Chest wall osteoradionecrosis, one of the most serious complications of radiation therapy for breast cancer treatment, is usually treated by wide debridement followed by coverage with a well-vascularized flap. However, the extent of radiation-induced injury and limits in performing wide resection of the injured bones often present challenges in treatment. Herein, we present our experience treating chest wall osteoradionecrosis with a contralateral breast Y-V flap in an 81-year-old woman. She was diagnosed with chest wall osteoradionecrosis and had grade 3 ptotic breasts. Redundant contralateral breast tissue was used for reconstruction to cover the wound. The flap was elevated in the subfascial plane after an inverted-T incision was made in the lower pole and inframammary fold of the contralateral breast, while preserving the perforators of the left lateral thoracic artery. The flap was spread using the Y-V advancement fashion to cover the wound. The patient was discharged 2 weeks after surgery. At 19 months postoperation, there were no complications or recurrence. The patient was satisfied with the short recovery time and surgical results. The contralateral breast Y-V flap allows simple and quick reconstruction, potentially expanding the available treatment options and therefore increasing flexibility in choosing a treatment plan for patients.

To investigate the risk factors and clinical characteristics of postrenal transplant diabetes mellitus (PTDM), we reviewed the records of 177 renal allograft recipients in Maryknoll Hospiatal whose allografts had functioned longer than 6 months. Nineteen patients (10.7%) developed PTDM at 5.0+/-7.8 (1-52) months; 9 (47%) of these within 1 month. PTDM patients were older than nondiabetic renal transplants (42+/-2 vs 37+/-1 years, P<0.05). Body mass index tended to be higher in PTDM (23.5+/-1.0 vs 21.8+/-0.3kg/m2, P=0.09). Number of acute rejections (0.6+/-0.2 vs 0.5+/-0.1) and serum creatinine at 1 year after transplantation (1.2+/-0.8 vs 1.3+/-0.3mg/dL) were not different. Fasting (103.6+/-10.4 vs 84.4+/-1.6mg/dL, P<0.05) and postprandial (189.2+/-24.8 vs 118.6+/-2.3 mg/dL, P<0.01) blood sugars, measured before transplantation, were higher in PTDM. CsA blood level at 1 month posttransplantation was higher in PTDM (350+/-34 vs 279+/-8ng/mL, P<0.05). Fasting serum insulin was significantly higher (28.2+/-12.2 vs 7.3+/-2.0 microunit/dL, P<0.05) and serum C-peptide tended to be higher in PTDM patients compared with euglycemic renal recipients (6.3+/-1.6 vs 3.8+/-0.9ng/dL, P=0.08). All the PTDM patients were treated by either insulin or oral agent; 15 of 19 required no treatment after 4.7+/-6.9 months. In conclusion, prevalence of PTDM was 10.7%. PTDM patients were older. Body mass index was tended to be higher. Fasting and postprandial blood sugars, measured before transplantation, were higher in PTDM. Faslting serum insulin was higher and C-peptide tended to be higher in diabetics. These results suggested that increased insulin resistance plays a major role in the pathogenesis of PTDM.
Allografts ; Blood Glucose ; Body Mass Index ; C-Peptide ; Creatinine ; Cyclosporine ; Diabetes Mellitus* ; Fasting ; Humans ; Insulin ; Insulin Resistance ; Prevalence ; Risk Factors*

In order to determine the contamination status of contact lens care system by Acanthamoeba, a nation-wide survey was carried out for the detection of amoeba from the storage cases and contact lenses solution of 739 asymptomatic lens wearers (238 male and 501 female). Subjects consisted of 280 residents in Youngnam, 270 in Honam, and 189 in Chungbu provinces. Acanthamoeba was demonstrated from 141 (19.1%) lens care systems. No significant difference of contamination status was observed between male (19.7%) and female (18.8). However, the contamination rate from Honam province (28.1%) were significnatly higher than those from Youngnam (16.1%) and Chungbu (10.6%) provinces. The isolation rate for Acanth-amoeba was higher in systems of daily wear soft lens (20.0%), extended wear soft lens (23.1), and hard lens (18.8%) than in system of disposable lens. The contamination rate was the higher in the sysems using chemical disinfection alone (19.8%) for disinfection. The contamination rate in systems of combined disinfection with chemicals and intermittent boiling ranged 7.0% to 8.3%, and it was different according to the boiling frequency a week. More attention should be paid to hygeneic maintenance of contact lens care system for the prevention of contact lens-related Acanthamoeba keratitis.
Acanthamoeba Keratitis ; Acanthamoeba* ; Amoeba ; Contact Lenses ; Disinfection ; Female ; Humans ; Korea* ; Male

