The clinical applications of free have been extended tremendously in head and neck reconstruction. In a nine-year period, 92 microvascular free flaps were performed to repair the defects following major head and neck ablative surgery. Twenty-one transverse rectus abdominis myocutaneous flaps, 18 radial foream flaps, 15 latissimus dorsi muscle flaps, 12 jejunal flaps, 8 fibular osteocutaneous flaps, 6 rectus abdominis muscle flaps, 6 iliac osteomyocutaneous flaps, 2 groin fasciocutaneous flaps, 1 scapular fasciocutaneous flap, 1 parascapular osteocutaneous flap, 1 tensor fascia lata muscle flap and 1 serratus anterior muscle flap were used for reconstruction. Twenty-five maxillary defects including the orbit or skull base, 16 pharyngoesophageal defects, 15 intraoral defects, 15 mandibular defects, 13 scalp defects, 1 cervical region and 7 other facial region were covered with various free flaps. The overall success rate of the flaps was 95.6%. The complications included total flap loss (3 cases), partial flap loss (1 case), recurrence of primary tumors (15 cases), cerebrospinal fluid leakage (3 cases), fistula formation (3 cases) and infection (5 cases). Superficial temporal artery, facial artery, superior thyroidal artery, lingual artery, occipital artery, transverse cervical artery were commonly used recipient arteries and 7 cases of vein grafts were used if indicated. End to end anastomosis was performed in 84 cases and end to side anastomosis in 8 cases. The average follow-up period was 42 months, ranging from 6 months to 8 years. One patent died during postoperative intensive care due to sepsis and 19 patients died because of recurrence of tumors and underlying medical diseases during the follow-up period. Although free flaps may appear to be riskier than traditional forms of reconstruction, they offer the surgeon a greater spectrum of reconstructive options. Free flap reconstruction also improves the quality of life and minimizes the loss of function. Limitations of the use of free flaps result only from a lack of technical skills and specialized equipment.
Arteries ; Cerebrospinal Fluid ; Fascia Lata ; Fistula ; Follow-Up Studies ; Free Tissue Flaps* ; Groin ; Head* ; Humans ; Critical Care ; Myocutaneous Flap ; Neck* ; Orbit ; Quality of Life ; Rectus Abdominis ; Recurrence ; Scalp ; Sepsis ; Skull Base ; Superficial Back Muscles ; Temporal Arteries ; Thyroid Gland ; Transplants ; Veins

Until recently, cranial base tumors or midfacial tumors were deemed unresectable due to an inability to accurately diagnose the extent of the involvement and to approach and excise the tumor safely. With refinements in CT and NMR scanning, as well as the development of craniofacial technique, reconstruction has become absolutely crucial in allowing successful resection of these tumors. Resection of these tumors may sometimes result in massive and complex extirpation defects that are not amendable to local tissue closure. In such cases, free tissue transfer was an effective alternative because it can provide a large amount of well-vascularized tissues arts reliable separation of the intracranial space from bacterial flora of the upper airway. Microvascular free tissue transfer was used in 15 patients at our center to reconstruct the cranial base and/or midfacial defects. Of these 12 were free rectus muscle flaps, 2 were free latissimus dorsi muscle flaps, 1 was a free scapular osteocutaneous flap and 1 was a free scapular fasciocutanegus flap. There were 2 cases of total flap loss. In those cases, revisions were performed using latissimus dorsi muscle free flap in one case and STSG in the other. One patient had a postoperative cerebrospinal fluid leak which was spontaneously resolved by conservative management. The large complex defects were successfully reconstructed by one-stage operation and the functional and esthetic results wee satisfactory with acceptable complication rates.
Cerebrospinal Fluid ; Free Tissue Flaps ; Humans ; Skull Base* ; Superficial Back Muscles

