The treatment application of cultured epithelial autograft (CEA) is the only selected treatment method when performing skin graft for treating massive burns over 70 to 80%. Clinically 2 types of CEA, sheet type and suspension type, are currently available in Korea. The sheet type of CEA, Holoderm(R), was commonly used since no other CEA were available. Since the recent introduction of the suspension type, Keraheal(R), the suspension type is also clinically used. Although 2 types are different in type of forms provided but both types are clinically effective for increasing survival rate of massive burn patients. The early treatment method of massive burn is selected based on the rage of burns using Warden or Parkland Formula. The escharectomy is performed within 3 to 7 days of burn then cadaver skin allograft is applied immediately. At this time, the full thickness skin biopsy in the size of 2x3 cm is obtained from non burned area such as axilla, inguinal or abdomen. Then the skin biopsy is sent to the labs. The length of culturing time is less than 3 weeks for Holoderm(R) and around 2 weeks for Keraheal(R). Holoderm(R) is provided as a sheet type. It is simply applied over 1:3~1:6 meshed skin autograft and fixed with staplers together with skin autograft. In the other hand, the suspension type of CEA, Keraheal(R), is provided in a glass vial and sprayed over 1:3~1:6 meshed skin autograft using Tissomat(R). The fibrin sealant is sprayed after application of Keraheal(R) as a fixation of suspension CEA sprayed. Extra wound care is necessary even after both types of CEA are successfully taken since CEA applied regions are much more fragile than those regions applied skin autograft only. The treatment methods of applying cadaver skin allograft and culture epithelial autograft (CEA) are the most advanced treatments available for increasing survival rate of massive burn patients. The sheet type and suspension type of CEA show difference in type of forms provided but they both show successful take rate that enhance the burn treatment. We suspect that both types of CEA still need ongoing efforts and researches to enhance their advantages and eliminate disadvantages to increase the efficacy that can promote wound healing process of massive burn patients.
Abdomen ; Axilla ; Biopsy ; Burns ; Cadaver ; Fibrin Tissue Adhesive ; Glass ; Hand ; Humans ; Korea ; Rage ; Skin ; Survival Rate ; Transplantation, Homologous ; Transplants ; Wound Healing

In the patient with extensive burn injury, the occult site of infection such as septic arthritis is easy to be overlooked because a painful hip joint may be confused for painful burn wounds around pelvic area. We describe a extensive burned young adult who experienced a septic hip joint with methicillin resistant Staphylococcus aureus bacteremia A 22 year old male who had full thickness burns of whole body (90%) presented with fever, groin pain, and immobility of right hip joint about 3 months after injury. The physical findings, radiographic findings and bone scan were diagnostic for a septic arthritis. Septic arthritis in the extensive burns may be misdiagnosed for painful burn wounds. Hematogenous septic hip arthritis by sustained bacteremia is rare, but clinical examination combined with appropriate laboratory and radiographic studies can lead to prompt diagnosis and treatment.
Arthritis ; Arthritis, Infectious ; Bacteremia ; Burns ; Fever ; Groin ; Hip ; Hip Joint ; Humans ; Male ; Methicillin Resistance ; Staphylococcus aureus ; Young Adult

PURPOSE: Vulvodynia is characterized by chronic vulvar pain caused by sexual intercourse and often results in female sexual dysfunction. Because the causes of vulvodynia are not clear, many patients do not receive optimal treatment. Recently, gabapentin and botulinum toxin A have both been shown to be effective treatments for vulvodynia. In this study, we retrospectively analyzed the clinical outcomes of botulinum toxin A and gabapentin treatment for chronic pain in women with this condition. MATERIALS AND METHODS: Seventy-three women with vulvar pain were administered either gabapentin (n=62) or botulinum toxin A (n=11) injections. Effectiveness was measured by use of a visual analogue scale (VAS). We analyzed the treatment method, treatment duration, success of treatment, and side effects or adverse reactions. RESULTS: Pain levels in both groups significantly decreased after treatment. In the gabapentin group, the VAS score decreased from 8.6 before treatment to 3.2 after treatment (p<0.001). The VAS score in the botulinum toxin A group was reduced from 8.1 to 2.5 (p<0.001). Side effects for both therapies were few and subsided with treatment with general antibiotics and nonsteroidal antiinflammatory drugs. CONCLUSIONS: Gabapentin and botulinum toxin A are safe and effective treatments for vulvodynia. This condition can cause sexual dysfunction and affect quality of life. However, with proper management, satisfactory outcomes for women with vulvodynia can be achieved.
Amines ; Anti-Bacterial Agents ; Botulinum Toxins ; Chronic Pain ; Coitus ; Cyclohexanecarboxylic Acids ; Dyspareunia ; Female ; gamma-Aminobutyric Acid ; Humans ; Quality of Life ; Retrospective Studies ; Vulvodynia

