We describe five patiens with autoimmune bullous der matosis who presented cutaneous lesions localized on the face. In these patients iuumunopathologically confirmed diagnoses were penphigus erythematosus, bullous pemphigoid, cicatricial pernphigoid(Brunsting-Perry variant), epidemic lysis bullosa acquisita and bullous systemic lupus erythematosus in each. Except, for the case of pemphigus erythematosus, facelimited cutnious lesions can be seen rarely with these imrnunobullous diseases. We suggest that some external, in malfactors such as UV light and photosensitivity might be regarded as the precipitating factors fo the clinical rnanifestations of those skin lesions, and which should be included in the differential diingosis of vesiculobullous diseases involving the face.
Diagnosis ; Humans ; Lupus Erythematosus, Systemic ; Pemphigoid, Bullous ; Pemphigus ; Precipitating Factors ; Skin ; Ultraviolet Rays

BACKGROUND: In autoimmune bullous dermatoses, such as pemphigus and bullous pemphigoid, variations in the expression of the antigen in different body locations are recognized. OBJECTIVE: The degree of expession of epidermolysis bullosa acquisita (EBA) antigen in different sites on the body surface was estimated from the highest dilution factor of EBA sera that gave a positive reaction at a site by indirect immunofluorescence (IF). METHODS: Two sera, obtained from EBA patients with inflammatory and mechanobullous skin lesions, having antihody titers of 160 against the dermal component of the NaCl split skin, were used by indirect IF techniques with 20 specimens (2 from each of 10 locations) of normal human skin from different sites. These 20 skin samples were obtained from 10 healthy adults (1-3 from each individual). RESULTS: The greatest expression of the antigen was in the skin taken from the upper back with the titer of 160. EBA antigen was least recognized in skin specimens from the inner thigh and calf. Skin from the scalp, abdomen, and anterior chest and others demonstrated intermediate degrees of expression. CONCLUSION: There was some moderate degree of variation in the expression of EBA antigens in skin samples obtained from different locations on the body. It seems however that there is not any positive correlation between the degree of expression of EBA antigen in each location and predilection sites (possibly the trunk) of clinical lesions in EBA.
Abdomen ; Adult ; Epidermolysis Bullosa Acquisita* ; Epidermolysis Bullosa* ; Fluorescent Antibody Technique, Indirect ; Humans ; Pemphigoid, Bullous ; Pemphigus ; Scalp ; Skin ; Skin Diseases, Vesiculobullous ; Thigh ; Thorax

The acute anterior cruciate ligament injury is one of the most common ligament injury of the knee joint and there are many controversies in its treatment. Warren reported that the primary repair for the acute anterior cruciate ligament injuries was good, but some had opposite oppinions. Authors studied 23 patients of actue anterior cruciate ligament injury who were treated by primary repair from January, 1982 to December, 1984. The results were as followings: 1. The most common associated injury was MCL injury and posteromedial capsular injury(13 cases; 56.5%). 2. The most common detachment site of ACL was femoral attachment(11 cases; 47.8%) . 3. A medial Hocky Stick incision was found good in repairing the combined MCL and posteromedial capsular tear with ACL injury. 4. The results were good in 74% by Cincinnati score and in 87% by objective score. It is concluded that primary repair of the acute anterior cruciate ligament tear is cosidered successful.
Anterior Cruciate Ligament ; Humans ; Knee Joint ; Ligaments ; Tears

We report a case of classic Kaposis sarcoma(KS) in a 74-year-old man who had asymptomatic red-dish-blue or dark-brown macules, papules and nodules on his bo hower extrimities. The biopsy specimen showed typical histopathologic features of FS including a highly vascularized lesion with a proliferation of spindle-shaped cells accompanied by etravasated erythrocytes and variable number of inflammatery cells. Many of the spindle-shaped cells associated with the proliferating vessels in KS lesion expressed factor VIII-related antigen. He was treated with 1500 cGy of radiation(300 cGy per day for 5 successive day. Four weeks after radiotherpy, gross and histopathologic findings were mucl improved and healed leaving hyperpigmentation.
Aged ; Biopsy ; Erythrocytes ; Humans ; Hyperpigmentation ; Radiotherapy* ; Sarcoma* ; von Willebrand Factor

BACKGROUND: Alteration of a wide variety of cellular oncogerms have now been implieated in the causation of many human cancers. However, genetic studies have indicated that an abnormality of a single gene is usually insufficient to elicit the fug transformed phenotype and that two or more genetic leaions may be necessary for this to occur. OBJECT: The purpose of this study is to examine the possibity of oncogene interaction which might be involved in the pathogenesis of human skin tugois. METHODS: The expression of the epidermal growth factor rattor(EGFR), c-jun protein, c-fos protein and p53 protein was assessed in frozen and corresgoAhng paraffin-embedded sections of 37 separate skin lesions (6 actinic keratoses, 6 squamo is ell carcinomas and 25 basal cell carcinomas using immunohistochemistry. RESULTS: Substantial number of the p53 positive cases were negative for c-fos, in contrast to normal tissue, which was p53 negative and c-fos positive. The negative correlation between p53 and c-fos staining was statistically significant(P<0.005). CONCLUSION: Although p53 appeared to have lost its normal role of regulatory early S phase protein in some lesions, in others high levels of p53 were assocated with underexpression of c-fos, reflecting the diversity of c-fos oncogene and the possible down regulation of c-fos expression by high levels of p53 protein.
Carcinoma, Basal Cell ; Down-Regulation ; Epidermal Growth Factor ; Humans ; Immunohistochemistry ; Keratosis, Actinic ; Oncogenes* ; Phenotype ; S Phase ; Skin*

