Perifolliculitis capitis abscedens et suffodiens is a rare chronic recalcitrant follicular disorder which clinically presents itself as pulstules, nodules, intercommunicating abscess and sinuses that leave atrophic, hypertrophic or keloidal scars. Although the etiology of this of condition is unknown, its association with acne conglobata and hidradenitis suppurativa, collectively termed the follicular occlusion triad, suggest a cammon basic pathogenic mechanism of follicular retention. The therapeutic problem is reflected in the variety of therapies that have been tried with varying degrees of success. We report a case of a 34-year-old man who showed a patch of alopecia on the vertex of his scalp. Clinically, the scalp showed multiple soft fluctuant elevated nodules with nonscarring alopecic patches. We performed a treatment with isotretinoin(13-cis-retinoic acid) during 6 months. The patients clinical appearance was much improved and local recurrence and hair loss have not been observed to date.
Abscess ; Acne Vulgaris ; Adult ; Alopecia ; Cicatrix ; Hair ; Hidradenitis Suppurativa ; Humans ; Isotretinoin* ; Keloid ; Recurrence ; Scalp

PURPOSE: To evaluate clinical characteristics of ileal neobladder as orthotopic bladder substitution, we examined the urodynamic characteristics, clinical symptoms and radiologic findings of 11 patients who had undergone ileal nobladder substitution following cystectomy or cystoprostatectomy. MATERIALS AND METHOD: From February 1993 to July 1996, 11 patients underwent lower urinary tract reconstruction with ileal neobladder. Cystectomy or cystoprostatectomy was done, and reservoirs were connected to the proximal urethra or urethrovesical junction. Urodynamic and radiologic studies were performed to evaluate neobladder function and upper tract. Clinical symptoms were evaluated via a detailed patient questionaire. RESULTS: Mean cystometric capacity was 434m1(293-640m1). All patients voided by Valsalva maneuver and achieved good peak flow rates(mean value was 22.6m1/sec). Of the patients 10 emptied bladder to near completion with a mean post-void residual of 30m1, while 1 had post-void residuals of 110m1 The neobladder demonstrated good compliance for the storage of urine Phasic neobladder contractions were present during filling cystometrography. While the number of phasic contractions increased at higher neobladder volumes, the mean length and mean pressure of phasic contractions were not Increased a higher neobladder volumes. Daytime continence was obtained in all patients(100%), while nighttime continence was achieved in 8 patients (73%). Of these 8 nighttime continent patients, 4 patients(50%) had to void at least once a night to keep dry. No difference was found in any urodynamic parameter between nighttime continent and incontinent patients. There was no difference in any important urodynamic parameter between patients who had and had not received post-operative chemotherapy. Renal function, based on serum creatinine levels, had remained stable and no significant electrolyte or acid-base imbalance was found in all patients. Voiding cystourethrograms obtained in 9 patients revealed 3 patients(33%) had grades ll-lll/V reflux IVP in 9 patients revealed hydronephrosis in 1/18(5.5%) of renal units. CONCLUSIONS: Neobladder constructed from detubularized ileum achieves adequate capacity at low pressures with a satisfactory continence rate. We conclude that neobladder may be the best choice of urinary diversion after cystectomy in the aspect of quality of life.
Acid-Base Imbalance ; Compliance ; Creatinine ; Cystectomy ; Drug Therapy ; Humans ; Hydronephrosis ; Ileum ; Quality of Life ; Urethra ; Urinary Bladder ; Urinary Diversion ; Urinary Tract ; Urodynamics ; Valsalva Maneuver

To elucidate the endocrine mechanism of human parturition, the expression of c-Jun and c-Fos mRNA were examined in relation to estrogen receptor (ER) and progesterone receptor (PR) in human myometrium. c-Jun mRNA was detected in all myometrial tissues (n=5) during labor but not before labor (n=5) and in oxytocin-resistant postterm pregnancy (n=3). c-Fos mRNA was detected in only one myometrial tissue from a woman in labor. The distribution and intensity of immunostaining for ER and PR were semiquantitatively scored. During the late pregnancies, no significant difference was seen in the receptor scores for myometrial ER and PR between the patients who experienced labor and those who did not. Receptor scores for ER and PR were significantly lower in postterm pregnancy than in late pregnancy, regardless of the labor status. These data suggest that there are no changes in ER and PR in human myometrium during parturition. On the other hand, postterm pregnancy is associated with low ER and PR. c-Jun, induced during labor without changes in ER and PR, may play a role as a signaling mechanism in human myometrium.
Adult ; Blotting, Northern ; Female ; Genes, jun/genetics* ; Human ; Immunohistochemistry ; Labor/metabolism* ; Myometrium/metabolism* ; Myometrium/cytology ; Pregnancy ; RNA, Messenger/analysis ; Receptors, Estrogen/metabolism* ; Receptors, Progesterone/metabolism* ; Reference Values

