The Infection after Augmentation Rhinoplasty Using Silicone Implant

Augmentation rhinoplasty using silicone implant is one of the most common cosmetic procedures in Korea, but is not without several complications such as exposure of the implant, its deviation and deformity. Above all, infection and extrusion through the skin is most serious complication. The purpose of this study was to determine the type of microbial colonization on silicone implant removed from symptomatic patients and to prevent from the infection. Over the past 11 years, from February of 1996 to February of 2007, we have done 134 aesthetic rhinoplasties using silicone implant in our clinic, patient ages ranged from 15 to 62 years with an average of 29.2 years. 78 percent of patients (105) were female, and 22 percent (29) were male. Among them, four cases had the local infection. The infection rate was 2.9 percent. Total six cases of implant including the other two case augmented elsewhere having the infection were removed and submitted for Gram stain, standard aerobic and anaerobic bacterial culture, and fungal cultures. Staphylococcus aureus was isolated most frequently (four cases), followed by Pseudomonas aeruginosa (one case) and Proteus mirabilis (one case). No fungal infections were identified. In order to reduce the infection rates after augmentation rhinoplasty using silicone implant, rhinorrhea as a source of bacterial nutrients should thoroughly be managed perioperatively. The hairs of the nostril should appropriately be shaved, and the patient's entire face and internal nares meticulously prepared. The implant should be shaped to be shorter, smaller and thinner, appropriately to the patient's nasal phenotype. Also, subperiosteal implantation rather than subcutaneous or subfascial is better choice.

The Effects of Arnica Montana Gel for the Decreasing on the Swelling and Bruise

Homeopathic medicine is becoming increasingly popular in this country and abroad. Arnica montana has been known since the 16th century as an acute topical treatment of sprains, bruises, painful swellings, and wounds. Although arnica has a long history in folk medicine and is widely used, efficacy in a decreasing of swelling and bruise has never been clinically studied. This study investigated the safety and efficacy of an Arnica montana gel, applied the twice daily, in 15 patients(6 men and 9 women) who had trauma with swelling and bruise without external wound of the face from April of 2006 through December of 2006. The trauma with swelling and bruise was made on the dorsum of the rat, and then applied the twice daily for 1 week divided in control site and arnica-applied site on the dorsum. On the patients' subjective assessment of efficacy, 15 patients felt an effect in 1 week, and time to onset of effect averaged 2.8 days. On the experimental study of efficacy, microscopic finding of control site showed the dermis is mildly widened interstitial spaces, the interstitial fluid is mildly increased, but arnica-applied site showed the interstitial edema is not evident, the dermal collagen fibers are relatively well preserved. Topical application of Arnica montana gel for 1 week was a safe, well-tolerated, and effective treatment of swelling and bruise of the face.

A Case Report of Liposarcoma on the Neck in an Adult

PURPOSE: Although liposarcoma is the second most common soft tissue sarcoma in adults, the incidence of liposarcoma of the head and neck is rare. There is only one reported case in Korea and moreover, only in adolescence. We report a case of liposarcoma on the neck in a 32-year-old male in adult. METHODS: The patient had a slow growing, none tender mass on the posterior neck without lymphadenopathy, which has been present for 3 years and recurred twice during that time. MRI showed a 1.5cm sized ovoid, well demarcated mass that was located in the subcutaneous layer of the posterior neck. RESULTS: The mass was surgically removed. The resection margin was free of tumor on frozen biopsy and histopathologic examination indicated myxoid and round cell liposarcoma. The whole body F-18 FDG PET-CT applied on the fourteenth day postoperatively, revealed a moderate FDG-uptaking soft tissue lesion showing postoperative wound healing process on the posterior neck region and there was no distant metastasis. CONCLUSION: Liposarcoma is the second most common soft tissue sarcoma in adults. But, it rarely involves the head and neck region. Prognosis is principally dependent on histologic subtype and grade. Low grade liposarcoma such as well differentiated and myxoid liposarcoma tend to recur locally, rarely metastasize. On the other hand, high grade liposarcoma such as round cell and pleomorphic liposarcoma have higher rates of local recurrence and distant metastasis. Complete surgical excision provides the most effective means of treatment. Radiotherapy or chemotherapy can be used as an asjunctive treatment modality.

