This paper presents the case of a ruptured hydrogel breast implant, along with its clinical, radiologic, and pathologic findings. Breast asymmetry is typically the most common clinical feature of breast implant rupture. In case of a hydrogel breast implant rupture, hydrogel spreads out after implant leakage and the breast is enlarged with swelling and edema. Intracapsular ruptures showed no significant collapse of the implants despite a collection of fluid surrounding the implant inside the capsule. However, extracapsular ruptures showed implant collapse and extensive inflammation or fibrosis extension to the muscle and chest wall. In this case, a large amount of fluid collection with enlarged implants inside the capsule and extracapsular granulomas were showed simultaneously. Since the use of silicone breast implants has been restricted, hydrogel implants have been used for some time as an alternative option for breast implants. However, hydrogel implants have been restricted because of their unpredictability and unreliability. This case report draws attention to an unusual presentation of complications following the insertion of hydrogel breast implants for augmentation mammoplasty.
Breast ; Breast Implants ; Edema ; Female ; Fibrosis ; Granuloma ; Hydrogel ; Inflammation ; Mammaplasty ; Muscles ; Rupture ; Silicones ; Thoracic Wall

No abstract available.
Child* ; Humans

Nodular type malignant melanoma is uncommon in fingers. In previous publications, treatment, diagnosis and case reports of subungal melanoma is often, however fingertip lesion was not focused. A 64-year-old woman who had a non-healing red and dark colored nodular mass with ulceration over the finger tip in the right thumb visited our clinics. Biopsy results was malignant melanoma then we performed amputation surgery of distal phalanx. Lymph node biopsy and resection margin was negative for melanoma. Chemotherapy was administered immediately. After 5 months, pulmonary nodular lesion was found and diagnosed as metastatic malignant melanoma by the wedge resection surgery. The patient is treated for additional chemotherapy consistently and disease free for 2 years. Nodular type melanoma of the finger is uncommon and it could be presented as ulceration and amelanotic nodular mass. Therefore we recommend biopsy to diagnose correctly if there are chronic non healing lesions on the fingers.
Amputation ; Biopsy ; Diagnosis ; Drug Therapy ; Female ; Fingers ; Humans ; Lymph Nodes ; Melanoma* ; Middle Aged ; Thumb* ; Ulcer

PURPOSE: When deciding a treatment plan in diabetic foot ulcer patients, predicting a possibility of healing wounds is important since not a few patients have poor general condition to get successful wound healing. This study was planned to find out if a serum collagen level can be used as a predictor for healing wounds in diabetic foot patients. METHODS: Fifty-seven patients, who visited our clinic from January to June, 2007 for treatment of diabetic foot ulcers, were included in this study. Serum levels of type I collagen were checked using carboxy terminal type I propeptide kits. Simultaneously serum levels of vitamin C and iron, cofactors of collagen synthesis, were checked. The patients were divided into two groups; a group of successfully healed wounds and the other of unhealed wounds. Serum levels of the parameters were compared between the 2 groups. RESULTS: The serum level of collagen was 197.65+/-86.26ng/ml in a healed group and 87.91+/-28.76ng/ml in the unhealed group(p<0.05). The serum iron and vitamin C levels were did not show significant differences. CONCLUSION: The serum collagen level may predict healing or nonhealing wounds in diabetic foot ulcers.
Ascorbic Acid ; Collagen ; Collagen Type I ; Diabetic Foot ; Humans ; Iron ; Ulcer ; Wound Healing

