Combination Treatment of Osmidrosis by Liposuction and Endoscopic Shaver

Many surgical procedures have been introduced for treatment of axillary osmidrosis, but some complications, such as symptom recurrence, hematoma, seroma, delayed wound healing, skin flap necrosis and scarring, are not solved yet. Recently introduced liposuction method has several advantages over previous surgical methods, such as increased skin flap vascularity, minimal scarring and bleeding, etc, but the sympton recurrence rate has been reported 10-30%. Liposuction method could remove apocrine glands in subcutaneous tissue effectively, but the glands firmly seated in subdermis remain as the cause of sympton recurrence. For this reason, we employed combination treatment of liposuction and endoscopic subdermal shaving method. From March 1997 to February 2001, a total 71 patients (24 men and 47 women) had been treated with this procedure for bilateral axillary osmidrosis. In our procedure, apocrine glands in subcutaneous tissue were removed by liposuction method and the glands in subdermis were removed by using 4.5 mm incisor blade of endoscopic shaver. Follow-up evaluation period was from 3months to 24 months, and the results were satisfactory. No one suffered from sympton recurrence. Postoperative scar was negligible (below 0.5 cm) and other complications were minimal.

Separation of symphysis pubis during vaginal delivery - Report of 5 cases - / 대한산부인과학회잡지

No abstract available.

Comparative Study of Subcutaneous Buried Suture Materials in Rabbits

To have useful information and basic rationale for selection of suture materials in the subcutaneous buried suture, a study on tensile strength, clinical handing property, scar nature and histological changes was done in rabbits with four kinds of absorbable suture materials (chromic catgut, Monocryl, coated Vicryl and PDS) and two kinds of nonabsorbable suture materials (Nylon and Gore-tex). The clinical handling property included pliability, ease of tying, knot security and passage in tissue. The tensile strength of the absorbable and non-absorbable suture materials was compared before and after subcutaneous implantation, and the histology of suture materials was examined after separate subcutaneous buried sutures. The test of tensile strength and the histological examination of suture materials were done on the 1st, 3rd, 7th, 14th, 30th and 90th day after subcutaneous implantation and suturing. In the clinical handing property, pliability was good in Vicryl. Ease of tying and knot security were good in both catgut and Vicryl, but passage in tissue was poor in both. In Gore-tex, pliability, ease of tying, knot security and tissue passage were better than Nylon. In the tensile strength of absorbable suture materials before implantation in the abdominal flap, Monocryl was the strongest one and catgut was the weakest one. Vicryl was a little stronger than PDS. The tensile strength of Moncryl rapidly dropped down from the 3rd day after implantation and became the weakest one after the 7th day of implantation. There was no remarkable change in the strength order of other absorbable suture materials. In the non-absorbable suture materials, Gore-tex was about two times stronger than Nylon before and after implantation. In histology, there were more severe and prolonged inflammatory reactions in absorbable suture materials than in nonabsorbables. The most severe reaction was seen in catgut. Monocryl, Vicryl and PDS were similar in inflammatory reaction. Severe giant cell and histiocytic reaction were seen in Vicryl. The least absorption was seen in PDS and it was well correlated with loss of tensile strength. Nylon showed less inflammatory reaction than Gore-tex. There are few clinical studies for recently developed Monocryl and Gore-tex. Our results suggest to us that Monmcryl is one of the best absorbable suture materials and Gore-tex is two times stronger than Nylon.

