• Archives of Plastic Surgery
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• 제41권3호
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• pp.213-217
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• 2014

The widespread use of microsurgery in numerous surgical fields has increased the need for basic microsurgical training outside of the operating room. The traditional start of microsurgical training has been in undertaking a 5-day basic microsurgery course. In an era characterised by financial constraints in academic and healthcare institutions as well as increasing emphasis on patient safety, there has been a shift in microsurgery training to simulation environments. This paper reviews the stepwise framework of microsurgical skill acquisition providing a cost analysis of basic microsurgery courses in order to aid planning and dissemination of microsurgical training worldwide.

• Journal of Chest Surgery
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• 제52권1호
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• pp.44-46
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• 2019

Gorham-Stout disease (GSD) was first described by Gorham and colleagues in 1954, but its precise mechanism and cause remain to be elucidated. In this condition, voluminous and potentially fatal chylous effusions into the thorax can occur. Herein, we describe a case of GSD in which the patient presented with massive pleural effusions and mottled osteolytic bone lesions. We performed multiple operations, including thoracic duct ligation using video-assisted thoracoscopic surgery and thoracotomic decortication, but these procedures did not succeed in preventing recurrent pleural effusion and chest wall lymphedema. After administering sirolimus ($0.8mg/m^2$, twice a day) and propranolol (40 mg, twice a day), the process of GSD in this patient has been controlled for more than 2 years.

• Journal of Chest Surgery
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• 제51권3호
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• pp.172-179
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• 2018

Background: This study aimed to compare preliminary data on the outcomes of sutureless aortic valve replacement (SU-AVR) with those of aortic valve replacement (AVR). Methods: We conducted a retrospective study of SU-AVR in moderate- to high-risk patients from 2013 to 2016. Matching was performed at a 1:1 ratio using the Society of Thoracic Surgeons predicted risk of mortality score with sex and age. The primary outcome was 30-day mortality. The secondary outcomes were operative outcomes and complications. Results: A total of 277 patients were studied. Ten patients (50% males; median age, 81.5 years) underwent SU-AVR. Postoperative echocardiography showed impressive outcomes in the SU-AVR group. The 30-day mortality was 10% in both groups. In our study, the patients in the SU-AVR group developed postoperative thrombocytopenia. Platelet counts decreased from $225{\times}10^3/{\mu}L$ preoperatively to 94.5, 54.5, and $50.1{\times}10^3/{\mu}L$ on postoperative days 1, 2, and 3, respectively, showing significant differences compared with the AVR group (p=0.04, p=0.16, and p=0.20, respectively). The median amount of platelet transfusion was higher in the AVR group (12.5 vs. 0 units, p=0.052). Conclusion: There was no difference in the 30-day mortality of moderate-to high-risk patients depending on whether they underwent SU-AVR or AVR. Although SU-AVR is associated with favorable cardiopulmonary bypass and cross-clamp times, it may be associated with postoperative thrombocytopenia.

• Archives of Plastic Surgery
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• 제40권3호
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• pp.181-186
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• 2013

Background Partial or complete necrosis of a skin flap is a common problem. Polydeoxyribonucleotide (PDRN) can be extracted from trout sperm and used as a tissue repair agent. The aim of this study was to investigate whether PDRN could improve the survival of random pattern skin flaps in rats. Methods Twenty-two male Sprague-Dawley rats were randomly divided into two groups: the PDRN treatment group (n=11) and the control group (n=11). Caudally pedicled random pattern skin flaps were elevated on their dorsal skin and resutured. The treatment group received daily intraperitoneal administration of PDRN (8 mg/kg/day), and the control group received fluid vehicle (NaCl 0.9%, 8 mg/kg/day) from day 0 to day 6. On day 7, the flap survival was evaluated and the harvested tissue surrounding the demarcation line of the necrotic area was stained with H&E, anti-rat vascular endothelial cell growth factor (VEGF) antibody, and PECAM-1/CD31 antibody. Results The average necrotic area of the flap in the PDRN group was significantly smaller when compared with that of the control group. Histologic and immunohistochemical evaluation showed that granulation thickness score and VEGF-positive staining cells were marked higher in the PDRN group than in the control group. PECAM-1/CD31-positive microvascular densities were significantly higher in the PDRN group when compared with the control group. Conclusions This study confirms that PDRN improves the survival of random pattern skin flaps in rats. These results may represent a new therapeutic approach to enhancing flap viability and achieving faster wound repair.

