PURPOSE: As a rare congenital anomaly, Poland's syndrome has been known to show hypoplasia in breast and nipple, absence of pectoralis major muscle, and aplasia or deformity of rib or costal cartilage which has been reported to be more common in male. However, most patients who are seeking operation are female patients having one-side deformity. In the field of plastic surgery, the major surgical indications could be asymmetric chest wall depression in man or breast hypoplasia in woman. There are many reconstruction options according to the degree of patient's deformity: a prosthetic implant, breast implant with or without tissue expander, latissimus dorsi musculocutaneous pedicled flap with or without implant and/or tissue expander, and free tissue transfer with or without tissue expander. METHODS: The authors have treated 4 patients(2 male, 2 female) who had a diagnosis of Poland's syndrome. According to the degree of patient's deformity, all patients underwent correction of breast asymmetry and unilateral anterior thoracic hypoplasia with one-staged or two-staged reconstruction. RESULTS: All patents were satisfied with the results and there occurred no specific complications. CONCLUSION: The authors propose the treatment plan for patient with Poland's syndrome, according to the degree of patient's deformity. In case of male patient with mild deformity, the prosthetic implant or latissimus dorsi musculocutaneous pedicled flap will simulate the missing pectoralis and improve the contour deformity. In case of female patient with moderate to severe breast asymmetry and upward displaced nipple areolar complex (NAC), NAC can be lowered with tissue expander, breast can be enlarged with autologous free flaps or latissimus dorsi musculocutaneous pedicled flap with implant.
Breast Implants ; Breast* ; Cartilage ; Congenital Abnormalities ; Depression ; Diagnosis ; Female ; Free Tissue Flaps ; Humans ; Male ; Mammaplasty* ; Nipples ; Ribs ; Superficial Back Muscles ; Surgery, Plastic ; Surgical Flaps ; Thoracic Wall* ; Thorax* ; Tissue Expansion Devices

PURPOSE: The main goals of correcting syndactyly of the hand are to form normal web appearance and to prevent motor dysfunction. We modified the original three-square-flap to improve interdigital web space and to reduce the wound healing problem due to tension. METHODS: From July 2005 to February 2006, three cases of moderate to minor syndactyly were treated using modified three-square-flap. These flaps were made in such as way that the A flap from dorsal side, the B flap from the interdigital surface, and the C flap from the volar side. We modified the design of dorsal A flap as a hourglass shape instead of square shape to make normal hourglass shaped interdigital web and to reduce the tension of closure with other two flaps(B and C flap). The B and C flap were made as square shape. RESULTS: During 4 to 10 months follow-up period, acceptable esthetic results were obtained without any specific complication, using our modification of the three-square-flap. CONCLUSION: Our method showed more satisfactory web appearance and was safe to use even in the cases of syndactyly secondary to burns and post- traumatic scars because of excellent blood circulation.
Blood Circulation ; Burns ; Cicatrix ; Follow-Up Studies ; Hand ; Syndactyly* ; Wound Healing

OBJECTIVES: To evaluate the clinical significance of abnormal bronchi originating from the trachea or main bronchi. METHODS: 21 patients (male:female ratio, 13:8; mean age, 58.2 years, range 34-77), who were diagnosed with major tracheobronchial anomalies by bronchoscopy from January 2001 to March 2005, were enrolled in this study. The anomalous bronchi consisted of 13 tracheal bronchi and 8 cardiac accessory bronchus. The clinical features, bronchoscopic findings, and outcomes were analyzed retrospectively. RESULTS: Common symptoms, including hemoptysis, cough and dyspnea, resulted from the underlying lung disease regardless of the bronchial anomalies. In this series of 13 tracheal bronchi, 7 cases originated from the trachea within 1cm of the carina (carinal type) and 6 cases originated at a higher level(tracheal type). Most patients had favorable outcome with conservative treatment for the underlying lung disease. CONCLUSION: Most tracheobronchial anomalies are found incidentally in the process of diagnosing lung disease. The clinical outcome of patients with a bronchial anomaly depends on the underlying lung disease.
Bronchi* ; Bronchoscopy ; Cough ; Dyspnea ; Hemoptysis ; Humans ; Lung Diseases ; Retrospective Studies ; Trachea*

There have been several recent reports on bladder calculi in women with a previous history of pelvic operation. We experienced 3 patients with foreign body induced bladder stones within 1 year. These calculi had formed on a retained intravesical non-absorbable sutures or a pledget. The radiological and cystoscopic findings and operative technique are discussed.
Calculi ; Female ; Foreign Bodies* ; Humans ; Sutures ; Urinary Bladder Calculi* ; Urinary Bladder* ; Urinary Incontinence, Stress

