BACKGROUND: Most patients with head and neck cancer successfully undergo oncologic resection followed by free or local flap reconstruction, depending on the tumor’s size and location. Despite effective curative resection and reconstruction, head and neck cancer patients still face a high risk of recurrence and the possibility of a second primary cancer. Moreover, surgeons hesitate to perform sequential reconstruction following curative resection for several reasons. Few large-scale studies on this subject are available. Therefore, we retrospectively evaluated the outcome of sequential head and neck reconstruction to determine the possible risks. METHODS: In total, 467 patients underwent head and neck reconstruction following cancer resection at our center from 2008 to 2017. Of these cases, we retrospectively reviewed the demographic and clinical features of 58 who had sequential head and neck reconstruction following resection of recurrent cancer. RESULTS: Our study included 43 males (74.1%) and 15 females (25.9%). The mean age at the initial operation was 55.4±15.3 years, while the mean age at the most recent operation was 59.0±14.3 years. The interval between the first and second operations was 49.2±62.4 months. Twelve patients (20.7%) underwent surgery on the tongue, and 12 (20.7%) had procedures on the oropharynx. Thirty-four patients (58.6%) received a sequential free flap reconstruction, and 24 patients (41.4%) were treated using locoregional flaps. No cases of flap failure occurred. CONCLUSIONS: Our findings suggest that patients who need additional operations with recurrent head and neck cancer could optimally benefit from sequential curative resections and reconstructions.
Female ; Free Tissue Flaps ; Head and Neck Neoplasms ; Head ; Humans ; Male ; Microsurgery ; Neck ; Neoplasms, Second Primary ; Oropharynx ; Recurrence ; Retrospective Studies ; Surgeons ; Tongue

OBJECTIVE: We investigated the impact of depressed mood (dysphoria) and loss of interest or pleasure (anhedonia)on the risk of dementia in cognitively-normal elderly individuals. METHODS: This study included 2,685 cognitively-normal elderly individuals who completed the baseline and 4-year follow-up assessments of the Korean Longitudinal Study on Cognitive Aging and Dementia. We ascertained the presence of dysphoria and anhedonia using the Mini International Neuropsychiatric Inventory. We defined subjective cognitive decline as the presence of subjective cognitive complaints without objective cognitive impairments. We analyzed the association of dysphoria and anhedonia with the risk of cognitive disorders using multinomial logistic regression analysis adjusted for age, sex, education, Cumulative Illness Rating Scale score, Apolipoprotein E genotype, and neuropsychological test performance. RESULTS: During the 4-year follow-up period, anhedonia was associated with an approximately twofold higher risk of mild cognitive impairment (OR=2.09, 95% CI=1.20–3.64, p=0.008) and fivefold higher risk of dementia (OR=5.07, 95% CI=1.44–17.92, p=0.012) but was not associated with the risk of subjective cognitive decline. In contrast, dysphoria was associated with an approximately twofold higher risk of subjective cognitive decline (OR=2.06, 95% CI=1.33–3.19, p=0.001) and 1.7-fold higher risk of mild cognitive impairment (OR=1.75, 95% CI=1.00–3.05, p=0.048) but was not associated with the risk of dementia. CONCLUSION: Anhedonia, but not dysphoria, is a risk factor of dementia in cognitively-normal elderly individuals.
Aged ; Anhedonia ; Apolipoproteins ; Cognition Disorders ; Cognitive Aging ; Cohort Studies ; Dementia ; Depression ; Education ; Follow-Up Studies ; Genotype ; Humans ; Logistic Models ; Longitudinal Studies ; Mild Cognitive Impairment ; Neuropsychological Tests ; Pleasure ; Prospective Studies ; Risk Factors

