PURPOSE: To determine the effectiveness of percutaneous transarterial embolization for the treatment of arteriovenous malformation (AVM). MATERIALS AND METHODS: Seven patients with AVMs located in the kidney, liver, lung, chest wall, uterus and paraspinal region underwent angiography and percutaneous transarterial embolization. The embolic materials used were steel coil, gelfoam, contour emboli, and absolute alcohol; in some cases, more than one of these were employed. The analysed the angiographic findings and clinical status following embolization were assessed and analysed. RESULTS: The AVMs had tortuous, dilated feeding arteries (n=7) and veins with early venous drainage (n=6). In the hepatic AVM, a grape-like dilated vessel arose from the hepatic artery and was connected to the portal vein. In the uterine AVM, numerous dilated feeding arteries formed a honeycomb. In the feeding arteries of the chest wall AVM and in the nidus of the pulmonary AVM, aneurysms were present. In simple AVMs, the patient's symptoms were relieved by first embolization. Complex AVMs, however, required repeated embolizations for symptomatic relief. Although extensive, complex AVMs of the chest wall and uterus recurred after initial embolization, repeated treatment successfully improved the clinical status of such patients. The complications developing after emboliation were fever (n=3) and pain (n=3), but these were relieved by conservative care. CONCLUSION: Percutaneous transarterial embolization is a safe and effective therapeutic method for the treatment of AVM. In a case of inoperable complex AVM, repeated embolization is the only method for symptomatic relief and the maintenance of life.
Aneurysm ; Angiography ; Arteries ; Arteriovenous Malformations* ; Drainage ; Ethanol ; Fever ; Gelatin Sponge, Absorbable ; Hepatic Artery ; Humans ; Kidney ; Liver ; Lung ; Portal Vein ; Steel ; Thoracic Wall ; Uterus ; Veins

Dislocations of the toes are comparatively rare. The majority of the these injuries occur in the great toe at the metatarsophalangeal joint. Dislocations of the interphalangeal joint of the great toes are extremely unusual, especially interphalangeal dislocation of the grcat toe with interposition of a sesamoid bone is extremely rare. Authors wishes to report two cases of interphalangeal dislocation of the great toe with interposition of the interphalangeal sesamoid.
Dislocations ; Joints ; Metatarsophalangeal Joint ; Sesamoid Bones ; Toes

It is well known that the early diagnosis and treatment are very important for the patient with ankle instability to provide a favorable occupational function through the whole life. Therefore, to evaluate the result of treatment of lateral ankle instability, we analyzed the 10 cases with 3.1 years follow-up period who were treated at the Orthpaedic department, National police Hospital, from January, 1980 to December, 1986. The results were as follows : l. Among the 10 patients, 4 patients were female, 6 patients were male and all patients were required operative procedures. 2. The aversge age was 21.3 years ranging from 18 years to 24 years and average follow-up period was 3.1 yesrs ranging from 6 months to 7 years. 3. In occupstional distribution, volley ball players were 4 patients, soccer players were 2, combat police were 3, student was 1 snd athletes were 6 patients (60%) among the 10 patients. 4. In the method of treatment, surgical treatment by Evans or Watson-Jones reconstructive procedure was used for 10 pstients. 5. The results of treatment were Excellent in 6 patients (60%), Good in 2 (20%) and Poor in 2(20%) by author's rating system. 6. The most common complication was the degenerative arthritis.
Ankle ; Athletes ; Early Diagnosis ; Female ; Follow-Up Studies ; Humans ; Male ; Methods ; Osteoarthritis ; Police ; Soccer ; Surgical Procedures, Operative

PURPOSE: Median cleft of upper lip is defined as any congenital vertical cleft through the midline of the upper lip. It is uncommon, its embryological pathogenesis remains unexplained to date. The authors hereby report a rare case of median cleft of the upper lip associated with enlarged frenulum and palatal mass. This case offers some understanding of the possible embryologic development of this anomaly. METHODS: A 10-month-old boy born by normal vaginal delivery at full-term had a notch in the midline of the upper lip with widened philtrum along with enlarged median frenulum, alveolar cleft, and mass of the hard palate. We performed en bloc resection of the enlarged frenulum and palatal mass and cheiloplasty under general anesthesia. RESULTS: Histological examination revealed that the frenulum and palatal mass was consisted of fibrous tissue with normal mucous membrane. The postoperative course was satisfactory. CONCLUSION: A rare case of median cleft of the upper lip with associated enlarged frenulum and palatal mass was presented with proper surgical management. The surgical technique includes marginal excision of the clefted epithelium and reconstruction of orbicularis oris muscle, in addition to en bloc resection of the palatal mass and frenulotomy.
Epithelium ; Humans ; Infant ; Lip ; Mucous Membrane ; Muscles ; Palate, Hard

