OBJECTIVES: Monitoring viability of flap is important. The flap survival depends on the vascularity of the flap, on which the skin temperature depends. The authors applied digital infrared thermographic imaging (DITI) for monitoring the vascular supply of the flap and for the prediction of the prognosis of the flap survival. METHODS: Eight male New Zealand white rabbits with average weight of 3kg were used. A 10 x 10 cm unipedicled fasciocutaneous island flap was elevated based on the left superficial inferior epigastric vessel. The surface temperatures on designed flap were checked with DITI for 24 hours after the operation. On 14th day after the operation, the surviving area was measured and compared with DITI image which was taken on 24 hours after the operation using digital analysis software ImageJ. Statistical analysis was evaluated by paired T-test. RESULTS: On DITI image 24 hours after the flap elevation, distal portion of the flap showed remarkable color change. The average percentage and the standard deviation of the survival area of the flap which is predicted by DITI and the average percentage and the standard deviation of the survival area of the flap which was actually measured 2 weeks after flap elevation were 55.3 (16.6), 56.2 (18.0), respectively. This shows no significant difference between the two. CONCLUSIONS: This study shows that DITI system could be used in evaluation of flap vascularity with ease, quickness and safety for patient and flap. Thus, it could be used clinically for the prediction of flap survival.
Humans ; Male ; Prognosis ; Rabbits ; Skin Temperature* ; Skin*

BACKGROUND: Treatment of skull base tumors is challenging due to limited access and presence of important neurovascular structures nearby. The success of a complete tumor resection depends on the extent of tumor exposure and secure field of view. While these tumors are often removed by transcranial endoscopic access, transfacial approach is sometimes required depending on the location and size of the tumor. This study describes various transfacial approaches in patients undergoing skull base tumor resection. METHODS: From March to November 2013, 15 patients underwent skull base tumor resection via transfacial accesses at a tertiary institution. Data were reviewed for patient demographics, type of access used, completeness of tumor resection, surgical outcome, and postoperative complications. RESULTS: Two clivus tumor patients underwent transmaxillary approach; three tuberculum- sellae and suprasellar-hypothalamus tumor patients underwent transbasal approach; three clinoid and retrobulbar intraconal orbital tumor patients underwent orbitozygomatic approach; and seven petroclival-area, pons, cavernous sinus, and lateral-sphenoid-wing tumor patients underwent zygomatic approach. In all cases, the upper and lower margins of the tumor were visible. Complete tumor removal consisted of 10 cases, and partial tumor removal in 5. There were no immediate major complications observed for the transfacial portion of the operations. The overall cosmetic results were satisfactory. CONCLUSION: Plastic surgeons can use various transfacial approaches according to the location and size of skull base tumors to secure a sufficient field of view for neurosurgeons.
Cavernous Sinus ; Cranial Fossa, Posterior ; Demography ; Humans ; Orbit ; Pons ; Postoperative Complications ; Skull Base*

OBJECTIVES: This study was performed to evaluate the relationships between psychosocial characteristics and changes in the stage of breast cancer screening behavior. METHODS: The 474 study subjects were randomly sampled from 21,459 women (age range, 40-70 years) who were eligible for the Korean National Cancer Screening Program in 2006 in Jinju, Gyeongsangnam-do. The information, including behaviors and sociodemographic characteristics, attitudes, subjective norms and self-efficacy, was collected by trained interviewers via home visits. The breast cancer screening stages were grouped as precontemplation, contemplation, action, maintenance and relapse, according to Rakowski. RESULTS: Of the 474 women, 18.8% were in the precontemplation stage, 23.3% were in the contemplation stage, 13.1% were in the action stage, 36.6% were in the maintenance stage, and 8.2% were in the relapse stage. The distribution of stages was associated with attitude, subjective norms and self-efficacy (p for trend<0.01). To investigate the overall relationship between the variables, we conducted a linear structural equation model analysis based on the theory of planned behavior. The subjective norms and self-efficacy influenced the stage of the women's screening behavior. CONCLUSIONS: We should target on self-efficacy about the screening behavior of women by performing timely, thoughtful interventions. The support from family members, friends and other people is crucial for women to undergo breast cancer screening and to improve the breast cancer screening rate.
Adult ; Aged ; Asian Continental Ancestry Group ; Breast Neoplasms/prevention & control/*psychology ; Data Interpretation, Statistical ; *Early Detection of Cancer ; Female ; *Health Behavior ; Humans ; Interviews as Topic ; Korea ; Mass Screening/*psychology ; Middle Aged ; Models, Theoretical ; Questionnaires ; Self Efficacy ; Socioeconomic Factors ; Women's Health