BACKGROUND: Medium-sized congenital melanocytic nevi (CMN) require surgical excision because of the risk of malignant transformation and aesthetic concerns. There are various possible reconstruction methods after excision, such as primary repair, skin graft, local flap, and composite graft. In this study, we used skin-fat composite grafts for reconstructing full-thickness skin defects and assessed the aesthetic outcomes. METHODS: Facial nevi excision plus skin-fat composite grafts were performed in 11 children (range, 3-16 years old). All grafts were harvested from the preauricular area on one or both sides; they included the epidermis, full-thickness dermis, and subcutaneous fat. All procedures were performed simultaneously. Standardized photographs were taken preoperatively and at a mean follow-up of 10.5 months. Viewing the photographs, four plastic surgeons rated the aesthetic outcomes of all patients using the following scale: 1, poor; 2, fair; 3, good; 4, very good; and 5, excellent. RESULTS: No patient was diagnosed with malignancy. There were no complications, such as graft loss, infection, or aesthetic problems that required surgical revision. All donor sites healed well and exhibited only minimal scarring. The aesthetic outcomes of skin-fat composite grafts were outstanding with a mean score of 4.2 +/- 0.4. Most patients and parents were highly satisfied with the results. CONCLUSIONS: Skin-fat composite grafts provide good color match, texture, and contour. They are more tolerable, especially in children, because the technique involves simpler procedures and shorter operation times than local flaps. They may be the ideal option for facial defects after excision of medium-sized melanocytic nevi.
Child* ; Cicatrix ; Dermis ; Epidermis ; Follow-Up Studies ; Humans ; Nevus ; Nevus, Pigmented* ; Parents ; Reoperation ; Skin ; Skin Transplantation ; Subcutaneous Fat ; Surgical Flaps ; Tissue Donors ; Transplants*

PURPOSE: We aim to compare the erythropoietic effects of epoetin-alpha (EA, 4000 IU SC thrice a week) with those of darbepoetin-alpha (DA, 60ug IV weekly, conversion rate to EA=200:1). METHODS: Forty one stable hemodialysis patients were enrolled in this randomized crossover study. After a washout period of erythropoietin stimulating agents (ESA), the patients with hemoglobin (Hb) level of < or =11.0 g/dL were randomly assigned to DA or EA and we measured Hb and reticulocyte levels. When Hb reached >11.0 g/dL, we stopped ESA. When Hb level decreased to < or =11.0 g/dL again, we switched to alternative ESA and repeated the rest of the steps. RESULTS: Thirty six patients (M:F=20:16, age 62+/-11 years, Kt/V 1.65, nPCR 1.13 g/kg/day) completed the study. No significant differences were observed in baseline parameters between DA and EA during the period of the clinical trial. The rate of Hb level increase (EA 0.29 g/dL/week, DA 0.30 g/dL/week, p=0.76) and decrease (EA 0.45 g/dL/week, DA 0.38 g/dL/week, p=0.14) were not different between two periods. After ESA stopped, the duration of decreased Hb level of < or =11.0 g/dL was not significantly different (4 weeks in EA vs. 3.9 weeks in DA, p=0.86). Erythropoietin resistance index was 10.59 in the EA period. It was not significantly different from 10.97 in DA period (p=0.49). Nine patients (25%) showed a >30% change in EA efficiency relative to DA efficiency. CONCLUSION: There was no significant difference in erythropoietic parameters for both EA and DA.
Anemia ; Cross-Over Studies ; Erythropoietin ; Hemoglobins ; Humans ; Recombinant Proteins ; Renal Dialysis ; Reticulocytes ; Darbepoetin alfa ; Epoetin Alfa

Sirolimus is a promising immunosuppressive drug for renal transplantation to avoid nephrotoxicity of calcineurin inhibitor. However, it has been associated with uncommon but, important pulmonary toxicity. We present a case of sirolimus related dyspnea with abnormal chest radiographic finding in a 63 year old male renal transplantation recipient. There was no evidence of bacterial, fungal, or viral infection. Dose reduction of sirolimus resulted in a significant improvement of the symptoms and chest radiographic finding.
Calcineurin ; Dyspnea ; Humans ; Kidney Transplantation ; Lung Diseases, Interstitial ; Male ; Pneumonia ; Sirolimus ; Thorax

