• Korean Journal of Cleft Lip And Palate
• /
• v.11 no.2
• /
• pp.49-58
• /
• 2008

The development of fetal surgery has led to promising options for many congenital malformations, such as congenital diaphragmatic hernia (CDH), obstructive uropathy, twin-to-twin transfusion syndrome (TTTS), and sacrococcygeal teratoma. However, preterm labor (PTL) and premature rupture of membranes continue to be uniquitous risks for both mother and fetus. To reduce maternal morbidity and the risk of prematurity, minimal access techniques were developed and are increasingly employed recently. Lift-threatening diseases as well as severely disabling but not life-threatening conditions are potentially amenable to treatment. Recently, improvement of video-endoscopic technology has boosted the development of operative techniques for feto-endoscopic surgery, which has been demonstrated to be less invasive than the open approach. Fetal surgery for repair of cleft lip and palate, a congenital anomaly which is not life threatening, is inappropriate until such time that the benefits are shown to outweigh the risks of both the procedure itself and preterm delivery. Further animal studies will be needed before intrauterine surgery for humans should be considered. For the better understanding of recent techniques and complications associated with fetal intervention of congenital facial defect patients, we reviewed recent related articles about the current knowledge and new perspectives of experimental fetal fetal surgery in the cleft lip and palate defects.

• Archives of Plastic Surgery
• /
• v.32 no.3
• /
• pp.347-356
• /
• 2005

The wound healing process in fetus is quite different form that of adult. Regeneration plays an important role and scarless wound healing is possible in early gestational fetal period. Recently, the various effects of the hypoxia and reoxygenation in the wound healing process have been investigated by many researchers. The hypoxic state is known to alter protein synthesis and gene expression of TGF-${\beta}$, VEGF. The authors hypothesize there may be differences between fetal and adult fibroblast and this difference may play a possible role in the mechanism of scarless fetal wound healing. In this study, we investigated the growth of fibroblast, the amount of collagen deposition, the amount of protein synthesis and gene expression in TGF-${\beta}$(transforming growth factor-${\beta}$), VEGF(vascular endothelial growth factor) under the various hypoxic and reoxygenation conditions. Through these processes, we tried to determine the relationships between scarless fetal wound healing and hypoxic condition. In control group, fetal and adult fibroblasts were cultured under normoxic condition. The experimental groups were allocated into four different groups. The differences in TGF-beta, VEGF under 24, 48, 72 hours were statistically investigated. Compared to adult fibroblast group, there was a statistically significant increase (p<0.01) in the rates of protein synthesis in TGF-beta and VEGF of fetal fibroblast. In this study, these results may reflect the possibility that fetal fibroblast are more susceptible to change in oxygen and has a superior rate of angiogenesis through increased VEGF expression. The possible superiority of angiogenesis in fetal fibroblast may play an important role in scarless wound healing.

• Advances in pediatric surgery
• /
• v.11 no.1
• /
• pp.1-8
• /
• 2005

With the development of fetal ultrasonography, detection of fetal ovarian cysts has been increased. Although ovarian cyst formation during the perinatal period is a self limiting process, there is still considerable controversy regarding the best treatment of the fetal ovarian cyst. The purpose of this study is to evaluate the natural history of fetal ovarian cysts and to analyze the result of treatment. From 1995 to 2004, 31 consecutive fetuses with ovarian cysts were followed by ultrasonography during the perinatal period. The fetal ovarian cyst was diagnosed by prenatal ultrasonography between 25weeks and 38 weeks and the mean size of the cysts was 5cm (ranged from 2 to 8cm). At birth, 3 cysts disappeared. In 2 cases, the diagnoses were changed to multicystic kidney disease and intestinal duplication. During following up of 26 cysts, 15 cysts have resolved completely. Seven cysts required oophorectomy because of cyst torsion (n=3), differentiation of tumorous condition (n=2), increased size of cyst (n=1), and large size (8cm) of cyst at birth (n=l). Fetal ovarian cyst should primarily be observed, and only in the limited cases, surgical treatment would be required for the risk of complications such as torsion and differentiation from benign to malignant pathology.

• Advances in pediatric surgery
• /
• v.10 no.1
• /
• pp.56-59
• /
• 2004

Ovarian cyst is found in 32% of necropsies in neonates, and can be visualized during gestation by ultrasonography. The clinical evolution of these Cysts is variable, but in most cases the prognosis is favorable. Ovarian torsion, bleeding, rupture, and peritonitis have been described as complications. We report a newborn girl with torsion of ovarian cyst. A cystic mass measuring $41.9{\times}31.9mm$ on left side of abdomen was identified at 32 weeks of gestation by fetal ultrasonography. Surgery was performed after birth.

• Korean Journal of Cleft Lip And Palate
• /
• v.14 no.1_2
• /
• pp.37-44
• /
• 2011

Amniotic fluid is a complex and biological reservoir that provides mechanical cushioning and has many nutrients required for fetal growth and development. During our main research works about the fetal surgery of congenital facial defects, we reviewed several recent articles about the effectiveness and composition of amniotic fluid. Among these review processes, amniotic fluid, as the convenient medium to store sking grafts, was focused especially for its growth factors and rich nutrients, and we summarized some experimental investigations of skin grafts stored in amniotic fluid in rats. We reviewed mainly the article, "Turhan-haktanir N. et al. Histological assessment of skin grafts in amniotic fluid and saline. J Plast Surg Hand Surg 2010;44:226-30."

