Reconstruction of the auricle is one of the most fastidious fields in plastic and reconstructive facial surgery, because the ear is made up of complex cartilage framework arid its thin skin envelope. Insertion of carved rib cartilage is the most popular method for framework fabrication. But it has some disadvantages such as donor site morbidity, lesser flexibility of rib cartilage, difficulty in carving structure and distortion of cartilage after calving. Furthermore surgeon's talent and sufficient practice are necessary for a satisfactory result. So we introduced the concept of perichondral graft to improve the framework fabrication. In 1972 Skoog and associates reported that free perichondral grafts could be used to produce new cartilage. And several other reports supported the chondrogenesis of free perichondral graft. We molded the human ear using silicone rubbed impression material. And the eat mold was wrapped up in perichodrium of rabbit ear and placed in a subcutaneous pocket in formes of graft and flap. Six and eight weeks later, rabbits were sacrified and the newly formed cartilage framework was harvested. Grossly it showed the same appearance as the human eat and elastic property of normal cartilage. In histologic examination, it showed mature structure of normal cartilage; large lacunae containing spherical chondrocytes surrounded by well defined capsule.
Aptitude ; Cartilage ; Chondrocytes ; Chondrogenesis ; Ear ; Ear Cartilage* ; Fungi ; Humans ; Plastics ; Pliability ; Rabbits ; Ribs ; Silicones ; Skin ; Tissue Donors ; Transplants*

Changing trends in anticancer research have altered the treatment paradigm to the extent that it is difficult to investigate any anticancer drugs without mentioning immunotherapy. Thus, we are finally contemplating tumour regression using magic bullets known as immunotherapy drugs. This review explores the possible options and pitfalls in tumour regression by first elucidating the features of cancer and the importance of tumour microenvironments. Next, we evaluated the trends of anticancer therapeutics regulating tumour microenvironment. Finally, we introduced the concept of tumour regression and various targets of tumour microenvironment, which can be used in combination with current immunotherapy for tumour regression. In particular, we emphasize the importance of regulating the neurological manifestations of tumour microenvironment (N) in addition to inflammation (I) and hypoxia (H) in cancer.

PURPOSE: Little is known about the effect of the prostate volume on the free prostate-specific antigen(PSA) level and the percent of the free PSA level with administering finasteride medication. We studied the effect of finasteride therapy on the levels of serum PSA, the free PSA and the percentage of free PSA according to the prostate volume. MATERIALS AND METHODS: Patients with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia(BPH) and who were over 50 years old were treated with finasteride 5mg for 6 months. Male patients with a PSA level between 3.5ng/ml and 15ng/ml were included and these patients were biopsied. alpha-blockers were prescribed to treat them for LUTS. The serum levels of the total PSA and free PSA were measured at baseline and after 6 months. We analyzed the changes of PSA and fre-PSA before and after finasteride administration. We also analyzed the patients' changes based on the prostate volume. RESULTS: The analysis included 44 patients with a mean age of 71.7 years, a baseline prostate volume of 56.0cc and a baseline total PSA level of 6.74ng/ml. The total PSA and free PSA levels declined from 6.74ng/ml and 2.57ng/ml at baseline to 3.83ng/ml and 1.45ng/ml after 6 months of treatment, respectively(p<0.05). The mean percent free PSA was not significantly altered by finasteride treatment. Those patients with a small prostate volume showed larger decrements in the PSA and free PSA than did the patients with a large prostate volume, but the prostate volume at baseline did not affect the percent free PSA levels. CONCLUSIONS: It is debatable that the application of the 'double's rule' without considering the volume of the prostate is appropriate for the treatment of patients who are taking finasteride medication.
Finasteride* ; Humans ; Lower Urinary Tract Symptoms ; Male ; Middle Aged ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Hyperplasia

Although the medical applications of He-Ne lasers remain controversial, the clinical use of these devices for a variety of analgesic and wound healing applications is steadily increasing. Research studies of the effects of He-Ne laser irradiation on biologic function are growing in number and scope. Many investigators have described successful treatment of a wide variety of painful musculoskeletal, rheumatologic, and neurologic conditions with He-Ne lasers. Since we have recently initiated studies examing the effects of He-Ne lasers on wound healing and pain relief, we investigated the effect of He-Ne laser irradiation on the healing of skin defect, abrasion, burn and on the pain relief of temporomandibular joint dysfunction in admitted patients. The total number of patients was 96. The He-Ne laser power was 1 mW, dose was 1 J/cm2 and the wavelength was 632.8 nm. Each patient underwent 2 to 8 trials of irradiation on point around the wound area and painful joint at a frequency of 2 times a week. After every 1 trial up to 8 trials, we evaluated the efficacy of He-Ne laser irradiation by checking the wound size and by questioning the patients about degree of pain. Following the estimation by patients, excellent, good, and fair were accounted as effective, and poor as noneffective. The efficacy of the laser at the end of 2 to 8 trials was noticed on 78.1%, and the degree of pain relief was 73.9%. These results suggested that the irradiation of He-Ne laser is an effective and safe treatment for wound healing and pain relief. In this overview, we are summarizing some of our results which suggest a potential usefulness of He-Ne lasers for stimulation of wound healing and pain relief. Although its clinical use can be anticipated in the future, further research is required to clarify the basic mechanisms and the preferred optical parameters, such as treatment time and intensity, for increased wound healing and pain relief.
Burns ; Humans ; Joints ; Research Personnel ; Skin ; Temporomandibular Joint ; Wound Healing ; Wounds and Injuries

