Most common signs of human aging often include skin fold and wrinkles in the lateral canthal area. It is called "crow's feet". The accordion-like activity of the orbicularis oculi muscle during movements of facial expression accentuates this phenomenon because the muscle shortens but the skin does not. The purpose of this study is to present the classification of the crow's feet and to look for it's clinical characteristics in Koreans. The pictures of lateral view of the crows feet in 105 patients taken with digital camera are classified by their age, sex, types and degree of direction. Results show that there are three types of crows feet such as upper, lower and bidirectional types. Bidirectional type is the most common type(85%), lower directional type is 15% and upper directional type is 5%. In thirties, bidirectional type is 50% but the rate of this type increases in older groups. So in over sixties, bidirectional type is almost 100%. There are no differences between the two sexes. The degree of the direction of wrinkles increases in thirties and forties, but in fifties or over no difference was seen. In summary, this study could be helpful to decide the procedure in correction of the crow's feet.
Aging ; Classification* ; Crows ; Facial Expression ; Foot* ; Humans ; Skin

There are several surgical or non-surgical methods for osmidrosis, which have their own merits and drawbacks. Especially, recurrence and scarring of operation site are cumbersome problems. One of the limitations of each method is recurrence of osmidrosis. The authors evaluated surgical treatments of recurrent cases. The authors experienced 14 recurrent osmidrosis cases from January 1998 to December 2003. Previous methods in recurrent cases are as follows; dermal shaving with Inaba dermal shaver(3 cases), liposuction method(10 cases), non-surgical hair removal method(4 cases). The authors managed recurrent cases with radical excision in 4 recurrent cases which had severe scar with large fibrotic tissue due to previous operations, and dermal manual resection in 10 cases. We had no recurrence in our series and no complications like hematoma, seroma, infection, wound disruption or dehiscence and brachial plexus compression. In conclusion, dermal manual resection can be applied to recurrent osmidrosis cases, and radical resection is also applicable to managing recurrent cases with severe scar with large fibrotic tissue.
Brachial Plexus ; Cicatrix ; Hair Removal ; Hematoma ; Lipectomy ; Recurrence ; Seroma ; Wound Infection

Tuberculous involvement of the esophagus is very rare even in the presence of extensive pulmonary tuberculosis or in the endemic area. This is resulted from local extension to the esophagus from contiguous tuberculosis organs or miliary spread. Such secondary involvement is more common than primary tuberculosis, in which there is no evidence of tuberculosis elsewhere. The diagnosis of esophageal tuberculosis may be difficult. So the radiologic, endoscopic, histologic findings and clinical feature including the response to chemotherapy may be needed to avoid misdiagnosis. Most cases can be treated successfully with antituberculosis medication. A 67-year-old man was admitted to our hospital complaining of swallowing difficulty for 2 months. On the gastrofibroscopic examination, 22 cm sized protruding mass with central deep ulceration was discovered at the mid-esophagus. The biopsy showed the ulcer with chronic granulomatous inflammation and multinucleated giant cells consistent with tuberculosis. After antituberculosis medication, the lesion of esophageal tuberculosis was healed completely remaining minimal ulcer scar.
Aged ; Biopsy ; Cicatrix ; Deglutition ; Diagnosis ; Diagnostic Errors ; Drug Therapy ; Esophageal Neoplasms* ; Esophagus ; Giant Cells ; Humans ; Inflammation ; Tuberculosis* ; Tuberculosis, Pulmonary ; Ulcer

Blow-out fractures usually occur at the weakest point of orbital wall such as medial wall or orbital floor. The operative treatment of blow-out fracture involve restoration of intra-orbital soft tissue and bony structural integrity. The surgical reduction of medial blow-out fracture are mainly transcutaneous, transnasal and transconjunctival approaches. The conventional methods has several disadvantages, such as external scar, narrow operative field and injury of neurovascular bundle. But medial transconjunctival approach has advantages such as minimal scar, short operative time and relative safety. We experinced 26 cases of medial blow-out fracture using medial transconjunctival approach from June 2001 to May 2003. Preoperatively 21 cases showed diplopia and 14 cases showed enophthalmos. In postoperative complications, diplopia were 2 cases, enophthalmos was 1 case, anterior displacement of implant were 2 cases, conjunctival scar were 2 cases and injury of caruncle was 1 case. We report the medial transconjunctival approach that was effective treatment for medial blow-out fracture without specific complications.
Cicatrix ; Diplopia ; Enophthalmos ; Operative Time ; Orbit ; Orbital Fractures* ; Postoperative Complications

