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Head and neck cutaneous metastasis of advanced gastric cancer is uncommon, and scalp metastasis is particularly rare. We present the case of a 60-year-old man who was diagnosed with cutaneous metastasis on the scalp originating from advanced gastric cancer. The patient was referred to the plastic surgery department for a scalp mass near the hairline. He had been diagnosed with advanced gastric cancer and undergone total gastrectomy and Roux esophagojejunostomy 3 years previously. The differential diagnosis for a single flesh-colored nodule on the scalp included benign tumors such as epidermal cyst or lipoma; therefore, the patient underwent excision and biopsy. In the operative field, the mass was found to be located in the frontalis muscle. The biopsy result showed that the mass was a metastatic lesion of advanced gastric cancer. Whole-body computed tomography revealed a gastric tumor with blood vessel infiltration, peritoneal carcinomatosis, liver metastasis, and multiple disseminated subcutaneous metastases. Although scalp metastasis originating from an internal organ is extremely rare, plastic surgeons should always consider a metastatic lesion in the differential diagnosis if a patient with a scalp lesion has a history of malignant cancer.

Background Latissimus dorsi (LD) flaps are often used in breast reconstruction procedures, but seroma formation is a frequent complication. To decrease the incidence of seroma formation, fibrin sealants and/or quilting sutures have been proposed, with controversial results. The primary objective of this study was to assess the effectiveness of the Harmonic scalpel in association with Tisseel and three-point deep dermal sutures in reducing the incidence of this complication. Methods A retrospective study was conducted of 108 patients undergoing immediate unilateral breast reconstruction with LD flaps over a 3-year period (2016–2018) by a single surgeon. In the experimental group, 37 patients underwent the procedure with a Harmonic scalpel and three-point deep dermal sutures (a modified version of quilting sutures), and the other 71 received conventional electrocautery. Fibrin sealant was applied to the donor site of all patents to reduce seroma formation. Results Statistically significant differences in the incidence of seroma were found between the two groups. There was a lower incidence of seroma formation in the group of patients treated with a Harmonic scalpel and three-point deep dermal sutures than in the other group. The total drainage amount and drain removal date between the two groups were not significantly different. Conclusions Within the limitations of this study, we suggest that Harmonic scalpel use can be a good choice among the many ways to reduce seroma formation following LD flap procedures, and that this technique will be very helpful for patients.

Necrotising fasciitis (NF) is a rapidly progressing fatal disease. Craniofacial necrotising fasciitis (CNF) is limited to the region above the mandibular margin, and early diagnosis is particularly difficult in the absence of related studies. Ten-year data of patients with craniofacial infection were collected from four separate hospitals. Based on the diagnostic criteria, patients were classified into abscess and CNF. The risk factors for early diagnosis were analysed by comparing the two groups. Simple abscess was found in 176 patients, and CNF was detected in 25 patients. The risk factors associated with CNF include old age, presence of odontogenic infection, elevated white blood cell count (WBC), increased C-reactive protein (CRP), high levels of creatinine (Cr) and glucose (Glu) and low levels of haemoglobin (Hb) and albumin (Alb). In addition, fever above 38°C and sinusitis at the time of admission and progressive sepsis after admission were also risk factors. Among the statistically significant risk factors, low Alb level showed the greatest association with CNF progression. Appropriate management of CNF via early diagnosis and extensive surgical intervention based on identified risk factors can reduce the mortality rate, complications and unnecessary medical expenses. Clinical question/level of evidence: Diagnostic, III.

Blepharoplasty is one of the most popular cosmetic surgical procedures for people who are concerned with minimizing the effects of aging and maintaining an aesthetically attractive appearance. If periorbital surgery is not performed by an expert, the risk of complications increases. In particular, retrobulbar hematoma, which is the most serious complication after blepharoplasty, can lead to permanent blindness. We report a rare case of unilateral permanent blindness due to careless and unprofessional treatment following a retrobulbar hematoma after lower blepharoplasty. In conclusion, it is necessary to check for symptoms and signs including pain, proptosis, visual acuity, and light reflex after the operation. Careful instructions should then be given to patients and their caregivers to avoid actions that may cause postoperative bleeding. We emphasize that if a patient complains of symptoms, painkillers should not be used and computed tomography should be performed for an accurate and rapid diagnosis. Appropriate procedures must then be taken to prevent permanent vision loss.

The anterolateral thigh free flap is one of the most preferred options for reconstructing soft tissues of the extremities and vascular anastomosis is one of the most important factors for flaps survival. T-anastomosis and double venous anastomosis have been widely used for increasing flap survival. This report shows both application of T-shape pedicle and multiple venous anastomosis to each 43 cases for extremity reconstruction that have not been described so far in the literature and it showed the necessity of multiple anastomosis. The locations of the lesions were 8 upper extremities (4 hands, 3 forearms, and 1 upper arm) and 35 lower extremities (5 forefeet, 6 dorsal feet, 4 plantar feet, 11 ankles, and 9 lower legs). We applied T-shaped arterial pedicle to limited anatomical area that had 2 or more major arterial communication sites to overcome the obstruction by reverse flow from communication vessels when 1 of the 2 anastomosis was obstructed. We classified multiple venous anastomosis according to flow direction and the vascular connections between the superficial and deep veins. In result, 37 cases survived completely but 2 flaps developed severe necrosis (>50%) because of infection and hematoma and 4 flaps developed partial necrosis due to wound infection. In conclusion, T-shaped pedicle and multiple venous anastomosis is a method to improve free flap survival and useful in cases where sacrificing a dominant vessel is inevitable or those in which only 1 vessel remains.

