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: 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

No abstract available.
Hair*

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

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: 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*

Fungi have been recognized as a significant cause of external otitis and it may be the primary pathogen or be part of a mixed infection. In the immunocompromised host, fungus is capable of producing infection in inner ear or middle ear. Otomycoses are most frequently caused by Aspergillus spp. and Candida sap. There are few reports that Aspergillus species other than A. fumigatus, A. niger and f. flavus have caused chronic otitis media. We report two cases of chronic otitis media caused by Aspergillus ferrous in Korea. One case is a 7-year-old girl who had recurrent serous otorrhea and otalgia for 4 years, was reattended otolaryngology clinics with otorrhea of 3 days durations and another is a 6-year-old girl who had serous otorrhea for 2 months and 3 day fever, was attended otolaryngology clinics with them. Microscopic appearance and colony morphology from ear discharge cultures revealed A. ferrous. The infection responded well to topical ketoconazole therapy. This report should help to raise medical personnel's awareness of such human opportunistic fungal ear infections.
Aspergillus* ; Candida ; Child ; Coinfection ; Ear ; Ear, Inner ; Ear, Middle ; Earache ; Female ; Fever ; Fungi ; Humans ; Immunocompromised Host ; Ketoconazole ; Korea ; Niger ; Otitis Externa ; Otitis Media* ; Otitis* ; Otolaryngology ; Otomycosis

BACKGROUND: Tuberculosis continues to be a major threat to health throughout the world, with an estimated 8 to 10 million new cases and 3 million deaths annually. And control of the disease is further threatened by the emergence of drug resistance. Recent major advances have been made in unravelling the molecular basis of M. tuberculosis resistance to isoniazid, streptomycin, quinolones and rifampin. And rifampin resistance is the useful indicator for the occurance of the multi-drug resistance. Hence, the rapid detection of rifampin resistant strain of M. tuberculosis is the key to have successful anti-tuberculosis therapy. Here we present our experience using PCR and line probe assay (INNO-LiPA) for easy and rapid detection of rifampin resistance of M. tuberculosis. METHODS: Thirty rifampin resistant and twenty susceptible strains of M. tuberculosis were collected from the routine culture and analyzed with INNO-LiPA. And results were compared with conventional antibiotic susceptibility testing. After amplification of the region of the RNA polymerase(rpoB), the amplified product is hybridized with a set of 10 oligonucleotides immobilized onto a membrane strip. From the pattern obtained the presence or not of rifampin resistance M. tuberculosis can be assessed. RESULTS: Ninety three percent of patients who had rifampin resistant strain revealed the multidrug resistance while only two showed resistance to rifampin only. The INNO-LiPA test results were generally agreeable with that of the conventional susceptibility testing(90%). The mutations in codon 531 (absence of 55 probe) were most commonly observed. In 55.2% of the 31 rifampin resistance M. tuberculosis confirmed on mutation by R-probes on the INNO-LiPA strips. CONCLUSIONS: The line probe assay after polymerase chain reaction is a fast and convenient method to detect both presence of M. tuberculosis complex strains and its resistance to rifampin in clinical specimens. We have suggested that detection of rifampin resistance may play a key role in monitoring multi-drug resistance. Consequently, the INNO-LiPA test may constitute an important tool for the control of tuberculosis.
Codon ; Drug Resistance ; Drug Resistance, Multiple ; Humans ; Isoniazid ; Membranes ; Mycobacterium tuberculosis* ; Mycobacterium* ; Oligonucleotides ; Polymerase Chain Reaction ; Quinolones ; Rifampin* ; RNA ; Streptomycin ; Tuberculosis