No abstract available.
Female ; Hysterectomy, Vaginal*

We report a case of lupus vulgaris following BCG vaccination in a 12-year-old male. The patient was vaccinated against tuberculosis on right shoulder 6 months ago. The erythemstous papular eruptions began to develop on the BCG vaccinated site 2 weeks after vaccination. The eruptions progressed to be pruritic, erythematous plaque which was flat, crescent shaped, and centrally covered by adherent scales for 6 months. Histopathological findings revealed tubercles and tuberculoid structures composed of epitheloid cells and Langhans giant, cells in the dermis. Caseation necrosis within the tubercles was slight or absent. In addition, there was an infiltrate of mononuclear cells around the tubercles. The skin lesions cleared after 6 months of treatment with oral isoniazid 300mg daily.
Child ; Dermis ; Humans ; Isoniazid ; Lupus Vulgaris* ; Male ; Mycobacterium bovis* ; Necrosis ; Shoulder ; Skin ; Tuberculosis ; Vaccination* ; Weights and Measures

Sclerosing lymphangitis of the penis is a rare disorder characterized by painless. firm. cord-like lesion in the coronary sulcus of the penis. Although sexual trauma may be causative factor the etiology is unknown. Histologic findings reveal hypertrophy and sclerosis of lymphatic vessel wells, and some cases show thrombus formation within dilated vessels. Most cases are self-limited and conservative management is indicated. We report two cases of sclerosing lymphangitis of the penis in a 37-year-old man and a 28-year-old man.
Adult ; Humans ; Hypertrophy ; Lymphangitis* ; Lymphatic Vessels ; Male ; Penis* ; Sclerosis ; Thrombosis

Congenital dyserythropoietic anemia Type II (herditary erythroblatic multinuclearity with positive acidified serum test; HEMPAS) is characterized by binuclearity, multinuclearity, pluripolar mitoses, karyorrhexis of normoblasts, and the presence of abnormal antigens on the red cells. We experienced a case of HEMPAS in a 2 month old girl patient who had an intermittent fever, abdominal distention with palpable liver & spleen, and generalized jaundice. The blood analysis revealed anemia, and thrombocytopenia. Peripheral blood smear showed an averge of 6 mature normoblast per 100 leukocyte count. The red cells showed moderate anisocytosis, poikilocytosis, irregularly crenated, contracted cells and occasional spherocytes. The leukocytes showed relative lymphocytosis, and there were occasional villous lymphocytes. The marrow smear showed abnormality in erythroid series. About ten percent of the erythroblasts showed 2~7 nuclei or lobulated nuclei. The mitotic forms of the erythroid precursors were also increased in frequency. The M:E ratio was 1:3.2. Blood culture on this patient showed a pure growth of Coxiella burnetti. Medical treatment with Doxycycline and Rifampin was performed. After treatment, she became afebrile showing improved general condition with decreased size of liver & spleen. In spite of clinical improvement, she died suddenly 3 weeks after initial treatment.
Anemia ; Anemia, Dyserythropoietic, Congenital* ; Bone Marrow ; Coxiella ; Doxycycline ; Erythroblasts ; Female ; Fever ; Hempa ; Humans ; Infant ; Jaundice ; Leukocyte Count ; Leukocytes ; Liver ; Lymphocytes ; Lymphocytosis ; Mitosis ; Rifampin ; Spherocytes ; Spleen ; Thrombocytopenia

No abstract available.
Fetal Macrosomia*

PURPOSE: To determine the accuracy of automated computer aided volumetry for simulated small pulmonary nodules at computed tomography using various types of phantoms MATERIALS AND METHODS: Three sets of synthetic nodules (small, calcified and those adjacent to vessels) were studied. The volume of the nodules in each set was already known, and using multi-slice CT, volumetric data for each nodule was acquired from the three-dimensional reconstructed image. The volume was calculated by applying three different threshold values using Rapidia(R) software (3D-Med, Seoul, Korea). RESULTS: Relative errors in the measured volume of synthetic pulmonary nodules were 17.3, 2.9, and 11.5% at -200, -400, and -600 HU, respectively, and there was good correlation between true volume and measured volume at -400 HU (r=0.96, p<0.001). For calcified nodules, relative errors in measured volume were 10.9, 5.3, and 16.5% at -200, -400, and -600 HU, respectively, and there was good correlation between true volume and measured volume at -400 HU (r=1.03, p<0.001). In cases involving synthetic nodules adjacent to vessels, relative errors were 4.6, 16.3, and 31.2 % at -200, -400, and -600 HU, respectively. There was good correlation between true volume and measured volume at -200 HU (r=1.1, p<0.001). CONCLUSION: Using computer-aided volumetry, the measured volumes of synthetic nodules correlated closely with their true volume. Measured volumes were the same at each threshold level, regardless of window setting.
Cone-Beam Computed Tomography ; Seoul