Reconstruction of Multiple Defects after Head and Neck Cancer Ablation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The traditional form of reconstruction of multiple defects after head and neck cancer ablation has been the two-combined regional flaps or that of one regional flap and skin graft. Such flaps, however, have functional and aesthetic problems such as donor site morbidity, and post-operative stenosis and fistula. MATERIALS AND METHODS: We reviewed clinical data of eleven head and neck cancer patients who have been reconstructed with bilobed flaps or gemini flaps after ablation from November 1988 to October 1998. The patients were divided into four groups. Type I flap is bilobed flap consisting of one bed and fused skin, type II flap is gemini flap consisting of one bed and separated skin, type III flap is gemini flap consisting of separated skin and bed, and type IV flap is bilobed flap or gemini flap composed of free bone graft. RESULTS: The survival rate of bilobed flaps and gemini flaps was 91%. The most common complication was fistula, followed by donor vein thrombosis and total loss of flap. CONCLUSIONS: The advantages of bilobed flaps and gemini flaps were one-stage operation, and aesthetic effect for reduced bulk of thinned radial free forearm flap, and diminished morbidity of donor site. Bilobed flaps and gemini flaps were also used for salvage operation of the patients who had been treated with concomitant chemo-radiotherapy, or combined chemo-radiotherapy, or radiotherapy alone for malignant tumors of head and neck.

Distally-Based Sural Artery Flap

Reconstruction of soft tissue defect with exposure of the tendons and bone in the lower third of the leg and the heel represents a challenge to plastic surgeons. The sural artery flap is a fasciocutaneous flap supplied by the sural artery that accompanies the sural nerve and connects with a septocutaneous perforator of the peroneal artery via a suprafascial network of vessels. For the coverage of soft tissue defects, we operated on 10 patients using a distally-based sural artery flap. The sites of the soft tissue defect were the lower third of the leg in 7 cases and the heel in 3 cases. The size of flap varied from 3.5x4cm to 12x18cm. Nine of 10 flaps survived completely. One flap in which the sural nerve was preserved showed partial necrosis but healed spontaneously. Two flaps showed slightly venous congestion which disappeared after a few days. The advantages of the sural flap are a reliable blood supply, easy and quick elevation of the flap, preservation of the major artery and minimal donor site morbidity. The disadvantage of the flap is hypoesthesia at the lateral part of the foot. In conclusion, the distally-based sural artery flap can be used safely for soft tissues coverage in the lower third of the leg and the heel.

Distraction Osteogenesis after Membranous Onlay Bone Graft in a Dog Model

The purpose of this study was to investigate the possibility of distraction osteogenesis in membranous onlay bone graft on the mandible and to clarify the histology of bone repair during distraction osteogenesis in the membranous onlay bone in a dog model. Four dogs, 5 months of age at the beginning of the experiment, were used for this study. The zygomatic arch was exposed in the subperiosteal plane and the full-thickness zygomatic arch was harvested to 3 centimeters in length. The lateral surface of the mandibular body was exposed in the subperiosteal plane and the membranous onlay bone graft was performed with firm contact using screws. The osteotomy on the membranous onlay bone graft and underlying mandibular body was carried down week 1 in dog 1, week 2 in dog 2, week 3 in dog 3, and week 4 in dog 4 after membranous onlay bone graft. The external distraction device was applied to the mandibular body. Mandibular distraction was started 7 days after the operation at a rate of 1mm per day for a total of 10 mm distraction over 10 days. After completion of distraction, the distraction device was left in place for 6 weeks bony consolidation of the distracted area. Radiographs were carried out at 2 weeks, 4 weeks and 6 weeks after distraction. New bone between the native underlying mandibular segments was generated in the distracted zone in all dogs. The new bone between the native underlying mandibular segments was generated in the distracted zone in all dogs. The new bone between segments of membranous onlay bone graft was not generated in dog 1, but it was generated in dogs 2, 3 and 4. However, in dog 2 and 3, the new bone between segments of the distracted membranous onlay bone graft presented less firmness with fibrous tissue than that of the native underlying mandibular segment. Histologically, the distracted gap between segments of the membranous onlay bone graft was composed of much fibrous tissue in the central zone while activated osteoblastic cells formed new bone in the margins of the distracted gap in dogs 2 and 3. In dog 4, there were abundant osteoblastic activities in the distracted gap and the new bone appeared as nearly-normal cortical bone. In conclusion, these findings suggested that membranous onlay bone graft had an osteogenic capacity and that distraction osteogenesis was possible in membranous onlay bone graft.

