Fournier's gangrene is an infective necrotizing fasciitis of the perineal, genital or perianal regions. Management of this disease has involved prompt surgical debridement with initiation of broad spectrum antibiotics and intensive supportive care. Multiple debridements orchiectomy, urinary deversion, and fecal diversion should be performed as clinically indicated. Hyperbaric oxygen therapy and topical application of unprocessed honey may prove to be useful adjuncts as new therapies. After excision of all necrotic tissue, the tissue losses have been managed by primary repair. split-thickness skin grafts, rotational or free myocutaneous flaps and omental flaps. Skin graft did not take on bare testis lacking the tunica vaginalis, and gracilis myocutanous flap was too bulky to cover the scrotal area. The progress of necrosis ceased by using intravenous PGE1 injection in the aspect of characteristic obliterative endarteritis causing cutaneous and subcutaneous vascular thrombosis and necrosis of tissue in Fournier's gangrene. We have reconstructed large scrotal defects with bilateral superomedial thigh flap in three Fournier's gangrene patients after stopping tissue necrosis with PEG1 treatment and several surgical debridements of the wounds. The use of this flap ensures a virtually normal sensation, which is important for the erotic propensity of the scrotum. Easy flap design and dissection, as well as primary closure of the donor site, are another benefits of this method.
Alprostadil* ; Anti-Bacterial Agents ; Debridement ; Endarteritis ; Fasciitis, Necrotizing ; Fournier Gangrene* ; Honey ; Humans ; Hyperbaric Oxygenation ; Myocutaneous Flap ; Necrosis ; Orchiectomy ; Scrotum ; Sensation ; Skin ; Testis ; Thigh* ; Thrombosis ; Tissue Donors ; Transplants ; Wounds and Injuries

A case of malignant mixed mesodermal tumor (MMMT) developed after radiation therapy for a uterine cervix cancer is described. The patient was a 62-year-old female at the time of diagnosis of stage Ib squamous cell carcinoma of the cervix and a total of 12,000 rads of x-ray was administered on the pelvic area. Five years later she manifested vaginal spotting and rectal pain. Endometial curettage and biopsy revealed carcinosarcoma. Radical hysterectomy was done and a 5x3x2 cm sized polypoid mass was noted in the uterine cavity. Microscopically, the tumor showed intimate admixture of adenocarcinomatous and sarcomatous areas. The sarcomatous stroma was composed of compactly arranged atypical spindle cells with frequent mitoses, merging into a loosely textured reticular areas and abundant amount of heterologous elements such as skeletal muscle and cartilage. The rhabdomyosarcomatous element was confirmed by PTAH staining and immunohistochemical staining for myoglobin and desmin. Multiple metastases to the liver, lung, and lymph nodes appeared within one year of total abdominal hysterectomy and bilateral salpingo-oophorectomy. In spite of palliative radiotherapy, she expired one month later.
Female ; Humans ; Biopsy ; Neoplasm Metastasis

The effect of melatonin on morphological changes after ischemia-reperfusion injury was investigated in rat skeletal muscle. Dimethyl-sulfoxide(DMSO) was also tested for comparison. Muscle injury was evaluated in 4 groups as a single laparotomy group(control), ischemia-reperfusion group, DMSO group, melatonin group. Left hind limb ischemia was induced for 4 hours by vascular clamping of the common femoral artery and followed by 24 hours of reperfusion. The midportion of gastrocnemius muscle was taken for histological evaluation. In light microscopic study, ischemia-reperfusion group showed severe neutrophil infiltration, interstitial edema, and partial loss or degeneration of muscle fibers. The muscle tissue of melatonin group showed relatively normal architecture with mild inflammatory cell infiltration. In electron microscopic study, dilated cisternae of sarcoplasmic reticulum, dilated mitochondria with electron loose matrix and dilated cristae, disordered or loss of myofilament, indistinct A-band and I-band, intracytoplasmic vacuoles, and markedly decreased glycogen granules were observed in ischemia-reperfusion group. But relatively well maintained A-band, I-band, Z-line, M-line, and mildly dilated mitochondria with well preserved cristae were observed in melatonin group. The DMSO group showed intermediately attenuated ultrastructural changes. The results show that melatonin improves morphologically ischemia-reperfusion injury more effectively than DMSO. In conclusion, melatonin seems to be a promising agent that can salvage the skeletal muscle from severe ischemia-reperfusion injury.
Animals ; Constriction ; Dimethyl Sulfoxide ; Edema ; Extremities ; Femoral Artery ; Glycogen ; Ischemia ; Laparotomy ; Melatonin* ; Mitochondria ; Muscle, Skeletal* ; Myofibrils ; Neutrophil Infiltration ; Rats* ; Reperfusion ; Reperfusion Injury* ; Sarcoplasmic Reticulum ; Vacuoles

