• 제목/요약/키워드: Clinical cases

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Encountering Peritoneo-Cutaneous Perforators in Microsurgical DIEP Flap Breast Reconstruction

  • Duncan Loi;Justin L. Easton;Warren M. Rozen
    • Archives of Plastic Surgery
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    • v.50 no.2
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    • pp.153-155
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    • 2023
  • The vascular anatomy of the deep inferior epigastric artery perforator (DIEP) flap has been well studied in the planning for autologous breast reconstruction. Preoperative imaging with computed tomography angiography (CTA) provides accurate assessment of this vascular anatomy, which varies widely across patients. Several papers to date have described their encounter with an anomalous "epiperitoneal" or "peritoneo-cutaneous" perforator during flap harvest, a perforator that pierces the posterior rectus sheath from a peritoneal origin, to traverse rectus abdominis and supply the DIEP flap integument. In the course of over 3,000 CTA assessments of the vascular anatomy of the abdominal wall, we have encountered dominant peritoneo-cutaneous perforators in 1% of cases, and smaller perforators seen in many more cases, approaching 5% of cases. With increasing sensitivity of imaging, we also describe a unique case of multiple large bilateral peritoneo-cutaneous perforators, and present these findings in the context of DIEP flap harvest. It is critical to recognize these peritoneo-cutaneous perforators preoperatively to avoid mistaking them for a DIEP during the raising of a DIEP flap. The routine use of preoperative CTA enables the safe identification of individual vascular anatomy, including significant peritoneo-cutaneous perforators.

BRAFV600E Mutation Analysis in Fine Needle Aspiration Biopsy Cytology and Formalin Fixed Paraffin Embedding Block of the Thyroid

  • Han, Kyung Hee;Park, Won Young;Lee, Young Nam
    • Korean Journal of Clinical Laboratory Science
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    • v.45 no.2
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    • pp.66-72
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    • 2013
  • Fine Needle Aspiration Biopsy Cytology (FNABC), which is known as the most accurate and cost-effective method for diagnosis of the thyroid nodule, may still result in indeterminate cases that are cellular paucity and show minor nuclear atypia. However, most cases are associated with suspicion of papillary thyroid carcinoma (PTC). A B-type Raf kinase (BRAF) mutation was found in about half of PTCs which is currently helping us to differentiate malignancies from benign lesions. Cases studied included 46 histological, confirmed PTC cases. FNABC 102 cell paucity and 74 atypia benign cases were previously diagnosed as suspicious of PTC using cytologic examination. These cases were analyzed for BRAF mutation by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) with a new restriction enzyme. In this study, the sensitivity and specificity were calculated and, BRAF mutation was detected by means of a histological method in 23 of 46 cases of PTC and no mutation was found in 22 cases. However, one case was not detected. In using FNABC, BRAF mutation was detected in 6 of 102 cases in cell paucity and in 11 of 74 cases in the atypia. Two cases were not detected in the atypia. The sensitivity and specificity of PCR-RFLP in FNABC were 60% and 97.4% respectively. Assessment of Formalin Fixed Paraffin Embedding (FFPE) block demonstrated similarly a 51.1% positive and 48.9% negative in PTC. Evaluation of BRAF mutation revealed high specificity and low sensitivity in using FNABC method. This study suggests that BRAF mutation analysis should be useful for the clinical diagnosis of PTC in FNABC with cytological findings suspicious for PTC.

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Combined Percutaneous and Minimal on Internal Fixation of Calcaneal Fractures Using Extensile Lateral Approach (광범위 외측 도달법을 이용한 종골 골절의 경피적 및 최소 내고정술)

  • Yu, Sun-O;Kim, Joo-Sung;Kim, Jong-Jin
    • Journal of Korean Foot and Ankle Society
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    • v.6 no.2
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    • pp.201-207
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    • 2002
  • Purpose: To present the clinical analysis of the results obtained in 38 cases of displaced intraarticular calcaneal fractures undergone combined percutaneous axial pin fixation of calcaneal body and minimal internal fixation using extensile lateral approach. Materials and Methods: From March 2000 to February 2002, thirty-eight displaced intraarticular fractures of the calcaneus in 35 patients were fixed with 3.5mm cannulated screws and percutaneous 2.5mm K-wires. The extensile lateral approach was used in all cases. The average follow-up period was 16 months. Clinical evaluation was assessed according to the Ankle-Hind Foot Scale of American Orthopedic Foot and Ankle Society. Results: The clinical results were graded as excellent in 8 cases(21%), good in 22 cases(58%), fair in 6 cases(16%), and poor in 2 cases(5%). Two cases of poor result were type IV of Sanders classification. The postoperative reduction status of the articular surface was analyzed by computed tomography in all cases and was found to be less 2mm of step off in 30 cases and between 2 and 4mm in 8 cases. Unsatisfactory results were correlated with severity of articular comminution and failure to obtain accurate reduction of the articular surface. Using early functional postoperative care, all fractures healed without secondary displacement except 1 case on an average of ten weeks. Two cases had superficial necrosis of the wound margins, however, secondary wound healing was uneventful and skin grafting was not needed. Conclusion: Combined minimal internal fixation and percutaneous pin fixation using extensile lateral approach is useful operative method of intraarticular calcaneal fractures because providing enough stability to permit functional aftercare and allowing excellent anatomical reduction. In addition, this method diminishes the risk of lateral soft tissue problems.