An Experimental Study on the Survival of Membranous Inlay Bone Graft on the Mandible

Bone graft is an important procedure in craniomaxillofacial reconstruction and the success of reconstruction depends on the survival of the grafted bone. In this study, the survival of the membranous inlay bone graft on the mandibles of dogs was investigated with bone scan and histologic examination. The inlay bone graft, 1x2cm critical-sized bone, was completely separated from the lower border of the mandible of dogs and then refixed to the original site. Bone scan and histologic examination were done at 1,2,3 and 4 weeks postoperatively. The bone scan after 1 week showed radioisotope uptake on the margin of the grafted bone and the isotope count was 21% compared to the uptake of the normal bone. After 2 weeks, the radioisotope uptake in the grafted bone increased to 52% of normal bone uptake. After 3 and 4 weeks, the degree of isotope uptake was 111% and 124% respectively. Histological findings after 1 week showed the absence of osteoblastic activity and 6 viable blood vessels in one 200X magnified field, which was 25% compared to the vessels of the normal bone. After 2 weeks, osteoblastic activities were noted and the number of viable blood vessels totalled 15, which was 63% of the vessels of the normal bone. After 3 weeks, osteoblastic activities increased and the number of viable blood vessels totalled 21, which was 88% of the vessels of the normal bone. After 4 weeks, there were markedly increased osteoblastic activities with a total number of 23 vessels, which was 96% of the normal bone. In summary, the revascularization of the membranous inlay bone graft began from the first week after bone graft, and then it gradually increased. After 3 weeks, the revascularization had returned to a nearly normal value compared with the value of the near-by normal mandibular bone.

Reconstruction of various sized soft tissue or compound tissue defect using free serratus anterior muscle or composite flap

A wide variety of free muscle or composite flaps have been used clinically for the reconstruction of soft tissue or compound tissue defects since introduction of the microsurgical technique but there were still difficulties in their application due to donor site morbidity and flap bulkiness. Free serratus anterior muscle flap and free composite flap, including serratus anterior muscle have been applied to 17 patients with small or medium sized tissue defects or large sized compound tissue defects from June 1995 to July 1997. There were 11 male cases and 6 female. Average age was 27 years. Defect sites were the anterior tibial area in 6 cases, the dorsum of foot in 6, the medial malleolar area in 1, the heel area in 1, the foot in 2, and the thumb and 1st web space in 1. There were 12 free muscle flaps, 2 free serratus anterior and rib composite flaps, 2 free serratus anterior and latissimus dorsi combined muscle flap and 1 free serratus anterior and latissimus doris and rib composite flap. The average follow up period was 14 month. The survival rate was 100% in 16 cases, 80% in 1 case. There was no remarkable donor site morbidity and operative results were satisfactory in all cases. The advantages of this flap are consistent and reliable flap with minimal donor site morbidity, long constant large caliber pedicle, taking a thin flap, excellent malleability allowed a broad of range of inserting technique, and additional possibility of a composite flap.

Reconstruction of the defects with free flaps after head and neck cancer ablation

