A Novel Retractable Robotic Device for Colorectal Endoscopic Submucosal Dissection

Background/Aims@#Appropriate tissue tension and clear visibility of the dissection area using traction are essential for effective and safe endoscopic submucosal dissection (ESD). In this study, we developed a retractable robot-assisted traction device and evaluated its performance in colorectal ESD. @*Methods@#An experienced endoscopist performed ESD 18 times on an ex vivo porcine colon using the robot and 18 times using the conventional method. The outcome measures were procedure time, dissection speed, procedure-related adverse events, and blind dissection rate. @*Results@#Thirty-six colonic lesions were resected from ex vivo porcine colon samples. The total procedure time was significantly shorter in robot-assisted ESD (RESD) than in conventional ESD (CESD) (20.1±4.1 minutes vs 34.3±8.3 minutes, p<0.05). The submucosal dissection speed was significantly faster in the RESD group than in the CESD group (36.8±9.2 mm 2 /min vs 18.1±4.7 mm 2 /min, p<0.05). The blind dissection rate was also significantly lower in the RESD group (12.8%±3.4% vs 35.1%±3.9%, p<0.05). In an in vivo porcine feasibility study, the robotic device was attached to a colonoscope and successfully inserted into the proximal colon without damaging the colonic wall, and ESD was successfully performed. @*Conclusions@#The dissection speed and safety profile improved significantly with the retractable RESD. Thus, our robotic device has the potential to provide simple, effective, and safe multidirectional traction during colonic ESD.

Growth and Bone Mineral Density Changes in Ovariectomized Rats Treated with Estrogen Receptor Alpha or Beta Agonists

Background@#Estrogen controls the pubertal growth spurt, growth plate closure, and accretion of bone mineral density (BMD) of long bones after biding estrogen receptor (ER).There are two subtypes of ER, ERα and ERβ. If each ER subtype has different effects, we may control those actions by manipulating the estrogen binding intensity to each ER subtype and increase the final adult height without markedly reducing BMD or impairing reproductive functions. The purpose of our study was to compare these effects of ERα and ERβ on long bones in ovariectomized rats. @*Methods@#Thirty female rats were ovariectomized and randomly divided into 3 groups. The control, propylpyrazole triol (PPT), and 2,3-bis (4-hydroxyphenyl) propionitrile (DPN) groups were subcutaneously injected for 5 weeks with sesame oil, PPT as an ERα agonist, and DPN as an ERβ agonist, respectively. The crown-lump length and body weight were measured weekly.BMD, serum levels of growth hormone (GH) and estradiol were checked before and after 5 weeks of injections. Pituitary GH1 expression levels were determined with quantitative realtime polymerase chain reaction, the proximal tibias were dissected, decalcified and stained with hematoxylin-eosin, and the thicknesses of epiphyseal plates including proliferative and hypertrophic zones were measured in 20-evenly divided sites after 5 weeks of injections. Comparisons for auxological data, serum hormone and pituitary GH1 expression levels, BMD, and epiphyseal plate thicknesses among 3 groups before and after injections were conducted. @*Results@#There was no significant difference in body lengths among 3 groups. The body weights were significantly lower, but, serum GH, pituitary GH1 expression levels, and BMDs were higher in PPT group than the other 2 groups after 5 weeks of injections. There was no significant difference in the thicknesses of the total epiphyseal plate, proliferative, and hypertrophic zone among 3 groups. @*Conclusion@#ERα is more involved in pituitary GH secretion and bone mineral deposition than ERβ. Weight gain might be prevented with the ERα agonist.

Correlations between Tumor to Background Ratio on Breast-Specific Gamma Imaging and Prognostic Factors in Breast Cancer

The purpose of this study was to investigate the correlations between tumor-to-background ratio (TBR) obtained from breast-specific gamma imaging (BSGI) and the prognostic factors of breast cancer. Sixty-seven patients with invasive ductal carcinoma who underwent preoperative BSGI were enrolled. The BSGI images were visually scored from 1 to 5 according to a breast imaging reporting and data system (BIRADS). The TBR results obtained from positive BSGI images were compared according to the following prognostic factors: tumor size; axillary lymph node metastasis; nuclear grade (NG); histologic grade (HG); subtype; Ki-67; and the expression profile of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). Among 67 images, 60 were classified as a positive finding (sensitivity 89.6%). A higher TBR value was significantly correlated with tumor size ≥ 2 cm (P = 0.001), axillary lymph node metastasis (P = 0.007), high HG (P = 0.029), negative PR status (P = 0.036), and Ki-67 ≥ 14% (P = 0.007). The TBR showed a significant difference between the luminal A and non-luminal A subtypes (P = 0.007). On multivariate analysis, TBR had a high correlation with tumor size ≥ 2 cm, axillary lymph node metastasis, and negative PR status (P = 0.003, 0.048, and 0.030, respectively). A high TBR on BSGI was significantly correlated with poor prognostic factors of breast cancer. Luminal A subtype, a breast cancer subtype with more favorable prognosis, was associated with a low TBR on BSGI.

