Nipple Reconstruction Using a Scar-Based Modified C-V Flap

BACKGROUND: Numerous techniques have emerged for nipple-areolar complex (NAC) over the years. Scar-based modified C-V flap technique is a new method for creating NAC, surgeons can accomplish nipple reconstruction and scar revision simultaneously. This article described the modified C-V flap technique for nipple reconstruction. This modified method is simple and reliable with good outcome. METHODS: To evaluate the effectiveness of our technique, we reviewed 21 patients who underwent nipple reconstruction using the scar-based modified C-V flap technique. For scar-based modified C-V flap, a C flap was designed to match the contralateral nipple in width while a V flap including scar after mastectomy was designed. The flap pedicle was centrally located. The V flap was then fixed surrounding the central part with a proper shape and volume considering the distal part of the flap that had poor vascularization. RESULTS: The average age of the 21 patients was 48.4 years. The average length of follow up was 7.4 months. Complication rate was 19.0% including projection loss in 2 cases, tip necrosis in 1 case, postoperative infection in 1 case, and wound dehiscence in 1 case. Re-operations were performed for 2 cases of projection loss, 1 case of partial flap necrosis, and 1 case of wound dehiscence. CONCLUSIONS: The scar-based modified C-V flap technique is a simple and reliable method for nipple reconstruction with aesthetic outcome. Patients who have undergone this surgical technique tend to have great satisfaction with the results.

The Efficacy of Bioabsorbable Mesh in Craniofacial Trauma Surgery

BACKGROUND: The ultimate goal of craniofacial reconstructive surgery is to achieve the most complete restoration of facial functions. A bioabsorbable fixation system which does not need secondary operation for implant removal has been developed in the last decade. The purpose of this study is to share the experience of authors and to demonstrate the efficacy of bioabsorbable mesh in a variety of craniofacial trauma operations. METHODS: Between October 2008 and February 2015, bioabsorbable meshes were used to reconstruct various types of craniofacial bone fractures in 611 patients. Any displaced bone fragments were detached from the fracture site and fixed to the mesh. The resulting bone-mesh complex was designed and molded into an appropriate shape by the immersion in warm saline. The mesh was molded once again under simultaneous warm saline irrigation and suction. RESULTS: In all patients, contour deformities were restored completely, and bone segments were fixed properly. The authors found that the bioabsorbable mesh provided rigid fixation without any evidence of integrity loss on postoperative computed tomography scans. CONCLUSION: Because bioabsorbable meshes are more flexible than bioabsorbable plates, they can be molded and could easily reconstruct the facial bone in three dimensions. Additionally, it is easy to attach bone fragments to the mesh. Bioabsorbable mesh and screws is effective and can be easily applied for fixation in various craniofacial trauma reconstructive scenarios.

Outcomes of the Different Types of Total Knee Arthroplasty with the Identical Femoral Geometry

PURPOSE: There are controversies around the role of the posterior cruciate ligament and the effect of design modifications for high flexion in total knee arthroplasty (TKA). So, we compared the clinical outcomes of the cruciate retaining (CR), posterior stabilized (PS), and high flexion posterior stabilized (F-PS) designs in TKA with identical femoral geometry. MATERIALS AND METHODS: One hundred seventy nine knees with 3 different types of prostheses after a minimum 5-year follow-up were enrolled in this retrospective study: 45 with CR, 40 with PS and 94 with F-PS. The mean ages of these groups were 65.7, 67.2, and 67.5, and the mean durations of follow-up were 8.1, 8.0, and 6.8 years, respectively. We compared the range of motion, functional outcomes, and radiographic measurements at the 2-year follow-up and last follow-up. RESULTS: The maximal flexion angle was significantly lower in the CR group than the F-PS group at the 2-year follow-up. However, there was no significant difference at the last follow-up. Functional outcomes and survival rate of the three groups were similar at the last follow-up. CONCLUSIONS: Three different types of TKAs (CR, PS and F-PS) with identical femoral geometry showed similar mid-term outcomes with regard to the range of motion, functional outcomes and survival rate.

