Background : Nipple-sparing mastectomy (NSM) is gaining popularity due to its superior aesthetic results. When reconstructing the breast with free abdominal tissue transfer, we must readdress the recipient vessel, because NSM can cause difficulty in access to the chest vessel. Methods : Between June 2006 and March 2011, a total of 92 women underwent NSM with free abdominal tissue transfer. A lateral oblique incision was used for the nipple-sparing mastectomy. For recipient vessels, the internal mammary vessels were chosen if the mastectomy flap did not block access to the vessels. If it did, the thoracodorsal vessels were used. Age, degree of breast ptosis, weight of the mastectomy specimen, and related complications of the internal mammary vessel group and the thoracodorsal vessel group were compared. Results : Thoracodorsal vessels were used as recipient vessels in 59 cases, and internal mammary vessels in 33 cases including 4 cases with perforators of the internal mammary vessels. Breast reconstruction was successful in all cases except one case involving a total flap failure, which was replaced by a silicone gel implant. The internal mammary group and the thoracodorsal group were similar in terms of age, height, breast weight, and degree of ptosis. The flap related complications such as flap loss and take-back operation rates were not significantly different between the two groups. The rate of nipple necrosis was higher in the internal mammary group. Conclusions : The thoracodorsal vessels could produce comparable outcomes in breast reconstruction after nipple-sparing mastectomies. If access to internal mammary vessels is difficult, the thoracodorsal vessel can be a better choice.
Purpose: Gynecomastia is an abnormal increase in the volume of the male breast. Subcutaneous mastectomy was the first surgical treatment for gynecomastia. But because of the complications such as nerve injury and scar formation, subcutaneous mastectomy has been substituted with liposuction. Recently various techniques including ultrasound - assisted liposuction has been used for treatment of gynecomastia. The purpose of this study is to evaluate the results of XPS$^{(R)}$ microresector(Shaver) for treatment of gynecomastia. Methods: 17 patients, 33 breasts of gynecomastia, Simon grade I or II have been treated with XPS$^{(R)}$ microresector(Shaver). The mean age was 24.5. The subcutaneous tissue and glandular tissue were removed with XPS$^{(R)}$ microresector(Shaver). The operation time, the weight of removed tissue and patients' satisfaction score were accessed. Results: The mean operation time was 78.2 minutes. The mean weight of removed tissue was 113.8 g. There was no significant complications such as necrosis, hematoma, infection or scar contracture. Patients' satisfactory score of scar, shape and confidence were 8.4, 8.2 and 8.4 respectively. As the average score was 8.3, almost patients were satisfied with their breasts. Conclusion: The authors have treated 17 patients suffering from gynecomastia with XPS$^{(R)}$ microresector(Shaver). We obtained short operation time, early recovery, minimal operative scar and less complications with XPS$^{(R)}$ microresector(Shaver) for the treatment of gynecomastia, and patients were satisfied with the results of our method. We concluded XPS$^{(R)}$ microresector(Shaver) is an alternative option for the treatment of gynecomastia.
The purpose of this study is to investigate the effects of eight weeks high fat intake and regular exercise in skeletal muscle and adipose tissue for Endoplasmic Reticulum (ER) stress in rats. This experiment involved 32 subjects (sprague-dawley rats) divided into four groups as follows: chow group (Chow, n = 8), chow and exercise group (Chow + EX, n = 8), high fat diet-induced hyperlipidemia group (HF, n = 8), and HF and exercise group (HF + EX, n = 8). As a result, there were significant decrease in body weight and abdominal fat, and blood lipid level was significantly improved by exercise for eight weeks (p < .05). There were variables changed about the skeletal muscle and ER stress in GRP78, XBP-1, ATF4, CHOP and JNK mRNA. There increased in mRNA factor by exercise, especially GRP78, and ATF4 mRNA were significantly increased in exercise (p < .05). However, there were increased in adipose tissue by exercise and there were significantly decreased in mRNA factor by high fat diet (p < .05). Consequently, this study suggests that the consistent exercise was more improved of obesity factor, such as dyslipidemia, hyperlipidemia, hyperglycemia, as well as body weight or abdominal fat. The response of ER stress in adipose tissue and skeletal muscle were more sensitive in exercise than high fat diet feed.
