Sung-No Jung

In vivo cartilage formation using chondrogenic-differentiated human adipose-derived mesenchymal stem cells mixed with fibrin glue.

Human adipose-derived mesenchymal stem cells (MSCs) were differentiated into chondrogenic MSCs, and fibrin glue was used together to explore the feasibility of whether cartilages can be generated in vivo by injecting the differentiated cells. Mesenchymal stem cells extracted from human adipose were differentiated into chondrogenic MSCs, and such differentiated cells mixed with fibrin glue were injected subcutaneously into the back of the nude mouse. In addition to visual evaluation of the tissues formed after 4, 8, and 12 weeks, hematoxylin-eosin staining, Masson trichrome staining, measurement of glycosaminoglycan concentration using dimethylmethylene blue, agreecan through reverse transcriptase-polymerase chain reaction, type II collagen, and expression of SOX-9 were verified. Moreover, the results were compared with 2 groups of controls: 1 control group that received only injection of chondrogenic-differentiated MSC and the supporting control group that received only fibrin glue injection. For the experimental group, cartilage-like tissues were formed after 4, 8, and 12 weeks. Formation of cartilage tissues was not observed in any of 4, 8, and 12 weeks of the control group. The supporting control group had only a small structure formation after 4 weeks, but the formed structure was completely decomposed by the 8th and 12th weeks. The range of staining dramatically increased with time at 4, 8, and 12 weeks in Masson trichrome staining. The concentration of glycosaminoglycan also increased with time. The increased level was statistically significant with more than 3 times more after 8 weeks compared with 4 weeks and more than 2 times more after 12 weeks compared with 8 weeks. Also, in reverse transcriptase-polymerase chain reaction at 4, 8, and 12 weeks, all results expressed a cartilage-specific gene called aggrecan, type II collagen, and SOX-9. The study verified that the chondrogenic-differentiated MSCs derived from human adipose tissues with fibrin glue can proliferate and form new cartilage. Our findings suggest that formation of cartilages in vivo is possible.

Models of Abnormal Scarring

Keloids and hypertrophic scars are thick, raised dermal scars, caused by derailing of the normal scarring process. Extensive research on such abnormal scarring has been done; however, these being refractory disorders specific to humans, it has been difficult to establish a universal animal model. A wide variety of animal models have been used. These include the athymic mouse, rats, rabbits, and pigs. Although these models have provided valuable insight into abnormal scarring, there is currently still no ideal model. This paper reviews the models that have been developed.

Pregnancy and patients with preexisting lupus nephritis: 15 years of experience at a single center in Korea

We investigated obstetric outcomes and comorbidities during pregnancy in females with preexisting lupus nephritis (LN) and identified predictors for renal flare. In cases of renal flare during pregnancy, we assessed the long-term post-delivery renal outcome. We performed a retrospective analysis of 183 systemic lupus erythematosus (SLE) pregnancies including blood chemistry, urinalysis, urinary protein, and disease activity recorded at prepregnancy, during pregnancy, and at one month, six months, and one year post-delivery. Pregnancies with preexisting LN had a greater frequency of adverse obstetric outcomes and maternal comorbidity. Renal flares occurred in 50.7% of pregnancies with preexisting LN, 89.2% of which were reactivations. Renal flare among pregnancies with SLE was predicted based on preexisting lupus nephritis (OR 17.73; 95% CI, 5.770–54.484), an active disease prior to pregnancy (OR 2.743; 95% CI, 1.074–7.004), and prepregnancy eGFR < 90 ml/min/1.73 m2 (OR 11.151; 95% CI, 3.292–37.768). Persistent LN one year after delivery was observed in 33.3% of pregnancies. The median follow-up time after delivery was 5.9 (3.1–9.7) years and chronic kidney disease (CKD) occurred in 21.4% of pregnancies with renal flare. In patients with renal flare, failing to achieve a ≥ 50% reduction in urine protein levels within six months, longer total duration of renal flare, and acute kidney injury at renal flare was associated with CKD development. Females with preexisting LN should achieve remission before pregnancy. When patients experience renal flares during pregnancy, it is important to reduce the proteinuria level by >50% within six months and to achieve early remission for excellent long-term renal outcomes.

Posterior reversible encephalopathy syndrome in Korean patients with systemic lupus erythematosus: risk factors and clinical outcome

Posterior reversible encephalopathy syndrome (PRES) is an uncommon neurologic condition associated with systemic lupus erythematosus (SLE). This study aimed to demonstrate the risk factors and clinical outcome of PRES in patients with SLE. Fifteen patients with SLE were diagnosed with PRES by characteristic clinical manifestations and magnetic resonance imaging (MRI) features from 2000 to 2012. Clinical profiles and outcomes were assessed for this study population. Additionally, 48 SLE patients with neurologic symptoms who underwent brain MRI were included for comparative analyses. The median age and duration of SLE in patients with PRES was 27 and 6.1 years, respectively. Comparison between patients with and without PRES revealed significant differences in the presentation of hypertension and seizure, lupus nephritis with renal insufficiency, treatment with high-dose steroid and cyclophosphamide, recent transfusion, and lupus activity measured by SLE disease activity index. Renal failure was the single independent factor with a high odds ratio of 129.250 by multivariate analysis. Of 15 patients, four experienced relapse and two died of sepsis during hospitalization. Our results suggest that lupus nephritis with renal dysfunction and other related clinical conditions can precede the occurrence of PRES in patients with SLE. It is important to perform early brain imaging for a timely diagnosis of PRES when clinically suspected.