Comparative Analysis of (99m)Tc-MDP Three-Phase Bone Scan with SPECT/CT and (99m)Tc-HMPAO-Labeled WBC SPECT/CT in the Differential Diagnosis of Clinically Suspicious Post-traumatic Osteomyelitis / 대한핵의학회잡지

PURPOSE: To identify differences between three-phase bone scan and SPECT/CT (TBS) and WBC SPECT/CT (WS) and compare diagnostic accuracies of each modality in patients with suspicious post-traumatic osteomyelitis (OM).METHODS: Twenty-one patients with suspicious post-traumatic OM were enrolled. All patients performed TBS and WS within 1 week. Foci ofMDP andWBC accumulation were divided into three categories: bone (OM), soft tissue (soft tissue inflammation; STI), negative for inflammation (NI). Confirmative diagnosis was made upon operative pathology or long-term clinical follow-up.RESULTS: Of 21 patients, four OM, eight STI, nine NI were finally diagnosed. TBS diagnosis was correct in three of four positive cases and nine of 17 negative cases. Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV) of TBS were 75 %, 52.9 %, 57.1 %, 27.3 %, 90 %. WS diagnosis was correct in two of four positive cases and 17 of 17 negative cases. Sensitivity, specificity, accuracy, PPV, NPV were 50 %, 100 %, 81.0 %, 100 %, 89.5 %. Twelve of 21 cases showed agreement between TBS and WS. TBS misdiagnosed nine cases (six STI and two NI as eight OM; one OM as one STI), while WS misdiagnosed four cases (two OM as two STI; two STI as two NI). Combining results from TBS and WS led to better diagnostic accuracy (91.7 %) than either TBS or WS alone.CONCLUSION: TBS and WS showed moderate agreement in assessment of clinically suspected post-traumatic OM. WS better evaluated inflammation than TBS. WS tended to underestimate inflammation whereas TBS tended to overestimate inflammation. Combining TBS and WS enhanced diagnostic accuracy.

Clinical and Physical Characteristics That Affect Apnea-Hypopnea Index in Suspected Obstructive Sleep Apnea Patients : The Preliminary Study

OBJECTIVES: The purpose of this study is to find the influential clinical and physical characteristics which affect apnea-hypopnea index (AHI) in suspected obstructive sleep apnea (OSA) patients. METHODS: We evaluated the comprehensive factors including sleep related symptoms, clinical scales, medical history, substance use, and anthropometric data of the 119 participants who complained of the symptoms of OSA. All the participants underwent attended-full night laboratory polysomnography. The correlation and multiple regression analysis were conducted to find the influential and predictive factors of AHI. RESULTS: A multiple linear regression model 1 showed that higher AHI was associated with higher body mass index (BMI)(p < 0.001) and higher frequency of observed apnea (p = 0.002). In multiple linear regression model 2, AHI was associated with higher BMI (p < 0.001) and loudness of snoring (p = 0.018). CONCLUSIONS: The present preliminary results suggest that BMI and observed apnea are most influential factors that affect AHI in suspected OSA patients. In the future study we will design the prediction formula for the OSA and AHI, which is useful in the clinical medical field.

Correction of Closed Outer Table Fracture of Frontal Sinus using Upper Eyelid Incision and Autogenous Bone Graft

PURPOSE: The bicoronal incision, traditional procedure to correct the frontal sinus fracture, could remain a long scar, alopecia etc. Hence, the authors introduce the procedure to fix the outer table fracture of the frontal sinus through the upper eyelid incision as a concealed scar. MATERIAL & METHODS: From November, 2007 to December, 2010, five patients who suffered from outer table fracture of frontal sinus fracture underwent operation to correct the depressed contour of forehead. Instead of the reduction of depressed outer wall, autogenous bone was grafted trough the upper eyelid incision. The result of operation was evaluated with VAS score system(score arrange 0 to 5). VAS score was taken from patients as well as 4 plastic surgeons. RESULTS: Both patients and surgeons were satisfied about result of operation. The overall average score from plastic surgeon was 4.2. Especially to the scar of upper eyelid incision, the score was 4.7. Average score from the patients was 4.1. And there were no other complications as follow-up periods. CONCLUSION: This technique could be one of good options to correct the depression after the outer table fracture of the frontal sinus. And this technique has some benefits to overcome the disadvantage of previous introduced methods.