Background: Acellular dermal matrix (ADM) is widely used for prosthetic breast reconstruction. Although many studies have investigated the efficacy and complications of ADM in prosthetic breast reconstruction, studies on drainage and seroma formation according to the size of ADM manufactured using the same process are lacking. This study analyzed drainage and seroma formation according to the size of sterile ADM. Methods: From January 2011 to June 2018, the authors retrospectively reviewed the medical charts of patients who underwent direct-to-implant breast reconstruction using MegaDerm at a single institution. The ADMs used were classified as small or large groups. The two groups were compared in terms of the volume and duration time of two closed-suction drains (supramuscular and submuscular drains). Seroma and infection risk were also analyzed. Results: Of 344 patients, 69 were included. Among them, 22 patients were in the small-ADM group and 47 patients were in the large-ADM group. The supramuscular drain volume (P=0.295) and time (P=0.365) were not significantly different between the two groups. However, the submuscular (P=0.001) and total drain volume (P=0.004) were higher in the large-ADM group. In addition, seroma occurred significantly more frequently in the large-ADM group (P=0.048), but there was no significant difference in minor infections (P=0.088). Conclusions The size of sterile ADM affected drainage and seroma formation, with a larger size increasing drain volume and seroma risk. This study could provide a clinical basis for the safe usage of large sterile ADM.

BACKGROUND: Minimally invasive techniques for open heart surgery are widely accepted in these days. There are minimally invasive approaches by the right or left parasternal incision and another approaches by mini-sternotomy of upper or lower half or sternum. We report the safety and efficacy of minimally invasive technique with right parasternal incision compared with the routine full sternotomy. MATERIAL AND METHOD: From April 1997 through February 1999, 20 patients (Group A) underwent minimally invasive cardiac operations. We chose 41 patients (Group B) whose preoperative diagnosis were the same and general conditions were similar and who underwent routine full sternotomy before April 1997. We compared A group and B group in many aspects. We performed routine full median sternotomy in B group but we did a minimally invasive technique through a small right parasternal incision in A group. RESULT: mean age was 36.1 years in both groups. In disease entities, there were 11 cases of ASD, 9 cases of mitral valve disease in group A, and 16 cases of ASD, 25 cases of mitral valve diseases in group B. In ASD, operation time, cardiopulmonary bypass time of aortic occulusion time were 263 min, 82 min, and 41 min in group A and 180 min, 53 min, and 32 min in group B. In mitral valve disease, operation time, cardiopulmonary bypass time and aortic occlusion time were 267min, 106 min, and 70min in A group and were 207 min, 82 min, and 69 min in group B. There were significant differences in operation time, CPB time, and ACC time between group A and group B. There was a significant difference in the amount of bleeding in postoperative day 1 between group A and group B of mitral diasease. However, there was no significant difference in the amount of bleeding in other comparisons. Mean length of incision was 8.7 cm in group A. There was no significant difference in postoperative complications between A group and B group. There was no mortality in either group. CONCLUSION: We conclude that this minimally invasive technique with right parasternal incision is cosmetically excellent but it is not effective in reducing operative time and there was no significant difference in recovery time and postoperative complications compared with routine full sternotomy.
Cardiopulmonary Bypass ; Diagnosis ; Hemorrhage ; Humans ; Mitral Valve ; Mortality ; Operative Time ; Postoperative Complications ; Sternotomy ; Sternum ; Thoracic Surgery*