Recent works state that adipose tissue hosts cells which are able to display various differentiation potentials. Moreover, this adult tissue is abundant and easy to sample with no ethic limitation. In addition, the simple isolation procedures provide a clear advantage for tissue engineering. The adipose cells which are used for tissue engineering can be isolated from the stromal vascular fraction (SVF) obtained after adipose tissue digestion that may be used either freshly prepared or after culture. In this last case, cultured cells represent a particular cell subpopulation, which is restricted to the adherent cell fraction of SVF, and termed adipose derived stromal cells(ADSCs). However, there is a confusing inconsistency in the literature in the use of terms to describe multipotent precursor cells from adipose tissue stroma, such as processed lipoasporate cells, ADSCs, preadipocytes, adipose stoma vascular cell fraction, SVF cells, and others. In addition, characteristics of such cells have not clearly been defined and still controversial. The aim of this brief and comprehensive review is to define terminologies for such cells, to describe preparation and isolation procedures for SVF cells and ADSCs, to summarize molecular characterization of SVF cells and ADSCs, and to discuss clinical cases using these cells.
Adult ; Male ; Female ; Humans

PURPOSE: Diagnosis of diabetic foot infection is sometimes difficult, since the classical inflammatory signs and leukocytosis may be absent due to the decreased host immune response in diabetics. Therefore inflammatory blood markers, such as white blood cell(WBC) count, erythrocyte sedimentation rate(ESR), and C-reactive protein(CRP) have been commonly needed to confirm the diagnosis of infection. The purpose of this study is to evaluate the diagnostic usefulness of WBC, ESR and CRP for detection of diabetic foot infection. METHODS: Peripheral blood samples were taken from 113 patients with diabetic foot ulcers admitted from June 2007 to April 2009. Diabetic foot infection was diagnosed according to the microbiological culture from soft tissue and bone specimens. Reference values of tests were 4500-11000/microliter for WBC count, 0-20mm/hr for ESR, and 0-5 mg/L for CRP(13,14). Sensitivities, specificities, positive and negative predictive values of laboratory tests were calculated and analysed. Receiver-operator characteristic (ROC) curve was also created. RESULTS: There was a significant difference in WBC, ESR, and CRP between infectious group and noninfectious group(p<0.05). The sensitivity of WBC>11,000/microliter ESR >20 mm/hr, and CRP > 5mg/L was 30%, 96%, and 84%. The specificity was 86%, 14%, and 50% for WBC, ESR, and CRP, respectively. Positive predictive value was 88%, 78%, and 84%, and negative predictive value was 28%, 50%, and 50% respectively. The areas under the ROC curve for WBC, ESR and CRP were 0.72, 0.75, and 0.78 respectively. CONCLUSION: Based on the results of this study, we conclude that CRP is more useful method in predicting and diagnosing infection than WBC, ESR in diabetic foot ulcer patients.
C-Reactive Protein ; Diabetic Foot ; Erythrocyte Count ; Humans ; Leukocyte Count ; Leukocytes ; Leukocytosis ; Reference Values ; ROC Curve ; Sensitivity and Specificity ; Ulcer

BACKGROUND: Bioabsorbable plates and screws are commonly used to reduce maxillofacial bones, particularly in pediatric patients because they degrade completely without complications after bone healing. In this study, we encountered eight cases of a delayed foreign body reaction after surgical fixation with bioabsorbable plates and screws. METHODS: A total of 234 patients with a maxillofacial fracture underwent surgical treatment from March 2006 to October 2013, in which rigid fixation was achieved with the Inion CPS (Inion, Tampere, Finland) plating system in 173 patients and Rapidsorb (Synthes, West Chester, PA, USA) in 61 patients. Their mean age was 35.2 years (range, 15-84 years). Most patients were stabilized with two- or three-point fixation at the frontozygomatic suture, infraorbital rim, and anterior wall of the maxilla. RESULTS: Complications occurred in eight (3.4%) of 234 patients, including palpable, fixed masses in six patients and focal swelling in two patients. The period from surgical fixation to the onset of symptoms was 9-23 months. Six patients with a mass underwent secondary surgery for mass removal. The masses contained fibrous tissue with a yellow, grainy, cloudy fluid and remnants of an incompletely degraded bioabsorbable plate and screws. Their histological findings demonstrated a foreign body reaction. CONCLUSIONS: Inadequate degradation of bioabsorbable plates caused a delayed inflammatory foreign body reaction requiring secondary surgery. Therefore, it is prudent to consider the possibility of delayed complications when using bioabsorbable plates and surgeons must conduct longer and closer follow-up observations.
Absorbable Implants ; Follow-Up Studies ; Foreign Bodies* ; Foreign-Body Reaction* ; Humans ; Maxilla ; Maxillofacial Injuries ; Sutures