• Journal of Chest Surgery
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• 제30권11호
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• pp.1136-1138
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• 1997

승모판막 폐쇄부전증으로 승모판막 치환술을 받은 45세 남자가 확장성 심근증으로 심장이식수술을 받았다. 환자는 수술전 면역억제를 위하여 cyclosporine 400 mg, Immuran 250 mg과 Solumedrol 500 mg을 투약하였 다 술후 cyclosporine을 2 mg/kg/day로 정주했는데 술후 8시간이 지나도 혼수상태가 지속되어 cyclosporine을 1 mg/kg/day로 감량하였다. 당시 혈장내 cyclosporine농도는 345$\mu\textrm{g}$/L, 크레아티닌 수치는 1.8 mg/dl였으며 마그 네슘 수치는 정상수준이 였다. 환자의 의식은 술후 31시간째 완전히 회복되었으나 술후 36시간경부터 전신근 력약화, 초조감, 환청 및 환각을 호소하였다. 신경증상들은 술후 4일째 정상으로 회복되었으며, 환자는 술후 28일째 퇴원하였고 12개월째 후유증은 보이지 않고 있다.

• Archives of Plastic Surgery
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• 제33권6호
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• pp.732-736
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• 2006

Purpose: The purpose of this pilot study was to investigate a potential of platelet concentrate obtained from blood bank(PCBB) in accelerating wound healing and to determine an effective treatment protocol by quantifying levels of platelet derived growth factor (PDGF)-BB in PCBB in vitro. Methods: The first study was designed to investigate quantity of PDGF-BB over stored time of the PCBB. The stored times for each PCBB were 1, 3, 5, 7, 9, 11 and 13 days. The second study was designed to determine efficacy of adding thrombin to stimulate release of PDGF-BB from the platelets of PCBB. The platelets were suspended and incubated in either with or without thrombin. On 30 minutes and days 1, 3, 5, 7 after incubation, the levels of PDGF-BB were measured. Results: PDGF-BB level showed a linear decrease over stored time of PCBB from the first day to the 13th day. Addition of thrombin increased PDGF-BB release from 30 minute through the 5th day. Conclusion: The results indicate that PCBB can provide sufficient amount of growth factors to stimulate wound healing and adding thrombin accelerate it.

• Journal of Acupuncture Research
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• 제28권5호
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• pp.77-86
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• 2011

Objective : This study was designed to evaluate the effect of bee venom pharmacopuncture therapy in patients with FBSS(failed back surgery syndrome). Methods : We investigated 30 cases of patients with FBSS, who had been treated from October 2010 to July 2011. We divided patients into two groups : group I was treated by acupuncture therapy only, and group II was treated by bee venom pharmacopuncture therapy and general acupuncture. We measured the efficacy of treatments using the numerical rating scale(NRS) and grade and straight leg raising(SLR) test. Results : 1. The treatment method for group II was more effective than that of group I in reducing the NRS score on the fifteenth day after admission but there was no statistically significant difference between the results of two groups on the fifth day after admission and the tenth day after admission. 2. The treatment method for group II was more effective than that of group I in NRS improvement rate from its admission day to the fifth day after admission and from the tenth day after admission to the fifteenth day after admission but there was no statistically significant difference between the performance of two groups from the fifth day after admission to the tenth day after admission. 3. Group II had a higher grade improvement rate from the seventh day after admission to the fifteenth day after admission than group I but no statistically significant difference was observed between the results of two groups from its admission day to the seventh day after admission. 4. In SLR test improvement rate the treatments applied to group II was more effective than those applied to group I. Conclusion : The results of this study suggest that bee venom pharmacopuncture therapy is effective in reducing pain for patients with FBSS. Further clinical research is needed to verify these results and findings.

• 한국수정란이식학회지
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• 제17권2호
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• pp.123-128
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• 2002