BACKGROUND: There has been controversy over the prevalence of recoarctation in infants treated by subclavian flap aortoplasty (SFA) for coarctation of the aorta. To assess the rate of recurrence of coarctation after SFA, we reviewed the surgical results of SFA in infants with coarctation of the aorta. MATERIAL AND METHOD: Between 1986 and 1998, a total of 25 patients less than 1 year of age (12 neonates and 13 infants) underwent SFA for aortic coarctation. Age at operation was 3.0+/-3.0 months (mean +/- standard deviation); mean weight was 5.0+/-1.4kg. Classic SFA was performed in 20 patients, reversed SFA in 2 patients, subclavian artery reimplantation in 2 patients and the combined resection-flap aortoplasty in one. The aortic clamping time ranged from 20 to 88 minutes(mean 35.8 minutes). There were one operative death and two late deaths. There was no case of paraplegia or left arm ischemia in complications. Twenty-one (84%) of 24 hospital survivors were followed for 26.0+/-24.0 months. The risk of recoarctation in neonates (33.3%) was a little greater than infants (25.0%) without statistical significance. CONCLUSION: This study revealed that SFA resulted a relatively high incidence of recarctation in infants. It is desirable to select other methods of surgical treatment (combined resection-flap aortoplasty, extended end-to-end repair etc.) for severe isthmic coarctation or hypoplasia of the distal aortic arch in infants, instead of choosing SFA indiscriminately.
Aorta, Thoracic ; Aortic Coarctation* ; Arm ; Constriction ; Humans ; Incidence ; Infant* ; Infant, Newborn ; Ischemia ; Paraplegia ; Prevalence ; Recurrence ; Replantation ; Subclavian Artery ; Survivors

BACKGROUND: Median sternotomy remains the standard approach used by surgeons for most intracardiacscar we have tried to use alternative skin incision (bilateral subm-ammary skin incision) to median sternal skin incision, In this study we have tried to compare different postoperative results of wound between two different skin incisional methods. MATERIAL AND METHOD: Between June 1997 and June 1998, a bilateral subma-mmary skin incision combined with v operations but the residual scar is cosmetically unsatisfactory. To avoid an unsightly midline ertical sternotomy was performed in 21 pediatric female patients (submammary group)to repair acyanotic congenital heart disease. after the period we carried out a retrograde sion controls in whom there were 23 pediatric patients (control group). RESULT: Patients' age ranged from 14 to 96 months(mean 38.2 months) Mean duration of subcutaneous drains using Hemovac which was used only in the patients of submammary group was 4.2 days and total amount of the drained effusion was 51.1 ml. Postoperative wound complications included wound eruption in one patient wound disruption in one patient and skin necrosis in 3 patients in submammary group and included wound disruption in 4 patients in controls. mean duration required for wound healing was 15,5 days in submammary group versus 10.4 days in controls. The mean scar length was 12.5 cm in submammary group versus 11.3 cm in controls. The average follow-up was 8.2 months in submammary group versus 9.0 months in controls. In submammary group 3 patients parents(14.3%) were pleased with their cosmetic results of wound scar but 8(38.1%) were dissatisfied. Among the 23 patients in control group 8(34.8%) were pleased but 8(34.8%) complained ofunhappiness with the scar.
Cicatrix ; Female ; Follow-Up Studies ; Heart Defects, Congenital ; Heart* ; Humans ; Necrosis ; Skin* ; Sternotomy* ; Thoracic Surgery* ; Wound Healing ; Wounds and Injuries*