안토시아닌 결핍 돌연변이 토마토 변종인 H957은 낮은 인산 공급에 대하여 내성(耐性)을 보인다. 본 저린산(低燐酸) 내성(耐性)을 연구하기 위해 미량의 인산을 포함한 조직배양 배지 위에서 H957의 생장도를 측정하였다. 이를 위하여 야생형의 모계품종(H883)과 공동 배양을 실시하여 생/건물질의 중량, callus/shoot 형성도, 무기질함량을 검사하였다. 본 연구에 사용된 배지의 인산 농도는 $0-400{\mu}M$ 사이의 일곱가지이다. 0과 12.5μM의 인 농도에서는 두 변종의 조직은 거의 생존하지 않았으나 $50-200M$에서는 H957이 H883을 앞선 것으로 나타났다. H957은 생/건물질 중량 부문에서 매우 앞선 것으로 나타났으며, cellus 및 shoot 형성도에 있어서도 미량의 인산 농도에 대해 H883보다 덜 민감한 것으로 나타났다. 이는 세포 및 조직 차원에 있어 H957의 높은 항저린산(抗低燐酸) 특성을 입증하는 것이다. 아울러, 인의 함량을 측정한 결과, H957 조직은 H883보다 낮은 농도의 인을 함유하고 있는 것으로 나타났다. 이 결과는 H957의 항저린산(抗低燐酸) 특성이 이미 흡수된 인의 세포 및 조직 차원에서의 높은 활용성에 기인함이라고 판단된다.
Two groups of esophagus graft were done in canine esophagus in 34 adult mongrel dogs. For the first group segmental replacement graft was done with fresh autologous pericardium tube, and for the second, patch graft was done utilizing fresh autologous pericardium, fresh homologous pericardium,and dacron piece. All eight dogs in the first segmental replacement graft group died 2 to 5 days after operation with severe empyema caused by anastomosis disruption. Among 26 patch graft dogs 2 died during operation and 7 died 13 to 18 days after operation. For the 17 long-term patch grafted survivors esophagography and postoperative weight check were done. Postoperative stool was collected and examined for dacron patch excretion. One, two, three, and four months postoperative long-term survivors were sacrificed to obtain specimens in each group respectively and the following observations were made.I. Survival; Autologous pericardium patch group showed no mortality but in homologous pericardium and dacron patch group only two thirds were long-term survivors. II. Postoperative swallowing; There was no case which demonstrated postoperative dysphagia. About half of the cases showed postoperative weight increase and in only 3 cases weight decrease followed operation. III. Dacron patch was excreted in the stool 8 to 23 days after operation. Animals which excreted dacron patch up to 9 days after operation all died of empyema due to anastomosis disruption.IV. Postoperative esophagogram; All esophagograms in each group showed no leakage of barium, no passage disturbances and no remarkable stenotic signs.V. Morphological findings; [A] Macroscopical findings; In one month group specimens of each group dense adhesion with surrounding structures was noted and luminal surface was smooth with contraction of the patched area. In two month groups anastomosis sutures were still exposed but patched area showed lesser abnormality. In three to four months groups sutures were covered completely and patched area showed only very slight signs of contraction. [B] Microscopic findings; In one month group luminal surface of the replaced tissue [transplanted tissue] showed almost complete epithelial covering that is composed of several layers of squamous cells with no evidence of keratinization. Basement membrane was also well distinct throughout. Slight to minimal inflammatory cells comprising of large mononuclears, lymphocytes and plasma cells were observed in the subepithelial fibrous stroma consisted entirely of loose fibrous tissue containing many newly formed capillaries and fibroblastic proliferation. Scattered suture granulomas were found, few of which became acutely inflamed. In two months group repairing process progressed with lesser degree of inflammatory cell infiltration and young capillary proliferation. Fibrous tissue was more matured showing even focal collagenization.Suture granuloma persisted but with lesser reactive changes. Epithelial covering was that of a mature non-keratinizing stratified squamous epithelium. In three and four months groups the replaced area showed essentially similar histological findings. However, subepithelial stroma still consisted entirely of connective tissue without evidence of smooth muscle regeneration. In this group, inflammatory cell infiltration was minimal or negligible. Among these patch materials autologous pericardium group showed the most satisfactory repairing process.The above mentioned results may signify the feasibility of autogenous pericardium patch graft in clinical esophageal surgery.