BACKGROUND: Minimal (subclinical) hepatic encephalopathy (mHE) currently diagnosed by psychometric tests or neurophysiological test adversely affects daily functioning. In view of its sociomedical relevance, simple and reproducible tests for routine diagnosis are required. The aims of this study are to evaluate cognitive function of patients with chronic liver disease by computerized neuropsychological test (STIM), and the difference of cognitive function according to Child classification. METHODS: Between June, 2002 and February, 2003 We enrolled 61 randomized consecutive patients diagnosed with chronic liver disease by biochemical tests, ultrasonographic finding or histology. This study used finger tapping, visual CPT, spatial memory test, Wisconsin card sorting test chosen from Neuscan and STIM system (Neurosoft company, U.S.A) and global-local processing test. RESULTS: In the present study, significant correlation was found between neurologic abnormalities and the degree of liver disease. The result of neuropsychological test showed that cognitive function was decreased according to the severity of chronic liver disease, especially liver cirrhosis. Cirrhotic patients, especially Child C group, exhibited selective deficits in complex attentional and fine motor skills, visuospatial perception, with preservation of memory. CONCLUSION: The STIM in this study is simple, objective and reproducible method because it can subdivide evaluation of cognitive function and computerize the measurement of response. We assume that STIM may be used early detection method of mHE if the study will be in a large scale. Because psychomotor deficits found in mHE could have a disadvanting influence on daily functioning of patients, e.g., driving abilty of a car or performance at work, we concluded early detection of mHE and aggressive treatment of mHE in clinically asymptomatic cirrhotic patients is necessary for improvement of their quality of life.
Child ; Classification ; Diagnosis ; Fingers ; Hepatic Encephalopathy ; Humans ; Liver Cirrhosis ; Liver Diseases* ; Liver* ; Memory ; Motor Skills ; Neuropsychological Tests* ; Psychometrics ; Quality of Life ; Wisconsin

BACKGROUND/AIMS: This study was designed to determine the effect of hepatic fibrotic severity on pharmacokinetics of propranolol in CCl4-treated rats. METHODS: 1 mL/kg of 10% CCl4 in olive oil was injected intramuscularly to rats twice weekly for 4, 6, 8 and 10 weeks, respectively (n=6). Control (n=6) was a sham-injected equal dose of olive oil for 10 weeks. After intravenous bolus injection of 2 mg/kg propranolol to rats, the serum propranolol concentrations were analyzed for 4 hours at various time points by a HPLC-fluorimetric system, and pharmacokinetic parameters such as C0, MRT, AUC, Vdss, t1/2( ) and CLp were determined. Then, a small amount of hepatic tissue was obtained and subjected to determination of the hepatic 4-hydroxyproline content, which confirmed the hepatic fibrotic severity. RESULTS: The serum concentrations of propranolol at 0.5, 1, 2 and 4 hours were significantly increased in CCl4-treated rats (p<0.01). In proportion to the duration of CCl4 treatment, C0 and AUC were significantly increased, and Vdss and CLp were significantly decreased (p<0.001). But MRT and t1/2( ) were not significantly changed. The hepatic 4-hydroxyproline content was gradually increased in CCl4-treated rats (p<0.001). CONCLUSION: Gradual changes in pharmacokinetic parameters of propranolol were seen to be dependent on the hepatic fibrotic severity. We suggest that gradual dosage modification, according to their hepatic fibrotic severity, is necessary for many drugs administered to patients with chronic liver disease.
Animals ; Area Under Curve ; Humans ; Hydroxyproline ; Liver Diseases ; Olea ; Pharmacokinetics ; Propranolol* ; Rats* ; Olive Oil