BACKGROUND: Enophthalmos may not appear immediately after trauma due to periorbital swelling in a blowout fracture, and preoperative measurements of enophthalmos cannot be used as a reliable guideline. It is important to predict the eventual final extent of enophthalmos in order to determine whether to perform surgery, and there have been several attempts to predict the degree of late enophthalmos using preoperative orbital volume. The purpose of this study is to investigate the correlation between the orbital volume ratio (OVR) with final enophthalmos and the palpebral fissure, and to find the OVR that induced 2 mm of enophthalmos in unilateral unoperated blowout fractures. METHODS: We retrospectively reviewed the medical records of 38 patients and divided them into 3 groups, determined by the fracture location. The relationships between the OVR and both the degree of enophthalmos and the palpebral fissure ratio (PFR) were assessed and, in particular, the OVR that induced 2 mm of enophthalmos was sought. RESULTS: Enophthalmos increased in proportion to the OVR, and there was a highly significant correlation between the increase in the OVR and the degree of enophthalmos (P<0.05). On the other hand, there was no correlation between OVR and PFR (P>0.05). The OVR that induced 2-mm enophthalmos was 112.18%. CONCLUSIONS: The final degree of enophthalmos can be estimated by the preoperative measurement of OVR. Preoperative measurements of OVR can be used as quantitative values to predict the final degree of enophthalmos in pure blowout fractures.
Enophthalmos* ; Hand ; Humans ; Medical Records ; Orbit* ; Orbital Fractures ; Retrospective Studies

PURPOSE: Diabetic foot ulcer is a representative disease of chronic would with multiple defects of wound healing factors. Many nutrition factors have been known to be essential for wound healing, but objective data are lacking. The purpose of this study is to determine those factors essential for wound healing, and to find out which of those factors are lacking in diabetic foot ulcer patients through this pilot study. METHODS: We studied 100 patients who visited our clinic from March 2005 to February 2006 for treatment of diabetic foot ulcers with a duration of more than 6 weeks. We checked serum levels of protein, albumin, vitamin A, C, E, iron, magnesium, zinc, copper and hemoglobin by drawing 23cc blood after 8 hours of fasting. Protein, albumin, iron, magnesium levels were measured by colorimetry; hemoglobin levels were measured by auto analysis. Vitamin levels were measured by high performance liquid chromatography (HPLC), copper and zinc levels were measured by Inductively coupled plasma (ICP). They were compared with normal values. The patients were divided by transcutaneous oxygen pressure levels, age and sex to study the effects of these parameters. RESULTS: 76% and 61% of patients had within-normal range serum protein and albumin levels, respectively. Among vitamins, only the level of vitamin C was low in 55% of the patients. Levels of vitamin A, E were normal or high in 93% and 100% of patients. As for trace elements, levels of iron and zinc were low in 63% and 60% of patients, but levels of magnesium and copper were usually normal or high. Levels of vitamin C, iron and zinc were lower in the low-transcutaneous oxygen pressure group. There were no definite differences according to age and sex. CONCLUSION: Serum levels of Hb, vitamin C, iron, zinc were low in most diabetic foot ulcer patients. The deficit was very severe in the low-transcutaneous oxygen pressure group.
Ascorbic Acid ; Chromatography, Liquid ; Colorimetry ; Copper ; Diabetic Foot* ; Fasting ; Humans ; Iron ; Magnesium ; Oxygen ; Pilot Projects ; Plasma ; Reference Values ; Trace Elements ; Ulcer* ; Vitamin A ; Vitamins ; Wound Healing* ; Wounds and Injuries* ; Zinc