BACKGROUND: Since the exact pathogenesis of sepsis-induced ARDS has not been elucidated, the mechanisms of enhanced neutrophilic respiratory burst were probed in endotoxin primed neutrophils associated with the roles of phospholipase A2 (PLA2), platelet activating factor (PAF) and apoptosis. METHODS: In isolated fresh human neutrophils, effects of the inhibition of PLA2 and PAF on the apoptosis were examined by the method of Annexin-FITC/dual PI flow cytometry. The roles of PLA2 and PAF on the neutrophilic respiratory burst were also examined by measuring oxidant generation in cytochrome-c reduction assay. Activities of the PLA2 and lysoPAF acetyltransferase (lysoPAF AT) of the neutrophils were determined to understand the effect of endotoxin on these enzymatic activities which may be related to the neutrophilic respiratory burst and apoptosis. In addition, the role roles of PLA2 and PAF in neutrophilic adhesion to bovine endothelial cells were examined in vitro by neutrophil adhesion assay. To investigate the effect of oxidants on pulmonary surfactant, cytochemical ultrastructural microscopy was performed. To inhibit PLA2 and PAF, non-specific PLA2 inhibitor mepacrine (100 nM) and WEB 2086 (100 nM) or ketotifen fumarate (10 kg/ml) were used respectively in all in vitro experimental sets. WEB 2086 is PAF receptor antagonist, and ketotifen fumarate is a lyso PAF AT inhibitor. RESULTS: The mapacrine treatment, provided after the endotoxin (ETX) treatment, resulted in increased apoptosis of neutrophils (p<0.001) while treatments of WEB 2086 and ketotifen did not. The inhibition of PLA2 and PAF decreased (p<0.001) production of oxidants from PMA-stimulated neutrophils. While endotoxin increased the PLA2 activity of neutrophils (p<0.01), mepacrine supressed (p<0.001) the activity, provided after treatment of ETX. The lyso PAF actyltransferase activity (lyso PAF AT) increased(p<0.01) after treatment of ETX. In contrast, mepacrine, WEB 2086 and ketotifen showed a tendency of decreasing the activity after treatment of ETX. The Treatment of ETX increased (p<0.001) neutrophil adhesion to endothelial cells, which was reversed by inhibition of PLA2 and PAF (p<0.001). The binding of oxidants to pulmonary surfactant was identified histologically. CONCLUSIONS: The enhanced neutrophilic respiratory burst by ETX plays a pivotal role in the pathogenesis of ARDS in term of oxidayive oxidative stress. Increased production of oxidants form neutrophils is mediated by the activations of PLA2 and lyso PAF AT.
Apoptosis* ; Endothelial Cells ; Flow Cytometry ; Humans ; Ketotifen ; Microscopy ; Neutrophils* ; Oxidants ; Oxidative Stress ; Phospholipases A2 ; Platelet Activating Factor ; Pulmonary Surfactants ; Quinacrine ; Respiratory Burst*

PURPOSE: Free nipple graft reduction mammaplasty is a simple and effective way to reduce huge breasts. However, this technique is frequently criticized for producing poor projection and hypopigmentation of the nipple areola complex(NAC). METHODS: Sixty three patients(126 breasts) underwent the procedure from 1998 to 2005. Authors' method is similar with the modified Gradinger's technique except the keyhole pattern. After skin flap closing, the position of NAC is determined considering symmetry. The NAC is initially harvested and then resection of the breast followed, leaving a deepithelized inferior parenchymal pedicle(5 x 5cm). The upper point of inferior pedicle is sutured to the fascia of the pectoralis to produce the upper bulge. The nipple is replaced as a free and composite graft. RESULTS: An average of 823grams of breast tissue per breast was removed. There was no major complications. All grafted nipples showed long lasting projection. And also, all NAC eventually regained their normal color except for 3 patients who needed medical tattoos. The overall results were good and patient satisfactory score was high. CONCLUSION: This useful technique greatly enhances long lasting projection and recovers nipple color.
Breast* ; Fascia ; Female ; Humans ; Hypopigmentation ; Mammaplasty ; Nipples* ; Skin ; Transplants*

PURPOSE: Free nipple graft reduction mammaplasty is a simple and effective way to reduce huge breasts. However, this technique is frequently criticized for producing poor projection and hypopigmentation of the nipple areola complex(NAC). METHODS: Sixty three patients(126 breasts) underwent the procedure from 1998 to 2005. Authors' method is similar with the modified Gradinger's technique except the keyhole pattern. After skin flap closing, the position of NAC is determined considering symmetry. The NAC is initially harvested and then resection of the breast followed, leaving a deepithelized inferior parenchymal pedicle(5 x 5cm). The upper point of inferior pedicle is sutured to the fascia of the pectoralis to produce the upper bulge. The nipple is replaced as a free and composite graft. RESULTS: An average of 823grams of breast tissue per breast was removed. There was no major complications. All grafted nipples showed long lasting projection. And also, all NAC eventually regained their normal color except for 3 patients who needed medical tattoos. The overall results were good and patient satisfactory score was high. CONCLUSION: This useful technique greatly enhances long lasting projection and recovers nipple color.
Breast* ; Fascia ; Female ; Humans ; Hypopigmentation ; Mammaplasty ; Nipples* ; Skin ; Transplants*

