The authors evaluated the results of various operative methods for the treatment of axillary osmidrosis in 256 axillae of 132 patients. The methods studied herein are elliptical excision with(without Z-plasty, excision by modified W-plasty, undercutting of apocrine glands with preserving deep dermal vascular plexus (DDP) designed by the authors, undercutting of apocrine glands with ignoring deep dermal vascular plexus. With the undercutting methods, the skin incision was made by three different ways ', single vertical line, double vertical lines or single horizontal line in respect to the long axis of axillary vault. The results were as follows: 1. In the undercutting methods the stitch removals were done earlier than those of the excision methods by 3 to 8 days. The earliest stitch removal was in the undercutting methods with preservation of DDP done by single vertical incision (UPS). 2. Operative complications (wound disruption, flap necrosis or hematoma) occured in 12.9%. The wound disruption was main complication in the excision methods, the hematoma and flap necrosis in the undercutting methods. In the undercutting methods flap necrosis was seen only when DDP was ignored. 3. 123 axillae were followed up for more than 6 months after the operations. Among these the widely extended scars were seen in 94% of simple elliptical excisions(31 cases) and in 100% of excision with Z-plasty(16 cases) or modified W-plasty(3 cases). In the undercutting methods the scars were linear or invisible and best in UPS. 4. Success rate for the eradication of the malodor showed somewhat better results with undercutting methods compared with excisionmethods, but there was no statistical differences between the different groups. 5. In 6 axillae with the undercutting methods, histological examinations were done after more than three months. Apocrine glands were not seen in all the specimens. But some of them showed eccrine glands.
Apocrine Glands ; Axilla ; Axis, Cervical Vertebra ; Cicatrix ; Eccrine Glands ; Hematoma ; Humans ; Necrosis ; Skin ; Wounds and Injuries

In dermatologic practice, acute urticaria showing leukocytosis and fever suggesting syatemic bacterial infection is often observed. The clinician in dealing with such patients is tempted to use antibiotics in addition to corticosteroids and antihistamines before the patient can be sure that there is no bacterial infection. Authors observed the degree of the leukocytosis with its differential counts in 106 cases of acute urticaria to evaluate what percentages of acute urticaria patients are showing similar data with the changes seen in leukocyte counts of patients of erysipelas, and evaluated the effect of aqtibiotics-administered group with non-administered group of acute urticaria patients. The results were as follows: 1. In 106 acute urticaria patients, 42% showed higher total leukocyte count ( >12, 500/cu mm) than the mean total leukocytes of 20 erysipelas patients(12, 412/cu mm) and 29% showed greater neutrophilia(>70%) than the mean neutrophil differential count of the erysipelas (69.1%). In the cases showing both leukocytosis (>12,500/cu mm) and fever (>37. 5C) there was no difference in the course of treatment between the antibiotics-administered group and non-administered group. 3. The corticosteroid hormone reduced the total WBC count toward normal level generally within a week.
Adrenal Cortex Hormones ; Anti-Bacterial Agents ; Bacterial Infections ; Erysipelas ; Fever ; Histamine Antagonists ; Humans ; Leukocyte Count ; Leukocytes* ; Leukocytosis ; Neutrophils ; Urticaria*

Two cases of neurofibrossrcoma involving cutaneous tissues of the patients with multiple neurofibromatosis were presented. One case, 49-year-old man, showed highly malignant histopathological feature with lethal outcome and the other case, 56-year-old man, showed less malignant histopathology with good recovery from local excision.
Humans ; Middle Aged ; Neurofibromatoses* ; Neurofibrosarcoma*

Sixteen cases of congenital hemangiomata were treated with intralesional corticosteroid injectinn and followed up for 3 to 48 months. They consisted of 9 cases of strawberry hemangiomata with soft consistency, 4 cases of strawbery hemangiomata with firm consistency and 3 cases of cavernous hemangiomata. The results were as follows : 1) All the soft strawberry hemangiomata showed excellent response with marked shrinkage by single treatment. 2) The firm strawberry hemangiomata showed poor response with visible shrinkage after five times treatment, in average. 3) Among three cases of cavernous hemangiomata, one case with large palpable blood vessels in the lesion showed poor response, and two cases without palpable blood vessels in the lesion showed good response. 4) Temporary atrophy and pallor of the skin color were noticed in about half of the cases. Considering the concern of the patients parents, course of the hemangiomata., and the simplicity and effects of the treatment, this therapeutic method is regarded useful in the management of congenital hemangiomata, especially in soft st r awberry hemangiomata.
Atrophy ; Blood Vessels ; Fragaria ; Humans ; Pallor ; Parents ; Skin

Observation of hair roots by simple plucking is a comnon methad in trichology. But the plucking method is subject to artificial deformation of hair roots during the procedure and the possibility of the artifact may be greater when hair roots are in pathological state. Treatment of the scalp tissue with 1 M CaC12 permits epidermodermal separation and subsecuent harve.sting of hair follicles without any damage on the structures. To make sure if the possible artificial deformation of the hair roots of plucking method could affect significantly the overall evaluation of the hairs in alopecia areata, authors compared the results of plucking method(total 171 hair roots) with the results of CaCl2 method(total l94 roots) in 15 cases of alopecia areata. The sites of taking hair roots by the two rnethocds were located side by side at the edges of the bald areas. The results were as frllows: 1. The average percentages of actual dystrophic hairs in 15 alopecia areat.a patients are 55% by plucking method and 53% by CaCl2, method, thus showing no significant difference in overall evaluation of the hair roots. 2. The shapes of proximal hair shafts obtained by plucking were similar with the shape obtained by CaCl2 method.
Alopecia Areata* ; Alopecia* ; Artifacts ; Hair Follicle ; Hair* ; Humans ; Scalp

