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Background@#During the coronavirus disease 2019 (COVID-19) pandemic, the everyday use of face masks massively increased to prevent the spread of infection. Many people complain of ear pain and erosion when wearing a mask for extended periods of time. If prolonged mask usage is uncomfortable for ordinary people, a question arises—how much more inconvenient must mask wearing be for patients with a full-thickness skin graft (FTSG) donor site in the retroauricular region? Herein, we evaluated complications related to face mask use in 27 patients with a retroauricular FTSG donor site, with the goal of clarifying whether the retroauricular region is still an appropriate FTSG donor site in the context of the COVID-19 pandemic. @*Methods@#Complications in 27 patients treated by FTSGs harvested from the retroauricular region from 2019 to 2021 were investigated. A questionnaire comparing the normal and the operated sides was administered. Pain, itching, soreness, deformity, and symmetry were further investigated. @*Results@#Pain and itching were the only observed complications. The operated side was slightly more painful than the normal side in four patients (14.8%), and four patients (14.8%) reported itching on the operated side. However, all patients who experienced complications stated that the pain or itching did not interfere with mask wearing. Most symptomatic patients were older than 60 years of age (23.8%, p=0.185) and wore masks for longer periods of time (28.5%, p=0.326). @*Conclusion@#Few retroauricular donor site-related complications occurred, and none of these complications caused inconvenience in daily life. Therefore, in the COVID-19 pandemic, the use of the retroauricular region as an FTSG donor site remains appropriate.
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Water beads are dangerous foreign bodies causing intestinal obstruction in young children because the beads absorb water and are radiolucent. Although the features lead to progressive intestinal obstruction, it is difficult to diagnose ingestion of the beads by imaging studies. For the diagnosis, ultrasonography is safe, fast, and accurate. The imaging modality can show intestinal water beads as spherical, anechoic, smoothly demarcated cysts. This characteristic finding may be more useful in rapid and accurate diagnosis than computed tomography scan. We report a case of an 8-month-old boy who obtained a timely sonographic diagnosis of water bead-induced small bowel obstruction in the emergency department.
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Reconstruction of lip defects is important because the lips play an important role in maintaining aesthetic facial balance, facial expressions, and speech. There are various methods of lip reconstruction such as primary repair, skin grafting, and utilization of local and free flaps. It is important to select a proper reconstruction method according to the size and location of lip defect. Failure to select an appropriate method may result in distortion, color mismatch, sensory loss, and aesthetic imbalance. Herein we present a case of successful aesthetic reconstruction of the lower vermilion. We removed a venous malformation, which was limited to the lower vermilion and adjacent to the white roll, and repaired the defect using the modified O-Z flap.
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Background@#Two hypothetical mechanisms have been proposed for fat embolism syndrome: mechanical obstruction and biochemical reactions. However, it has not been proven whether these mechanisms are correlated. This study aimed to demonstrate the relationship between these two hypothetical mechanisms by observing biochemical and histological changes in animals. @*Methods@#After a preliminary study, 700 mg/kg of triolein was injected via the ear vein into 25 rabbits and hemodynamic changes in triglycerides, lipases, free fatty acids, and albumin over time were observed. Necropsies were immediately conducted on all experimental animals, and the lungs were examined histologically. @*Results@#Eight rabbits died within 1 hour after the injection due to mechanical obstruction. Six rabbits died 7–60 hours after the injection due to diffuse hemorrhage of the lung induced by the toxic biochemical reactions of free fatty acids. Histological examinations of the lungs of the surviving rabbits showed petechiae on the surfaces and evidence of recovery from hemorrhage. Blood levels of free fatty acids increased immediately after the injection of triolein. @*Conclusions@#This study revealed that fat emboli primarily injure the lung via mechanical obstruction. The fat is hydrolyzed into fatty acids and causes secondary damage via biochemical reactions. The present study sheds light on the pathophysiology of fat embolism syndrome, with possible implications for its management and prevention.
