A Case Report of Sweet's Syndrome with Parotitis

Sweet's syndrome is characterized by clinical symptoms, physical features, and pathologic findings which include fever, neutrophilia, tender erythematous skin lesions, and a diffuse infiltrate of mature neutrophils. This is a report of our experience of Sweet's syndrome with parotitis. A 57-year-old man initially presented with tender swelling on the right cheek similar to parotitis. His symptoms relapsed despite the use of an oral antibiotic agent for 3 weeks. He additionally presented with erythematous papules and plaques on the periocular area and dorsum of both hands. Histiopathologic findings on punch biopsy of the right dorsum of the hand showed superficial perivenular histiocytic infiltration without vasculitis. We confirmed this as histiocytoid Sweet's syndrome and used systemic corticosteroid. After initiation of treatment with systemic corticosteroids, there was a prompt recovery from both the dermatosis-releated symptoms and skin lesions. Sweet's syndrome should be considered in patients with therapy-refractory parotitis and unclear infiltrated nodules. We present a confusing case who initially appeared to have parotitis but turned out to have histiocytoid Sweet's syndrome.

Recent Trend of the Reduction Mammaplasty and comparing with Vertical Reduction Method and Inverted T-scar Method

PURPOSE: The goal of reduction mammaplasty is breast with natural cone shape, minimizing scars, well-placed and sensate nipple-areolar area and maintaining breast physiology. In order to satisfy that goal, variable reduction mammaplasty methods are performed, however, two methods such as vertical reduction method and inverted T-scar method are currently most used. We compared indications and advantages of the two methods and set up useful guidlines. METHODS: For 15 years from 1995 to 2010, we experienced 84 patients(162 breasts). We performed vertical reduction method as Lejour's superior pedicle technique(45 patients) and inverted T-scar method as Goldwyn's inferior dermal flap technique(39 patients). We evaluated the result of the operation comparing patient's age, amount of resected tissue, complications and post-operative scars of the two methods. RESULTS: The mean age was 36 years and the vertical reduction group was 3 years younger than inverted T-scar group. The mean breast tissue resection amount per one breast, inverted T-scar group(712 gm) was lagger than vertical reduction group(395 gm). CONCLUSION: There is no ideal method for reduction mammaplasty until now. However, we suggest that guide line, the vertical reduction method is effective for minimal and moderate macromastia in young and middle aged women and inverted T-scar method is appropriate for severe macromastia with ptosis in elderly women. Recently, all procedures tried shorter and smaller scar on the vertical line as small I, J or L shape scar, and inframammary fold as short inverted T-scar.

Extended Indications of Bilhaut-Cloquet Procedure for Type III and IV of Duplicated Thumb

PURPOSE: The authors applied Bilhaut-Cloquet procedure to Wassel type III and IV duplicated thumb, which was limited to patients with Wassel type I, II. This procedure was applied in order to improve the growth potential, range of joint motion, joint stability and cosmetic outcome. METHODS: Sixteen patients received Bilhaut-Cloquet procedures to correct duplicated thumbs from May, 2005 to December, 2010. Seven patients were Wassel type III, nine patients were type IV. This procedure was applied not only to balanced type, but also unbalanced type or convergent type. Five patients were balanced type and eleven patients were unbalanced type. Convergent type of Wassel type IV was three. Sex ratio was the same, mean age at the operation was 20.1 months old(8~52 months old). Angular deformity, joint stability and range of joint motion and cosmetic outcome were considered together and estimated in Tada score. Also, postoperative subjective satisfaction score of the parents was evaluated by a 100-points scale. RESULTS: Mean subjective satisfaction scored 75 points at 28 months after the operation. Radiologic study showed bony union of proximal phalangeal bone and stable joint in all patients. Range of motion was mean 20 degrees in interphalangeal joint and mean 73 degrees in metacarpophalangeal joint. Tada score showed 'good' in eleven patients(68.8%), 'fair' in three patients(18.7%) and 'poor' in two patients(12.5%). In seven patients those who were able to follow up for a long term showed no significant difference in length of proximal and distal phalangeal bones compared to the opposite thumb. CONCLUSION: Bilhaut-Cloquet procedure can be applied not only to balanced type of Wassel type III, IV duplicated thumb, but also to unbalanced type or convergent type that focused on functional reconstruction and cosmetic improvement.

Breast Reconstruction Make Use of Contralateral Breast Tissue after Mastectomy

PURPOSE: Unilateral breast reconstruction after mastectomy confront the challenges of recreating a natural appearing breast mound and achieving symmetricalness of the breasts. If the patient's remaining breast is large compared to reconstructed breast, the most common procedure is reduction mammoplasty of the large breast side. The authors experienced a new method of breast reconstruction using the excess breast tissue from the contralateral breast after breast reduction. METHODS: The excess tissue from the contralateral breast after vertical reduction mammoplasty with superior pedicle and remaining lower breast tissue were transferred to the mastectomy site breast through the subcutaneous tunnel on the chest wall. The main blood supplies of the flap are perforator branches of the 4th, 5th and 6th anterior intercostal artery. After elevating and detaching the flap on the lower lateral area of the breast, the turned over flap is fixed on the upper portion of the chest wall of the mastectomy site. RESULTS: On two cases of the breast reconstructions, remaining excess breast tissue from reduction mammoplasty was transferred to the contralateral breast side as pedicles. Both patient and operator were satisfied with the outcome of the reconstruction as the breasts were symmetrical and in natural shape. CONCLUSION: We have performed unilateral breast reconstruction using the excess breast tissue after reduction mammoplasty of the contralateral breast. As Oriental women's breasts are relatively smaller than those of Caucasian women, delayed breast reconstruction cases of Oriental women with large breasts(macromastia) seem to be ideal for this procedure.