• Advances in pediatric surgery
• /
• v.17 no.2
• /
• pp.179-187
• /
• 2011

Experimental tracheal ligation (TL) has been shown to reverse the pulmonary hypoplasia associated with congenital diaphragmatic hernia (CDH) and to normalize gas exchange. The purpose of this study was to determine whether the TL would correct the surfactant deficiency present in the fetal rabbit model of CDH by using lamellar body count. Lamellar bodies are synthesized and secreted by the type II pneumocytes of fetal lung. The phospholipids present in these bodies constitute the major component of pulmonary surfactant. Twenty-one pregnant New Zealand rabbits underwent hysterotomy and fetal surgery on gestational day 24. Two fetuses of each pregnant rabbit were operated. In the fetus of one end of bicornuate uterus, left DH was created by excision of fetal diaphragm through open thoracotomy (DH Group). In the fetus of the other end of bicornuate uterus, left DH and TL were created (TL Group). The fetuses were delivered by Cesarean section on gestational day 31. Fourteen in control group, 12 in the DH group and 13 in TL group were born alive. En bloc excision of lungs, bronchi and trachea was done in all newborn rabbits. A five Fr catheter was inserted through trachea and repeated irrigations with 10 cc normal saline were done. The irrigated fluid was centrifuged at $280{\times}g$ for 5 minutes and the lamellar bodies were counted with the upper level fluid in platelet channel of electronic cell counter. The average lamellar body counts were $37.1{\pm}14.2{\times}10^3/{\mu}L$ in control group, $11.5{\pm}4.4 {\times}10^3/{\mu}L$ in DH group, and $6.5{\pm}0.9{\times}10^3/{\mu}L$ in TL group. Lamellar body count in DH group was lower than in control group and did not increase after TL. This study shows TL has no therapeutic effect on decreased surfactant level of CDH and the pregnant rabbit is appropriate for the animal model of CDH.

• Journal of Chest Surgery
• /
• v.42 no.3
• /
• pp.388-391
• /
• 2009

Well-differentiated fetal adenocarcinoma (WDFA) of the lung is a rare lung tumor that's composed of glycogen rich neoplastic glands and tubules that resemble the fetal lung at 10 to 15 weeks of gestation. Although WDFA is classified as a subtype of pulmonary blastoma or pulmonary adenocarcinoma, its prognosis is better than conventional pulmonary blastoma (biphasic blastoma) or pulmonary adenocarcinoma. It is important to identify this low grade malignancy tumor in younger patients because it is associated with low mortality. We report here on 3 cases of WDFA and the patients are all currently alive without tumor recurrence.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.17 no.4
• /
• pp.331-336
• /
• 1995

To use cultured mucosa as a graft of full thickness, our laboratory has been involved in the development of techniques to grow epidermis together with connective tissue. Human oral mucosa was obtained at dental surgery. Under sterile conditions the tissues were cut into explants of 0.1 $cm^2$ which were placed in the center of 24 well tissue culture dishes and incubated in a growth medium. The growth medium used for epithelial was MEM(Minimum Essential Medium) supplemented with 10% fetal calf serum, 0.5% dimethyl sulfoxide, glutamine (0.292 g/l), epidermal growth factor (40 ug/ml), cholera toxin (30 ng/ml), hydrocortisone (2 ug/ml), insulin (40 ug/ml) and transferin (5 ug/ml). The medium for stratification of epithelial cells was MEM supplemented with 10% fetal calf serum, 0.5% dimethyl sulfoxide and glutamine (0.292 g/l). The medium used for fibroblasts was MEM supplemented with 10% fetal calf serum. With the three types of media used alternatively, a mucosa composed of epidermis and connective tissue was obtained after 3 weeks of culture.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.37
• /
• pp.24.1-24.5
• /
• 2015

Ultrasonographic examination is widely used for screening of abnormal findings on prenatal screening. Cleft lip with or without cleft palate of the fetus can also be screened by using ultrasonography. Presence of abnormal findings of the fetal lip or palate can be detected by the imaging professionals. However, such findings may not be familiar to oral and maxillofacial surgeons. Oral and maxillofacial surgeons can use ultrasonographic imaging of fetal cleft lip with or without cleft palate to provide information regarding treatment protocols and outcomes to the parent. Therefore, surgeons should also be able to identify the abnormal details from the images, in order to setup proper treatment planning after the birth of the fetus. We report two cases of cleft lip with or without cleft palate that the official readings of prenatal ultrasonography were inconsistent with the actual facial structure identified after birth. Also, critical and practical points in fetal ultrasonographic diagnosis are to be discussed.

• Journal of Chest Surgery
• /
• v.23 no.5
• /
• pp.998-1002
• /
• 1990

We managed a 30 years old female pulmonary aspergillosis patient concomitant with staged pneumothorax bilaterally whose lung function decreased severely. Operative indication was fetal hemoptysis. She discharged at four weeks after left upper lobectomy in good general condition. And we .concluded that early resection should be considered in patients with pulmonary aspergilloma and coexistent pulmonary tuberculosis because those are at greater risk of fetal hemorrhage, particularly once severe hemoptysis has occurred although poor lung function in our country.