Living Donor Liver Transplantation (LDLT) using Monosegment Graft for a Small Infant / 대한이식학회지

A 1.5-month-old girl, weighing 4.7 Kg, presented with vomiting, blood tinged stool and jaundice. We performed living donor liver transplantation(LDLT) for the management of fulminant hepatic failure with worsening encephalopathy. The donor was her father, 30 years old, weighing 51 kg. During the pre-operative donor evaluation, a computed tomography volumetry was 170 mL for left lateral section of the liver, which was 3.61% of the graft-recipient weight ratio(GRWR). In donor operation, the reduction of the left lateral section was made just after parenchyma resection of left lateral section was completed, and before clamping of the vessels. The segment II was resected from the left lateral section in situ. The transection plane between segment II and III was identified with the use of intraoperative ultrasonography and clamping of Glisson of segment II. The segment III graft weighed 135 g, which was 2.87 % GRWR. The operation time was 6 hours 15 minutes and transfusion was not needed. Recipient operation was performed in conventional manner of pediatric LDLT using left lateral section with primary closure of abdominal wall without tension. The operation time was 7 hours 35 minutes and cold ischemic time was 1 hour 33 minutes. She recovered well without any significant complications. She discharged on the post operative 24th day. Total bilirubin, aspartic acid transaminase and alanine aminotransferase was 0.6 mg/dL, 26 IU/L and 37 IU/L respectively at the point of discharge. LDLT with monosegment seems to be a feasible option for neonates and small infants requiring liver transplantation.

A Verification of Neogenesis of Vascular Cells by BrdU Immunohistochemistry During Callotasis of the Tibiae in Sprague-Dawley Rats

The callotasis is widely used in lengthening of bones without bone graft. We thought that the accompanying vessels is critical in the viability of distal tissue to the lengthened area and has an important effect on the bone-lenthening itself. So we made an assumption that the accompanying vessels is adapted to the lengthening via neogenesis more than simple physical stretching. At this, we placed a pair of small external fixator in the left tibiae of ten Spraugue-Dawley rats and made an osteotomies. At two weeks after 25% lengthening, vessels of both lengthened and unlengthened side was harvested and five sections from each vessels were stained with BrdU immunohistochemical staining. We investigated the DNA synthesis counting the number of BrdU labeled cells. The number of BrdU labeled cells is significantly increased in the lenthened side arteries(p<0.0001). The synthesis of DNA was significantly increased in the center rather than the ends (p<0.0001). And there was no difference between the number of the BrdU labeled cells of proximal part and that of distal parts(p=0.316). It means that the accompanying vessles in the distraction-lengthening are adapted to the lengthening not only by just physical stretching but also by neogenesis of vascular cells.

Sclerotherapy for Craniofacial Venous Malformation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Venous malformations are one of the most common vascular anomalies, and are more frequently found in head and neck region. Various treatment options are available, and intralesional injection of sclerosant is the commonest primary treatment modality. We reviewed 20 cases of venous malformation treated with sclerotherapy at Seoul National University Hospital. MATERIALS AND METHODS: Twenty cases of venous malformation in head and neck were reviewed retrospectively, which had been managed with sclerotherapy from January 1991 to July 2001. The patients were treated at the department of otolaryngology-Head and Neck Surgery or plastic surgery of Seoul National University Hospital. Emulsion of Ethamolin and Lipiodol was used as a sclerosing agent. Some patients received surgical treatment after sclerotherapy. All of the patients received direct-puncture venography(Digital subtraction angiography) before sclerotherapy. Treatment results were evaluated by using MRI, angiography, or CT. If the reduction of volume of mass was more than 50 percent after sclerotherapy, we regarded the result as effective, if less than 50 percents, non-effective. Statistical analysis was done using SPSS10.0 for windows. RESULTS: Among twenty patients, there were eight males(40%), and twelve females(60%). Ages at the beginning of treatment ranged from six to thirty-eight years(mean age:20.6 years). The most common site of lesions was cheek(in 12 cases). Mass sizes(largest diameter) ranged from 2 cm to 20 cm. Nine cases were managed with both sclerotherapy and surgical excision, and eleven cases, only with sclerotherapy. Thirteen cases(65%) responded well to sclerotherapy(volume reduction>or=50%). There was no major complication. Tenderness, induration, swelling, and pain were reported as post-sclerotherapy complaints. Mild dyspnea occurred in one case, and the patient was managed at ICU shortly without fatal event. CONCLUSION: Sclerotherapy with or without surgical excision was an effective treatment modality for venous malformation, with minimal risk of major complications. There were no significant differences in the treatment results according to the initial size of the lesions.

Successful surgical treatment of massive hemangioma on the face and neck

Hemangioma is one of the most common congenital tumors in the region of the face and neck. Although histologically benign, these facial masses are clinically malignant for their deforming and inexorable growth, especially in so-called cavernous hemangioma. Today, hemagiomas have been treated by various methods; steroids, electrocoagulation, injection of sclerosing agent, cryotherapy, radiation therapy, laser therapy, and surgical treatment, etc. The response of treatment varies with the types, surgical skills, regions of hemangioma, the age of patient, but the appropriate method of the treatment has not been yet established. In the case of massive hemangioma, which involves most part of the face and neck, we prefer surgical treatment and consistently obtain better result than other treatment modalities. Wide excision and proper reconstruction of the face helps the patient for their better life aesthetically and functionally.

A case of mandibular reconstruction using fibular osteospectocutaneous flap / 대한이비인후과학회지

No abstract available.