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Nipple size varies from person to person, but having a large nipple, or macrothelia, can be a concern for some women; therefore, some surgical methods have been developed for the reduction of nipple size. Conventional surgical methods for nipple reduction are classified into two types according to their purpose: reduction of length and reduction of diameter. For reduction of length, soft tissue is resected (except the central supplying vessel) and shortened by circumferential repair. The disadvantage of this method is possible necrosis of the nipple and impairment of the lactiferous duct. For reduction of diameter, a wedge-shaped resection is done from side to center and the defect is covered by a local advancement flap. The disadvantage of this method is the locally focused tension line, which is associated with unfavorable aesthetic outcomes. In this article, we present a case involving a novel method of nipple reduction surgery, referred to as the tripod wedge resection technique, which has three benefits compared to conventional nipple reduction surgery: simultaneous reduction of both length and diameter, relative safety for the vasculature and lactiferous duct, and an evenly tensioned incision line.
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Nipple size varies from person to person, but having a large nipple, or macrothelia, can be a concern for some women; therefore, some surgical methods have been developed for the reduction of nipple size. Conventional surgical methods for nipple reduction are classified into two types according to their purpose: reduction of length and reduction of diameter. For reduction of length, soft tissue is resected (except the central supplying vessel) and shortened by circumferential repair. The disadvantage of this method is possible necrosis of the nipple and impairment of the lactiferous duct. For reduction of diameter, a wedge-shaped resection is done from side to center and the defect is covered by a local advancement flap. The disadvantage of this method is the locally focused tension line, which is associated with unfavorable aesthetic outcomes. In this article, we present a case involving a novel method of nipple reduction surgery, referred to as the tripod wedge resection technique, which has three benefits compared to conventional nipple reduction surgery: simultaneous reduction of both length and diameter, relative safety for the vasculature and lactiferous duct, and an evenly tensioned incision line.
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PURPOSE: The optimal perioperative treatment for resectable esophageal squamous cell carcinoma (ESCC) remains controversial. We evaluated the efficacy and safety of leucovorin and 5-fluorouracil (LV5FU2) and LV5FU2 plus oxaliplatin (FOLFOX) combination chemotherapies administered adjuvantly for curatively-resected, node-positive ESCC. MATERIALS AND METHODS: Patients with pathologically node-positive esophageal cancer after curative R0 resection were enrolled and randomly assigned to receive LV5FU2 or FOLFOX biweekly for up to eight cycles. The primary endpoint was disease-free survival (DFS). RESULTS: Between 2011 and 2015, 62 patients were randomized into the two treatment groups (32 in the LV5FU2 arm and 30 in the FOLFOX arm). The median age was 60 years and both groups had similar pathologic characteristics in tumor, nodal status, and location. Treatment completion rates were similarly high in both groups. The DFS rate at 12 months was 67% in the LV5FU2 group and 63% in the FOLFOX group with a hazard ratio of 1.3 (95% confidence interval [CI], 0.66 to 2.62). After a median follow-up period of 27 months, the median DFS was 29.6 months (95% CI, 4.9 to 54.2) in the LV5FU2 arm and 16.8 months (95% CI, 7.5 to 26.1) in the FOLFOX arm (p=0.428), respectively, while the median overall survival was not reached in either arm. Grade 3 or 4 neutropenia was more frequent in patients in the FOLFOX arm than the LV5FU2 arm (20.0% vs. 3.1%). CONCLUSION: The addition of oxaliplatin (FOLFOX) did not lead to better efficacy compared to LV5FU2 chemotherapy in an adjuvant setting in node-positive ESCC patients.
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Humanos , Braço , Carcinoma de Células Escamosas , Quimioterapia Adjuvante , Intervalo Livre de Doença , Tratamento Farmacológico , Quimioterapia Combinada , Células Epiteliais , Neoplasias Esofágicas , Fluoruracila , Seguimentos , Leucovorina , NeutropeniaRESUMO
PURPOSE: The optimal perioperative treatment for resectable esophageal squamous cell carcinoma (ESCC) remains controversial. We evaluated the efficacy and safety of leucovorin and 5-fluorouracil (LV5FU2) and LV5FU2 plus oxaliplatin (FOLFOX) combination chemotherapies administered adjuvantly for curatively-resected, node-positive ESCC. MATERIALS AND METHODS: Patients with pathologically node-positive esophageal cancer after curative R0 resection were enrolled and randomly assigned to receive LV5FU2 or FOLFOX biweekly for up to eight cycles. The primary endpoint was disease-free survival (DFS). RESULTS: Between 2011 and 2015, 62 patients were randomized into the two treatment groups (32 in the LV5FU2 arm and 30 in the FOLFOX arm). The median age was 60 years and both groups had similar pathologic characteristics in tumor, nodal status, and location. Treatment completion rates were similarly high in both groups. The DFS rate at 12 months was 67% in the LV5FU2 group and 63% in the FOLFOX group with a hazard ratio of 1.3 (95% confidence interval [CI], 0.66 to 2.62). After a median follow-up period of 27 months, the median DFS was 29.6 months (95% CI, 4.9 to 54.2) in the LV5FU2 arm and 16.8 months (95% CI, 7.5 to 26.1) in the FOLFOX arm (p=0.428), respectively, while the median overall survival was not reached in either arm. Grade 3 or 4 neutropenia was more frequent in patients in the FOLFOX arm than the LV5FU2 arm (20.0% vs. 3.1%). CONCLUSION: The addition of oxaliplatin (FOLFOX) did not lead to better efficacy compared to LV5FU2 chemotherapy in an adjuvant setting in node-positive ESCC patients.