PURPOSE: This study analyzed the prognostic factors affecting the survival rate and evaluated the role of radiation therapy in muscle-invading bladder cancer. MATERIALS AND METHODS: Twenty eight patients with bladder cancer who completed planned definitive radiotherapy in the Departments of Therapeutic Radiology and Urology, Chonnam National University Hospital between Jan. 1986 to Dec. 1998 were retrospectively analyzed. The reviews were performed based on the patients' medical records. There were 21 males and 7 females in this study. The median of age was 72 years old ranging from 49 to 84 years. All patients were confirmed as having transitional cell carcinoma with histological grade 1 in one patient, grade 2 in 15, grade 3 in 9, and uninformed in 3. Radiation therapy was performed using a linear accelerator with 6 or 10 MV X-rays. Radiation was delivered daily with a 1.8 or 2.0 Gy fraction size by 4 ports (anterior-posterior, both lateral, alternatively) or 3 ports (Anterior and both lateral). The median radiation dose delivered to the isocenter of the target volume was 61.24 Gy ranging from 59 to 66.6 Gy. The survival rate was calculated by the Kaplan-Meier method. Multivariate analysis was performed on the prognostic factors affecting the survival rate. RESULTS: The survival rate was 76%, 46%, 33%, 33% at 1, 2, 3, 5 years, respectively, with 19 months of median survival. The potential factors of age (less than 70 years vs above 70), sex, diabetes mellitus, hypertension, hydronephrosis, T-stage (T3a vs T3b), TUR, chemotherapy, total duration of radiotherapy, radiation dose (less than 60 Gy vs above 60 Gy), and the treatment response were investigated with uni- and multivariate analysis. In univariate analysis, the T-stage ( p=0.078) and radiation dose ( p=0.051) were marginally significant, and the treatment response ( p=0.011) was a statistically significant factor on the survival rate. Multivariate analysis showed there were no significant prognostic factors affecting the survival rate. CONCLUSION: The treatment response and radiation dose are suggeted as the statistically significant factors affecting the survival rate of muscle invasive bladder cancer. A Further prospective randomized study is needed to confirm these prognostic factors.
Aged ; Carcinoma, Transitional Cell ; Diabetes Mellitus ; Drug Therapy ; Female ; Humans ; Hydronephrosis ; Hypertension ; Jeollanam-do ; Male ; Medical Records ; Multivariate Analysis ; Particle Accelerators ; Radiation Oncology ; Radiotherapy* ; Retrospective Studies ; Survival Rate ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Urology

PURPOSE: Gallstone disease has been presumed to be a sequellae of gastrectomy. To know correlation between gallbladder disease and gastrectomy, we check anatomical and functional status of gallbladder with ultrasonogram in our study. METHODS: Gallbladder motility after gastrectomy was studied by means of measuring fasting and postprandial gallbladder volume using real time ultrasonography in 50 gastrectomized patients and in 28 controls (healthy but not operated gastric cancer patients) were selected as study subjects. RESULTS: Mean fasting and postprandial gallbladder volume was significantly increased in gastrectomized patient group (FV: 37.63+/-20.70 ml, PV: 11.50+/-10.26 ml) than control group (FV: 22.17+/-10.35 ml, PV: 5.44+/-3.67 ml, p<0.01). The ejection fraction of gallbladder in gastrectomized patient group (69.05+/-14.57%)was significantly smaller than control group (75.57+/-10.26%, p<0.05). CONCLUSION: The risk of gallbladder disease was independent of age, sex, and post-operative duration in our study. Gastrectomy may have the possibility of increasing the risk of gallbladder disease by causing gallbladder dysmotility and bile stasis. So, gallbladder motility evaluation would be helpful for prevention and understanding gallstone formation. Further study will be needed about the clinical benefits of prophylactic cholecystectomy during gastrectomy.
Bile ; Cholecystectomy ; Fasting ; Gallbladder Diseases ; Gallbladder* ; Gallstones* ; Gastrectomy* ; Humans ; Stomach Neoplasms* ; Ultrasonography

The accumulation of fluid in the pericardium in an amount sufficient to cause serious obstruction to the inflow of blood to the ventricles results in cardiac tamponade. This complication may be fatal if it is not recognized and treated promptly. We report a case of cardiac tamponade caused by acute pancreatitis, which resolved after catheter drainage.
Cardiac Tamponade* ; Catheters ; Drainage ; Pancreatitis* ; Pericardium

