• Archives of Plastic Surgery
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• v.35 no.5
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• pp.615-618
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• 2008

Purpose: Pyoderma gangrenosum is a rare cutaneous ulcerative disease. First described in 1930, the condition is characterized by progressive ulceration with deeply undermined purple-red edge. The lower extremities are most commonly affected but other parts of the skin and mucous membranes may also be involved. Although medical treatments with topical wound therapy are commonly used, surgical intervention is still controversial. In this paper, we report an atypical case of pyoderma gangrenosum which was characterized by extensive soft tissue breakdown. Methods: A 27-year-old male patient was referred to our institution with a $7{\times}8cm$ sized deeply undermined ulceration with pus-like discharge and fever. Incision and drainage was performed at another clinic 3 days prior to admission to our institution. After a thorough physical examination and the MRI review, a diagnosis of necrotizing faciitis was made. Accordingly, fasciotomy and debridement was performed. However, the wound enlarged progressively and the patient remained highly febrile for 9 days after the treatment. Septic screening did not reveal any occult infection. After a secondary review of the case, the initial diagnosis of necrotizing fasciitis was rejected and changed to pyoderma gangrenosum. With the use of dexamethasone intravenously, the wound improved dramatically and the fever was eliminated. Steroid mediation was tapered with duration of 1 month. The wound was stabilized and subsequently covered with split-thickness skin graft. Results: Split-thickness skin grafting with 1 : 1.5 mesh was successfully taken. Conclusion: Initial clinical features of pyoderma gangrenosum are very similar to that of necrotizing fasciitis. High fever and progressive ulceration with severe pain could invite earlier surgical approach. The advancing wound margins (the well defined violaceous, undermined border and necrotic ulcer base) and lack of isolation of pathogenic organism was used to make the correct diagnosis of pyoderma gangrenosum. We achieved a good result with proper medication and split-thickness skin graft.

• The Korean Journal of Physiology
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• v.11 no.1
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• pp.45-50
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• 1977

This study was undertaken to investigate the effect of cingulate cortical ablation upon gastric ulceration, and the pathway through which cingulate cortex exerts the effect. 56 female rats were divided equally into cingulate (cingulate cortical ablation), cingulate-vagal (cingulate cortical ablation and vagotomy), normal control and vagal (vagotomy) groups. Cingulate cortex was ablated through a slit-shaped opening (1 mm in width, 13 mm in length) which was made symmetrically on both sides of, and parallel to, the sagittal suture by removing a bone flap from parietal and frontal bones on each side. Vagus nerves on both sides were transected around the distal end of the esophagus. In the normal control animals, surgical intervention ended with scalp incision. All rats were kept without restraint or food deprivation for 3 weeks after surgery. The stomach of each rat was inflated with 7 ml of physiological saline and then removed under deep anesthesia. The mucosal surface was examined under dissecting microscope for the location, shape and number of ulcers, and then enlarged photograph $(4{\times})$was taken. The incidence of ulcer in each group was counted and the number of ulceration as well as the total area of glandular mucosa were measured on the photograph. Results obtained were as follows: 1. The mean number of ulcer per stomach and the total area of ulcer exprssed as permillage of the total area of glandular mucosa were significantly higher in the cingulate group than the cingulate-vagal, the normal control and the vagal groups. There was no difference among the latter three groups. 2. The incidence of ulcer in the cingulate group was significantly higher than that in the .normal control group and was also higher, though not significantly, than those in the cingulate-vagal and the vagal groups. There was no difference among the normal control, the cingulate-vagal and the vagal groups. It is inferred from the above results that the cingulate cortex exerts an inhibitory influence upon gastric ulceration and that this influence is mediated by controlling the vagal activity.

• Proceedings of the Korean Society of Veterinary Clinics Conference
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• 2008.10a
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• pp.170-170
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• 2008

• The Korean Journal of Physiology
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• v.14 no.1
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• pp.1-5
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• 1980