Prostate intraepithelial neoplasia (PIN) is a putative premalignant change in the human prostate, which is an intraluminal proliferation of the secretory cells of the prostatic duct-acinar system that is enveloped by a basal cell layer and displays a spectrum of dysplastic cytologic features ranging from minimal atypia (low grade PIN) to those which are ultimately indistinguishable from carcinoma cells (high grade PIN). To evaluate the clinical significance of the PIN in prostatic tumor and BPH, we reviewed the serum prostate specific antigen (PSA), prostate specific antigen density (PSAD), and pathologic findings in the specimen of 21 BPH and 11 Prostate cancers, which were pathologically confirmed. The distributions of PIN are 7/21 (33%) in BPH and 8/ 11 (73%) in prostatic ca (P<0.05). The mean value (+/-SD) of PSA and PSAD in BPH patient were 8.42+/-5.57 ng/ml, 0.16+/-0.09 for PIN(-), 10.13+/-5.97 ng/ml, 0.17+/-0.09 for PIN(+), and in prostatic cancer patient were 60.53+/-1.83 ng/ml, 1.42+/-0.25 for PIN(-), 54.15+/-34.61 ng/ml, 1.28+/-0.84 for PIN(+), respectively. The mean value (+/-SD) of PSA & PSAD according to histologic types of BPH were 9.04+/-3.88 ng/ml, 0.17+/-0.06 for glandular type, 5. 57+/-1.31 ng/ml, 0.10+/-0.03 for stromal type, and 11.18+/-8.93 ng/ml, 0.19+/-0.13 for mixed type. The distributions of PIN according to histologic types of BPH were 30% (3/10) for glandular type, 40% (2/5) for stromal type, and 33% (2/6) for mixed type. All 7 PIN(+) BPH were low grade, while, of the 8 PIN(+) prostatic Ca, 1 was low grade and 7 were high grade. From these results, the frequent of PIN was higher in prostatic cancer than BPH (P<0.05). PIN had no significant influence on PSA elevation in prostatic cancer and BPH. There was no correction between PSA, PSAD and histologic types of BPH (P>0.05). There was no significant difference in the distribution of PIN according to histologic types of BPH. And high grade PIN was observed only in prostatic cancer. Therefore, if high grade PIN is observed in pathologic specimens, undetected prostatic cancer should be found.
Humans ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Hyperplasia* ; Prostatic Intraepithelial Neoplasia* ; Prostatic Neoplasms*

Microvascular surgery can provide the necessary soft tissue coverage from the remote donor areas by free flap transfer into the defect. Correct selection of the appropriate recipient vessels is difficult and remains the most important factor in successful free flap transfer. Recently, vascular anastomosis to recipient vessels distal to the zone of injury has been advocated and retrograde for flaps are well established in island flaps. Purpose of this study is to report our clinical experiences with lower extremity reconstruction in 9 patients. 9 patients with soft tissue defect below the knee underwent lower extremity reconstruction with distally based free flaps using retrograde arterial flow. For assessment of the retrograde flow, intraoperative retrograde arterial pressure was quantified and compared with systolic blood pressure taken at the same time. Suitable candidates had ben chosen with pulsatile retrograde flow and a diastolic retrograde arterial pressure of 60 mmHg. Three different free flaps were used. All flaps were successful. Retrograde flow anastomosis could not interrupting the major blood vessels which were essential for survival of the distal limb, the compromise of fracture or wound healing might be prevented. In cases wherein arteriography demostrates significant vascular flow interruption within the zone of injury, those are also candidate for retrograde arterial anastomosis.
Angiography ; Arterial Pressure ; Blood Pressure ; Blood Vessels ; Extremities ; Free Tissue Flaps* ; Humans ; Knee ; Lower Extremity ; Surgical Flaps ; Tissue Donors ; Wound Healing