BACKGROUND: PUVA has been used effectively in the treatment of vitiligo, but the mechanism by which PUVA stimulates melanocyte proliferation in vitiligo is not known. Several mechanisms have been suggested to be involved in the process of repigmentation of vitiligo. First, UV light, with or without psoralen, directly stimulates the proliferation of melanocytes. Secondly, PUVA may act. on epidermal keratinocytes or dermal components to stimulate t,hem to release certain melanocyte growth st,inulation factors that enhance the proliferation of melanocytes in depigmented lesions. Thirdly, PUVA irnmunologically leads to the impairment of epidermal Langerhans cell function and alteration of circulating T and B cell function, which results in the suppression of the stimuli is for rnelanocyte destruction during the therapy. OBJECTIVE: To test, th hypothesis that PUVA induced repigmentation in vitiligo results from the stimulation of growth factors that induce melanocyte proliferation, and that PUVA may suppress the immune reacticin to melanocytes, especially in autoantibody synt,hesis, we examined the effects of sera on the growth of epidermal melanocytes and control cells, and the incidence of antibodies to melanocyte and melanoma cells(SK-Mel 2~3) in the sera of patients with vitiligo. We also had normal control individuals and studied the changes of the antibody titer in the sera of patients with vitiligo. METHODS: The rate of H thymidine uptake was estimat,ed in cultured melanocytes and fibroblasts t,reated by patients sera before and after PUVA treatment. SDS-PAGE and immunoblotting analysis were used to idcntify anti pigment cell autoantibodies and were compared to the titers of autoantibodies after PUVA. RESULTS: 1. Melanocyte and fibrablast proliferation was increased by PUVA treated sera. Their proliferation was in proportion to the duration of the PUVA treatment. Melanocytes proliferated more than fibroblasts. 2. Significant differences between vitiligo patients and normal controls were found in the inci dence of anti-pigment cell antibodies. The antibodies were predominantly directed to melanocyte antigens of 110 kD, 65 kD, 45 kD and melanoma cell antigens of 110 kD, 103 kD, 88kD, 70 kD, 56 kD, 41 kD. 3. The titer of anti piment cell antibodies showed a tendency to decrease after PUVA treat- ment in most patients regardless of clinical improvement. Conclusion ; PUVA treated sera induced proliferation of melanocytes and fibroblasts and the production of aut,oantibodies was suppressed against pigment cell antigens through irnmunosuppression, which might help in the repigmentation of vitiligo.
Antibodies ; Autoantibodies ; Candida* ; Classification* ; DNA* ; Electrophoresis, Polyacrylamide Gel ; Fibroblasts ; Ficusin ; Humans ; Immunoblotting ; Incidence ; Intercellular Signaling Peptides and Proteins ; Keratinocytes ; Melanocytes ; Melanoma ; Thymidine ; Ultraviolet Rays ; Vitiligo

BACKGROUND: PUVA has been used effectively in the treatment of vitiligo, but the mechanism by which PUVA stimulates melanocyte proliferation in vitiligo is not known. Several mechanisms have been suggested to be involved in the process of repigmentation of vitiligo. First, UV light, with or without psoralen, directly stimulates the proliferation of melanocytes. Secondly, PUVA may act. on epidermal keratinocytes or dermal components to stimulate t,hem to release certain melanocyte growth st,inulation factors that enhance the proliferation of melanocytes in depigmented lesions. Thirdly, PUVA irnmunologically leads to the impairment of epidermal Langerhans cell function and alteration of circulating T and B cell function, which results in the suppression of the stimuli is for rnelanocyte destruction during the therapy. OBJECTIVE: To test, th hypothesis that PUVA induced repigmentation in vitiligo results from the stimulation of growth factors that induce melanocyte proliferation, and that PUVA may suppress the immune reacticin to melanocytes, especially in autoantibody synt,hesis, we examined the effects of sera on the growth of epidermal melanocytes and control cells, and the incidence of antibodies to melanocyte and melanoma cells(SK-Mel 2~3) in the sera of patients with vitiligo. We also had normal control individuals and studied the changes of the antibody titer in the sera of patients with vitiligo. METHODS: The rate of H thymidine uptake was estimat,ed in cultured melanocytes and fibroblasts t,reated by patients sera before and after PUVA treatment. SDS-PAGE and immunoblotting analysis were used to idcntify anti pigment cell autoantibodies and were compared to the titers of autoantibodies after PUVA. RESULTS: 1. Melanocyte and fibrablast proliferation was increased by PUVA treated sera. Their proliferation was in proportion to the duration of the PUVA treatment. Melanocytes proliferated more than fibroblasts. 2. Significant differences between vitiligo patients and normal controls were found in the inci dence of anti-pigment cell antibodies. The antibodies were predominantly directed to melanocyte antigens of 110 kD, 65 kD, 45 kD and melanoma cell antigens of 110 kD, 103 kD, 88kD, 70 kD, 56 kD, 41 kD. 3. The titer of anti piment cell antibodies showed a tendency to decrease after PUVA treat- ment in most patients regardless of clinical improvement. Conclusion ; PUVA treated sera induced proliferation of melanocytes and fibroblasts and the production of aut,oantibodies was suppressed against pigment cell antigens through irnmunosuppression, which might help in the repigmentation of vitiligo.
Antibodies ; Autoantibodies ; Candida* ; Classification* ; DNA* ; Electrophoresis, Polyacrylamide Gel ; Fibroblasts ; Ficusin ; Humans ; Immunoblotting ; Incidence ; Intercellular Signaling Peptides and Proteins ; Keratinocytes ; Melanocytes ; Melanoma ; Thymidine ; Ultraviolet Rays ; Vitiligo

