This article presents a description of the ultrasonographic and computed tomographic findings with a discussion on the imaging features in three patients with epigastric hernias, simulating abdominal wall lipomas. Ultrasonogram showed a heterogeneous hypoechoic mass encircled by echogenic rim within subcutaneous space of the abdominal wall. Computed tomographic findings were a localized fatty mass surrounded by a thin capsule in as sociation with a focal discontinuity of the linea alba. Ultrasonogram was not diagnostic, but computed tomogram was suggestive because of the well demonstrated focal defect in linea alba.
Abdominal Wall ; Hernia* ; Humans ; Lipoma ; Ultrasonography*

With the continuous development of diagnostic techniques of precancerous lesion and an improved patient-transfer system, it is unusual to examine patients who have a life-threating malignant skin lesion. However it is still a problem in some far-advanced inoperable skin tumors which have been neglected and have become aggravated, Another problem in oncologic surgery is previous irradiation around a lesion. The only effective way to treat these lesions is to excise widely and cover with an appropriate free flap. But in such conditions, selection of recipient vessel is not easy. Many surgeons have used vein graft as the conduit from a distant non-radiated vessel to the free flap. This technique requires a long segment of vein for anastomosing both the artery and vein. We used intra-lesional vessels as the recipient vessel of the free flap, which were suspiciously damaged by irradiation and malignant cell infiltration. The guidelines include: 1) malignancy-infiltrated vessels are to be dissected until a clear field is obtained under a frozen section 2) irradiated vessel can be used only if active spurting is present without intraluminal thrombosis. All of our case obtained satisfactory results in all cases except one of irradiated squamous cell carcinoma at inguinal area whose gracilis myocutaneous free flap loss was in 10%. But even this case, the cause of partial loss of the flap may not be due to a vascular problem but an internal failure of the flap. We concluded, that carefully selected intra-lesional vessels, although they may be damaged by irradiation or malignant cell infiltration can be used as the recipient vessels of free flaps.
Arteries ; Carcinoma, Squamous Cell ; Free Tissue Flaps* ; Frozen Sections ; Humans ; Skin ; Thrombosis ; Transplants ; Veins

BACKGROUND: Herpes zoster is an important and troublesome disease. OBJECTIVE: The purpose of this study was the elucidation of the epidemiological and clinical characteristics of herpes zoster through patient assessrnent. METHODS: During a 5- Year period, January 1990 to December 1994, 215 patients with herpes zoster were assessed with regard to annual and monthly frequency in occurrence, age and gender incidence. Associated conditions, dermatomic distributions, the relationship of onset of pain and skin lesions, Multi-CMI test and complications were also evaluated. RESULTS: 1. The annual freguency of herpes zoster ranged from 0.88% to 1.78% (mean 1.23%) during the 5-year period. The highest number of herpes zoster patients was observed in winter (p<0.001) especially in January. 2. Herpes zoster was found to most frequently afflict persons aged 50-59 (27.9%). 71% of the patients were over 40 years of age. 3. In 76 patients (41.8%), neuralgia occurred several days (4 days mean) before the development of skin lesions. In 92 patients (50.5%), pain and skin lesions developed simultaneously while skin lesion development occurred before the onset of pain in 14 patients (7.7%). 4. Among the patients, 42.8% had associated conditions such as diabetes mellitus, hypertension, pulmonary tuberculosis, liver diseases, peptic ulcer, hypothyroidism, pharyngitis, fracture, etc. 5. The dermatomic invclvement of herpes zoster patients having one dermatome was most frequent in thoracic dermatome ca. es (52.6%). Others included cervical (16.7%), trigeminal (11.6%), sacral (6. 0%), lumbar (4.2%), facial (0.5%). Cases having two different dermatomes constituted 8.4%. 6. The most common complication of herpes zoster was postherpetic neuralgia although instance of ophthalmologic compiications, secondary bacterial infection, scar formation, Ramsay-Hunt syndrome, keloid formation, and urinary difficulty were also documented. 7. Multi-CMI (Cell-mediated immunity) tests were done on 88 herpes zoster patients. Thirteen of them (14.8%) were found to have comparatively depressed scores. Ten of the 79 single dermatome involvement patients (12.7%) and three of the 9 two dermatome involvement patients (33.3%) exhibited similar scores. CONCLUSION: These results are in accordance with those of previous reports with the exception of the higher incidence ot two different dermatome involvements and seasonal variation.
Bacterial Infections ; Cicatrix ; Diabetes Mellitus ; Herpes Zoster* ; Humans ; Hypertension, Pulmonary ; Hypothyroidism ; Incidence ; Keloid ; Liver Diseases ; Neuralgia ; Neuralgia, Postherpetic ; Peptic Ulcer ; Pharyngitis ; Seasons ; Skin ; Tuberculosis

