The clinical and histopathologic study of 26 cases with tsutsugamushi disease seen at the Department of Derrnatology, Kosin Medical Center, Pusan, Korea from October 1986 to December 1988 was performed. The results were summarized as follows : 1. Age distribution was from 12 to 73 years and male to female ratio was 1: 1.2 (1P, males 14 females). 2. The disease occurred from September to December in a year. The peak incidence was in October (61.5%). 3. Major clinical manifestations were as follows : Chill, fever and headache (100 %), maculopapular eruption (90.2%), eschar (88.5%) and myalgia (84.6%). 4. Eschars were distributed on the abdomen (34.8%), chest (30.4%), leg (7.4%) and ot.her sites. 5. Histopathologic findings of the erythernatous macules in 24 patients showed epiderrnal changes including exocytosis of rnononuclear cells (66.7%), liquefaction degeneration of basal cells (54.2%), spongiosis (33.3%) and epidermal cell necrosis (29.2%). Dermal changes revealed vascular dilatation and perivascular infiltration of rnononuclear cells (100%), extravasated RBC (50%), and edema of papillary dermis (45.8%). Epidermal changes around the eschar were liquefaction degeneration of basal cells (52.2%), spongiosis (43.5%) and exocytosis of mononuclear cells (30.4%). Dermal changes included vascular dilatation and perivascular mononuclear cell infiltration (100%), vessel wall necrosis (73.9%), ederna of papillary dermis (65.2%) and endothelial cell swelling (65.2%).
Abdomen ; Age Distribution ; Busan ; Dermis ; Dilatation ; Edema ; Endothelial Cells ; Exocytosis ; Female ; Fever ; Headache ; Humans ; Incidence ; Korea ; Leg ; Male ; Myalgia ; Necrosis ; Scrub Typhus* ; Thorax

The authors experienced a case of secondary glaucoma combined with mesodermal dysgenesis of anterior segment, which disclosed extensive peripheral iridocorneal adhesion of congenital origin while his fellow eye revealed a sclerocornea. This case is extremely rare and entirely different from the previously reported Axenfeld's and Rieger's anomalies. We report this interesting case with brief review of the literatures.
Glaucoma* ; Mesoderm*

A 47-year-old male patient presented us with erythematous, telangiectatic, purpuric or hyperpigmented patqhes, recurrent painful ulceration and ivory white atrophic scars on the lower portions of his legs, ankles and dorsal surfaces of both feet exacerbating on every summer for 5 years. The histopathalogical findings of an atrophic patch showed endothelial proliforetiion, partial occlusion of the dermal capillaries and fibrinoid material) on the superficial blood vessels, This patient was treated with aspirin and dipyriclamole for 4 months, and the skin lesions were improved significantly.
Ankle ; Aspirin ; Blood Vessels ; Capillaries ; Cicatrix ; Foot ; Humans ; Leg ; Male ; Middle Aged ; Skin ; Ulcer ; Vasculitis*

Trichoepithelioma, a tumor of the hair follicle, is usually seen as multiple lesions, but occasionally appears as a single tumor. Multiple trichoepithelioma is a dominant hereditary skin conditions whereas solitary trichoepithelioma is not hereditary and is growing tumor, usually seen in adults. A case of 56 year old housewife with solitary trichoepithelioma was reported. The skin lesion appeased as a firm, skin colored papule and the size was 0.5cm in diameter on right side of nose. Shaving biopsy was done and showed a high degree of differentiation toward hair structure and horn cyst that the keratinization is abrupt and complete. The methood of treatment is a surgical excision and electrodesiccation but remain a scar due to surgical trauma. And so, we used a 5-fluorouracil ointment instead of surgical excision and electrodesiccation, The skin lesion on nose was cured completely as a result of 5-FU ointment application without any scar formation cosmetically.
Adult ; Animals ; Biopsy ; Cicatrix ; Fluorouracil* ; Hair ; Hair Follicle ; Horns ; Humans ; Middle Aged ; Nose ; Skin

