CT-Guided C2 Dorsal Root Ganglion Radiofrequency Ablation for the Treatment of Cervicogenic Headache: Case Series and Clinical Outcomes.

Cervicogenic headache is a secondary headache syndrome attributable to upper cervical spine pathology. Osteoarthritis of the lateral atlantoaxial joint with resultant C2 dorsal root ganglion irritation is an important and potentially treatable cause of cervicogenic headache. In this case series, we present 11 patients with cervicogenic headache who underwent C2 dorsal root ganglion thermal radiofrequency ablation. Radiologists should be familiar with this efficacious procedure and technical considerations to avoid complications.

Robotic-assisted latissimus dorsi muscle flap for autologous chest reconstruction in poland syndrome.

BACKGROUND: As chest reconstructions in Poland syndrome are performed for patients at young ages, patients are generally concerned about conspicuous scars. Meanwhile, a robotic-assisted latissimus dorsi (LD) muscle harvest with inconspicuous scars has been performed for autologous breast reconstruction. As our experience with robotic-assisted LD flap harvest has increased over the years, we have made improvements in surgical techniques to optimize results. The purpose of this study was to introduce and identify the role of the refined robotic-assisted LD muscle flap harvest technique in autologous chest reconstruction in patients with Poland syndrome. METHODS: Autologous chest reconstruction using a robotic-assisted LD muscle flap harvest was performed for 21 patients with Poland syndrome. Subjective assessments were performed to evaluate improvement in chest deformity, patient satisfaction with overall outcomes, chest symmetry, and scars. Assessments by the operator and two independent evaluating investigators were carried out with patients' photographs. The complication rates and the time for robotic surgery were also evaluated. RESULTS: At the last visit, the average patient grades for improvement in chest deformity, satisfaction with overall outcomes, chest symmetry, and scars were 4.80, 4.72, 4.18, and 4.87, respectively. Assessments by the operator and two independent evaluating investigators demonstrated that improvement in chest deformity was achieved in all patients. No serious complications such as flap loss were recorded for any patient. The time for robotic surgery markedly decreased as experience accumulated. CONCLUSIONS: Surgical refinements for robotic-assisted LD flap harvest might be effective and reduce operative times for patients with Poland syndrome.

Clinical and radiological outcomes of transoral endoscope-assisted treatment of mandibular condylar fractures.

Fractures of the mandibular condyle are one of the most common craniofacial fractures. However, the diagnosis and treatment of these fractures is controversial because of the multiple surgical approaches available. The purposes of this study were to identify surgery-related technical tips for better outcomes and to evaluate the results as well as complications encountered during 7 years of endoscope use to supplement the limited intraoral approach in the treatment of mandibular condylar fractures. Between 2005 and 2012, 50 patients with condylar fractures underwent endoscope-assisted reduction surgery. Postoperative facial bone computed tomography and panoramic radiography demonstrated adequate reduction of the condylar fractures in all patients. No condylar resorption was detected, and most patients displayed a satisfactory functional and structural recovery. There was no facial nerve damage or transitory hypoesthesia, and there were no visible scars after the surgery. Transoral endoscope-assisted treatment is a challenging but reliable method with lower morbidity and a rapid recovery.

Immunosuppressive activity of adipose tissue-derived mesenchymal stem cells in a rat model of hind limb allotransplantation.

