[Merkel cell carcinoma on left thigh: a case report].
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Aged↗
Biomedical subjects
Yu-sheng Yu
Publications and source records attributed to Yu-sheng Yu.
[Deep inferior epigastric perforator (DIEP) free flap in immediate breast reconstruction].
OBJECTIVE: In order to facilitate psychological rehabilitation of the women who underwent modified radical mastectomy for breast cancer, the DIEP free flap was used for immediate breast reconstruction in a series of patients. We present a review of the surgical outcomes. METHODS: From December 2001 to January 2003, unilateral breast reconstruction was performed in 12 patients using the DIEP free flap at the same time of modified radical mastectomy in our department. The recipient vessels were the thoracodorsal artery and vein or the internal mammary artery and its venae concomitants. RESULTS: Of the 12 DIEP flaps, 1 was vascularized by a single perforator, 3 were vascularized by two perforators, 6 by three perforators, 1 by four an 1 by five perforators. One flap failed totally, likely due to previous multiple lower abdominal operations. The eleven reconstructed breasts achieved almost the same size and shape as the healthy sides. The time of patient getting out of bed ranged from 3 to 7 days and the mean hospital stay was 8.8 days. All patients were satisfied with the outcome. No complications were observed in the abdominal wall, including weakness, abdominal bulge or hernia. CONCLUSION: Immediate breast reconstruction facilitates the psychological rehabilitation and helps to avoid the dressing inconveniences resulted from total mastectomy. Free DIEP flap is a new and reliable technique for immediate breast reconstruction with autologous tissue. This flap offers the patients the same advantages as the TRAM flap and avoids its most important disadvantage of potential abdominal wall weakness, by preserving the continuity of the rectus abdominis muscle. The donor site morbidity is thus reduced and recovery is faster. The more complex nature of this procedure leads to increased operating time and requires more demanding surgical skills.
Adult↗
[The therapy with rhVEGF gene for ischemic TRAM flap in rats].
OBJECTIVE: To establish a stable ischemic TRAM flap model in rats and observe the effects of rhVEGF gene on the ischemic flap. METHODS: Materials were administrated via subcutaneous injection 5 days before the TRAM flap procedure. 32 animals were divided into four groups. The first group was treated with PcDNA3.1 VEGF; the second group with PcDNA3.1 as the negative control; the third group with normal saline as the frank control, and the fourth group with VEGF as the positive control. The material was given while the procedures were performed. The serum levels of VEGF before and after the operation were measured with ELISA kit. The flap was harvested for immunohistological evidence of VEGF protein expression. The viable area of the flap was calculated with AutoCAD software. The microvessel density(MVD) of the subcutaneous tissue of the flap was counted. RESULTS: The average viable area of the TRAM flap in model animals was (3.61 +/- 1.06) cm2 [(16.04 +/- 4.71)%]. Comparing the mean viable area of the flap in the PcDNA3.1 VEGF group[(7.98 +/- 2.64) cm2] with that in the normal saline group [(4.13 +/- 1.77) cm2], the difference was significant(P < 0.05). There was no significant difference between the PcDNA3.1 VEGF group and the VEGF group[(7.31 +/- 1.22)cm2] in terms of mean viable flap area. The difference of mean MVD values between the PcDNA3.1 VEGF group and the negative control group was significant(P < 0.05), but was not significant between the gene treatment group and the positive control group. The serum level of VEGF did not increase significantly up to 9 days after the administration of PcDNA3.1 VEGF(P > 0.05). Immunohistochemical staining documented the increased deposition of VEGF protein in the plasma of endothelial cells of the flap that was injected with PcDNA3.1 VEGF. CONCLUSION: The unilateral inferior-pedicled TRAM flap as an ischemic flap model is stable and suitable for statistic treatment. Subcutaneous injection of rhVEGF gene can express biologically active VEGF at the site, increase MVD and the viable area of the TRAM flap.
Animals↗
Idiopathic IgA nephropathy with diffuse crescent formation.
OBJECTIVE: To investigate the clinicopathological features and outcome of idiopathic IgA nephropathy with diffuse crescent formation in Chinese patients. METHODS: Twenty-five patients with diffuse crescentic IgA nephropathy (DCIgAN), 15 males and 10 females with median age of 28.5, and median disease duration of 5.1 months, were studied. Their clinical, laboratory and pathological features and outcome were investigated. Twenty-one were administered pulse immunosuppressive therapy, and 15 were followed up for more than 6 months. RESULTS: 1.14% had total IgA nephropathy, and 16.4% total diffuse crescentic glomerulonephritis. Clinically, most of patients (88%) showed rapidly progressive glomerulonephritis associated with a high level of serum creatinine (418 +/- 264 micromol/l). Gross hematuria was noted in 72%, hypertension in 64%, and nephrotic syndrome in 48%. Pathologically, except for diffuse crescent formation (a median 65% and range 50-95%), we observed segmental necrosis of glomerular capillaries in 60%, glomerular infiltrating cells in 48%, endothelial cells proliferation in 32%, and rupture of Bowmans' capsule in 24%. Severe tubular interstitial damage was also found, tubular atrophy in 64%, interstitial fibrosis in 60%, diffuse interstitial infiltrating cells in 74%, and interstitial vasculitis in 40%. Immunopathologically, four phenotypes were observed; however, IgA associated with IgM deposition was higher than that in patients with general IgA nephropathy (IgAN). In addition, the infiltrating CD4+, CD8+, CD68+ and PCNA+ cells in renal tissue were significantly high compared with that in controls. In a follow-up study, 66.7% of patients had life-sustaining renal function, 4 of them had normal range of serum creatinine (<124 micromol/l), and only 5 were dialysis-dependent. CONCLUSIONS: The patients with crescentic IgA nephropathy mostly show rapidly progressive nephritis associated with more severe pathological changes including glomerular, tubular interstitial and vascular lesions than in patients with general IgAN. The infiltrates in glomeruli may contribute to the crescentic formation, and the intensive immune suppressing treatment is useful to improve renal damage in patients with DCIgAN.
Adult↗