Subgenus classification of Acanthamoeba remains uncertain. Twenty-three reference strains of Acanthamoeba including 18 (neo)type-strains were subjected for classification at the subgenus level by riboprinting. PCR/RFLP analysis of 18S rRNA gene (rDNA). On the dendrogram reconstructed on the basis of riboprint analyses, two type-strains (A. astronyxis and A. tubiashi) of morphological group 1 diverged early from the other strains and were quite distinct from each other. Four type-strains of morphological group 3, A. culbertsoni, A. palestinensis, A. healyi were considered taxonomically valid, but A. pustulosa was regarded as an invalid synonym of A. palestinensis. Strains of morphological group 2 were classified into 6 subgroups. Among them, A. griffini which has an intron in its 18S rDNA was the most divergent from the remaining strains. Acanthamoeba castellanii Castellani, A. quina Vil3, A. lugdunensis L3a, A. polyphaga Jones, A. triangularis SH621, and A. castellanii Ma strains belonged to a subgroup, A. castellanii complex. However, A. quina and A. lugdunensis were regarded as synonyms of A. castellanii. The Chang strain could be regarded as A. hatchetti. Acanthamoeba mauritaniensis, A. divionensis, A. paradivionensis could be considered as synonyms of A. rhysodes. Neff strain was regarded as A. polyphaga rather than as A. castellanii. It is likely that riboprinting can be applied for rapid identification of Acanthamoeba isolated from the clinical specimens and environments.
Acanthamoeba/genetics ; Acanthamoeba/classification* ; Animal ; DNA, Protozoan/analysis ; Polymerase Chain Reaction/methods* ; Polymorphism, Restriction Fragment Length* ; RNA, Protozoan/genetics ; RNA, Protozoan/analysis* ; RNA, Ribosomal, 18S/genetics ; RNA, Ribosomal, 18S/analysis*

Transmission electron microscopy of an Acanthamoeba isolate (KA/L5) from a contact lens case revealed bacterial endosymbionts within cytoplasm of the amoebae. The Acanthamoeba isolate belonged to the morphological group II. Based on the polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) of 18S ribosomal RNA coding DNA (rDNA), the isolate was identified as A. lugdunensis. Strain typing by isoenzyme analysis using isoelectric focusing (IEF) and mitochondrial (Mt) DNA RFLP revealed that the isolate was closely related with KA/L1, the most predominant type of isolates from contact lens storage cases, KA/E2, a clinical isolate, KA/W4, previously reported to host endosymbionts, and L3a strains of A. lugdunensis. The endosymbionts were similar to those of KA/W4 in aspects that they were randomly distributed in both trophozoites and cysts, and were rod-shaped bacteria measuring approximately 1.38 x 0.50 microns. But the number of endosymbionts per amoeba was significantly lower than that of KA/W4. They were neither limited by phagosomal membranes nor included in lacunaelike structure.
Acanthamoeba/microbiology* ; Acanthamoeba/cytology ; Animal ; Bacteria/isolation & purification* ; Colony Count, Microbial ; Contact Lenses* ; Cytoplasm/microbiology ; Symbiosis*

To evaluate amoebicidal efficacy of various disinfectants, we treated ten ocular isolates of Acanthamoeba with polyhexamethylene biguanide(PHMB), chlorhexidine and hexamidine. Acanthamoeba cysts were collected from axenic nonnutrient agar plates from 4 week culture. Cyst suspension(100microliter) was inoculated on 96-well microplate with concentration of 105 cys/ml. Each well was treated with two-fold diluted hexamidine, PHMB and chlorhexidine(100microliter each, 8 and 48hrs). Each well was examined under the inverted microscope until 7 days after treatment. Minimal cysticidal concentration(MCC) of each disinfectant qas measured after five experiments. MCC of hexamidine, chlorhexidine and PHMB against ten ocular isolates ranged 6.07-500microgram/ml, 3.12-12.50microgram/ml, 1.17-4.68microgram/ml respectively in 48hr treatment. In 8hr treatment, MCC of PHMB and chlorhexidine ranged 4.42-12.50microgram/ml and 4.67-17.71microgram/ml, but hexamidine did not demonstrate cysticidal effect. For proper disinfection of contact lens, disinfectants having cysticidal efficacy should be included in the composition of contact lens solution. Among the currently used topical amoebicidal agents, PHMB showed the greatest cysticidal activity on ten ocular strains of Acanthamoeba in invitro study.
Acanthamoeba* ; Agar ; Chlorhexidine* ; Contact Lens Solutions ; Disinfectants ; Disinfection