The finger-tip is a specially-differentiated end structure of the human body in anatomic aspect. Although it is covered with thick dermis and a heavily-cornified epithelial layer, the finger-tip represents tremendous sensory perception because of dense sensory nerve endings. This highly sensitive skin is attached to the phalangeal bone or fascia and stabilizd during grip or pinch by the fascial septa, which form compartments of fat pads in the pulp tissue. In addition to its functional aspect, the finger tip plays an important cosmetic role because it is an exposed area like the face. So, when reconstructing finger-tips, especially the thumb or radial side of the index finger, one must take into account both the functional and esthetic results. In this study, 8 cases of great toe pulp sensory free flaps for fresh amputations (n=4) and previously reconstructed wounds (n=4) are included. In previously-reconstructedcases cases, all of them complained of incomplete recovery of sensation or cosmetic dissatifaction. The fingers covered with flaps were the index finger (n=5), ring finger (n=2), and thumb (n=1). The mean size of flaps was 3 x 1.9 cm and all of the flaps survived without significant complications, except 1 case of venous insufficiency. Sensory complications, except 1 case of venous insufficiency. Sensory perception was detected within 4 months and improved gradually during the follow-up period to 10.5 mm/8 mm in static/moving two-point discrimination test. Even though, some patients complained of postoperative paresthesia including cold intolerance (37.5%), pain (25%) and hyperesthesia (12.5%), the great toe pulp sensory flap is an aesthetically superior and sensuously more satisfactory alternative to other reconstructive procedures for fingertip defects.
Adipose Tissue ; Amputation ; Dermis ; Discrimination (Psychology) ; Fascia ; Fingers ; Follow-Up Studies ; Free Tissue Flaps* ; Hand Strength ; Human Body ; Humans ; Hyperesthesia ; Paresthesia ; Sensation ; Sensory Receptor Cells ; Skin ; Thumb ; Toes* ; Venous Insufficiency ; Wounds and Injuries

No Abstract Available.
Hemangioma*

The mandibular contour determines the shape of the lower part of face and thus influences the appearance of head and neck. A prominent mandibular angle produce characteristic quadriangular, coarse and muscular appearance. To correct this facial contour to oval shape, the prominent angle can be contoured. the cutaneous approach has been used, but it leaves noticeble scar and has risk of facial nerve injury. Thus the intraoral approach has been used commonly. But because of restricition of operation field, the intraoral approach disadvantages of long operation time, high risk of complications. So, we have performed mandibular contouring procedure by new approach which uses reciprocating saw through stab incision under the mandibular body to correct the 9 patients of mandibular angle protrusion who visited our clinics recently. And we found that mandibular angle contouring by this new approach is easy, and makes the operation and recovery time shorter. There were no complications and cosmetic results were quite satisfactory.
Cicatrix ; Facial Nerve Injuries ; Head ; Humans ; Neck

The goal of cleft lip surgery is to reconstruct normal shape of the lip. To acomplish this goal, various operative method were contrived and concept of the method decided the shape of reconstructed lips. According to the operative result, some operative methods were disappeared or have been developed with a little modifiation. Traditional Millard's rotation-advancement method for unilateral cleft lip patients is largely accepted and developed as proper method for acquiring these functional and anatomic purposes. As a trial for this development, Mulliken add some modifications. He uses exaggerated high rotation incision and it lengthens into midcolumella without backcut. Also he dosen't steal from alar base or lateral lip for vertical height. C-flap is used to lengthen the affected columella and upper lip. The isolated orbicularis oris muscle is coaptated each other for more functional result. With supraperichondral dissection of alar cartilage and transpositioning of caudal septum, he performs synchronous repair of cleft lips, nose and sometimes alveolus. It is still debated when is most suitable age for surgical correction of nasal deformity of cleft lip patients. Done at the time of primary lip repair, there are both some apprehension and inducement. The former are based on technical difficulties due to shortage and fragility of neonatal tissue and possibility of progressive deformities with growing because of iatrogenic injuries to the alar cartilages. But te latter is rationalized because early reposition of deformed nasal cartilage in proper position would induce more natural growth of nasal structures. Some long-term follow up reports reveal the early operation innocent of any growth deterioration. Mulliken treats his cleft lip patient for separated lip and nasal deformities with single operation, and does gingiovoperiosteal alveoloplasty at the same time if necessary. He uses Latham appliance from 4 to 6 week after birth in case of severly collapsed lateral alveolar segment or wide alvolar gap, and perform the definitive opertation at the age of 4 to 6 months. I use lip adhension method to correct more than 10 mm alveolar gap without severe collapse of lateral alveolar segment, but if lateral segment was severely collapsed and away from alvolar arch, I apply the Latham appliance somewhat modificate from original type, which has a metal ring fastened at the front limb of appliance for rubber banding to coaptate easily. I have experienced repair of cleft lip by Mulliken's concept with some modification of my own to 44 cases of unilateral cleft lip patients and conclude that it was very flexible method. Doing with synchonous repair of cleft lip nose, we could get harmonious lip and nose with symmetric nostril sill, cupid's bow and red line. Columella was lengthened primarily. Normal growth of nose was anticipated by anatomic repositioning of alar septal cartilage.
Alveoloplasty ; Cartilage ; Cleft Lip* ; Congenital Abnormalities ; Extremities ; Follow-Up Studies ; Humans ; Lip ; Nasal Cartilages ; Nose ; Parturition ; Rubber