Despite an aggressive surgical debulking followed by front-line chemotherapy, most patients with advanced ovarian carcinoma die of drug-resistant disease. Drug resistance can be overcome in a subset of patients with hematologic malignancies and lymphoma with high-dose therapy (HDT) and hematopoietic stem cell transplantation, suggesting that this therapy may also be value in ovarian carcinoma. We report the successful outcome of HDT and peripheral blood stem cell transplantation (PBSCT) in a 41-year-old nulliparous woman who initially was diagnosed with advanced ovarian carcicnoma with FIGO stage IIIc. Her disease relapsed after 19 months from initial therapy of definitive surgery and intra- and post-operative chemotherapy. Subsequently, she received optimal debulking surgery and salvage chemotherapy followed by HDT with triple- alkylating regimen, composed of cyclophosphamide (100 mg/kg), thiotepa (500 mg/m2), and melphalan (100 mg/m2). Her pretranplant characteristics were platinum-sensitive and complete response state. She showed rapid hematologic recovery and mild regimen-related toxicity (Bear man's toxicity criteria), stomatitis (grade I), cardiac toxicitiy (grade II). She has been followed up for 36 months after the inital therapy and is doing well without relapse.
Adult ; Cyclophosphamide ; Drug Resistance ; Drug Therapy ; Female ; Glycogen Storage Disease Type VI ; Hematologic Neoplasms ; Hematopoietic Stem Cell Transplantation ; Humans ; Lymphoma ; Melphalan ; Ovarian Neoplasms ; Peripheral Blood Stem Cell Transplantation* ; Recurrence ; Stomatitis ; Thiotepa

PURPOSE: We tried to evaluate the clinical usefullness of fractionated low-dose infusions of peripheral blood stem cells (PBSCs) as a supportive care. MATERIALS AND METHODS: Four patients were entered onto this study who were diagnosed to have gastric lymphoma (n=1) and advanced ovarian carcinomas (n=3). To overcome the hematologic toxicities, G-CSF-mobilized PBSCs were collected early in disease course. Harvested products were cryopreserved in aliquotes and then infused after each cycle. Planned therapeutic schedules should be performed without changes of dose and interval regardless of hematologic toxicities. RESULTS: 20 cycles of chemotherapies were performed and data of infused cell doses were as follows: median number of PBSCs infusions, 4.5 (3~5); median MNCs, CFU-GM colony counts per infusion of low-dose PBSCs, 1.7 108/kg (1.0~2.4), 3.2 104/kg (2.1~11.8). Among 20 cycles, delayed recovery of thrombocytopenia was shown on 10 cycles. Leukopenia (III/IV) and thrombocytopenia (III/IV) were shown on 8/6 cycles and 8/2 cycles. In spite of myelosuppression, they were successfully treated with planned dose-intensity. Especially incomplete platelet recovery was successfully rescuced by using fractionated infusions of low-dose PBSCs. CONCLUSION: These data warrant further clinical trials to evaluate the potentials of fractionated low-dose infusions of PBSCs collected early in disease course for overcoming accumulated hematologic toxicities, especially thrombocytopenia complicated by repeated chemotherapies.
Appointments and Schedules ; Blood Platelets ; Drug Therapy ; Drug Therapy, Combination* ; Granulocyte-Macrophage Progenitor Cells ; Humans ; Leukopenia ; Lymphoma ; Stem Cells* ; Thrombocytopenia

BACKGROUND/AIMS: There was some technical difficulty in applying the hemoclip on the posterior wall of the body, cardia of the stomach and posterior wall of duodenum because the angle of approach was tangential. Use of transparent cap on the tip of the endoscope could reduce some of these problems. The purpose of this study was to examine the efficacy of endoscopic hemoclipping using a transparent cap. METHODS: From August 1997 to July 2000, 74 patients with bleeding peptic ulcer and stigmata of recent hemorrhage were treated with endoscopic hemoclipping. There was technical difficulty in applying the hemoclip in 18 patients and the transparent cap was used. RESULTS: There was no statistically significant difference between the patients treated with cap and the patients treated without cap in initial hemostasis rate (91.1% vs 94.4%), rebleeding rate (11.8% vs 11.7%), and permanent hemostasis rate (92.9% vs 94.4%). CONCLUSIONS: Use of transparent cap on the tip of the endoscope was an efficient method when the angle of approach was tangential.
Cardia ; Christianity ; Duodenum ; Endoscopes ; Hemorrhage ; Hemostasis ; Humans ; Peptic Ulcer ; Stomach