Effect of Interrupted Agitation and Removal of Leukocyte on Platelet Quality during the Storage of Platelet Concentrates / 대한진단검사의학회지

BACKGROUND: This study aimed to analyze the influence of the interruption of agitation and removal of leukocytes on platelet concentrates (PCs), and determine the maximum amount of time the agitation could be interrupted without impairing PCs' effectiveness during the storage period. METHODS: Four ABO-identical random donor platelets agitated for 24 hr were pooled, and divided into 4 units, and 2 units of them were leukoreduced. Then 52 pooled units were categorized into 4 groups, non-leukoreduced continuous agitation (Non-LRCA), non-leukoreduced interrupted agitation (Non-LRIA), leukoreduced continuous agitation (LRCA), and leukoreduced interrupted agitation (LRIA), and preserved for 6 days (total 7 days). Mean platelet volume (MPV), pH, HCO3-, pO2, pCO2, CD62P, CD61, glucose, lactate, ammonia and free fatty acid were measured during the period. RESULTS: Starting from the Day 4, the pH and HCO3- of Non-LRIA group begun to decrease while the amount of lactate production, glucose consumption, and MPV increased compared to the Non- LRCA group (P<0.01). An increase in pO2 level was observed in the interrupted agitation groups as the storage period prolonged (P<0.01). The pH levels of all the units in the agitation groups remained higher than 6.4 up to Day 7, while those of the non-leukoreduction group did so only up to Day 2, but those of leukoreduction in the interrupted agitation groups did so up to Day 4. CONCLUSIONS: The interruption of agitation reduced the platelet's capacity to utilize oxygen, increasing lactate amount and reducing pH level. However, the in vitro parameters of the Non-LRIA and Non-LRCA groups on Day 2 were similar to each other and the pH level remained at 6.4 or higher, making one day of agitation interruption possible after 24 hr of agitation. With leukocytes removed, the effective agitation interruption period may become longer.

Translocation of Phospho-ser 15-p53 in Eugenol-induced Apoptosis of in vitro Cultured Cancer Cells / 체질인류학회지

Eugenol (4-allyl-2-methoxyphenol), a major ingredient of herbs such as clove and Magnoliae Flos, is known to induce apoptosis in mast cells via p53 pathway. This study was undertaken to examine the in vivo effect of eugenol and the molecular mechanism underlying eugenol-induced apoptosis in several cancer cells with different p53 status. Effect of eugenol on mesenteric mast cells was tested using a rat anaphylaxis model. And TUNEL staining was conducted to observe the cells undergoing apoptosis. Several cancer cells were treated with eugenol, and Western blotting, immunocytochemistry, confocal microscopy and mitochondrial fractionation were conducted. Eugenol induced apoptosis in mast cells of mesentery in vivo, decreasing the density of mast cells. Although eugenol did not increase the expression level of p53, it caused the translocation of p53 into mitochondria and subsequent release of cytochrome c. Eugenol increased the level of phospho-ser 15-p53 in several cancer cells with wild type p53 but not in the cells with mutant p53 or p53 deficient cancer cell. In cancer cells with wild type p53, p53 translocated into mitochondria was phosphorylated on ser 15. In conclusion, eugenol induces apoptosis in cancer cells with wild type p53 via the translocation of phospho-ser 15- p53. Furthermore our data suggest that the anticancer effect on cancer cells with wild type p53 may be involved with the pharmacological effect of eugenol regulating apoptosis via a phospho-ser 15-p53 dependent fashion.