To overcome the facial aging, various facial rejuvenation techniques have been presented but each of them has some shortcomings respectively. Extended SMAS technique is not easy to apply and has high risk of facial nerve injury. Moreover, Orientals have some anatomical characteristics different from Caucasians; thicker facial skin, more conspicuous postoperative scar and less cervical deformity such as gobbler neck deformity. Considering these facts, we performed minimal incision rhytidectomy with lateral SMASectomy in 25 patients with aging faces. Based on our experiences, this technique is considered as an easy and quick method with minimal postoperative scar and no risk of facial nerve injury. And lateral SMASectomy is excellent for the correction of deep nasolabial fold, jowl and saggy jaw line. As a result, minimal incision rhytidectomy with lateral SMASectomy is suitable and recommendable facial rejuvenation for Koreans.
Aging ; Cicatrix ; Congenital Abnormalities ; Facial Nerve Injuries ; Humans ; Jaw ; Nasolabial Fold ; Neck ; Rejuvenation ; Rhytidoplasty* ; Skin

The occurrence of Non-Hodgkin's lymphoma (NHL) during pregnancy is very rare and this malignancy is most commonly associated with aggressive histology and dissemination. Treatment in pregnant women with low-grade lymphoma may be delayed until after delivery but women with an aggressive lymphoma must have a immediate initiation of standard chemotherapy whether to have a therapeutic abortion or not. A-32-year-old woman with NHL stage IIb complicating pregnancy is presented. The diagnosis was made aggressive lymphoma. The baby weighting 1,830 gm was delivered by normal spontaneous vaginal delivery. Following delivery, the patient received combination chemotherapy with cyclophosphamide, adriamycin, vincristine, prednisone regimen but magnetic resonance imaging undertaken during follow-up showed leptomeningeal involvement, indicating poor prognosis. She wanted discharge ten months later from disseminated disease. We experienced a case of rapid growing Non-Hodgkin's lymphoma developed on anterior mediastineum that diagnosed during pregnancy and treated following delivery. We report this case with a brief review of literature.
Abortion, Therapeutic ; Cyclophosphamide ; Diagnosis ; Doxorubicin ; Drug Therapy ; Drug Therapy, Combination ; Female ; Follow-Up Studies ; Humans ; Lymphoma ; Lymphoma, Non-Hodgkin* ; Magnetic Resonance Imaging ; Prednisone ; Pregnancy* ; Pregnant Women ; Prognosis ; Vincristine

The aging change that occur to the upper eyelid is the obscurity of the position of eyelid crease by the appearance of redundant upper eyelid skin and fold displacement. The solution is to raise the eyelid crease of the affected upper eyelid through the excision of excess soft tissue. Despite of many descriptions of blepharoplasty in the literature, marking the upper lid skin excision has not been well described. Many operators advocate use of a forceps to measure the amount of skin to be excised. But this method is not accurate and may result asymmetric double folds especially in less- experienced operators. Thus we present easy, accurate, and simple method to determine the amount of the skin to be excised as follows: The lower incision is drawn 6-8mm apart from the lid margin in sitting position while gently pulling upward the upper eyelid. While the marking pen is held at the level of the lower incision line, upper lid return to initial natural position, then a mark is made at the same level. After this procedure is repeated at several points, the dots are connected to a continuous line for the upper line of skin excision.
Aging ; Blepharoplasty* ; Eyelids ; Skin* ; Surgical Instruments

Oriental blepharoplasty or the commonly called "double eyelid" operation is the most common cosmetic procedure among Orientals because the Orientals tend to be conscious of the fold due to the influx of Caucasians and social westernimtion. Anatomically, the upper eyelids of the Orientals are considerably digerent from those of Caucasians, and nearly half of them have single eyelids. Considering the anatomic characteristics of the Koreans, an appropriate design and operative technique must be selected carefully to obtain an aesthetically satisfactory result. However, the incidence of complications occurs frequently. Patients who are faced with unsatisfactory results are perplexed by the fact that such a commonly performed procedures yield such a high dissatisfaction rate, and that secondary revisions can not be easily done. An unfavorable result does not necessarily imply a postoperative complication. Equally important is the unsatisfaction of the patient, whose goal may not be based on good aesthetic principles. The most common source of dissatisfaction in patients who underwent double eyelid operation is postoperative asymmetry and high level of the lid fold. During the eight years from 1991 to 1997, a total 72 patients underwent the secondary blepharoplasty either by transversely slitting and removing multilaminated septal structures exposed to the previous operative scar and or by spreading the preaponeurotic fat, that was extruded into a thin layer. The average age of the patients was 26.5 years and average follow up period was 2 years. No remarkable complications were encountered after operarion by our method and desired aesthetic improvements were acquired in the majority of the patients.
Blepharoplasty ; Cicatrix ; Eyelids* ; Follow-Up Studies ; Humans ; Incidence ; Postoperative Complications