BACKGROUND: The hepatocyte growth factor (HGF) is a cytokine modulating epithelial cell proliferation and motility. A circulating HGF level is frequently increased in a variety of tumors including advanced breast cancer. The clinical usefulness of measuring circulating HGF in breast cancerwas evaluated in this study. MATERIALS AND METHODS: The plasma HGF levels in patients with primary (n=58) and recurrent breast cancer (n=13) were measured by the ELISA method using Quantikine (R&D, Minneapolis, MN, USA) kit. The results were compared with those of age-matched healthy controls (n=53). The mean (+/-SD) levels of HGF were also compared between primary and recurrent breast cancerpatients. The correlation of the circulating HGF level and the conventional prognostic factors such as tumor size, lymph node involvement, Her-2/neu over-expression, DNA aneuploidy was studied to evaluate the clinical usefulness of HGF as a new prognostic indicator in breast cancer. RESULTS: Plasma HGF levels (mean+/-SD) increased in breast cancer patients (788+/-853 pg/mL), compared with those of age-matched healthy control women (426+/-120 pg/mL) (P<0.05). Patients with recurrent breast cancer (1, 945+/-1, 544 pg/mL) showed increased HGF levels compared with primary breast cancer (592+/-132 pg/mL) (P<0.001). No significant correlations between plasmaHGF levels and conventional prognostic indicators of breast cancer including tumor size, lymphnode involvement, Her-2/neu over-expression, DNA aneuploidy, and histologic grade were found. CONCLUSIONS: The above findings suggest that the measurement of plasma HGF levels in breast cancer patients may be useful for early detection of recurrence.
Aneuploidy ; Breast ; Breast Neoplasms* ; DNA ; Enzyme-Linked Immunosorbent Assay ; Epithelial Cells ; Female ; Hepatocyte Growth Factor* ; Humans ; Lymph Nodes ; Plasma ; Recurrence

In perforator flap reconstruction, vascular mapping using preoperative computed tomography (CT) angiography is widely used to confirm the existence and location of an appropriate perforator. This study proposes a rapid, accurate, and convenient method for marking the perforator location on the skin surface. For 12 patients who underwent perforator flap reconstruction between November 2011 and November 2013, metal clips were fixed on the skin surface at the anticipated perforator locations, which were decided using a handheld Doppler. CT angiography was used to compare the location between the metal clip and the actual perforator. The metal clip was moved and repositioned, if needed, on the basis of the CT images. The locations of the appropriate perforator and the metal clip, which were observed during the surgery, were then compared. In CT angiography, the mean distance between the metal clip and the perforator was 3+/-3.9 mm, and the mean distance that was measured during surgery was 0.8+/-0.8 mm. In conclusion, we report a simple, rapid, and precise technique to indicate the accurate location of the appropriate perforator on the skin surface.
Angiography* ; Humans ; Multidetector Computed Tomography ; Perforator Flap* ; Skin ; Ultrasonography, Doppler

