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Autologous Fat Graft in the Reconstructed Breast: Fat Absorption Rate and Safety based on Sonographic Identification

  • Kim, Hong Youl;Jung, Bok Ki;Lew, Dae Hyun;Lee, Dong Won
    • Archives of Plastic Surgery
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    • v.41 no.6
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    • pp.740-747
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    • 2014
  • Background Autologous fat graft has become a useful technique for correction of acquired contour deformity in reconstructed breasts. However, there remains controversial regarding the efficacy and safety of the practice for reconstructive breast surgery. Methods A retrospective review was performed on 102 patients who had secondary fat grafting after breast reconstruction. Fat harvest, refinement and injection were done by Coleman's technique. All patients were followed up postoperatively within 1 month and after 6 months including physical examination and ultrasonography. In 38 patients, the reabsorption rate was calculated by serial changes of thickness between skin and pectoral fascia in the ultrasonic finding. Locoregional recurrence rate was compared with control group of 449 patients who had breast reconstruction without fat graft in the same time period. Results Average 49.3 mL fat was injected into each breast. The most common location of fat graft was upper pole, followed by axilla, lower and medial breasts. During 28.7 months of average follow-up period, 2.9% of total patients had symptoms of palpable mass on fat graft side and ultrasonography identified fat necrosis and cyst formation in 17.6% of the patients. Calculated fat reabsorption rate was 32.9%. Locoregional recurrence was occurred in 1 patient (0.9%) and the rate was not different significantly with control group (2%). Conclusions Although further studies are required to provide surgeons with definitive guidelines for the implementation of fat grafting, we propose autologous fat graft is an efficient and safe technique for secondary breast reconstruction.

Mammary Squamous Cell Carcinoma in a Collard Peccary (Tayassy Tajacu) (페커리 (Collard peccary)에서 발생한 유선 편평 세포 선암종)

  • Lee, So-Young;Yoo, Jong-Hyun;Park, Chul;Sur, Jung-Hyang;Park, Hee-Myung
    • Journal of Veterinary Clinics
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    • v.26 no.4
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    • pp.386-390
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    • 2009
  • A 10-year-old female collared peccary (Tayassu tajacu) was referred due to a large palpable mass in caudal abdomen. Physical examination revealed a firm and freely moveable mass (15 ${\times}$ 9 cm) in the right side of caudal abdomen. Thoracic radiographic findings revealed a few well circumscribed nodules. This case was diagnosed as mammary gland squamous cell carcinoma with pulmonary metastasis based on histopathological and immunohistochemical findings. This type of mammary gland tumors is uncommon in wild animals. The patient survived for one month after the diagnosis. This is the first case report of mammary squamous cell carcinoma in a collard peccary and the second case report of metastatic carcinoma to lung in a collared peccary.

Chest Wall Metastasis from Unknown Primary Hepatocellular Carcinoma -A case report - (원발성 종양의 증거 없이 발생한 간세포암종의 흉벽 전이 -1예 보고-)

  • Kim, Hyuck;Yang, Joo-Min;Kang, Jung-Ho;Kim, Young-Hak;Chung, Won-Sang;Chon, Soon-Ho
    • Journal of Chest Surgery
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    • v.37 no.9
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    • pp.809-812
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    • 2004
  • Chest wall metastases from malignant tumors are rare and the majority of them are from adjacent structures such as the breast, lung, pleura, and mediastinum. Paticularly, chest wall metastases from distant organs are an even rarer event. There are few reports of chest wall metastasis with obscure or absent primary tumor. A 51-year-old man was diagnosed with metastatic hepatocellular carcinoma after an operation for a palpable mass on his left upper chest wall, At that time, there was no evidence of primary hepatocellular carcinoma in the liver after various examinations. We report a case of chest wall metastasis from unknown primary hepatocellular carcinoma.

Recurrent Herpes-Stomatitis Mimicking Acute Necrotizing Ulcerative Gingivitis (급성괴사성궤양성 치은염을 닮은 재발성 허피스 구내염)

  • Kim, Han-Seok;Lee, Suk-Keun;Park, Young-Wook
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.33 no.1
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    • pp.89-92
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    • 2011
  • Herpes simplex is caused by viruses of the herpesvirus hominus family. HSV have four categories: type 1, 2, 6, and 8. Generally HSV-1 affects the mouth. Once infected by HSV, the person's infection is permanent. Retrograde transport through adjacent neural tissue to sensory ganglia leads to a lifelong latent infection. Recently, we treated a patient with recurrent herpes-stomatitis mimicking acute necrotizing ulcerative gingivitis (ANUG). The results were satisfactorty so we report this case. 31 years old male patient showed sore throat, gingival ulceration, palpable both submandibular lymph node, and sulcular pus formation around posterior decayed teeth. This is the third time he has suffered from this symptom. Tentative diagnosis was acute necrotizing ulcerative gingivitis. Antibiotic therapy was started. But, intraoral symptom got worse in process of time. Especially ulcer of marginal gingiva got worse. Viral disease was suspected. We carried out viral cultivation. At the same time topical application of antiviral ointment (herpecid$^{(R)}$) was performed on oral ulcer unilaterally for the purpose of diagnosis and reducing pain experimentally. The next day pain was decreased dramatically on application area. Basing on the viral cultivation and clinical effect of antiviral ointment (herpecid$^{(R)}$), we have diagnosed it as a recurrent herpes-stomatitis and concluded that viral infection was major cause of disease and bacterial infection was secondary.