The purpose of this study was to evaluate the reliability of 6-axis model surgery simulator (6AMSS) for orthognathic surgery. A rectangular parallelepiped plastic block was assembled to model-mounting plate of 6AMSS. Left-right (X), anterior-posterior (Y), up-down (Z) translation and pitching (empty set X), rolling (empty set Y) and yawing (empty set Z) rotation was planned and performed using 6AMSS. The actual translation and rotation were measured with dial gauge and precisional protractor, respectively. Comparison between the planned and actual movements of plastic block for each variable were made using paired t- test. Statistical analysis for X, Y, Z, empty set X, empty set Y and empty set Z movement have shown no significant differences between planned and actual movement (P > 0.05). This indicate that model surgery performed with the aid of the 6AMSS is accurate in 3D translation and rotation. The 6AMSS is practically useful for accurate fabrication of surgical splint for orthognathic surgery.
Orthognathic Surgery ; Plastics ; Splints

PURPOSE: To assess the usefulness of rectal filling using ultrasonographic gel in patients with lower rectal cancer. MATERIALS AND METHODS: Twenty five patients with lower rectal cancer were enrolled. High resolution pelvic MR was performed twice before and after gel filling. Independently and retrospectively, two radiologists reviewed each set of MR images using five-grade scales for sphincter involvement, CRM (circumferential resection margin) involvement and depiction of the tumor. Same two radiologists retrospectively performed consensus review of each set of MR images for tumor distance from the anal verge and T&N staging. RESULTS: Tumor depiction scores from MR with gel filling were significantly higher than those of MR without distention (p<0.001). Compared to MR without distension, MR with gel filling had no significant differences in prediction of CRM or sphincter involvement (p>0.05). Distance from the anal verge was significantly different between MR with gel filling and rigid endoscopy (6.8 +/- 1.6 cm vs. 5.8 +/- 1.6 cm, p=0.001). There were no significant differences between pathological staging and MR staging with or without gel filling. CONCLUSION: MR with gel filling improved tumor depiction. And also MR with gel filling revealed same ability for the predictions of CRM or sphincter invasion in patients with lower rectal cancer, comparing with MR without gel filling.
Consensus ; Endoscopy ; Humans ; Rectal Neoplasms* ; Rectum ; Retrospective Studies ; Weights and Measures

Heterotopic pregnancy, simultaneous intrauterine and extrauterine pregnancy, classically was considered a exceedingly rare obstetrical phenomenon. But nowadays the natural incidence is increasing and especially in association with assisted reproductive technologies, such as use of variable methods for ovulation inductions, in-vitro fertilization and embryo transfer, and gamate intrafallopian transfer. In spite of the difficult early diagnosis, which is potentially dangerous to the mother and fetus, the maternal mortality, morbidity and fetal loss is low when the diagnosis is made in timely fashion and proper management is achieved. The presence of a intrauterine pregnancy dose not exclude the possibility of a extrauterine pregnancy, and in women associated with assisted reproductive technologies, the possibility of a heterotopic pregnancy should be considered. We report a case of a heterotopic pregnancy following ovulation induction and intrauterine insemination with brief review of literature.
Diagnosis ; Early Diagnosis ; Embryo Transfer ; Female ; Fertilization ; Fetus ; Humans ; Incidence ; Insemination ; Maternal Mortality ; Mothers ; Ovulation Induction* ; Ovulation* ; Pregnancy ; Pregnancy, Heterotopic* ; Reproductive Techniques, Assisted

BACKGROUND: Intravenous recombinant tissue plasminogen activator (r-tPA) infusion is the only established treatment for acute ischemic stroke so far. We explored whether the demonstrated efficacy of r-tPA could be applied to communi-ty-based hospitals in Korea and whether the immediate improvements after r-tPA infusion had any predicting value for long-term outcomes. METHODS:Twenty-six patients (mean age, 69; 46% female) with acute ischemic stroke were treated with r-tPA, abiding by the National Institute of Neurological Disorders and Stroke (NINDS) protocol. The Neurological status was measured with the National Institutes of Health Stroke Scale (NIHSS) at baseline, at 1 hour after r-tPA , at 24 hours, and at 7 days and the functional outcome was evaluated with the modified Rankin scale (mRS) and Barthel Index at 90 days after stroke. RESULTS: Of 26 patients, 16 (62%) made full recovery or became independent, 4 (15%) had severe physical disability, and 6 (23%) patients died. Three patients (11.5%) had intracranial hemorrhage (asymptomatic, 2; symptomatic, 1). There were no significant differences in age, sex, risk factors, baseline NIHSS scores, hemorrhagic complication, initial brain CT abnormalities, and onset to needle time between good (full recovery or mRS 0-2) and poor groups (mRS 3-5 or death) at day 90, except for the improvement of NIHSS examined at 1 hour after r-tPA (repeated measured ANOVA test, p<0.01). CONCLUSIONS The NINDS r-tPA protocol is feasible in the community-based hospitals in Korea with the safety and efficacy comparable to the results of NINDS r-tPA trials. In addition, we suggest that the immediate neurological improvement after r-tPA be a predictor for favorable long-term outcomes. (J Korean Neurol Assoc 19(4):364~369, 2001)
Brain ; Cerebral Infarction ; Humans ; Intracranial Hemorrhages ; Korea ; National Institute of Neurological Disorders and Stroke ; National Institutes of Health (U.S.) ; Needles ; Risk Factors ; Stroke* ; Thrombolytic Therapy ; Tissue Plasminogen Activator ; Treatment Outcome