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Background@#The placement of a closed suction drain is indispensable for preventing serious infections; however, closed suction drains are inevitably accompanied by increases in local infections, pain, and length of hospital stay, and delays in breast cancer treatment including postoperative chemotherapy and radiotherapy. We analyzed predictive factors of total drainage volume and duration. @*Methods@#Among patients who were diagnosed with primary breast cancer between January 2016 and December 2017, we retrospectively analyzed those who underwent immediate implant-based breast reconstruction. Factors that could affect the total volume and duration of drainage, including lipo-prostaglandin E1 use, preoperative chemotherapy, resected breast issue weight, age, body mass index (BMI), serum white blood cell count, erythrocyte sedimentation rate, and C-reactive protein (CRP) level, were analyzed. @*Results@#The mean volume and duration of drainage were 1,213.6 mL and 14.8 days respectively. BMI and CRP on postoperative day (POD) 1 were correlated with the total drainage volume. Age, BMI, and resected breast tissue weight were correlated with the drainage duration. Multiple regression analysis showed that CRP level on POD 1, age, and resected breast tissue weight significantly affected the drainage duration. Multiple regression analysis also showed that the total drainage volume was significantly affected by BMI and CRP level on POD 1. @*Conclusions@#The factors found to affect the duration of drainage in patients undergoing implant-based breast reconstruction were CRP on POD 1, age, resected breast tissue weight, and BMI. The CRP level on POD 1 and BMI influenced the total volume of drainage.
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Reconstruction of lip defects is important because the lips play an important role in maintaining aesthetic facial balance, facial expressions, and speech. There are various methods of lip reconstruction such as primary repair, skin grafting, and utilization of local and free flaps. It is important to select a proper reconstruction method according to the size and location of lip defect. Failure to select an appropriate method may result in distortion, color mismatch, sensory loss, and aesthetic imbalance. Herein we present a case of successful aesthetic reconstruction of the lower vermilion. We removed a venous malformation, which was limited to the lower vermilion and adjacent to the white roll, and repaired the defect using the modified O-Z flap.
ABSTRACT
Background@#Two hypothetical mechanisms have been proposed for fat embolism syndrome: mechanical obstruction and biochemical reactions. However, it has not been proven whether these mechanisms are correlated. This study aimed to demonstrate the relationship between these two hypothetical mechanisms by observing biochemical and histological changes in animals. @*Methods@#After a preliminary study, 700 mg/kg of triolein was injected via the ear vein into 25 rabbits and hemodynamic changes in triglycerides, lipases, free fatty acids, and albumin over time were observed. Necropsies were immediately conducted on all experimental animals, and the lungs were examined histologically. @*Results@#Eight rabbits died within 1 hour after the injection due to mechanical obstruction. Six rabbits died 7–60 hours after the injection due to diffuse hemorrhage of the lung induced by the toxic biochemical reactions of free fatty acids. Histological examinations of the lungs of the surviving rabbits showed petechiae on the surfaces and evidence of recovery from hemorrhage. Blood levels of free fatty acids increased immediately after the injection of triolein. @*Conclusions@#This study revealed that fat emboli primarily injure the lung via mechanical obstruction. The fat is hydrolyzed into fatty acids and causes secondary damage via biochemical reactions. The present study sheds light on the pathophysiology of fat embolism syndrome, with possible implications for its management and prevention.