A Case Report of Liposarcoma on the Neck in an Adult

PURPOSE: Although liposarcoma is the second most common soft tissue sarcoma in adults, the incidence of liposarcoma of the head and neck is rare. There is only one reported case in Korea and moreover, only in adolescence. We report a case of liposarcoma on the neck in a 32-year-old male in adult. METHODS: The patient had a slow growing, none tender mass on the posterior neck without lymphadenopathy, which has been present for 3 years and recurred twice during that time. MRI showed a 1.5cm sized ovoid, well demarcated mass that was located in the subcutaneous layer of the posterior neck. RESULTS: The mass was surgically removed. The resection margin was free of tumor on frozen biopsy and histopathologic examination indicated myxoid and round cell liposarcoma. The whole body F-18 FDG PET-CT applied on the fourteenth day postoperatively, revealed a moderate FDG-uptaking soft tissue lesion showing postoperative wound healing process on the posterior neck region and there was no distant metastasis. CONCLUSION: Liposarcoma is the second most common soft tissue sarcoma in adults. But, it rarely involves the head and neck region. Prognosis is principally dependent on histologic subtype and grade. Low grade liposarcoma such as well differentiated and myxoid liposarcoma tend to recur locally, rarely metastasize. On the other hand, high grade liposarcoma such as round cell and pleomorphic liposarcoma have higher rates of local recurrence and distant metastasis. Complete surgical excision provides the most effective means of treatment. Radiotherapy or chemotherapy can be used as an asjunctive treatment modality.

Survival Analysis and Its Prognostic Factors after Distant Relapse in Breast Cancer Patients

PURPOSE: Little attention has been paid to predictive the factors for recurrence and survival after relapse in patients with breast cancer in Korea. The purpose of this study was to identify the survival and potential prognostic factors associated with survival from the time of a distant relapse. METHODS: Between 1989 and 2000, 2355 patients were treated by surgery for breast cancer at the Breast Clinic of the Asan Medical Center. We retrospectively analyzed 247 women who developed a distant relapse among that. RESULTS: The median follow-up duration from the first distant relapse was 10.5 months (0.5-101 months) and the median age at the time of relapse was 46.8 years, retrospectively. The median survival was 19.2 months with a 41.5% and 19.5%, two and five year overall survivals. The dominant sites for the spread were bone (32.0%), lung (29.3%), soft tissue (20.0%) and other visceral organs (18.7%). The median survivals along the site of the relapse were as follows: bone, 26.6; soft tissue, 19.5; lung, 15.8; and other visceral organs, 9.0 months. The location of recurrence, number of metastatic site (both visceral and multiple), the axillary lymph node status (above 4), and operation methods (breast conserving operation) were significantly associated with shorter survivals from the first distant relapse. Conversely, the estrogen receptor status, adjuvant chemotherapy and disease free interval, all failed to reach statistical significance. CONCLUSION: We confirmed that our results for survival of the distant relapsed patients were similar, when comparing to those of Western countries. In this study, the site of the initial recurrence and the axillary lymph node status were important factors for predicting survival after distant recurrence and should help in designing new therapeutic strategies for this group of patients.

Post-thyroidectomy Hypocalcemia in High- Risk Patients Following Total Thyroidectomy

PURPOSE: Parathyroid injury is the major cause of post-thyroidectomy hypocalcemia. This prospective study aimed to define the relation between the preservation status of the parathyroid glands and post-thyroidectomy hypocalcemia as well as to determine whether the number of preserved parathyroid glands could be a guideline for the management of post-thyroidectomy hypocalcemia. METHODS: We analyzed a total of 76 cases of total thyroidectomy due to malignancy were analysed. Parathyroid gland status at the end of thyroidectomy was classified as preserved intact, discolored (color change or equivocal viability), or autotransplanted. Patients were grouped according to the number of intact preserved parathyroid glands into group 1 (more than two), group 2 (one), or group 3 (zero). The total and ionized serum calcium levels of each group were monitored for three days after surgery. RESULTS: The number of intact preserved parathyroid glands was not found to be closely related to serum calcium level, although ionized serum calcium level was significantly lower in group 1 than group 2 (P<0.001). Hypocalcemia was not found in group 1. Hypocalcemia was found in 31% (10/32) of group 2. Among the 32 patients of group 2, all 4 parathyroid gland were identified in 9 patients and 4 patients were shown to be hypocalcemic. Therefore, the incidence of hypocalcemia for patients in whom only one intact parathyroid was preserved and all 4 parathyroid were indentified was 44% (4/9). Hypocalcemia was transient in all patients. CONCLUSION: The parathyroid glands should be preserved as much as possible to minimize post-thyroidectomy hypocalcemia. The number of intact preserved parathyroid glands can be a good guideline for predicting post-thyroidectomy hypocalcemia and proper care management.