Purpose: Breast volume is an important factor in breast reconstruction; however, the surgeon is expected to deliver the volume expectation with his aesthetic inspiration. Therefore, objective volumetry must be developed. This study aimed to conduct an MRI-based breast volumetric analysis. With periodic analysis of 2-stage breast reconstruction, we suggest the possibility of clinical use of breast volumetry in implant volume prediction. Methods: This retrospective study included 140 patients who underwent unilateral 2-stage breast reconstruction (tissue expander followed by implant insertion) between January 1, 2017 and December 31, 2019. The MRI image was converted into a 3-dimensional image with a reconstruction program (A-VIEW, Coreline Soft). MRI image was obtained before the surgery and then at 1, 3, 6, 12, and 24 months postoperatively. The volume was automatically calculated. Results: Compared with the preoperative volume, maximized volume and differences were noted at 1 month and minimized at 1 year. The correlation between MRI-based preoperative breast volumetry and the mastectomy specimen volume was 0.611. Volume difference between the MRI-based preoperative state and the implant volume showed a minimal difference at 1 year. The final implant size prediction formula was calculated using the 1-year postoperative volume (P < 0.001, R 2= 0.594). Conclusion To avoid breast reconstruction based solely on the surgeon’s subjective assessment, MRI-based breast volumetry could be a useful method to develop more scientific and objective breast reconstruction planning. We suggest a volume prediction formula that describes the relationship between the postoperative breast volume and the final breast implant size.

Purpose: Acellular dermal matrix (ADM) supports tissue expanders or implants in implant-based breast reconstruction. The characteristics of ADM tissue are defined by the manufacturing procedure, such as decellularization, preservation, and sterilization, and are directly related to clinical outcomes. This study aimed to compare the properties of a new pre-hydrated-ADM (H-ADM-low) obtained using a decellularization reagent reduction process with a low concentration of detergent with those of radiation-sterilized H-ADM and freeze-dried ADM (FD-ADM). Methods: ADMs were evaluated in terms of structure, mechanical quality, and cytotoxicity using histochemical staining, tensile strength testing, and in vitro cell viability analysis. Results: The tissue structure of H-ADM-low (CGDERM ONE-STEP) was similar to that of native skin despite complete decellularization. By contrast, in FD-ADM, the tissue structure was damaged by the freeze-drying process, and radiation-sterilized H-ADM showed a compact fibrillar arrangement. Furthermore, matrix components such as collagen and elastin were preserved in H-ADM-low, whereas a loss of elastin fibers with fragmented distribution was observed in radiation-sterilized H-ADMs. H-ADM-low's tensile strength (58.84 MPa) was significantly greater than that of FD-ADM (38.60 MPa) and comparable with that of radiationsterilized H-ADMs. The residual detergent content in H-ADM-low (47.45 mg/L) was 2.67-fold lower than that of H-ADM decellularized with a conventional detergent concentration (126.99 mg/mL), and this finding was consistent with the cell viability results (90.7% and 70.7%, respectively), indicating that H-ADM-low has very low cytotoxicity. Conclusions H-ADM-low produced through aseptic processes retains the original tissue structure, demonstrates excellent mechanical properties, and does not affect cell viability.Therefore, this newer H-ADM is suitable for use in implant-based breast reconstruction.

OBJECTIVES: Infection and replication of the hepatitis B virus are closely related to the host immunity. Anticancer chemotherapy decreases the immune response of the host, Especially, glucocorticoid can activate the replication of hepatitis B virus directly. It is well known that hepatitis B virus infection and hepatic complications are more common in patients with hematologic malignancies like malignant lymphoma. We studied the incidence of hepatitis B virus infection and hepatic complications following anti-cancer chemotherapy in patients with malignant lymphoma. METHODS: Among 224 cases diagnosed as malignant lymphoma from January 1989 to December 1993 at Yonsei University Medical Center, 77 cases tested for hepatitis B virus serology was studied. RESULTS: 1) Eighteen cases (23%) was HBsAg positive. 2) The results of hepatitis C virus serology in six cases were all negative. 3) Eight (57%) of 14 follow-up cases had hepatic complications, Two patients had fulminant hepatitis, two nonicteric hepatitis and four icteric hepatitis. 4) Interferon-alpha was administered in three cases among the patients with hepatic complications. Loss of HBeAg was observed in one case and loss of HBsAg in another case. CONCLUSION: Serious hepatic complications can be occurred following anticancer chemotherapy in HBsAg-positive patients with malignant lymphoma. Therefore, we recommend that patients being considered as candidates for anticancer chemotherapy should routinely undergo serologic test for Hepatitis B virus. In addition HBsAg-positive patients with anticancer chemotherapy should be regularly monitored for hepatic injury. And with the careful use of steroid and interferon, prolongation of survival might be searched for these patients.
Academic Medical Centers ; Drug Therapy* ; Follow-Up Studies ; Hematologic Neoplasms ; Hepacivirus ; Hepatitis ; Hepatitis B ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens* ; Hepatitis B virus ; Humans ; Incidence ; Interferon-alpha ; Interferons ; Lymphoma* ; Serologic Tests

