Comparison of Survival of SureDerm(R), Permacol(R) Graft in Mouse

PURPOSE: Numerous materials, both autologous and nonautologous, have been used for augmentation of sunken areas and each has its own limitations. The ideal material for augmentation should not be absorbed in any manner. This study is designed to assess the survival of SureDerm(R), Permacol(R) graft according to the volume and histologic change. METHODS: Twenty four mice, weighing about 50 grams and of 5 weeks of age were used. SureDerm(R) is an acellular dermal matix obtained from human cadaveric skin. Permacol(R) is a porcine derived acellular dermal matrix whose manufacture involves trypsinisation, solvent extraction. Graft pieces standardized to 1x1cm size were used in each group. The implanted material were taken 1, 4, 8 and 12 weeks later, respectively. The changes of graft volume during the graft period were measured on initial, 1, 4, 8 and 12 weeks. RESULTS: The initial shape of graft was maintained up to 12 weeks in Permacol(R) graft group and mean survival rate was 80.36+/-8.21% in SureDerm(R), 89.57+/-6.39% in Permacol(R)(p=0.01). The volume of each graft decreased 29% from initial volume on 12 weeks in SureDerm(R), 18% in Permacol(R). The structure of Permacol(R) remained until 12 week after implantation. CONCLUSION: Our experimental study suggests that Permacol(R) could be a safe material as an implant for permanent augmentation. However, There are further study remained for antigenicity of these material, and the choice of graft for augmentation should be remained to the clinical situations.

Myofibrosarcoma of the Nostril Sill after Excision of a Wart

Myofibroblasts are mesenchymal spindle cells that share morphologic and functional features with fibroblasts and smooth muscle cells, especially in relation to matrix production and contractility. Myofibroblastic sarcomas have been described recently and such lesions are relatively rare and almost unknown, especially developed in the skin. Most examples of myofibrosarcoma occur de novo. We herein report a case of solitary myofibrosarcoma occurred after several laser and pharmacological treatment of a wart. A 28-year-old woman had a 10-month history of small firm painless papule on the lower margin of her nostril. Her lesion was once treated with laser at a local clinic. At first visit to our hospital, the lesion was 0.4 x 0.3 cm solitary skin colored keratotic flat papule and it was diagnosed as a wart and ablated with carbon dioxide laser. Two subsequent recurrences occurred within 6 months and repeatedly ablated with the same laser. One year later the patient appeared with 1.5 x 1.5 cm pale red rubbery-firm nodule on the same site. On punch biopsy, it showed thickened collagen with mild inflammatory infiltrate. We performed intra-lesional triamcinolone injection every three weeks under the impression of hypertrophic scar after the wart removal, and no improvement was made and the lesion's growth was accelerated. On exicisional biopsy of lesion, a myofibroblastic tumor of uncertain malignant potential was suggested and subsequent wide excision and lateral lip advancement flap was done. The patient has been free of recurrence 14 months after wide excision. This report emphasizes the possibility that iatrogenic manipulation of the normal wound healing process may well contribute to the development of myofibrosarcoma.

The Effects of Alloderm, Chitosan Mesh and Gelfoam in Chondrogenesis of Auricular Cartilage Donor Site in Rabbits

Auricle is frequently used as a donor site of autogenous cartilage graft, but a lot of cartilage donation can make auricular deformity. In various animal studies, perichondrium has been described as the source of new cartilage. However, if any cartilage was formed, the amount was variable and limited. This study was designed to investigate the effect of Alloderm, Chitosan mesh and Gelfoam as a template for chondrogenesis at the donor site of auricular cartilage graft and to compare the effect of single layer perichondrium and double layer perichondrium in chondrogenesis. In each experimental group, one of Alloderm, Chitosan mesh and Gelfoam were implanted at the donor site of cartilage graft in New Zealand White rabbits(n = 18) into two groups. In group I(n = 9), both(ventral & dorsal) sides perichondrium were preserved and in group II(n = 9) only one(ventral) side perichondrium was preserved. Each 3 rabbits were sacrificed at 3, 8 weeks, postoperatively. Formation of neocartilage was evaluated with histological examination. Neocartilage was formed in all control and implanted sites. Templates wrapped with perichondrium groups generated much more neocartilage than control group and there was little difference among each template groups. These results indicat that the amount and regeneration velocity of neocartilage may be controlled by implantation of templates. The template serves as an inducer for the perichondrium to produce chondrogenic cells and serves as a scaffold for the cartilage differentiation. Therefore templates may be helpful in decreasing auricular deformity after graft donation of auricular cartilage and in correcting other structural defects that also require new cartilage formation.