PURPOSE: Piezolith 3000(R) is one of the 3rd generation lithotriptors that uses double layered piezoelectric shock waves for the treatment of urinary stone. We evaluated the safety and effectiveness of the Piezolith 3000(R) lithotriptor and we compared it with the previous Piezolith 2300(R) lithotriptor. MATERIALS AND METHODS: We reviewed the records of 500 patients with urinary calculi who had been treated with extracorporeal shock wave lithotripsy (ESWL) from January 2002 to December 2003, but complete follow up data was available for only 385 cases. The distribution of stones, the success rate and the number of ESWL sessions according to the size and location of the stones, the auxiliary procedures and their complications were analyzed. RESULTS: There were 172 cases with renal stone and 213 cases with ureteral calculi. The success rate, defined as being stone-free or having asymptomatic residual fragments measuring 3mm or less, was 82.0% for the renal stones and 93.0% for the ureteral calculi. The overall success rate for all the calculi was 88.1%. The mean number of sessions was 3.6 for the renal stones and 2.3 for the ureteral calculi. The overall mean number of sessions was 2.8. All the treatments were performed without analgesia or sedation except for one child (5 years old) who was given oral sedation. Any serious complications or side effects such as renal hematoma were not observed. CONCLUSIONS: The Piezolith 3000(R) lithotriptor allows shorter treatment sessions and it has more comfortable positioning tools to focus on the stone. It also has the advantage of being anesthesia free and a lower morbidity rate (e.g. pain). Yet we couldn't find any difference of the success rate between the previous standard piezo-system and the Piezolith 3000 .
Analgesia ; Anesthesia ; Calculi* ; Child ; Follow-Up Studies ; Hematoma ; Humans ; Lithotripsy ; Shock* ; Ureteral Calculi ; Urinary Calculi ; Urinary Tract*

PURPOSE: We evaluated the survival rate, prognostic factors and patterns of failure in malignant and atypical meningiomas, and investigated the role of radiation therapy in the treatment of these tumors. MATERIALS AND METHODS: We retrospectively reviewed nineteen patients treated at Asan Medical Center between Mar. 1994 and Jun. 2000 with histologically confirmed malignant or atypical meningiomas. The median patient age was 52 years. The extent of surgery prior to radiation was gross total resection in 13 and subtotal resection in 6. Eleven patients were referred for radiation immediately after diagnosis and the remainder after at least one recurrence. All patients received megavoltage radiation to a median dose of 55.8 Gy. The median follow-up period was 41 months. RESULTS: Eleven patients (57.9%) showed no evidence of disease, five patients died of meningioma and three were alive with disease. The 5-year overall and relapse-free survivals were 75.9 and 50.6%, respectively. There were no statistically significant prognostic factors found to be associated with relapse-free survival by univariate or multivariate analysis. During the follow-up period, no significant treatment-related complications were detected. CONCLUSION: The major patterns of failure were in-field recurrence. In order to reduce local failure, a higher radiation dose may be needed and a high precision therapy should be considered.
Chungcheongnam-do ; Diagnosis ; Follow-Up Studies ; Humans ; Meningioma* ; Multivariate Analysis ; Recurrence ; Retrospective Studies ; Survival Rate

PURPOSE: Hepatocellular carcinoma is a highly malignant disorder that carries a poor prognosis. It is a fatal disease with a high incidence, especially in areas with an already high prevalence of hepatitis types B & C. The primary sites for extrahepatic metastases include the lung and adrenal glands, while bone, especially the skull, is rarely affected. This paper notes a rare case of extrahepatic metastasis to the skull. METHODS: A 62-year-old male, with a previous history of hepatitis B, developed hepatocellular carcinoma. The patient received several treatments of TACE(Transarterial chemoembolization) and PEI(Percutaneous ethanol injection) with no resolution, which prompted a hepatology follow-up. Recently, patient requested to have an enlarging mass on the forehead removed, for which an incisional biopsy was perfomed since the mass involved bone. Pathologic findings confirmed metastatic HCC. RESULTS: The only complication encountered during the incisional biopsy was profuse bleeding from the incision site. There was some difficulty in controlling the bleeding, but hemostasis was achieved using Gelfoam. There were no postoperative complications. The patient was treated with radiotherapy and follow-up CONCLUSION: Patients with cranial metastasis of HCC presents with a subcutaneous mass and a headache while simple X-rays show osteolytic lesions, computed tomography studies are needed for a definitive diagnosis. Treatement options include radiotherapy, surgery and chemotherapy. In this case the patient received radiotherapy. Skull metastases should be considered in the differential diagnosis of patients who present with a subcutaneous mass and an osteolytic defect on X-ray films of the skull.
Adrenal Glands ; Biopsy ; Carcinoma, Hepatocellular ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Ethanol ; Follow-Up Studies ; Forehead ; Gastroenterology ; Gelatin Sponge, Absorbable ; Headache ; Hemorrhage ; Hemostasis ; Hepatitis ; Hepatitis B ; Humans ; Incidence ; Lung ; Male ; Middle Aged ; Neoplasm Metastasis ; Postoperative Complications ; Prevalence ; Prognosis ; Radiotherapy ; Skull* ; X-Ray Film