OBJECTIVE: To evaluate the maternal complications and perinatal outcomes in twin pre-gnancies with one fetal demise PATIENTS: From January 1990 to December 1996, 20 twin pregnancies with single fetal death were observed in Seoul National University Hospital : in 6 cases(group 1) between 20 ~26 weeks and in 14 cases(group 2) after 26 weeks gestation by gestational age of fetal death ; in 7 cases of monochorionic and in 13 cases of dichorionic placentation. RESULTS: The incidence of one fetal death was 5.4% in twin pregnancy. Diagnosis-to- delivery interval of group 1 was longer than group 2(61.0 days : 8.9 days). So it was thou- ght that the gestational age of delivery in group 1 was not always earlier than in group 2. And other parameters(chorionicity, preterm delivery, cesarean section, coagulopathy, IUGR, perinatal mortality, neurologic sequelae, IVH) didn't show the statistical differences between group 1 and group 2. According to chorionicity, it seemed that the perinatal mortality rate of monochorionic group was higher than dichorionic(86% : 62%) and that cesarean section rate was higher in dichorionic group(54% : 14%). But there were no statistical significances between two gruops. All other parameters also didn't show differences statistically. CONCLUSION: We fail to demonstrate that monochorionic placentation is associated with increased risks for the survivor in twin pregnancies of single fetal demise. It may be part- ially explained due to small numbers of cases in this study.
Cesarean Section ; Chorion ; Female ; Fetal Death ; Fetal Growth Retardation ; Gestational Age ; Humans ; Incidence ; Perinatal Mortality ; Placentation ; Pregnancy ; Pregnancy, Twin* ; Seoul ; Survivors

Contact Dermatitis due to cosmetics is also common in Korea. as in other developed countries. However. detection of the causative antigens is in a difficult situation due to many reasons. We have routinely patch tested with Japanese cosmetic series patch test allergens, Types 17 and 18 in addition to Hollister standard battery and patients own cosmetics to 4Q cases of suspected cosmetic contact dermatitis who have visited our Environmental and Occupational Clinic during the past one year. The study result was as follows. Total 55% ositive reaction related to cosmetics was observed in 4p patch tested patients. 2 The most frequently observed antigens were hydroxycitronellal, benzyl saliylate and cinnamic alcohol.
Allergens ; Asian Continental Ancestry Group ; Dermatitis, Contact* ; Developed Countries ; Humans ; Korea ; Patch Tests*

The ability of nicotinic acid and its substitutes to increase cutaneous blood flow has been measured by laser Doppler flowmeter in 30 healthy human volunteers. We applied nicotinarnide, nicotinic acid ethyl ester, nicotinic acid methyl ester, hexyl nicozinate each in an acqeous solution at a concentration of 10 mM/liter for 10 minutes occlusion on the forearm. The change of blood flow was serially checked at 5 to 10 minutes intervals for one hour. The study results were as follows : l. The relative maximum cutaneous blood flow response was in following order nicotinic acid methyl ester(100%), nicotinic acid ethyl ester(98%), hexyl nicotinate (84%) and nicotinic acid(63%). However, there was no statistically significant difference(p>0.05) between each drug. There was statististically significant difference between nicotinamide and all other nicotinic acid substitutes(p<0.05). 2. The time required to reach maximum blood flow response was 6.7 minutes for hexyl nicotinste, 10 minutes for nicotinic acid ethyl ester, 12.5 minutes for nicotinic acid methyl ester and 20 minutes for nicotinic acid. However, there was statistically significant difference between hexyl nicotinate and nicotinic acid only(p<0.05). 3. Significant decrease of cutaneous blood flow was observed one hour after the removal of the patches in all drugs.
Flowmeters ; Forearm ; Healthy Volunteers ; Niacin* ; Niacinamide