This study was under taken to investigate the influences of predictable or unpredictable stress upon gastric ulceration, and the hippocampectomy upon the ulceration order the stressful conditions. Sixty male albino rats(Sprague-Dawley strain) were divided equally into 3 groups: One was the hippocampal group(N=20) which received hippocampal ablation by suction, another was the cortical control group(N =20) which received partial cortical ablation over the hippocampus, and a third was the normal control group(N=20). Each group was further divided into two subgroups: One was the predicted subgroup(N=10) in which animals could predict the imminent stressful stimuli by hearing a sound(1,000 Hz, 2 sec in duration) 3 sec before the onset of the stress, and the other was the unpredicted subgroup(N=10). After starvation for 24 hours, but water ad libitum, each rat received the electric stimulation(3 mA, 60 Hz, 2 sec in duration, and once per minute in average) for 6 hours via a pair of electrodes attached on the tale. The electric stimulation served as the stress causing the gastric ulcer. Five hours after completion of stimulation, the stomach filled with the physiological saline was removed under deep anesthesia and spread out on a small glass plate. The numbers of the ulcer in each stomach were counted and the shape was examined under the dissecting microscope. Results obtained were as follows: 1. The mean numbers of the ulcer of the predicted subgroups were significantly larger than those of the unpredicted subgroups in the normal control and the cortical control groups, but there was no difference between the values of the two subgroups in the hippocampal group. 2. The mean numbers of the ulcer of the predicted subgroups in the normal control and the cortical control groups were larger(but not significant) than that in the hippocampal group. It is inferred from the above results that the prediction of the stress strengthens the effect of the stress on the gastric ulceration, and the hippocampus facilitates the effect of the prediction of the stress.

• The Korean Journal of Physiology
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• v.10 no.2
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• pp.39-45
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• 1976

This study was conducted to see whether the hippocampectomy exerted facilitatory influence upon gastric ulceration in animals, and if so, whether the effect of hippocampectomy could be suppressed by adrenalectomy. 107 male rats were divided into 5 groups: rats that had over 90% of their hippocampal tissue removed through an opening on each side of the cerebral cortex(hippocampal group, N=21), rats that received bilateral adrenalectomy(adrenal group, N=29), rats that received adrenalectomy as well as hippocampectomy(hippocampo-adrenal group, N=10), rats that received damage to each side of the cortex over the hippocampus(cortical control group, N=20), and rats that had solely their head skin incised(normal control group, N=27). All rats were kept without restraint or food deprivation until on the 25th day after surgery, the stomach of each rat was inflated with 7ml of physiological saline and then removed under deep anesthesia. The mucosal surface was sketched under dissecting microscope, and enlarged photographs$(4{\times})$ were taken. The percentage of animals developing gastric ulcer in each animal group was calculated, the number of ulcer in each stomach was counted, and the total area of ulceration per stomach was measured on the Photograph with the aid of superimposed graph paper and expressed as permillage of total area of the glandular mucosa. Results obtained were as follows: 1. The percentage of animals developing gastric ulcer was significantly larger in the hippocampal group than they were in the hippocampo-adrenal, the adrenal, the cortical, and the normal control groups. 2. The mean number of ulcer per stomach was significantly larger in the hippocampal group than they were in the adrenal, the cortical control, and the normal control groups, while no significant difference existed between the hippocampal and the hippocampo-adrenal groups. 3. Total area of ulcer per stomach was significantly larger in the hippocampal group than they were in the cortical control and the normal control groups, but no significant differ-ence existed among the hippocampal, the adrenal, and the hippocampo·adrenal groups. 4. All measured values of the adrenal group were not significantly different from those of the hippocampo-adrenal, the cortical control, and the normal control groups. It is inferred from the above results that the hippocampus exerts an inhibitory influence upon gastric ulceration and that the hippocampal influence is mediated only partly through suppression of pituitary·adrenal activity.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.2
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• pp.240-245
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• 2009

Pyoderma gangrenosum associated with ulcerative colitis is an unknown etiology of destructive skin disorder, characterized by progressive painful ulceration. It begins as a erythematous areola or pustule and rapidly progress into a deep ulceration with a discrete and violaceous edge. Early diagnosis followed with non-compressive moist dressing, topical application and systemic immunosuppressants are cornerstone in treating this disease. We report a case of pyoderma gangrenosum exacerbated with incision and drainage in a 15 year old girl with ulcerative colitis. This case emphasizes the importance of early consideration of pyoderma gangrenosum in patient with a background of related systemic disease and minimal traumatized wound care.

