PURPOSE: Skin and soft tissue defect is one of the major challenges faced by plastic surgeons. Adipose derived stromal cells, which can be harvested in large quantities with low morbidity, display multilineage mesodermal potential. Therefore, adipose derived stromal cells have been met with a great deal of excitement by the field of tissue engineering. Recently, Adipose derived stromal cells have been isolated and cultured to use soft tissue restoration. In order to apply cultured cells for clinical purpose, however, FDA approved facilities and techniques are required, which may be difficult for a clinician who cultures cells in a laboratory dedicated to research to utilize this treatment for patients. In addition, long culture period is needed. Fortunately, adipose derived stromal cells are easy to obtain in large quantities without cell culture. The purpose of this study is to present a possibility of using uncultured adipose derived stromal cells for wound coverage. METHODS: Seven patients who needed skin and soft tissue restoration were included. Five patients had diabetic foot ulcers, 1 patient got thumb amputation, and 1 patient had tissue defect caused by resection of squamous cell carcinoma. The patients' abdominal adipose tissues were obtained by liposuction. The samples were digested with type I collagenase and centrifuged to obtain adipose derived stromal cells. The isolated adipose derived stromal cells were applied over the wounds immediately after the wound debridement. Fibrin was used as adipose derived stromal cells carrier. Occlusive dressing was applied with films and foams and the wounds were kept moist until complete healing. RESULTS: One hundred to one hundred sixty thousand adipose derived stromal cells were isolated per ml aspirated adipose tissue. All patients' wounds were successfully covered with the grafted adipose derived stromal cells in a 17 to 27 day period. No adverse events related to this treatment occurred. CONCLUSION: The use of uncultured adipose derived stromal cells was found to be safe and effective treatment for wound coverage without donor site morbidity.
Adipose Tissue ; Amputation ; Carcinoma, Squamous Cell ; Cell Culture Techniques ; Cells, Cultured ; Collagenases ; Debridement ; Diabetic Foot ; Fibrin ; Humans ; Lipectomy ; Mesoderm ; Occlusive Dressings ; Quaternary Ammonium Compounds ; Skin ; Stromal Cells ; Thumb ; Tissue Donors ; Tissue Engineering ; Transplants ; Ulcer ; Wound Healing

PURPOSE: Cryptotia is a congenital deformity in which the upper third of the auricle is buried under the temporal skin. It is rare in Caucasians, yet it is more common in Asians. Although a variety of methods to treat cryptotia have been introduced, there is still no acceptable single procedure that can successfully manage this deformity in its entity. We present a triangular V-Y advancement flap and rhomboid flap for correcting cryptotia that can overcome the diverse shortcomings of the conventional methods. METHODS: This operative method was used to correct 18 auricles in patients ranging in age from 4 to 33 years. A triangular flap was prepared over the auricle by making a skin incision according to Ohmori's method. Then a rhomboid flap with a side length of about 8 to 10 mm that sets the lower portion as a pedicle in the anterior region was prepared to supplement the contracted portion of the helix. The cartilage deformity was corrected by the banner flap or the radiating cartilage incisions with cartilage graft or high density polyethylene graft. RESULTS: We have treated 16 patients with severe cryptotia using this method and have obtained good aesthetic results. All cases showed widened scaphoid fossa and smooth triangular fossa of antihelix. There were no major postoperative complications, such as necrosis or infection of the flaps. CONCLUSION: Correction of cryptotia using the triangular V-Y advancement flap and rhomboid flap is useful a method for certain conditions, when a severe contraction of the helix is present.
Asian Continental Ancestry Group ; Cartilage ; Congenital Abnormalities ; Contracts ; Humans ; Necrosis ; Polyethylene ; Postoperative Complications ; Skin ; Transplants