Morphological Changes of Anterior Horn Cells of Lumbar Spinal Cord after Anterior Root Avulsion in Adult Rat / 대한해부학회지

The morphological changes in the anterior horn of the L4 and L5 spinal segments were observed following anterior root avulsion in the adult male Sprague-Dawley rat (300~350 gm) at 5 days, 1 week, 2 weeks and 3 weeks postlesion. The animals were perfused with 4% paraformaldehyde, 0.15% picric acid in 0.1 M phosphate buffer solution and cryostat sections were prepared. Immunohistochemistry was used to identify changes of the phenotype in the anterior horn cells. Primary antibodies, goat anti-choline acetyltransferase (ChaT, 1 : 500, Chemicon), mouse antirat ED-1 (1 : 200, Serotec), rabbit anti-glial fibrillary acidic protein (GFAP, 1 : 200, DAKO) and rabbit anti-vascular endothelial growth factor (VEGF, 1 : 500, Santa Cruz Biotechnology) were used. Avidin-Biotin complex method was performed for immunohistochemical reaction and color reaction was developed with DAB-H2O2. Following results were observed in the anterior horn of lumbar spinal cord; 1. The number of ChaT-immunoreactive (ir) cells were reduced 20% level of control animals at 3 weeks after avulsion. 2. ED-1-ir microglia were significantly increased at 1 week and processes of ED-1-ir microglia surrounded around the axotomized neuronal cell bodies. 3. Gliosis defined by extensive GFAP immunoreactivity was observed both ipsilateral and contralateral side of lesion but the VEGF-ir cells were significantly increased in the ipsilateral side of lesion. Therefore, this study suggested that the majority of axotomized motor neurons were degenerated and the cellular proliferation and phenotype changes including glial cell activation were observed in the lumbar spinal cord after anterior root avulsion of adult rats.

Percutaneous Endoscopic Interlaminar Discectomy for L5-S1 Disc Herniation: Axillary Approach and Preliminary Results

OBJECTIVE: The purpose of this study was to describe a surgical technique of axillary approach of percutaneous endoscopic interlaminar discectomy for L5-S1 disc herniation and its preliminary results. METHODS: From July 2002 to September 2003, 101 patients with lumbar radiculopathy due to L5-S1 disc herniation, who were treated by percutaneous interlaminar endoscopic discectomy, were retrospectively reviewed. There were 57 males and 44 females with a mean age of 44.8 years (range, 18 to 62 years). The surgery consisted of needle insertion into the epidural space via the interlaminar space, sequential dilatation, and endoscopic discectomy through the axillary area of the S1 root. RESULTS: The mean follow-up period was 14.5 months and the average surgical time was 41 min. According to the modified Macnab criteria, 44 patients (43.6%) had excellent outcomes, 49 (48.5%) had good results and only 8 (7.8%) had fair or poor outcomes. Four patients had a revision microdiscectomy due to incomplete removal of disc fragment. There were no major complications related to this surgical approach. CONCLUSION: Axillary approach of percutaneous endoscopic interlaminar discectomy is safe and effective procedure for the treatment of L5-S1 disc herniation. It combines the advantages of MED and conventional percutaneous endoscopic discectomy.

Comparison of the Effects of NOS Inhibitor or HS-1580 on Nigrostriatal Dopaminergic System in MPTP-induced Parkinson's Disease Animal Model / 대한해부학회지

The antioxidant effects of HS-1580 derived from Brown seaweeds in comparison with NOS inhibitor, L-NAME, were tested in the Parkinson's disease animal model. C57BL/6 mice were implanted with osmotic pump containing vehicle, HS-1580 or L-NAME intraperitoneally 2 days before MPTP injection. The Parkinson's animal model were prepared by intraperitonal injection of MPTP (20 mg/kg, 4 times with 2 hours intervals in a ay).The mice were perfused with Zamboni fixative 2 days or 7days after MPTP injection. The 30 micrometer cryostat section were immunostained with free-floating method. Rabbit anti-tyrosine hydroxylase (TH)and rat anti-mouse MAC-1 were used as the primary antibodies. The following results were obtained. The number of TH-immunoreactive (ir)neurons in substantia nigra (SN)and the relative density of TH-ir axon terminals in striatum were decreased by MPTP injection. But the ecrease was significantly attenuated with 10%HS-1580 or L-NAME (50 mg/kg)pretreatment before MPTP injection. MAC-1-ir activated microglia were observed in substantia nigra 2 days after MPTP injection. Activated microglia were showed as thickened processes with round cell bodies. The morphological changes of MAC-1-ir activated microglia were inhibited by HS-15980 or L-NAME pretreatment before MPTP injction. Above results mean that the damage of nigrostriatal dopaminergic system was rescued by pretreatment of HS-1580 or L-NAME in MPTP-induced Parkinson's disease animal model.

