic effects when they were administrated simultaneously. METHODS: Curcumin(40mg/kg) and/or 1.0x10(6) ADSCs were applied to an 1.5x1.5cm-sized full thickness wound on the backs of male Lewis rats(n=5 in each group). In control group(n=5), saline was administrated instead of curcumin and ASCs. The wound size was followed by computer planimetry in 5, 7, and 14 days, and wounds were harvested for histological analysis in 7 and 14 days. RESULTS: The dimensions of wounds of curcumin, ADSCs, and curcumin-ADSCs group significantly decreased in 5, 7, 14 days compared with those of control group(p0.05). There were infiltration of more epithelization and more precisely organization of extracellular matrix in curcumin, ADSCs, and curcumin-ADSCs group compared with those of control group. CONCLUSION: The results suggest that curcumin and ADSCs have beneficial effects in the acceleration of wound healing. Although the simultaneous application of curcmin and ADSCs also has beneficial effects on wound healing, there are no significant synergic effects.

Amelanotic Melanoma on Fingertip: A Case Report

PURPOSE: Amelanotic melanoma represents a melanoma with an absence or a small number of melanin pigments and comprises 2% of all melanomas. These melanomas are frequently misdiagnosed, probably because of its nonspecific clinical features and difficulty in diagnosis, resulting in delayed diagnosis and treatment. We report a patient with amelanotic melanoma, who underwent surgical treatment with sentinel lymph node biopsy using gamma probe. METHODS: A 32-year-old female was presented with a slowly growing ill-defined, hypopigmented nonerythematous lesion with nail defect on right index finger tip. Preoperative punch biopsy was performed, showing an amelanotic melanoma. Sentinel lymph node biopsy was done using gamma probe(Crystal probe system, CRYSTAL PHOTONICS GmbH, Germany) and confirmed no evidence of regional lymph node metastases. The patient underwent amputation at the proximal interphalangeal joint. RESULTS: Histopathologic findings showed superficial spreading melanoma. There were no melanin pigments in Hematoxylin & Eosin stain but positive immunohistochemical stainings for S-100 protein and Hmb45, which were consistent with amelanotic melanoma. Patient's postoperative course was uneventful without any complication and had no evidence of recurrence of tumor in 6 months follow-up period. CONCLUSION: Amelanotic melanoma is extremely rare subtype of malignant melanoma with histopathologic findings of atypical melanocytes without melanin pigments. Early detection is crucial since survival is strongly related to tumor thickness and tissue invasion at the time of diagnosis. Wide excision is the treatment of choice and other conjunctive therapy has not been successful.

A Case of Surgical Correction of Undercorrected Unicoronal Synostosis

PURPOSE: Unicoronal synostosis is the craniofacial anomaly caused by premature fusion of unilateral coronal suture. Ipsilateral flattening of the frontal and parietal bones, temporal retrusion with elevation and recession of the supraorbital rim are main clinical features. Compensatory contralateral frontal bossing and deviation of the nasal root and/or chin can also occur. There is a controversy about techniques for surgical correction, however, bilateral approach technique is more effective for correction of deformity. METHODS: A 4-year-old patient with unicoronal synostosis had undergone unilateral suturectomy at 28-month-old but fronto-facial deformity had remained and aggravated as she grew older. She had both fronto-facial and endocranial asymmetry. We performed coronal cranial approach and fully exposed affected cranium including supraorbital rim. Anterior 2/3 calvarial reconstruction with bilateral frontal bone osteotomy and fronto-orbital bandeau advancement was performed. RESULTS: Fronto-facial symmetry including fronto-orbital contour, nasal devation was improved. Endocranial twisting was also improved from 158degrees to 162degrees in CSO(crista galli- sella turcica-opisthion) degree. There was no postoperative complications and no need for revision, and facial asymmetry improved at the period of 2 years of follow-up. CONCLUSION: Bilateral approach with fronto-orbital bandeau remodeling in surgery of unicoronal synostosis looked superior to unilateral approach in achieving better symmetry and preventing recurrence of asymmetry. Remodeling surgery should be tried in patients even at an older age to correct fronto-facial asymmetry.

Reconstruction of Large Skull Defect Using Right-Angled Zigzag Osteotomy

PURPOSE: Among the materials for cranioplasty, autogenous bone is ideal because it is less susceptible to infection and has lower rates of subsequent exposure. However, the procedure is technically demanding to perform and requires a donor site. Disadvantages further exist when the defect is large and there are attendant limitations in donor site. The authors present their experience with reconstruction of large skull defect using right-angled zigzag osteotomized outer table of autogenous calvarial bone, overcoming the limitation in donor site. METHODS: From 2000 to 2006, 9 patients were retrospectively reviewed, who had undergone reconstruction with right angled zigzag osteotomized outer table of autogenous calvarial bone. RESULTS: Aesthetically satisfactory skull shape was achieved. Major complications of infection, hematoma, plate exposure, and donor site complications of dural tear with bleeding, cerebrospinal fluid leak, and meningitis were not seen. One patient had delayed wound healing and was successfully managed conservatively. CONCLUSION: Autogenous bone is the material of choice for cranioplasty, especially in complicated cases. Right angled zigzag osteotomy is a useful method in reconstruction of large skull defects with less donor site morbidity.

