PURPOSE: A retroperitoneoscopic adrenalectomy is theoretically the ideal procedure for an adrenalectomy. However, it is not popular due to its technical difficulty. Herein, we report our experience with retroperitoneoscopic adrenalectomies and describe the difficulties encountered during the operations. METHODS: From November 1996 to October 1999, a total of 41 retroperitoneoscopic adrenalectomies were performed. Forty (40) patients had a unilateral adrenal tumor (size: 1-6 cm): 21 aldosteronomas, 12 Cushing adenomas, 3 neurogenic tumors, 2 nonfunctioning adenomas, 1 vascular cyst, and 1 angiomyolipoma of the kidney. One (1) had bilateral hyperplasia. The operations were carried out in prone position in all cases with 3 trochars. RESULTS: Thirty five (35) operations were completed endoscopically. Five were converted to open procedures, and one was converted to a transperitoneal laparoscopic approach. The causes of conversion were 1 severe subcutaneous emphysema, 2 technical difficulties, 1 bleeding, 1 partial nephrectomy, and 1 missing tumor. The average operating time for the complete endoscopic adrenalectomies was 183 minutes in the first 14 cases and 142 minutes in the next 21 cases. There was no operative morbidity or mortality. The average hospital stay was 4.3 days in the first 14 cases and 2.8 days in the next 21cases. CONCLUSION: A retroperitoneoscopic adrenalectomy is a less invasive procedure than any other adrenalectomy procedure, and its only disadvantage is technical difficulty. However, the technical difficulty can be overcome with increasing experience.
Adenoma ; Adrenalectomy* ; Angiomyolipoma ; Hemorrhage ; Humans ; Hyperplasia ; Kidney ; Length of Stay ; Mortality ; Nephrectomy ; Prone Position ; Subcutaneous Emphysema

The objective of this study is to establish the genotyping methods of new HLA gene, TAP1 and TAP2, and determine the genetic polymorphisms for database study in Koreans before using in clinical laboratory. Polymerase chain reaction- Restriction Fragment Length Polymorphism (PCR-RFLP) and PCR-Sequence Specific Primers (PCR-SSP) techniques were used for TAP1 and TAP2 genotying, respectively. Restriction enzymes, Bcll and Accl, and 4 oligonucleotide primers were used for the PCR-RFLP analysis of TAP1. Whereas for PCR-SSP assay of TAP2, 12 oligonucleotide primers were synthesized. The results of control cells were correlated well with the types which were analyzed at Xlth histocompatibility international workshop. Arnong three and six different alleles of TAP1 and TAP2 found in 200 unrelated Korean individuals, TAP1A (84%) was the most frequent allele. TAP1B and TAP1C were 15.5% and 0.5% respectively. TAP2A represented more than a half (55.1%). TAP2B and TAP2C were 32.2% and 9.2% respectively. TAP1D, TAP2F and TAP2G were not found in Koreans.
Alleles ; DNA Primers ; Education ; Histocompatibility ; Polymerase Chain Reaction ; Polymorphism, Genetic* ; Polymorphism, Restriction Fragment Length

The use of a cultured autologous keratinocyte sheet has become a recognized method for the coverage of extensive bums during recent years. The disadvantages of these sheet grafts are a long time-lag until keratinocyte sheets are available, the fragility and difficulty in handling of grafts, an unpredictable take rate and extremely high costs. In this study we investigated the transplantation of cultured keratinocytes as single cells suspended in autologous fibrin glue. In a rat model with standardized full thickness wounds, this new transplantation technique was evaluated and compared directly to the conventional keratinocyte sheet grafting technique. After transplantation, wounds were evaluated for the degree of epithelial coverage, and then microscopic structures were evaluated under light and electron microscopy. The results were as follows: 1) The fibrinogen solution prepared from autologous blood had 12 times more fibrinogen compared to the original blood. 2) After transplantation of cultured keratinocyt-es in fibrin glue, the degree of epithelial coverage was 79% at 2 weeks, which was comparable to 17% for cultured keratinocyte sheet graft 3) Typical basement membrane structures were consistently found at 2 weeks after transplantation of keratinocytes in fibrin glue. 4) Rete ridges were found at 4 weeks after transplantation of keratinocytes in fibrin glue. In conclusion, the transplantation technique of keratinocytes in fibrin glue is available earlier than sheet grafts, it transfers actively proliferating cells and it simplifies the grafting procedure. As well, this technique leads to an earlier epithelial covering and an earlier restoration of the dermo-epidermal junction than sheet grafting.
Basement Membrane ; Fibrin Tissue Adhesive* ; Fibrin* ; Fibrinogen ; Keratinocytes* ; Microscopy, Electron ; Models, Animal ; Transplants ; Wounds and Injuries