Achilles tendon is the most powerful and the biggest tendon of the body and its rupture is frequently sports-related. Many authors reported the effects of mobilization, electricity, ultrasound and various drugs as factors influencing the injured tendon. We studied the effects of early passive mobilization after firm suture using plantaris tendon as tension suture material and reinforcing membrane on the repair of a ruptured Achilles tendon. From March 1992 to December 1995, twenty-two operations on the Achilles tendon were carried out in our hospital. 1. Fourteen patients were male and eight patients were female. The mean patient age was 38 years, ranging from 13 to 68 years. Average follow-up periods was 2 years and 7 months, ranging from 12 months to 3 years and 8 months. 2. The rupture site was 4.7cm proximal to the tendon insertion into the calcaneus on average. 3. We performed the operations with end to end suture technique. After approximation of the ruptured ends of the tendon with a No. 5 Ethibond tension suture using a modified Kessler stitch, placed plantaris tendon in a fascial needle and pass it circumferentially and distal plantaris tendon is fanned out and tacked over the repair. 4. Postoperative treatment was done as following protocol Short leg cast was done with equinus position for initial 3 weeks, and then cast was removed, hydrotherapy and passive exercises was employed. About 6 weeks after operation when the foot can be brought to right angle, a reverse 90degrees ankle stop short leg brace was applied for additional 6 weeks and partial weight bearing was aUowed. 5. Follow-up results were classified according to the Arner-Lindholm scale. We had 16 excellent results and 6 satisfactory results. After rigid suture it may be possible to introduce a regimen of progressive isometric stimulation and protected loading and streching combined with removable orthosis. Such early exercises are likely to improve the rate of rehabilitation over plaster immobilization.
Achilles Tendon* ; Ankle ; Braces ; Calcaneus ; Electricity ; Exercise ; Female ; Follow-Up Studies ; Foot ; Humans ; Hydrotherapy ; Immobilization ; Leg ; Male ; Membranes ; Needles ; Orthotic Devices ; Rehabilitation ; Rupture* ; Suture Techniques ; Sutures ; Tendons ; Ultrasonography ; Weight-Bearing

Nickel is widely known as a common source of contact dermatitis and nickel sensitivity amounts to nearly 10 percent of allergic contact dermatitis patients. Common sources of nickel dermatitis are well known as necklaces, watches, rings, hooks, earrings and spectacle frames. Recently, we have seen five cases of nickel dermatitis the suspected sources of which were metal spectacle frames. The interim patch test result in our occupational and environmental clinic suggests that the metal spectacle frame is one of the most common sources of nickel dermatitis. Out of 84 medical students 27 wore metal spectacle frames. We have done a dimethylglyoxime spot test to the metal spectacle frames and got a positive result in 12 out of 27(44.4%). We conclude that metal spectacle frame seems to be one of the dominant causes of nickel dermatitis and it will be an increasing problem in our society.
Dermatitis ; Dermatitis, Allergic Contact ; Dermatitis, Contact* ; Ear ; Humans ; Nickel ; Patch Tests ; Students, Medical

Pigmented contact dermatitis, firstly reported by Dr. Osmudsen in 1970, is a disease result from recurrent contact dermatitis due to hypersensitivity to cosmetic companents, which produces secondary bizarre dark brown hyperpigmentation. Histological examination of this condition reveals liquefaction degeneration of the basal cells of the epidermis and melanophages in the upper dermis. However, this entity has not been reported in the Korean literature until now. We report three cases of pigmented contact dermatitis which were diagnosed by the histological examinations and the patch tests.
Dermatitis, Contact* ; Dermis ; Epidermis ; Hyperpigmentation ; Hypersensitivity ; Patch Tests

Quaternium-15 (Dowicil 200) which is a water-soluble antimicrobial agent and a formaldehyde releaser is widely being used as a preservative in cosmetics and medicaments these days. However, there are scanty reports about it in the Korean literature. Recently, we have experienced two cases of Quaternium-15 contact dermatitis probably related with their cosmetics and topical medicament, respectively. We report our cases with the patch test results.
Dermatitis, Contact* ; Formaldehyde ; Patch Tests

Alopecia areata is a relatively common disorded but the exact psthogenesis is still unknown and there is no satisfactory treatment. Recently contact immunotherapy has been studied with dinitrochlorogenzene(DNCB) which is known to have in vitro mutagenecity limiting its clinieal application. In contrast, diphencyprone (DPCP) is a potent contact sensitizing agent which is not known to be mutagenic. We treated 40 patients with alopecia areata who were refraetory to standard treatment.DPCP was dissolved in acetone in concentrations of 0.0001 2%. After sensitization, DPCP was topically applied to the right side of the scalp with left side sewing as control. After obvious hair growt,h, DPCP was applied on both sides of the scalp. A positive respanse was defined as growth of terminal hairs on the scalp. The response rate was estimated by determing the percentage of hair covered areas com- pared to the total area of the scalp. The results were as follows. 1) Of 20 patients who were followed over 3months, 9 patients(45% ) showed positive response, and 6 patients(30%) showed almost complete regrowth of terminal hairs (above 90% of scalp area). 2) The response time varied from 4 weeks to 33 weeks, with average duration of 10.6 weeks. 3) Nine out of forty patients developed side effects such as severe contact eczema, cervical lymph node swelling and vitiligo. Three out of 40 patients had to discontinue therapy due to side effects. 4) Patients with mild alopecia areata ganerslly showed a higher response rate(50%) than those with alopecis totalis(33%) and alopecia universalis(43%), but the differences were not statistically signifieant(p>0.05). 5) No correlation was found between reaponse rates and clinical factors such as age, sex and duration ot the disease. In conclusion, treatment with DPCP was thought to be effective in patients with alopecis areata who were refractory to standard treatment. Further long-term studies may be neees- sary to find out clinical course of the disease after trestment, and long-term safety of this treatment.
Acetone ; Alopecia Areata* ; Alopecia* ; Dermatitis, Contact ; Hair ; Humans ; Immunotherapy ; Lymph Nodes ; Reaction Time ; Scalp ; Vitiligo

