There are some effective methods for removing layers of skin to improve aging face and dermatologic defects : chemabrasion (chemical peeling), dermabrasion(surgical removal), laserabrasion. Chemabrasion, generally performed with a chemical solution, is most useful for removal of fine facial wrinkles and abnormal pigmentation. The application of chemical caustics, especially TCA (trichloroacetic acid), is known to be an effective and is now commonly practiced to improve the surface of the facial skin that has been blemished by pigmentation, wrinkles, solar damage and certain scars. Trichloroacetic acid is a colorless melting crystal and derivatives of acetic acid which das protein precipitating properties. It has specific odor but there is not systemic toxic effect like a phenol. It has heavy caustic effect on skin and mucosa and cause the coagulation necrosis of the skin and therefore, it must be handled carefully and stored in the proper condition. Especially, moderate to high concentrated TCA solution must be treated by well-trained persons. A 46-year-old woman visited a private clinic for removal of fine wrinkles around the lip. She was refered to our department because of acute upper lip coagulation necrosis which was caused by injection of 35% TCA solution mistaken for lidocaine, which was supposed to be used for anesthesia. At her arrival, cental half of upper lip showed severe coagulation necrosis. The lesion was well discriminated in a few days, then debridement and immediate reconstruction was done using an Abbe flap. Chemical peeling is a relatively effective procedure for improvement of aging skin lesion in a lower cost with a short time operation, if the practitioner has much experience and optimal indication is properly selected. But not so as, side effect and complication may be often ocurred in a mistake and as a result irreversible scars are remained. We experienced a rare case of upper lip necrosis which was caused by TCA injection mistaked for lidocaine in a private clinic and so, We report this case with the results of experiment of rabbit model which was observation of macroscopic and microscopic changes of the abdominal skin of the rabbit injected with serially diluted TCA solution.
Acetic Acid ; Aging ; Anesthesia ; Caustics ; Cicatrix ; Debridement ; Female ; Freezing ; Humans ; Lidocaine ; Lip* ; Middle Aged ; Mucous Membrane ; Necrosis* ; Odors ; Phenol ; Pigmentation ; Skin ; Trichloroacetic Acid

Bleomycin, a tumoricidal antibiotic agent, may produce unusual cutaneous manifestations such as pigmentation scleroderma, and gangrene. We report a case of the development of linear streaky pigmentation and cutaneous scleroderma in a patient treated with bleomycin for choriocarcinoma of undescented testis. The patient was 45-year-old male presented with linear brown and slate gray streaking over the trunk and extremities after three cycles of chemotherapy(bleomycin, etoposide, cisplatine). After the fourth cycle of the same chemotherapy, 18 weeks after initiation of bleomycin, the development of cutaneous scleroderma-like conditions was observed involving the same sites. Histopathologic examination showed increased basal pigmentation and thick collagen bundles through the entire dermis, extending to the subcutis. Herein, we describe a case of streaky pigmentation and scleroderma in association with bleomycin anticancer chemotherapy simultaneously in a patient.
Bleomycin* ; Choriocarcinoma ; Collagen ; Dermis ; Drug Therapy ; Etoposide ; Extremities ; Female ; Gangrene ; Humans ; Hyperpigmentation ; Male ; Middle Aged ; Pigmentation* ; Pregnancy ; Testis

BACKGROUND: Androgenetic alopecia is considered to be a genetically determined disorder influenced by age and androgen. The proportion of patients with androgenetic alopecia among the total number of patients with alpecia seems to be gradually increasing. OBJECTIVE: The purpose of this study is to determine the family history, clinical and endocrine status of the patients with androgenetic alopectia. METHODS: 387 patients with androgenetic alopecia who had visited the Department of Dermatology, Yongsan Hospital, College of Medicine, Chung-Ang University during the last 4 years (1990.1-1993.12)were examined. RESULTS: 1) Annual incidence of androgenetic alopecia among the total number of alopecia patients averaged over 4 years was 38.95 having increased recently. 2) There were 286 male and 101 female patients being most prevalent in the 3rd decade in both sexes. 3) Patients younger than 30 years old, patients with premature androgenetic alopecia, made up 687.5% of the male patients and 56.4 of the female patients with androgenetic alopecia. 4) Of the 73 male patients Hamilton's type III was most common (46, 63.0%). 5) Of the 34 female patients Ludwig's type I was most common (21, 61.2%). 6) there was a family history of baldness in 39.4% of first degree relatives in male patients and 41.25 of first degree relatives in female patients. 7) Associated diseases were observed in 152 (53.1%) of the male patients and 63(62.4%) of the female patients : seborrheic dermatitis (36.7%/35.7%), acne vulgaris (5.2%/5.95), atopic dermatitis, thyroid diseases, pulmonary tuberculosis, depression, and gastrointestinal diseases. In female patients menstrual irregularity, hypertrichosis, and polycystic ovary disease were also observed. 8) Serum testosterone levels were increased in 24 (8.8%0 of male patients and in 17 (17.45) of female patients. CONCLUSION: Based on our findings, the development of androgenetic alopecia is significantly related to the positive family history of baldness. Serum testosterone levels in most patients were within normal limit and were increased only in a small number of the patients with androgenetic alopecia. Therefore, it seems reasonable to suggest that the inhibitory effecfts of androgens on the dermal papilla cells may be mediated by an increased density and/or functional activity of androgen receptors or through an acceleration in the metabolic activity of androgen.
Acceleration ; Acne Vulgaris ; Adult ; Alopecia* ; Androgens ; Depression ; Dermatitis ; Dermatitis, Atopic ; Dermatitis, Seborrheic ; Dermatology ; Female ; Gastrointestinal Diseases ; Humans ; Hypertrichosis ; Incidence ; Male ; Ovary ; Receptors, Androgen ; Testosterone ; Thyroid Diseases ; Tuberculosis, Pulmonary