Little objective information is avilable on the influence of occlusive dressings on the healing of cutaneous partial skin defect wounds. Our purpose was to examine the effects of occlusive dressing by using the synthetic dressing mateial, PolyMem in the management of 2nd degree burn wounds and donor sites of split thicknes skin graft and partial-thickness wounds in rabbits. New Zealand white rabbits, 12 to 14 weeks of age, were divided into 2 groups. Two partial thickness skin wounds measuring approximately 40x30 mm were induced using a scalpel on the back of each anesthetized animal. They were designated as group I (dressing with conventional method, n=15), group II (dressing with PolyMen, n=15). Each treated wound was individually covered with the assigned dressing immediately after wounding. Wound were examined and measured at 10 days to determine the extent of healing. By day 10, the PolyMem dressed wounds were approximately 67% healed, while all vaseline gauze dressed wounds were about 50% healed. Standardized 20 mm full-thickness biopsy wounds were treated for 10 days. Section of PolyMem group at POD 10 days showed complete epidermal regeneration above fibrotic dermis (H&E, x40). Section of conventional group at POD 10 days showed marginal epidermal regeneration (H&E, x40). 72 patients (44 patients with 2nd degree burn and 28 patients with skin graft donor sites) were divided into four groups. They were designated as group I (Burn patients with PolyMem, n=24), group II (Burn patients with conventional methods, n=24), group III (S.T.S.G. patients with PolyMem, n=14), group IV (S.T.S.G. patients with conventional methods, n=14). We investigated wound site pain, healing time, comfort and numbers of dressing change. As compared with the control group, the PolyMem dressed group had less pain, more rapid healing time, more comfort, less frequent dressing changes. From these results, we concluded that the occlusive dressing with PolyMem was an effective alternative to the conventional gauze dressig on the wound healing. Our results suggest tat PolyMem is one of the ideal dressing materials.
Animals ; Bandages ; Biopsy ; Burns ; Dermis ; Humans ; Occlusive Dressings ; Petrolatum ; Pheniramine ; Rabbits ; Regeneration ; Skin ; Tissue Donors ; Transplants ; Wound Healing* ; Wounds and Injuries*

No abstract available.

No abstract available.
Nasal Cavity* ; Solitary Fibrous Tumors*

No abstract available.
Stevens-Johnson Syndrome*

The result of artificial skins made with collagen is poor after grafting over the full thickness wounds due to their rapid degradation by enzymatic cleavage. This study is an in vivo study of an artificial skin made with a biodegradable polymer, which can better address the problem of the collagenous artificial dermis. To investigate the availability of a biodegradable polymer for an artificial dermis and to get an information about the optimal degradation rate of a polymer for an artificial dermis, we made an artificial dermis by seeding of fibroblasts within the vicryl mesh and made a bilayer artificial skin by covering the artificial dermis with cultured keratinocytes. And these artificial dermis and artificial skin were evaluated in a full thickness wound model. The results are as followings: 1. The artificial dermis was available for grafting for 1 week culture of vicryl mesh-fibroblast. 2. The artificial dermis retarded the contraction of full thickness wounds. 3. The artificial dermis generated the granulation tissue and accepted the STSG completely. 4. The generated tissue from the artificial dermis had incorporated into the surrounding tissue by 4 weeks postgrafting. 5. Vicryl in the artificial dermis became to biodegrade from the culture period and absorbed completely by 5 weeks. 6. The epidermal portion was poorly differntiated during in vitro culture period. In conclusion, the polymer-fibroblast graft can retard the wound contraction and generate a new tissue permitting a useful dermal replacement. And to get more optimal results, another polymer which has slower biodegradation rate than vicryl should be used for the artificial dermis and the epidermal portion should be differentiated after in vivo grafting.
Collagen ; Dermis* ; Fibroblasts ; Granulation Tissue ; Keratinocytes ; Polyglactin 910 ; Polymers ; Skin, Artificial ; Transplants ; Wounds and Injuries

No abstract available.
Fibroblasts* ; Skin*

PURPOSE: A retroperitoneoscopic adrenalectomy is theoretically the ideal procedure for an adrenalectomy. However, it is not popular due to its technical difficulty. Herein, we report our experience with retroperitoneoscopic adrenalectomies and describe the difficulties encountered during the operations. METHODS: From November 1996 to October 1999, a total of 41 retroperitoneoscopic adrenalectomies were performed. Forty (40) patients had a unilateral adrenal tumor (size: 1?? cm): 21 aldosteronomas, 12 Cushing adenomas, 3 neurogenic tumors, 2 nonfunctioning adenomas, 1 vascular cyst, and 1 angiomyolipoma of the kidney. One (1) had bilateral hyperplasia. The operations were carried out in prone position in all cases with 3 trochars. RESULTS: Thirty five (35) operations were completed endoscopically. Five were converted to open procedures, and one was converted to a transperitoneal laparoscopic approach. The causes of conversion were 1 severe subcutaneous emphysema, 2 technical difficulties, 1 bleeding, 1 partial nephrectomy, and 1 missing tumor. The average operating time for the complete endoscopic adrenalectomies was 183 minutes in the first 14 cases and 142 minutes in the next 21 cases. There was no operative morbidity or mortality. The average hospital stay was 4.3 days in the first 14 cases and 2.8 days in the next 21 cases. CONCLUSION: A retroperitoneoscopic adrenalectomy is a less invasive procedure than any other adrenalectomy procedure, and its only disadvantage is technical difficulty. However, the technical difficulty can be overcome with increasing experience.
Adenoma ; Adrenalectomy* ; Angiomyolipoma ; Hemorrhage ; Humans ; Hyperplasia ; Kidney ; Length of Stay ; Mortality ; Nephrectomy ; Prone Position ; Subcutaneous Emphysema