BACKGROUND: Laser treatment in melasma has previously failed because of the resulting inflammation and consequent pigmentation and excessive thermal damage caused by the use of high fluence. OBJECTIVE: This study is aimed at establishing the concept of the collimated low fluence Q-switched Nd : YAG laser as a treatment for melasma by investigating its therapeutic effects clinically as well as histopathologically. METHODS: 27 patients were treated weekly with Q-switched Nd : YAG laser (1,064 nm wavelength, 7 mm spot size, 1.6~2.5 J/cm2 fluence) for 8 weeks. The results were evaluated based on standardized clinical images that used Robo skin analyzer, spectrophotometer, MASI score and general severity. RESULTS: 17 (58.8%) patients showed "GOOD" (50~75% improvement) and no case of full recurrence was examined and partial recurrence was detected in 12/17 patients. Common adverse effects include pain, erythema, and temporary edema. Rarely partial hypopigmented macules and diffuse hyperpigmentation appeared. Additional studies, such as immunohistochemical examination and electron microscopic examination, are also currently in progress. CONCLUSION: The collimated low fluence Q-switched Nd : YAG Laser is effective in melasma treatment. This treatment method is a new concept that can be described as selective photothermolysis with minimal thermal damage and inflammation reaction to affected tissues by pigmentation. We consider this treatment method should be regarded as Minimized Selective Photothermolysis (MSP) that will provide a new effective treatment for melasma.
Edema ; Electrons ; Erythema ; Humans ; Hyperpigmentation ; Inflammation ; Lasers, Solid-State ; Melanosis ; Pigmentation ; Recurrence ; Skin

PURPOSE: Split-thickness skin grafts (STSG), as a treatment of full thickness burn have played a significant role in re-surfacing to date. The major disadvantage of traditional STSG is related to donor site morbidity, including scar formation and cosmetic changes. SureDerm(TM) is acellular human dermis, which is intended for the repair or replacement of damaged soft tissue. Then, we present our experience of using SureDerm(TM) as a tool for the skin graft of full thickness burns. METHODS: We reviewed the medical records of 20 patients treated in our burn center who received SureDerm(TM) graft with thin STSG in full thickness burns since November 2006 to October 2008. RESULTS: SureDerm(TM) was used with thin STSG (range 0.006~0.008 inches) concurrently. Thickness of SureDerm(TM) was 0.2~0.4 mm and the type of SureDerm(TM) was meshed. The average size of SureDerm(TM) used in the burn patients was 329.6 cm2 (32~1,384). All burn areas grafted SureDerm(TM) were full thickness burns and the locations were upper and lower extremities including joints (8 and 6 cases), trunk (3 cases), ankle (2 cases), and axilla (1 case). Each SureDerm(TM) grafted area had more than 95% take-rate. No complications were observed except 1 case of partially infected STSG. The mean follow up period was 8.7 months (1~17), and the assessment of scars, which had more than six months follow up periods was performed by Modified Vancouver Scar Scale and the results were good. CONCLUSION: SureDerm(TM) can be used as a dermal substitute for the treatment of full thickness burns and the result seems to be good cosmetically and functionally while it solves donor site morbidity followed by autograft.
Animals ; Ankle ; Axilla ; Burn Units ; Burns ; Cicatrix ; Cosmetics ; Dermis ; Follow-Up Studies ; Humans ; Joints ; Lower Extremity ; Medical Records ; Skin ; Tissue Donors ; Transplants

