PURPOSE: The selection of the recipient vessels in breast reconstruction has a great influence on the surgical result and the shape of the reconstructed breast. We would like to introduce the criteria for the selection of recipient vessels in delayed reconstruction of the breast. METHODS: We studied 56 patients with delayed breast reconstruction using free TRAM flaps from April 1994 to December 2006. The thoracodorsal and the ipsilateral internal mammary vessels were used as recipients in 25 patients each, the opposite internal mammary vessels in 3 patients, the thoracoacromial vessels in 2 patients, and the transverse cervical artery with the cephalic vein in 1 patient. The survival rate of the flaps, the vessel diameter, the length of the pedicles, and the convenience of vessel dissection were studied. RESULTS: The diameter of the recipient vessel did not influence the anastomosis. The operation time, the survival rate of flap, the postoperative complications showed no significant difference according to the recipient vessel. Dissection of the thoracodorsal vessels was tedious due to scar formation from the prior operation. Dissection of the internal mammary vessels proved to be relatively easy, and the required length of the pedicle was shorter than any other site, but the need for removal of rib cartilage makes this procedure inconvenient. CONCLUSION: The first choice of the recipient vessel in immediate breast reconstruction is the thoracodorsal vessels, but in cases of delayed reconstruction the internal mammary vessels are favored as the first choice, because the thoracodorsal vessels have a high unusability rate. If the ipsilateral internal mammary vessels prove to be useless, the contralateral vessels can be used. The thoracoacromial vessels are useful, when the mastectomy scar is located in the upper portion. The transverse cervical artery and the cephalic vein can serve as the last resort, if all other vessels are unreliable.
Arteries ; Breast* ; Cartilage ; Cicatrix ; Female ; Health Resorts ; Humans ; Mammaplasty* ; Mastectomy ; Postoperative Complications ; Ribs ; Survival Rate ; Veins

Hallermann-Streiff syndrome is a very rare congenital disorder, which is primarily characterized by the head and face abnormalities. Approximately 180 cases have been reported worldwide, including 8 cases in Korea since it was first described by Hallermann in 1893. Patients exhibit a bird-like face, hypotrichosis, atrophy of skin, dental abnormalities, proportionate nanism, and various ophthalmic disorders, including congenital cataracts and bilateral micropthalmia. As a result of many life-threatening complications, such as respiratory and cardiac difficulties, many patients die during infancy. We report here two cases of HSS diagnosed immediately after birth with literature reviews. They showed two additional characteristics, including chubby cheeks and antenatal ultrasonographic findings, which have not been mentioned in previous reports.
Atrophy ; Cataract ; Cheek ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Dwarfism ; Hallermann's Syndrome ; Head ; Humans ; Hypotrichosis ; Korea ; Microphthalmos ; Parturition ; Skin

PURPOSE: Childhood obesity is associated with nonalcoholic fatty liver disease (NAFLD), and it has become one of the most common causes of childhood chronic liver diseases which significant as a cause of liver related mortality and morbidity in children in the United States. The development of simpler and easier clinical indices for medical practice is needed to identify advanced hepatic fibrosis in childhood NAFLD instead of invasive method like liver biopsy. FibroScan and aspartate aminotransferase (AST)-to-platelet ratio index (APRI) have been proposed as a simple and noninvasive predictor to evaluate hepatic fibrosis in several liver diseases. APRI could be a good alternative to detect pathologic change in childhood NAFLD. The purpose of this study is to validate the efficacy of APRI for assessing hepatic fibrosis in childhood NAFLD based on FibroScan. METHODS: This study included 23 children with NAFLD who underwent FibroScan. Clinical, laboratory and radiological evaluation including APRI was performed. To confirm the result of this study, 6 patients received liver biopsy. RESULTS: Factors associated with hepatic fibrosis (stiffness measurement >5.9 kPa Fibroscan) were triglyceride, AST, alanine aminotransferase, platelet count, APRI and collagen IV. In multivariate analysis, APRI were correlated with hepatic fibrosis (>5.9 kPa). In receiver operating characteristics curve, APRI of meaningful fibrosis (cutoff value, 0.4669; area under the receiver operating characteristics, 0.875) presented sensitivity of 94%, specificity of 66%, positive predictive value of 94%, and negative predictive value of 64%. CONCLUSION: APRI might be a noninvasive, simple, and readily available method for medical practice to predict hepatic fibrosis of childhood NAFLD.
Alanine Transaminase ; Aspartate Aminotransferases ; Aspartic Acid ; Biopsy ; Child ; Collagen ; Fatty Liver ; Fibrosis ; Humans ; Liver ; Liver Diseases ; Multivariate Analysis ; Obesity ; Platelet Count ; ROC Curve ; Sensitivity and Specificity ; United States