No abstract available.
Hyperthyroidism*

We report a case of type IV hyperlipoproteinemia associated with xanthoma tuberosum and diabets mellitus in a 48 year old female patient. She had several yellowish-brown papules on the knees and palms. The blood glucose level was elevated and serum lipid and lipoprotein analysis revealed patterns of type IV hyperlipoproteinemia. Histopathologic findings of yellowish-brown papules on the knee showed the aggregation of foam cells in the dermis. She has been treated with diet control and hypolipidemic drug(lovastatin and procetofen) and is under our continuing supervision.
Blood Glucose ; Dermis ; Diabetes Mellitus* ; Diet ; Female ; Foam Cells ; Humans ; Hyperlipoproteinemia Type IV* ; Knee ; Lipoproteins ; Middle Aged ; Organization and Administration ; Xanthomatosis*

Using audiometric test data, noise exposed workers were followed up to assess the activities for hearing conservation from 1989 to 1992. The subjects of study were 71 workers who could be followed up at least two years during this follow-up period. In all subjects, increasing trend of hearing threshold levels (HTLs) was observed after three years of follow-up at all testing frequencies in audiometry and this increase was statistically significant at 8KHz(p<0.05). Also, HTLs increased significantly(p<0.05) in the workers who complained tinnitus(at 0.25, 8KHz), who ws below 90 dB (at 8KHz). Effectiveness of the activities for hearing conservation, assessed by sequential test-retest comparisons, was lower in the workers who complained tinnitus, who had past history of ear disease, and whose workplace noise level was below 90 dB. These findings suggest that the activities for hearing conservation at workplace may have been unsatisfactory until now and more stringent measures may be necessary, especially in the workers who complain tinnitus, who have past history of ear disease, and whose workplace noise level is below 90dB.
Audiometry ; Ear Diseases ; Follow-Up Studies ; Hearing* ; Noise ; Tinnitus

We report a case of subungual solitary glomus tumor in a 28-year-old female, who has suffered from pain and tenderness of the left 4th finger tip for about 5 years. Simple surgical excision was performed for removal of the tumor mass and for the relief of the subjective symptoms. No recurrence has been observed for 5 months following excision of the tumor.
Adult ; Female ; Fingers ; Glomus Tumor* ; Humans ; Recurrence

PURPOSE: In general, the amount of vertical rectus surgery is based on achieving 3 prism diopters (PD) of realignment for each millimeter of muscle recession. The study aimed to determine the surgical correction of vertical deviation in patients with hypertropia after superior rectus muscle recession. METHODS: A total of 32 patients with hypertropia underwent 2-8 mm recession of the superior rectus muscle. The average surgical correction for each millimeter of recession was calculated by deducting the post-surgical deviation from the pre-surgical vertical deviation and dividing the remnant by the amount of recession (mm). RESULTS: The average surgical correction was 2.2 +/- 0.7 PD for each millimeter of superior rectus recession. There was no statistical significance in the change in surgical correction in terms of follow-up period, which was categorized as one day, one, two, and six months, and one year (P>0.05). The relationship between surgical correction and age (below and above 11 years old), gender or the amount of recession (below or above 5 mm) was not statistically significant (P>0.05). There was no statistically significant difference in vertical correction between esodeviation and exodeviation (P>0.05). CONCLUSIONS: The study showed an average surgical correction of vertical deviation of 2.2 PD for each millimeter of superior rectus muscle recession. The results suggest that increased recession, within the maximum limit of 8 mm, is an effective approach to prevent undercorrection for children who have hypertropia but cannot undergo adjustable strabismus surgery.
Child ; Esotropia ; Exotropia ; Follow-Up Studies ; Humans ; Strabismus*