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Humanos , Braço , Carcinoma de Células Escamosas , Quimioterapia Adjuvante , Intervalo Livre de Doença , Tratamento Farmacológico , Quimioterapia Combinada , Células Epiteliais , Neoplasias Esofágicas , Fluoruracila , Seguimentos , Leucovorina , NeutropeniaRESUMO
PURPOSE: The purpose of this study was to examine the influence of radial overgrowth after surgical treatment for pediatric distal radius fractures. MATERIALS AND METHODS: Twenty-two pediatric patients under the age of 10 years who underwent surgical treatment for a distal radius fracture without physeal injury were enrolled in this study. They were divided into 2 groups according to the ulnar fracture; distal radius alone fracture in 9 patients group and radioulnar both fracture in 13 patients group. The radial length, ulnar variance, and radial inclination at the last follow-up X-ray were measured using a simple lateral radiograph. The visual analogue scale (VAS) of distal radioulnar joint pain, the Mayo wrist score, and range of motion of the wrist were assessed for the clinical results. RESULTS: At mean follow-up period of 3.7 years, radial overgrowth was 2.2 mm (p=0.01) compared with the un-injured side. There was negative ulnar variance on the injured side, an average of 0.8 mm (p=0.01). Clinically, mean VAS was 0.2, and the Mayo wrist score was 99.3. No significant difference in radial overgrowth (p=0.32), ulnar variance (p=0.99), VAS (p=0.29), and the Mayo wrist score (p=0.34) was observed between groups. CONCLUSION: Radial overgrowth and negative ulnar variance was observed after surgical treatment of pediatric distal radius fracture without physeal injury. However, the radial overgrowth does not affect clinical outcomes.
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Humanos , Artralgia , Seguimentos , Pediatria , Fraturas do Rádio , Rádio (Anatomia) , Amplitude de Movimento Articular , PunhoRESUMO
PURPOSE: This study was performed to readjust the clinical implications of a nonrecurrent laryngeal nerve by assessing the reported Korean cases of a nonrecurrent laryngeal nerve. METHODS: We analyzed the cases of nonrecurrent laryngeal nerve that have been reported in Korea between 1997 and 2008 by reviewing the literature. An internet search was conducted in the NDSL (National Digital Science Library) and the Korean Medical Database. RESULTS: The data included 3 men and 25 women with an average age of 45.1 (age range: 28~58). All the cases were right-sided, and the incidence rate was 0.38% and 0.86% in two articles, respectively. There was a type I variation in 4 cases (17.4%), type IIa in 19 cases (82.6%), and the others are unknown. Twenty-five cases (89.3%) had the vascular anomaly called arteria lusoria. Only 8 cases (28.6%) were preoperatively predicted as possibly having a nonrecurrent laryngeal nerve. Iatrogenic nerve injury developed in 1 case (3.57%) with a type I variation during the postoperative period. CONCLUSION: A similar tendency for the incidence rate, the genderratio, the type distribution and vascular anomaly was observed when comparing the Korean reports with those reports of overseas. The nonrecurrent laryngeal nerve can be preoperatively predicted if proper attention is given when vascular anomaly is noted on CT or USG, and injury will be avoided by intraoperatively following the standard operation technique. There is currently an increasing incidence of thyroid diseases, and so adequate attention must be given to the possibility of a nonrecurrent laryngeal nerve and its management.