Simultaneous Non-transcolumellar Incisioned Rhinoplasty in Nasal Bone Fracture : Analysis of 121 Cases

The traditional treatment of nasal bone fracture is closed manual reduction. Disadvantage of the method arises from frequent recurrence and inaccurate correction because open method is nonused in anatomical result. In addition, since the interest about cosmetic problems rapidly rises, people who want aesthetic correction during reduction surgery are increasing. From June 2007 to June 2009, This study includes 121 patients who had been performed by correction of nasal bone fracture in our center. 98 out of 121 patients, were undergone with nasal tip plasty, septoplasty was done in 51 patients. Cartilage graft for augmentation rhinoplasty was performed in 36 patients. Average period of follow-up was 6 months and existence of complications such as nasal deviation, nasal obstruction, infection and etc were investigated. Reoperation was done in one patient who showed nasal obstruction, and patients who complained about other complications, such as nasal deviation, were observed. There is the need of more accurate reduction method than traditional non-invasive reduction maneuver, in order to reduce the occurrence of secondary deformation after nasal bone fracture. Hence the authors operated precise reduction by extended endonasal approach without columellar scar, and aesthetic correction rather than anatomical correction was done with variable cartilage if needed.

Erratum Announcement

No abstract available.

Ventricular Tachycardia in Rhinoplasty: A Report of Two Cases

Local infiltration(lidocain and epinephrine) has been used to control bleeding in local or general anesthesia in plastic surgery field. However epinephrine also has various side effects, such as tarchycardia, arrhythmia, pulmonary edema, cardiac arrest, etc. We experienced two cases of ventricular tachycardia after local infiltration in rhinoplasty. The first case was a 21 year-old female and the second case was a 40 year-old male. None of them had previous history of cardiac disease. We performed cardiac massage and cardioversion several times immediately after ECG changed to Ventricular tachycardia in operation room until ECG turned to normal sinus rhythm. Patients were transferred to intensive care unit. The condition of patients improved rapidly in a few days and additional complications were not detected except pulmonary edema following cardiac massage. Conclusion: We experienced ventricular tachycardia unexpectedly after local infiltration during the surgical procedure. We report these cases with literature.

Superior Orbital Fissure Syndrome after Repair of Blow Out Fracture

PURPOSE: Superior orbital fissure syndrome is a rare neurological complex. Superior orbital fissure syndrome may result from a variety of inflammatory, infectious, neoplastic, iatrogenic, traumatic, vascular cause. The author report a patient who suffered from superior orbital fissure syndrome after inferior orbital wall reduction. METHODS: A 26-year-old female suffered from inferior orbital wall fracture with inferior gaze limitation and orbital soft tissue herniation. On posttrauma 10 day, inferior orbital wall was reduced using endoscope and porous polyethylene(Medpor(R)) was inserted. On immediate postoperation, she reported that extraocular movement was limited in almost any directions. She underwent exploration surgery to release the presence of extraocular muscle impingement. But, there was no observation of extraocular muscle impingement. On postoperative one day, high- dose steroid therapy was started to release superior orbital fissure syndrome which was defined in postoperative computed tomography. RESULTS: After one month of high-dose steroid therapy, extraocular movement limitations improved progressively in all directions. In four months, extraocular movement recovered completely. CONCLUSION: Superior orbital fissure syndrome may occur after surgical procedure of orbital wall reduction. Prompt diagnosis and treatment with mega-dose corticosteroid is an effective option for avoiding disaster from compressive syndrome.

A Simple Evaluation Method Using a "Sun-Wukong's Headband" Wire for Positional Plagiocephaly Correction after Cranial Remodeling Helmet Therapy

PURPOSE: A cranioremodeling helmet for correcting plagiocephaly was recently developed. However, no discrete objective methods to evaluate how the deformity is being corrected have been developed. We have established an easy and cost-effective method that can be used not only to show the correction process, but can also be used by physicians to assess the degree of plagiocephaly two-dimensionally. METHODS: For two-dimensional evaluation, a length of malleable memory wire (2 mm in diameter) resembling "Sun-Wukong's headband" was placed on the patient's head. The wire around the patient's head was positioned on a plane including points 1 cm above the eyebrow and 1 cm above the auricle. The wire was placed on a sheet of paper and the outline was marked using pens of various colors during each visit. The degree of plagiocephaly correction could then be shown to the patient's parents at every consultation. RESULTS: The method established by the present study easily shows the horizontal cross-section transformation of the head, illustrates plagiocephaly correction by the helmet, and shows the degree of correction in a two-dimensional manner. CONCLUSION: A soft-shell helmet is widely used for correcting plagiocephaly. However, evaluating the effectiveness of the helmet has been determined in a subjective manner, and a more objective method is now in demanded. Our study found that a "Sun-Wukong's headband" wire can accurately measure two-dimensional changes. Future studies will be required to identify landmarks needed for assessing plagiocephaly correction.

