BACKGROUND: Epidermis is directly exposed to various external stimuli and protects internal structures. Most studies about skin tension focused on the dermis, and epidermal tension has not been able to attract interest because dermis much thicker than epidermis and dermal collagen fibers play a predominant role in the skin tension. However, circumstances which involve only the epidermis are often shown, and thus it is necessary to study the mechanical property of the epidermis. OBJECTIVE: The purpose of this study is to quantify the role of the epidermis as a mechanical barrier. METHODS: Human epidermal sheets were obtained from suction blisters in 14 patients with vitiligo during epidermal grafting. Maximal tension, that is the power required to break the epidermal sheets, was measured by tensiometer. RESULTS: The maximal tension of the epidermis ranged from 40.0 g/cm² to 84.5g/cm² with a mean values of 56.1g/cm² and did not differ significantly according to the age or anatomical sites. CONCLUSION: The barrier function of epidermis is important and the results are expected to be used as the basic information for other studies about the mechanical property of the epidermis. In addition, this will be important data in developing an artificial skin whose mechanical property is similar to that of the human skin.
Blister* ; Collagen ; Dermis ; Epidermis* ; Humans* ; Skin ; Skin, Artificial ; Suction* ; Transplants ; Vitiligo

No abstract available.
Hair*

BACKGROUND: Acne scars are not effectively corrected by a single treatment modality because of their widely varied depths and widths. OBJECTIVE: This study was performed to assess the effectiveness of staged combinations of several surgical modalities in the treatment of various acne scars. METHODS: Chemical peeling, CO₂ laserbrasion, scar excision, punch grafting, and dermabrasion were included in this study as surgical modalities. Initially, chemical peeling was performed on all patients and then CO₂ laserbrasion, scar excision and punch grafts were used for deep scars. Finally, dermabrasion was done for the remaining scars. Questionnaires were completed for clinical assessments by the patients and clinicians. RESULTS: Clinicians assessed the results as "excellent and good" in 75% of patients. However, only 53% of patients gave this same result. The degree of satisfaction escalated as the followup periods and number of chemical peeling procedures increased and as the sequence of the 3 staged operation progressed. CONCLUSION: We suggest that the principle of 3 staged operations would be effective in the treatment of patients with various types of acne scars.
Acne Vulgaris* ; Cicatrix ; Dermabrasion ; Follow-Up Studies ; Humans ; Transplants

A 30-year-old man developed basal cell carcinoma 3 years ago which showed as a pea sized, crusted nodule with extending pigmentation and telangiectasia on the inner side of the right lower eyelid. Five stages of Mohs micrographic surgery were required for the complete eradication of all tumor cells in the lesions of the nodule and extending pigmentation. The defect following the surgery was 4.5 × 3.5cm and was too large to repair with a primary closure or simple single flap. So, the defect was repaired with a combined flap of glabellar bilobed and cheek rotation. We report that the combined flap of glabellar bilobed and cheek rotation is a useful and relatively simple method for the reconstruction of a large defect on the inner side of the lower eye-lid area.
Adult ; Carcinoma, Basal Cell ; Cheek ; Eyelids ; Humans ; Methods ; Mohs Surgery* ; Peas ; Pigmentation ; Telangiectasis

BACKGROUND: Lipids of horny layer forming multiple lamellar structure in the intercellular space acts as a skin barrier having a primary protective function and keeps softness and flexibility of the skin by absorbing and maintaining moistures. Among the intercellular lipids, ceramides mainly contribute to this important role. In xerotic eczema, atopic dermatitis, psoriasis, ichthyosis, and experimentally induced scaly lesion showing dryness and scales, the amount of ceramides is decreased or distribution of ceramide is changed. In addition to lipids, free amino acids, a component of NMFs, serve as a water retainer and are decreased in ichthyosis or experimentally induced scaly lesion. Hand eczema has dry and scaly lesion showing impaired skin barrier and low water content. So, changes of ceramides or free amino acids can be considered in the lesion of hand eczema. OBJECTIVE: The purpose of this study was to confirm the relationship between the development of hand eczema and changes of ceramides or free amino acids. METHOD: The lipids and free amino acids in scales from lesion of hand eczema were analyzed by using high performance thin layer chromatography and amino acid analyzer. RESULTS: Amounts of total lipids extracted were 0.63+/-0.33 microgram/cm2 in hand eczema and 0.44+/-0.26 microgram/cm2 in control. There was no difference between the two groups. Cholesterol sulfate, glucosyl ceramide, cholesterol, triglyceride, sterol ester, and n-alkane showed no difference between hand eczema and control. But ceramides were significantly decreased in hand eczema(11.0+/-5.5%) compared with control(21.4+/-8.0%)(p<0.05). Especially, ceramide type IV was significantly decreased in hand eczema (6.6+/-5.3%) compared with control(15.6+/-6.2%)(p<0.05) but ceramide type III in hand eczema did not differ from control. Amounts of total free amino acids in 10mg of scale were 10.4+/-3.1nmol in hand eczema and 9.5+/-3.0nmol in control. There was no significant difference between the two groups. CONCLUSION: Dry skin and scales in hand eczema are related to the decrease of total amount of ceramides and ceramide type IV than amino acids in horny layer. To clarify the exact pathogenesis of hand eczema, further investigations on all types of ceramides and their defect in the process on biosynthesis of ceramides will be necessary.
Amino Acids* ; Ceramides* ; Cholesterol ; Chromatography, Thin Layer ; Dermatitis ; Dermatitis, Atopic ; Eczema* ; Extracellular Space ; Hand* ; Ichthyosis ; Pliability ; Psoriasis ; Skin ; Triglycerides ; Water ; Weights and Measures

