Adrenal ganglioneuroma with nodal metastases on 123I-MIBG SPECT/CT and 18F-FDG PET/CT.

Ganglioneuroma is a well-differentiated tumor originating from neural crest cells of the sympathetic nervous system. Although benign, a few cases have been reported that ganglioneuroma can metastasize to other sites. We report a case of adrenal ganglioneuroma with para-aortic nodal metastases with low FDG and MIBG uptake. In order to avoid unnecessary wide excision or aggressive medication, it is important to consider the possibility of ganglioneuroma preoperatively even if with metastases.

Novel Application of Cultured Epithelial Autografts (CEA) with Expanded Mesh Skin Grafting Over an Artificial Dermis or Dermal Wound Bed Preparation.

Cultured epithelial autografts (CEA) with highly expanded mesh skin grafts were used for extensive adult burns covering more than 30% of the total body surface area. A prospective study on eight patients assessed subjective and objective findings up to a 12-month follow-up. The results of wound healing for over 1:6 mesh plus CEA, gap 1:6 mesh plus CEA, and 1:3 mesh were compared at 3, 6, and 12 months using extensibility, viscoelasticity, color, and transepidermal water loss by a generalized estimating equation (GEE) or generalized linear mixed model (GLMM). No significant differences were observed among the paired treatments at any time point. At 6 and 12 months, over 1:6 mesh plus CEA achieved significantly better expert evaluation scores by the Vancouver and Manchester Scar Scales (p < 0.01). Extended skin grafting plus CEA minimizes donor resources and the quality of scars is equal or similar to that with conventional low extended mesh slit-thickness skin grafting such as 1:3 mesh. A longitudinal analysis of scars may further clarify the molecular changes of scar formation and pathogenesis.

Effectiveness of basic fibroblast growth factor for pediatric hand burns.

AIM OF THE STUDY: Pediatric hand deep dermal and deep burns may lead to serious hand deformity with functional impairment and result in an esthetically unfavorable outcome. Since there is no guideline regarding the use of growth factors for pediatric hand burns, we sought to investigate the effectiveness of an angiogenic and regenerative growth factor, basic fibroblast growth factor (bFGF). METHODS: Consecutive series of second degree or third degree palmer burns at less than 3 years of age seen from January 2010 to June 2014 were included for evaluation at 6 months post-wound healing. The bFGF treatment started from just after injury and continued up to 21 days. Each patient had their scars scored using the Vancouver Scar Scale (VSS) at 6 months after wound healing. RESULTS: There were 34 children with 49 acute palmar burns. The mean healing period was 13.5 ± 4.3 days (7-44 days) and 43 wounds healed within 21 days. There was no need of additional surgery in the 43 wounds, healed within 21 days. In comparison to the wounds for which healing took more than 21 days, the wounds that healed within 21 days demonstrated significantly better pigmentation, pliability, and height according to the VSS (p < 0.05), as well as no scar contracture or hypertrophic scars. CONCLUSION: bFGF treatment was effective in cases that healed within 21 days, avoiding scar contractures and hypertrophic scars. Our methods using bFGF to complete wound healing are less invasive and produce better results in pediatric palmer burns.

Combined treatment with artificial dermis and basic fibroblast growth factor for cranial bone-exposing wounds.

AIM OF THE STUDY: Cranial bone-exposing wounds should be resurfaced as soon as possible using flaps. However, early one-stage wound closure is sometimes difficult due to the poor general condition of the patient or equipment shortages. Artificial dermis composed of atelocollagen sponge is useful for reconstructing bone-exposing wounds. In addition, the treatment of wounds with basic fibroblast growth factor helps more severe wounds to heal faster. We employed combined treatment with artificial dermis and basic fibroblast growth factor to treat cranial bone-exposing wounds in 2 cases, and we describe these cases here. MATERIALS AND METHODS: Case 1: A 56-year-old man suffered severe burns, which exposed the occipital bone and mandible, after attempting suicide. Case 2: A 79-year-old woman suffered a full-thickness skin defect on her forehead due to a fall, which resulted in her frontal bone being exposed. Both patients underwent combined treatment with artificial dermis and basic fibroblast growth factor, followed by free skin grafting. RESULTS: The combined treatment promoted the formation of granulation tissue, which acted as a wound bed for the subsequent skin grafting. The free skin grafting resulted in the complete resurfacing of the patients' wounds. CONCLUSION: Combined treatment with artificial dermis and bFGF is an easy, fast-acting, and effective way of preparing a favorable wound bed for skin grafting, and hence, is useful for the treatment of cranial bone-exposing wounds.