Effect of PDN(R)(Prosthetic Disc Nucleus) on the Mobility and Height of the Intervertebral Disc: Preliminary Report

OBJECTIVE: The purpose of the current study is to investigate the effect of the prosthetic disc nucleus replacement on the mobility and height of the intervertebral disc and adjacent segments. METHODS: Thirteen patients who underwent L4-L5 prosthetic disc nucleus replacement were included in this study. A retrospective review of clinical and radiological data was conducted. The L4-L5 disc height and sagittal rotation angle of L3-L4, L4-L5, L5-S1 were measured in the static and dynamic lateral radiographs pre- and postoperatively. RESULTS: There were seven men and six women whose mean age was 37 years(range, 24-49 years). The mean follow-up period was nine months(range, 6-14 months). In all cases the L4-L5 motion segment demonstrated angular motion between flexion and extension with a mean of 4degrees(+/-2.3degrees) of sagittal rotation angle. The disc height increased from preoperative levels by 117%. There was no difference in angular motion of adjacent segments between pre- and postoperative data. CONCLUSION: The prosthetic disc nucleus replacement after discectomy is shown to restore the disc height and maintain segmental mobility.

Platelet Activation of Stored Platelets with Storage / 대한수혈학회지

BACKGROUND: Effects of storage period on platelet activation of random-donor platelets (RDP) prepared from whole blood units and single-donor platelets (SDP) prepared from single-donor apheresis collections have been investigated in this study. We also analyzed the correlation between amount of blood cells and platelet activation in random-donor platelets. METHODS: RDP and SDP were collected at 1 day, 3 day, or 5 day during storage. In case of SDP, whole blood was also collected just before apheresis. The platelet activation in RDP and SDP was measured by flowcytometry using monoclonal antibodies against CD41a, CD61 and CD62p. RESULTS: In SDP, MCFI against CD62p has been significantly increased during storage and any significant differences are not found according to the kinds of pheresis machines. In RDP, no significant differences in MCFI against CD62p were found with storage period and showed a increased MCFI dependent only on the number of platelets. CONCLUSION: Single-donor platelets should be used as soon as possible for transfusion due to progressive platelet activation with storage period. On the other hand, a proper number of platelets should be maintained under strict quality control system to minimize platelet activation in RDP.

Factors Affecting pH Changes in Preserving Platelet Concentrates / 대한수혈학회지

BACKGROUND: The purpose of this study is to examine whether the blood cells in the platelet concentrate (PC) and the PC arrangement method can affect the pH which is one of the important factors influencing the survival and function of the preserved PCs. METHOD: Two groups of CPDA-1 added PC were preserved at 20 ~ 24degrees C for 7 days. The PCs in group I were overlapped one another while those in group II were not overlapped and arranged separately during the preservation period. The number of RBC, WBC and platelets were measured at the first day of the preservation period while the pH was measured at the 1st, 3rd, 5th and 7th day. RESULTS: The number of blood cells in the PC was 0.6x109 for WBC, 1.6x109 for RBC and 800x109 for platelet. As for the average pH, the 1st day's average pH was 7.4 for group I and 7.3 for group II, while at the 7th day, both decreased by 0.6. According to the correlation analysis between the blood cells and the pH changes, as for group I, the more the number of platelets were, the lower the pH decreased, and as for group II, the more the WBC and platelets were, the lower the pH decreased. (p<0.01) CONCLUSION: This study indicates that the major parameter affecting the pH of the preserved PCs is the number of platelets. In addition to platelet, the number of WBCs affected the pH when PCs were overlapped during storage. Conclusionally the key factor which affects pH of stored PCs was the number of platelets. And the number of contaminated WBCs also were thought to be an important factor.

