Since the introduction of expansion technique by Neuman(1957), the use of it has been repeatedly adjusted to the breast reconstruction, head and neck reconstruction and treatment of male pattern baldness, and so on, by the improvement of expansion devices and advancement of expansion techniques. We also used this technique in 5 patients who have scalp tumor, either benign or malignant, for 3 years(from 2000 to 2003) and specific complications were not found except wide scars. This technique has shown more excellent result than any other techniques already used and has made it possible to cover the scalp defect without the loss of hair in donor site, so we report this paper and then can ascertain the further benefits, such as the effective coverage of scalp defect by hair bearing normal scalp.
Alopecia ; Cicatrix ; Female ; Hair ; Head ; Humans ; Mammaplasty ; Neck ; Scalp* ; Tissue Donors ; Tissue Expansion*

Thrombocytosis(a platelet count>400,000/mm3) is found to be frequently in association with malignant disease and recently has been suggested to be a poor prognostic indicator in patients with certain cancers. The objective of this retrospective study was to determine the relevance of a preoperative platelet count in ovarian cancer with a possible prognostic significance of thrombocytosis in this disease. Between June 1989 and December 1995, eighty-five patients with epithelial ovarian cancer were evaluated, who were managed at Asan Medical Center by cytoreductive surgery and chemotherapy, and had at least 6 months' follow-up. Prevalence of thrombocytosis was 22.4% and significantly correlated with FIGO stage(p=0.003), histologic subtype(p=0.002), tumor grade(p=0.040), performance status of patient(p=0.006) and preoperative serum CA 125 level(p=0.002). And the linear regression analysis revealed a significant correlation(p<0.001) between platelet count and preoperative serum CA 125 level, which suggested that platelet count was positively associated with tumor volume. No difference in survival between patients with or without thrombocytosis was found(p=0.68), whereas residual tumor size and serum CA 125 level after 2nd chemotherapy were found to be independent prognostic factors. In conclusion, thrombocytosis is not a useful prognostic factor in epithelial ovarian cancer, but significantly associated with tumor volume.
Blood Platelets ; Chungcheongnam-do ; Drug Therapy ; Follow-Up Studies ; Humans ; Linear Models ; Neoplasm, Residual ; Ovarian Neoplasms* ; Platelet Count ; Prevalence ; Retrospective Studies ; Thrombocytosis* ; Tumor Burden

Although there have been several reported cases of enterocolitis caused by Yersinia enterocolitica, its colonoscopic findings have not been reported in Korea. We recently experienced two cases of Y. enterocolitica enterocolitis, where the colonoscopic examinations were performed. Two patients visited our hospital due to right lower quadrant pain. The thickened terminal ileum and right side colon with enlarged mesenteric nodes were observed on ultrasonography using graded compression method. Y. enterocolitica was isolated from stool in both cases, The colonascopy revealed nodular elevations, erosion., hyperemia, and edema on the terminal ileum and small hyperemic erosions or aphthoid ulcers on the colon, especially on the right side of the colon. In one of the cases, the aphthoid ulcers could be also seen on the sigmoid colon. Their clinical symptoms and signs improved 3-5 days after their visit without using antibiotics. We report these cases with a review of the relevant literature.
Anti-Bacterial Agents ; Colon ; Colon, Sigmoid ; Colonoscopy ; Edema ; Enterocolitis* ; Esophagus* ; Humans ; Hyperemia ; Ileum ; Intestines* ; Korea ; Lymphadenitis* ; Stomach* ; Ulcer ; Ultrasonography ; Yemen* ; Yersinia enterocolitica* ; Yersinia*

