The gigantic lipoma could be categorized into subcutaneous and subfascial type. We experienced eight cases from seven patients. Five cases of them were proved to be subcutaneous gigantic lipomas, and three cases were proved to be subfascial gigantic lipomas. Among the subcutaneous type, three cases of liposarcomas were confirmed by final biopsy results. And three cases of recurrences were shown. Among the subfascial type, one case of chondrolipoma was confirmed by final biopsy result and no recurrence was not found. In brief, subcutaneous and subfascial gigantic lipoma had a specific characteristics as followings: Subcutaneous type showed asymptomatic mass with bulging, multilobulated and poorly marginated. And it was difficult for complete removal with a high recurrence rate. Radical excision and liposuction recommended for its treatment. On the other hand, subfascial type showed diffuse expansion, late onset of symptom. And it was readiness for complete removal with no recurrence after complete excision.
Biopsy ; Hand ; Humans ; Lipectomy ; Lipoma* ; Liposarcoma ; Recurrence

In this study, 42 Polytetrafluoroethylene prostheses (Gore Tex: internal diameter 1.5 mm, length 8 mm, fibrilar length 30micromiter, wall thickness 0.2 mm) were used to reconstruct the vascular gap of rabbit femoral vein. To enhance the patency rate and promote the healing process, the prostheses were connected to rabbit femoral vein by means of stair-like sleeve anastomosis. The specimens were obtained in 12 hours (n=4), 1 day (n=4), 3 days(n=4), 1 week (n=10), 2 weeks (n=10), 3 weeks(n=10). After determination of patency, the specimens were prepared with H&E stains and investigated under microscope. After 1 week, endothelial-like cells were observed around anastomotic area from the adjacent vein. After 3 weeks, all microvenous grafts were completely covered by endothelial lining. The anastomotic area was more prominent in the endothelial lining than in the central area. There was some evidence of migrating cells from adjacent soft tissue through micropores of PTFE prostheses. Overall patency rate of PTFE prostheses connected by stair-like sleeve anastomosis was 85.7%. We concluded stair-like sleeve anastomsis of PTFE prostheses in the rabbit femoral vein result in better overall patency rate than end-to-end anastomosis.
Coloring Agents ; Femoral Vein* ; Polytetrafluoroethylene* ; Prostheses and Implants ; Transplants ; Veins

In the treatment of this complicated diabetic foot patient, we need an effective treatment principle because the complicated diabetic foot patient needs a longer hospitalization period and suffers from more frequent recurrences. We reviewed 43 diabetic foot patients who were treated in our department during the past 4 years. The 43 patients were divided into 4 groups according to their combined complications. Group A was the simple diabetic foot group(no complication group, n = 17). Group B was the diabetic foot group combined with the extensive cellulitis(n = 9). Group C was the diabetic foot group combined with the peripheral vascular disease(n = 8). Group D was the diabetic foot group combined with the renal failure(n = 9). As a results, wide range of reconstructive methods can be selected in the simple diabetic foot group. In group B, early and wide debridement was important to control the infection and later flap reconstruction was appropriate. In group C, the bypass operation should be desperate before improving the circulation of lower extremities, and therefore we successfully reconstructed the foot with various metohds including plantar V-Y advancement flap, considered as the most useful in our series. In group D, recurrence was more frequent and lower extremity amputations above the ankle level couldn't be avoided in spite of many operations and longer hospitalization. Therefore consideration of early amputaiotn is recommended for the effective treatment of this group.
Amputation ; Ankle ; Debridement ; Diabetic Foot* ; Foot ; Hospitalization ; Humans ; Lower Extremity ; Peripheral Vascular Diseases* ; Recurrence ; Renal Insufficiency*

