Ghrelin, an endogenous ligand for the growth hormone (GH) secretagogue receptor, has been reported to induce a GH-releasing, orexigenic effect on weight gain, and adipogenic actions. It is, therefore, thought that ghrelin links the regulatory systems for growth and energy balance.We examined 25 obese children undergoing a 3-month inpatient weight reduction program for obese children based on a combination of diet and exercise therapy and evaluated the change in the serum ghrelin levels.The subjects consisted of 25 children with moderate to severe simple obesity [17 boys, 8 girls ; mean age 9.9±1.3 years, percent overweight (% overweight) 52.1±13.6%]. Height, weight, percent body fat (% BF), fat mass, fat-free mass (FFM), and serum ghrelin were measured before and after weight reduction.After therapy, body weight, % BF and fat mass had all significantly decreased (p<0.001), while height and FFM had both significantly increased (p<0.001 ; p<0.05, respectively). There were no correlations between pre-therapy serum ghrelin and any of the following: initial height, weight, % overweight, % BF, fat mass, or FFM. However, after therapy, serum ghrelin levels were negatively correlated with body weight (r_s=-0.544, p<0.01). Serum ghrelin levels increased significantly from pre- to post-therapy (113.9±30.7 to 129.6±42.9 fmol/ml, p<0.05). The rate of changes in ghrelin levels was negatively correlated with the rate of change in the % overweight (r_s=-0.412, p<0.05).These findings suggest that long-term weight reduction based on a combination of diet and exercise therapy lessens the severity of obesity and increases serum ghrelin levels in obese children.

Locally advanced breast cancer (tumor > 5 cm, widespread infiltration of the skin and muscle, or metastases to lymph nodes) is difficult to resect by surgery, and even when it is resectable, there is a high probability of local recurrence and distant metastasis. Therefore, systemic therapy should be administered first. However, as cutaneous infiltration progresses, the patient's quality of life is impaired by pain, bleeding, presence of exudates, and a foulsmelling odor. Treatment with Mohs paste with systemic therapy can control symptoms associated with skin infiltration and can also be expected to decrease tumor volume.Herein, we report a case in which a tumor was resected following Mohs paste and systemic chemotherapy administration, and the skin defect was reconstructed with a latissimus dorsi myocutaneous flap. We also review the literature for previously reported cases of breast cancer involving Mohs paste.