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Feminino , Humanos , Masculino , Incidência , Internet , Coreia (Geográfico) , Nervos Laríngeos , Período Pós-Operatório , Doenças da Glândula TireoideRESUMO
BACKGROUND: In modern industrial society, the complexity and diversity of social structure has deeply influenced job stress, and thereby threatens mental health of jobholders more than ever. Therefore, the purpose of this study was to examine the effect of job stress in jobholders on propensity of anxiety. METHODS: Initially, 235 jobholders living in Cheonan, Asan or Seoul, from May to June 2003, were the subjects of this questionnaire. Only 233 jobholders were evaluated due to inadequate responses from two subjects. The questionnaire was made up of three contents: socio-demographic characteristic, Extended Karasek questionnaire for evaluation of job stress, and the Korean version of Goldberg anxiety scale for evaluation of anxiety. The data were analyzed by chi-square test and multiple logistic regression analysis. RESULTS: Univariate analysis of propensity to anxiety showed a statistical significance on age, monthly income and job characteristics. Moreover, in terms of multivariate analysis, in accordance with age, 40 to 49 (OR: 6.1), showed the highest odds ratio of propensity to anxiety, followed by 30 to 39 (OR: 5.2) and 10 to 29 (OR: 5.4). In job characteristics, high strain group (OR: 3.7) showed highest odds ratio, but neither low strain group nor active group revealed any statistical significance. In monthly income, there was no statistical significance. CONCLUSION: Job stress in jobholders and propensity to anxiety was positively associated; especially, the more stress jobholders got, the higher propensity to anxiety was.
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Ansiedade , Distribuição de Qui-Quadrado , Modelos Logísticos , Saúde Mental , Análise Multivariada , Razão de Chances , Seul , Inquéritos e QuestionáriosRESUMO
PURPOSE: To evaluate the biologic changes of xenograft (Lubboc, Transphyto S. A., Clermont-Ferrand, France) applied in the surgical treatment of calcaneal fractures. MATERIALS AND METHODS: Xenograft were used in twenty-five calcaneal fractures, as bone substitutes for mechanical support of the articular surface from March 1994 to December 1996. Twenty-four cases had obtained clinical and radiological bony union without complications. We performed biopsy at the xenograft area in eight cases when the hardware was removed. And then we took a magnetic resonance imaging of the calcaneus after the biopsy in three cases. RESULTS: The pathologic findings of the xenografts showed dead bony trabeculae with inflammed fibrous tissue. There was no osteoblastic activity but some osteoclastic activity was seen in the graft-host junctional area. MRI findings showed that there was well-circumscribed, low-signal intensity in the xenograft area contrast to the normal bony signal intensity. Its lesion was equal to the sclerotic finding in the calcaneal radiograph. CONCLUSIONS: Xenograft (LUBBOC'), which is used in the mechanical support of the articular surface, apparently lacks osteogenic capacity.
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Biópsia , Substitutos Ósseos , Calcâneo , Xenoenxertos , Imageamento por Ressonância Magnética , Osteoblastos , OsteoclastosRESUMO
The Graf system has supposed advantages with its flexible nature, as compared with rigid fixation. But there have been no reports about effects in the adjacent motion segment after soft stabilization. The purpose of this study was to evaluate the radiologic changes occuring in the adjacent segments of the Graf system and to assess its ability stabilizing the lumbar spine. A retrospective review of radiographs and medical records was undertaken in 32 cases who had been treated with the Graf system in degenerative lumbar spinal disorders. The average age at operation was 52.5 years and the average follow up period was 49.6 months. The results of this study were as follows: clinical assesments based on the Kirkaldy-Willis criteria revealed excellent in 13 cases (40.6%), good in 16 cases (50%), fair in 2 cases (6.3%) and poor in 1 case (3.1%). Radiologically we analysed the adjacent segments in 25 cases except the cases which did not have the correspondence between the clinical findings and the radiological findings, and the fixated segments in 32 cases. The acceleration of degenerative changes were found in the above adjacent segments in 11 cases (44%) and in the below adjacent segments in 5 cases (27.7%). Also, those changes were found in the fixated segments with discectomy in 19 cases (50%) and in the fixated segments without discectomy in 9 cases (37.5%). In conclusion, we think that the Graf system in a lumbar region may biomechanically influence the adjacent segments. The mechanical effects of the device could be changed by the polyester bands which were followed for a longer period of time in the fixated segments. Therefore, randomized prospective studies comparing the Graf system to other treatement methods could provide clear indications for lumbar spinal disorders.