Many reports have shown that bone marrow-derived mesenchymal stem cells exhibit immunosuppressive effects in allogeneic transplantation. However, few reports have evaluated the immunosuppressive properties of adipose tissue-derived mesenchymal stem cells (ASCs) in vitro and in vivo. In this study, we investigated the immunosuppressive characteristics of ASCs, and investigated whether ASCs originating from donor rats prolong allotransplant survival in a rat hind limb allotransplantation model. T-cell proliferation stimulated by allogeneic stimuli or mitogen with or without ASCs originating from the donor was assessed in vitro. The effects of cellular contact or soluble factors on the inhibition of T-cell proliferation were also evaluated. In the in vivo study, cultured ASCs (1 × 10(5)) that originated from the donor were injected into recipient animals intravenously immediately after operation, followed by 1 dose per day for 3 consecutive days post-transplantation. When immune rejection occurred, the survival time of allotransplants was determined and rejected tissue was histologically and immunochemically assessed for determining regulatory T-cell infiltration. ASCs inhibited the T-cell proliferation stimulated by alloantigen or mitogen in a dose-dependent manner, and recipient T cells proliferated less in animals treated with ASCs than in controls. Although ASCs were separated from T cells, ASCs persisted to elicit a suppressive effect. ASC culture supernatants did not inhibit T-cell proliferation; however, supernatants obtained from the mixed lymphocyte reaction in the presence of ASCs suppressed T-cell proliferation. ASCs prolonged allotransplant survival time, reduced inflammatory cell infiltration, and induced regulatory T cells. In conclusion, ASCs can exhibit in vitro immunosuppressive properties and prolong allotransplant survival time in a rat hind limb composite tissue allotransplantation model, possibly through the induction of regulatory T cells.

Wetting behavior and nanotribological properties of silicon nanopatterns combined with diamond-like carbon and perfluoropolyether films.

A large number of silicon (Si) patterns consisting of nanopillars of varying diameter and pitch have been fabricated and further coated with diamond-like carbon (DLC) and perfluoropolyether (Z-DOL) films. The wetting behavior and nano-adhesion/friction of the patterns are investigated experimentally in relation to the nanostructures and the hydrophobicity of the materials. Measurements of water contact angle illustrate that the patterning-enhanced wettability of the Si flat surface, along with two distinct wettings which are in good agreement with the Wenzel and hemi-wicking states, depended on the value of the pitch-over-diameter ratio. In the case of the coated patterns, three wetting states are observed: the Cassie-Baxter, the Wenzel, and a transition from the Cassie-Baxter into the Wenzel, which varies with regard to the hydrophobic properties of the DLC and Z-DOL. In terms of tribological properties, it is demonstrated that a combination of the nanopatterns and the films is effective in reducing adhesive and frictional forces. In addition, the pitch and diameter of the patterns are found to significantly influence their adhesion/friction behaviors.

Enhanced post-germinative growth of encapsulated somatic embryos of Siberian ginseng by carbohydrate addition to the encapsulation matrix.

This experiment was carried out to enhance conversion and ex vitro survival of encapsulated somatic embryos of Siberian ginseng (Eleutherococcus senticosus). Cotyledonary somatic embryos were encapsulated with 3.0% sodium alginate; 96% of the encapsulated embryos converted to plantlets with well-elongated epicotyls in Perlite containing sucrose as a carbon source. However, although they germinated, post-germinative growth of encapsulated embryos was suppressed on Perlite that did not contain sucrose. Instead of sucrose addition to Perlite, addition of carbon sources to the encapsulation matrix enhanced post-germinative growth of encapsulated embryos. In the encapsulation matrix with 2% sucrose, post-germinative growth of encapsulated embryos was more than twice (23.5%) that of the control capsules without sucrose (10.0%). Embryos encapsulated with both 2% sucrose and 1% starch powder showed the highest post-germinative growth percentage (42.1%). Iodine staining and analysis of starch content in the encapsulation matrix revealed that starch in the encapsulation matrix decomposed during embryo germination. This result indicates that carbohydrate treatment in the encapsulation matrix enhanced post-germinative growth of encapsulated embryos of Siberian ginseng.

Agrobacterium rhizogenes-mediated transformation of Taraxacum platycarpum and changes of morphological characters.