The rib cartilage has been the most popular autogenous tissue for microtia reconstruction. Donor site complications, especially chest wall deformities occurring after harvest of costal cartilage graft are presented and discussed in many reports. In this study, 100 chest donor sites were evaluated in 34 patients (25 male and 9 female) who underwent costal cartilage grafts for microtia reconstruction from 1992 to 1999, and reviewed for donor site complications by radiography and physical examination. Ribs from which costal cartilage had been harvested showed increased inward bowing on radiographs in 38 of 100 donor sites; the upper ribs record a higher incidence of deformity than lower ribs. The frequency of rib deformity in donor site was 21 percent when cartilages were harvested from patients older than 10 years of age, whereas it was 73.3 percent in patients younger than 10 years. This difference was statistically significant. In our study, the incidence of chest wall deformity was 57 percent, concerning donor site morbidity after the supraperichondrial rib harvesting procedure, whereas it was 35 percent in patients after the subperichondrial rib harvesting procedure. In conclusion, surgeons should consider the possibility of thoracic deformity when planning costal cartilage grafting. To avoid these deformities, costal cartilage harvesting should be made at lower levels of the rib cage, and delayed operation time for thoracic maturation is recommended. More care should be taken to preserve the perichondrium and the germinative zone of the costochondrial junction.
Cartilage* ; Congenital Abnormalities ; Humans ; Incidence ; Male ; Physical Examination ; Radiography ; Ribs ; Thoracic Wall* ; Thorax* ; Tissue Donors ; Transplants

The craniosynostosis is the term that designates premature fusion of one or more sutures in the cranial vault and thus causes deformities of cranial base and vault. When a suture fused prematurely, the skull and growing brain beneath the suture are forced to expand in the fused suture area. Between April of 1992 and September of 1999, six patients of bilateral coronary synostosis were operated with frontal bone advancement and calvarial remodeling. The supraorbital bar was reshaped with partial osteotomy, greenstick fracture and interpositioning bone grafts. The frontal bone was divided along the metopic suture and transposed one another to make an esthetic shape of the forehead. The parietal bone was expanded with multiple barrel stave osteotomies and fixed to advanced frontal bone with interpositional bone graft. The six patients were operated at the mean age of 10 months. The mean operation time was about 5 hours and mean transfusion volume was 190 cc. There was no postoperative complications and no need for more revisional operation. For a superior result of correciton of craniosynostosis, early surgical intervention is mandate. Efforts for reducing complications, parents' understanding and periodic follow- up are important factors for successful correction.
Brain ; Congenital Abnormalities ; Craniosynostoses ; Forehead ; Frontal Bone ; Humans ; Osteotomy ; Parietal Bone ; Postoperative Complications ; Skull ; Skull Base ; Sutures ; Synostosis* ; Transplants

Microform cleft lip is a mild expression of cleft lip. Downward depression of the nostril rim, skin striae of the upper lip, notching of the Cupid`s bow, and deformity of the vermilion border are characteristic findings. The definition is very important to aid in selection of the operative methods. Based on our operative experiences of cleft lip, we classified microform cleft lip according to our new definition.. According to author`s classification, class I(1 case) has cleft lip nose deformity without lip deformity or with slight short lip of cleft side, class IIa(5 cases) has minimal lip deformity with blurring of cupid`s bow, vermilion notching, and skin striae with intact of orbicularis oris muscle, class IIb(12 cases) has discontinuity of the orbicularis oris muscle, class III(5 cases) has mild lip nose deformity with discontinuity of orbicularis oris muscle including Cupid`s bow deviation. In class IIb and class III, reconstruction of orbicularis oris muscle is important and we repaired it with radical operation by rotation-advancement method. A total of 23 microform cleft lip result was reviewed. We treated the clefts following the above principles according to the classification and obtained satisfactory results.
Classification* ; Cleft Lip* ; Congenital Abnormalities ; Depression ; Lip ; Microfilming* ; Nose ; Skin

The purpose of palatoplasty in cleft palate patient is to form normal speech and normal growth of maxilla. Still now, varient trial and evaluation to palatoplasty have been introduced and investigated for long time, but evaluation of long term result in platoplasty has been neglected. So, authors tried to analyze long term result in bilateral complete palatoplasty by speech analysis. The speech outcome was studied retrospectively in 27 bilateral complete cleft patients who underwent push-back palatoplasty from October 1990 to November 1997. The patient was underwent palatoplasty in 9-10 month old. The patients were divided to 4 group as 3-4, 5-6, 7-8, 9-10 year old and compared with 20 normal children (control groups were divided to 4 groups). Nasal emission test and hypernasality test and articulation test were done by speech evaluation table which was consisted of 39 different words. For nasal emission test, we test the numbers of nasal emission word. For hypernasality test and articulation test, each word has score such as normal; 3 points, fair; 2 points, poor 1 point and thus total score was 87points. The score of nasal emission was that the number of nasal emission word, and the number was reduced by aging. And the score of hypernasality test and articulation test was improved by aging. The score of patients who have been taken speech therapy was high in their age group. In comparison with normal control group, the score of patients was slightly lower than control group. And about 74.1% of the patients obtained normal speech after bilateral complete palatoplasty. So we think speech test after palatoplasty is necessary for assessment and treatment of the patients.
Aging ; Child ; Cleft Palate ; Humans ; Maxilla ; Retrospective Studies ; Speech Therapy

