The Influence of Palatoplasty on Eating Function.

Postoperative dietary control and surgical procedures are important for minimizing complications after a palatoplasty because the palate is always exposed to stresses by various movements associated with eating. Currently, we provide fluid foods (food paste, liquid food, and soft food) to postpalatoplasty patients. However, nutritional inadequacies associated with fluid food necessitate the need to develop a new food specifically for postpalatoplasty patients. Although evaluating the influence of a palatoplasty on eating function is important for the development of a new diet, no data have been published on this topic. Thus, to evaluate the influence of a palatoplasty on eating function, we analyzed postoperative changes in the eating condition of cleft palate patients. We performed a retrospective study. All participants had undergone surgery for a cleft palate at our hospital. Nurses recorded the amount of food that patients consumed as a ratio of the whole meal, and we extracted data on the food type and the amount consumed at each meal from their medical records. After the ratio was expressed as a percentage of the whole meal (eating rate), we calculated the mean value of the percentage of the subject group and examined chronological changes. The eating rate was very low on postoperative day 1, it improved over time and was constant on postoperative day 7. From this result, we concluded that palatoplasty greatly influences the eating function of patients, and the influence lasts for at least a week after surgery.

Primary cardiac malignant fibrous histiocytoma with abdominal wall metastasis.

We present a rare case of cardiac malignant fibrous histiocytoma (MFH; undifferentiated pleomorphic sarcoma); to date, fewer than 100 cases of cardiac MFH have been reported. In this case, transthoracic echocardiography revealed cardiac tumors in the left atrium (LA) of a 53-year-old woman with a 3-month history of worsening dyspnea; the largest tumor was found to protrude through the mitral valve in diastole, causing stenosis. Three of the four tumors were resected during emergency surgery; however, the residual tumor extension into the left pulmonary vein could not be removed. Histological findings of the resected tumors, such as organized thrombus and myxomatous tissue changes, indicated that the tumors were benign. After 3 months, the patient underwent total resection for a small mass that developed on her right abdominal wall, which was revealed histologically to be MFH; additionally, the residual mass in the LA had enlarged progressively. After undergoing radiation therapy without further surgery, she died of cerebral bleeding 6 months after cardiac surgery. Postmortem examination revealed that the tumor in the LA was an MFH. Thus, cardiac MFH should be considered as a differential diagnosis for tumors on the posterior wall of the LA. .

Utility of Dermoscopy before and after Laser Irradiation in Port Wine Stains.

BACKGROUND: Port wine stains (PWSs) are commonly treated with pulsed dye laser (PDL) as a standard therapy. However, it is not easy to predict the minimal effective dose in the first treatment session. OBJECTIVE: The aim of this study was to assess whether dermoscopic findings before and after laser irradiation corresponded with the clinical improvement of PWS in patients undergoing PDL therapy. METHODS: Seven untreated PWSs in 6 patients (a male and 5 females), who presented to our hospital between May 2008 to January 2010, were assessed in this study. The mean age was 36.3 years, ranging from 14 to 57 years. A PDL with a wavelength of 585 nm and a spot size of 7 mm was used. Before and after test irradiation, patients underwent dermoscopy and clinical photography, and we assessed whether the dermoscopic findings corresponded with clinical improvement after 3 months. RESULTS: There were no obvious differences observed in the clinical photographs between each test level immediately after irradiation. However, dermoscopic photographs showed differences as the irradiated energy increased. These changes corresponded to the clinical improvement after 3 months. CONCLUSION: Our study indicates that the minimal effective fluence can be predicted by observing dermoscopic change immediately after irradiation. We think that examining the dermoscopic findings immediately after irradiation allows the laser surgeon to predict the minimal effective fluence and this prevents adverse effects of the skin.

Mucous-flap method for cleft-lip revision using transverse everted full-length lower-lip flap.

In patients who had undergone the first surgery for cleft lip and in whom the volume of tissue was smaller for the upper lip than for the lower lip, transfer of tissue from the lower lip using a full-length mucous flap allowed the tissue volume of the upper lip to be increased and external appearance of the lips to be improved. The subjects of this study were 6 patients who underwent this surgery between February and September 2001 and were followed for up to 3 years postoperatively. This surgery can be performed under topical anesthesia, without necessitating restriction on mouth opening and oral ingestion. Furthermore, it allows easy adjustment of the tissue volume in both upper and lower lips. This operative procedure is recommended for cases of cleft lip where surgical treatment has been performed before and the tissue volume is smaller in the upper prolabium than in the vermilion.

Superiority of water application to water sealing in burn wound healing.

BACKGROUND: Recently there have appeared on the market many external dressings for wound management. They all use water-sealing materials to maintain wounds in a moist state. However, in our daily clinical observations, a water-sealing material sometimes results in poor wound healing. Although a water-sealing material does in fact keep the wound moist, the quality of the water is far from that of the optimum extracellular fluid. METHODS: A second-degree burn wound was made in the rat by contact with a metal stick. Experiment 1 was to evaluate the influence of delayed primary wound treatment on burn-wound depth progression. We used a time lag procedure. Each group was treated with a water-sealing application (hydrocolloid sheet). Experiment 2 was to investigate the progression-preventing effect of normal saline on a burn allowed to dry for 3 hours, we compared a group that received a water sealing (non-moistening and incomplete moisture) dressing with one that received a water-supplying (moistening) dressing with using chi-square test. RESULTS: In the Experiment 1 (time lag and water sealing test), the early group showed quite normal wound healing at 7 days after onset. The slough was thin (about 10-20% of full dermal thickness). The delayed groups showed the poor healing characteristic. The slough was relatively thick (about 30-60% of full dermal thickness). Three hours' delay seemed to bring about poor healing. In the Experiment 2 (water application test), the moistening (water application) group showed relatively good healing after seven days. The slough was as thin as in the early group in the Experiment 1. The non-moistening group showed a poor healing process like the delayed group in the Experiment 1. For the moistening group, the healing percentage of 77.8% was significantly greater than the 41.3% observed in the non-moistening group (chi-square test, p < 0.05). CONCLUSIONS: All the materials in wound dressing are water-sealing. When the component water under the sheet is far from the extracellular fluid, these applications bring about poor healing. Delayed application and incomplete moisture should be corrected by external water-application.