The facelift is one of the most popular cosmetic surgery methods of antiaging. There are many complications in facelift, but infections rarely occur relatively. The authors would like to introduce a patient who developed infection after a facelift procedure. The cause of the infection was preauricular sinus, one of the congenital anomalies. The patient was treated with complete excision of sinus tract and the patient was treated without any further complications. Based on this clinical report, surgeons performing cosmetic surgery need to be interested in rare congenital lesions such as preauricular sinus.

This study evaluated the effects of meditation programs on nurses’ power and quality of life. In this study, Barrett’s power theory derived from Rogers’ unitary human being science was used as a theoretical framework. A randomized controlled design with 50 recruited and randomly allocated participants was used. The results demonstrated that the eight-week meditation program significantly improved nurses’ power and quality of life. These results suggest that meditation has positive effects on power and quality of life.

Background and objective Elevated serum ferritin levels have been reported to be associated with several metabolic disorders. We investigated the relationship between serum ferritin level and metabolic syndrome and its components in healthy Korean men. Methods In this cross-sectional study, serum ferritin level and metabolic syndrome and its components were measured from 18 581 men from January to December in 2008. The presence of metabolic syndrome was determined according to the most recent consensus report of the National Cholesterol Education Program's Third Adult Treatment Panel. Logistic regression models were applied to examine the relationship between the serum ferritin level and the metabolic syndrome and its components. Results After adjusting for clinical covariates, the odds ratio and 95% confidence intervals of metabolic syndrome with respect to Q2, Q3 and Q4 were 1.34 (1.14–1.57), 1.49 (1.24–1.70) and 1.99 (1.70–2.33), respectively (p for trend < 0.001). The multivariable-adjusted model also showed a significantly graded relationship between individual components of metabolic syndrome and the quartile groups of serum ferritin. Conclusions In this study, elevated ferritin concentration is independently associated with metabolic syndrome and its components among healthy Korean men. Copyright © 2011 John Wiley & Sons, Ltd.

－ Recently some researches have established that the melatonin, secreted by pineal gland, may evoke the changes of contractile responses on smooth muscles. We examined the effects of melatonin on the motility of rat pyloric antrum and which mechanism might be involved in the effects. Pyloric antral strips from the stomach of 20 Sprague-Dawley rats were prepared for isometric tension recording in organ bath. The strips were precontracted by acetylcholine and high-KCl solutions. In precontracted conditions the tensions were increased by accumulative application of melatonin (10 −8 -10 −4 M) dose-dependently, even in resting states. And the effects were almost disappeared when the concentrations of ACh were over than 10 μM. The effects of melatonin were inhibited by pretreatment of 10 mM TEA and/or 10 μM 4-AP and rarely affected by pretreatment of 1 mM TEA, 10 μM glibenclamide and 10 μM verapamil respectively. From these results it is concluded that the contractile responses of smooth muscles of rat pyloric antrum were enhanced by melatonin application and the mechanism might be concerned with the inhibition of some voltage-dependent potassium channels.Keywords: Melatonin, Smooth muscle, Pyloric antrum, Potassium channel

Background The latissimus dorsi (LD) flap is widely used in breast cancer reconstruction, but donor-site morbidity is one of the major limitations of this surgery. Donor-site seroma is the most common complication. To prevent seroma formation, we consider the use of a fibrin sealant (FS) because of its hemostatic and sealing effects. In this study, we investigate the effect of a FS on seroma prevention and as a hemostatic agent at the LD donor site. Methods A retrospective study was conducted from 2011 to 2015. Herein, we analyzed the preoperative status, changes in the hemoglobin (Hb) level according to the postoperative day, postoperative drain amount, and the drain removal time. Results The decline in the Hb level was not statistically significantly less in the FS group than in the control group. Further, the difference in the drain amount between the 2 groups was not statistically significant either. The seroma rate and the drain removal time between the 2 groups also did not show any statistically significant difference. Conclusions The FS does not have hemostatic effect and the drain amount reduction in the early phase of recovery and does not prevent seroma. Therefore, an empirical use of the FS alone is no longer recommended to prevent seroma. In contrast, the quilting suture has been reported to be effective in seroma prevention. Therefore, it is necessary to study the effects of a combination of quilting sutures and the FS on seroma and the other risk factors of this surgical complication.

The aim of this study was to examine the association between serum apolipoprotein B (apoB) and the risk of coronary heart disease (CHD) using Framingham risk score (FRS) in healthy Korean men. A total of 13,523 men without medication history of diabetes and hypertension were enrolled in this study. The FRS is based on six coronary risk factors. FRS ≥ 10% was defined as more-than-a-moderate risk group and FRS ≥ 20% as high risk group, respectively. The logistic regression analyses were conducted. When quartile 1 (Q1) set as a reference, in unadjusted analyses, the Q2, Q3, Q4 of apoB level had increased odds ratio (OR) for the risk of CHD in both more-than-a-moderate risk and high risk group, respectively. After adjusting for confounding variables, multivariable-adjusted logistic regression analyses showed a strong relationship between the quartiles of apoB level and more-than-a-moderate risk and high risk group, respectively. These associations were attenuated, but still remained statistically significant. ApoB is found to be independently related to the risk of CHD using FRS in healthy Korean men, and the link between apoB and the risk of CHD is dose-dependent.