PURPOSE: The importance of the deformities in alar - columellar complex has been underestimated in Asian ethnic groups for the last few decades. Fortunately, with increasing familiarity of the open rhinoplasty techniques, the anatomic details of the nasal tip have been pointed up. Definitely, having an interest and demand for improving the sub-normal relationship between the alar rim and columella are indebted for such growing of knowledge about nasal tip anatomy. However, it is true that any single procedure is not settled as versatile and fully confident modality to correct the retracted notching of the alar rim. With this article, I would like to propose another useful option for treating retracted ala. METHODS: The authors have tried to correct alar rim retraction by means of: (1) Triangular onlay septal cartilage graft on the lower lateral cartilage with the medial end fixed to the anterior surface of the lateral crus(Alar extension graft), (2) Inserting lateral end of the alar extension graft to the vestibular skin pocket in the form of a finger-in-groove, (3) using the vestibular skin in the form of an advancement flap, and (4) using the soft shield graft to prevent possible visible step-off of the alar margin. RESULTS: The authors applied an alar extension graft to 16 patients in order to correct a retracted ala for the last 27 months (August 2003-October 2005). The distance from alar rim to long axis of nostril was improved to be within 2mm in all cases, and also the shape of the alar rim changed to a round form. Nostril asymmetry (6%) was observed in one case, temporary palpable step-off (18%) in three cases, temporary visible step-off (6%) in one case, and temporary paresthesia of the tip (25%) in four cases, respectively. CONCLUSION: The alar extension graft is simple and efficacious. It does not need donor sites other than the operative field, and its results are predictable. In particular, since it may give structural intensity to a weak lower lateral cartilage, it may be preferentially used for the correction of a retracted ala that arises from hypoplastic lower lateral cartilage. Moreover intensified lower lateral cartilage also improves the esthetic shape of lobule.
Asian Continental Ancestry Group ; Axis, Cervical Vertebra ; Cartilage ; Congenital Abnormalities ; Ethnic Groups ; Humans ; Inlays ; Paresthesia ; Recognition (Psychology) ; Rhinoplasty ; Skin ; Succinates ; Tissue Donors ; Transplants

No abstract available.
Dermoscopy* ; Diagnosis

Erythromelalgia(Erythermalgia) is a syndrome of red, warm, congested, and burning painful extremities. Presently, there are three distinct clinicopathological entities: erythromelalgia, primary erythermalgia, and secondary erythermalgia. Secondary erythermalgia usually arises at an adult age either in association with a detectable underlying disorder or with the use of vasoactive drugs. Typically, it responds to proper treatment of the underlying disorder or discontinuation of the causative drugs. A seven-year-old boy presented with persisting burning pain, erythema, and warmth on both of his feet and lower legs, along with hypertension. He had had this condition for 20 months. Laboratory studies of the patient revealed increased urinary catecholamines and plasma renin activity. Various treatment modalities including aspirin, captopril, sodium nitroprusside, labetalol, epidural block, and stellate ganglion block yielded unfavorable results. Herein, we report an intractable case of secondary erythermalgia associated with hypertension in a child.
Adult ; Aspirin ; Burns ; Captopril ; Catecholamines ; Child ; Erythema ; Erythromelalgia* ; Estrogens, Conjugated (USP) ; Extremities ; Foot ; Humans ; Hypertension* ; Labetalol ; Leg ; Male ; Nitroprusside ; Plasma ; Renin ; Stellate Ganglion