SMA Syndrome after Corrective Surgery of Thoracic Kyphoscoliosis: A Case Report / 대한척추외과학회지

Superior mesenteric artery (SMA) syndrome is a rare condition that results from an extrinsic compression of the third portion of the duodenum, between the SMA and the aorta. The symptoms for the condition consist of abdominal pain and recurrent vomiting, caused by ileus, and can be followed by an electrolyte imbalance and nutrient deficiency. SMA syndrome can follow surgical correction of a spinal deformity, as the aorta migrates forward as the degree of the lumbar lordosis increases, and the retroperitoneal fat tissue decreases, during perioperative abstinence. Any symptoms suggestive of SMA syndrome, after correction of a spinal deformity, should be investigated, as SMA syndrome carries a prolonged hospital stay, with the potential for mortality. An 11 year 10 month old boy, who underwent correction for thoracic kyphoscoliosis, developed postoperative abdominal distension, pain and bilious vomiting. An upper gastrointestinal contrast study revealed SMA syndrome, which required a laparotomy.

Anterior Lumbar Interbody Fusion for Focal Type of Degenerative Flat Back: Preliminary Report

OBJECTIVE: The purpose of this study is to determine the efficacy of anterior lumbar interbody fusion(ALIF) for the patients with focal type of degenerative flat back. METHODS: The authors reviewed clinical and radiologic data of 16 patients with focal type of degenerative flat back who underwent ALIF during the period between December 1999 and November 2000. The operation procedure was ALIF using titanium or carbon fiber cages of lordotic angle, which were filled with allograft or autograft mixed with allograft through minilaparotomy. RESULTS: The majority of the patients were female(15 female: 1 male) and the mean age was 60.1 years. Six patients were operated on one level, ten on two levels. The mean follow up period was 10.7 months. The mean operation time was 131minutes and the average estimated blood loss was 133ml. Transfusion was not needed in any case. The mean preoperative lumbar lordotic angle was 4.1 degree(-7.4-41.6) and improved to 17.5 degree(-4.5-41.9) postoperatively. Radiological fusion was achieved in 13 patients(81%). The Oswestry disability index score improved from 62.5% to 23.9% and the patient's subjective improvement rate was 80%. Complications were infection in one patient, incisional hernia in one, symptomatic pseudoarthrosis in one and transient sympathetic disturbance in left leg in three. CONCLUSION: In a subset of the patients with degenerative flat back who showed disc degeneration in one or two levels, ALIF using cages improved patient's symptoms effectively. It seems that ALIF through minilaparotomy can be one of the surgical options in the treatment of the focal type of degenerative flat back.

Spinal Intramedullary Ependymal Cyst

The authors report a case of intramedullary ependymal cyst at the level of conus medullares in 44-year-old man. The patient was admitted to our hospital due to progressing both lower extremities weakness and radiating pain for 6months. Magnetic resonance(MR) imaging showed intramedullary cystic mass at the level of conus which compressed spinal cord. The patient underwent partial removal and made cyst to communicate with subarachnoid space. The histologic finding was ependymal cell cyst. After surgery the patient had symptomatic improvement and in follow-up MR image cyst regressed in size.

