The ability of photochemotherapy(PUVA) or UVA phototherapy to stimulate melangenesis is well known. It is now recognized that the PUVA lentigines, irregular in outline and often more darkly and unevenly pigmented than solar lentigines, are related to the additional pigmentary effects of the PUVA therapy. We present herein four cases of unusual pigmentation after one month of UVB irradiation. Raticulated dark brown pigmentation appeared on the lower extremities of the patients. Histopathologicially, an increase in melanin in the basal layer was found, but no dysplasia or malignant change. We suggest UVB as the cause of this unusual hyperpigmentation.
Humans ; Hyperpigmentation ; Lentigo ; Lower Extremity ; Melanins ; Phototherapy* ; Pigmentation* ; Psoriasis* ; PUVA Therapy

BACKGROUND: Althogh drug euption refers to a common dermatological condition, there are numerous holdbacks on the diagnosis. OBJECTIVE: This study atternpts to define the clinical features and causavite drug of the patients with drug eruptions, and to evalarate the diagnostic value of various skin tests. METHOD: 130 patients with drug eruptions were reviewed clinically. In 54 patients, intradermal test, patch test, and scratch patch test were performed using suspected drugs. Result : The exanthematous eruption(53.0%), fixed drug eruptior.(29.2%), and urticaria(6.2%) were the common types of the drug eruption. The common causative agenst of drug eruptions were antibiotics/antimicrobials, antipyretics/NSAIDs, and CNS depressants. 28 paitients out of the 54 patients on skin tests with suspected drugs had positive results in at least one slinest. CONCLUSION: In our study, we were able to obtain somewhat meaningfi 1 results based on data from the combination of various skin tests.
Central Nervous System Depressants ; Diagnosis ; Drug Eruptions* ; Humans ; Intradermal Tests ; Patch Tests ; Skin Tests* ; Skin*

We observed a 51-year-old male, who developed depigmented patches on the lower abdomen after photochemotherapy(PUVA) of psoriasis without evidence of phototoxic reaction. The depigmented patches did not orginate from the sites of previous psoriatic lesions. Fontana-Masson stain of the biopsy specimen revealed nearly absent melanin pigments in the epidrmis of the hypopigmented patch, while lots of pigments were obsereved on the surrounding hyperpigmented area. Electron micrograph showed no melanocytes in the hypopigmented patch. Thus we report this case as having vitiliginous patches induced by photochemotherapy of psoriasis.
Abdomen ; Biopsy ; Humans ; Male ; Melanins ; Melanocytes ; Middle Aged ; Photochemotherapy* ; Psoriasis* ; Vitiligo

A giant abdominal aortic aneurysm (AAA) renders surgical treatment much more difficult by deforming the proximal infrarenal aortic neck (shortened length and disturbed angulation), by altering the iliac arteries (marked tortuosity and aneurysmal dilatation), and by displacing abdominal organs. Because the retroperitoneal rupture of giant AAA makes the mesentery more elongated and deformed, compromising its blood flow and thus increasing the risk of mesenteric ischemia such as colon ischemia. We describe here the surgical repair of a large infrarenal AAA with a ruptured huge left common iliac artery aneurysm of 13.5 cm in diameter, accompanied by colostomy due to colon ischemia which occurred during the operation. We discuss the pathophysiology and preventive strategy of colon ischemia during ruptured giant AAA repair.
Aneurysm* ; Aneurysm, Ruptured ; Aortic Aneurysm, Abdominal ; Colitis, Ischemic ; Colon* ; Colostomy ; Iliac Artery ; Ischemia* ; Mesentery ; Neck ; Rupture

A 31-year-old male patient had malignant atrophic papulosis that afected the skin only. He had multiple typical porcelain-white skin lesion on the face and trunk without abdominal symptoms. Histopathologic studies showed moderate inflammatory infiltration in addition to the typical cone-shaped region of necrobiosis, There are no satisfactory treatment modes, and in the present case, the patient's condition improved transiently on oral medication of aspirin, but we lost the contact with him afterwards.
Adult ; Aspirin ; Humans ; Male ; Malignant Atrophic Papulosis* ; Necrobiotic Disorders ; Skin