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Background@#Several oncoplastic approaches have been implemented in recent years to enhance cosmetic results and to reduce complications. The round block technique is a volume displacement technique for breast reconstruction after breast-conserving surgery (BCS). However, its indications are currently limited according to tumor location, and its cosmetic results and complications have not been clearly established. We hypothesized that the round block technique could produce favorable cosmetic results without major complications regardless of tumor location or nipple-tumor distance, below a certain resected tumor volume and tumor-breast volume ratio. @*Methods@#All breast reconstructions using the round block technique after BCS were included in this analysis. Patients’ data were reviewed retrospectively to investigate complications during follow-up, and clinical photos were used to evaluate cosmetic results. The relationships of tumor location, nipple-tumor distance, tumor volume, and the tumor-breast volume ratio with cosmetic results were investigated. @*Results@#In total, 108 breasts were reconstructed. The mean resected tumor volume was 30.2±15.0 mL. The cosmetic score was 4.5±0.6 out of 5. Tumor location, nipple-tumor distance, tumor volume, tumor-breast volume ratio, radiotherapy, and chemotherapy had no significant effects on cosmetic results or complications. There were no major complications requiring reoperation. @*Conclusions@#Breast reconstruction using the round block technique after BCS can lead to good cosmetic results without major complications regardless of the tumor location, nipple-tumor distance, radiotherapy, or chemotherapy. Below the maximum tumor volume (79.2 mL) and the maximum tumor-breast volume ratio (14%), favorable results were consistently obtained.
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After a partial mastectomy, large or ptotic breasts can be reconstructed using breast reduction techniques. Wise-pattern reduction is typically used to remove masses in any quadrant of the breast, but this technique leaves a large inverted T-shaped scar. Instead, the short scar periareolar inferior pedicle reduction (SPAIR) technique involves a periareolar line and does not result in a scar along the inframammary fold (IMF). A 49-year-old patient with macromastia and severely ptotic breasts was diagnosed with invasive cancer of the left breast. Her large breasts caused pain in her back, shoulders, and neck. She also expressed concern about postsurgical scarring along the IMF. In light of this concern, we chose the SPAIR technique, and we designed and performed the procedure as described by Hammond. During surgery, we removed 36 g of breast tumor and 380 g of breast parenchyma from the left breast. To establish symmetry, we also removed 410 g of tissue from the right breast. Postoperatively, the patient reported satisfaction regarding the reduction mammaplasty and, in particular, noted decreased back, shoulder, and neck pain. In summary, we used the SPAIR technique to achieve oncologic and aesthetic success in a patient with macromastia and a tumor located lateral to the nipple-areolar complex.
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BACKGROUND: Non-melanoma skin cancers (NMSCs, basal cell carcinoma [BCC], and squamous cell carcinoma, [SCC]) are skin conditions, and the propensity of NMSCs to develop multiple tumors may be associated with some genodermatoses, arsenic poisoning, and chronic exposure to radiation or coal tar. OBJECTIVE: To report our experience of treating multiple NMSCs and to investigate the clinical characteristics of NMSCs. METHODS: We retrospectively evaluated 16 patients who had been diagnosed with NMSCs from May 2010 to December 2014. RESULTS: The male-female sex ratio was 0.6:1 in the patients with multiple BCCs and SCCs. The most frequent age group was the seventh decade (75%). The mean patient age was 76.36 years. The most common involved site was the face, particularly the cheek (54.3%). Nodular BCCs were the most frequent (61.9%), followed by infiltrate BCCs (28.6%) and superficial BCCs (9.5%). Among the SCCs, the moderately differentiated SCCs were the most frequent (50%). More NMSCs were found on the left than on the right side of the head and neck areas in both sexes. Development of BCC (68.8%) was more frequent than that of SCC in sun-exposed areas. CONCLUSION: In our study, differences in the demographic variables, such as age, sex, or residence were found between the patients with multiple BCCs and SCCs. The incidence of BCC has markedly increased, which is mainly because of the increment of aged people in their residence, along with environmental factors. Further cohort studies that include cumulative lifetime sun exposure and a large sample size are needed.