Transformed hairy roots were efficiently induced from seedlings of Taraxacum platycarpum by infection with Agrobacterium rhizogenes 15834. Root explants produced transformed roots at a higher frequency (76.5+/-3.5%) as compared to stem (32.7+/-4.8%) or cotyledon (16.2+/-5.7%). Hairy roots exhibited active elongation with high branching of roots on growth regulator-free medium. The competence of plant regeneration from non-transformed adventitious roots and transformed hairy roots was compared. The frequency of adventitious shoot formation from transformed roots was much higher (88.5+/-9.8%) than that of non-transformed roots (31.7 +/-9.5%) on hormone-free medium. Rooting of hairy root-derived adventitious shoots occurred easily on growth regulator-free medium but no rooting was observed on non-transformed shoots. The stable introduction of rol genes into Taraxacum plants was confirmed by PCR and Southern hybridization. Transgenic plantlets showed considerable differences in their morphology when compared to the corresponding wild-type (non-transgenic) plants. Plantlets formed from transformed roots had numerous fibrous roots with abundant lateral branches instead of the thickened taproots in non-transformed plants. The differences observed may reflect the modification of morphological root characters by introduction of rol genes.

Laser punch-out for acne scars.

Patients with acne scars want smooth facial skin. However, achieving this is difficult with dermabrasion or chemical peeling. Nor can acne scars be covered with cosmetics, due to their ice-picked or cobblestone appearance. Laser resurfacing is more effective and safer than other conventional methods due to its precision with depth control and variable methods of surface cutting. Even depth resurfacing with a laser shows unsatisfactory results, therefore, for the deep-sited acne scar the cutting methods have to be changed according to the depth and pattern of the scar. For 2 years, starting in January 1996, we treated 71 patients with a high-powered CO2 laser (Ultrapulse). Different resurfacing methods were applied according to the depth and pattern of the scars. For mild depressed scars, even depth resurfacing was done. For moderate-depth acne scars, the shoulder technique was also used. For the deepest and ice-picked scars, the laser punch-out was combined. Laser resurfacing was carried out at 300-500 mJ, with two to five passes. Laser punch-out was done at 500 mJ, with three to seven continuous passes on the ice-picked scar. From the pathologic findings of acne scars showing that there was thick intradermal scar, we knew that laser punch-out was necessary for improvement of acne scars. Depth-wide, the ice-picked scars improved by over 80% and the sharp demarcated margin of the acne scar faded out. Most of the patients with acne scars were satisfied with laser resurfacing. Only six patients had a second laser treatment, with an interval of 12 months. There were no hypertrophic scars after laser resurfacing, but erythema lasted for 3-12 months. Patients taking oral retinoic acid were not contraindicated for laser resurfacing but required special caution because they had atrophic skin and delayed wound healing. Laser resurfacing is the most versatile method for acne scars, with a high-powered CO2 laser. The laser punch-out method is better than even depth resurfacing for improving deep acne scars and can be combined with the shoulder technique or even depth resurfacing according to the type of acne scar.

The outcome of the nonoperated contralateral hand in carpal tunnel syndrome.

It is not well known how the nonoperated contralateral hand behaves in bilateral carpal tunnel syndrome (CTS). The postoperative clinical course of the nonoperated contralateral hand in unilateral CTS is not well documented either. Of 324 CTS patients, the authors studied 37 who had carpal tunnel release on one hand only to evaluate the postoperative outcome of the nonoperated contralateral hand. The other 287 patients had operations on both hands. Seven patients were excluded because of missing data or because they could not be contacted. All 324 patients were subject to clinical and electrodiagnostic studies on both hands. The patients were divided into three groups. Group I was composed of patients who had bilateral CTS, diagnosed clinically and electrophysiologically, but who had surgery done only on the hand with the most pronounced symptoms. The patients in group II showed symptoms of CTS in one hand only. However, the opposite hand was diagnosed with subclinical CTS: Electrodiagnostic studies showed involvement of the median nerve, but without symptoms. Group III was composed of true unilateral CTS patients, diagnosed by symptoms and electrodiagnostic study. The results of the electrodiagnosis were categorized according to the severity of median nerve damage (mild, moderate, severe). The outcome and postoperative clinical course of the nonoperated contralateral hand were evaluated by electromyography and telephone survey. This method of survey was used because of the vast spread of patients throughout the country. Within 1 year, all 30 operated hands showed significant improvement, 20 of which belonged to group I. Regarding progress of the nonoperated contralateral hand, 10 patients showed improvement of one grade whereas 5 patients showed three grades of improvement. In another 5 patients there was no change whatsoever. In addition, from groups II and III there were 5 patients who showed no change in the nonoperated hand. The postoperative electromyographic findings of the nonoperated contralateral hand was not commensurate with the symptoms. However, regardless of electromyographic results, the nonoperated contralateral hand showed significant improvement (p < 0.0001). Patients with unilateral CTS did not experience any symptom development in the nonoperated contralateral hand.