PURPOSE: Despite recent progress in the procedures of revascularization, acute limb ischemia continues to account for a wide variety of complications, culminating very often in limb loss or death. These poor results after treatment of acute limb ischemia still remains a major challenge in vascular surgery. METHOD: To evaluate the clinical characteristics and risk factors for early limb loss in acute limb ischemia, the clinical data of 87 limbs (8 upper and 79 lower limbs) in 83 patients. that underwent revascularization for acute limb ischemia at Yeungnam University Hospital from January 1995 to February 2003 were analyzed retrospectively. A Log-Rank test of Kaplan-Meier method and Cox proportional hazard analysis were performed to identify those main effects predictive of amputation free survival. RESULT: The patients, 78 males and 9 females, ranged from 30 to 83 years of age, with a mean age of 67. The highest incidence occurred among people in their 50s and 60s. The underlying causes of acute limb ischemia were arterial embolism in 42 limbs (42/87, 48.2%), arterial thrombosis in 36 (36/87, 41.3%), bypass graft occlusion in 9 (9/87, 10.3%). The primary sources of embolism were cardiac origin in 25 cases (25/42, 59.5%), aneurysmal origin in 2 (2/42, 4.8%) and unknown origin in 15 (15/42, 35.7%). As for the severity of ischemia according to SVS/ISCVS classification, 40 limbs (40/87, 46.0%) were classified as category IIa, 39 (39/87, 44.8%) as category IIb, and 8 (8/87, 9.2%) as category III. For the treatment, 66 thromboembolectomies (including 20 cases treated with intraoperative thrombolytic therapy), 19 arterial bypasses and 2 catheter directed thrombolytic therapies were performed. There were 13 major amputations and 8 mortalities at 6 months after revascularization. Cumulative 15 day, and 1, 2, 4, and 6-month amputation-free survival rate of all survival patients were 88.8%, 85.7%, 83.9%, 83.9% and 81.4% respectively. Among the univariate analysis of 26 clinical variables, 10 factors were identified as being associated with amputation-free surviva: age (P=0.01), preoperative tissue gangrene (P=0.03), preoperative skin color change (P=0.00), preoperative muscle status (P=0.00), preoperative motor and sensory deficit (P=0.00, P=0.00), severity of ischemia by clinical category (P=0.00), symptom duration (P=0.02), length of occlusion (P=0.01), and cause of occlusion (P=0.01). In multivariate analysis, age (P=0.04), and preoperative skin color change (P=0.00) predicted a poorer response to therapy. The major limb amputations were performed in 2 limbs (2/41, 4.9%) of the emboli group, and 11 limbs (11/42, 26.2%) of the thrombi group. For the limb with thrombosis, the major limb amputations were performed in 9 limbs (9/26, 34.6%) of the thromboembolectomy group and in 2 limbs (2/16, 1.3%) of the arterial bypass group. CONCLUSION: These results suggest that prompt and appropriate treatment is critically important in the management of acute limb ischemia. In thrombi cases Especially, a more aggressive surgical approach may be necessary for limb salvage.
Amputation ; Aneurysm ; Catheters ; Classification ; Embolism ; Extremities* ; Female ; Gangrene ; Humans ; Incidence ; Ischemia* ; Limb Salvage ; Male ; Mortality ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Skin ; Survival Rate ; Thrombolytic Therapy ; Thrombosis ; Transplants