No abstract available.
Ovarian Neoplasms* ; Prognosis

The area overlying the ischium is a frequent site for the development and recurrence of pressure sores because they directly overlie the points of maximum pressure on the sitting surface. Furthermore, they are frequently complicated by abnormal lesional bursae, or by extension, fistula toward the perineum or peritoneal cavity. In all cases of the ischial pressure sores, total en bloc excision of the ulceration, underlying bony prominence with immediate closure, and healthy, well-vascularized soft tissue is required to obtain the satisfactory result. It is well known that the choice of the treatment of the ischial pressure sore is the gluteal or posterior thigh flap. There have been many reports on the reconstruction of the ischial pressure sores such as cases involving the fasciocutaneous flap, muscle and musculocutaneous flaps, V-Y advancement flaps, rotation flaps, and long random flaps. In spite of these varieties, the recurrence of the ischial pressure sore after treatment still remains about seventy-five percent according to Conway and Griffith.9 Consequently, any surgical plane for ischial pressure sores must provide a stable, durable soft tissue cover that can be reused in the event of recurrence. From February to December 2002, we have performed the reconstruction of the ischial pressure sores on the posterior thigh's transposition flap in order to get following advantages: simplicity of the operation, sufficiency of padding with skin flap, preservation of the adjacent normal tissues and the capability of recycling this same flap in case of recurrences. Its design is somewhat different from and more extended widely than that of the gluteal or posterior thigh flap. This flap was elevated above the deep fascia to be cutaneous with appropriate backcut incision; some perforators from the inferior gluteal artery were also preserved. We present some cases of ischial pressure sores treated with a laterally based posterior thigh transposition flap herein. Therefore, the need to perform repetitive surgery in the future must be considered so that the maximum number of reconstructive options can be preserved. Although the follow-up period has not always been satisfactory, we have not had any serious complications in these patients until recently.
Arteries ; Fascia ; Fistula ; Follow-Up Studies ; Humans ; Ischium ; Myocutaneous Flap ; Perineum ; Peritoneal Cavity ; Pressure Ulcer* ; Recurrence ; Recycling ; Skin ; Thigh* ; Ulcer

The correction of secondary cleft lip and nose deformity often presents an extremely difficult plastic surgical problem. The deformity is a complex, three dimensional alteration in nasal anatomy with defects in all tissue layers : skin, cartilage, vestibular lining and bone. The patient who has these kinds of deformities undergoes the aggravation of deformities, as the patient grows older. And the decreased length of maxilla is accompanied by the deficiency of posterior development. As a result, the depression of nose and midface is usually developed and especially the depression of nose is severely noted in an oriental. To correct this secondary cleft lip nose deformity in Oriental patients, alar cartilge mobilization and suspension techniques have been developed. But, these techniques have critical limitations in the suspension vector and power. Oriental people usually have thin alar cartilages and thick skin. So, the suspended, deformed alar cartilage may relapse and pull the normal alar cartilage to the deformed side. To overcome these limitations, we have carried out the augmentation rhinoplasty using a silicone implant with Tajima's inverted U incision and interdomal suturing at the same time, which is inexpensive and easily handled, to twelve patients of secondary cleft lip and nose deformity for recent 2 years. The results were considerably satisfactory, so we report this paper and then can ascertain the further aesthetic benefits, such as the postoperative augmentation of a nose, finer nasal tip and the symmetry of both nostrils.
Cartilage ; Cleft Lip* ; Congenital Abnormalities* ; Depression ; Humans ; Maxilla ; Nose* ; Recurrence ; Rhinoplasty* ; Silicones* ; Skin

BACKGROUND/AIMS: It is recommended that duodenal ulcer patients who are infected with H. pylori should be treated with eradication therapy, whether the ulcer is active or in remission. However, there has been no report on the effect of eradication treatment in patients with incidentally found S-2 stage duodenal ulcer scar. METHODS: We prospectively enrolled 80 H. pylori-positive patients with S-2 stage duodenal ulcer scar who have no past history of ulcer treatment. Treatment group received triple therapy consisted of omeprazole, amoxicillin, and clarithromycin for 2 weeks, whereas control group received no treatment. The follow-up endoscopy was performed every 1 year and when the patients have symptoms of ulcer disease. Fifty-three patients were followed up for more than 1 year. RESULTS: The eradication rate of the treatment group was 92.9%. During the follow-up period of 14.7 months, 20% (5/25) of patients in the control group (2 gastric ulcers and 3 duodenal ulcers) and 3.6% (1/28) of patients in the treatment group (1 duodenal ulcer) developed active or healing stage peptic ulcers (p=0.089). CONCLUSIONS: Our results suggest that H. pylori eradication may he effective in preventing peptic ulcers in patients with S-2 stage duodenal ulcer scar.
Amoxicillin ; Cicatrix* ; Clarithromycin ; Duodenal Ulcer* ; Endoscopy ; Follow-Up Studies ; Helicobacter pylori* ; Helicobacter* ; Humans ; Omeprazole ; Peptic Ulcer ; Prospective Studies ; Stomach Ulcer ; Ulcer