Methemoglobinemia results from the oxidation of ferrous iron (Fe++) to ferric iron (Fe+++) within hemoglobin. It is caused by various etiologies, including the herbicide Propanil. Patients with low levels of methemoglobin (metHb) are asymptomatic but symptomatic patients and patients with high levels of metHb require treatment. Methylene blue is the first choice for the treatment of methemoblobinemia, but has some complications such as hemolytic anemia and rebound methemoglobinemia. We report the case of a 91-year-old woman who died of aniline herbicides poisoning. The level of metHb in her blood was initially 20.7% and her mental status was drowsy. She was intravenously treated with methylene blue within a therapeutic range for methemoglobinemia. After treatment with methylene blue, the level of metHb decreased but later increased above 20%. Methylene blue treatment was repeatedly attempted, but the patient suffered from hemolytic anemia and rebound methemoglobinemia. The patient finally died from renal failure and cardiopulmonary collapse. We must be careful because methemoglobinemia can occur even when treated pesticides such as propranil.
Anemia, Hemolytic ; Female ; Herbicides ; Humans ; Iron ; Methemoglobin ; Methemoglobinemia* ; Methylene Blue ; Pesticides ; Poisoning ; Propanil* ; Renal Insufficiency

Transitional cell carcinoma such as renal cell carcinoma is the relatively common urinary tract cancer in patients who are on dialysis. A 66-year-old male patient, who had been on maintenance hemodialysis for 5 years, was suffering from gross hematuria. The subsequent image studies revealed multiple masses at the right renal pelvis, the right distal ureter and the trigonal area at the bladder. We performed cystoscopy to evaluate the multiple bladder papillary masses and their blood clots. The patient then underwent bilateral radical nephroureterectomy and radical cystectomy. Histological examination revealed the papillary urothelial carcinoma. Our case may imply that dialysis patients have an increased susceptibility to urological malignancies. Physicians should always raise the possibility of urological malignancy when encountering a dialysis patient with gross hematuria. Because of the high recurrence rate, a more extensive operation and aggressive follow-up protocols should be done for these patients on dialysis.
Male ; Humans

Purpose: The greatest concern in the androgen replacement therapy (ART) is the possible side effects to the prostate. We evaluated the effects of ART focusing on the prostate specific antigen (PSA). Materials and Methods: From 2003 to 2006, 47 patients 44 to 75 years old (mean age 60.1) received ART. At baseline and after ART, digital rectal examination, serum testosterone and PSA measurement and transrectal ultrasonography were evaluated. Mean follow-up was 7.9 months (range 1 to 41). Patients were classified into two groups based on the initial PSA level, as PSA levels of 2.5 ng/ml or greater (group 1) (n=29) and PSA levels of less than 2.5 ng/ml (group 2) (n=18). Results: ART significantly increased serum testosterone, PSA and free PSA levels. However, prostate volume did not change significantly. When serum PSA was compared, the increase of PSA levels was greater than in high PSA group (group 1) than in group 2, although the ratio between the two groups in PSA increase was 38.3% for group 2 and 18.2% for group 1, respectively. A total of 4 patients (16.7% of group 1 and 3.4% of group 2) with a serum PSA level greater than 4 ng/ml after ART underwent a prostate biopsy but no patients were found to have prostate carcinoma. Conclusions: Rates of PSA elevation (>4 ng/ml) and prostate biopsies were higher in patients with high baseline PSA level (> or =2.5 ng/ml) than in those with PSA level less than 2.5 ng/ml who received ART. However, our findings suggest that an increased risk of prostate cancer was not associated with ART.
Biopsy ; Digital Rectal Examination ; Follow-Up Studies ; Humans ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Testosterone

