Island flaps have been widely used for the management of soft tissue defects in reconstructive surgery. The necrosis of the flap has been a catastrophe in clinical fields. It is well known that revascularization to the flap after ligation of its pedicle comes from the recipient bed and flap margins. The authors investigated the effects of the ischemic recipient bed on island flap survival after the ligation of its pedicle in the rats. One hundred and thirty inferior epigastric island flaps were divided into three groups (Group I, Group II, and Group III) according to the degree (0%,20%, and 60%) of interruption of contact of flap with the recipient bed, respectively. In Group I,the vascular pedicles were ligated before and on the 0, 2nd, 3rd, 4th and 5th days after flap elevation, and in Group II & III, the vascular pedicles were ligated on the 2nd, 3rd, 4th and 5th days after flap elevation. Flap survival was assessed on the 3rd day after pedicle ligation. Microangiographic studies were also performed on the 3rd day after pedicle ligation to study revascularization within the flap and the change of blood vessels around the flap margins. The results were as follows: 1. Flap survival was increased significantly in the flaps with pedicle ligation on the 4th and 5th postoperative days compared to those at the 2nd and 3rd postoperative days. 2. From the 3rd postoperative day, flap survival was not influenced significantly by the degree of limited bed contact and the date of pedicle ligation. 3. In spite of limited bed contact, the flap will likely survive with abundant revascularization from the flap margins. In conclusion, the flaps with limited bed contact were revascularized significantly from the flap margin by the 3rd postoperative day.
Animals ; Blood Vessels ; Ligation ; Necrosis ; Rats ; Surgical Flaps

No abstract available.
Rabeprazole* ; Sebaceous Glands*

Acute focal bacterial nephritis (AFBN), synonymous with acute lobar nephronia (ALN) or focal pyelonephritis, is an inflammatory mass without liquefaction caused by severe acute bacterial infection of kidney. Unless treated effectively, progression to a renal abscees may ensue. Clinically, AFBN presents as acute pyelonephritis, and radiologically, as focal swelling or mass. The distinction between AFBN and renal abceess or even tumor may be confusing and difficult. Ultrasonography and computerized tomography(CT) aid in establishing the correct diagnosis. However, the appearance of AFBN on sonography and CT is by no means pathognomonic. Benign or malignant renal tumors may have a similar appearance. With the clinical history, a high index of suspicion, and follow-up studies after institution of medical treatment may further aid in the differentiation. Herein we report 2 cases of AFBN, which were presented as renal masses.
Bacterial Infections ; Diagnosis ; Kidney ; Nephritis* ; Pyelonephritis ; Ultrasonography

During the microvascular operation, vasospasm can be disastrous because it may cause necrosis of the flap. But we could not fully understand the pathophysiology of contraction of operated vessels. We performed microvascular anastomosis of the femoral artery in the rats and decided the maximum initia tension and intensity of electrical stimulus. At the site of operation, postoperative 1st, 2nd, 3rd, 5th and 7th days, we took the samples of vessels including microvascular anastomotic site. Using myometry, we observed the responses of the samples responding to the stimuli and compared the results to that of the other unoperated femoral artery. The contractibility of the artery was increased in the first day and remained continuously until the postoperative 7th days.
Animals ; Arteries ; Femoral Artery* ; Necrosis ; Rats*