Primary hyperparathyroidism is a rare endocrine disease in children. It involves bone and joint, urinary tract, gastrointestinal tract and cardiovascular system. The main cause of these involvement is high level of PTH in serum, resulting in hypercalcemia.An 11 years old male patient who had complained of limping gait since last 18 months, showed typical laboratory and radiological findings of primary hyperparathyroidism. At the ultrasonography, computed tomography and radionuclide scanning, a well defined mass(10 X 15mm) was found on the posterior aspect of the right thyroid lobe. The mass was confirmed histologically as adenoma of parathyroid gland. The patient was successfully treated with subtotal parathyroidectomy and temporal administration of calcium and vitamin D.We report this case of primary hyperparathyroidism with brief review of the literatures.
Adenoma ; Calcium ; Cardiovascular System ; Child ; Endocrine System Diseases ; Gait ; Gastrointestinal Tract ; Humans ; Hyperparathyroidism, Primary ; Joints ; Male ; Parathyroid Glands ; Parathyroidectomy ; Thyroid Gland ; Ultrasonography ; Urinary Tract ; Vitamins

PURPOSE: We report an example of successful operation of rare convergent strabismus fixus, which had previously been mistaken for orbital tumor in private clinics because of severe adduction with unseen cornea. METHODS: A 57-year-old woman had convergent strabismus fixus with inward deviation of the left eye that had gradually progressed since she was around 40. Her cornea was buried in the intraorbital rim. An eye movement examination revealed that the eyeball was fixed to the internal part and that eyeball movement was impossible in all directions. When the forced duction test was performed, strong resistance was shown in all directions when abducted. During surgery, the medial rectus muscle was disinserted after resection of 3.0 mm for the left eye, and lateral rectus muscle tucking of 11.0 mm for the left eye was conducted. Since there was resistance in the inferior oblique muscle by the forced duction test during the operation, inferior oblique muscle myectomy of 4.0 mm was simultaneously performed. RESULTS: In the forced duction test implemented immediately after the operation, resistance subsided considerably and eye movement was shown in all directions, with cosmetically satisfactory results. Optic atrophy was found in the fundus examination after the operation. CONCLUSIONS: Convergent strabismus fixus, which recurs frequently and causes severe limitation of eye movement, was changed from the primary position to orthophoria by medial rectus muscle resection with disinsertion and lateral rectus muscle tucking. The eye movement disorder was improved and a satisfactory result was obtained.
Cornea* ; Esotropia* ; Eye Movements ; Female ; Humans ; Middle Aged ; Ocular Motility Disorders ; Optic Atrophy ; Orbit

PURPOSE: The authors report their experience with four cases of paralytic exotropia from a pit viper snakebite, accompanied with a literature review. METHODS: Four patients (two males and two females) visited the emergency room in the hospital with symptoms including diplopia, limitation of eye movement, exotropia, and blepharoptosis, after being bitten by a presumed pit viper, and were treated by antivenom. RESULTS: No visual disturbance was observed in the first examination, while limitation of adduction was found in four cases in the ocular movement test. As to the type of tropia, three patients showed intermittent exotropia and the other showed exotropia. The angle of strabismus in the distance was 20~30 prism diopters (PD) while that in the near was 18~35 PD. Two cases were accompanied with blepharoptosis. Except one case which was unavailable for follow-up observation, three cases became normal in diplopia, blepharoptosis, and limitation of ocular movement between the 4th and 11th day after the snakebite. CONCLUSIONS: Neurotoxicity induced by a pit viper snakebite is rare. However, neurotoxicity including strabismus and blepharoptosis can occur because extraocular muscles have a higher ratio of nerve fibers to the extraocular muscle fibers compared with skeletal muscles.
Blepharoptosis ; Diplopia ; Emergency Service, Hospital ; Exotropia* ; Eye Movements ; Follow-Up Studies ; Humans ; Male ; Muscle, Skeletal ; Muscles ; Nerve Fibers ; Snake Bites* ; Strabismus