In Crohn's disease, mild gastrointestinal bleeding often occurs; however massive gastrointestinal hemorrhage, which can have a dramatic effect on a patient's vital sign, is rare. This could result in potentially life-threatening complications, which can lead to death. Massive hemorrhagic Crohn's disease is not well known and for this reason, they are a diagnostic and therapeutic challenge. Various diagnostic and therapeutic methods are currently being developed and used. The surgical method is often used only as a last measure since this approach has the risk of serious complications that may endanger patients. However, if massive bleeding continues even after all therapeutic methods are used, the surgical method must be implemented. In this case, all therapeutic methods were found to be ineffective; therefore, surgery was used as a last option. Ultimately, the surgical method was found to be successfully used to treat life-threatening hemorrhagic Crohn's disease.
Crohn Disease ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Vital Signs

Background: Ectropion, a common complication after lower blepharoplasty, causes significant patient discomfort and dissatisfaction, yet effective treatments remain lacking. In this study, we evaluated the efficacy of intradermal injections of polydeoxyribonucleotide (PDRN) and platelet-rich plasma (PRP) for scar regeneration and the rapid recovery of temporary ectropion following lower blepharoplasty. Methods: This retrospective study analyzed 21 cases of ectropion among 420 patients who underwent transcutaneous lower blepharoplasty between January 2020 and October 2022. PDRN and PRP were injected intradermally into the lower eyelid, with patients monitored at 1- or 2-week intervals. We investigated patient satisfaction, the total number of injections administered, and the time to complete improvement of the ectropion. Results: The average time for complete ectropion resolution was 9.3 weeks, with a relatively high patient satisfaction rating (mean, 4.3 out of 5). Ten primary cases responded well to a single injection, whereas all six patients with previous operations required two or more injections. The rate of improvement was faster than previously reported, likely due to the enhanced collagen synthesis and anti-inflammatory effects of PDRN, along with the tissue repair and angiogenic properties of PRP. Conclusions Intradermal injections of PDRN and PRP demonstrated promising results in rapidly resolving ectropion after lower blepharoplasty, thereby reducing patient discomfort and increasing overall satisfaction.

Background: Ectropion, a common complication after lower blepharoplasty, causes significant patient discomfort and dissatisfaction, yet effective treatments remain lacking. In this study, we evaluated the efficacy of intradermal injections of polydeoxyribonucleotide (PDRN) and platelet-rich plasma (PRP) for scar regeneration and the rapid recovery of temporary ectropion following lower blepharoplasty. Methods: This retrospective study analyzed 21 cases of ectropion among 420 patients who underwent transcutaneous lower blepharoplasty between January 2020 and October 2022. PDRN and PRP were injected intradermally into the lower eyelid, with patients monitored at 1- or 2-week intervals. We investigated patient satisfaction, the total number of injections administered, and the time to complete improvement of the ectropion. Results: The average time for complete ectropion resolution was 9.3 weeks, with a relatively high patient satisfaction rating (mean, 4.3 out of 5). Ten primary cases responded well to a single injection, whereas all six patients with previous operations required two or more injections. The rate of improvement was faster than previously reported, likely due to the enhanced collagen synthesis and anti-inflammatory effects of PDRN, along with the tissue repair and angiogenic properties of PRP. Conclusions Intradermal injections of PDRN and PRP demonstrated promising results in rapidly resolving ectropion after lower blepharoplasty, thereby reducing patient discomfort and increasing overall satisfaction.