The number of cancers in the head and neck areas has been increasing due to the increasing life span of the patients and a free flap is a common procedure to reconstruct defect in the head and neck area. From March 1990 to February 1998, 105 patients underwent 110 free flap operations after head and neck cancer ablation and they were reviewed retrospectively. Among 110 free flaps, 93 are forearm flaps, 6 jejunal flaps, 5 vascularized fibular osteocutaneous flaps, 2 lateral arm flaps, 2 rectus abdominis myocutaneous flaps and 1 latissimus dorsi muscle flap and 1 latissimus dorsi myocutaneous flap. Sixty-five radial forearm flaps and 4 ulnar forearm flaps were utilized in patched type and 24 radial forearm flaps in tubed type mainly for the reconstruction of intraoral and hypopharyngeal defects. Sis jejunal flaps were utilized for the esophageal reconstruction and 5 vascularized fibular osteocutaneous flaps for the mandibular reconstruction. The remaining flaps were for the reconstruction of other areas of head and neck.Overall survival rate of the flap was 95.5%. Immediate complications were fistula formation(3 cases), total flap loss (4 cases) or partial flap loss(3 cases) and donor site problems(10 cases). Superior thyrodial artery was the most commonly used recipient artery(89 cases) which was followed by facial artery, lingual artery and transverse cervical artery. Size discrepancy was not remarkable between the donor and recipient arteries. However, there was usually a marked size discrepancy between donor and recipient veins. More than two venous anastomoses were performed to increase the success rate of the flap surgery. An average follow-up period was 38 months ranging from 3 months to 6 years. There was no patient who died during or right after the operations, but 23 patients died due to recurrence of tumors or underlying heart disease during the follow-up period. Remaining patients lived well excluding 6 late postoperative complications such as 4 cases of esophageal stenosis and 2 cases of osteoradionecrosis. We conclude that free flap reconstruction after head and neck cancer ablation improves the quality of life and minimizes the loss of function.

Treatment of osteonecrosis of the femoral head with free vascularized fibula transfer

Thirty one free vascularized fibula bone grafts were performed for treatment of osteonecrosis of the femoral head in 26 patients, 24 men and 2 women aged from 16 to 48(mean:32 years). Twenty one patients had unilateral disease. Five patients had bilateral disease underwent staged bilateral free vascularized fibula grafts three months apart. Associated etiological factors included alcohol(9 patients), steroid(7 patients), and trauma(one patient). The condition was considered idiopathic in the remaining 9 patients. Radiologic staging by Ficat included stage 1 in one hip, stage II in 15 hips, stage III in 14 hips, and stage IV in one hip. A skin island flap was used for monitoring purpose for the grafted fibula. One monitoring, flap was necrotized due to vascular occlusion but the fibula bone graft was left in place to use as a nonvascularized bone graft. Average follow-up period was 21 months in 31 hips. Pain was relieved in 28 hips(93.3 percent) and aggravated in 2 hips(6.7 per cent). On radiographic evaluation, 26 hips(86.7 per cent) demonstrated excellent preservation of the femoral head contour. Progressive collapse of the femoral head (greater than 1-2 mm) occurred in 2 hips, i mm depression in one hip with stage III and 2 mm collapse in one hip with stage IV. In conclusion, the free vascularized fibula bone graft is an excellent treatment modality for preserving the femoral head and relieving symptoms in cases of the osteonecrosis of the femoral head.

TREATMENT OF A PATIENT WITH APLASTIC ANEMIA WITH INFECTION AND ULCERATION OF THE BREAST SKIN

No abstract available.

CHANGE OF TEMPERATURE OF CANNULA AND ITS INFLUENCE ON MUSCLES, VESSELS, AND NERVES DURING ULTRASONIC LIPOSUCTION

It has been suspected that the cannula of the ultrasonic generator became heated during liposuction, and that the heated cannula might possibly damage the soft tissues such as vessels, nerves and muscles. To confirm these suspicions, the actual temperature of the cannula was measured after being switched on, and the influence of the heated cannula on the soft tissues of 30 rabbits was studied macroscopically and microscopically. When the cooling system of ultrasonic generator was not operated, the temperature of a cannula tip increased to 100degrees C in 10 seconds, and the temperature of a cannula shaft did not increase over 40 degrees C. When the cooling system of the ultrasonic generator was operated, the temperature of the cannula tip increased to 70 degrees C in 20 seconds and to 100 degrees C in 1 minute. The stronger ultrasonic power was, the higher the temperature of the cannula tip was. When the heated cannnula tip touched the muscles, vesseles and nerves directly, the arterial and venous walls were perforated in about 20 seconds and 10 seconds, respectively. Gross changes of the muscles, such as color change and depression of the contacted area, were seen in about 30 seconds, and histological changes occurred in about 3 seconds. When adding the Klein solution, an infiltration solution for increasing the destructive effects of the ultrasound, the onset time of tissue damage was significantly shortened in vessels and nerves, but there was no significant difference in muscles. Although there was no finding of damage by the ultrasonic wave itself on the vessels, nerves, and muscles during ultrasonic liposuction, this study confirmed that the heated cannula could damage vessels, nerves, and muscles. Thus we must try to avoid placing the cannula at certain areas for more than 10 seconds douring the ultrasonic liposuction.