BACKGROUND: Packing after closed reduction of a nasal bone fracture causes inconvenient nasal obstruction in patients. We packed the superior meatus with Vaseline gauze to support the nasal bone, and packed the middle nasal meatus with a Doyle Combo Splint consisting of an airway tube, a silastic sheet, and an expandable sponge to reduce the inconvenience. In addition, we aimed to objectively identify whether this method not only enables nasal respiration but also sufficiently supports the reduced nasal bone. METHODS: Nasal ventilation was measured via spirometry 1 day before surgery and compared to 1 day after surgery. To compare support of the reduced nasal bone by the 2 methods, 2 plastic surgeons assessed the displacementon X-rays taken after the surgery and after removing the packing. The extent of nasal obstruction, dry mouth, sleep disturbance, headache, and swallowing difficulty were compared with visual analog scales (VAS) on a pre-discharge survey. RESULTS: In the experimental group, the nasal respiration volume 1 day after surgery remained at 71.3%+/-6.84% on average compared to 1 day prior to surgery. Support of the reduced bone in the experimental group (2.80+/-0.4) was not significantly different from the control group (2.88+/-0.33). The VAS scores for all survey items were lower in the experimental group than in the control group, where a lower score indicated a lower level of inconvenience. CONCLUSIONS: The nasal cavity packing described here maintained objective measures of nasal respiration and supported the reduced bone similar to conventional methods. Maintaining nasal respiration reduced the inconvenience to patients, which demonstrates that this packing method is useful.
Airway Management ; Deglutition ; Dimethylpolysiloxanes ; Headache ; Humans ; Mouth ; Nasal Bone ; Nasal Cavity ; Nasal Obstruction ; Nasal Surgical Procedures ; Petrolatum ; Porifera ; Respiration ; Silicones ; Spirometry ; Splints ; Ventilation ; Weights and Measures

PURPOSE: Hyoid bone is a U-shaped bone in the anterior of the neck. Hyoid bone fractures are exceedingly rare and represent only 0.002% of all fractures because of its protective position relative to the mandible and its suspension by elastic musculature. We report a patient who presented hyoid bone fracture associated with hypoglossal nerve palsy. We also discuss the possible complication and treatment. METHODS: A 69-year-old man was transferred from another institution because of persistent purulent discharge from the left chin. He had a history of trauma in which a knuckle crane grabbed his face and neck in the construction site. A CT scan at the time of the accident demonstrated a comminuted fracture of the right side of the mandible and hyoid bone fracture at the junction between body and right greater cornua. The displaced fracture of hyoid bone and fullness in the pre-epiglottic space were noted, probably indicating some edema. The patient was transferred into ICU after treatment of emergency tracheostomy because the patient showed respiratory distress rapidly. When the patient was hospitalized in our emergency room, he complained of dysphagia and pain when swallowing. On examination of oral cavity, the presence of muscle wasting with fasciculation of the tongue was noted and the tongue deviates to the left side on protruding from the mouth. Pharyngolarygoscopy was performed to make sure that there was no evidence of progressive swelling and pharyngeal laceration. RESULTS: The patient underwent surgical removal of dead and infected tissue from the wound and reconstruction of mandibular bony defect by iliac bone grafting. Hyoid bone fracture was managed conservatively with oral analgesics, soft diet and restricted movement. Hypoglossal nerve palsy was resolved within 7 weeks after trauma without complications. CONCLUSION: Closed hyoid bone fracture is usually uncomplicated and thus it can be treated conservatively. Surgical intervention for hyoid bone fracture is recommended for patient with airway compromise, pharyngeal perforation and painful symptoms which show no response to conservative care. Furthermore, since respiratory distress syndrome may develop quickly, close observation is required. Besides, hypoglossal nerve palsy is a rarely recognized complication of hyoid bone fracture.
Aged ; Analgesics ; Bone Transplantation ; Chin ; Deglutition ; Deglutition Disorders ; Diet ; Edema ; Emergencies ; Fasciculation ; Fractures, Comminuted ; Humans ; Hyoid Bone ; Hypoglossal Nerve ; Hypoglossal Nerve Diseases ; Mandible ; Mouth ; Muscles ; Neck ; Tongue ; Tracheostomy

