A 70-year-old male with a history of diabetes mellitus, hypertension, and coronary stent insertion visited our hospital 7 days after biting his lower lip. Swelling and inflammation had worsened despite debridement and antibiotic treatment. On the 8th hospital day, fungal infection with Candida albicans and superimposed bacterial infection with Klebsiella pneumoniae were found on tissue culture. Extensive necrosis resulted in a defect of approximately 3/4 of the entire lower lip and a full-layer skin defect from the vermilion to the gingivobuccal sulcus at the right corner of the mouth. To correct drooling, incomplete lip sealing, and trismus, staged reconstruction was performed with consideration of cosmetic and functional features. The treatment process using staged reconstruction and antifungal treatment for an extensive lower lip defect caused by fungal stomatitis is described.
Aged ; Bacterial Infections ; Candida ; Candida albicans ; Debridement ; Diabetes Mellitus ; Gangrene ; Humans ; Hypertension ; Inflammation ; Klebsiella pneumoniae ; Lip* ; Male ; Mouth ; Necrosis ; Noma* ; Sialorrhea ; Skin ; Stents ; Stomatitis ; Trismus

Necrotizing ulcerative stomatitis (NUS) refers to ulceration of the oral mucosa that precedes rapid orofacial soft- and hard-tissue destruction. NUS on the upper lip is considered a reconstructive challenge because of the functional importance and complex multidimensional structure of the facial units that are involved, and is most commonly found in developing countries. Therefore, few studies have been conducted on NUS. Moreover, reconstruction options vary from local regional flaps to free-tissue transfers. We report a very interesting case in which we performed regional flap surgery using bilateral cheek advancement in a patient with NUS. A 75-year-old woman with a history of diabetes mellitus and hypertension, but no other immunological diseases, presented with skin necrosis on the upper lip. At presentation, necrotic tissue covered the upper lip and philtrum, but it had not invaded the nose or lower lip. After debridement of the necrotic tissue, approximately 70% of the upper lip was missing. We therefore designed a bilateral cheek advancement and rotation flap, in which the flap was sutured in 3 layers. There was no need to perform additional procedures, as the flap healed well and showed no other complications or recurrence. The patient exhibited good voluntary muscle control and oral competence while eating and drinking, and she was also very satisfied with the cosmetic results. Thus, regional flap surgery using a simple advancement flap may result in good recovery of both functional and aesthetic units in patients with NUS.
Aged ; Cheek* ; Debridement ; Developing Countries ; Diabetes Mellitus ; Drinking ; Eating ; Female ; Gingivitis, Necrotizing Ulcerative* ; Humans ; Hypertension ; Immune System Diseases ; Lip* ; Mental Competency ; Mouth Mucosa ; Muscle, Skeletal ; Necrosis ; Noma ; Nose ; Reconstructive Surgical Procedures ; Recurrence ; Skin ; Surgical Flaps ; Ulcer*

The purpose of this study is to analyze the cariogenicity of vitamin supplements for children by the Caries Potentiality Index (CPI), pH drop capacity, proliferation rate of Streptococcus mutans.Four vitamin supplements were selected - Noma (NM), Cenovis Kids (CK), Animal Parade (AP), and Character Vitamin (CV).CPI value decreased in the order of AP, CV, CK, and NM. Initial values of all experimental groups showed acidity below pH 7.0. Analysis of the colony forming units of Streptococcus mutans showed that NM and CV resulted a higher proliferation rate (p < 0.05) than CK and AP (p < 0.05). Bacterial activity of the control group was lower than other groups when observed with a confocal laser scanning microscope.Considering the bacterial activity and acidity of vitamin supplements, it is necessary to pay close attention when children taken the vitamin supplements for their oral health.
Animals ; Biofilms ; Child ; Humans ; Hydrogen-Ion Concentration ; Noma ; Oral Health ; Stem Cells ; Streptococcus mutans ; Vitamins