The rib cartilage has been the most popular autogenous tissue for microtia reconstruction. Donor site complications, especially chest wall deformities occurring after harvest of costal cartilage graft are presented and discussed in many reports. In this study, 100 chest donor sites were evaluated in 34 patients (25 male and 9 female) who underwent costal cartilage grafts for microtia reconstruction from 1992 to 1999, and reviewed for donor site complications by radiography and physical examination. Ribs from which costal cartilage had been harvested showed increased inward bowing on radiographs in 38 of 100 donor sites; the upper ribs record a higher incidence of deformity than lower ribs. The frequency of rib deformity in donor site was 21 percent when cartilages were harvested from patients older than 10 years of age, whereas it was 73.3 percent in patients younger than 10 years. This difference was statistically significant. In our study, the incidence of chest wall deformity was 57 percent, concerning donor site morbidity after the supraperichondrial rib harvesting procedure, whereas it was 35 percent in patients after the subperichondrial rib harvesting procedure. In conclusion, surgeons should consider the possibility of thoracic deformity when planning costal cartilage grafting. To avoid these deformities, costal cartilage harvesting should be made at lower levels of the rib cage, and delayed operation time for thoracic maturation is recommended. More care should be taken to preserve the perichondrium and the germinative zone of the costochondrial junction.
Cartilage* ; Congenital Abnormalities ; Humans ; Incidence ; Male ; Physical Examination ; Radiography ; Ribs ; Thoracic Wall* ; Thorax* ; Tissue Donors ; Transplants

PURPOSE: There has been a recent trend of using ureteroscopic removal of stone (URS) for treating upper ureter stones, due to its safety and success rate; therefore we attempted to find the varying success of URS for different locations and sizes of upper ureter stone. MATERIALS AND METHODS: 107 patients with upper ureter stones, who were treated with URS in our hospital, between January 2000 and May 2005, were retrospectively reviewed. The patients were classified into three groups according to the locations (named L3, L4 and L5) and sizes (<10mm and > or=10mm) of the upper ureter stones. RESULTS: The overall success rate of URS was 71.0%. With regard to the three locations, L3 had a 46.3% success rate, while L4 and L5 had success rates of 76.9 and 92.5%, respectively. The success rates of URS were significantly higher in L4 and L5 locations compared with that in L3 (p<0.05). In addition, the success rates of URS for stones equal to or larger than 10mm and less than 10mm were 59.5 and 78.5%, respectively, with the former being significantly lower than the latter (p=0.036). CONCLUSIONS: The success rates of URS were significantly higher when the location of upper ureter stones was lower than L4 and when the size of the stone was less than 10mm. Therefore, both the location and size of the stones are important factors potentially influencing the outcome of URS for upper ureter stones.
Humans ; Retrospective Studies ; Ureter* ; Ureteral Calculi ; Ureteroscopy

PURPOSE: Due to the recent trend of performing ureteroscopic removal of stone (URS) for treating upper ureter stones, stone migration into renal pelvis and calices has increased the morbidity and the need for auxillary procedures. The Stone Cone is a device that prevents stone migration during URS. We report here our initial experience of using the Stone Cone during the treatment of upper ureteral stones. MATERIALS AND METHODS: From February 2005 till May 2005, we treated fifteen consecutive patients who were suffering with upper ureteral stones by using the Stone Cone and performing semi-rigid ureteroscopy and pneumatic lithoclast. Pneumatic lithotripsy was done in 11 patients and the remaining 4 cases were treated by using a stone basket and forceps. RESULTS: The Stone Cone was successfully placed in all 15 cases. In 13 patients, it was placed via cystoscopy under fluroscopic guidance, while 2 patients with 2 impacted stones required ureteroscopic placement. No patients had residual fragments greater than 3mm and they didn't require auxiliary procedures. CONCLUSIONS: The Stone Cone is a new device that prevents stone migration and allows safe extraction of fragments during URS. This study shows that the success rate of URS for proximal ureteral stones was 100% with using the Stone Cone.
Cystoscopy ; Equipment and Supplies ; Humans ; Kidney Pelvis ; Lithotripsy ; Surgical Instruments ; Ureter* ; Ureteral Calculi ; Ureteroscopy

Subungal malignant melanoma is a relatively rare disease with reported incidence between 1% to 3% of all melanoma cases in the USA, 10% to 31% in Japan. It is a serious disease with a survival period of 5 years. This poor prognosis is the result of late diagnosis in many of the cases, usually the patient not presenting himself early enough in the course of the disease. However, far more important is the frequent failure of the physician or surgeon to recognize the clinical signs and to perform a biopsy from the correct site, which leads to an accurate diagnosis. Therefore we focused the nail color change of the subungal malignant melanoma to diagnose the disease at the early stage. Five patients who visited our hospital with nail color change into black took the biopsy. This should be done on nail bed and matrix lesions which shows color change into black. A wedge form is taken from the area with maximal clinical concern, including normal tissue at the edge of the lesion. In cases of melanoma in situ (4 cases) diagnosed during the previous biopsy, surgical treatment was done as soon as possible. The melanoma was excised by Mohs technique and the margins were checked by frozen section. If the margins and base of tumor did not have micrometastasis, immediate reconstruction using various flaps was done. In case that micrometastasis was suspicious however, special staining using HMB45 immunostaining was done for confirmation. After a few days for special staining, delayed reconstruction was done. By means of the early diagnosis and Mohs micrographic operation technique, we could excise the tumor completely and preserve the tendon, bone, joint and length of digits.
Biopsy ; Delayed Diagnosis ; Diagnosis* ; Early Diagnosis ; Frozen Sections ; Humans ; Incidence ; Japan ; Joints ; Melanoma* ; Neoplasm Micrometastasis ; Prognosis ; Rare Diseases ; Tendons

