Cerebro-oculo-facio-skeletal syndrome: A case report / 소아과

The Cerebro-oculo-facio-skeletal (COFS) syndrome is a rare autosomal recessive disorder characterized by multiple abnormalities that involve the brain, face, eyes, and extremities. COFS syndrome is regarded as a degenerative disorder of the brain and spinal cord caused by a mutation of the DNA repair genes. We report on an 8-month-old girl with COFS syndrome who exhibited growth and developmental delay, hypotonia, microcephaly, nystagmus, cleft palate, widely separated nipples, inguinal hernia, camptodactyly, and rocker-bottom feet with vertical talus.

Multifactorial Factors of Diabetic Foot on Diabetes Mellitus Comparative Clinical Study

Among several kinds of diabetic complications reported, diabetic foot ulcers and lower extremity amputations are serious and expensive one. About 10 to 15% of people with diabetes mellitus experience that complication during their life time and half of all nontraumatic lower extremity amputation occur in people with diabetes. The prevention and care of diabetic complication of the foot continue to represent a major challenge to physicians. Neuropathy, infection, deformity and ischemia are major threats to the diabetic foot and overall functional well-being is the main concern of the diabetic foot patients. This retrospective study based on chart reviews 108 cases of diabetic patients: 54 cases of diabetic patients without foot problems and the other 54 cases with foot problems. The mean age of DM foot patients was 57.4 years and they suffered from diabetes for 12.9 years. The diabetic foot problems developed to gangrene, ulcer, and mummification in 33.2 days and their healing time required more than 40 days(mean 42.9 days). The patient of diabetic foot problems had higher level of blood sugar(p=0.023) and longer duration of diabetes mellitus(p=0.040). The most common site was digit, especially 1st and 2nd toe. Multiple lesions were involved in more than 10% of the patients. The majority of operation were debridement and closure, amputation, skin graft. The complications were wound disruption or delayed wound healing and partial skin graft loss. The incidence of diabetic foot was 2.6 times higher in peripheral neuropathic patient and the healing time was related to velocity of development of noticeable diabetic foot(Pearsson correlation coefficient). The peripheral neuropathy was significantly related to diabetic foot(p=0.000), and that was noticed in patients with longer duration of diabetic mellitus (p=0.023) and older age(p=0.032). The majority of DM foot patients was in the 5th to 7th decades(83.3%) and most of DM foot developed more than 5 years after DM diagnosis(91.7%). The mean healing time was 42.9 days and most common healing time was 5 weeks(38.8%). Managements of the diabetic foot require a multisystem approach that addresses the component problems of the neurovascular, skeletal, immune and integumentary system. A coordinated team effort by the plastic surgeon, vascular surgeon, endocrinologist, infectious disease specialist, neurologist, podiatrist as well as the physical therapist and social service representatives are often need to provide the diabetic patient with complete foot care.

Topographic Anatomy of the Arteries Supplying Sternocleidomastoid Muscle for Osseomusculocutaneous Flap Surgery / 체질인류학회지