BACKGROUND: Lipids of horny layer forming multiple lamellar structure in the intercellular space acts as a skin barrier having a primary protective function and keeps softness and flexibility of the skin by absorbing and maintaining moistures. Among the intercellular lipids, ceramides mainly contribute to this important role. In xerotic eczema, atopic dermatitis, psoriasis, ichthyosis, and experimentally induced scaly lesion showing dryness and scales, the amount of ceramides is decreased or distribution of ceramide is changed. In addition to lipids, free amino acids, a component of NMFs, serve as a water retainer and are decreased in ichthyosis or experimentally induced scaly lesion. Hand eczema has dry and scaly lesion showing impaired skin barrier and low water content. So, changes of ceramides or free amino acids can be considered in the lesion of hand eczema. OBJECTIVE: The purpose of this study was to confirm the relationship between the development of hand eczema and changes of ceramides or free amino acids. METHOD: The lipids and free amino acids in scales from lesion of hand eczema were analyzed by using high performance thin layer chromatography and amino acid analyzer. RESULTS: Amounts of total lipids extracted were 0.63+/-0.33 microgram/cm2 in hand eczema and 0.44+/-0.26 microgram/cm2 in control. There was no difference between the two groups. Cholesterol sulfate, glucosyl ceramide, cholesterol, triglyceride, sterol ester, and n-alkane showed no difference between hand eczema and control. But ceramides were significantly decreased in hand eczema(11.0+/-5.5%) compared with control(21.4+/-8.0%)(p<0.05). Especially, ceramide type IV was significantly decreased in hand eczema (6.6+/-5.3%) compared with control(15.6+/-6.2%)(p<0.05) but ceramide type III in hand eczema did not differ from control. Amounts of total free amino acids in 10mg of scale were 10.4+/-3.1nmol in hand eczema and 9.5+/-3.0nmol in control. There was no significant difference between the two groups. CONCLUSION: Dry skin and scales in hand eczema are related to the decrease of total amount of ceramides and ceramide type IV than amino acids in horny layer. To clarify the exact pathogenesis of hand eczema, further investigations on all types of ceramides and their defect in the process on biosynthesis of ceramides will be necessary.
Amino Acids* ; Ceramides* ; Cholesterol ; Chromatography, Thin Layer ; Dermatitis ; Dermatitis, Atopic ; Eczema* ; Extracellular Space ; Hand* ; Ichthyosis ; Pliability ; Psoriasis ; Skin ; Triglycerides ; Water ; Weights and Measures

BACKGROUND: The diagnosis of tuberculosis has been based on the detection of tubercle bacilli by acid-fast stain of smear or cultures, and recently the serologic diagnosis of tuberculosis has been provided a means of sensitive and specific detection of Mycobacterium tuberculosis. We evaluated the utility of enzyme immunoassay using determiner Tuberculosis Glicolipids(TBGL) antibody kit(Kyowa Medex Co. Ltd, Japan) to detect anti-TBGL antibody for diagnosis of pulmonary tuberculosis. METHODS: Anti-TBGL antibody assay was performed to the form 44 patients with active pulmonary tuberculosis(17 patients with smear positive, 7 patients with only culture positive, 20 patients with clinically active tuberculosis) and 80 controls (30 healthy controls, 24 patients with non-tuberculous respiratory diseases, 26 patients with inactive tuberculosis). We compared the sensitivity and specificity of anti-TBGL antibody with culture and AFB stain. RESULTS: Anti-TBGL antibodies were detected in 16 of 17(94%) smear positive patients, 4 of 7 patients with only culture positive and 16 of 20(80%) smear negative patients who had been clinically diagnosed as active pulmonary tuberculosis. Nine(35%) out of 26 patients with inactive tuberculosis, one(4%) out of 24 patients with non-tuberculous respiratory diseases and no one of healthy control had a positive antibody response. Overall sensitivity, specificity of the anti-TBGL antibody assay were 82%, 88%, respectively and sensitivities and specificities of culture and AFB smear 64%, 97%, and 49%, 100%, respectively. Anti-TBGL antibody titers in patients with active tuberculosis were significantly higher than control grup(P<0.05). Conclusions : The anti-TBGL antibody assay was sensitive, rapid and convenient. This assay will be useful as a tool for the diagnosis of tuberculosis in combination with other conventional methods.
Antibodies ; Antibody Formation ; Diagnosis* ; Humans ; Immunoenzyme Techniques* ; Mycobacterium tuberculosis ; Sensitivity and Specificity ; Tuberculosis ; Tuberculosis, Pulmonary*