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Impact of Weight Bearing Surface on Fractures of the Talus (거골 골절에서 체중 부하 관절면의 중요성)

  • Chung, Hyun-Wook;Yoo, Si-Hoon;Suh, Jin-Soo
    • Journal of Korean Foot and Ankle Society
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    • v.13 no.2
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    • pp.156-161
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    • 2009
  • Purpose: The fracture of talus has critical complications and results in various clinical outcomes. The purpose of this study is to evaluate clinical outcome and influence on involvement of ankle and subtalar joint. Materials and Methods: From December 1999 to December 2008, a total of 66 fractures and dislocations of talus was treated with minimal 9 months follow up period. Ankle-hindfoot scale of the American Orthopedic Foot & Ankle Society (AOFAS) was used to evaluate the clinical outcome. The complications and sequential radiologic findings were also analyzed. Results: There were 28 neck fractures, 11 lateral process fractures, 10 body fractures, 7 osteochondral fractures, 4 posteromedial tubercle fractures and 4 medial process fractures. In 38 cases, there were concomitant injuries. Ipsilateral ankle fracture, which found in 19 cases, was most common. The surgical treatment was performed in 36 cases. Mean AOFAS score was 85.5 (range, 72 to 96). In 13 of 47 cases, one or more fracture lines involving weight bearing surface were confirmed. The involvement of ankle or subtalar joint had resulted in unsatisfied outcome. Complications were developed as follows, post-traumatic arthritis in 8 cases, avascular necrosis in 3 cases, and deep infection in 2 cases. Conclusion: The involvement of ankle or subtalar joint in fractures of talus seemed to be common and to impact the clinical outcome. Meticulous consideration about that will be positively necessary.

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A Review Study of Researches on Jakyakgamcho-tang (작약감초탕(芍藥甘草湯)의 연구동향(硏究動向) 분석(分析))

  • Shin, Young Sub;Lee, Soong In
    • Herbal Formula Science
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    • v.25 no.2
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    • pp.271-302
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    • 2017
  • Objectives : Jakyakgamcho-tang has been used to treat muscular tension, spasm and pain. On this study, new clinical uses of Jakyakgamcho-tang were confirmed and the other pharmacological results were summarized by analysing trends of modern experimental studies and clinical studies. Methods : Papers related to Jakyakgamcho-tang were searched on PUBMED, RISS, and National Assembly Library, and classified by categories and effects of clinical application and a variety of experiment around abstract. Also, figures were used for sketching out a timeline of expressing when these papers were read and core research content was described as a digest for identifying research trends. Results : Until today, there are 104 researches about the antispasmodic, analgesic, anti-inflammatory effects of Jakyakgamcho-tang. In total, 91 papers were analyzed in this study. In matter of subject, researches on the antispasmodic effects were 17 cases, researches on the analgesic effects were 14 cases, researches on gynecological therapeutics were 14 cases, researches on pharmacokinetics were 12 cases, researches on the constituent identification were 7 cases, studies about constituents efficacy were 6 cases, studies about interactions with drugs were 6 cases. Conclusion : The traditional use of Jakyakgamcho-tang on muscle tension, spasm and pain has proven to have effects through the experimental evidences. Other effects of Jakyakgamcho-tang such as gynecological therapeutics, anti-inflammatory effects, are now emerging as a new area in clinical use. Futhermore as an auxiliary treatment, Jakyakgamcho-tang is a good alternative for muscle cramps during maintenance of hemodialysis, myalgia or arthralgia induced by anticancer drugs, amenorrhea induced by neuroleptics.

An analysis of Clinical Studies on Galgeun-tang (갈근탕의 임상연구 논문 분석)

  • Song, Si-Young;Kang, Yu-Seon;Byeon, Sung-hee;Lee, Soong-In
    • Herbal Formula Science
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    • v.28 no.1
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    • pp.91-115
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    • 2020
  • Objective : This study's purpose was to review the clinical studies of Galgeun-tang. Method : We searched papers about Galgeun-tang using KISS, RISS, OASIS, PUBMED and J-stage. The key words we used were "Galgeuntang", "Kakkonto", "Ge gen tang", and "Pueraria Decoction". Papers not matched with inclusion criteria were excluded. Results : Until today, there have been 223 studies on Galgeun-tang. Of these, 25 studies were classified as clinical research papers. There were 4 cases of fever, 5 cases of inflammation on respiratory system, 3 cases of head, neck and shoulder disorder, 2 cases of diarrhea, 6 cases of pharmacokinetics and interaction, 5 cases of side effect. Conclusion : It can be seen that Galgeun-tang has established the basis for application to the purpose of treating fever (common cold, influenza), inflammation on respiratory system (nasal obstruction, maxillary sinus retention cyst, mucoid pseudomonas aeruginosa chronic lower respiratory tract infection), head, neck and shoulder disorder (temporomandibular disorders, shoulder stiffness, tetanus), and diarrhea. On the other hand, considering 4 cases of side effect on drug eruption, caution should be exercised when observing the progress of the patient taking Galgeun-tang.