A new classification of male pattern baldness and a clinical study of the anterior hairline.

Male pattern baldness is the most common type of baldness occurring after the age of puberty. Various surgical techniques for hair reconstruction have been introduced. Since the Norwood classification method is too detailed and complicated to be used for various surgical operations, there is a strong need for a simpler classification. Selection of the shape and height of the frontal and temporal hairlines is important in hair restoration surgery. But due to lack of standard measures, there have been difficulties in performing surgical operations for male pattern baldness. We therefore studied the prevalence of male pattern baldness in 1731 Korean men according to age and types, based on the new classification method, between September 1995 and February 1996. At the same time, we also measured the average heights of the frontal and temporal hairlines and identified the morphology and the incidence of various types of anterior hairlines in 108 normal male adults. There are six types of male pattern baldness according to the new classification method. One peculiar type could not be classified by the Norwood classification method. The six types are designated types M, C, O, U, MO, and CO. In the morphological classification of the anterior hairline, the linear type was most common (70.37%). The heights of the frontal and temporal hairlines were 6.53 cm for the median line, 5.9 cm (left side) and 5.95 cm (right side) for the paramedian line, 8.49 cm (left and right side) for the temporal recession line, and 6.61 cm (left side) and 6.62 cm (right side) for the temporal hairline. The authors present the research outcomes as baselines that can be used for hair restoration surgery and further study of male pattern baldness.

A prospective study of the anatomic variations of the median nerve in the carpal tunnel in Asians.

A prospective study of anatomic variations of the median nerve and its relationship to the surrounding structures was performed of 354 consecutive operations in 192 patients with carpal tunnel syndrome at Korea University Anam Hospital from July 1995 to September 1997. A total of 184 patients were women and 8 patients were men. A total of 162 patients were bilateral and 30 were unilateral. Regarding the course of the motor branch, the extraligamentous type was most common (96.1%, 340 patients). A total of 81.1% of patients (N = 287) had the origin of the motor branch at the radial side of the median nerve (or radial one third), and 17.2% of patients (N = 61) had the origin of the motor branch at the anterior portion of the median nerve. Of these 61 patients, 30 patients (49.1%) were of the preligamentous type. Only one motor nerve branch was found in 89.5% of patients (N = 317), and multiple branches were found in 10.5% of patients. As a result of the comparison between two hands when both hands were operated, the origin and number of motor branches and their courses were identical in most patients (>60%). Hypertrophy of the flexor pollicis brevis was found in 8.5% of patients (N = 30), hypertrophy of the palmaris brevis was found in 4.2% of patients (N = 15), absence of the palmaris longus was discovered in 0.6% of patients (N = 2), existence of the median artery was found in 0.6% of patients (N = 2), and high division of the median nerve rejoining with the thenar motor nerve was found in 0.3% of patients (N = 1). Clearly, the anatomy of the carpal tunnel in Koreans is somewhat different, in part, from the results obtained from studies of whites, but overall results are not significantly different. These results can help obtain a better surgical outcome and complete decompression of the median nerve during operation while preventing inappropriate or inadvertent injury to the motor branch of the median nerve in Koreans.