No abstract available.
Bone Diseases, Developmental ; Craniofacial Abnormalities ; Hyperostosis ; Hypertelorism

PURPOSE: It is difficult to objectively evaluate the outcomes of plastic surgical procedures. The combination of aesthetic and medical factors makes outcome quantification difficult. In this study, fracture reduction accuracy was objectively evaluated in patients with zygomatic complex fractures. Patients satisfaction with the accuracy was also examined. In addition, the patients' overall satisfaction and discomfort due to complications were analyzed. METHODS: Eighty-five patients who had surgeries via bicoronal incision for zygomatic complex fracture from March 2006 to December 2009 were included in this study. Two plastic surgeons evaluated the accuracy of the fracture reduction with postoperative computed tomography. A survey questionnaire was administered to evaluate the patients' overall satisfaction and the impact of symptoms associated with the procedure on the patients' daily lives. RESULTS: The overall patient satisfaction rate was 82.1 +/- 10.9% (range, 45~100%). The level of deformation was 6.7 +/- 10.9%, the levels of discomfort in daily life due to pain, paresthesia, scar, and facial palsy were 8.5 +/- 13.2%, 5.8 +/- 8.9%, 4.4 +/- 9.9%, and 1.9 +/- 9.2%, respectively. According to the visual analogue scale, paresthesia was found to be the most frequent symptom (43.5%), and pain was the most troublesome symptom. CONCLUSION: The use of bicoronal incision for treating zygomatic complex fractures can cause various complications due to wide incision and dissection. However, this technique can provide optimized reduction and rigid fixation. Most of these postoperative complications can cause significant discomfort in the patient. It is thought that the use of correct surgical technique and the accurate knowledge of craniofacial anatomy will result in a reduction of complications and significantly increase patient satisfaction.
Cicatrix ; Facial Paralysis ; Humans ; Paresthesia ; Patient Satisfaction ; Postoperative Complications ; Questionnaires

Section of the corpus callosum(SCC) is a useful surgical therapy in selected types of epilepsy, i.e., tonic, atonic, and intractable generalized convulsive seizures. The object of this study was to determine effect of SCC on behaviors, electroencephalography(EEG) and Fos expression in the lithium-pilocarpine model of status epilepticus in the rat. A total of 40 Sprague-Dawley rats were used. They were divided into two groups: control and lesioned group, 20 rats for each. The control group had no callosal section and was injected with lithium-pilocarpine. The lesioned group had callosal section before lithium-pilocarpine injection. In each group, ten rats were used for behavior and EEG monitoring and other 10 were used for Fos expression. The results were as follows: 1) In the SCC group, four(40%) rats never developed status epilepticus, among them two(20%) never exhibited any seizure, while all of the control group developed seizure and status epilepticus. None of the SCC animals died until 24 hours after lithium-pilocarpine injection but 70% of the control animals died within 24 hours of status epilepticus. This difference was statistically significant(p<0.05). 2) The mean latency to the first seizure, status epilepticus and periodic epileptiform discharges after lithium-pilocarpine injection were 34.7+/-2.6min, 32.3+/-1.8min and 180.4+/-9.8min, respectively, in the SCC group, while was 21.0+/-2.0min, 58.2+/-6.9min and 215.6+/-7.2min, respectively, in the control group. These latencies were significantly longer than in the control group(p<0.05). 3) There was a massive Fos expression on the cerebral cortex in the control group at 4 hours after lithiumpi-locarpine injection , while it was less in the SCC group. This difference was statistically significant(p<0.05). In conclusion, complete corpus callosotomy had contributed to the protective effect on the development of status epilepticus in the lithium-pilocarpine model which was similar to that observed in humans. And result of Fos expression suggest that Fos immunohistochemisty may be useful in the study of seizure pathways as a metabolic marker in the lithium-pilocarpine model.
Animals ; Cerebral Cortex ; Electroencephalography ; Epilepsy ; Humans ; Rats* ; Rats, Sprague-Dawley ; Seizures ; Status Epilepticus