Two groups of esophagus graft were done in canine esophagus in 34 adult mongrel dogs. For the first group segmental replacement graft was done with fresh autologous pericardium tube, and for the second, patch graft was done utilizing fresh autologous pericardium, fresh homologous pericardium,and dacron piece. All eight dogs in the first segmental replacement graft group died 2 to 5 days after operation with severe empyema caused by anastomosis disruption. Among 26 patch graft dogs 2 died during operation and 7 died 13 to 18 days after operation. For the 17 long-term patch grafted survivors esophagography and postoperative weight check were done. Postoperative stool was collected and examined for dacron patch excretion. One, two, three, and four months postoperative long-term survivors were sacrificed to obtain specimens in each group respectively and the following observations were made. I. Survival; Autologous pericardium patch group showed no mortality but in homologous pericardium and dacron patch group only two thirds were long-term survivors. II. Postoperative swallowing; There was no case which demonstrated postoperative dysphagia. About half of the cases showed postoperative weight increase and in only 3 cases weight decrease followed operation. III. Dacron patch was excreted in the stool 8 to 23 days after operation. Animals which excreted dacron patch up to 9 days after operation all died of empyema due to anastomosis disruption. IV. Postoperative esophagogram; All esophagograms in each group showed no leakage of barium, no passage disturbances and no remarkable stenotic signs. V. Morphological findings; [A] Macroscopical findings; In one month group specimens of each group dense adhesion with surrounding structures was noted and luminal surface was smooth with contraction of the patched area. In two month groups anastomosis sutures were still exposed but patched area showed lesser abnormality. In three to four months groups sutures were covered completely and patched area showed only very slight signs of contraction. [B] Microscopic findings; In one month group luminal surface of the replaced tissue [transplanted tissue] showed almost complete epithelial covering that is composed of several layers of squamous cells with no evidence of keratinization. Basement membrane was also well distinct throughout. Slight to minimal inflammatory cells comprising of large mononuclears, lymphocytes and plasma cells were observed in the subepithelial fibrous stroma consisted entirely of loose fibrous tissue containing many newly formed capillaries and fibroblastic proliferation. Scattered suture granulomas were found, few of which became acutely inflamed. In two months group repairing process progressed with lesser degree of inflammatory cell infiltration and young capillary proliferation. Fibrous tissue was more matured showing even focal collagenization. Suture granuloma persisted but with lesser reactive changes. Epithelial covering was that of a mature non-keratinizing stratified squamous epithelium. In three and four months groups the replaced area showed essentially similar histological findings. However, subepithelial stroma still consisted entirely of connective tissue without evidence of smooth muscle regeneration. In this group, inflammatory cell infiltration was minimal or negligible. Among these patch materials autologous pericardium group showed the most satisfactory repairing process. The above mentioned results may signify the feasibility of autogenous pericardium patch graft in clinical esophageal surgery.
Objective : Repeated administration of mannitol in the setting of large hemispheric infarction is a controversial and poorly defined therapeutic intervention. This study was performed to examine the effects of multiple-dose mannitol on a brain edema after large hemispheric infarction. Methods : A middle cerebral artery was occluded with the rat suture model for 6 hours and reperfused in 22 rats. The rats were randomly assigned to either control (n=10) or the mannitol-treated group (n=12) in which intravenous mannitol infusions (0.8 g/kg) were performed six times every four hours. After staining a brain slice with 2,3,5-triphenyltetrazolium chloride, the weight of hemispheres, infarcted (IH) and contralateral (CH), and the IH/CH weight ratio were examined, and then hemispheric accumulation of mannitol was photometrically evaluated based on formation of NADH catalyzed by mannitol dehydrogenase. Results : Mannitol administration produced changes in body weight of $-7.6{\pm}1.1%$, increased plasma osmolality to $312{\pm}8\;mOsm/L$. It remarkably increased weight of IH ($0.77{\pm}0.06\;gm$ versus $0.68{\pm}0.03\;gm$ : p<0.01) and the IH/CH weight ratio ($1.23{\pm}0.07$ versus $1.12{\pm}0.05$ : p<0.01). The photometric absorption at 340 nm of the cerebral tissue in the mannitol-treated group was increased to $0.375{\pm}0.071$ and $0.239{\pm}0.051$ in the IH and CH, respectively from $0.167{\pm}0.082$ and $0.162{\pm}0.091$ in the IH and CH of the control group (p<0.01). Conclusion : Multiple-dose mannitol is likely to aggravate cerebral edema due to parenchymal accumulation of mannitol in the infarcted brain tissue.
