The gigantic lipoma could be categorized into subcutaneous and subfascial type. We experienced eight cases from seven patients. Five cases of them were proved to be subcutaneous gigantic lipomas, and three cases were proved to be subfascial gigantic lipomas. Among the subcutaneous type, three cases of liposarcomas were confirmed by final biopsy results. And three cases of recurrences were shown. Among the subfascial type, one case of chondrolipoma was confirmed by final biopsy result and no recurrence was not found. In brief, subcutaneous and subfascial gigantic lipoma had a specific characteristics as followings: Subcutaneous type showed asymptomatic mass with bulging, multilobulated and poorly marginated. And it was difficult for complete removal with a high recurrence rate. Radical excision and liposuction recommended for its treatment. On the other hand, subfascial type showed diffuse expansion, late onset of symptom. And it was readiness for complete removal with no recurrence after complete excision.
Biopsy ; Hand ; Humans ; Lipectomy ; Lipoma* ; Liposarcoma ; Recurrence

The craniosynostosis is the term that designates premature fusion of one or more sutures in the cranial vault and thus causes deformities of cranial base and vault. When a suture fused prematurely, the skull and growing brain beneath the suture are forced to expand in the fused suture area. Between April of 1992 and September of 1999, six patients of bilateral coronary synostosis were operated with frontal bone advancement and calvarial remodeling. The supraorbital bar was reshaped with partial osteotomy, greenstick fracture and interpositioning bone grafts. The frontal bone was divided along the metopic suture and transposed one another to make an esthetic shape of the forehead. The parietal bone was expanded with multiple barrel stave osteotomies and fixed to advanced frontal bone with interpositional bone graft. The six patients were operated at the mean age of 10 months. The mean operation time was about 5 hours and mean transfusion volume was 190 cc. There was no postoperative complications and no need for more revisional operation. For a superior result of correciton of craniosynostosis, early surgical intervention is mandate. Efforts for reducing complications, parents' understanding and periodic follow- up are important factors for successful correction.
Brain ; Congenital Abnormalities ; Craniosynostoses ; Forehead ; Frontal Bone ; Humans ; Osteotomy ; Parietal Bone ; Postoperative Complications ; Skull ; Skull Base ; Sutures ; Synostosis* ; Transplants

In the treatment of this complicated diabetic foot patient, we need an effective treatment principle because the complicated diabetic foot patient needs a longer hospitalization period and suffers from more frequent recurrences. We reviewed 43 diabetic foot patients who were treated in our department during the past 4 years. The 43 patients were divided into 4 groups according to their combined complications. Group A was the simple diabetic foot group(no complication group, n = 17). Group B was the diabetic foot group combined with the extensive cellulitis(n = 9). Group C was the diabetic foot group combined with the peripheral vascular disease(n = 8). Group D was the diabetic foot group combined with the renal failure(n = 9). As a results, wide range of reconstructive methods can be selected in the simple diabetic foot group. In group B, early and wide debridement was important to control the infection and later flap reconstruction was appropriate. In group C, the bypass operation should be desperate before improving the circulation of lower extremities, and therefore we successfully reconstructed the foot with various metohds including plantar V-Y advancement flap, considered as the most useful in our series. In group D, recurrence was more frequent and lower extremity amputations above the ankle level couldn't be avoided in spite of many operations and longer hospitalization. Therefore consideration of early amputaiotn is recommended for the effective treatment of this group.
Amputation ; Ankle ; Debridement ; Diabetic Foot* ; Foot ; Hospitalization ; Humans ; Lower Extremity ; Peripheral Vascular Diseases* ; Recurrence ; Renal Insufficiency*

The rib cartilage has been the most popular autogenous tissue for microtia reconstruction. Donor site complications, especially chest wall deformities occurring after harvest of costal cartilage graft are presented and discussed in many reports. In this study, 100 chest donor sites were evaluated in 34 patients (25 male and 9 female) who underwent costal cartilage grafts for microtia reconstruction from 1992 to 1999, and reviewed for donor site complications by radiography and physical examination. Ribs from which costal cartilage had been harvested showed increased inward bowing on radiographs in 38 of 100 donor sites; the upper ribs record a higher incidence of deformity than lower ribs. The frequency of rib deformity in donor site was 21 percent when cartilages were harvested from patients older than 10 years of age, whereas it was 73.3 percent in patients younger than 10 years. This difference was statistically significant. In our study, the incidence of chest wall deformity was 57 percent, concerning donor site morbidity after the supraperichondrial rib harvesting procedure, whereas it was 35 percent in patients after the subperichondrial rib harvesting procedure. In conclusion, surgeons should consider the possibility of thoracic deformity when planning costal cartilage grafting. To avoid these deformities, costal cartilage harvesting should be made at lower levels of the rib cage, and delayed operation time for thoracic maturation is recommended. More care should be taken to preserve the perichondrium and the germinative zone of the costochondrial junction.
Cartilage* ; Congenital Abnormalities ; Humans ; Incidence ; Male ; Physical Examination ; Radiography ; Ribs ; Thoracic Wall* ; Thorax* ; Tissue Donors ; Transplants

