A case of hypertrophic lichen planus was reported and the literature reviewed. A 69-year-old widowed woman displayed generaIized discrete, multiple, round, various sized, flat-topped, hypertrophied papules and nodules on the abdomen, trunk and four extrimies for 42 years. An electron microscopic finding revealed widespread breakdown and thickening of the basal lamina at the dermo-epidermal junction and a degenerating change of the desmosomes. No particular intran uclear particles or bodies were discovered. We suggest that emotional factors and autoimmune mechanism might be the cause of the eruption in this case.
Abdomen ; Aged ; Basement Membrane ; Desmosomes ; Female ; Humans ; Lichen Planus* ; Lichens* ; Widowhood

PURPOSE: The natural history of deep vein thrombosis (DVT) has been of increasing interest since the mid-1960s. Prevention, diagnosis & management of DVT has been continously development. Howerver, Early diagnosis for prevention & effectivly choice of management method of DVT has been difficult problem. METHODS: We reviewed retrospectively 42 patients who were admitted and out patients department follow up to Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, for treatment of DVT from November, 1990 to August, 1998. RESULTS: There was a wide age distribution from teenage to 9th decade, and peak age distribution was 7th decade (23.8%). It occured more old age than younger age. Sex distribution, male to female, was about 1.2 : 1 and occured more male than female. Main chief complaint in pateints with DVT at initial our hospital visit was painful swelling (57.1%), and followed by swelling (33.3%) of lower extremity. Duration of sign and symptom in pateints with DVT at initial our hospital visit was more than 1 month (38.1%), and followed by less than 1 weeks (31.0%). The left side of lower extermities was more frequently involved than that of right side, left to right ratio was 2.1:1. Most location of involved vein of lower extremity was Popliteal vein (71.4%), and followed by Superficial femoral vein (55.4%), Calf vein (44.6%), and Common femoral vein (39.4%) in ration of 56 limbs. More frequent risk factor of DVT was major surgery (28.6%), and followed by immobility (16.7%). but most frequent risk factor was idiopathic (31.0%). Diagnosis of DVT was made with color doppler (90.5%) and venogram (57.1%). Treatment was done with intravenous or oral anticoagulants in most pateints (90.5%), Forgarty thrombectomy (7.1%), and Bypass and A.-V. fistula (2.4%) and followed by only or combined oral anticoagulants theraphy. Treatment of DVT was wide duration from less than 3 month to more than 1 years. It was done for less than 3 month (52.4%), and followed by 6 to 12 month (19.0%), 3 to 6 month (14.3%) and 14.3% were continued more than 1 years. During oral anticoagulant theraphy, GOT/GPT elevation was observed in 26.2%, and 23.8% was detected bleeding tendency (hematuria). Post-treatment response of DVT was divided three group, good (31.0%), moderated (42.9%), no response group (26.3%) in pateint complaint of before or after treatment. Most pateint were improved in 3 month. CONCLUSION: We have been thick that DVT in the lower extremity must done early diagnosis and choiced more massively intensively method of treatment and with only or combined oral anticoagulant therapy after operation was prevented for reccured and serious complication.
Age Distribution ; Anticoagulants ; Diagnosis ; Early Diagnosis ; Extremities ; Female ; Femoral Vein ; Fistula ; Follow-Up Studies ; Hemorrhage ; Humans ; Lower Extremity* ; Male ; Natural History ; Outpatients ; Popliteal Vein ; Retrospective Studies ; Risk Factors ; Sex Distribution ; Thrombectomy ; Veins ; Venous Thrombosis*

BACKGROUND: The i-gel™ (i-gel) and Laryngeal Mask Airway Supreme™ (LMA Supreme) have been safely used in children. We compared the airway performance of the i-gel and LMA Supreme in infants undergoing general anesthesia. METHODS: Sixty infants with American Society of Anesthesiologists physical status I or II were randomly assigned to place either the i-gel or the LMA Supreme. The size 1 or 1.5 of each airway was selected by the weight of infants. The primary outcome variable was oropharyngeal leak pressure (OLP). We also assessed insertion success rate, insertion time, fiberoptic view of the larynx, airway quality, airway manipulations, and perioperative complications. RESULTS: Demographic data did not differ between the two groups. Insertion success rate was similar in both groups. OLP for the i-gel (26.0 ± 3.8 cmH2O) was higher than for the LMA Supreme (23.7 ± 3.2 cmH2O) (P = 0.016). Insertion time for the i-gel (16.4 ± 2.8 s) was shorter than for the LMA Supreme (18.5 ± 2.7 s) (P = 0.002). There were no differences in fiberoptic view of the larynx, airway quality, airway manipulations, and complications between the two groups. CONCLUSIONS This study demonstrated that the i-gel and LMA Supreme provided a similar performance of airway in infants. Compared with the LMA Supreme, the i-gel provided shorter insertion time and higher OLP in infants.