BACKGROUND: Dendritic epidermal T cells(DETC) are skin specific members of the epithelial gammadelta-T cell family that reside normally in mouse epidermis. Although the mechanisms of antigen recognition by alpabeta-T cells have become better defined, the physiological role of the gammadelta-T cells and ligands they recognize are still poorly understood. OBJECT: In the present study we sought to elucidate the antigen specificity and whether the DETC recognize transformed keratinocyte derived antigen. METHOD: We used a DETC and TCR(-) DETC which were obtained by 1600R gamma-irradiation and sorting, in addition to transformed keratinocyte cell lines. We performed coculture experiments of DETC/transformed keratinocyte cell lines to detect direct evidence that DETC recognize the keratinocyte-derived antigen. RESULT: 1. TCR negative variants of DETC do not respond to concanavalin(Con)-A, but respond to phobol myristate acetate(PMA)/ionomycin. 2. PAM 212, UV-irradiated PAM 212 and heat shocked PAM 212 cells stimulate DETC. PAM 212 cells could perform as stimulator of DETC even in the absence of stress signal. 3. UV irradiated XB2 cells stimulate DETC, but XB2 and heat shocked XB2 cells could not stimulate DETC. 4. DETC do not respond to fibroblast, UV-irradiated fibroblast and heat shocked fibroblast 5. TCR negative variants of DETC are no longer stimulated by PAM 212 cells, suggests that PAM 212 cells mediate their effects through the TCR CONCLUSION: The above results strongly suggest that DETC recognize specific, transformed and stressed keratinocyte-derived antigens and may play a role as an immune surveillant for cellular damage. Therfore, DETC may play critical roles during the induction of immune reaction in the skin.
Animals ; Cell Line* ; Coculture Techniques ; Epidermis ; Fibroblasts ; Hot Temperature ; Humans ; Keratinocytes* ; Ligands ; Mice* ; Myristic Acid ; Receptors, Antigen, T-Cell ; Sensitivity and Specificity ; Shock ; Skin

BACKGROUND: To decide the optimal antibiotics and application of chest tube, examination of pleural fluid is fundamental in the management of empyema. Some criteria for drainage of pleural fluid have been recommended but some controversies have been suggested. Recently, newer radiologic methods including ultrasound and computed tomography scanning, have been applied to the diagnosis and management of pleural effusions. We undertook a retrospective analysis of 30 patients with pleural effusion who had CT scans of the chest in order to apply the criteria of Light et at retrospectively to patients with loculation and to correlate the radiologic appearance of pleural effusions with pleural fluid chemistry. METHOD: We analyzed the records of 30 out of 147 patients with pleural effusion undergoing chest CT scans. RESULTS: 1) Six of the pleural fluid cultures yielded gram negative organisms and three anaerobic bacterias and one Staphylococcus aureus and one non-hemolytic Streptococci. No organism was cultured in nineteen cases(63.0%). 2) The reasons for taking chest CT scans were to rule out malignancy or parenchymal lung disease(46.7%), Poor response to antibiotics(40.0%), hard to aspirate pleural fluid(10.0%) and to decide the site for chest tube insertion(3.3%). 3) There was no significant correlations between ATS stages and loculation but there was a tendency to Inoculate in stage III. 4) There was a significant inverse relationship between the level of pH and loculation(P<0.05) but there appeared to be no relationship between pleural fluid, LDH, glucose, protein, loculation and pleural thickening. 5) In 12 out of 30, therapeutic measures were changed according to the chest CT scan findings. CONCLUSION: We were unable to identify any correlations between the plerual fluid chemistry, ATS stages and loculations except pH, and we suggest that tube thoracotomy should be individualized according to the clinical judgement arid serial observation. All patients with empyema do not need a chest CT scan but a CT scan can provide determination of loculation, guiding and assessing therapy which should decrease morbidity and hospital stay.
Anti-Bacterial Agents ; Bacteria, Anaerobic ; Chemistry ; Chest Tubes ; Diagnosis ; Drainage ; Empyema* ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Length of Stay ; Lung ; Pleural Effusion ; Retrospective Studies ; Staphylococcus aureus ; Thoracotomy ; Thorax* ; Tomography, X-Ray Computed* ; Ultrasonography