BACKGROUND: Vasodilators including angiotensin converting enzyme inhibitor(ACEI) have been suggested to reduce left ventricular volume and to improve left ventricular performance in patients with moderate to severe regurgitant valvular heart diseases. However, long-term effects of angiotensin converting enzyme inhibitor upon left ventricular size and function in asymptomatic or minimally symptomatic patients with chronic mitral regurgitation remain to be elucidated. MATERIALS AND METHOD: Forty five patients with moderate to severe chromic mitral regurgitation on echocardiography and mild or no symptoms were studied. Serial changes of left ventricular dimension and ejection fraction were analyzed retrospectively using M-mode echocardiography in patients treated with ACEI(ACEI group, n=21) and in patients treated with other medications except ACEI or with no medication(non-ACEI group, n=24). RESULTS: The mean duration of follow-up was 30+/-15 months. ACEI group showed trends of decreasing left ventricular end-systolic dimension(LVESD) and left ventricular end-diastolic dimension(LVEDD) and a trend of increasing ejection fraction(EF), though statistically insignificant when compared to those of before-treatment or non-ACEI group. In patients with larger initial LVESD(>35mm), LVEDD was reduced(the percent changes of LVEDD 2 and 3 years after ACEI treatment were -4.2# and -4.4%) that was significantly different from those of non-ACEI group(+3.4% and +3.4% each)(p<0.05). In patients with larger initial LVEDD(>60mm), the percent changes of LVEDD 2 and 3 years after ACEI treatment were -4.9% and -5.8%, and in patients with initial EF less than 60%, the percent change of LVEDD 2 years after ACEI treatment was -0.57%. Those changes were also statistically significant compared to those of non-ACEI group(p<0.05 each). CONCLUSION: In mildly symptomatic chronic mitral regurgitation patients, especially whose left ventricular dimension is increase, long-term ACEI therapy seems to be effective in preventing left ventricular dilatation or in reducing left ventricular volume and such therapy may have a beneficial effect on the natural history of such patients.
Angiotensins* ; Dilatation ; Echocardiography ; Follow-Up Studies ; Heart Valve Diseases ; Humans ; Mitral Valve Insufficiency* ; Natural History ; Peptidyl-Dipeptidase A* ; Retrospective Studies ; Vasodilator Agents

BACKGROUND: Onychomycosis, especially toenail onychomycosis has become one of the common fungal infection and has historically been regarded as a cosmetic rather than medical problem by many patients, even by physicians. Recently, however, there are several reports that this is a refractory disease which may cause a deleterious effect on patients' quality of life (QOL). OBJECTIVE: The purpose of this study was to investigate the impact of toenail onychomycosis on QOL in Korea and to assess the changes of QOL after treatment. METHODS: Total 1004 patients with toenail onychomycosis which was confirmed by clinical findings and KOH preparation were enrolled at 47 dermatologic centers in Korea, and interviewed with standardized QOL questionnaire before and after systemic antifungal treatment. Responses to the questionnaire were scored by f-point scale (0~4) and averaged, and were analyzed for 5 dimensions of emotional impact, social impact, symptom and functional impact, patients' views concerning treatment, and relationship with doctor. RESULTS: 1. Before and after treatment, the most serious impact was emotional dimension showing 1.90 and 1.30 in average score (AS), and social (AS: 1.14 and 0.83) and symptom and functional impact (AS: 1.05 and 0.92) was also affected. 2. In female rather than male, statistically more significant impact on patients' QOL was observed in all dimensions. 3. After treatment, 3 of 5 dimensions were improved significantly - emotional dimension (AS: from 1.90 to 1.30), social dimension (AS: from 1.14 to 0.83), patients' view concerning treatment(AS: from 1.34 to 1.02) 4. The degree of patients' satisfaction at the therapeutic effect was very high - 62.4% (immediately after. treatment) and 65.8% (9 months after initiation of treatment) of patients answered excellent or good. CONCLUSION: This study confirms that toenail onychomycosis has significant Impact on the overall QOL of patients. Also the effect of antifungal therapy on patients' QOL were satisfactory. Therefore, both doctor and patient should pay more attention to the treatment of onychomycosis.
Female ; Humans ; Korea* ; Male ; Nails* ; Onychomycosis* ; Quality of Life* ; Social Change ; Surveys and Questionnaires