Reconstruction of scalp defect after Moyamoya disease surgery using an occipital pedicle V-Y advancement flap.

Scalp necrosis is an infrequent complication of Moyamoya disease surgery, which is more prevalent in the parietotemporal area. Because scalp vascularity is severely compromised after Moyamoya disease surgery, reconstruction of defects with local scalp tissue is challenging. To cover defects, a flap is needed that is highly vascularized and has great mobility and territory to avoid existing scars. After tracing ipsilateral occipital artery, an advancement flap that was based on occipital artery and vein was designed to fit the defect. The flap was elevated in the subperiosteal layer and advanced without tension to cover the defect. Occipital pedicle V-Y advancement flaps were used in 7 patients who had scalp necrosis of the parietotemporal area and a mean defect size of 8.7 cm2. There were no complications such as flap necrosis, infection, or recurrence of defect in all patients during 9-month follow-up. Occipital pedicle V-Y advancement flap is a useful alternative flap for scalp defects after surgical treatments that compromise scalp vascularity, such as Moyamoya disease surgery.

Use of split thickness plantar skin grafts in the treatment of hyperpigmented skin-grafted fingers and palms in previously burned patients

Palmar and finger burns are often seen in children, and are usually as a result of contact burns. Some patients with deep hand burns are treated with full-thickness or split-thickness skin grafts. Skin graft is commonly used for hand reconstruction. However, the grafted skin would be more pigmented than the adjacent skin and different from skin texture. 19 patients who showed hyperpigmentation after skin graft of finger and palm were treated. They all were injured by hand burns. We performed mechanical dermabrasion of the hyperpigmentation scar and application of a split thickness skin harvested from medial aspect of plantar of foot. Patients were asked about their level of satisfaction with the procedure and scar appearance was assessed using a five-point Likert scale. Also scar appearances were assessed using a Vancouver Scar Scale (VSS). The grafts were completely taken in all 19 patients. The color of the graft became similar to adjacent tissue. 15 patients were very satisfied, and four patients were relatively satisfied. The average score of the patients postoperative appearance improvement was 4.5 (improved to significantly improved postoperative appearance). Average VSS score was improved from 9.53 to 2.53. There was no hypertrophic scar on plantar donor site. The technique of the split-thickness plantar skin graft after mechanical dermabrasion is simple and provided good results in both color and texture for the patients who showed hyperpigmentation after grafting.

Intramuscular lipoma of the sternocleidomastoid muscle.

Intramuscular lipoma is a rare benign mesenchymal tumor that infiltrates the skeletal muscle. These lipomas are usually found on the extremity, but rarely occur in the head and neck. To our knowledge, only 4 cases of intramuscular lipoma in the sternocleidomastoid muscle have been reported in the literature. The recurrence rate of intramuscular lipoma is high, and it shows the pattern of infiltration to tissues, and thus different from general lipomas, its resection should include adjacent normal muscular tissues. In addition, although rare, concerning intramuscular lipoma that developed in the head and neck area, because important structures are present densely in a small space, it is important to establish a preoperative plan by determining the size and location of the tumor through preoperative clinical and radiologic tests. We had a case of intramuscular lipoma in sternocleidomastoid muscle and resected the mass completely including a portion of attached muscles. The postoperative course was uneventful, and no evidence of recurrence occurred after 6 months of follow-up.

Symmetric Lipofibromatous Hamartoma Affecting Digital Nerves

Lipofibromatous hamartoma of the nerve is a benign tumor, which affects the major nerves and their branches in the human body. It is often found in the median nerve of the hand and is commonly associated with macrodactyly, but it is rarely found in the digital nerves at the peripheral level. This tumor is often found in young adults and may go through a self-limiting course. However, operation is indicated when the tumor size is large or when the associated nerve compressive symptoms are present. We have experienced a rare case of lipofibromatous hamartoma that symmetrically involved the volar digital nerves of both index fingers on the ulnar side. With the aid of a microscope, we dissected and removed the tumor as much as possible without sacrificing the nerve. No sensory change occurred in both fingers and no sign of recurrence was observed upon follow-up.

Giant epidermal inclusion facial cyst.

Epidermal inclusion cyst is one of the most common subcutaneous tumors, and its size normally varies from 1 to 5 cm in diameter. Only few giant epidermal inclusion cysts have been reported in the literature, and giant epidermal cyst of the face has never been reported. An 83-year-old woman visited our hospital for a huge mass on the right side of her face extending to the temporal area, creating deformity of her right ear. The mass was 15 × 15 × 8 cm(3) with soft, cystic nature. It has developed since 20 years ago with no known etiology. Computed tomography scan was obtained for preoperative evaluation, which showed a 15 × 15 × 7-cm(3) huge, lobulated, and septated mass with no underlying bone or brain involvement. We performed complete excision sand biopsy. On histologic examination, the final diagnosis of epidermal inclusion cyst was made. Keratotic material was within the cyst, and the cystic wall was composed of lamellate keratin. Follow-up period was 10 months, and no signs of recurrence were seen. The patient was satisfied with the improvement of her facial appearance. We have observed a case of giant epidermal inclusion cyst of the face, which has never been reported, and present this case with a brief review of literature.

Fibrolipoma of the tip of the nose.

Fibrolipoma is a rare benign tumor that usually presents as an asymptomatic, slowly growing mass with a firm or soft consistency clinically. Histopathologic findings show the proliferation of normal mature fat and fibrous tissue. We report a first case of the fibrolipoma of the nasal tip in a 24-year-old man. The lesion was totally excised and showed no evidence of recurrence after 6 months of follow-up.