BACKGROUND: The i-gel™ (i-gel) and Laryngeal Mask Airway Supreme™ (LMA Supreme) have been safely used in children. We compared the airway performance of the i-gel and LMA Supreme in infants undergoing general anesthesia. METHODS: Sixty infants with American Society of Anesthesiologists physical status I or II were randomly assigned to place either the i-gel or the LMA Supreme. The size 1 or 1.5 of each airway was selected by the weight of infants. The primary outcome variable was oropharyngeal leak pressure (OLP). We also assessed insertion success rate, insertion time, fiberoptic view of the larynx, airway quality, airway manipulations, and perioperative complications. RESULTS: Demographic data did not differ between the two groups. Insertion success rate was similar in both groups. OLP for the i-gel (26.0 ± 3.8 cmH2O) was higher than for the LMA Supreme (23.7 ± 3.2 cmH2O) (P = 0.016). Insertion time for the i-gel (16.4 ± 2.8 s) was shorter than for the LMA Supreme (18.5 ± 2.7 s) (P = 0.002). There were no differences in fiberoptic view of the larynx, airway quality, airway manipulations, and complications between the two groups. CONCLUSIONS: This study demonstrated that the i-gel and LMA Supreme provided a similar performance of airway in infants. Compared with the LMA Supreme, the i-gel provided shorter insertion time and higher OLP in infants.
Anesthesia, General ; Child ; Humans ; Infant ; Laryngeal Masks ; Larynx

PURPOSE: The aims of this study were to find the difference in frequency between genders and to determine the correlation between age-related disease and other diseases in obstructive defecation. METHODS: A consecutive series of 1,513 patients (343 males, 1,170 females) with obstructive defecation who undertook defecography and/or cinedefecography during 1 year period was analyzed. RESULTS: The causes of obstructive defecation in males showed as spastic pelvic floor syndrome (SPFS) (48.3%), rectal prolapse (RP) (31.4%), descending perineum syndrome (DPS) (25.9%), enterocele or sigmoidocele (7.6%), and rectocele (7%). However, in females, the causes were rectocele (83.8%), DPS (49.2%), RP (37.6%), SPFS (32.5 %), and enterocele or sigmoidocele (11.2%). The SPFS was negatively correlated with enterocele or sigmoidocele, DPS, RP in both genders, but SPFS had no statistical correlation with rectocele. DPS was correlated with RP in both genders and with enterocele or sigmoidocele in females, but no statistical correlation was seen in males. The size of the rectocele showed a slight correlation with age in females (r=0.102, P=0.01). Age was correlated with rectal prolapse in females; however, it showed a negative correlation with SPFS in females. CONCLUSIONS: The frequency of diseases causing obstructive defecation is different between genders. Age may not play a role in aggrevating the diseases causing obstructive defecation. Further pathophysiologic study of gender differences in patients with obstructive defecation is needed.
Defecation* ; Defecography ; Female ; Hernia ; Humans ; Male ; Muscle Spasticity ; Pelvic Floor ; Perineum ; Rectal Prolapse ; Rectocele

PURPOSE: To assess the outcome of complete anatomical repair (sphincteroplasty, rectal wall plication, rectovaginal septum plication, perineal body repair, levatoroplasty) and to identify the preoperative factors influencing the outcome for the perineal obstetric injury. METHODS: Eighteen, consecutive female patients who had undergone complete anatomical repair with chronic fecal incontinence due to perineal injury during 13 months were evaluated. Mean age was 48.9+/-10.1 years, mean duration of symptom was 18.9 (range: 1-33) years, mean delivery numbers were 2.8 +/-1.2 times, and mean follow up was 11.9 +/- 4.7 months. The predictive factors were age, manometry, PNTML (pudendal nerve terminal motor latency), rectal sensation, RAIR (rectoanal inhibitory reflex), duration of symptom, angle of sphincter defect, vaginal delivery numbers, hospital stay, follow-up period, wound healing period, and Wexner's incontinence score. RESULTS: The anatomical success rate via endoanal ultrasonography was 100%, complication rate was 5.5%, and functional success rate (Wexners' score < or =5) was 88.9%. The patients showed lower maximal resting pressure, maximal squeezing pressure, maximal voluntary contraction, mean resting pressure, mean squeezing pressure, and maximal tolerable volume than the normal control group (p<0.05). The median incontinence score was significantly decreased after surgery (pre op=12.2 vs post op=2.9) (p<0.05). Among the preoperative predictive factors, the incontinence score correlated significantly with postoperative functional success (r=0.552, P=0.017). CONCLUSIONS: Complete anatomical repair showed an excellent anatomical result and a good functional outcome. Patient with high preoperative incontinence score had a tendency for postoperative residual incontinence.
Fecal Incontinence ; Female ; Follow-Up Studies ; Humans ; Length of Stay ; Manometry ; Sensation ; Ultrasonography ; Wound Healing