Subject(s)
Humans , Arsenic Poisoning , Carcinoma, Basal Cell , Carcinoma, Squamous Cell , Cheek , Clinical Study , Coal Tar , Cohort Studies , Head , Incidence , Neck , Retrospective Studies , Sample Size , Sex Ratio , Skin Neoplasms , Skin , Solar SystemABSTRACT
PURPOSE: The purpose of this study was to investigate the nursing informatics competencies, problem-solving ability, and nursing performance ability of nurses, and to determine factors that affect their nursing performance ability. METHODS: Data were collected from 210 clinical nurses employed by a general hospital having more than 500 beds in Seoul. The data were collected from June to October, 2014. The questionnaires included a nursing informatics questionnaire, the Korea problem solving process inventory, and a nurse performance appraisal tool. The data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficient, and stepwise multiple regression. RESULTS: Nursing performance ability had statistically significant correlation with nursing informatics competencies (r=.49, p<.001) and problem-solving ability (r=.66, p<.001). Factors influencing nursing performance ability were problem-solving ability, nursing informatics competencies, work experience, and educational status, accounting for 54% of the variance. CONCLUSION: Findings indicate that nursing informatics competencies and problem-solving ability have important influences on the nursing performance ability of clinical nurses. Thus, in order to provide an improvement in nursing performance ability, educational programs towards nurses' problem-solving ability and nursing informatics competencies should be provided.
Subject(s)
Educational Status , Hospitals, General , Korea , Nursing Informatics , Nursing , Problem Solving , Seoul , Task Performance and AnalysisABSTRACT
BACKGROUND: Striae gravidarum (SG) is a common skin change that occurs in pregnancy. Various risk factors associated with SG have been reported, but the results are controversial. OBJECTIVE: This study aimed to determine the incidence, clinically associated factors, and awareness of SG in postpartum women at the dermatology clinic of a university hospital. METHODS: A questionnaire-based survey was conducted on women with fertility histories who had visited the dermatologic clinic of our hospital from October 2015 to December 2016. The survey items included the time of SG appearance, maternal age, and factors related to the development of SG (e.g., maternal weight gain, fetal weight and sex, and family history). We also investigated the awareness of SG development and treatment, and excluded subjects with various diseases that could affect SG. RESULTS: The subjects were 38 primiparas and 62 multiparas, and SG was observed in 91 subjects (91%). In 55.9% of the primiparous women, the SG became evident in the second trimester, although 63.1% of the multiparous women experienced the development of SG in the third trimester. There was a statistically significant difference in the time of SG appearance between primiparas and multiparas. In addition, fetal weight, maternal weight gain, and family history of SG were statistically associated with the occurrence of SG. However, fetal sex was not related to SG. The pregnant women considered the weight gain during pregnancy to be the most common cause of SG, while family history, fetal overweight, and the use of cream for skin regeneration were thought to be other causes of SG. 53.8% of the subjects with SG experienced various treatment methods, which did not show any significant difference in terms of effectiveness when compared with non-treated subjects. CONCLUSION: In our study, maternal weight gain, family history, and fetal weight were statistically significantly associated with the development of SG. We believe that this study may be useful to enhance our understanding of the awareness, prevalence, and related factors of SG in dermatologic outpatients at a university hospital. Multi-center studies with large numbers of patients are warranted to further investigate the clinical features of SG.
Subject(s)
Female , Humans , Pregnancy , Dermatology , Fertility , Fetal Weight , Incidence , Maternal Age , Outpatients , Overweight , Postpartum Period , Pregnancy Trimester, Second , Pregnancy Trimester, Third , Pregnant Women , Prevalence , Regeneration , Risk Factors , Skin , Weight GainABSTRACT
Ketamine is an anesthetic with hypertensive effects, which make it useful for patients at risk of shock. However, previous ex vivo studies reported vasodilatory actions of ketamine in isolated arteries. In this study, we reexamined the effects of ketamine on arterial tones in the presence and absence of physiological concentrations of 5-hydroxytryptamine (5-HT) and norepinephrine (NE) by measuring the isometric tension of endothelium-denuded rat mesenteric arterial rings. Ketamine little affected the resting tone of control mesenteric arterial rings, but, in the presence of 5-HT (100~200 nM), ketamine (10~100 µM) markedly contracted the arterial rings. Ketamine did not contract arterial rings in the presence of NE (10 nM), indicating that the vasoconstrictive action of ketamine is 5-HT-dependent. The concentration-response curves (CRCs) of 5-HT were clearly shifted to the left in the presence of ketamine (30 µM), whereas the CRCs of NE were little affected by ketamine. The left shift of the 5-HT CRCs caused by ketamine was reversed with ketanserin, a competitive 5-HT(2A) receptor inhibitor, indicating that ketamine facilitated the activation of 5-HT(2A) receptors. Anpirtoline and BW723C86, selective agonists of 5-HT(1B) and 5-HT(2B) receptors, respectively, did not contract arterial rings in the absence or presence of ketamine. These results indicate that ketamine specifically enhances 5-HT(2A) receptor-mediated vasoconstriction and that it is vasoconstrictive in a clinical setting. The facilitative action of ketamine on 5-HT(2A) receptors should be considered in ketamine-induced hypertension as well as in the pathogenesis of diseases such as schizophrenia, wherein experimental animal models are frequently generated using ketamine.