A Clinical Analysis of Atherosclerosis Obliterance in the Lower Extremity (폐쇄성 하지 동맥 경화증의 임상적 고찰)

  • 김종만
    • Journal of Chest Surgery
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    • v.23 no.2
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    • pp.333-341
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    • 1990
  • aortoiliac pattern, Group II; femoropopliteal pattern and Group g; tibioperoneal pattern. A majority of patients belonged to group I [27 cases], 8 patients came under group II .and none in group g. Thirty patients underwent bypass operation with autogenous saphenous vein or synthetic graft with or without concomitant lumbar sympathectomy. Remaining 5 patients were operated on with sympathectomy only, Bypass procedures were anatomic bypass in 22 cases: aortoiliac artery bypass in 11 cases, femoropopliteal artery bypass in 10 cases, sequential femoropopliteal artery bypass in one case and extra-anatomic bypass in 8 cases, axillary-bifemoral artery bypass in one case and femorofemoral artery bypass in 7 cases. Postoperative complications which mainly composed of superficial wound infection[5 cases] which were treated without any significant sequel in all cases and thrombosis[2 cases]. Three patients died whose causes of death were acute renal failure in 2 cases and myocardial infarction in other, The overall patency, rate was 70Zo in 5 years. In conclusion, the clinical pattern and operative outcome were similar to he western pattern and all cases of death did not related to operative procedures and ischemic symptoms were relieved by bypass operations except several cases. I think and recommend that all patients suffering chronic arterial insufficiency by atherosclerosis obliterans ought to be managed with urgent and adequate operative procedure.

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The Clinical Experience of 610 Cases Open Heart Surgery (개심술 610례에 관한 임상적 고찰)

  • 정황규
    • Journal of Chest Surgery
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    • v.21 no.1
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    • pp.36-47
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    • 1988
  • 610 cases of open heart surgery was performed in the Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital from July 1981 to September 1987. The clinical data was summarized as follows: 1. The age distribution of congenital heart surgery patients was 2 to 41 years old [mean; 13.2 years] and surgery for acquired heart disease was 10 to 57 years old [mean: 32.8 years]. 2. There were 389 cases [63.8%] of acyanotic congenital heart anomalies, 63 cases [10.3%] of cyanotic congenital anomalies and 158 cases [25.9%] of acquired heart disease. 3. For myocardial protection, Bretschneider and potassium glucose solution had been used as cardioplegic solution and then since 1983, GIK solution has been used with repeated infusion method once for every 20 to 30 minutes of time interval after starting initial cardioplegia during operation with excellent results. 4. The ingredient of the priming solution is Hartmann`s solution, sodium bicarbonate, mannitol, potassium chloride, fresh ACD whole blood, calcium chloride, heparin and dexamethasone. 5. There were 96 cases [15.7%] of mild hypothermia, 333 cases [54.6%] of moderate hypothermia and 181 cases [29.7%] of intermediate hypothermia. 6. The mortality rate was 2.3% [9 out of 389 cases] in acyanotic congenital heart disease, 36.5% [23 out of 63 cases] in cyanotic congenital heart disease and 10.8% [17 out of 158 cases] in acquired heart disease, with overall mortality rate of 8.0% [49 out of 610 cases].

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A Clinical Study of Parotid Gland Tumors (이하선 종양의 임상적고찰)

  • JeGal Young-Jong;Choi Wone
    • Korean Journal of Head & Neck Oncology
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    • v.2 no.1
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    • pp.33-39
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    • 1986
  • This is a clinical analysis of 24 cases of parotid gland tumor who were treated in the department of Surgery, Chonnam National University Medical School during the past 10years from January, 1976 to December, 1985. According to this analysis of total 24 cases, we concluded as follows; 1) 21 cases were benign tumors and 3 cases were malignant tumors. As the histopathological findings, benign tumor included 88%and malignant tumor 12%. Majority of benign tumor contained mixed tumor(86.7%), and the malignant tumor contained mucoepidermoid carcinoma (66.7%). 2) The peak age incidence was 40th in benign tumor and 50th in malignant tumor. 3) The chief complaints of patient was a painless mass and the duration of illness was average 5.2 years. 4) The mean size of mass was 4.5cm in diameter. 5) The surgical procedures were performed with excision 6 cases, superficial lobectomy 8 cases, wide excision with partial parotidectomy 4 cases, total parotidectomy 3 cases in benign tumors. In malignant tumors, total parotidectomy 2 cases and wide excision with partial parotidectomy 1 case were performed. 6) Major postoperative complications such as facial nerve palsy 7 cases (temporary ; 5 cases, permanent; 2 cases), Frey syndrome 1 case, seroma 1 case, hematoma 1 case, and wound infection 1 case were developed. The recurrence contained pleomorphic adenoma 1 case and mucoepidermoid carcinoma 1 case.

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