Soft Tissue Giant Cell Tumor of Low Malignant Potential - Case Report - (슬부에 발생한 낮은 악성도의 연부조직 거대 세포종 - 증례 보고 -)

  • Lee, Eun-Yoo;Kang, Ki-Ser;Kang, Soo-Young;Lee, Han-Jun;Kim, Jong-Won;Lee, Gi-Hyun;Park, Young-Uk
    • The Journal of the Korean bone and joint tumor society
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    • v.9 no.1
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    • pp.101-104
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    • 2003
  • Folope et al(1999) reported soft tissue giant cell tumor which was similar to malignant giant cell tumor in clinical, pathologic, and immunohistological aspect but represented low malignancy. We reported a 30-year-old female suffered from pain and palpable mass on the anterolateral aspect of the right knee for one year. Excisional biopsy from the lesion revealed some giant cells and polymorphous cells containing eosinophilic cytoplasm and vacuolated nucleus. Histopathologic findings of the lesion were consistent with soft tissue giant cell tumor of low malignant potential. Hereby, we report a case of soft tissue giant cell tumor of low malignant potential with a review of the literature.

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Vascular Malformation of Flexor Hallucis Longus Muscle Associated with a Flexion Deformities of Toes: A Case Report (장무지 굴곡근의 혈관성 기형에 동반된 발가락의 굴곡 변형: 증례 보고)

  • Ahn, Jong-Chul;Kim, Jung-Rae;Shin, Ji-Hoon;Shin, Duk-Seop
    • The Journal of the Korean bone and joint tumor society
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    • v.17 no.2
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    • pp.100-105
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    • 2011
  • Vascular malformations may typically present with palpable mass that can be either asymptomatic or can present with symptoms including swelling and pain. On rare occasions, vascular malformation of muscle may produce joint deformities caused by contracture of the involved muscle. When vascular malformation involves the flexor muscle of the leg, ankle equinus deformity may occur. However, there are no reports of toe deformities secondary to intermuscular or intramuscular vascular malformations of flexor muscles of toe. Thus, we report a case of vascular malformation of flexor hallucis longus muscle with flexion contracture of toes in a 40-years-old woman who was treated with surgical excision.

A Case of Choledochal Cyst Complicated by Liver Cirrhosis on Pathology in a 20-Month-Old-Girl (수술 후 임상증상이 호전된 간경화를 합병한 2세 여아에서의 총수담관낭 1례)

  • Bae, Sun Hwan;Choi, Sung Yun;Lee, Tae Seok;Lee, Ho Jeong
    • Clinical and Experimental Pediatrics
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    • v.48 no.1
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    • pp.104-107
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    • 2005
  • Choledochal cyst is considered to be congenital anomalies of the biliary tract, characterized by varying degrees of cystic dilatation at various segments of the biliary tract. A 20-month-old girl was admitted to Eul-Ji general hospital because of abdominal distension. Physical examination revealed marked splenomegaly and hepatomegaly with nodular surface and hard consistency. Laboratory examination showed elevated transaminase level, alkaline phosphatase level and gamma glutamyltranspeptidase level without evidence of cholestasis. Diagnostic imaging study revealed choledochal cyst with Todani classification type 1. Cholecystectomy and Roux-en-Y choledochojejunostomy was performed, and wedge liver biopsy showed diffuse periportal fibrosis with cirrhotic change and ductular proliferation in the portal area. After operation, hepatosplenomegaly and abnormal laboratory examinations improved rapidly, and in 9 months, the liver and spleen became not palpable. We experienced a case of choledochal cyst complicated by liver cirrhosis on pathology in a 20 month-old girl, and removal of choledochal cyst improved clinical manifestations rapidly.

A Case Report of Salivary Duct Carcinoma (이하선에 생긴 침샘관암의 치험례)