Fracture of distal one third of tibia is prone to develop angular deformity during weight bearing and delayed union by inadequate immobilization. Most surgeons have performed internal fixation with plate and screws or interlocking Kuentscher nail to provide stability to the fractured tibia. When open reduction and internal fixation is carried out, the periosteum and muscular attachments must be stripped off. And in interlocking Kuentschernailing extraoperative time needed to insert distal screw, and the medullary reaming destroys nutrient circulation by which fracture healing is hindered. However, flexible Ender nailing is a simple procedure which does not necessitate reaming, and also does not disrupt or strip off soft tissues at the fracture site. Authors carried out Ender nailing in 16 patients having distal tibial fractures who were treated at the Orthopaedic Department, Kang-Nam St. Mary's Hospital from February, 1985 to December, 1988. The results are as follows: 1. The radiological union was obtained at 13.3 weeks after operation, and primary healing was taken place. 2. Fractures could be securely fixed by intramedullary Ender nailing. 3. Mild angulation developed in 3 cases, but it did not affect the results. Through the results Ender nailing is proven to be an effective, reliable, and safe method in treatment of fracture of the distal one third of tibia with minimum residua and complication, and brings the natural fracture healing.
Congenital Abnormalities ; Fracture Healing ; Humans ; Immobilization ; Methods ; Periosteum ; Surgeons ; Tibia ; Tibial Fractures ; Weight-Bearing

Introduction: This study examined the factors related to the amount of blood loss and transfusion after primary total hip arthroplasty. Materials and methods: Sixty THRA patients, who had records of perioperative complete blood counts and transfusion, were enrolled in this study. Age, gender, diagnosis, use of cement, size of an incision, operative time, intraoperative crack, estimated blood loss, use of suction drain and the amount drained were used as possible variables. Results: The decrease in the serum hemoglobin level immediately after and 1 day after surgery was 3.18 and 3.90g/dL respectively. An average of 2.30 units were transfused in 78.3% of cases. The preoperative serum hemoglobin level, the use of a suction drain and the amount drained was related to the total amount of transfusion. Adverse transfusion reactions were found to be associated with the amount of transfusion Discussion: The reduction in the hemoglobin level and total amount of blood transfused showed no relationship with the variances associated with the surgical techniques. The total amount of blood transfused was significantly lower in the groups that had no suction drain. Therefore, a reduction in the volume of intraoperative transfusion and avoiding use of a suction drain can reduce the total amount of blood needed and reduce the adverse reactions of the transfusion.
Arthroplasty, Replacement, Hip* ; Blood Cell Count ; Blood Group Incompatibility ; Diagnosis ; Humans ; Operative Time ; Suction

Serovars of 22 leptospiral field isolates from rats trapped in Korea were identified by cross-agglutinin absorption test (CAAT). Genomic characteristics of 7 selected isolates and 6 antigenically closely related reference serovars of lai, yeonchon, birkini, gem, mwogolo, and canicola were differentiated by arbitrarily primed PCR (AP-PCR) and southern blot hybridization using 16S rRNA gene probe from Borrelia burgdorferi. Among the 22 isolates, 21 strains were identified as serovar lai by CAAT, while the serological reactivity of NR13 did not accord with that of serovar lai. Results of AP-PCR using primers RSP, KF and PB-1 were in general agreement with those obtained by serological identification, and all 7 isolates including NR13 showed the same profile with serovar lai or yeonchon. In the southern blot hybridization with 16S rRNA gene probe, the isolates were divided into two ribotype groups when HindIII and BamHI digests were employed: isolates NR4, NR13, and serovar lai showed the same profile, and isolates JR34, JR57, KR48, JR77, and JR82 were classified as the another ribotype group. Isolate NR13 and serovar yeonchon, which were isolated in Korea and showed serological differences with serovar lai, were indistinguishable from serovar lai in this DNA study using AP-PCR and ribotyping. These results demonstrate that Korean leptospiral isolates were closely related in DNA level, and ribotyping would be useful for subgrouping of field isolates.
Absorption ; Animals ; Blotting, Southern ; Borrelia burgdorferi ; DNA ; Genes, rRNA ; Korea ; Leptospira* ; Polymerase Chain Reaction* ; Rats ; Ribotyping*