Ameloblastoma is a histologically benign tumour originating from epithelial components of the embryonic tooth, arrested developmentally prior to enamel formation. Clinically this tumour is locally invasive, potentially lethal and occasionally shows malignant features with systemic metastases. The maxilla is by far less frequently affected than the mandible. We have experienced a case of multicystic ameloblastoma originating from right maxilla. The patient was 39-year-old male who complained pain and numbness on right cheek. The patient was treated with subtotal maxillectomy by midfacial degloving approach. The final histopathologic diagnosis was a acanthomatous ameloblastoma.
Adult ; Ameloblastoma* ; Cheek ; Dental Enamel ; Diagnosis ; Humans ; Hypesthesia ; Male ; Mandible ; Maxilla* ; Neoplasm Metastasis ; Tooth

Reactive perforating collagenosis(RPC) is a kind of perforating dermatosis characterized by transepithelial elimination of an altered dermal collagen. RPC is classified into two forms; childhood or inherited form, and adult or acquired form. Acquired RPC is reported to occur in association with the severe complicated diabetes mellitus, chronic renal failure and other diseases. We describe a patient with acquired RPC associated with controlled, non-complicated diabetes mellitus and severe pruritus. Skin lesions showed rapid improvement after the intralesional injection of triamcinolone.
Adult ; Collagen ; Diabetes Mellitus* ; Humans ; Injections, Intralesional ; Kidney Failure, Chronic ; Pruritus ; Skin ; Skin Diseases ; Triamcinolone

Clear cell sarcoma of the tendon and aponeurosis was first described by Enzinger in 1965, and has become a well-accepted clinicopathological entity as malignant melanoma of soft parts. Although it posesses the ability to produce melanin, it is quite different from conventional melanoma in that, it is more deeply located, usually associated with tendon and aponeurosis, displays pale-staining round to oval-shaped tumor cells and has a longer clinical course and better prognosis.Several cases have been reported in Korea, and we experiened an additional case of this rare tumor that showed ulceration.
Korea ; Melanins ; Melanoma ; Sarcoma, Clear Cell* ; Tendons* ; Ulcer

BACKGROUND: Although actigraphy has been used to evaluated sleep-wake patterns and quality of sleep disorders patients, its usefulness in obstructive sleep apnea syndrome (OSAS) and primary insomnia is unclear. To investigate the value of actigraphy in OSAS and differentiating OSAS from primary insomnia, night polysomnography (PSG) and actigraphy were performed simultaneously. METHODS: 31 OSAS patients and 21 primary insomnia patients were included (16 females, 36 males). Sleep latency, total sleep time, sleep efficiency and actual wake time, movement and fragmentation index (MFI) were obtained in actigraphy and compared with PSG results. Spearmann correlation analysis and Mann-Whitney U test were used. RESULTS: The sleep efficiency and total sleep time are highly correlated in PSG and actigraphy (p<0.05, p<0.01). Respiratory disturbance index and arousal index in PSG was relatively correlated with MFI in actigraphy (p<0.05). Sleep latency is not correlated in PSG and actigraphy (p>0.05). OSAS had a significantly higher movement and fragmentation index (MFI) than that of primary insomnia (p<0.05) CONCLUSIONS: Actigraphy is a useful and convenient test in differentiating OSAS from insomnia as well as sleep-wake cycle disorders.
Actigraphy* ; Arousal ; Female ; Humans ; Polysomnography* ; Sleep Apnea, Obstructive* ; Sleep Wake Disorders* ; Sleep Disorders, Circadian Rhythm ; Sleep Initiation and Maintenance Disorders*

LiCl at doses sufficient to induce conditioned taste aversion (CTA) causes c-Fos expression in the brain regions implicated in CTA formation. It has been reported that nitric oxide (NO) may play a role in CTA learning and LiCl increases both the synthesis and activity of NO synthase (NOS) in the brain. In this study, we examined the effect of central N omega-nitro-L- arginine methyl ester (L-NAME) on the brain c-Fos expression and CTA learning induced by lithium in rats. In the results, intracerebroventricular L-NAME given prior to lithium did not change either the lithium-induced CTA or c-Fos in the relevant brain regions. This suggests that the brain NO system may not be involved in the neuronal activation during lithium-induced CTA formation.
Animals ; Avoidance Learning/*drug effects/physiology ; Brain/*physiology ; Conditioning (Psychology) /*drug effects/physiology ; Immunohistochemistry ; Injections, Intraventricular ; Lithium/*pharmacology ; Male ; NG-Nitroarginine Methyl Ester/*pharmacology ; Nitric Oxide/physiology ; Proto-Oncogene Proteins c-fos/*analysis ; Rats ; Rats, Sprague-Dawley ; Support, Non-U.S. Gov't ; Taste/*drug effects/physiology