No abstract available.
Dexamethasone* ; Prognosis*

OBJECTIVES: To understand the importance of the serum level of Ca-125 among pelvic mass, we performed a study. METHOD: From January to December 1998, we performed the study. Before hysterectomy, we performed a blood sampling to know the serum level of Ca-125, After hysterectomy, we weighed the uterus and measured the thickness of endometrium and other histologic characteristics. RESULTS: We performed my research to 80 peoples. The relation between uterine weight and the serum level of Ca-125 is little, if ever(R2=0.0007), and the relation between the thickness of endometrium and the serum level of Ca-125 is also little, if ever(R2=0.0353). The relation between leiomyoma, the cycle of endometrium and the serum level of Ca-125 were also little, but there was a close relationship between adenomyosis and the serum level of Ca-125. CONCLUSION: There was little relationship between uterine weight and the serum level of Ca-125.
Adenomyosis ; Endometrium ; Female ; Humans ; Hysterectomy* ; Leiomyoma ; Uterus

OBJECTIVE: Gait pattern in patients with lumbar degenerative kyphosis (LDK) is disturbed because trunk bends forward due to decreased lumbar lordosis. Surgical therapy in LDK is required when conservative management fails. We investigated kinematic and kinetic changes of the pelvis, hip, and knee joints on the sagittal plane in patients with LDK before and after operation. METHOD: Fifteen patients underwent operations between March 1999 and September 2003. Gait analysis was performed for all patients. RESULTS: Total lumbar lordotic angle increased from 10.50 degrees +/-11.22 degrees to 26.71 degrees +/-8.80 degrees postoperation. In gait analysis, anterior pelvic tilting angle increased from maximum 7.86 degrees +/-9.69 degrees, minimum 4.40 degrees +/-9.82 degrees to maximum 12.61 degrees +/-5.36 degrees, minimum 9.68 degrees +/-5.63 degrees (p<0.05). Maximum hip flexion angle changed from 31.39 degrees +/-11.71 degrees to 35.83 degrees +/-5.84 degrees (p<0.05). Maximum knee flexion angle in terminal stance phase decreased from 13.32 degrees +/-7.34 degrees to 8.30 degrees +/-6.38 degrees (p<0.05). CONCLUSION: After corrective operation, an increase of lumbar spine lordosis and anterior pelvic tilt with decrease of knee flexion were observed. However, an increase of maximum hip flexion secondary to increased anterior pelvic tilting influenced ambulation negatively. Therefore, stretching of the hip flexor and strengthening of the hip extensor are required before and after operation.
Animals ; Decompression Sickness ; Gait ; Hip ; Humans ; Knee ; Knee Joint ; Kyphosis* ; Lordosis ; Lower Extremity* ; Pelvis* ; Spine ; Walking

Non-human primate studies must be conducted prior to the clinical trial of xenotransplantation. In order to develop clinically applicable immune-modulatory regimen through non-human primate studies, close monitoring of xenogeneic immune responses is required. We adopted multiplex cytokine analysis in assessment of the immune status during the course of pig-to-non-human primate islet transplantation. This study aimed to assess the feasibility of this multiplex cytokine assay in the development of immune-modulatory regimen. Using this assay, we were able to detect different cytokines with a minimal usage of blood samples, and this allowed us to detect various immunological situations in the recipients. Detection of TNF-alpha surge (347.8 pg/mL) guided us to block TNF-alpha in the early phase of transplantation. Supportive information for in vivo efficacy of cytokine neutralizing antibody could be speculated by in vitro neutralization assay (1,250 pg/mL --> 0 pg/mL). In addition, periodic monitoring of cytokines in peripheral blood allowed the detection of the infection episode prior to other routine assays. These benefits of multiplex cytokine assay may be generally applied to other pre-clinical research, which is a prerequisite for clinical trials.
Animals ; Antibodies, Neutralizing/immunology ; Blood Cell Count ; Cytokines/*blood/immunology ; Immunoassay/*methods ; Interleukin-6/blood ; Islets of Langerhans Transplantation/*immunology ; Macaca mulatta ; Swine ; Transplantation, Heterologous ; Tumor Necrosis Factor-alpha/blood/immunology