This study was designed to introduce free toe tissue transfer using infiltration method of local anesthetic agent. Four toe pulp tissues were transferred to reconstruct finger tip defect in four patients who were not suitable for general anesthesia. Two flaps taken from the lateral side of the great toe was used for reconstruction of thumb defect and two flaps from the medial side of the second toe for resurfacing of the index and fifth finger. Flap sizes were various from 2.0x2.0 cm2 to 1.6x4.0 cm2. Anesthesia was induced by infiltration of 2% lidocaine hydrochloride (with 1:100,000 epinephrine) with dilution of normal saline in same volume unit, as like as in ordinary digital block. All vessels were anastomosed within 2 cm of distance from the proximal margin of the defect. Whole operative procedures were carried out by one team. All flaps were successfully taken without complication. The average operation time was 4 hours 10 minutes. The amount of anesthetic agent used in whole operative procedures was roughly 4 mL in the toe, 8 mL in the finger, and 12 mL totally. In conclusion, free toe tissue transfer using infiltration method of local anesthetic agent would be good strategy for finger tip reconstruction in the patient not suitable for general anesthesia.
Anesthesia ; Anesthesia, General ; Fingers ; Humans ; Lidocaine ; Surgical Procedures, Operative ; Thumb ; Toes*

The binding of microorganisms to platelets is a critical step in the development of infective endocarditis. In Streptococcus gordonii, this binding is mediated in part by serine-rich repeat proteins, which interact directly with sialic acid residues located on GPIIb receptors in the platelet membrane. In this study, we found that S. gordonii DL1 strain binds to platelets through bridging between sialic acid residue of fibronectin and serine-rich repeat protein (Hsa). Pretreatment of fibronectin with sialidases specific for alpha(2-3)-linked sialic acids was shown to significantly inhibit binding of the DL1 strain and the binding region(BR) of Hsa protein. Similarly, pre-incubation of bacteria or BR of Hsa with alpha(2-3)-sialyl-N-acetyllactosamine blocked fibronectin binding in the DL1 strain, but not the M99 strain. Together, these data show that the alpha(2-3)-sialic acid residues of fibronectin play an important role in the binding of S. gordonii DL1 to fibronectin through interactions with the Hsa receptor. This interaction is thought to play an important role in the development of pathogenic endocarditis, and may represent an important therapeutic target for the treatment of infective endocarditis.
Bacteria ; Blood Platelets ; Endocarditis ; Etorphine ; Fibronectins* ; Membrane Glycoproteins* ; Membranes ; N-Acetylneuraminic Acid* ; Sialic Acids ; Streptococcus gordonii*

Pulmonary arteriovenous fistula is an uncommon capillary abnormality. It may be accompanied by neurological complications such as cerebral abscess and be associated with or without hemorrhagic telangiectasia. We recently experienced a case of cerebral abscess with pulmonary arteriovenous fistula(PAVF), which was not associated with hereditary hemorrhagic telangiectasia. We report this case with review of the related literature.
Arteriovenous Fistula* ; Brain Abscess* ; Capillaries ; Telangiectasia, Hereditary Hemorrhagic ; Telangiectasis

PURPOSE: The hospital-acquired outbreak of acute gastroenteritis caused by a virus is currently one of major health problems among newbron nurseries in Korea. We report an outbreak of acute gastroenteritis with metabolic acidosis over a eight-month period in many nurseries in Gyeonggi-do, Korea. METHODS: We retrospectively evaluated 73 neonates who were admitted in Ansan Hospital, Korea University Medical Center, presenting with symptoms of acute viral gastroenteritis from March, 2001 to September, 2003. Epidemiologic, clinical and laboratory data for these neonates were reviewed. Enzyme-linked immunosorbent assay (ELISA) for rotavirus and enzyme immunoassay (EIA) for astrovirus, norwalk virus and enteric adenovirus were performed in 54 and 16 neonates, respectively. RESULTS: The mean age at admission was 9.5 +/- 3.9 days. The mean body weight was significantly decreased, compared with mean birth weight. The numbers of severe dehydration were 37 (50.7%) and severe metabolic acidosis (pH < 7.2) were 40 (54.8%). Although the symptoms and laboratory findings were all compatible with acute gastroenteritis caused by a virus, the positive results for ELISA for rotavirus and EIA for astrovirus, norwalk virus and enteric adenovirus were 8 (14.8%) for 54 neonates and none for 16 neonates, respectively. CONCLUSION: Recognizing an outbreak of viral gastroenteritis necessitates notification of local health officials, collection of appropriate specimen for diagnosis and prompt institution of infection control measures.
Academic Medical Centers ; Acidosis* ; Adenoviridae ; Birth Weight ; Body Weight ; Cross Infection ; Dehydration ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Gastroenteritis* ; Gyeonggi-do* ; Humans ; Immunoenzyme Techniques ; Infant, Newborn ; Infection Control ; Korea* ; Norwalk virus ; Nurseries* ; Retrospective Studies ; Rotavirus