PURPOSE: The aim of this study is to determine whether cardiac biomarkers, such as N-terminal-proB-type natriuretic peptide (NT-proBNP), are good predictors of adverse events in acute pulmonary embolism (APE). METHODS: We conducted a retrospective analysis of patients with APE, which was confirmed by a computed tomography in the emergency room. Patients were divided into 2 groups: the major adverse event (MAE) group and the no-MAE group. MAE was defined as one of the following occurrences: in-hospital-death, cardiopulmonary resuscitation, mechanical ventilation, vasopressors, thrombolysis, or surgical embolectomy. Blood samples were obtained during the first hour of presentation to the emergency room. RESULTS: A total of 90 patients were included in this study. Twenty-seven patients had MAE. According to the univariate analysis, NT-proBNP, troponin I, and D-dimer plasma levels were significantly higher in the MAE group than in the noMAE group (919.8 vs. 2,131.0 ng/mL, p=0.032; 0.091 vs. 0.172 ng/mL, p=0.037; 2.43 vs. 3.74 ng/mL, p=0.049, respectively). However, according to the multivariate logistic regression, NT-proBNP was not independently associated with MAE in APE (odds ratio, 1.01; 95% confidence interval, 1.00-1.01). Conversely, troponin I was independently associated with MAE (odds ratio, 1.09; 95% confidence interval, 0.99-1.18). The NT-proBNP plasma level was not significantly different between the right ventricular dysfunction (RVD) group and the no-RVD group (p=0.178). CONCLUSION: The NT-proBNP level, unlike the troponin I level, in the emergency room was not identified as an independent predictor of MAE in acute pulmonary embolism. Further studies of large-scale with controlled timing of blood sampling and echocardiography are required.
Biomarkers* ; Cardiopulmonary Resuscitation ; Echocardiography ; Embolectomy ; Emergencies* ; Emergency Service, Hospital* ; Hominidae ; Humans ; Logistic Models ; Noma ; Plasma ; Pulmonary Embolism* ; Respiration, Artificial ; Retrospective Studies ; Troponin I ; Ventricular Dysfunction, Right

Noma is a gangrenous disease of the orofacial region that leads to severe facial tissue destruction and is a significant cause of death among children. With the advent of modern antibiotics and improved nutrition, children with noma may survive into adulthood, but must face the challenge of undergoing repair of the sequelae of noma. This report describes a case of bony fusion of the maxilla and mandible in a 28-year-old female patient, which was a sequelae of a childhood case of noma.
Adult ; Anti-Bacterial Agents ; Cause of Death ; Child ; Female ; Humans ; Jaw Diseases ; Mandible* ; Maxilla* ; Noma* ; Tomography, X-Ray Computed

Cancrum oris is a kind of gangrenous disease happening on the maxillofacial region. It is characterized by developing rapidly, high lethality and deforming rate. This article reported a case of maxillofacial deformity caused by cancrum oris, and discussed based on relevant literatures.
Humans ; Maxilla ; pathology ; Noma

Acquired facial deformities following cancrum oris sequelae manifested variably according to the nature of tissue necrosis. In cases that tissue loss extends over a wide area of the face, or the tissue nature is different due to congenital facial cleft, it is difficult to reconstruct with a single operation. As cancrum oris has virtually disappeared from our country, clinical report of reconstruction is also rare. We report 5 cases of facial deformities following cancrum oris sequelae. Since 1988, five adult patients(4 female and 1 male) were treated by authors. These patients, with an age ranged from 47 to 58 years, all suffered from acquired facial cleft such as facial mutilation, asymmetry. The stages of operation were from 1 to maximum of 5 operations. All surgeries achieved satisfactory results after a long-term follow-up. But one surgery in the case of palatal mucosal flap for the coverage of reconstructed maxilla alveolar bone resulted tissue sloughness, followed by osteomyelitis. Those were debrided and discarded. In conclusion, all sites of deformities were positioned around one of the oral commissures. In their past medical history, they have been suffering from measles, typhoid fever and unknown febrile illness. We diagnosed the acquired facial deformity following cancrum oris sequelae. The reconstruction of acquired facial deformity following cancrum oris sequelae were difficult due to extensive multiple tissue defects. Therefore multiple staged operations were inevitable. The authors reconstructed 5 cases of simple and complex form of facial deformity with minimum staged\ operations. All patients were satisfied functionally and cosmetically.
Adult ; Congenital Abnormalities* ; Female ; Follow-Up Studies ; Humans ; Maxilla ; Measles ; Necrosis ; Noma* ; Osteomyelitis ; Typhoid Fever