BACKGROUND: Malnutrition frequently occurs in patients with liver cirrhosis independently for its etiology and can modify prognosis of the disease. Since malnutrition was observed at all clinical stages, but more frequently seen at advanced stages, early and detailed nutritional assessment in all patients with liver cirrhosis is important. The aims of this study are to define the nutritional status and the difference of nutritional index according to etiology and Child classification in patients with liver cirrhosis in Korea. METHODS: A total 138 cirrhotic patients (41 alcoholic cirrhosis, 97 virus-related cirrhosis) were studied. The diagnosis of cirrhosis was based on clinical, laboratory and ultrasonographic criteria and liver biopsy. The patients were divided into three groups according to the severity of their liver disease as assessed by the Child-Pugh classification. Nutritional parameter of protein (serum albumin, serum transferrin, total lymphocyte count) were measured. RESULTS: The patients with protein malnutrition are as follows: albumin 55, transferrin 68, total lymphocyte count 8. The frequency of moderate to severe protein malnutrition was high in alcoholic cirrhosis.: albumin (<2.9 g/dL) (26.8% vs 17.5%), transferrin (<180 mg/dL) (48.5% vs 24.8%), total lymphocyte count (<1200 number/L) (2.4% vs 2.0%). The mean value of nutritional index correlated with the degree of liver function impairment. (Child C showed the lowest value). CONCLUSION: In spite of limitation of nutritional index in this study, our study showed that severe protein-energy malnutrition was rare in Korea, and protein-energy malnutrition was not only more common in alcoholic cirrhosis but related to the severity of liver disease. Therefore, our data suggests that clinician should understand the importance of not imposing unnecessary restrictions and supplementation on protein intake for fear of imbalance of nutrition.
Biopsy ; Child ; Classification ; Diagnosis ; Fibrosis ; Humans ; Korea ; Liver Cirrhosis* ; Liver Cirrhosis, Alcoholic ; Liver Diseases ; Liver* ; Lymphocyte Count ; Lymphocytes ; Malnutrition* ; Nutrition Assessment ; Nutritional Status ; Prognosis ; Protein-Energy Malnutrition ; Serum Albumin ; Transferrin

Microscopic polyangiitis (MPA) is a systemic necrotizing vasculitis of small-sized vessels (capillary, venule, or arterioles) whose clinical manifestations are very similar to those of PAN (polyarteritis nodosa), but it is characterized by the presence of rapidly progressive glomerulonephritis (RPGN), which is nearly constant, and pulmonary involvement usually absent in PAN. Peripheral neuropathy occurs in only 14~36% of the patients with MPA, distinctly less frequent than in those with classic PAN. While PAN may be considered a self-limiting disease which tend not to recur once remission is acquired, relapse occurs frequently in MPA. Prognosis has been transformed by corticosteroids and immunosuppressive drugs, especially cyclophosphamide. We reported a 72-year-old woman with subacute sensorimotor polyneuropathy involving peroneal and sural nerve accompanied by focal segmental glomerulonephritis which was proven by renal biopsy.
Adrenal Cortex Hormones ; Aged ; Biopsy ; Cyclophosphamide ; Female ; Glomerulonephritis ; Humans ; Microscopic Polyangiitis* ; Peripheral Nervous System Diseases* ; Polyneuropathies ; Prognosis ; Recurrence ; Sural Nerve ; Vasculitis ; Venules

A delayed hemolytic transfusion reaction (DHTR) is the result of delayed anamnestic alloantibody response four to fourteen days after transfusion of apparently compatible blood. Most DHTRs are very mild and may not be recognized clinically. Some are manifested only by anemia. Only a few cases are severe enough to induce a massive hemolytic reaction followed by frank renal failure. Recently, we experienced a case of DHTR with acute renal failure (ARF) due to anti-E. A 21-year-old woman received compatible four units of packed red cells after right artificial total hip replacement arthroplasty due to juvenile rheumatoid arthritis. She had a history of transfusion 4 years ago. Fourteen days after the transfusion, she showed a fall in hematocrit, hemoglobinuria and a positive indirect antiglobulin test, and accompanied by ARF. Anti-E was identified in the patient's serum by antibody screening and identification test at that time. She recovered from ARF after hemodialysis with conservative management. However, eventually, she died due to disseminated intravascular coagulopathy.
Acute Kidney Injury* ; Anemia ; Arthritis, Juvenile ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Blood Group Incompatibility* ; Coombs Test ; Female ; Hematocrit ; Hemoglobinuria ; Humans ; Mass Screening ; Renal Dialysis ; Renal Insufficiency ; Young Adult