Postoperative Speech Improvement in the Patients of Velopharyngeal Dysfunction without Definite Cleft Palate

The velopharyngeal dysfunction usually occurs in patients with previous operation of the cleft palate or with submucosal cleft palate. In case of velopharyngeal dysfunction without cleft palate, no study has been made when it comes to operative method and postoperative results. Here, we would like to present the operative methods and the postoperative results with the cases we've experienced. This study is based on seven cases of velopharyngeal dysfunction without cleft palate from 1999 to 2004. Analysis of age, sex, etiology, operative methods, satisfaction rate and speech evaluation was done. The patients were 3 males and 4 females, with an age ranged from 10 to 28 at the time of surgery. The follow-up period was more than six months. One case had bifid uvula, another had atypical anomaly in palate, and five cases had no anatomical abnormality. The palatal lengthening was done on one patient, the levator muscle repositioning on another patient and to the rest of them, the superiorly based posterior pharyngeal flap was done. It was difficult to determine the etiology of the velopharyngeal dysfunction without cleft palate. The speech improvement and the satisfaction rate of the patients and parents were diverse. Although the authors had a problem with statistical analysis between the operative age and the speech improvement, it was reasonable to perform a surgical operation because post operative speech improvement was observed in most cases regardless of age. There is little statistical correlation, but significantly higher outcomes were observed in palatal lengthening and levator muscle repositioning than in pharyngeal flap.

A Study for the Mechanism of Abnormal Proliferation in Vascular Endothelial Cells using Inhibitors to the Signal Transduction Pathway

Protein tyrosine kinase(PTK), protein kinase C(PKC), oxidase, as a mediator, take a significant role in signal transduction pathway of angiogenesis. The authors utilized the inhibitors, targeting the formation of three co-enzyme in signal transduction pathway in order to quantify the suppression of abnormal vascular endothelial cell proliferation induced by DMH, to compare the level suppression in each up-regulated growth factors, CTGF, CYR61, ITGbeta1, FHL2, and to identify the relationship between abnormal cell proliferation and signal transduction pathway. Five groups were established; Control group, Group of DMH, Group of DMH-mixed Herbimycin, inhibitor of protein tyrosine kinase, Group of DMH-mixed Calphostin C, inhibitor of protein kinase C, Group Of Dmh-Mixed 10U Catalase, Inhibitor Of oxidase. The rise of vascular endothelial cell was compared by MTT assay, and four growth factors were analysed with RT-PCR method, at pre-administration, 4, 8, 12, and 24 hours after administration. In comparison of abnormal proliferation of vascular endothelial cell induced by DMH, suppression was noticed in Herbimycin and Calphostin C group, and Calphostin C group revealed higher suppression effect. Nevertheless, Catalase group did not have any suppression. In manifestation of four growth factors, Herbimycin and Calphostin C group presented similar manifestation with control group, except in ITGbeta. Catalse group had similar manifestation with DMH group in all four growth factors. Abnormal proliferation of vascular endothelial cell induced by DMH have a direct relationship with PTK and PKC, more specifically to PKC. Oxidase was confirmed not to have any relevance.

Simultaneous Reduction Mammoplasty with Excision of Benign Tumor

The purpose of study was to retrospectively assess the possibility of simultaneous breast reduction and tumor excision in women with benign tumor and mammary hyperplasia. Performance status of the patient, appropriate operation technique and postoperative results were analyzed. Evaluation was made regarding four patients who underwent simultaneous breast reduction and tumor excision with more than 6 months follow up. The types and locations of the tumor, corresponding operation technique, postoperative complication such as flap necrosis, subjective alteration in sensorium around the nipple-areolar complex and esthetic satisfaction were assessed. Preoperative radiologic examinations, histologic findings of the fine needle aspiration, and postoperative biopsy were equivalent. The histologic types revealed were tubular adenoma, leiomyoma and lipoma(2 cases). The tumor was each located in lower lateral quadrant, subpectoral, inframammary fold, and upper lateral quadrant of breast, respectively. Regarding the location of tumor and status of mammary hyperplasia, each breast reduction was done with superior, inferior and medial pedicle(2 cases). There were no postoperative complications and esthetic satisfaction rate was high in all patients. When accurate diagnosis based on preoperative radiologic and histologic evaluation and appropriate selection of operative technique were done, simultaneous breast reduction with excision of benign tumor showed satisfying outcome without postoperative complication even along with esthetic satisfaction.