PURPOSE: The purpose of this study is to evaluate the functional and aesthetic outcomes of the reconstruction of complicated open wounds with exposure of the bone, periosteum, or tendon using AlloDerm(R) and skin graft in hand and foot. MATERIALS AND METHODS: Seven cases of hand and 4 cases of foot were treated with combined AlloDerm(R) graft and split thickness skin graft in a single stage for managing the soft tissue defect of extremities where bone, periosteum, or tendon were exposed but flap operation was not feasible. The mean postoperative follow-up period was 30 months (range: 14-48 month). Postoperatively, we assessed graft taking rate, wound healing process, and the recovery of motion of hand and foot. RESULTS: AlloDerm(R) and skin graft were readily assimilated into the wound in all cases. The mean postoperative range of motions of the 5 fingers with exposed digital tendons were 89.2% of the normal side. Reconstructions of wound in the foot were successfully settled without unstable scar or ulcer in all cases. CONCLUSION: Composite grafting with AlloDerm(R) and autologous skin graft for reconstruction of complex open wound in hand and foot where deep structures are exposed provides stable reconstruction of the wound with high taking rate, successful recovery of tendon gliding motion by preventing adhesion.
Cicatrix ; Collagen ; Extremities ; Fingers ; Follow-Up Studies ; Foot ; Hand ; Hand Injuries ; Periosteum ; Skin ; Tendons ; Transplants ; Ulcer ; Wound Healing

PURPOSE: Although platelet-rich plasma (PRP) potentiate the wound healing activity of adipose-derived stem cells (ADSCs), its effect cannot be sustained for a prolonged period of time due to short duration of action. This led us to design and produce platelet-rich fibrin (PRF), in an effort to develop a tool which lasts longer, and apply it on wound healing. METHODS: Two symmetrical skin defects were made on the back of seven nude mice. ADSCs were applied to each wound, combined with either PRP or PRF. The wound area was measured over 14 days. By day 16, the wound was harvested and histologic analysis was performed including counting of the blood vessel. RESULTS: The healing rate was more accelerated in PRP group in the first 5 days (p<0.05). However, PRF group surpassed PRP group after 6 days (p<0.05). The average number of blood vessels observed in the PRF group was 6.53 +/- 0.51, compared with 5.68 +/- 0.71 for the PRP group. CONCLUSION: PRF exerts a slow yet pervasive influence over the two-week course of the wound healing process. Thus, PRF is probably more beneficial for promoting the activity of ADSCs for a sustained period of time.
Acceleration ; Animals ; Blood Platelets ; Blood Vessels ; Fibrin ; Mice ; Mice, Nude ; Platelet-Rich Plasma ; Skin ; Stem Cells ; Wound Healing

PURPOSE: We present our experience involving the management of this disease, identifying prognostic factors affecting treatment outcomes. METHODS: The patients treated for Fournier gangrene at our institution were retrospectively reviewed. Data collected included demographics, extent of soft tissue necrosis, predisposing factors, etiological factors, laboratory values, and treatment outcomes. The severity index and score were calculated. Multivariate regression analysis was used to determine the association between potential predictors and clinical outcomes. RESULTS: A total of 41 patients (male:female = 33:8) were studied. The mean age was 54.4 years (range, 24–79 years). The most common predisposing factor was diabetes mellitus (n = 19, 46.3%). Sixteen patients (39.0%) were current smokers. Seven patients had chronic kidney disease. The most frequent etiology was urogenital lesion (41.5%). The mortality rate was 22.0% (n = 9). Multivariate regression analyses showed that extension of necrosis beyond perineal/inguinal area and pre-existing chronic kidney disease were significant and independent predictors of mortality. Extension of necrosis beyond perineal/inguinal area was a significant predictor of increased duration in the intensive care unit and hospital stay. In addition, pre-existing chronic kidney disease was a significant predictor of flap reconstruction in the wound. CONCLUSION: Fournier gangrene with extensive soft tissue necrosis and pre-existing chronic kidney disease was associated with poor prognosis and complexity of patient management. Early recognition of dissemination and premorbid renal function is essential to reduce mortality and establish a management plan for this disease.
Causality ; Demography ; Diabetes Mellitus ; Fasciitis, Necrotizing ; Fournier Gangrene* ; Humans ; Intensive Care Units ; Kidney Failure, Chronic ; Length of Stay ; Mortality ; Necrosis ; Prognosis ; Renal Insufficiency, Chronic ; Retrospective Studies ; Wounds and Injuries