Silicone gel breast implants may induce local(fibrous capsular contracture) or systemic(rheumatoid arthritis, systemic sclerosis, etc) complications. The exact mechanism of fibrous capsular contracture has not been fully understood. In the present study, we tried to find out the effect of silicone gel on the fibroblast proliferation which has been known as a major contributing factor in fibrous capsular contracture formation. In vitro, activated macrophages are known to secrete monokines which affect fibroblast proliferation and collagen synthesis. And tumour necrosis factor-alpha(TNF-alpha) and interleukin-6(IL-6), which were released by macrophages, were reported as potent stimulator of fibroblast proliferation. The goal of this study is to investigate the role of macrophages and tumour necrosis factor-alphaor interleukin-6 in the interaction of fibroblasts and silicone gel. We designed four groups, two experimental and two control, using Institute for Cancer Research(ICR) mouse peritioneal macrophage and silicone gel. For the preparation of the conditioned medium of macrophages, peritoneal macrophages were prepared and cultured for 24 hours on the silicone gel-coated and naked (not coated) surface [silicone gel-macrophage conditioned medium(SCM; experimental group) and normal polystyrene-macrophage conditioned medium(NCM; control group) respectively]. To correct the effect of 10% fetal bovine serum which was included in Rapid Prototyping and Manufacturing Institute (RPMI) 1640 medium and draw the effect only by macrophages, the RPMI 1640 medium with 10% fetal bovine serum was cultured by the same method on the silicone gel-coated and naked surface (silicone gel-macrophage free conditioned medium; SFM and normal polystyrene-macrophage free conditioned medium; NFM respectively). Each conditioned medium was added onto NIH 3T3 fibroblasts culture at a final 25% concentration of total culture medium and followed by the cultivation for 24 hours. For antibody neutralizing experiments, each conditioned medium was preincubated with polyclonal rabbit anti-mouse TNF-alpha antibody or polyclonal rat anti-mouse IL-6 antibody for 1 hour and then, conditioned medium with antibody was added to the culture medium of NIH 3T3 fibroblasts by the same method. After 24 hours cultivation, total number of viable fibroblast(cell growth), DNA synthesis and collagen synthesis of fibroblasts with each medium were measured by sulforhodamine B(SRB) assay, 3H-thymidine and 3H-proline incorporation respectively. The results were as follows: 1. In the experiment about the effect of the conditioned medium on the fibroblast activity, the experimental group(SCM), compared with the control group(NCM), showed a significant increase of the cell growth (p<0.01), a significant decrease of DNA synthesis(p<0.001), but no significant difference in the collagen synthesis. 2. In the experiment about the effect of polyclonal rabbit anti-mouse TNF-alpha antibody on the fibroblast activity, after the addition of antibody the experimental group, compared with the control group, showed a significant decrease of the cell growth(p<0.001), a significant increase of DNA synthesis(p<0.01), but no significant difference in the collagen syn thesis. 3. In the experiment about the effect of polyclonal rat anti-mouse IL-6 antibody on the fibroblast activity, after the addition of antibody the experimental group, compared with the control group, showed a significant decrease of the cell growth(p<0.001), a significant increase of DNA synthesis(p<0.0001), but no significant difference in the collagen synthesis. In conclusion, culture supernatants (conditioned medium) of peritoneal macrophages, activated by silicone gel, stimulate the NIH 3T3 fibroblast proliferation. TNF-alpha and IL-6, products of macrophage, are involved in the stimulation of NIH 3T3 fibroblast proliferation in an in vitro condition.
Animals ; Arthritis ; Breast Implants ; Collagen ; Contracture ; Culture Media, Conditioned ; DNA ; Fibroblasts* ; Interleukin-6* ; Macrophages ; Macrophages, Peritoneal* ; Mice ; Monokines ; Necrosis ; Rats ; Scleroderma, Systemic ; Silicone Gels* ; Tumor Necrosis Factor-alpha*

PURPOSE: The purpose of this study was to evaluate the morphologic changes of the injured hepatic acini following ligation of common bile duct and to investigate the pathophysiologic process of hepatic failure and biliary liver cirrhosis in the extrahepatic cholestasis. MATERIALS AND METHODS: The common bile ducts of 18 rabbits were ligated partially. The rabbits were killed and selective microangiography was carried out with infusion of barium suspension via portal vein 4 to 24 weeks after ligation. Selective microangiography was also carried out in two normal rabbits. The microangiographic findings were evaluated and correlated with histopathologic features. RESULTS: The sinusolds of the liver acinus showed distortion, varying degrees of luminal widening, and irregularities in architecture. Terminal branches of the portal vein (TPV) showed increased number of branches, luminal narrowing, tortuosity, distortion, and beaded appearance. Peribiliary plexi were found as thin curvilinear, barium-filled structures along the wall of the dilated bile duct. The microangiographic findings were well correlated with histopathologic findings. The grades of microangiographic and histopathologic findings were poorly correlated with the duration of the ligation of CBD. CONCLUSION: Changes in microvasculature of the liver acinus following partial ligation of common bile duct were demonstrated by microangiography. Although the microvascular changes were evoked secondary to the injury, they might have some active roles in the pathophysiologic process in the liver.
Barium ; Bile Ducts ; Cholestasis, Extrahepatic ; Common Bile Duct* ; Ligation* ; Liver Cirrhosis ; Liver Failure ; Liver* ; Microvessels ; Phenobarbital ; Portal Vein ; Rabbits

Small cell carcinoma of the kidney is very rare, but lethal due to early metastasis and rapid progression. We report a case of the primary small cell carcinoma of the kidney with large rena1 calculus resulting in spontaneous rupture of the kidney, and was managed by total nephrectomy and evacuation of retroperitoneal hematoma and calculus. Immunohistochemical studies revealed the positive staining for cytokeratin and neuron-specific enolase, and dense-core neurosecretory granules were identified in the cytoplasm by electron microscopy. This report is the first case of the primary small cell carcinoma of the kidney resulting in spontaneous rupture of the kidney.
Calculi ; Carcinoma, Small Cell* ; Cytoplasm ; Hematoma ; Keratins ; Kidney* ; Microscopy, Electron ; Neoplasm Metastasis ; Nephrectomy ; Phosphopyruvate Hydratase ; Rupture, Spontaneous*