BACKGROUND/AIMS: We evaluated the effects of cisapride tartrate on gastrointestinal symptoms and gastric emptying times in diabetic patients with dysmotility like dyspeptic symptoms. METHODS: Cisapride was administered before each meal in 61 patients for 4 weeks. The intensity of gastrointestinal symptoms before and after cisapride administration was scored from 0 to 4, in the order of increasing severity of symptoms. In addition, a gastric emptying test was performed. RESULTS: A significant reduction in the total intensity score of symptoms was observed during the first two weeks, from 8.5+/-2.1 to 4.0+/-3.0 (p < 0.05), and a further reduction was noted during the next two weeks, to 2.8+/-2.8 (p < 0.05). Good to excellent improvement was obtained in 70.4% of the patients, but the improvement in symptoms was not related to age, duration of diabetes, glucose, Hb A1c, neuropathy, or retinopathy. Treatment with cisapride induced a significant regression of symptoms and a significant improvement of delayed gastric emptying from 104.0+/-31.7 minutes to 79.5+/-17.1 (p < 0.05). However, there was a lack of association between the changes in gastric emptying times and improvements in symptoms(r(2)=0.00186). Only 3 patients complained of loose stool, nausea, or dizziness. CONCLUSIONS: Cisapride was effective in improving dysmotility like dyspeptic symptoms in diabetic patients without serious side effects.
Cisapride* ; Dizziness ; Dyspepsia ; Gastric Emptying ; Glucose ; Hemoglobin A, Glycosylated ; Humans ; Meals ; Nausea

BACKGROUND/AIMS: Chronic gastrointestinal (GI) symptoms are believed to be common in the general population, but there is a lack of data from Korea. The aim of this study was to estimate the prevalence of chronic gastrointestinal symptoms in a rural community in Korea by using the Bowel Symptom Questionnaire (BSQ), which was based on the multinational diagnostic Rome criteria for functional bowel disorders, as a measure of GI symptoms. METHODS: A cross-sectional survey, using a reliable and valid questionnaire based on the fulfillment of the Rome criteria, was performed in a densely populated district in a Korean rural community on the residents aged 18-69 yr (mean 48 +/- 14 yr). 95.5% responded (n=420). All respondents were interviewed at their home or offices by a team of interviewers. RESULTS: Two thirds of Korean rural residents experience gastrointestinal symptoms and one fifth of them visit a clinic or hospital at least once a year. Prevalences of weekly heartburn, gastroesophageal reflux disease, dyspepsia, irritable bowel syndrome (IBS), and chronic constipation were 5.2% (95% confidence interval [CI], 3.1-7.4), 2.6% (95% CI, 1.1-4.2), 15.5% (95% CI, 11.9-19.0), 8.6% (95% CI, 5.8-11.3), and 24.3% (95% CI, 20.1-28.5) respectively. The prevalence of dyspepsia was 25%, taking medication usage into consideration. Ulcer-like dyspepsia (11.2%) was the most common subtype and 40% of the subjects with dyspepsia were classified into more than one subtype of dyspesia. There was an overlap between subjects with IBS and dyspepsia with 6.1% of dypeptics having IBS and 11.1% of IBS patients having dypepsia. CONCLUSIONS: The prevalence of GERD was low in Korea compared with that of the Western contries. The prevalences of dyspepsia and IBS were similar to those of the Western countries. The most common gastrointestinal symptom in a rural community in Korea is dyspepsia.
Constipation ; Cross-Sectional Studies ; Surveys and Questionnaires ; Dyspepsia ; Gastroesophageal Reflux ; Gastrointestinal Diseases ; Heartburn ; Humans ; Irritable Bowel Syndrome ; Korea* ; Prevalence* ; Rural Population*