Subject(s)
Animals , Humans , Rats , Arteries , Blood Pressure , Hypertension , Ketamine , Ketanserin , Mesenteric Arteries , Models, Animal , Norepinephrine , Receptor, Serotonin, 5-HT2A , Schizophrenia , Serotonin , Shock , VasoconstrictionABSTRACT
The umbilicus is of paramount aesthetic importance for the abdomen, and its absence can be psychologically distressing to patients for cosmetic reasons. An aesthetically-pleasing umbilicus tends to be small and vertically oriented in nature, with superior hooding and shadow, inferior retraction and slope, and a position at the topmost level of the iliac crest. A 42-year-old woman had undergone delayed breast reconstruction using a transverse rectus abdominis myocutaneous (TRAM) flap. Unfortunately, the patient developed umbilical necrosis following surgery. She underwent complete surgical debridement, which resulted in a large vertical scar. Delayed umbilical reconstruction was performed with four transposition flaps. The patient underwent follow-up at 11 months postoperatively, and the umbilicus had a satisfactory appearance. This case shows that using four transposition flaps can yield sufficient depth and an aesthetically pleasing shape for the umbilicus.
Subject(s)
Adult , Female , Humans , Abdomen , Abdominoplasty , Cicatrix , Debridement , Follow-Up Studies , Mammaplasty , Necrosis , Rectus Abdominis , Surgical Flaps , UmbilicusABSTRACT
Temporal hollowing occurs to varying degrees after pterional craniotomy. The most common cause of temporal hollowing is a bony defect of the pterional and temporal regions due to the resection of the sphenoid ridge and temporal squama for adequate exposure without overhang. The augmentation of such bony defects is important in preventing craniofacial deformities and postoperative hollowness. Temporal cranioplasty has been performed using a range of materials, such as acrylics, porous polyethylene, bone cement, titanium, muscle flaps, and prosthetic dermis. These methods are limited by the risk of damage to adjacent tissue and infection, a prolonged preparation phase, the possibility of reabsorption, and cost inefficiency. We have developed a method of temporal augmentation using a calvarial onlay graft as a single-stage neurosurgical reconstructive operation in patients requiring craniotomy. In this report, we describe the surgical details and review our institutional outcomes. The patients were divided into pterional craniotomy and onlay graft groups. Clinical temporal hollowing was assessed using a visual analog scale (VAS). Temporal soft tissue thickness was measured on preoperative and postoperative computed tomography (CT) studies. Both the VAS and CT-based assessments were compared between the groups. Our review indicated that the use of an onlay graft was associated with a lower VAS score and left-right discrepancy in the temporal contour than were observed in patients undergoing pterional craniotomy without an onlay graft.