• Clinical and Experimental Pediatrics
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• v.49 no.1
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• pp.107-111
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• 2006

Crohn disease (CD) is rare, but the incidence of CD has been increasing over the past ten years. We found two cases of CD, associated with myelodysplastic syndrome (MDS), for the first time in children. In the first patient, MDS was diagnosed at three years of age and CD developed later at eight years of age. The patient presented with recurrent abdominal pain, diarrhea, bloody stools and failure to thrive. Colonoscopy revealed cobble stone like mucosa and mass like lesions with superficial ulceration and inflammatory exudates, observed from the cecum to ascending colon. Ileo-cecal biopsy samples showed ulcers with skipped areas and lymphoid infiltrations. The patient was started on treatment with mesalazine and deflazacort, and symptoms remitted. In the second patient, MDS was diagnosed at nine years of age and CD developed at 13 years of age. This patient has recurrent hematochezia, abdominal pain, vomiting and fever. Colonoscopy revealed a large, deep indurative ulceration on the cecal side of the ileo-cecal valve. Ileocecectomy was done, and histology revealed ulceration with transmural inflammation and lymphoid aggregates. Symptoms improved after ileocecectomy.

• Archives of Plastic Surgery
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• v.35 no.6
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• pp.743-747
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• 2008

Purpose: Malignant changes of Marjolin's ulcer arising from chronic burn scar are rare. The majority of them are squamous cell carcinoma and basal cell carcinoma. Malignant fibrous histiocytoma is a deep seated pleomorphic sarcoma, which occurs principally as a mass of the extremities, abdominal cavity, or retroperitoneum in adults. Methods: We report a 58-year-old male patient who was admitted due to $3.5{\times}5cm$ chronic ulceration of anterior chest wall on the center of old burn scar. His scar had been occurred by boiling oil and treated with conservative treatment 45 years ago. Preoperative punch biopsy showed suspicious malignant changes and contrast enhanced chest CT showed well-defined, irregular shape enhancing lesion on anterior chest wall without intrathoracic metastasis. Results: The tumor was widely excised and defect was covered with skin graft without infection, necrosis and any other complication. The pathologic findings are compatible with malignant fibrous histiocytoma(storiform - pleomorphic type). The patient underwent 3 cycles of chemotheraphy. Although distant metastasis to the lung developed 6 months later and the patient died 9 month later, there was no local reoccurrence. Conclusion: Aggressive and early excision is needed because malignant fibrous histiocytoma has characteristics of high malignancy with a propensity for early and distant spread. Furthermore, the patient's education about disease entity and postoperative regular follow-up for local recurrence or metastasis is very important. To prevent malignancy from secondly healing burn scar, early skin graft is recommended for patients with deep second degree burn.

• Archives of Plastic Surgery
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• v.45 no.6
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• pp.583-587
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• 2018

Kaposiform hemangioendothelioma (KHE) is a very rare, locally aggressive vascular neoplasm. It occurs mostly in children and is rarely observed in adults. It typically originates on the skin, later affecting the deep soft tissue of the extremities, head or neck, and retroperitoneum by infiltrative growth. It is locally aggressive, does not regress spontaneously, and tends to metastasize locally as well as to the regional lymph nodes. In this article, we report a case of adult-onset KHE with neurofibromatosis type 1. The patient presented to our department with a 2-month history of a painful ulceration in her left popliteal area. Since KHE had not previously been reported in patients with neurofibromatosis, the diagnosis was difficult due to the similarity of the skin manifestation to neurofibromatosis-associated lesions. We share our experience of diagnosing and treating this rare case of adult-onset KHE.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.2
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• pp.631-638
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• 2016

Radiation proctitis is a common complication after radiotherapy for pelvic malignant tumors. This study was conducted to assess the efficacy of novel almagate enemas in hemorrhagic chronic radiation proctitis (CRP) and evaluate risk factors related to rectal deep ulcer or fistula secondary to CRP. All patients underwent a colonoscopy to confirm the diagnosis of CRP and symptoms were graded. Typical endoscopic and pathological images, risk factors, and quality of life were also recorded. A total of 59 patients were enrolled. Gynecological cancers composed 93.1% of the primary malignancies. Complete or obvious reduction of bleeding was observed in 90% (53/59) patients after almagate enema. The mean score of bleeding improved from 2.17 to 0.83 (P<0.001) after the enemas. The mean response time was 12 days. No adverse effects were found. Moreover, long-term successful rate in controlling bleeding was 69% and the quality of life was dramatically improved (P=0.001). The efficacy was equivalent to rectal sucralfate, but the almagate with its antacid properties acted more rapidly than sucralfate. Furthermore, we firstly found that moderate to severe anemia was the risk factor of CRP patients who developed rectal deep ulcer or fistulas (P= 0.015). We also found abnormal hyaline-like thick wall vessels, which revealed endarteritis obliterans and the fibrosis underlying this disease. These findings indicate that almagate enema is a novel effective, rapid and well-tolerated method for hemorrhagic CRP. Moderate to severe anemia is a risk factor for deep ulceration or fistula.