TREATMENT OF SKIN AND SOFT TISSUE DEFECT USING THE ARTIFICIAL DERMIS (TERUDERMIS)

No abstract available.

MR Imaging of Acute Cervical Spine Injuries

No anstract available.

Usefulness of Automated Biopsy Guns in Image-guided Biopsy

PURPOSE: To evaluate the usefulness of automated biopsy guns in image-guided biopsy of lung, liver. pancreas and other organs. MATERIALS AND METHODS: Using automated biopsy devices, 160 biopsies of variable anatomic sites were performed:Biopsies were performed under ultrasonographic(US) guidance in 95 and computed tomographic (CT) guidance in 65. We retrospectively analyzed histologic results and complications. RESULTS: Specimens were adequate for histopathologic diagnosis in 143 of the 160 patients(89.4%)-Diagnostic tissue was obtained in 130 (81.3%), suggestive tissue obtained in 13(8.1%), and non-diagnostic tissue was obtained in 14(8.7%). Inadequate tissue was obtained in only 3(1.9%). There was no statistically significant difference between US-guided and CT-guided percutaneous biopsy. There was no occurrence of significant complication. We have experienced mild complications in only 5 patients-2 hematuria & 2 hematochezia in transrectal prostatic biopsy, and 1 minimal pneumothorax in CT-guided percutaneous lung biopsy. All of them were resolved spontaneously. CONCLUSION: The image-guided biopsy using the automated biopsy gun was a simple, safe and accurate method of obtaining adequate specimen for the histopathologic diagnosis.

The outcome of twin pregnancies, PIH versus Non-PIH group / 대한산부인과학회잡지

No abstract available.

Clinical and pathological observation on the diagnosis and treatment of cervical intraepithelial neoplasia III(CIN III) of the uterine cervix / 대한산부인과학회잡지

No abstract available.

Experimental study on the survival of venous flap

No abstract available.

Transabdominal ultrasonographic measurement of prostate size and weight in the normal Korean adults

Author analyzed 154 cases of transabdominal ultrasonography of normal adults who had normal urinalysis, no complaint of symptoms related with urinary system and no evidence of prostate disease. The maximum anteroposterior, transverse and longitudinal diameters of prostate were measured. The weight of prostate was computed using the formular for the weight of ellipsoid object (W=SGx4/3 pie r1.r2.r3, w; weight, SG; specificgravity about 1.05 gm/ml, r; radious of prostate in any dimension). The results were as follows; 1. The averagesized of prostate were 4.12±0.68 cm in transverse diameter, 3.46±0.49 cm in longitudinal diameter and 2.36±0.40cm in AP diameter. Transeverse diameter was the longest and AP diameter was the shorteset in all cases. 2. Theaverage weight of prostate in each age groups were 19.25±6.78 gm in the 3rd decade, 16.64±5.18 gm in the 4th decade, 16.28±5.31 gm in the 5th decade, 22.31±6.95gm in the 6th decade and 13.06±8.18 gm in over the 7th decade. The average weight of prostate in groups more than 50 years of age were significantly greater than youngerage groups (p<0.005). Total average weight was 18.96±6.78 gm. 3. The distribution of prostate weighting over 30gm in each groups were 14.29%(5/35) in the 3rd decade, 0%(0/34) in the 4th decade, 2.63%(1/38) in the 5th decade,20%(6/30) in the 6th decade and 23.5%(4/17) in the 7th decade.