Congenital macrostomia is a result of defective union between the mandibular and maxillary processes and it is a rare deformity seen in every 100 to 300 facial clefts. Ohnizuka1`classified macrostomia into two groups as congenital and posttraumatic. We experienced two cases of acquired macrostomia due to NOMA sequelae(58/F:Lt & 51/F:Rt) and one case of congenital macrostomia (3 months/M:Rt). Many plastic surgeons have developed surgical procedures for repair of this congenital macrostomia. Among them, McCarthy6,11 described the classic commissuroplasty. We could repaired 1 case of congenital macrostomia and two cases of acquired macrostomia due to NOMA sequelae using modified technique of McCarthy,s classic commissuroplasty. McCarthy described new oral commissure 2-3mm laterally for prevention of postoperative contraction, orbicularis oris muscle transposition to restore labial function and a z- plasty cutaneous closure. But some author raise an objection to new oral commissure 2-3mm laterally, and they made new oral commissure at same distance of opposite side normal commissure. And so, we designed the new oral commissure moved 1mm laterally comparing to original commissuroplasty in a congenital case for the prevention of displacement. In cases of acquired macrostomia due to NOMA sequelae, we reconstructed new oral commissure like congenital case, moved 1mm laterally. Orbicularis oris muscle transposition could not be possible because of destruction of muscle, adhesion and atrophy. And so we dissected muscle and just sutured side by side. Acquired macrostomia following NOMA sequelae manifsted facial deformity variably, and reconstruction of the facial deformity is difficult by using simple approach. Other variable reconstructive procedures were needed with commissuroplasty as like Washio flap, rotation advancement flap, bone graft and free radial forarm flap, etc. Postoperative results were relatively good. We propose that macrostomia due to NOMA sequelae must add to Ohnizuka classification of acquired macrostomia.
Atrophy ; Classification ; Congenital Abnormalities ; Macrostomia* ; Noma ; Transplants

PURPOSE: A pancreaticoduodenectomy is the procedure of choice for patients with resectable carci nomas of the pancreatic head, duodenum, or periampullary region. Although the morbity and the mortality are decreasing now, but there are still high. Leakage of the pancreatic duct remains the major source of death and complications after a pancreaticoduodenectomy. Thus, the authors used a stented pancrea ticojejunostomy and jejunojejunostomy after a pancreaticoduodenectomy to decrease leakage of the pancreatic duct. METHODS: The authors studied retrospectively 44 consecutive patients who had a pancrea ticoduodenectomy with a stented pancreaticojejunostomy and jejunojejunostomy at Kwangju Christian Hospital between 1993 and 1998. RESULTS: Leakage of the pancreaticojejunostomy was diagnosed in one of the 44 patients (2.5%). There were two deaths after the pancreaticoduodenectomy, one from compli cation of leakage of the pancreaticojejunostomy and the other from UGI bleeding. CONCLUSION: The stented pancreaticojejunostomy and jejunojejunostomy is an effective and safe method for use with a pancreaticoduodenectomy. However, the leakage that might occur despite the stented pancreaticojeju nostomy and jejunojejunostomy can be managed less invasively.
Duodenum ; Gwangju ; Head ; Hemorrhage ; Humans ; Mortality ; Noma ; Pancreatic Ducts ; Pancreaticoduodenectomy* ; Pancreaticojejunostomy* ; Retrospective Studies ; Stents*

BACKGROUND: Activation of the K-ras oncogene by specific point mutations at codon 12 occurs at a remarkably high frequency in pancreatic adenocarcinomas. Also, inactivation of the p53 suppressor gene function in pancreatic adenocarcinomas leads to the loss of cellular proliferation regulation and to the induction of cell death. Though K-ras mutation and inactivation of the p53 suppresser gene have been considered to be events in the oncogenesis of a pancreatic adenocarcinoma, whether their association with differences or survival in pancreatic adenocarcinoma is controversial. We investigated the presence of K-ras mutation and overexpression of p53 protein in the carcinogenesis of a pancreatic adenocarcinoma. Also, their correlations with tumor grade, stage, and survival were investigated. METHODS: We examined surgically resected, formalin-fixed, paraffin-embedded pancreatic adenocarci nomas from 48 patients. By using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), we detected a K-ras oncogene mutation at codon 12. An overexpression of p53 protein was detected by using an immunohistochemical staining (IHC) method with anti-p53 monoclonal antibody. RESULTS: K-ras oncogene mutation at codon 12 was detected in 64.6% of the cases and p53 protein was overexpressed in 47.9%. Both K-ras oncogene mutation and p53 protein overexpression were detected in 29.2% of the cases. There was no correlation between the rate of K-ras mutation and tumor grade, T category (tumor size or depth of invasion), N category (lymph-node metastasis) and clinical stage. Also, K-ras mutation was not correlated with the survival rate. A positive correlation between p53 protein overexpression and clinical stage was found (p<0.05). The patients with p53 protein overexpression had a shorter survival than the patients without p53 protein overexpression (p>0.05). CONCLUSION: The mutation of the K-ras oncogene and p53 suppresser gene might play an important role in pancreatic carcinogenesis. However, the mutation of the K-ras oncogene is not thought to be related to the progression of a pancreatic adenocarcinoma and the corresponding survival rate. It is suggested that overexpression of the p53 protein seems to be associated with the progression of pancreatic adenocarcinoma.
Adenocarcinoma* ; Carcinogenesis ; Cell Death ; Cell Proliferation ; Codon ; Genes, ras ; Genes, Suppressor ; Humans ; Noma ; Point Mutation ; Prognosis ; Survival Rate