Posterior 2/3 Calvarial Remodeling using Bioccipital Bandeau Advancement in Bilateral Lambdoid Synostosis

PURPOSE: Lambdoid synostosis can be found unilaterally, bilaterally or in combination with other forms of craniosynostosis. Based on concept of frontoorbital advancement, we used the technique of occipital advancement in order to correct lambdoid synostosis MATERIAL & METHOD: From 2002 to 2006, standardized occipital bandeau advancement with barrel stave osteotomy was performed in two children who had multiple synostosis. The surgery was carried out for patients 12 & 18 months of age. RESULTS: Aesthetically satisfactory skull shape and normalization of the intracranial pressure could be achieved. A major complication in the form of life-threatening intraoperative hemorrhage and other complications such as infection have not occurred. CONCLUSION: Standardized occipital Bandeau advancement with barrel stave osteotomy allows precise, reproducible and predictable positioning of the segments. Artificial sutures are created as a result of the osteotomy. Remodeling leads to a well-proportioned skull shape and posterior advancement leads to an increase in intracranial volume.

Surgical Refinements in Correction of Unilateral Secondary Cleft Lip and Nose Deformity

PURPOSE: Secondary correction of unilateral cleft lip and nose deformity is necessary in number of patients despite advanced techniques and overall treatment philosophy. Various techniques and modifications have been reported by many centers. But the definite procedure for secondary unilateral cleft lip nasal deformity is the question under debate. METHODS: Secondary cleft lip and nosede formity has its own anatomical abnormalities, including incomplete release of nasal lining, incomplete alar cinching, and progressive septal deviation. In order to correct these anatomical abnormalities, we have performed the procedures of complete release of congenital cicatricial contracture of nasal lining, extended cinching of alar, suspension of orbicularis oris muscle, and anteriorly limited open rhinoplasty. RESULTS: Between June of 2001 and Feb of 2006, 45 patients with secondary cleft lip and nose deformity underwent correction according to our procedures. During 36 month period of follow up, there were no significant complications. Esthetic and functional improvement was identified. CONCLUSION: Consequently, total mobilization of all the displaced anatomical structures and placing them in a normal position are the basic and essential in correction of secondary cleft lip and nose deformity

Clinical Experience of Foreign Body Granuloma in the Apex of Orbit

It is often difficult to identify and localize intraorbital foreign bodies despite of modern high-resolution imaging investigation. Especially, posteriorly located foreign bodies have increased risks of morbidity that surgical approach is often complicated. No matter how trivial it seems, retained foreign body, particularly organic in nature, may give rise to severe orbital and cerebral complications. High clinical suspicion, proper diagnostic studies, timely referral to a skilled orbital surgeon are mandatory. We report a case of intraorbital wooden foreign body that required two separate exploration for removal. Initial exploration failed to identify and locate the foreign body completely. After the operation, fistula formation and purulent discharge were developed and the imaging investigation results were equivocal, complicating the management. A second exploration yielded multiple intraorbital wooden foreign body in the apex of orbit. The patient fully recovered without complication. The evaluations and the details of management strategy are discussed.

Vascular Transformation of Sinuses in Cervical Lymph Node

Vascular transformation of lymph node sinuses is a rare condition and only isolated cases have been reported in the literature. Most lymph nodes with vascular transformation of sinuses are found in abdomen, and head and neck involvement is rare. It is characterized by the intrasinusoidal proliferation of endothelial cells forming a system of anastomosed channels filled with blood, and by an intrasinusoidal fibrous reaction. It is important to recognize that they may be a marker for the presence of any undetected malignant tumor. In this article, we report a rare case of vascular transformation of cervical lymph node sinuses with some reviews of the literature.

The Effects of Time Dependent Lipo-PGE1 Administration on Survival of a TRAM Flap in the Rat

The purpose of the present study was to examine a number of various times of Lipo-PGE1 administration in an attempt to determine the most effective time. In addition, this study examined the possible role of vascular endothelial growth factor(VEGF) on Lipo-PGE1 stimulation of a TRAM flap in the rat. Forty Sprague-Dawley rats were divided into 4 groups and a left inferior epigastric vessel pedicled TRAM flap, sized 5.0x3.5cm was created on the upper abdomen of each rat. Experimental groups included group 1(control): the flap was dissected and replaced, group 2(pharmacologic delay): Lipo-PGE1(0.5microgram) was given intraperitoneally for 5 days before elevation of flap daily, group 3(flap enhancement): Lipo- PGE1(0.5microgram) was given intraperitoneally for 5 days after flap elevation daily, group 4(pharmacologic delay and flap enhancement): Lipo-PGE1(0.5microgram) was given intraperitoneally for 5 days before elevation of flap then for 5 days after elevation of flap daily. On postoperative 5th day, we evaluated and compared the results of flap survival area, the number of blood vessel, and the VEGF expression using the western blot method. The results were as following: First, the mean percentage of the flap survival area of group II(63.9+/-12.6%), III(54.9+/-20.5%), IV(68.1+/- 18.2%) were higher than that of group I(28.7+/-15.2%) significantly(p<0.05). Second, the number of blood vessels were of group II(3.8+/-1.4), III(3.5+/-1.8), IV(4.0+/-1.5) were higher than that of group I(1.0+/-0.6) significantly(p<0.01). Third, the western blot method demonstrated a qualitatively greater amount of VEGF expression in the experimental groups. These results suggest that Lipo-PGE1 increased VEGF production and that Lipo-PGE1 may thereby enhance flap survival through VEGF production regardless of the time of Lipo-PGE1 administration.