Report of phenol peel for Asians.

With the advancement of trichloroacetic acid peel technology and wound care, trichloroacetic acid peeling has become very successful in Korea. Its success has opened studies on the possibility of using phenol on Korean skin. Dr. Mee's phenol formula (molding mask technique) was chosen for experiments on Korean skin because of the presumed safety of use on non-Caucasian skin. Between January of 1996 and January of 1998, 30 cases of significant small pox scars were treated with phenol at the Korea University Anam Hospital. The age range was from 43 to 60 years, with a mean of 49 years. The average follow-up period was 13 months, ranging from 1 month to 2 years. All of the procedures were performed in the operating room while the patient was under deep i.v. sedation. After the entire face was peeled, it was covered with an occlusive tape mask. During the recovery period, the patients underwent a post-peel skin care program. All 30 patients showed significant improvement of the severe pox marks with a marked rejuvenation effect. There was no sign of hypopigmentation or hyperpigmentation. As a complication, two patients developed hypertrophic scars on the perioral area, which responded well to steroid injections. Another pair of patients had herpetic infection, which left minimal scarring. Five patients developed cardiac arrhythmia with this rapid technique, but this was safely managed by an anesthesiologist during the procedure. Korean skin belongs to Fitzpatrick types IV and V and occasionally to type III or VI. It is common knowledge that performing chemical peeling on the latter types of skin is dangerous, but in this report, excellent results were obtained from all 30 patients, even though the peeling itself was very deep. With more knowledge and experience, phenol peel can be safely conducted on Asian skin.

Plant regeneration via adventitious bud formation from cotyledon explants of Panax ginseng C. A. Meyer.

Cotyledon explants of ginseng (Panax ginseng C. A. Meyer) produced somatic embryos directly on medium without growth regulators, with 89% of the explants forming somatic embryos. Cytokinin treatment greatly suppressed somatic embryo formation but stimulated the direct formation of adventitious buds. BAP treatment was more effective than the kinetin treatment for adventitious bud formation. Auxin (0.05 mg/l IBA) in combination with cytokinin enhanced adventitious bud formation, with the highest frequency, 40%, at 0.05 mg/l IBA and 5 mg/l BAP. Adventitious buds were mainly formed near the distal portion of the cotyledons, while somatic embryos were formed near the proximal excised margins. Shoots were developed from adventitious buds after transfer to MS medium with 10 mg/l GA3. Root formation from the shoots was obtained after the shoots were transferred to half-strength MS medium with auxin (IAA). When the plants derived from adventitious buds were transferred to greenhouse soil, 36% were successfully acclimatized.

Genetic and molecular characterization of embryonic mutants identified following seed transformation in Arabidopsis.

Over 5000 transgenic families of Arabidopsis thaliana produced following seed transformation with Agrobacterium tumefaciens were screened for embryonic lethals, defectives, and pattern mutants. One hundred and seventy-eight mutants with a wide range of developmental abnormalities were identified. Forty-one mutants appear from genetic studies to be tagged (36% of the 115 mutants examined in detail). Mapping with visible markers demonstrated that mutant genes were randomly distributed throughout the genome. Seven mutant families appeared to contain chromosomal translocations because the mutant genes exhibited linkage to visible markers on two different chromosomes. Chromosomal rearrangements may therefore be widespread following seed transformation. DNA gel blot hybridizations with 34 tagged mutants and three T-DNA probes revealed a wide range of insertion patterns. Models of T-DNA structure at each mutant locus were constructed to facilitate gene isolation. The value of such models was demonstrated by using plasmid rescue to clone flanking plant DNA from four tagged mutants. Further analysis of genes isolated from these insertional mutants should help to elucidate the relationship between gene function and plant embryogenesis.