Wound Healing Effects of Low-Power Laser and Hydrocellular Dressing

There are many methods known to improve the effect of wound healing. Among them, low-power laser light have been used on the basis that it cause increase of new capillary formation, fibroblast, collagen synthesis, and blood flow. But there are some controversies, so the authors tried to prove the efficacy of low-power laser for wound healing on donor sites of skin graft. Performing this study, we also used hydrocelulla dressingr(Allevyn(R)), which is known to accelerate wound healing via providing a clean moist environment with its high absorption capacity, to compare the efficacy with that of low-power laser. We evaluated the wound healing results of fifty patients who underwent split-thickness skin graft for various reasons in Pusan National University Hospital from July 2000 to March 2001. Donor site wounds were formularized with the extent of 7 x 10cm2 width and 13/1000 inch depth on patients' thigh for accurate collection of data. Fifty patients were divided into five groups(n = 10 in each group) according to the method of treatment; Group I: hydrocellular drssing only, Group II: hydrocellular dressing and He-Ne laser, Group III: hydrocellular dressing, He-Ne and infrared (IR) laser, Group IV: hydrocellular dressing, He-Ne, infrared, and CO2 laser, and Group V: adaptive gauze dressing as a conventional method. All groups excluding group V were treated every other day. In laser treated groups, donor site wounds were subjected to irradiation with 500 Hz and 1 J/cm2. In assessing the efficacy of each treatmnet, time for complete epithelialization was assessed in all groups and all groups except for group V were examined every other day by questioning the patients about degree of pain according to the visual analogue pain scale(VAS) and calculated VAS improvement rate after treatment. As a result, laser treated groups(II, III and IV) were superior to hydroclullar dressing treated group(I), although the latter was more effective than the conventional group(V), in aspects of wound healing and pain relief. In conclusion, although hydrocellular dressing promotes wound healing in some aspects, low-power laser was more effective in wound healing and pain relief especially on donor site wounds after partial-thickness skin graft. We think that these low-power lasers with or without hydrocellualr dressing will be helpful in various fields of wound treatment as an adjunctive method.

5 Case of Dermatofibrosarcoma Protuberans

Dermatofibrosarcoma protuberans(DFSP) is an uncommon soft-tissue neoplasm that usually presents as a painless, often long-standing mass arising in the dermis of skin. It has a frequent tendency to recur after standard surgical excision. Clinically, the initial appearance of the tumor is similar to that of benign tumor such as keloid and dermatofibroma. Therefore making an accurate clinical diagnosis and ensuring adequate surgical excision of this uncommon skin tumor are important. The authors experienced 5 patients of dermatofibrosarcoma protuberans during the recent 2 years, 3 male and 2 female patients. The age of the patients ranged from 21 to 43. Lesions were various in size and shape, and location varies: lower abdomen, right suprabrow region, right anterior superior iliec spine region, right clavicular region, and upper back. Wide excision of tumor with frozen section biopsy or Mohs' microscopic surgery was performed and reconstruction of surgical defect was made according to the size, shape and location. As reconstructive methods, the authors used median forehead flap, split thickness skin graft, or direct closure. The patients were followed up after operation from 4 to 14 months and all remained free of disease. The authors present the experience of 5 cases of dermatofibrosarcoma protuberans occurred in various sites during the short period of time . They obtained satisfactory results with appropriate diagnosis and treatment, which emphasize the importance of accurate diagnosis in early stage. They also present an operative plan of this locally aggressive and highly recurrent tumor.