BACKGROUND: Bullous pemphigoid is a rare autoimmune bullous disease characterized by subepidermal bulla. The serum of these patients contains detectable autoantibodies which bind to the hemidesmosome of the basement membrane zone. It is well known that there are two bullous pemphigoid antigen molecules, 230KD and 170KD protein. Serum studies in Caucasian patients show that 70-80% of the patients recognize 230KD antigen while 10-30% recognize 170KD antigen, In contrast, in herpes gestationis, which is an autommune-mediated bullous disease of pregnancy, 90% of the patients recognize 170KD and 10% recognize 230KD antigen, The autoantibody of herpes gestationis(HG factor) has a strong complement binding capacity and it may share the same epitope as the antibody of bullous pemphigoid patients which recognize 170KD antigen. OBJECTIVE: The purpose of this study was to characterize the clinical and histological manifestations of Korean patients with bullous pemphigoid and to characterize the autoantibodies of Korean bullous pemphigoid patients by immunoblotting. We also wished to compare the characteristics of the antibodies with that of American bullous pemphigoid patients, and to elucidate the hypothesis that the bullous pemphigoid autoantibody against 170KD protein has the same strong complement binding capacity as the herpes gestationis autoantibody. MEHTODS: We investigated the clinical and histological characteristics of 9 Korean patients and also performed a complement binding capacity and immunoblotting study on the sera of 9 Korean patients and 16 American patients. RESULTS: 1. Korean bullous pemphigoid patients clinically showed polymorphic skin eruption in addition to tense bullae. They frequently showed pruritic erythematous patches and urticarial plaques. Histologically, infiltration of subepidermal bullae with eosinophils, neutrophils and lymphocytes were observed in all patient's specimen, in which eosinophils were the most predominant cells, Uncommonly, eosinophilic spongiosis, vaculoar degeneration of basal cells were observed. These observations did not have any particular characteristics or racial differences compared to those patients reported in Western literature. 2. In the immunoblotting study of Korean bullous pemphigoid patients, 7 of 9 sera(785) recognized 230KD antigen and, also, 7 of 9 sera(78%)recognized 170KD antigen, In contrast, 15 of 16 American patients sera (94%) recognized 230KD antigen and 6 of 16 patients sera(38%) recognized 170KD antigen. The high incidence of the autoantibody against 170KD in Korean patients shows possible racial differences in autoantibody formation. 3. There was no relationship between the types of autoantibodies typed by immunoblotting and the complement binding capacity. In other words, autoantibodies against 170KD antigen do not carry the same potential as autoantibodies of herpes gestationis for the complement biding capacity, CONCLUSION: The above results suggest tha there may be racial difference in bullous pemphigoid autoantibodies between Korean bullous pemphigoid patients and American patients. In conclusion, We conclude that 170KD bullous pemphigoid antibodies do not always have the same strong complement binding as herpes gestationis antibody.
Antibodies ; Autoantibodies ; Basement Membrane ; Complement System Proteins* ; Eosinophils ; Female ; Hemidesmosomes ; Humans ; Immunoblotting* ; Incidence ; Lymphocytes ; Neutrophils ; Pemphigoid Gestationis ; Pemphigoid, Bullous ; Pregnancy ; Skin ; Transcutaneous Electric Nerve Stimulation

Plastic surgeons have frequently encountered wide and long skin defects which require flap coverage. These include defects that occur after radical tumor resection of the head and neck region, release of severe bum scar contracture, and defects with exposure of the bone or tendons in upper and lower extremities. Lateral thigh fasciocutaneous flap, first introduced by Baek in 1983, has a long and wide skin territory. By using this flap, we performed 6 cases of burn scar contractures and 2 cases of head and neck cancer defects. In the flap elevation, it is not necessary to change the patient's position, therefore, the two-team approach shortens the operating time. The donor site can be closed primarily if the width of flap is not over 8 cm. The donor scar of the thigh is easily concealed. The lateral thigh flap can also be used as a composite or sensate flap. We conclude that, due to the lateral thigh flap being a thin and pliale fasciocutaneous flap which has a long and wide skin territory, it is very useful for reconstruction of large skin defects.
Burns ; Cicatrix ; Contracture ; Free Tissue Flaps* ; Head ; Head and Neck Neoplasms ; Humans ; Lower Extremity ; Neck ; Skin* ; Tendons ; Thigh* ; Tissue Donors

No abstract available.
Emergencies* ; Transplantation*

No abstract available.
Kidney Transplantation*

No abstract available.

No abstract available.
Kidney Transplantation* ; Pregnancy*

No abstract available.
Female ; Humans ; Neck*

No abstract available.
Hypertension, Portal

No abstract available.
Dermatitis* ; Streptococcus pyogenes

Comminuted fracture of the acetabulum in association with dislocation of the hip has aiways been a serious injury because of its protracted convalescent period and the permanent disability. Conventional open reduction, however, has contained much technical difficulties and its end result has usually been disappointing to both the patient and the surgeon. Recent concept is that total hip replacemet can be the primary choice of treatment in the management of such complicated injuries. In contemplating THR in this occasion, however, the acetabular defect secondary to its fracture-dislocation stands out as a primary source af cup loosening atter operation. A special consideration has been given in this respect and in five clinical cases the TMR with our modification was carried out with the following results. 1. In three cases of comminuted central fracture-dislocation of the hip, the gap and deformity of the fractured acetabulum was successfully corrected by inserting two pieces of T-shaped bone graft taken from the removed femoral head. 2. In another two cases of comminuted posterior fracture-dislocation of the hip, the posterior wall defect of the acetabulum was prepared by reduction of the fragments displaced and then temporary fixation with two Steinmann pins during the operative step of cup insertion. The pins could easily be removed after setting of the bone cement. 3. By applying this new modification, the THR surgery was successful and uneventful in all five cases with smooth postoperative courses.
Acetabulum ; Arthroplasty, Replacement, Hip ; Congenital Abnormalities ; Dislocations ; Fractures, Comminuted ; Head ; Hip ; Humans ; Transplants