Interlocking medullary nails have been widely used in the treatment of long bone fractures especially in tibia and femur. But with increasing use of nails, many preoperative, intra-operative and post-operative complications have been reported. We have experienced 3 cases of very rare complication, fracture of tibia shaft which occurred during removal of interlocking medullary nail after complete healing of original tibial fracture. We report these rare complications with literature review.
Femur ; Fractures, Bone ; Tibia* ; Tibial Fractures

In orthopedic practice, patients sometimes ask certain kinds of medical documents certifying their disability grading. But many orthopedic surgeons are not accustomed to issue such medical certificates. So we want to review the way of evaluation and grading of disabilities for such different kinds of medical certificates(for examples: disability grading certificate for use in traffic accident, industrial accident, liability of national compensation, private insurance, the handicapped, military service and others) and compare the differences between them.
Accidents, Occupational ; Accidents, Traffic ; Compensation and Redress ; Disability Evaluation ; Disabled Persons ; Humans ; Insurance ; Military Personnel ; Orthopedics*

70 cases free fiap were performed from March 1978 to July 1985. The donor fiap were dorsalis pedis flap in 34 cases, groin flap in 8 cases, osteocutaeous flap in 3 cases, gracilis flap in 17 cases, and latissimus dorsi flap in 8 cases respectively. The success rate was 90% in total including partial success. The causes of failure were 2 cases infection necrosis, and 1 case kinking of drain vessel. The gracilis and latissimus dorsi myocutaneous flap were very satisfactory method for the reconstruction of the upper extremity flexion power, especially in the case of Volkmann's ischemic contracture. The neurovascular dorsalis pedis flap was regarded as excellent method for the heel pad reconstruction, and tactile sensation reconstruction of the hand.
Free Tissue Flaps ; Groin ; Hand ; Heel ; Humans ; Ischemic Contracture ; Methods ; Microsurgery ; Myocutaneous Flap ; Necrosis ; Sensation ; Superficial Back Muscles ; Tissue Donors ; Upper Extremity

We describe a case of morphea which presented further typical lesions of the disease at the sites of mechanical trauma. It can be suggested that cutaneous lesions of morphea may be locally developed due to physical stimuli as an isomorphic response in patients or subclinical cases of the disease.
Case Report ; Female ; Human ; Middle Age ; Scleroderma, Circumscribed/*etiology ; Wounds and Injuries/*complications

Autograft is frequently used to restore anatomic morphology and functional properties in bone defects. Disadvantages of the autograft are related to donor site morbidity and include the risk of wound infection, increased blood loss and additional postoperative discomfort. Allograft and xenograft, which are currently employed as the most common alternative to autografts, encounter the complications such as fracture, resorption and nonunion secondary to immunologic rejection. These volumetric and immunologic concerns with biologic implants have stimulated interest in the potential for synthetic, bioinert materials as bone graft substitutes. Hydroxyapatite (HA), a calcium phosphate ceramic, is a well known biocompatible artificial bone substitite without induction of systemic toxic and foreign body reactions. Bone conduction usually occurrs by the implanted HA but biodegradation of HA is poor and the bone formation around HA is slow. Carbonate apatite has been known as that the physicochemical properties are similar of the natural bony apatite and demonstrates no toxic reactions with better biodegradation. Carbonate apatite collagen composite was reported to show more bone formation and biodegradation than hydroxyap atite. In this study, the composite (CA-C) consisted of carbonate apatite and type I collagen was implanted in rabbit tibiae to evaluate the possibility as an artificial bone substitute. Forty HA (HA group) and forty CA-C (CA-C group) were applied in 80 dissected rabbit tibiae and fixed by external fixators. For biomechanical study, the rabbits were sacrificed and the specimens were obtained in 2, 4, 6 and 8 weeks after implantation. Tensile load was applied to the prepared tibiae in Instron and biomechanical properties were investigated. The fracture at the callus occurred as transverse or short oblique fracture in the vertical direction to the axis of applied tensile load. In each group, the tensile strength at breaking point increased significantly with time and at 4 weeks more prominent increase in break strength was observed (p<0.05). HA group showed higher mean strength before 6 weeks and at 8 weeks CA-C group higher mean strength but statistical significance could not be found. There was no significant difference in extension length at breaking point between both groups and time intervals. In summary, carbonate apatite collagen composite revealed similar biomechanical properties as hydroxyapatite, suggesting its clinical usefulness as a bone substitute, but it will be necessary to improve biodegradational property, stiffness of carbonate apatite collagen composite.
Allografts ; Autografts ; Axis, Cervical Vertebra ; Bone Conduction ; Bone Substitutes ; Bony Callus ; Calcium ; Carbon* ; Ceramics ; Collagen Type I ; Collagen* ; Durapatite* ; External Fixators ; Foreign Bodies ; Heterografts ; Humans ; Osteogenesis ; Rabbits ; Tensile Strength ; Tibia* ; Tissue Donors ; Transplants ; Wound Infection