OBJECTIVE: The conventional methods to determine fetal genetic status, such as amniocentesis or chorionic villi sampling(CVS) have small procedure-related risk of abortion. Recently, several researchers reported that fetal genetic status, such as sex, can be confirmed by fetal nucleated erythrocytes in maternal blood and this method might reduce such risk. Therefore, in this study, we attempted to determine the basic fetal genetic status, sex, with fetal nucleated erythrocytes. METHODS: In twelve pregnant women who undertook amniocentesis or CVS, 20 ml of venous blood was drawn immediately before the procedure and the nucleated erythrocytes were recovered by magnetic activated cell sorting(MACS). After MACS, DNA was extracted from 200 microliter of sample and single nucleated erythrocyte was obtained by additional procedure, immunostaining, and microdissection. After recovery of nucleated erythrocytes by microdissection, nested polymerase chain reaction(PCR) and fluorescent PCR of amelogenin gene were performed to identify the fetal gender. RESULTS: The DNA of enriched erythrocytes after MACS could identify the fetal gender in the 58.3% of the samples by nested PCR. After the recovery of single nucleated erythrocyte by MACS, immunostaining and microdissection, the minute DNA in a single cell could be amplified by primer extension preamplification(PEP), nested PCR, and fluorescent PCR. Fetal genders were correctly identified in 8 out of 12 (66.7 %). CONCLUSION: Through this study, we could conclude that fetal nucleated erythrocytes in maternal blood might be sufficient sample to determine fetal sex. And single cell isolation by microdissection could get the better results than nested PCR after MACS only. However, in spite of the pregnancy of male fetus, female specific bands were obtained after nested PCR of amelogenin in several cells, which might suggest that part of nucleated erythrocytes in maternal blood might be maternal origin. Therefore, to determine fetal genetic condition by nucleated erythrocytes in maternal blood, further improvements of methods to identify the nucleated erythrocytes of fetal origin are needed.
Amelogenin ; Amniocentesis ; Cell Separation ; Chorionic Villi ; Diagnosis* ; DNA ; Erythroblasts* ; Erythrocytes ; Female ; Fetus ; Humans ; Male ; Microdissection ; Polymerase Chain Reaction ; Pregnancy ; Pregnant Women

This study was undertaken to elucidate extracutaneous hyperpigmentation of nevus of Ota by analyzing the 70 patients who visited Cryosurgery Clinic in Seoul National University Hospital between January 1984 and March 1985 This results were as follows: 1. The age of onset showed two peaks: the first one was at birth or soon after birth; 27 cases(38. 6%) and the second une was between 11 and 17 years; 37 cases (45. 7%). 2 Seventy cases were classified by Taninos method: 15.7% was type I a, 27. l% type I b, 28. 6% type Il, 20. O% type g and 8. 6% type IV 3.Fifty two out of 70 cases who were examined at the department of ophtha1rnology: pigrnentation of sclera was observed in 29 cases(55. 8%.), of conjunctiva in 18 cases(34.6%), of uveal tract in 14 cases(26. 9A), of fundus in 14 cases (26. 9%) and of optic papilla in 2 cases(3. 8%). 4 Fifty two out of 70 cases who were examined at the department of Otorhinolaryngology. pigmentation of tympanum was observed in ]0 cases(23, 8%,), of nasal mucosa in 6 cases(14. 3p,), of oral mucosa in 5 cases(11, 9%), of external auditory canal in 4 cases(9 5%) and of pharynx in 1 case(2.4%,)
Age of Onset ; Conjunctiva ; Cryosurgery ; Ear Canal ; Ear, Middle ; Humans ; Hyperpigmentation* ; Mouth Mucosa ; Nasal Mucosa ; Nevus of Ota* ; Nevus* ; Optic Disk ; Otolaryngology ; Parturition ; Pharynx ; Pigmentation ; Sclera ; Seoul ; United Nations