OBJECTIVE: We prospectively compared whole-body multidetector computed tomography (MDCT) and 3.0T magnetic resonance (MR) images with autopsy findings. MATERIALS AND METHODS: Five cadavers were subjected to whole-body, 16-channel MDCT and 3.0T MR imaging within two hours before an autopsy. A radiologist classified the MDCT and 3.0T MRI findings into major and minor findings, which were compared with autopsy findings. RESULTS: Most of the imaging findings, pertaining to head and neck, heart and vascular, chest, abdomen, spine, and musculoskeletal lesions, corresponded to autopsy findings. The causes of death that were determined on the bases of MDCT and 3.0T MRI findings were consistent with the autopsy findings in four of five cases. CT was useful in diagnosing fatal hemorrhage and pneumothorax, as well as determining the shapes and characteristics of the fractures and the direction of external force. MRI was effective in evaluating and tracing the route of a metallic object, soft tissue lesions, chronicity of hemorrhage, and bone bruises. CONCLUSION: A postmortem MDCT combined with MRI is a potentially powerful tool, providing noninvasive and objective measurements for forensic investigations.
Adult ; Aged ; Autopsy/*methods ; Cadaver ; Female ; Humans ; Image Processing, Computer-Assisted ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Prospective Studies ; Tomography, X-Ray Computed/*methods ; *Whole Body Imaging

Break of a stent delivery catheter and subsequent stent loss (SL) has been a rare event in the drug-eluting stent (DES) era. We here report a case of successful retrieval of a stent after a break if the delivery catheter and SL from a balloon catheter at a culprit lesion. We finally resolved this situation using a simple balloon technique for both the broken stent catheter inside of the guide catheter and the unexpanded stent in the culprit lesion. Thus balloons are an important weapon in our armamentarium in the cardiac catheterization laboratory for urgent retrieval of a lost stent. Their apt use definitely allowed our patient to avoid undergoing emergency cardiovascular thoracic surgery.
Angioplasty ; Cardiac Catheterization ; Cardiac Catheters ; Catheters ; Dimaprit ; Drug-Eluting Stents ; Emergencies ; Humans ; Stents ; Thoracic Surgery

Purpose: The presentations and geographic incidence of pediatric non-Hodgkin lymphoma (NHL) differfrom those of adults. This study delineated the characteristics and outcomes of pediatricNHL in East Asia. Materials and Methods: Medical records of 749 pediatric patients with NHL treated at participating institutions inmainland China, Japan, Korea, and Taiwan from January 2008 to December 2013 werereviewed. Demographic and clinical features, survival outcomes, and putative prognosticfactors were analyzed. Results: Five hundred thirty patients (71%) were male. The most common pathologic subtypes wereBurkitt lymphoma (BL) (36%). Six hundred seven patients (81%) had advanced diseases atdiagnosis. The 5-year overall survival and event-free survival (EFS) rates were 89% and 84%.The 5-year EFS rates of BL, lymphoblastic lymphoma, and diffuse large B-cell lymphomawere 88%, 88%, and 89%, and those of anaplastic large cell lymphoma (ALCL) and peripheralT-cell lymphoma (PTCL) were 71% and 56% (p < 0.001). Central nervous system involvement,high lactate dehydrogenase level (> 250 IU/mL), and advanced disease at diagnosis( stage III) were associated with poor outcomes (p < 0.05). ALCL and PTCL relapsedmore frequently than other pathologic subtypes (p < 0.001). Conclusion In East Asia, PTCL was more frequent than in Western countries, and bone marrow involvementdid not affect treatment outcome. This international study should motivate future collaborativestudy on NHL in East Asia.