A Case of Pancreatic Abscess Due to Salmonella Typhi / 대한내과학회지

Salmonella infection occurs in 5 different clinical forms; gasteroenteritis, enteric fever, bacteremia, chronic carried state and localization at one or more sites. Extraintestinal pyogenic infections caused by salmonella species include soft tissue abscesses, bone and joint infections, cholecystitis, liver abscess and splenic abscess etc. Pancreatic abscess due to Salmonella typhi is a very rare extraintestinal manifestation of salmonellosis. Infection pathways may be considered as reflux of infected bile through the pancreatic duct, hematogenous spread from a distant site or lymphatic spread from the intestinal tract. Treatment of pancreatic abscess needs surgical intervention and antibiotics therapy. We have experienced a case of a 40-years-old female with pancreatic abscess due to Salmonella typhi. She was treated with ultrasonography-guided catheter drainage and intravenous ceftriaxone for 18 days. After 14 days, the sonographic examination revealed the abscess cavity in pancreas almost disappeared. We report this case with review of literatures.

Predictors of Successful Balloon Dilation in Patients with Achalasia - Especially in patients who showed peristalsis after dilation / 대한내과학회지

OBJECTIVES: Achalasia is primary esophageal motility disorder characterized by aperistalsis in body and incomplete lower esophageal sphincter(LES) relaxation. The aim of this study was to evaluate the parameters of successful balloon dilatation predicting long term outcome METHODS: 17 patients with primary esophageal achalasia from March 1995 to December 1996 were included in this study. 5 patients were performed re-balloon dilatation due to recurrence of symptoms. We used Rigiflex Achalasia Balloon with diameter of 30 and 35mm and balloon is dilated for 1 minute at a 5 minute interval. Esophageal manometry and scintigraphy before and after 1 month of balloon dilation were compared between groups with good long term results and relapsed RESULTS: 1) After balloon dilatation, LES pressure, basal esophageal pressure and retention rate were significantly decreased 2) After 6 months of dilatation, 12 patients were successfully treated and 5 patients were recurred 3) No significant pre-dilatation parameters were found to predict the recurrence 4) After 1 month of dilatation, patients with recurrence of symptoms showed significant higher LES pressure and retention rate 5) 2 patients showed recovery of the peristasis, and in these patients, amplitude of esophageal body contraction of pre- and post-balloon dilatation were significantly high CONCLUSION: After 1 month of dilatation, LES pressure and retention rate can predict the outcome after balloon dilatation and high amplitude of esophageal body contraction predict recovery of peristalsis and long term good result

The Clinical Significance of Serum Hyaluronic Acid and Type IV Collagen Levels in Chronic Viral Hepatitis and Liver Cirrhosis / 대한내과학회지