PURPOSE: Gynecomastia is an abnormal increase in the volume of the male breast. Patients affected by gynecomastia with significant glandular enlargement may respond to suction alone and/or sharp dissection and excision. The purpose of this report is to introduce the indications and results of authors' two techniques. METHODS: The diameter of parenchyme was determined by a pinch test after liposuction. For the parenchymal diameter less than 4cm, ultrasound-assisted liposuction was performed, in conjunction with the "pull- out technique" to effectively remove the fibrofatty tissue of the male breast through a single 5-7mm incision. For the parenchymal diameter more than 4cm, ultrasound-assisted liposuction and excision were applied through 2.5cm periareolar approach. RESULTS: A total of 94 patients (185 breasts) underwent the operation from October 2000 to October 2003 and mean follow-up period was 12 months. The volume of aspirates ranged from 50 to 450 cc per breast. There were no major complications such as skin flap necrosis. Five reoperations were performed for 1 hypertrophic scar, 2 under-resected and 2 hematoma cases. The patient's satisfaction was high and most of them were pleased with the shape of the breasts and scars. CONCLUSION: These procedures can minimize scars and reduce the incidence of contour problem such as saucer deformity, and provides consistent results. Patients can return to full activities in 48 hours. It can be offered as an option for the treatment of gynecomastia.
Breast ; Cicatrix ; Cicatrix, Hypertrophic ; Congenital Abnormalities ; Follow-Up Studies ; Gynecomastia* ; Hematoma ; Humans ; Incidence ; Lipectomy* ; Male ; Necrosis ; Skin ; Suction

PURPOSE: Male hypertrophic nipples can lead to psychological distress and physical discomfort. The authors present a new technique of male nipple reduction and describe its advantages. METHODS: The neonipple is designed to reduce diameter and height of nipple while preserving the subdermal plexus. After the central wedge excision, additional four triangular section of nipple skin is excised. One of the remaining two flaps is amputated partially and both flaps were approximated using 4-0 PDS and 6-0 Nylon sutures. RESULTS: From December 2007 to January 2009, 52 nipple reductions were performed in 30 male patients (mean = 29.5 years). Postoperative recovery was rapid and few complications were observed. The mean diameter of the hypertrophic nipple was 9.1 +/- 2.5 mm (range, 7 to 15 mm). The mean diameter of the neonipple was 5.0 +/- 0.7 mm (range, 4 to 6 mm), with an average reduction of 3.8 +/- 0.6 mm (range, 2 to 11 mm). In follow-up, the neonipple had a natural appearance, with less projection and an inconspicuous scar. CONCLUSION: The wedge and triangular skin excision and partial amputation are easy to perform and yields consistent results. This technique decreases both the diameter and height of any size nipple and can be modified to meet patients' preferences.
Amputation ; Follow-Up Studies ; Humans ; Male ; Nipples ; Nylons ; Skin

PURPOSE: Severe type of inverted nipple (cannot be pulled out above the areola plane by manipulation, grade III) usually cannot be corrected by a relatively simple pursestring suture technique. Most patients want to avoid visible scars. To treat the severe case and avoid visible stigma, we introduce this invisible dermal flap method. METHODS: This new surgical procedure makes bilateral incisions on the sidewall of nipple and dissections vertically to free the ducts from the contracted tissues. After dissection, the tunnel is formed. We insert "dermal flaps" into the tunnel underneath nipple base. Then through-and-through sutures are performed vertically (6 o'clock and 12 o'clock positions) and the purse-string suture is added with 4-0 nylon. RESULTS: We had treated 35 primary inverted nipples (grade III) in 27 patients and 13 recurrent nipples in 7 cases. The results were excellent in 45 nipples (93.7%). All but 3 recurred cases was fully or very satisfied with the results. CONCLUSION: This technique is effective for the correction of severe inverted nipples and recurrent cases. We can avoid the visible scars on the areola surface
Cicatrix ; Contracts ; Humans ; Nipples ; Nylons ; Skin ; Suture Techniques ; Sutures