Childhood granulomatous periorificial dermatitis (CGPD) is a benign facial eruption of unknown etiology characterized by a monomorphic papular eruption occurring in the perinasal, perioral, and periocular areas. We report an 11-year-old boy with characteristic features of CGPD. He presented with a 4-month history of non-pruritic, papular eruptions on the face. The histopathologic exam revealed an upper dermal granuloma with surrounding lymphocytes. Treatment was initiated with tetracycline 500 mg/day, but there was no response for 3 weeks. We tried 0.03% topical tacrolimus to treat recalcitrant skin lesions. After 10 weeks of treatment, the lesions resolved without scarring.
Child ; Cicatrix ; Dermatitis ; Granuloma ; Humans ; Lymphocytes ; Skin ; Tacrolimus ; Tetracycline

Subungal malignant melanoma is a relatively rare disease with reported incidence between 1% to 3% of all melanoma cases in the USA, 10% to 31% in Japan. It is a serious disease with a survival period of 5 years. This poor prognosis is the result of late diagnosis in many of the cases, usually the patient not presenting himself early enough in the course of the disease. However, far more important is the frequent failure of the physician or surgeon to recognize the clinical signs and to perform a biopsy from the correct site, which leads to an accurate diagnosis. Therefore we focused the nail color change of the subungal malignant melanoma to diagnose the disease at the early stage. Five patients who visited our hospital with nail color change into black took the biopsy. This should be done on nail bed and matrix lesions which shows color change into black. A wedge form is taken from the area with maximal clinical concern, including normal tissue at the edge of the lesion. In cases of melanoma in situ (4 cases) diagnosed during the previous biopsy, surgical treatment was done as soon as possible. The melanoma was excised by Mohs technique and the margins were checked by frozen section. If the margins and base of tumor did not have micrometastasis, immediate reconstruction using various flaps was done. In case that micrometastasis was suspicious however, special staining using HMB45 immunostaining was done for confirmation. After a few days for special staining, delayed reconstruction was done. By means of the early diagnosis and Mohs micrographic operation technique, we could excise the tumor completely and preserve the tendon, bone, joint and length of digits.
Biopsy ; Delayed Diagnosis ; Diagnosis* ; Early Diagnosis ; Frozen Sections ; Humans ; Incidence ; Japan ; Joints ; Melanoma* ; Neoplasm Micrometastasis ; Prognosis ; Rare Diseases ; Tendons

PURPOSE: Differences in phenotypes between the two most common subtypes of Prader-Willi syndrome (PWS) indicate that a distinct response to growth hormone (GH) treatment may exist. To test this hypothesis, we compared the results of GH treatment in individuals with PWS due to uniparental disomy (UPD) to those of individuals with deletions. METHODS: Sixty-five children with PWS who had been treated with GH for more than two years were included in this study. Twenty-one individuals were confirmed as having UPD and 44 individuals had a deletion. Height, body weight, body mass index (BMI), and insulin like growth factor-1 (IGF-I) measurements were recorded before GH treatment and at intervals of 12 months thereafter. RESULTS: After two years of GH therapy, no significant differences were noted for yearly improvements in height standard deviation scores (SDS) between the groups (second year SDS, 0.93 +/- 0.94; deletion, 0.84 +/- 1.31; UPD, P = 0.717). Body weight SDS, BMI SDS, and IGF-I SDS also showed no differences between the two groups. CONCLUSION: Our study showed no significant differences in yearly improvements in height SDS between the deletion and UPD groups, at least for the first two years.
Body Height ; Body Weight ; Child ; Genotype ; Growth Hormone ; Humans ; Insulin ; Insulin-Like Growth Factor I ; Phenotype ; Prader-Willi Syndrome ; Sequence Deletion ; Uniparental Disomy