  • Park, Sung Wook;Kang, Sang Yoon;Kim, Tae Hun;Kim, Chung Hun
    • Archives of Plastic Surgery
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    • v.35 no.5
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    • pp.607-610
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    • 2008
  • Purpose: Salivary duct carcinoma(SDC) is uncommon but high grade adenocarcinoma arising in the ductal epithelium of salivary glands. SDC is characterized by distinctive clinical and pathologic features. The most important histologic aspect of this neoplasm is its resemblance to ductal carcinoma of the breast. Clinically SDC is defined by cervical lymph node involvement and distant metastasis with a high rate of recurrence and mortality. We described some of the clinical and pathological features of SDC and the management using case report for our patient. Methods: We present a case of a 40-year-old male with 2-year history of a swelling arising in his left preauricular region. There was a single painless, firm and solid $2{\times}1.5cm$ mass in the left parotid area. Facial nerve function was intact and no cervical lymph node were palpable. In August 2005, we found out $1.7{\times}1.8cm$ sized cystic, nodular lesions that were located in the superficial lobe of left parotid gland through Computed tomography. And then superficial parotidectomy and postoperative radiation therapy were performed in Jan 2007. Results: Pathologically, the specimen were consisted of homogeneous, chondoid to myxoid type of tissues. It was yellow mass that has multiloculated cystic lesions. In postoperative PET(Positiron emission tomography) CT, there was no evidence of uptaking FDG(Fluorodeoxyglucose) into the deep layers of parotid gland and distant metastasis were not seen. Conclusion: Salivary duct carcinoma(SDC) is a rare but high grade adenocarcinoma related to pleomorphic adenocarcinoma. The prognosis of SDC can be different according to the type of tumor such as mucoepidermoid adenocarcinoma, adenoid duct carcinoma and acinar cell carcinoma. So we need to study more carefully for accurate diagnosis in early stage of diagnosis. Although radiotherapy has not yet proven to be a significant factor in overall survival, the combination of parotidectomy and postoperative radiation therapy can lead to more favorable results in treating of SDC.

Congenital Aortic Valvular Stenosis: report of a case (선천성 대동맥판막 협착증 치험 1례)

  • 김병열
    • Journal of Chest Surgery
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    • v.12 no.4
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    • pp.350-354
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    • 1979
  • The incidence of congenital aortic valvular stenosis has been known rare, and approximately 3-6% of congenital heart diseases. Recently, we experienced 1 case of congenital aortic valvular stenosis, and which was corrected surgically under extracorporeal circulation successfully. A 11 years old male pt. was admitted to N.M.C. because of dyspnea, dizziness, chest pain and episode of syncope. An auscultation, harsh systolic murmur [Gr. IV/VI] was noted at aortic area and also palpable strong thrill. ECG showed LVH c strain pattern and suspicious LVH finding in simple chest P-A film. In Lt. cardiac catheterization, abrupt pressure change [110mmHg] between LV & Aorta was noted across the aortic valve. And aortic insufficiency was absent, well visualized both coronary arteries and suspicious bicuspid aortic valve in aortography. Valve form was bicuspid, large one was noncoronary cusp and another cusp was Rt. & Lt. coronary cusp which was interpositioned rudimentary commissure. Central aortic orifice was about 5ram in diameter. Valvulotomy was done along the fusioned commissure between noncoronary cusp and Rt. & Lt.coronary cusp, and then short incision was added between Rt. coronary cusp & Lt. coronary cusp. Immediate postoperative course smooth but unknown cardiac arrest was noted in POD second day. Complete recovery was done without sequelae by resuscitation. After operation, clinical symptoms were subsided but systolic murmur [Gr. II/VI] was audible at aortic area, diastolic murmur was absent. ECG showed still remained LVH but much decreased R wave voltage in Lt. precordial leads. Simple chest P-A showed no interval changes compared to preop film. Control Lt. heart catheterization revealed still remained pressure gradient [40ramrig] between LV & Aorta. But much decreased pressure gradient compared to preop pressure gradient [110mmHg].

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Cytologic Features of Gaucher's Disease in the Spleen - A Cese Report - (Gaucher병의 세포학적 소견 - 1예 보고 -)

  • Lee, Hun-Kyung;Park, Gyeong-Shin;Kim, Young-Shin;Lee, Kyo-Young;Kang, Chang-Suk;Shim, Sang-In
    • The Korean Journal of Cytopathology
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    • v.7 no.1
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    • pp.79-83
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    • 1996
  • Gaucher's disease is an autosomal recessive disorder resulting from mutation at the glucocerebrosidase locus on chromosome 1q21. As a result, glucocerebroside accumulates principally in the phagocytic cells known as Gaucher cells. In our case, a five-year old girl was admitted with seven days' history of fever and abdominal distension. At physical examination the patient had hepatosplenomegaly. Laboratory tests revealed a hemoglobin concentration of 2.8g/L: platelet counts of $23,000/{\mu}l$: normal range of white cell and differential counts, and negative Coombs' test. Liver enzymes were normal. For the evaluation of hepatosplenomegaly, fine needle aspiration was performed blindly against the palpable spleen. Wet-fixed hematoxylin and eosin-stained smears are made. The smears from the spleen showed predominantly macrophages with abundant cytoplasm and rather small, uniform, often eccentric nuclei with small nucleoli. The multinucleated cells were often found. The cytoplasm was pale, with more or less distinct fibrillarity. The cells had the characteristic appearance of Gaucher cells. Gaucher cells were also found in the tissue section from the liver, spleen and lymph node and the bone marrow aspirate. The diagnosis was later confirmed by determination of bela-glucosidase activity in peripheral blood leucocytes. Fine needle aspiration of the spleen is considered as a convenient procedure with a low complication rate for the diagnosis of lysosomal storage disease.

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