BACKGROUND: There are many reports showing the efficacy of polymerase chain reaction(PCR) for the diagnosis of Mycobacterium tuberculosis in sputum. but only few reports in extrapulmonary specimens. Because of the difficulty in establishing a diagnosis of tuberculosis in the extrapulmonary specimens there have been considerable interest in the development of a rapid sensitive diagnostic test that might be useful. Therefore we used PCR for detection of M. tuberculosis DNA in extrapulmonary specimens and compared the results of conventional acid-fast stain, culture methods and PCR assay. METHODS: Total of 63 clinical samples(10 cerebrospinal fluids, 12 pleural fluids, 1 pericardial fluid, 3 bone marrow aspirates, 1 ascitic fluid, 25 fine needle aspirates of lymph nodes, 7 urine, 1 stool and 3 tissue biopsies) in Ewha Womans University Tongdaemun hospital were analysed by the PCR. We performed the PCR using a species-specific M. tuberculosis DNA fragment(mtp 40 gene) as primers that was cloned and sequenced at recent and a 396-bp fragment was specifically amplified. We analyzed sensitivity and specificity of AFB culture and PCR for the diagnosis of extrapulomonary tuberculosis. RESULTS: The positivity of AFB smear, culture and PCR were 2(10%), 4(20%), 13(65%) out of total 20 cases diagnosed as clinically active extrapulmonary tuberculosis. respectively. All of 2 smear-positive samples and 2 of 4 culture-positive and smear-negative samples were PCR-positive. And 9 of 14 smear and culture negative specimens also gave detectable DNA products in PCR The specificity of PCR(95.4%) is compared with those of smear and culture(100.0%). CONCLUSIONS: This results suggest that the PCR assay is a sensitive and rapid diagnostic alternative to classical procedures for the diagnosis of extrapulmonary tuberculosis.
Ascitic Fluid ; Bone Marrow ; Cerebrospinal Fluid ; Clone Cells ; Diagnosis* ; Diagnostic Tests, Routine ; DNA ; Female ; Humans ; Lymph Nodes ; Mycobacterium tuberculosis ; Needles ; Polymerase Chain Reaction* ; Sensitivity and Specificity ; Sputum ; Tuberculosis*

Regardless of the any cause leg ulcers are painful and inconvenient to patients and present clinical and economic problems due to their chronicity. Conventional skin grafts, cultured allogenic epidermis, and cultured autologous epidermis have been used for the treatment of leg ulcers. In a twenty-year-old woman with leg ulcers, autologous pure epidermal sheets were obtained from the lower chest by means of suction blisters and grafted to the leg ulcers. All lesions were healed completely in 20 days after grafting. The donor sites showed slight postinflammatory hyperpigmentations without scars. The autologous epidermal graft using suction blisters appears to be a useful method for the treatment of leg ulcers, with no immunologic rejection, no need for cultivation and anesthesia, no desiccation, and no scars on the donor sites.
Anesthesia ; Blister* ; Cicatrix ; Desiccation ; Epidermis ; Female ; Humans ; Leg Ulcer* ; Leg* ; Methods ; Skin ; Suction* ; Thorax ; Tissue Donors ; Transplants*

Rapid progress in modern medical technology has made it possible to sustain life and/or delay death using 'heroic' treatments. The availability of life-sustaining treatment brings several issues in end-of-life care such as 'dying with dignity' and an radical increase in health care costs. The use of Advance Directives(AD) have been widely heralded by health care providers, gerontologists, and advocacy groups as means of protecting patients' right to accept or refuse life-sustaining treatment in end-of-life care. The use of AD can not only improve patients' autonomy and quality of life but also bring efficiency in distributing health care resources. The proportion of older persons in Korean population has been increasing. Those 65 years of age or over were about 7 percent of the population. Death and dying is not limited to older persons, but it is more prevalent among them. In conjunction with an aging population and the increasing prevalence of death, the issues of death and dying will become crucial in near future in terms of 'dying with dignity', 'autonomy', and 'self-control'. This paper attempts to explode and establish the concept of advance directives (AD) based on literature review. Data sources are computer searches with the MEDLINE database. Due to the lack of prior study on AD for a Korean cases, studies abroad are reviewed. This paper suggests the need for future study on the possibility of the use of AD in Korea.
Advance Directives* ; Aging ; Surveys and Questionnaires ; Delivery of Health Care ; Health Care Costs ; Health Personnel ; Humans ; Korea ; Patient Rights ; Prevalence ; Quality of Life