Mercury had been an important constituent of the remedial drugs for last few centuries, but substantially replaced by more specific and effective mordern medicines. However, metalic mercury, tbe vestige of the last decades, has still been employed for the patients of scabies by the herbal doctors in Korea. Therefore, we have often experienced patients with such complications as exfoliative dermatitis following topical applications of metalic mercury or inhalation of the vapor. There are three major toxic chernical forms of mercury, such as metalic (ele- mental) mercury vapor, salts of the mercury, and organic mercur.'als. Metailc mercury is the most volatile of the inorganic forms of the metal, Inhalation of the vapor of the metalic mercury is very toxic, but ingestion of the globular forms is rarely harmful. Acute mercury poison.ng due to topical mercurials is very rare. This case was a such patient who showed the mercury poisoning can result from the percutaneous absorption of topically applied mercury. The patient was an 11 year-old schoolboy with scabies. Three days after topical applications on the whole body with the mixture of rneta,lic rnercury, phosphorus and perilla oil, as prescribed by a herbal doctor, he was suffered from headache, fever, facial flushing, sore throat, a,nd stomatitis for a few days, and then followed by exfoliative dermatitis, renal and bone marrow fa'.lures. However, bone marrow failure due to mercury was very rarely described in the literatures. Virtually, the whole body was covered by thick scales on the dirty greyish pigmented or erytheinatoas Cohfluent payules. It whs oozing on the external genital area, and all nails were spontaneously extracted. Tbe findings of renal failures included puffy face, ascites, BUN 92. 8 mg/dl, serum creatinine 7. 3 mg/dl. creat.nine clearance 12rnl/min., proteinuria, rnicro and gross hematuria, and non or poor visualizations of IVP. The peak in severity was at about 50 days after onset and bacame normal except mild proteinuria at about 70 days after onset. The findings of aplastic anemia were shown by pancytopenia(Hb 7. 6g/dl, WBC 1, 700, seg. neutro. 18%, lympho. 40% mono. 26%, eosino. 16%, Hct25%, thrombocytes 40, 000, RBC 3, 000, 000, reticulocytes 0. 1%) and about 20 per cent of the cellularity in bone marrow aspiration from about 70 to 90 days after onset. In fact, the aplastic anemia was coincided with nasal bleeding, staphylococcal septisema, and staphylococcal pustulation at the site of IM injection. However, the levels of onset 80 day-urine and blood rnercury were high: 208 ug/1. (norm.alless than 100 ug/l)in urine, and 126. 3 ug/100g (normal less than 5 ug/100g) in blood.
Anemia, Aplastic ; Ascites ; Blood Platelets ; Bone Marrow* ; Child ; Creatinine ; Dermatitis, Exfoliative* ; Eating ; Epistaxis ; Fever ; Flushing ; Headache ; Hematuria ; Humans ; Inhalation ; Korea ; Mercury Poisoning ; Perilla ; Pharyngitis ; Phosphorus ; Proteinuria ; Renal Insufficiency ; Reticulocytes ; Salts ; Scabies ; Skin Absorption ; Stomatitis ; Weights and Measures

A22-year-old male patient presented with typical features of pachydermoperiostosis. Thickening and oiliness of the facial skin, clubbing of the fingers, and hyperhidrosis of the palms and soles were the most prominent features. Osteosclerosis and hypertrophic osteoarthropathy were present in the bones of the hands, feet and tibia. We administered isotretinoin with the rationale that the drug inhibits sebum and collagen production. The patient was quite satisfied with the reduction of facial oiliness.
Adult ; Case Report ; Clinical Trials ; Human ; Isotretinoin/*therapeutic use ; Male ; Osteoarthropathy, Primary Hypertrophic/diagnosis/*drug therapy