The vascularized sural nerve graft based on a peroneal artery perforator for reconstruction of the inferior alveolar nerve defect.

The sural nerve has been described for nerve reconstruction of the maxillofacial region since it provides many advantages. We report a case of a vascularized sural nerve graft based on a peroneal artery perforator for immediate reconstruction after the removal of intraosseous neuroma originating in the inferior alveolar nerve. The patient had a neuroma caused by iatrogenic injury to the inferior alveolar nerve. A 4-cm long neuroma existed in the inferior alveolar nerve and was resected. A peroneal perforator was chosen as the pedicle of the vascularized sural nerve graft for the nerve gap. The graft including the skin paddle for monitoring the perfusion supplied by this perforator was transferred to the lesion. The nerve gap between the two stumps of the inferior alveolar nerve was repaired using the 6-cm long vascularized sural nerve. The perforator of the peroneal artery was anastomosed to the branch of the facial artery in a perforator-to-perforator fashion. There was no need to sacrifice any main arteries. The skin paddle with 1 cm × 3 cm in size was inset into the incised medial neck. Perceptual function tests with a Semmes-Weinstein pressure esthesiometer and two-point discrimination in the lower lip and chin at 10 months after surgery showed recovery almost to the level of the normal side. This free vascularized sural nerve graft based on a peroneal artery perforator may be a good alternative for reconstruction of inferior alveolar nerve defects.

Transcatheter arterial embolization for shock caused by intratumoral hemorrhaging in neurofibromatosis type 1: a report of two cases.

Neurofibromatosis type 1 (NF-1) is an autosomal dominant disorder characterized by café-au-lait spots and neurofibroma. Vascular NF-1 lesions are rare, but bleeding from such lesions can sometimes cause lethal complications because surgical hemostasis is difficult to achieve due to the fragile nature of the surrounding blood vessels and soft tissue. In recent years, some reports have suggested that transcatheter arterial embolization (TAE) is an effective treatment for vascular NF-1 lesions. We report the cases of 2 NF-1 patients who developed intratumoral hemorrhaging and were successfully treated with TAE.

Acetylation of chitin nanofibers and their transparent nanocomposite films.

Chitin nanofibers were acetylated to modify the fiber surface and were characterized in detail. The acetyl DS could be controlled from 0.99 to 2.96 by changing the reaction time. FT-IR spectra indicate that chitin nanofibers were acetylated completely after 50 min reaction time. X-ray diffraction profiles and TGA curves show that the chitin nanofibers were acetylated heterogeneously from the surface to the core. SEM images show that fiber shape was maintained even in the high-DS sample and that the thickness of the nanofibers increased with the introduction of bulky acetyl groups. Acetylated chitin nanofiber composites were fabricated with acrylic resin with the fiber content of approximately 25 wt %. Due to the size effect, all nanocomposites had high transparency, despite the variety of acetyl DS, and the transparency of the chitin nanofiber composite was less sensitive to acetylation. By only 1 min acetylation, the moisture absorption of the nanocomposite drastically decreased from 4.0 to 2.2%. Although the coefficient of thermal expansion (CTE) of the tricyclodecane dimethanol dimethacrylate (TCDDMA) resin was 6.4 x 10(-5) degrees C(-1), the CTE of the chitin nanofiber/TCDDMA composite decreased to 2.3 x 10(-5) degrees C(-1) by the reinforcement effect of the chitin nanofibers with low thermal expansion.