The nodular vasculitis described by Montgomery on 1945 and is characterized by relatively chronic, persistent, or recurrent nodular lesions of nontuberculous origin chiefly on the legs. In the differential diagnosis the following must also be considered; erythema induratum, eythema nodosum, Weber-Christian disease, erythema nodosum migrans, recurrent thrombophrebitis and periarteritis nodosa. The authors observed one case of nodular vasculitis caused by sulfa drug. This patient was diagnosed to papulonecrotic tuberculid at first and treated by prednisolone 20 mg, INH 300 mg and streptomycin l.0 gm BIW. By the treatment, the patient, was cured completly within 3 months but visited again because of recurrence after 6 months. Therefore, same medication was given, but did not show improvment and added sulfa drug, Lederkyne. But, unfortunately the skin lesions was aggrevated after sulfa medication. It was suggestive that the cause of aggrevation was sulfa drug and discontinued the sulfa drug. The skin lesions were completely cured after the drug was discontinued.
Diagnosis, Differential ; Erythema Induratum ; Erythema Nodosum ; Humans ; Leg ; Panniculitis, Nodular Nonsuppurative ; Polyarteritis Nodosa ; Prednisolone ; Recurrence ; Skin ; Streptomycin ; Tuberculosis, Cutaneous* ; Vasculitis*

The authers observed one case of typical poikilodermatomyositis who was 47 year old female. The poikiIodermatomyositis is a rare disease which is a variant of dermatomyositis and has never been reported in Korea. This patient complained of a weakness of left lower leg and tingling sensation of both fingers since one year ago, And she has a difficulty of both finger flexion since 20 days ago. The skin lesions revealed mottled dark brownish pigmentation, hardness, scattered atrophic patches and telangiectasia in the lesion on the left lower leg since one year ago. The same skin changes appeared on the thigh, lower abdomen and upper chest on 4 months ago. Histopathologically, a biopsy was performed from the skin of lower leg, the skin shows typical poikiloderma, i.e. the epidermis shows moderate atrophy of the stratum malpighii, flattened rete ridges and hydropic degeneration of the hasal cells. The dermis is edematous and a band like dense lymphocytic cellular infiltration. And the muscIe biopsy from gastrocnemius muscle shows dermatomyositis finding which the muscle bundles are edematous and degenerative. Many inflammatory cells present between muscle bundles but there is no suppurative change. Diagnosis was confirmed by clinical appearance, histopathologically and other laboratory studies. The patient was markedly improved by the prednisolone 80 mg and vasculat (vascular dilatator) 100 mg daily.
Abdomen ; Atrophy ; Biopsy ; Bryophyta ; Dermatomyositis ; Dermis ; Diagnosis ; Epidermis ; Female ; Fingers ; Hardness ; Humans ; Korea ; Leg ; Middle Aged ; Muscle, Skeletal ; Pigmentation ; Prednisolone ; Rare Diseases ; Sensation ; Skin ; Telangiectasis ; Thigh ; Thorax

The authers observed one case of typical poikilodermatomyositis who was 47 year old female. The poikiIodermatomyositis is a rare disease which is a variant of dermatomyositis and has never been reported in Korea. This patient complained of a weakness of left lower leg and tingling sensation of both fingers since one year ago, And she has a difficulty of both finger flexion since 20 days ago. The skin lesions revealed mottled dark brownish pigmentation, hardness, scattered atrophic patches and telangiectasia in the lesion on the left lower leg since one year ago. The same skin changes appeared on the thigh, lower abdomen and upper chest on 4 months ago. Histopathologically, a biopsy was performed from the skin of lower leg, the skin shows typical poikiloderma, i.e. the epidermis shows moderate atrophy of the stratum malpighii, flattened rete ridges and hydropic degeneration of the hasal cells. The dermis is edematous and a band like dense lymphocytic cellular infiltration. And the muscIe biopsy from gastrocnemius muscle shows dermatomyositis finding which the muscle bundles are edematous and degenerative. Many inflammatory cells present between muscle bundles but there is no suppurative change. Diagnosis was confirmed by clinical appearance, histopathologically and other laboratory studies. The patient was markedly improved by the prednisolone 80 mg and vasculat (vascular dilatator) 100 mg daily.
Abdomen ; Atrophy ; Biopsy ; Bryophyta ; Dermatomyositis ; Dermis ; Diagnosis ; Epidermis ; Female ; Fingers ; Hardness ; Humans ; Korea ; Leg ; Middle Aged ; Muscle, Skeletal ; Pigmentation ; Prednisolone ; Rare Diseases ; Sensation ; Skin ; Telangiectasis ; Thigh ; Thorax