In reconstructing a defect of the mandible after removing tumor of an oral cavity or facial region, various musculocutaneous flaps are used. Among those, SCM musculocutaneous flaps are clinically frequently used due to its near donor site and it can be done without an additional operation. Because the SCM muscle is supplied by many vessels of the external carotid artery and subclavian artery, it is essential to the figure out its distribution to the SCM muscle, clavicle and the skin before making an osseomusculocutaneous flap including the clavicle. Especially, understanding the distribution status of the origin of superior thyroid artery and SCM branch is very important in making a SCM musculocutaneous flap including the clavicle and deciding the rotation arc of the musculocutaneous flap. The authors have dissected SCM muscles and arteries distributed to the SCM muscle of 50 cadavers and found the following results. The average distance from the origin of superior thyroid artery to SCM branch entering to SCM muscle was 30.1 mm (16.0 ~37.7 mm), and some were to have 2 ~3 branches inserted simultaneously into the SCM muscle. The average distance from the origin of superior thyroid artery to clavicular head of SCM muscle was 87.6 mm (57.7 ~123.8 mm), and to sternal head of SCM muscle was 131.2 mm(99.7 ~166.8 mm). After the SCM branch of superior thyroid artery distributed to the SCM muscle, the bifurcation point into clavicular branch and sternal branch is located at an average 58.8 mm(28.4 ~130.4 mm) above the clavicle. All of the nutrition artery distributed to the clavicle were branches of the thoracoacromial artery, and the SCM branch of superior thyroid artery distributed throughout the SCM muscle and downwards to the periosteal artery of the clavicle. The pattern of the superior thyroid artery was divided into 6 types. Among the branches of superior thyroid artery such as laryngeal, SCM and thyroid branch, The type I (36%) that the laryngeal branch arised first was most common. Next, the incidence of type II that all three branches arised at one point was 16%. In addition, the incidence of the case that SCM branch arised directly from the external carotid artery was 26%. In conclusion, because the origin of superior thyroid artery from the external carotid artery is located relatively close to the mandible above the neck, the length of SCM musculocutaneous flap including the SCM branch of superior thyroid artery is sufficient to reconstructing the mandible and the SCM osseomusculocutaneous flap including the clavicle is useful in reconstruction of the mandible.

Anatomical Study of the Variations of Motor Branches of Tibial Nerve to Gastrocnemius Muscle

No abstract available.

Influences of Plastic Surgery Web-Site on the Patients Who Visits Local Clinics

No abstract available.

Effects of Retinoic Acid on the Mesenchyme in the Palatine Process of the Fetal Rat

In this experiment, pregnant Sprague-Dawley rats were treated with 100mg/kg of alltrans retinoic acid at 10th day of gestation. Pregnant rats were sacrificed at gestation day 14, 15, 16 and 18. Fetuses were delivered, and palatal processes were dissected. The specimens were prepared with fibronectin immunohistochemical stain, and mesenchymal changes were observed with electron microscope. The results were as follows. 1. In the findings fo fibronectin immunohistochemial stain, a part of the mesenchyme of the palatine process of the control group showed weak positive reaction at 14th gestation day, and the reactivity increased progressively by each day. In retinoic acid treated group, the positive reaction was trace at 14th day of gestation, and the reactivity increased progressively, but it was weaker than that of the control group. 2. Examination under transmission electron microscopy revealed well-developed rough endoplasmic reticulum, Goigi apparatus, mitochondrias which were found at the palatine process of the control group. In the retinoic acid treated group, at 16th and 18th day of gestation, the mesenchymal cells of the elevated palatine process had fragmented, sacculated rough endoplasmic reticulums, their mitochondrias were swollen and dissolved, In all cases with retinoic acid treated group, mitotic cells at various stages were more frequently found than in control group. In conclusion, the retinoic acid induces alterations of the intracytoplasmic organells. This finding suggests that retinoic acid is ditectly cytotoxic to mesenchymal cells. Positive fibronectin reaction was demonstrated before palatal elevation at th 15th day of gestation. Therefore, it could be postulated that mesenchymal cells synthesize and release the fibronectin. In the retinoic acid treated group, fibronectin showed positive reaction before and after palatal elevation, and it suggests that fibronectin would be involved in palatal elevation.

A case of traumatic pseudoaneurysm of the dorsalis pedis artery

An aneurysm occurs in association with trauma, atherosclerosis, infection and congenital diseases. Among these, the traumatic arterial aneurysms developed from blunt trauma, crushing injury, perforation, and lacerations of vessels. Generally, most traumatic arterial aneurysms are false type, so called pseudoaneurysm. A pseudoaneurysm occurs by incomplete laceration of the vessel wall or partial division of the vessel. The vascular injury will make hematoma and fibrosis of neighboring tissues. After two to eight weeks post-trauma, the organized hematoma is liquefied and the fibrous tissue acts as an aneurysmal sac. We have experienced a case of dorsalis pedis artery pseudoaneurysm associated with arterial cannulation. So, we report a case of traumatic pseudoaneurysm with a review of literature.