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Aceleração , Discotomia , Equidae , Seguimentos , Região Lombossacral , Prontuários Médicos , Poliésteres , Estudos Retrospectivos , Coluna VertebralRESUMO
BACKGROUND: Interleukin-5 (IL-5) is responsible for eosinophilia in allergic diseases. In allergic bronchial asthma, there is a correlation between the extent of eosinophil infiltration in bronchial mucosa and IL-5 concentrations. In addition, IL-2 concentration is elevated in the airways and associated with eosinophilia in symptomatic patients with bronchial asthma. In animal studies, IL-2 can induce eosinophilia by increasing the synthesis of IL-5, however, it is still unknown how IL-2 can induce eosinophila in human being. The aim of this study is to evaluation the effect and mechanism of IL-2 on prolongation of eosinophil survival. METHODS: After purifiing the eosinophils from the venous blood of allergic patients with eosinophilia, we measured the survival rates of eosinophils using trypan blue dye exclusion test, and the number of eosinophils with Randolp's solution. We compared the survival rates of eosinophils in the presence of IL-2 or IL-5. Neutralizing antibody for IL-5 was added in IL-2 treated eosinophils to reveal whether IL-2 induced prolongation of eosinophil survival was mediated by IL-5. We checked IL-5 m-RNA expression of lymphocytes in the presence of IL-2 by using Reverse transcription-Polymerase chain reaction (RT-PCR) method to revealed the effect of IL-2 on IL-5 m-RNA expression on lymphocyte. alpha and beta IL-2 receptors were measured on eosinophils and lymphocytes with flow-cytometer after stimulated with IL-2. RESULTS: 1) Eosinophil survival rates increased dose dependently on IL-5 and IL-2. 2) The eosinophil survival rates increased by IL-2 were not inhibited by the pretreatment with neutralizing antibody for IL-5. 3) IL-5 m-RNA was not expressed on lymphocytes by the treatment with IL-2 up to 96 hours. 4) IL-2 upregulate the expression of IL-2Ralpha on eosinophils, instead of no effect on the expression of IL-2Rbeta. CONCLUSION: Interleukin-2 had the enhancing effect on the survival rates of eosinophils. The mechanism behind IL-2 induced eosinophilia might be the increment of IL-2 receptors on eosinophils rather than IL-5 synthesis by lymphocytes.
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Animais , Humanos , Anticorpos Neutralizantes , Asma , Eosinofilia , Eosinófilos , Interleucina-2 , Subunidade alfa de Receptor de Interleucina-2 , Interleucina-5 , Linfócitos , Mucosa , Receptores de Interleucina-2 , Taxa de Sobrevida , Azul TripanoRESUMO
Idiopathic bronchiolitis obliterans with organizing pneumonia (BOOP) is a specific clinicopathologic syndrome characterized by a pneumonia-like illness, with excessive proliferation of granulation tissue within bronchioles, alveolar ducts and alveoli. The changes are most numerous in alveolar ducts. The presence of intraluminal tufts of organizing connective tissue in alveolar ducts and more distal airspaces has been termed organizing pneumonia The radiologic manifestations are distinctive with bilateral, diffuse alveolar opacities predominantly in the subpleural and lower lung zone. Patchy migratory pneumonic foci or solely nodular infiltrates are rarely present in BOOP. BOOP is a diagnosis of importance because of its dramatic response to steroids.
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Bronquíolos , Bronquiolite Obliterante , Tecido Conjuntivo , Pneumonia em Organização Criptogênica , Diagnóstico , Tecido de Granulação , Pulmão , Pneumonia , EsteroidesRESUMO
The coexistence of spinal stenosis and scoliosis in lumbar spines is becoming a more frequent problem in elderly persons. Decreased bone mass in most of these patients also complicates their management. Recently, the pedicle screw instrumentation systems offer the way to solve these difficult problems. Most of the cases with degenerative scoliosis itself don't require surgical intervention. However, the case with severe clinical manifestations need surgery. From Jan. 1988 to Oct. 1993, authors had treated operatively for 15 cases of spinal stenosis with degenerative lumbar scoliosis. After adequate posterior decompression, pedicular instrumentation was carried out and correction of scoliotic deformity was attempted. Cotrel-Dubousset instrumentation was used in six patients, Graf instrumentation in three patients, and combined(Steffee and Graf) instrumentation in six patients. Follow up was obtained at an average of 20.4 months(Range; 10
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Idoso , Animais , Humanos , Anormalidades Congênitas , Descompressão , Seguimentos , Lordose , Métodos , Parafusos Pediculares , Escoliose , Estenose Espinal , Coluna VertebralRESUMO
From January 1992 to May 1993, we performed a new method of spinal instrumentation, namely the combined instumentation with the soft and rigid stabilizer, to minimize the adverse effects induced by rigid multi-segment fixation and fusion in twenty patients with complex degenerative lumbar disorders. By using this combined method, we were able to preserve one or two more motion segments from the fusion. And we also expect that the rate of deterioration at the adjacent motion segments to the fusion level will decrease. Though the follow-up period is short, the clinical results were satisfactory in 80% of the patients. We think that this combined instrumentation can be a choice of treatment for complex multi-segment lumbar disorders.