Background: Ectropion, a common complication after lower blepharoplasty, causes significant patient discomfort and dissatisfaction, yet effective treatments remain lacking. In this study, we evaluated the efficacy of intradermal injections of polydeoxyribonucleotide (PDRN) and platelet-rich plasma (PRP) for scar regeneration and the rapid recovery of temporary ectropion following lower blepharoplasty. Methods: This retrospective study analyzed 21 cases of ectropion among 420 patients who underwent transcutaneous lower blepharoplasty between January 2020 and October 2022. PDRN and PRP were injected intradermally into the lower eyelid, with patients monitored at 1- or 2-week intervals. We investigated patient satisfaction, the total number of injections administered, and the time to complete improvement of the ectropion. Results: The average time for complete ectropion resolution was 9.3 weeks, with a relatively high patient satisfaction rating (mean, 4.3 out of 5). Ten primary cases responded well to a single injection, whereas all six patients with previous operations required two or more injections. The rate of improvement was faster than previously reported, likely due to the enhanced collagen synthesis and anti-inflammatory effects of PDRN, along with the tissue repair and angiogenic properties of PRP. Conclusions Intradermal injections of PDRN and PRP demonstrated promising results in rapidly resolving ectropion after lower blepharoplasty, thereby reducing patient discomfort and increasing overall satisfaction.

Noonan syndrome is an autosomal dominant, multisystem disorder. Autoimmune thyroiditis with hypothyroidism is an infrequent feature in patients with Noonan syndrome. A 16-year-old boy was admitted because of chest discomfort and dyspnea; an echocardiogram revealed pericardial effusion. Additional investigations led to a diagnosis of severe hypothyroidism due to Hashimoto thyroiditis. The patient was treated with L-thyroxine at 0.15 mg daily. However, during admission, he developed symptoms of cardiac tamponade. Closed pericardiostomy was performed, after which the patient's chest discomfort improved, and his vital signs stabilized. Herein, we report a case of an adolescent with Noonan syndrome, who was diagnosed with Hashimoto thyroiditis with an unusual presentation of cardiac tamponade.
Adolescent ; Cardiac Tamponade* ; Diagnosis ; Dyspnea ; Hashimoto Disease* ; Humans ; Hypothyroidism ; Male ; Noonan Syndrome* ; Pericardial Effusion ; Pericardial Window Techniques ; Thorax ; Thyroiditis, Autoimmune ; Thyroxine ; Vital Signs

Chronic pancreatitis is a progressive inflammatory disease resulting from repeated episodes of acute pancreatitis that impair exocrine function and eventually produce endocrine insufficiency. Some causes of chronic pancreatitis appear to be associated with alterations in the serine-protease inhibitor, Kazal type 1 (SPINK1), cationic trypsinogen (PRSS1), and cystic fibrosis-transmembrane conductance regulator (CFTR) genes, or with structural disorders in the pancreaticobiliary ductal system, such as pancreatic divisum or anomalous pancreaticobiliary ductal union (APBDU). However, it is unusual to observe both genetic alteration and structural anomaly. Here, we report 2 cases with both APBDU and a mutation in the SPINK1 genes, and we discuss the implications of these findings in clinical practice.
Pancreatitis ; Pancreatitis, Chronic ; Trypsinogen

PURPOSE: Benign childhood epilepsy with centrotemporal spikes (BECTS) is known to have a good prognosis, and is easily controlled with antiepileptic drugs. In this study, we evaluate the efficacy of low-dose topiramate (TPM), once at night time in children with BECTS, and compare with that of oxcarbazepine (OXC). METHODS: OXC was used as a first drug in 58 patients with BECTS at the department of pediatrics, Chonnam National University hospital from Jan. 2003 to Nov. 2010. Their medical records were reviewed, focusing on the onset age of seizure, the dosage of drugs, response to treatment and other clinical features. Since Aug. 2008 through Apr. 2011, some newly diagnosed patients with BECTS were given a low-dose (25mg) of TPM, once at nighttime. The efficacy was reviewed in 14 children, who had been followed up in the outpatient clinic for longer than twelve months. RESULTS: Forty five out of 58 (77.6%) patients were well controlled with OXC. Thirteen out of 58 (22.4%), seizures recurred, on whom TPM (n=9) or lamotrigine (n=4) was added. Nine (64.3%) of the 14 patients who were started with low dose TPM became seizure-free for at least 12 months. However, Two out of 14, the dose of TPM had to be increased up to 100 mg/day and 75 mg/day, respectively. In three, seizure was controlled with OXC. CONCLUSION: A single low-dose TPM would be as effective as the conventional OXC without any adverse effects in children with BECTS.
Age of Onset ; Ambulatory Care Facilities ; Anticonvulsants ; Carbamazepine ; Child ; Epilepsy ; Epilepsy, Rolandic ; Fructose ; Humans ; Medical Records ; Pediatrics ; Prognosis ; Seizures ; Triazines