BACKGROUND: Ankyloglossia or tongue-tie is a congenital anomaly characterized by an abnormally short lingual frenum. Its prevalence in the newborn population is approximately 4%. Its mode of inheritance has been studied in some articles, but no conclusion has been established. Also, no relevant report has been published in Korea. This study was conducted to elucidate the genetic inheritance of ankyloglossia via pedigree analysis. METHODS: In this study, 149 patients with no other congenital anomaly who underwent frenuloplasty between March 2001 and March 2010 were studied. Pedigrees were made via pre- or post-operative history taking, and patients with uncertain histories were excluded. In the patient group that showed a hereditary nature, the male-to-female ratio, inheritance rate, and pattern of inheritance were investigated. RESULTS: One hundred (67.11%) of the patients were male and 49 (32.89%) were female (male-female ratio=2.04:1). Ninety-one (61.07%) patients reported no other relative with ankyloglossia, and 58 (38.93%) patients had a relative with this disease. The inheritance rate was 20.69% in the 58 cases with a hereditary nature. In the group with no family history of ankyloglossia, the male-female ratio was 3.79:1, which significantly differed from that of the group with a family history of ankyloglossia. X-chromosome mediated inheritance and variation in the gene expression was revealed in the pedigree drawn for the groups with hereditary ankyloglossia. CONCLUSIONS: Ankyloglossia has a significant hereditary nature. Our data suggest X-linked inheritance. This study with 149 patients, the first in Korea, showed X-linked inheritance in patients with a sole anomaly.
Female ; Gene Expression ; Genes, X-Linked ; Humans ; Infant, Newborn ; Korea ; Lingual Frenum ; Male ; Mouth Abnormalities ; Pedigree ; Prevalence ; Wills

Transverse rectus abdominis musculocutaneous (TRAM) flap is one of the best flap in breast reconstruction. Even though many trials have been attempted to increase the rate of the flap survival, the necrosis of distal flap area due to vascular compromise is troublesome. The aim of this study was to evaluate the effect of prostaglandin E1(PGE1), surgical delay and the combined procedure on TRAM flap survival rate in vascular compromised rat by diabetes. Left inferior epigastric vessel pedicled TRAM flaps(5.0 x 2.5 cm) were elevated in 40 Sprague-Dawley rats. In control group(N=10), there was no procedure before the flap elevation. In surgical delay group(N=10), the left superior epigastric vessels and the contralateral rectus perforators were ligated 2 weeks before the flap elevation. In PGE1 injection group(N=10), PGE1(0.5microgram) was given intraperitoneally for 2 weeks before the flap elevation daily. In combined procedure group(N=10), the same surgical delay and injection of PGE1 were done simultaneously. On the seventh postoperative day, we evaluated and compared the flap survival rates, the vessel distribution status through Microfil casts, the vessel area rates by histomorphometric analysis in each group. The results were as follows 1) The mean percentages of surviving flap areas of surgical delay group(73.41+/- 10.43%), PGE1 injection group(68.95 +/- 7.13%) and combined procedure group(79.39 +/- 13.44%) were greater than that of control group(44.85 +/- 18.08%) with a statistical significance(p< 0.05). 2) The vessel distributions of each procedure group were more abundant than those of control group in Microfil casts. 3) The mean percentages of vessel areas of surgical delay group(2.74 +/- 0.23%), PGE1 injection group(2.58 +/- 0.49%) and combined procedure group(3.15+/- 0.25) were greater than that of control group(1.24 +/- 0.40%) with a statistical significance(p< 0.05). The results indicated that PGE1 injection or surgical delay procedure could be used to increase the TRAM flap survival area in diabetic condition and the effect of PGE1 was comparable to that of surgical delay procedure. But, the synergistic effect of surgical delay and PGE1 injection was not observed statistically.
Alprostadil* ; Animals ; Female ; Mammaplasty ; Myocutaneous Flap* ; Necrosis ; Rats* ; Rats, Sprague-Dawley ; Rectus Abdominis* ; Silicone Elastomers ; Survival Rate

Contrast agents are now commonly used for both diagnostic and therapeutic purposes. Complications of these agents include allergic reactions and damage to specific organs such as the kidney. But in rare cases, a temporary visual loss have been reported as our case. The 20-year-old male patient with 3cm sized cheek mass was transferred to our hospital. Initial CT findings showed a hemangioma. During follow-up survey, the mass enlarged and the pulsation was palpable. Indicating a vascular malformation, the carotid angiography checked and it was diagnosed as the A-V malformation. At 3 hours after angiography, he complained a progressive visual loss. 2 hours after onset of the visual loss, he lost his visual acuity completely. High dose steroid therapy started and he restored a complete visual acuity by 15 hours. The transient cortical blindness associated with angiography is not always due to the contrast agent. Clinical features of the cerebral embolism are identical to those of the neurotoxic effect of the contrast agent. So physicians should examine the patient carefully and other causes such as embolism, vasospasm and thrombotic event need consideration in the differential diagnosis. We experienced a case of the transient cortical blindness after the carotid angiography and review the literatures on this complication.
Angiography* ; Blindness, Cortical* ; Cheek ; Contrast Media ; Diagnosis, Differential ; Embolism ; Follow-Up Studies ; Hemangioma ; Humans ; Hypersensitivity ; Intracranial Embolism ; Kidney ; Male ; Vascular Malformations ; Visual Acuity ; Young Adult