The Effects of Herb Extracts in Cerebrovascular Accidental Patient / 재활간호학회지

The several Chinese herbs such as Soon-Ki-Hwal-Hyul-Tang, Bo-Yang-Hwan-O-Tang, Seong-Hyang-Jeong-Ki-San, So-Hap-Hyang-Won and O-Yak-Soon-Ki-San were extracted with water and then lyophilized. For identification of the effect of extracted herbs, they were medicated to 103 patients of cerebrovascular accident for 4 week. They were hospitalized in D-Oriental Medical Hospital from April to August in 1999. The herbs were extracted with water and lyophilized and then, used as samples. The medical history of each patient was detected and analyzed from their medical records. The results were as follows: 1) Each sample (Soon-Ki-Hwal-Hyul-Tang, Bo-Yang-Hwan-O-Tang, Seong-Hyang-Jeong-Ki-San, and O-Yak-Soon-Ki-San) was statistically significant differences of systolic blood pressure(t=4.22, P=0.0004: t=3.44, P=0.0028: t=2.11. P=0.0463: t=3.23, P=0.0052). The statistically significant difference of diastolic blood pressure showed by medicated with Soon-Ki-Hwal-Hyal-Tang, Seong-HyangJeong-Ki-San, and O-Yak-Soon-ki-San(t=2.13, P= 0.0459: t=2.68, P=0.0136: t=3.12, P=0.0066). 2) The statistically significant difference of the arm/leg-ROM showed by medicated with Soon-Ki-Hwal-Hyul-Tang, Bo-Yang-Hwan-O Tang, So-Hap-Hyang-Won(t =4. 74/4. 95, P=0.0002/0.0001: t=2.25/2.44, P=0.0368/0.0248: t=585/6.76, P=0.0001/0.0001). 3) In the verbal disorder, Soon-Ki-Hwal-Hyul-Tang, Bo-Yang-Hwan-O-Tang had statistically significant differences(t=4.50, P=0.0002: t=3.32, P=0.0036) 4) In the conscious disorder, Soon-Ki-HwalHyul-Tang, Bo-Yang-Hwan-O-Tang, Seong-Hyang =-Jeong-Kj-San, and So-Hap-Hyang-Won had statistical1y significant differences(t =6.32, P = 0,0001: t=8.32, P=0.000l: t=3.74, P=0.0012: t=5.14, P=0.0001). 5) Bovine aortic endothelial cell (BAEC) were cultured in DMEM treating 0.01mg/ml. and 0.1mg/ml of each lyophilized samples for 24 hours, In BAECs were treated by 5 kinds of samples, the effect of So-Hyap-Hyang-Won induced syncytium of adjacent endothelial cells. It may induce the recovering of the damaged blood vessels in cerebrovascular accidental patient by angiogensis of endothelial cells. Therefore, it suggests that the medication of So-Hap-Hyang-Won will help to nursing care for cerebrovascular accidental patients.

Long Term Follow-up of SAH Patients with Conservative Treatment

Two hundreds and four consecutive patients who sustained proven spontaneous subarachnoid hemorrhage with conservative treatment were studied retrospectively. The reasons for conservative treatment were poor condition for surgery, difficulties in surgery and operation refusal. Comparative study was done in proven 47 cases of aneurysmal SAH, 27 cases of SAH with negative angiography and 130 cases of SAH without angiography about age, aneurysm site & size, neurologic grade mortality & morbidity, etc. Death had occurred in 2 weeks after attack predominantly. Rebleeding was most common cause of mortality(64%, 68/107). Survivals had good quality of life(73%, 19/26).

Clinical Analysis of Chronic Subdural Hematoma

The authors have experienced 62 cases of chronic subdural hematoma from Jan. 1987 to May 1992 at National Medical Center. In these cases, 58 cases of chronic subdural hematoma were treated with burr hole and closed draninage, 4 cases were managed with conservative management. Male was predominant to female with the ratio of 6:1 and common age was 50-60 years old. Most common causes was head injury and there was cases of chronic subdural hematoma developed after shunt operation. Common symptom was mental change and headache. Brain expansion was delayed in old age group(over 50 years old), Brain CT was available in diagnosis but brain MRI was useful in diagnosis of scantly chronic subdural hematoma. Surgical outcome was related to preoperative neurologic grade and time interval of diagnosis. In this study, clinical improvement rates was 88% in surgically treated cases.