PURPOSE: This study was to evaluate the expression pattern of CD 18(leukocyte adhesion glycoprotein) in ischemia-reperfusion injury of TRAM flap of rats. Through this study, we can obtain more information about ischemia-reperfusion injury. We want to develop specific medicine to improve the survival rate of TRAM flap in the future. METHODS: A TRAM flap supplied by a single pedicle superior epigastric artery and vein was elevated on 60 Sprauge-Dawley rats. The rats were divide into 6 groups (each group n=10); Group O: sham, no ischemia-reperfusion injury, Group I: 2 hour reperfusion after 4 hour ischemia, Group II: 4 hour reperfusion after 4 hour ischemia, Group III: 8 hour reperfusion after 4 hour ischemia, Group IV: 12 hour reperfusion after 4 hour ischemia, and Group V: 24 hour reperfusion after 4 hour ischemia. This study consisted of gross examination for flap survival and flow cytometry study of CD18 on neutrophils. RESULTS: The gross measurement of the flap showed different survival rate in group I(71%), II(68%), III(37%), IV(34%) and V(34%). All experimental groups showed an increase in the expression of CD18 compared to group O. The expression of CD18 was rapidly increased in ascending order in group I, II and III. But, the expression of CD18 was maintained in group IV and V. CONCLUSION: The results can be implemented in the study to develop drugs which are capable of reducing ischemia-reperfusion injury in microsurgical breast reconstruction.
Animals ; Epigastric Arteries ; Female ; Flow Cytometry ; Ischemia ; Mammaplasty ; Neutrophils ; Rats* ; Reperfusion ; Reperfusion Injury* ; Survival Rate ; Veins

No one technique provides an optimal outcome for all body contouring patients. There are many surgical options for abdominoplasty. Among these, this abdominoplasty without undermining consists of liposuction around abdominal subcutaneous fatty tissue, excision of lower abdominal flap. The procedure allows aggressive thinning and sculpting of abdominal flap. This operation minimizes the dead space, which often leads to postoperative complications, and preserves neurovascular supply to the abdominal skin. From 1999 to 2004, 18 patients underwent the abdominoplasty without undermining, resulting in high satisfaction rates with no significant complications, such as, pulmonary embolism and deep vein thrombosis. Patients could return to normal activity within a week. This abdominoplasty without undermining is an effective and safe alternative with low complication rate and enhances aesthetic results compared to traditional abdominal surgery.
Abdomen ; Abdominoplasty* ; Adipose Tissue ; Humans ; Lipectomy ; Postoperative Complications ; Pulmonary Embolism ; Skin ; Venous Thrombosis

PURPOSE: The major drawback of submuscular augmentation of the ptotic breast is a "double-bubble" deformity. If a traditional mastopexy is added to correct the ptosis, there would be additional scars. This article describes simultaneous periareolar mastopexy with dual plane or subfascial breast augmentations. METHODS: A series of 81 patients with grade I or II ptosis underwent the procedure from 1999 to 2005. Out of these, dual plane augmentation was done in 71 cases and subfascial plane in 10. After periareolar skin excision, an incision is made perpendicularly down to the fascia of pectoralis. At the lower pole, all breast implants are inserted into the subfascial plane. In case of upper pole thickness of above 20mm, we inserted the implant into the subfascial plane, whereas below 20mm, we inserted that into the submuscular plane. RESULTS: No major complications were noted and patients' satisfactory score was high. This technique avoids the "double-bubble" deformity and leaves a minimal periareolar scar. CONCLUSION: Simultaneous periareolar mastopexy/ breast augmentation is useful for correction of the ptotic breast, increasing the volume of breast and providing the natural breast shape with minimal scars. We consider that subfascial plane augmentation with periareolar mastopexy to be an alternative for cases with breast upper pole thickness of at least above 20mm.
Breast ; Breast Implants ; Cicatrix ; Congenital Abnormalities ; Fascia ; Humans ; Skin

PURPOSE: The major drawback of submuscular augmentation of the ptotic breast is a "double-bubble" deformity. If a traditional mastopexy is added to correct the ptosis, there would be additional scars. This article describes simultaneous periareolar mastopexy with dual plane or subfascial breast augmentations. METHODS: A series of 81 patients with grade I or II ptosis underwent the procedure from 1999 to 2005. Out of these, dual plane augmentation was done in 71 cases and subfascial plane in 10. After periareolar skin excision, an incision is made perpendicularly down to the fascia of pectoralis. At the lower pole, all breast implants are inserted into the subfascial plane. In case of upper pole thickness of above 20mm, we inserted the implant into the subfascial plane, whereas below 20mm, we inserted that into the submuscular plane. RESULTS: No major complications were noted and patients' satisfactory score was high. This technique avoids the "double-bubble" deformity and leaves a minimal periareolar scar. CONCLUSION: Simultaneous periareolar mastopexy/ breast augmentation is useful for correction of the ptotic breast, increasing the volume of breast and providing the natural breast shape with minimal scars. We consider that subfascial plane augmentation with periareolar mastopexy to be an alternative for cases with breast upper pole thickness of at least above 20mm.
Breast ; Breast Implants ; Cicatrix ; Congenital Abnormalities ; Fascia ; Humans ; Skin