In this study, the aim was to investigate the effect of Mahwangpohang-tang on the expression of obesity-related genes and cytokines in high fat diet induced obesity mice. In order to investigate the effects of Mahwangpohang-tang(MHPH) on the obesity-related genes and cytokines, C57BL/6 mice were fed with high fat diet. C57BL/6 mice were divided into three groups and fed for 13weeks. Body weight change, diet intake change, final increase of body weight, the ratio of the adipocyte in body weight, the expression of leptin gene in primary adipocytes, the expression of UCP-2 in primary adipocytes, the production change of $TNF-\alpha$ and leptin in primary adipocytes, the expression of leptin in adipocytes tissue. The body weight of Mahwangpohang-tang(MHPH) intake mice was significantly lower than high fat diet group. The amount of the adipocyte in body weight was decreased Significantly. In primary adipocytes, leptin gene expression and the expression of UCP-2 did not change significantly. In primary adipocytes, the amount of $TNF-\alpha$ was significantly decreased at dose of $100{\mu}/ml$ density. In adipocytes tissue, the expression of leptin did not change significantly. These results suggest that MHPH may inhibit the expression of obesity-related genes and cytokines in high fat diet induced obesity mice
The aim of the present study was to assess the effects of onion (Allium cepa) skin extract (OSE) on pancreatic lipase (PL), the key enzyme of the digestion and absorption of dietary fat in the small intestine, and to evaluate its potential for the inhibition of body-weight gain. OSE inhibited PL with an $IC_{50}$ of 53.70 mg/mL, which means as potent as 0.07635% of the activity of orlistat. At 3 and 4 hr after administration of OSE, the plasma triacylglycerol concentration was significantly lower in the OSE-treated rats than control. Body-weight gain and parametrial adipose tissue weights were significantly lower in mice fed the high-fat diet (fat comprises 31% of total calories) with 5%(w/w) OSE than in control. The results suggest that OSE may be an effective nutraceutical for the inhibition of body-weight gain.
Soft tissue defect on heel area of the foot present difficult problems particularly because of anatomic property of plantar surface of the foot. There is a paucity of available local tissue in the foot for coverage. In addition to having little expandable tissue, the foot's plantar surface has a unique structure, making its replacement especially challenging. Plantar skin is attached to the underlying bone by fibrous septa, preventing shear of the soft-tissue surfaces from the underlying skeleton. Plantar surface of foot is in constant contact with the environment. Protective sensibility also would be maintained or restored in the ideal reconstruction. So the ideal flap for reconstruction of the heel should include thin, durable hairless skin with potential for reinnervation. The aim of this article is to present a clinical experience of free lateral arm neurosensory flap for reconstruction of the heel. From March 1995 to December 1997, a total 16 lateral arm free flaps were performed to soft tissue defects on the weight-bearing area of the hindfoot. we used tibial nerve as recepient nerve in 11 and calcaneal branch of tibial nerve in 5 for restoration of sensibility of flap. All cases survived completely. A static two-point discrimination of 14 to 34mm was detected in the flap. Radial nerve palsy which was caused by hematoma in donor site occured in one case, but recorverd in 3 weeks later completely. In conclusion, the lateral arm free flaps are versatile, reliable and sensible cutaneous flap and especially indicated for soft tissue defect on plantar surface of the hindfoot which are not good indications for other better-known flaps.
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