Subject(s)
Humans , Bone Transplantation , Congenital Abnormalities , Craniotomy , Dermis , Inlays , Polyethylene , Temporal Bone , Titanium , Transplants , Visual Analog ScaleABSTRACT
Cowden Syndrome (CS) is a rare genodermatosis of autosomal-dominant inheritance, with variable expressivity and multiple types of hamartomas. The most consistent features of CS are small wart-like papillomatous papules on the face, hands, and mouth. A 31-year-old woman presented with a history of pearly papules on the face, hand, and foot for several years. The lesions were initially diagnosed as warts, and treated accordingly, but they did not subside. There was a history of endometrial cancer, breast cancer, and thyroid nodule, and her father had a history of thyroid cancer. A biopsy specimen from the facial papule showed plate-like growth of anastomosing epithelial cords, extending parallel to the epidermis. It was diagnosed as a tumor of the follicular infundibulum (TFI). The patient refused further treatment. Here, we report a rare case of CS presenting with TFI.
Subject(s)
Adult , Female , Humans , Biopsy , Breast Neoplasms , Endometrial Neoplasms , Epidermis , Fathers , Foot , Hamartoma , Hamartoma Syndrome, Multiple , Hand , Mouth , Pituitary Gland , Thyroid Neoplasms , Thyroid Nodule , Warts , WillsABSTRACT
Even though several techniques are available for repairing lower extremity skin defects, it is hard to challenge the advantages of local flaps (advancement, rotation, or transposition) due to lack of skin laxity of lower extremities. Modified keystone flap (MKF) is a simple and effective method of closing a large skin defect. It is especially useful for wound closure in circumstances where the defects show limited skin laxity. Compared to the keystone flap (KF), MKF has many advantages, including quick healing time, high flap viability, minimal postoperative pain, and excellent aesthetic results. Here, we report two cases of reconstruction of large skin defects of the lower extremities using MKF with satisfactory results.
Subject(s)
Lower Extremity , Methods , Pain, Postoperative , Skin , Wounds and InjuriesABSTRACT
Pyoderma gangrenosum is a rare inflammatory reactive dermatosis marked by painful cutaneous ulcers. Diagnosis of pyoderma gangrenosum is usually made based on past medical history and after the exclusion of other possible diseases based on the clinical manifestations of the lesion. Diseases that show rapid progression to necrosis and that should not be misdiagnosed as pyoderma gangrenosum include malignant neoplasms and necrotizing fasciitis. Immunosuppressive agents such as steroids and cyclosporine are considered first-line therapy. Surgical removal of the necrotic tissues is contraindicated, as it may further induce immune reaction and promote ulcer to enlarge. Here, we present a case to encourage plastic surgeons to consider pyodermagangrenosum in the differential diagnosis of idiopathic ulcers. Satisfactory outcomes for patients with pyodermagangrenosum may be expected when using steroids and immunosuppressive agents during the early stage of the disease.
Subject(s)
Humans , Cyclosporine , Diagnosis , Diagnosis, Differential , Fasciitis, Necrotizing , Immunosuppressive Agents , Necrosis , Pyoderma Gangrenosum , Skin Diseases , Steroids , UlcerABSTRACT
OBJECTIVE: By using a functional magnetic resonance imaging (fMRI) technique we assessed brain activation patterns while subjects were viewing the living environments representing natural and urban scenery. MATERIALS AND METHODS: A total of 28 healthy right-handed subjects underwent an fMRI on a 3.0 Tesla MRI scanner. The stimulation paradigm consisted of three times the rest condition and two times the activation condition, each of which lasted for 30 and 120 seconds, respectively. During the activation period, each subject viewed natural and urban scenery, respectively. RESULTS: The predominant brain activation areas observed following exposure to natural scenic views in contrast with urban views included the superior and middle frontal gyri, superior parietal gyrus, precuneus, basal ganglia, superior occipital gyrus, anterior cingulate gyrus, superior temporal gyrus, and insula. On the other hand, the predominant brain activation areas following exposure to urban scenic views in contrast with natural scenes included the middle and inferior occipital gyri, parahippocampal gyrus, hippocampus, amygdala, anterior temporal pole, and inferior frontal gyrus. CONCLUSION: Our findings support the idea that the differential functional neuroanatomies for each scenic view are presumably related with subjects' emotional responses to the natural and urban environment, and thus the differential functional neuroanatomy can be utilized as a neural index for the evaluation of friendliness in ecological housing.