PURPOSE: Female sexual dysfunction is a new, rapidly expanding area of sexual medicine. However, there is little knowledge of the neuroanatomy and pathophysiology involved in female sexual responses, especially with respect to the vagina. The purpose of this study was to identify the neurons in the spinal cord and brain, which are involved in the innervation of the rat vagina, and regulate vaginal sexual functions. To address this issue, a retrograde transneuronal tracing technique, with a pseudorabies virus, was used. MATERIALS AND METHODS: Eight Female Sprague-Dawley rats (250-300gm) were anesthetized with a ketamine/xylazine mixture, and the pseudorabies virus injected into the distal, posterior wall of the vaginas. At 3 (n=2), 4 (n=2) and 5 (n=2) days post-inoculation, the whole brain and spinal cord were cut in serial sections (30micrometer), and the virus-labeled neurons identified immunohistochemically. RESULTS: In the spinal cord, the majority of virus-labeled neurons were seen in L5-S1 segments, most of which were found in the lateral gray matter, the intermediate gray matter, and the dorsal gray commissure. In addition, virus-labeled neurons were seen in the T12-L4 and S2-S4 segments, which were found in the intermediolateral cell column (IML) and the lamina II, III, VII and X. In the brain, virus-labeled neurons were found in the nuclei gigantocellularis, raphe magnus nuclei, A5 noradrenalin cells, periaqueductal gray substance and paraventricular hypothalamic nuclei. CONCLUSIONS: The present findings provide the first morphological data on the multisynaptic circuit of the central nervous system neurons, involving the vagina, and presumably, the circuit of the vaginal sexual functions.
Animals ; Brain ; Central Nervous System ; Female ; Herpesvirus 1, Suid* ; Humans ; Neural Pathways* ; Neuroanatomy ; Neurons ; Periaqueductal Gray ; Pseudorabies* ; Rats* ; Rats, Sprague-Dawley ; Spinal Cord ; Vagina*

OBJECTIVE: To investigate the sagittal sacropelvic morphology and balance of the patients with SIJ pain following lumbar fusion. METHODS: Among 452 patients who underwent posterior lumbar interbody fusion between June 2009 and January 2013, patients with postoperative SIJ pain, being responded to SIJ block were enrolled. For a control group, patients matched for sex, age group, the number of fused level and fusion to sacrum were randomly selected. Patients were assessed radiologic parameters including lumbar lordosis, pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). To evaluate the sagittal sacropelvic morphology and balance, the ratio of PT/PI, SS/PI and PT/SS were analyzed. RESULTS: A total of 28 patients with SIJ pain and 56 patients without SIJ pain were assessed. Postoperatively, SIJ pain group showed significantly greater PT (p=0.02) than non-SIJ pain group. Postoperatively, PT/PI and SS/PI in SIJ pain group was significantly greater and smaller than those in non-SIJ pain group respectively (p=0.03, 0.02, respectively) except for PT/SS (p=0.05). SIJ pain group did not show significant postoperative changes of PT/PI and SS/PI (p=0.09 and 0.08, respectively) while non-SIJ pain group showed significantly decrease of PT/PI (p=0.00) and increase of SS/PI (p=0.00). CONCLUSION: This study presents different sagittal sacropelvic morphology and balance between the patients with/without SIJ pain following lumbar fusion surgery. The patients with SIJ pain showed retroversed pelvis and vertical sacrum while the patients without SIJ pain have similar morphologic features with asymptomatic populations in the literature.
Animals ; Humans ; Incidence ; Lordosis ; Pelvis ; Sacroiliac Joint* ; Sacrum

PURPOSE: To determine the usefulness of magnetic resonance imaging (MRI) after computed tomography (CT) inpatients with focal hepatic lesion. MATERIALS AND METHODS: We evaluated 100 patients with 103 focal hepaticlesions. The diagnosis of each lesion was made pathologically (n=19), or radiologically and clinically (n=84), andthe findings were as follows: he-mangioma (n=53), hepatocellular carcinoma (n=17), metastasis (n=10), cyst (n=5),regenerative nodule (n=3), and adenomatous hyperplasia (n=3). The patients underwent conventional CT (n=25),two-phase spi-ral CT (n=17) or three-phase spiral CT (n=61). MRI was performed using conventional T1- andT2-weighted imaging and dynamic contrast enhancement. The value of MRI after CT was assigned to one of fourgrades, according to the consensus of three radiologists: grade I (decisive), grade II (helpful), grade III (notadditional), or grade IV (confused). RESULTS: The outcome of MRI of 103 lesions was grade I in 14 cases(14%), IIin 34 (33%), III in 49 (48%), and IV in 6 (6%). MRI was not helpful (grade III or IV) in 40% (10/25), 47% (8/17),and 61%(31/61) of lesions after conventional, two-phase spiral, and three-phase spiral CT, respectively. Grade IIIor IV lesions were present in 45% of hemangiomas (24/53), 59% of hepatocellular carcinomas (10/17), and 80% ofcases in which metastasis had occurred(8/10). CONCLUSION: MRI after CT in patients with focal hepatic lesion washelpful in less than half of all cases. It was particularly valuable for patients who did not undergo three-phasespiral CT and in whom hemangioma was suspected.
Carcinoma, Hepatocellular ; Consensus ; Diagnosis ; Hemangioma ; Humans ; Hyperplasia ; Inpatients ; Magnetic Resonance Imaging* ; Neoplasm Metastasis ; Tomography, Spiral Computed