We report a case of Wells' syndrome consisting chiefly of papular, vesicular, pustular and vegetative lesions on the trunk, lower extremities and palms in a 48-year-old female, though characteristic lesions of this syndrome are known to be cellulitis or urticaria like plaques. Only a few cases with such lesions as ours have been reported until now. Histologic finding showed spongiotic vesicles in the epidermis and diffuse dense infiltration of eosinophils with characteristic flame figures in the dermis. In addition, marked blood eosinophilia was noted. We tried oral prednisolone for 3 weeks, and the skin lesions improved almost completely.
Cellulitis ; Dermis ; Eosinophilia ; Eosinophils ; Epidermis ; Female ; Humans ; Lower Extremity ; Middle Aged ; Prednisolone ; Skin ; Urticaria

Rupture of the anterior cruciate ligament is a serious injury that can cause severe degenerative change if untreated, and there are many controversies in its treatment. The authors experienced 126 patients of the anterior cruciate ligament rupture in the Department of Orthpaedic Surgery, Chung-Ang university from May 1985 to December 1992. Among them, we performed 36 anterior cruciate ligament reconstructions using bone-patellar tendon-bone autograft reinforced with Trevira ligament, an assumption that the artificial ligament acts as an internal splint during the vulnerable period of healing. Bone-patellar tendon-bone autograft was passed through the transosseous hole in the tibia, then across the knee and through the isometric path of lateral femoral condyle through a bone tunnel. Thereafter, the Trevira ligament was passed through the same tibial tunnel, but over the top route to the lateral femoral condyle. Of the 36 cases, 28patients (Group I: 15 cases of Mini-arthrotomy,Group II: 13 cases of Arthroscopic technique) with average follow up of 23.5 months (minimum 12 months, maximum 40 months) were analyzed. According to the Mullers criteria, the result were excellent in 12 cases (Group I: 5 cases; Group II: 7 cases), good in 14 cases(Group I: 9 cases ; Group II: 5 cases and fair in 2 cases (Group I: 1 case; Group II: 1 case). On stress roentgenograms by Telos arthrometer, the average difference of anterior displacement between the injured and normal sides were decreased to 2.3mm from average 9.1mm preoperatively (Group I: from 9.3mm to 2.6mm; Group II: from 8.8mm to 2.1mm). And subjectively, there was no difference between the injured and normal sides in 8 cases (Group I: 4 cases, Gruop II: 4 cases).
Anterior Cruciate Ligament ; Autografts ; Follow-Up Studies ; Humans ; Knee ; Ligaments ; Patellar Ligament ; Rupture ; Splints ; Tibia

BACKGROUND: Vitiligo is an acquired disorder with destruction of melanocytes and is clinically characterized by depigmented patches of skin. The pathogenesis of vitiligo is still unclear, but melanocyte self destruction, neurohumoral factors, autoimmunity and inherent cellular defects have all been proposed as possible etiological factors. OBJECTIVE: The purpose of this study was to find out the differences in expression of HLA antigens among subtypes of vitiligo according to classification, onset and family history and then to disclose the pathogenesis of vitiligo in view of genetic and autoimmunological aspects. METHODS: We investigated HLA-A, B, C, DR in subgroups of 87 vitiligo patients according to type, onset, and family history. Results : 1. There were no HLA antigens with significantly increased frequency in vitiligo patients compared to the control group. 2. There was a significant increase in frequency of HLA-DRl2 in patients of non-segmental vitiligo with a family history ; an increase in frequency of HLA Cw2 in patients without a family history ; and a significant increase in frequency of HLA-DRl2 in all patients of non-segmental vitiligo compared to the control group.(p(c)<0.05). 3. The frequency of HLA-B63 was significantly increased in all patients of segmental vitiligo compared to the control group(p(c)<0.05), but there were no HLA antigens with significantly increased frequency in patients of subgroups of segmental vitiligo divided by the presence or absence of a family history of vitiligo. 4. The frequency of HLA-B54 was significantly increased in all vitiligo patients with a family history(p(c)0.05) but there were no HLA antigens with significantly increased frequency in all vitiligo patients without a family history. 5. There were no HLA antigens with significantly increased frequency in vitiligo patients subgrouped by age of onset (less or over 16 years) of disease. Conclusion : From the above results, we can assume that non-segmental vitiligo may have autoimmune mechanisms in the pathogenesis, as there was a significant increase in HLA-DRl2 in patients with non-segmental vitiligo.
Age of Onset ; Autoimmunity ; Classification ; HLA Antigens* ; HLA-A Antigens ; Humans ; Melanocytes ; Skin ; Vitiligo*