OBJECTIVE: Histopathologic evaluation has been used to evaluate the degree of hepatic fibrosis. This method may have limitations because percutaneous liver biopsy is invasive and histopathologic change shows heterogenicity in the liver. It has been reported that the biochemical markers may have an important role in evaluating the degree of hepatic fibrosis. This study was performed to evaluate the clinical significances of serum hyaluronic acid (HA) and type IV collagen (IV-C) levels on hepatic fibrosis in the patients with chronic viral hepatitis B and liver cirrhosis. METHODS: This study included fifty eight patients with chronic viral liver diseases caused by HBV. Scheuer's classification was used to determine the degree of hepatic fibrosis. The levels of hyaluronic acid and type IV collagen was evaluated by one-step sandwich binding protein assay and one-step sandwich enzyme immunoassay respectively. RESULTS: The level of hyaluronic acid and type IV collagen in stage III (HA:589.4+/-193.7ng/ml, IV-C:444.5+/- 221.3ng/ml) and IV (727.5+/-306.1ng/ml, IV-C:519.2+/-210.5 ng/ml) were higher than stage I (HA:207.2+/-206.8ng/ml, IV-C:210.0+/-92.0ng/ml) and II (HA:223.7+/-172.9ng/ml, IV- C:209.6+/-70.7ng/ml) in the patients with chronic viral hepatitis and cirrhosis. At cutoff value of 500ng/ml for HA and 250ng/ml for IV-C in chronic hepatitis B patients, the sensitivities were 85% and 85%, and specificities were 89.5% and 78.9%, and diagnostic efficiencies were 87.9% and 81% respectively for discriminating patients with advanced hepatic fibrosis (stageIII-IV) from those with mild hepatic fibrosis (stageI-II). CONCLUSION: The serum levels of hyaluronic acid and type IV collagen correlated significantly with the degree of hepatic fibrosis in the patients with chronic viral hepatitis B and cirrhosis. The serum hyaluronic acid and type IV collagen is useful biochemical markers for evaluating hepatic fibrosis and follow up of the patients with chronic viral hepatitis B and cirrhosis.

Detection of Helicobacter pylori in Gastric Biopsy Specimens by Polymerase Chain Reaction / 대한내과학회지

OBJECTIVE: Helicobacter pylori (H. pylori) has been implicated in the pathogenesis of chronic gastritis, gastric ulcer, duodenal ulcer and gastric cancer. Histological examination and culture are considered to be the most specific tests, and rapid urease test and serological test are rapid but less specific tests. 'I he aim of this study was to investigate the efficiency of the polymerase chain reaction (PCR) assay as a procedure for the diagnosis of H, pylori infection in gastric biopsy specimens. METHODS: Biopsy specimens were obtained from the gastric antrum within 2cm from the pyloric channel of 42 patients during endoscopy and submitted for the histological examination, CLO test, and PCR assay. At the same time, another biopsy specimens were obtained from the lesion for the diagnosis of the diseases. Also, blood was sampled for the measure of the value of IgM and IgG. RESULTS: As the result of the histopathological examination, chronic gastritis was diagnosed in 13 patients, gastric ulcer in 11, duodenal ulcer in H, and gastric cancer in 10. By the histological examination of the antrum, H, pylori were found in 77% of chronic gastritis, 55% of gastric ulcer, 75% of duodenal ulcer, and 40% of gastric cancer. As a whole, the bacteria was identified in 62%, 60%, 88%, 90%, 69% of patients by histological test, CLD test, IgM, IgG, and P(;R respectively. The gold standard we used for the presence of bacteria was histological examination. Sensitivity, specificity, positive predictive value, ancl negative predictive value for PCR assay were 92%, 69%, 83% and 85% respectively. The results of other test were as follows. CLO test: 89%, 88%, 92%, 82%, IgM:92%, 19%, 65%, 60%, IgG:100%, 25%, 68%, 100%. CONCLUSION: CR is a very sensitive but some- what less specific test for the detection of H. pylori. This is mainly due to the contamination of H. pylori during endoscopy and biopsy. So, minimization of the contamination would make PCR clinically useful test.

A Case of Cutaneous Extramedullary Hematopoiesis in Idiopathic Myelofibrosis / 대한혈액학회지

Idiopathic myelofibrosis is characterized by replacement of the bone marrow with fibrous tissue and the development of extramedullary hematopoiesis. The latter involves mainly the spleen and liver but also occurs in lymph nodes, kidneys, retroperitoneal fat, and more rarely, the skin. We report a 48-year-old male with idiopathic myelofibrosis who was admitted due to numerous papules and nodules on his trunk. The skin lesions were histologically defined as cutaneous extramedullary hematopoiesis.