Wound Healing Effect of Bacterial Synthesized Cellulose on Full Thickness Skin Defect in the Rat

PURPOSE: Cellulose is a natural substance from plants or bacteria. It is known that bacterial synthesized cellulose has an effect of wound healing. The aim of this study is to show the effect of bacterial synthesized cellulose from citrus on wound healing. METHODS: Three full-thickness skin defects were made on the back of Sprague-Dawley rats. Three wounds were treated by vaseline gauze(Group V), Algisite M(R)(Group A) and bacterial synthesized cellulose from citrus(Group C) was used for dressing on skin defect on rats. We analyzed the gross, histological and biochemistry finding. RESULTS: Group C showed more decrease of wound size compared to Group V(33% versus 7.2#) after 14 days. The histologic findings revealed Group C and Group A preceed the process of wound healing rather than Group V(More rapid collagen deposition and neovascularization and reduced inflammation). Also, the expressions of vascular endothelial growth factor(VEGF) and transforming growth factor(TGF)-beta1 were increased in the Group C and Group A compared with the Group V in 7 days. VEGF and TGF-beta1 expression were decreased in the Group C and Group A in 14 days, however Group V was not decreased at 14 day because of delayed wound healing process. CONCLUSION: Bacterial synthesized cellulose from citrus affects wound healing by reducing the inflammatory stage. And stimulates wound contracture by the deposition of extracellular matrix, thus preventing the formation of chronic wounds.

Forehead Contouring Augmentation Surgery with Particulated Mandibular Bone Graft

Up to this date, the forehead contouring augmentation surgery was perfomed with silicone or microfat graft. However, augmentation with silicone has given complications such as postoperative infection, extrusion, long linear scar, and displacement of implant. Moreover, augmentation using microfat graft often requires re-operation due to fat resorption. Surgical technique was performed in 10 patients from September 2008 to April 2009. Eight patients had macrogenia and two had prognathism. Particulated bone was harvested from squared mandibular bone. The particulated mandibular bone was then grafted on the frontal bone through a 2cm incision posteriorly to the midforehead line. As a result from the three-dimensional Computer Tomogram, the frontal bone was engrafted 6 months after the particulated bone graft. Even though, traditional concept using prothesis for forehead augmentation is still popular, the author suggests autologous augmentation can make better facial contour which is named as 'facial bone redistribution concept'. Facial bone redistribution concept is the distribution of residual bone(mandible or zygoma) to deficient area(frontal bone) to achieve better facial contour. To achieve better survival rate of bone, bone marrow stem cell and platelet rich plasma(PRP) should be applied in next study to increase the survival rate of particulated bone.

Short Term Effects of Transdermal Scopolamine Patch for Drooling of Saliva in Patients with Cerebral Palsy

OBJECTIVE: To investigate the clinical usefulness of the transdermal scopolamine patch applied to control drooling of saliva in patients with cerebral palsy. METHOD: We enrolled twenty two patients with cerebral palsy residing in a rehabilitation center. The mean age of the patients was 24.0 years old. Transdermal scopolamine patch was applied to the patients for 2 weeks. We measured drooling quantity, severity of drooling, and visual analog scale of care givers' labor intensity at pre-application, post 1 week, and post 2 weeks. RESULTS: Drooling quantity decreased significantly from 4.1+/-1.9 ml to 2.8+/-1.5 ml at post 1 week (p<0.01), and 2.2+/-1.6 ml at post 2 weeks (p<0.01). Severity of drooling decreased from 4.1+/-0.8 to 2.9+/-1.1 at post 2 weeks (p<0.01). Visual analog scale of care givers' labor intensity decreased from 78.2+/-17.4 (mm) to 52.7+/-18.6 at post 1 week (p<0.01), and 45.9+/-22.8 at post 2 weeks (p<0.01). CONCLUSION: These findings suggested that the transdermal scopolamine patch is effective to reduce the drooling of saliva in patients with cerebral palsy within short term.

Using of a Straw as Liposuction Protector at the Treatment of Osmidrosis

Osmidrosis could have not cured completely with non-surgical treatment. Surgical methods are most effective but they usually make visible scar and complications. So less-invasive methods as liposuction assisted operation are performing broadly. However, contact burn had occurred by frictional stress of liposuction cannula. Several manufactures are commercialized for skin protection but they makes visible scar due to their large size. Therefore we had designed a device for skin protection using a straw. Regarding the method we have used, the end of sterilized straw into 4 strips for fixation to skin was divided. And skin incision about 7mm was performed and the straw was inserted through it. Fixation suture was done to each 4 strips by nylon 4-0. During liposuction, the cannula was inserted through the straw. After operation, straw was removed and subcutaneous suture is done by PDS 5-0, skin closure is done by Dermabond(R) (Ethicon, USA). Remarkably lesser scar had ranged from 7mm to 10mm had developed. And most patients had been satisfied with invisible scar. Using this device at the treatment of osmidrosis by liposuction, it is not only effective for skin protection but reduces length of incision scar.