Authors tried methyl-prednisolone pulse therapy in 12 cases of severe cases of alopecia areats(eight cases of alopecia totalis, two cases of alopecia universalis, and two cases of alopecia subtotalis) by the assumption that administration of corticosteroid by pulse method minimize its side effects and maximize its therapeutic effect. Authors followed the courses of therapeutic result of the 12 cases for at least one year after finishing t.he treatment. The results were as follows : 1. The overall evaluation of the treatment showed four cases with excellent response, one case with good response, one case with disappointed response and six cases with no response. 2. The responses of the therapy appeared to be dependent on the duration of the alopecia areata ; the better the response is, the shorter the duration of the alopecia is. Most cases shorter than 6 months duration of alopecia showed excellent response. 3. Side effects of the treatment were as follows ; facial flushing(12/12), intermenstrual spotting(4/7), weight gain(4/12), moon face(3/12), acneiform eruption(1/12), exacerbation of hypertension (1/12). Those side effects did not keep any patient from the planned treatment.
Alopecia Areata ; Alopecia* ; Humans ; Hypertension ; Prednisolone*

Secondary soft tissue injuries can occur from the pressure of the displaced fragment of posterior calcaneal tuberosity in calcaneal tongue-type fractures and calcaneal tuberosity avulsion fractures. The soft tissue injury can be prevented by immediate reduction of the displaced fragments. Various techniques can be used to fix the fracture fragments, but the stability of fixation and minimal invasiveness to soft tissue should be considered. This paper reports the successful outcomes of patients with soft tissue compromises in calcaneal tongue-type fractures and calcaneal tuberosity avulsion fractures. The fixation technique of a large cannulated screw and simple cerclage wiring is believed to be a useful surgical option for the treatment of secondary soft tissue compromised calcaneal fractures.
Bone Screws ; Bone Wires ; Calcaneus* ; Humans ; Soft Tissue Injuries

Chronic recurrent peroneal dislocation often responds poorly to conservative treatment. Surgical treatment has been reported to be more effective than conservative treatment, and various surgical treatment methods are available: superior peroneal retinaculum repair or reattachment, peroneal groove deepening procedures, rerouting procedures, or bone block procedures. Although various treatment options have been reported, there is no consensus regarding which treatment is better. This paper proposes a distal fibular rotational plasty that can prevent recurrent peroneal dislocations and recover its function well by securing a stable peroneal tendon excursion space.

PURPOSE: To introduce reliable and newly developed radiographic measures based on a lateral ankle radiograph to assess a syndesmotic reduction after screw fixation and to compare with the radiographic measures based on the anteroposterior (AP) and mortise radiographs. MATERIALS AND METHODS: The postoperative ankle radiographs of 34 ankle fracture cases after screw fixation for concurrent syndesmosis injury were reviewed. Two radiographic parameters were measured on each AP and mortise radiograph; tibiofibular clear space (TFCS) and tibiofibular overlap (TFO). Five radiographic parameters were measured on the true lateral radiographs; the anteroposterior tibiofibular (APTF) ratio, anterior tibiofibular ratio (ATFR), posterior tibiofibular ratio (PTFR), distances of intersection of the anterior fibular border and the tibial plafond to anterior cortex of the tibia (AA′), and the intersection of posterior fibular border and tibial plafond to the tip of the posterior malleolus (BB′). In addition, the distance (XP) between the fibular posterior margin (X) crossing tibial plafond or the posterior malleolus and posterior articular margin (P) of the tibial plafond was measured on the lateral view. RESULTS: Using TFCS and TFO in the AP and mortise radiographs, malreductions of syndesmosis were estimated in 17 of 34 cases (50.0%). Using the introduced and developed radiographic measures in the lateral radiographs, syndesmotic malreductions were estimated in 16 out of 34 cases (47.1%). Seventeen cases (50.0%) showed no evidence of postoperative diastasis using the radiographic criteria on the AP and mortise view, 10 cases (58.8%) of whom showed evidence of a malreduction on the lateral radiograph. The newly developed measurements, XP, were measured 0 in 11 out of 34 cases (32.4%). CONCLUSION: The reduction of syndemosis after screw fixation can be accurately assessed intraoperatively with a combination of several reliable radiographic measurements of the lateral radiograph and traditional radiographic measurements of the AP and mortise radiograph.
Ankle Fractures ; Ankle Joint ; Ankle* ; Diagnosis ; Tibia

The cavus foot is a deformity characterized by an elevated medial longitudinal arch and a hindfoot varus with plantarflexed 1st ray. The etiology of cavus foot is usually related to neuromuscular disease or idiopathic cause. Thorough clinical and radiographic evaluation is required for differentiating etiology of the cavus. Most cases of cavus foot are stable and slowly progressive deformities which can initially be managed with conservative treatment including orthoses and physical therapies. Determining whether the deformity is flexible or rigid, the apex of the deformity and any muscle imbalances in foot and ankle is important for achievement of an adequately balanced plantigrade foot. Treatment should include systematic preoperative planning for selection of appropriate procedures for maintaining a functional and flexible foot with combinations of soft-tissue release, osteotomy, tendon transfer, and arthrodesis.
Ankle ; Arthrodesis ; Congenital Abnormalities ; Diagnosis* ; Foot Deformities ; Foot* ; Neuromuscular Diseases ; Orthotic Devices ; Osteotomy ; Tendon Transfer