In this retrospective study, we assessed the clinical usefulness of postoperative decline of serum CA 125 level after initial surgery to predict the size of residual disease in patients with advanced epithelial ovarian cancer. Between June 1989 and December 1995, sixty-three patients with advanced epithelial ovarian cancer (FIGO stage II-IV) were evaluated, who were managed at Asan Medical Center by cytoreductive surgery followed by chemotherapy. All patients had elevated preoperative serum CA 125(>35U/ml) and had another serum CA 125 assay 7~10 days after surgery. Preoperative CA 125 levels were similar in patients with residual disease below 2 cm and in those with larger residuum. The postoperative decline of serum CA 125 was significantly higher in patients with smaller residual disease only if preoperative serum CA 125 value was over 400U/ml. By taking 70% as the cutoff of CA 125 decline for discriminating patients with residual disease above 2 cm, the specificity and positive predictive value of this parameter improved when we considered patients with increasing preoperative serum levels. Hence, in the subset of patients with preoperative serum CA 125 level over 400U/ml, 95.2% (20/21) of patients with residual disease below 2 cm showed postoperative decline of serum CA 125 level over 70%, and 91.7%(11/12) of patients with postoperative decline of serum CA 125 level below 70% had residual disease over 2 cm. In conclusion, postoperative decline of serum CA 125 level after initial surgery does not exactly reflect the size of residual disease, but shows limited clinical usefulness in subset of patients with preoperative serum CA 125 level over 400 U/ml.
Chungcheongnam-do ; Chymopapain* ; Drug Therapy ; Humans ; Ovarian Neoplasms* ; Retrospective Studies ; Sensitivity and Specificity

BACKGROUND: It is common to find enlarged lymph nodes within hepatoduoedenal ligament during ultrasonography in patients with chronic hepatitis B. But, its clinical significance has not been clearly understood. METHODS: Lymph node volume within the hepatoduodenal ligament in 50 patients with chronic hepatitis B and 15 healthy controls was evaluated using ultrasonography. In patients with chronic hepatitis B, possible correlation of lymph node volume with biochemical tests, hepatitis activity index, and hepatitis B viremia was investigated. RESULTS: One or more lymph nodes were detected in 48 (96%) out of 50 patients with chronic hepatitis B (volume=3.4+/-2.4 mL, mean+/-S.D.) and 2 (13%) out of 15 controls (volume=0.4 mL, 0.6 mL). In chronic hepatitis B, lymph node volume showed a significant correlation with serum AST (r=0.66), ALT (r=0.63), gammaGT (r=0.53), total score of histologic activity index (r=0.59), and necroinflammatory score (r=0.59, p<0.05 for all); but not with fibrosis score and serum hepatitis B viremia. CONCLUSION: Enlarged perihepatic lymph nodes reflects histologic and biochemical inflammatory activity of the liver in chronic hepatitis B.
Fibrosis ; Hepatitis ; Hepatitis B ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Ligaments ; Liver* ; Lymph Nodes* ; Ultrasonography ; Viremia

BACKGROUND/AIMS: Lamivudine is an oral nucleoside analogue with potent antiviral activity against HBV inducing normalization of ALT and improvement of necro-inflammation and fibrosis in chronic hepatitis B. But its role in decompensated cirrhosis has not been established. The Child-Pugh score is a reliable and convenient prognostic indicator reflecting liver synthetic function. We evaluated the incidence of any improvement in Child-Pugh score after lamivudine treatment in patients with decompensated cirrhosis. METHODS: Twenty-six patients with HBV associated active decompensated cirrhosis showing detectable serum HBV received lamivudine (100 or 150 mg/day) for 6-45 months (median 16). The Child-Pugh score at 6th month of lamivudine treatment was compared with base line score. RESULTS: The Child-Pugh score improved ( 2-point reduction) in 17 (65.4%) patients, was constant in 8 (30.8%), and aggravated ( 2-point increase) in one (3.8%) of 26 patients. HBV DNA was initially cleared in 24 cases (92.3%) but breakthrough developed in 7 (29.2%). HBeAg was lost in 5 (25%) of 20 cases. Initial improvement was maintained in 14 (82.4%) of 17 cases but aggravated with breakthrough in 3 (17.6%). Two of 5 patients waiting for liver transplantation showed marked improvement and were removed from the list. CONCLUSION: Lamivudine can be an effective treatment for patients with decompensated cirrhosis due to HBV infection, improving the Child-Pugh score in many cases. However, deterioration of liver function associated with DNA breakthrough was an important problem in patients showing initial improvement.
DNA ; Fibrosis* ; Hepatitis B e Antigens ; Hepatitis B, Chronic ; Herpesvirus 1, Cercopithecine* ; Humans ; Incidence ; Lamivudine* ; Liver ; Liver Transplantation