Extraskeletal chondroma is a rare benign tumor that develops in the soft tissues, and it manifests as a solitary subcutaneous nodule or a slowly growing tumor. It occurs preferentially in the hand and foot area of adults, and the development in the auricle is very rare. We report a rare case of chondroma that developed in the auricle, which were treated with wedge excision and reconstructed using a Burow's triangle, with a review of the literature.
Adult ; Chondroma* ; Foot ; Hand ; Humans

Lichen striatus and linear lichen planus are rare disorders that can be confused because they share similar clinical and histopathologic findings. We report a case of lichen striatus on the left wrist and fingers in a 54-year-old woman, who was initially diagnosed with linear lichen planus. She had overlapping clinico-histopathologic features of both lichen striatus and linear lichen planus. To discriminate between the two disorders, careful histological and clinical evaluations are needed, especially when a lichen striatus-like eruption occurs in adults.
Adult ; Female ; Fingers ; Humans ; Lichen Planus ; Lichens* ; Middle Aged ; Wrist

Benign prostatic hyperplasia (BPH) is the most common prostate disease in middle aged and elderly men. Therefore, identifying risk factors for BPH is crucial for understanding the etiology and for undertaking interventions or targeting strategies. The survey was carried out in two steps: first, pilot study was conducted prior to the main study in order to estimate baseline characteristics. Second, main study investigated prevalence and risk factors of BPH by clinical diagnostic tests and questionnaire. A total of 641 male aged 50-79 years participated in this community-based crosssectional study. Using 24 hour recall of food consumption, we found that animal fat intakes increased the risk of BPH with adjusted for age, chronic bronchitis, PSA level, drinking frequency, and excercise frequency (odds ratio 1.84, 95% confidence interval 1.10-3.06). Although BPH has been considered as unavoidable disease with advancing age, if these dietary risk factors are clearly identified, it can be prevented effectively by laying special emphasis on those at risk.
Aged ; Animals ; Bronchitis, Chronic ; Diagnostic Tests, Routine ; Diet ; Drinking ; Humans ; Hyperplasia* ; Male ; Middle Aged ; Mortuary Practice ; Pilot Projects ; Prevalence ; Prostate* ; Prostatic Hyperplasia ; Risk Factors ; Surveys and Questionnaires

Background and Objectives: The directed differentiation of pluripotent stem cells into motor neurons is critical for the development of disease modelling and therapeutics to intervene degenerative motor neuron diseases. Cell surface receptor Cdo functions as a coreceptor for Sonic hedgehog (Shh) with Boc and Gas1 in the patterning of ventral spinal cord neurons including motor neurons. However, the discrete function of Cdo is not fully understood. Methods: and Results: In this study, we examined the role of Cdo in motor neuron generation by utilizing in vitro differentiation of Cdo＋/＋ and Cdo−/− embryonic stem cells (ESCs). In response to Shh, Cdo−/− ESCs exhibited impaired expression of motor neuron specification markers while dorsal interneuron specification markers were significantly increased, compared to Cdo＋/＋ ESCs. Reactivation of Shh signalling pathway with Smoothened (Smo) agonist (SAG) restored motor neuron specification in Cdo−/− ESCs. In addition, electrophysiological analysis revealed the immature electrical features of Cdo−/− ESCs-derived neurons which was restored by SAG. Conclusions Taken together, these data suggest that Cdo as a Shh coreceptor is required for the induction of motor neuron generation by fully activating Shh signalling pathway and provide additional insights into the biology of motor neuron development.

Although a moderate degree of proteinuria is common in patients with IgA nephropathy (IgAN), nephrotic syndrome combined with IgAN is rare. It has been reported that approximately 5% of all patients with IgAN are complicated by minimal change disease and these patients respond well to corticosteroid therapy. However, spontaneous remission is uncommon in heavy proteinuric patients with IgAN. Recently, we experienced two cases of spontaneous remission of nephrotic syndrome combined with IgAN without use of corticosteroid. In these patients, heavy proteinuria disappeared in 1 month after the onset and no recurrence occurred during follow-up. With such limited number of cases, factors associated with spontaneous remission in these patients could not be explored. Further study with a larger number of patients is required and careful attention should be paid to these complicated cases.
Follow-Up Studies ; Glomerulonephritis, IGA ; Humans ; Immunoglobulin A ; Nephrosis, Lipoid ; Nephrotic Syndrome ; Proteinuria ; Recurrence ; Remission, Spontaneous