Atypical fibroxanthoma(AFX) is a tumor that occurs as a solitary and ulcerative nodule on actinically damaged or radiation damaged skin of the head and neck in the elderly. AFX is a pleomorphic spindle cell neoplasm of the dermis, which is a clinically benign reactive lesion despite of apparently malignant histologic features. We report a case of AFX which developed on the nasal root area of a 23-year-old man. This case is very unusual in terms of site(less sun-damaged area), overlying skin feature(grossly normal skin) and age(too young). This tumor was completely removed with surgical excision and remained free of recurrence for a period of about 1 year follow-up.
Actins ; Aged ; Dermis ; Follow-Up Studies ; Head ; Humans ; Neck ; Recurrence ; Skin ; Ulcer ; Young Adult

BACKGROUND: Tumor necrosis factor-alpha (TNF-alpha) is known to play an important role in various conditions such as inflammation, autoimmunity, apoptosis, insulin resistance and sleep induction. Five single nucleotide polymorphisms (SNPs) have been known to affect the transcriptional activities of TNF-alpha: 1,-031T/C, -863C/A, -857C/T, -308G/A and -238G/A. METHODS: We have investigated 5 SNPs of the promoter region of TNF-alpha gene, the distribution of 5-locus TNF-alpha haplotypes, and their haplotypic associations with previously typed HLA-A, -B and -DRB1 loci in 107 healthy unrelated Koreans. TNF-alpha SNPs were typed using PCR-single-strand conformation polymorphism (SSCP) and PCR-restriction fragment length polymorphism (RFLP) methods. RESULTS: The allele frequencies of -1,031C, -863A, -857T, -308A, and -238A, which are known as the high-producer-type, were 19.3%, 15.9%, 14.0%, 5.9%, and 2.9%, respectively. The frequency of -308A allele, known to be associated with autoimmune diseases, was 5.9% in Koreans which was lower than Caucasians (14-17%) and somewhat higher than Japanese (1.7%). Five most common TNF-alpha haplotypes (-1,031/ -863/ -857/ -308/ -238) comprised over 95% of total haplotypes: TCCGG (58.4%), CACGG (14.8%), TCTGG (13.7%), TCCAG (5.3%), and CCCGA (3.1%). Strong positive associations (P<0.001) were observed between TCCGG and B62; between CACGG and B51, DRB1*0901; between TCTGG and B35, B54, B59, DRB1* 1201; and between TCCAG and A33, B58, DRB1*0301, DRB1*1302. Five most common extended haplotypes (>3%) comprised around 16% of total haplotypes: A33-B58- TCCAG-DRB1*1302, A24-B52-TCCGG-DRB1*1502, A33-B44-TCCGG-DRB1*1302, A24- B7-TCCGG-DRB1*0101, and A11-B62-TCCGG-DRB1*0406. The distribution of extended HLA and TNF-alpha haplotypes showed that most of HLA haplotypes were almost exclusively associated with particular TNF-alpha haplotypes. CONCLUSION: The results obtained in this study would be useful as basic data for anthropologic studies and disease association studies in Koreans.
Alleles ; Apoptosis ; Asian Continental Ancestry Group ; Autoimmune Diseases ; Autoimmunity ; Gene Frequency ; Haplotypes* ; HLA-A Antigens ; Humans ; Inflammation ; Insulin Resistance ; Polymorphism, Single Nucleotide ; Promoter Regions, Genetic ; Tumor Necrosis Factor-alpha*

Limited data are available on inappropriate shocks in Korean patients implanted with an implantable cardioverter-defibrillator (ICD). We investigated the impact of inappropriate shocks on clinical outcomes. This retrospective, single-center study included 148 patients treated between October 1999 and June 2011. The primary outcome was a composite event of all-cause mortality or hospitalization for any cardiac reason. The median follow-up duration was 29 months (interquartile range: 8 to 53). One or more inappropriate shocks occurred in 34 (23.0%) patients. A history of atrial fibrillation was the only independent predictor of inappropriate shock (hazard ratio [HR]: 4.16, 95% confidence interval [CI]: 1.89-9.15, P < 0.001). Atrial fibrillation was the most common cause of inappropriate shock (67.7%), followed by supraventricular tachycardia (23.5%), and abnormal sensing (8.8%). A composite event of all-cause mortality or hospitalizations for any cardiac reason during follow-up was not significantly different between patients with or without inappropriate shock (inappropriate shock vs no inappropriate shock: 35.3% vs 35.4%, adjusted HR: 1.06, 95% CI: 0.49-2.29, P = 0.877). Inappropriate shocks do not affect clinical outcomes in patients implanted with an ICD, although the incidence of inappropriate shocks is high.
Adult ; Aged ; Atrial Fibrillation/complications ; Defibrillators, Implantable/*adverse effects ; Equipment Failure ; Female ; Hospitalization ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; *Predictive Value of Tests ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Shock/*etiology/mortality ; Tachycardia, Supraventricular/complications