The present study aimed at determining the effective dose of Folltropin, a follicle timulating hormone (FSH), on superovulation in indigenous cows of Bangladesh. Fifteen regularly cycling 5～7 years old dry cows, weighing 200～250 kg with 2.5～3.0 body condition scores (BCS) were divided into three groups (n＝5). Individual groups were superovulated with 100, 200 or 300 mg of Folltropin per animal. The superovulation treatment was initiated at Day 10 or Day 11 of the estrous cycle (Day 0＝day of estrus). Alfaprostol (6 mg) was injected to each cow 72 h after the initiation of superovulation treatment to induce eestrus. After confirming standing estrus, the cows were inseminated 2～3 times, 12 h apart, depending on the duration of estrus. At Day 6 or Day 7, individual horns of the uterus were flushed with 150～200 $m\ell$ of phosphate buffered saline supplemented with BSA (0.2％), penicillin (100 IU／$m\ell$) and streptomycin (100 $\mu\textrm{g}$／$m\ell$) using a two-way foley catheter. The embryos were concentrated, removing the excess medium through an embryo filter, and identified under a stereomicroscope. The identified embryos were collected, washed four times, evaluated and graded as excellent, good, fair or poor. The excellent, good and fair embryos were considered as transferable quality embryos. The mean (range). numbers of embryos collected vs. transferable quality embryos far 100, 200 and 300 mg of Folltropin were 4.5 (1～10) vs. 3.5 (1～8); 2.5 (1～4) vs. 1 (0～2) and 0.0 (0～0) vs. 0.0 (0～0), respectively, Folltropin at a dose of 100 or 200 mg produced suitable ovarian stimulation for superovulation in indigenous zebu cows of Bangladesh. A dose of 300 mg or more Folltropin consistently caused preovulatory corpora lutea formation in the ovaries and resulted in zero embryo recovery.

• Archives of Plastic Surgery
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• 제43권6호
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• pp.491-497
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• 2016

Background Hypertrophic scarring is a pathological condition that occurs after trauma or surgery. Angiogenesis occurs more often with hypertrophic scarring than with normotrophic scarring. The regulation of angiogenesis is one of the key factors in hypertrophic scar management. Vascular endothelial growth factor (VEGF) is an essential factor in the angiogenetic response. This study investigated whether decreasing the level of VEGF is effective for treating hypertrophic scarring. Methods Ten 8-week-old female New Zealand white rabbits were included. Four defects were created on each ear by using a 6-mm punch. Bevacizumab (Avastin, Roche Pharma, Basel, Switzerland) was administered in one ear and normal saline was administered in the other ear. Treatment was administered starting on day 2, every 2 days, until day 14. The levels of VEGF were measured using enzyme-linked immunosorbent assay on day 10 and histologic results were analyzed on day 40. Results Bevacizumab induced-defects showed less hypertrophic scarring when compared with the control group as measured by the scar elevation index (SEI) and loose collagen arrangement. The SEI in the experimental group was $1.89{\pm}0.13$, compared to $1.99{\pm}0.13$ in the control group (n=30, P=0.005). Additionally, the VEGF level was lower ($38.72{\pm}11.03pg$ vs. $82.50{\pm}21.64pg$, n=10, P=0.001) and fewer vessels existed ($8.58{\pm}0.76$ vs. $7.2{\pm}1.20$, n=10, P=0.007). Conclusions Preventing excessive angiogenesis is effective for preventing scar formation, especially with hypertrophic scarring. Although it is not an approach that is sufficient alone for the management of scarring, it may be one of several important strategies for scar treatment.

• Archives of Plastic Surgery
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• 제39권5호
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• pp.504-508
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• 2012

Background The most common complication of latissimus dorsi myocutaneous flap in breast reconstruction is seroma formation in the back. Many clinical studies have shown that fibrin sealant reduces seroma formation. We investigated any statistically significant differences in postoperative drainage and seroma formation when utilizing the fibrin sealant on the site of the latissimus dorsi myocutaneous flap harvested for immediate breast reconstruction after skin-sparing partial mastectomy. Methods A total of 46 patients underwent immediate breast reconstruction utilizing a latissimus dorsi myocutaneous island flap. Of those, 23 patients underwent the procedure without fibrin sealant and the other 23 were administered the fibrin sealant. All flaps were elevated with manual dissection by the same surgeon and were analyzed to evaluate the potential benefits of the fibrin sealant. The correlation analysis and Mann-Whitney U test were used for analyzing the drainage volume according to age, weight of the breast specimen, and body mass index. Results Although not statistically significant, the cumulative drainage fluid volume was higher in the control group until postoperative day 2 (530.1 mL compared to 502.3 mL), but the fibrin sealant group showed more drainage beginning on postoperative day 3. The donor site comparisons showed the fibrin sealant group had more drainage beginning on postoperative day 3 and the drain was removed 1 day earlier in the control group. Conclusions The use of fibrin sealant resulted in no reduction of seroma formation. Because the benefits of the fibrin sealant are not clear, the use of fibrin sealant must be fully discussed with patients before its use as a part of informed consent.