BACKGROUND: For the treatment of generalized vitiligo patients with oral PUVA, we can use two different methods; one is to treat the lesions while the whole body is exposed. Another one is to treat the lesions while only the lesions are exposed. PURPOSE: This study was performed to determine whether lesional and whole body exposure in oral PUVA for generalized vitiligo show any therapeutic differences in effectiveness. METHODS: The vitiligo lesions were distributed over the whole body skin of the subjects and the lesion area was less than 6% of the whole skin area. PUVA was done to the subjects more than 20 times after oral administration of psoralen. The patients were classified into two different groups. One is the lesional exposure group in which the patient exposed only the vitiligo lesion. The other is the whole body exposure group in which the patient exposed almost their whole body. RESULTS: Our results show that there is no statistical difference of the therapeutic effectiveness between the two methods. CONCLUSIONS: We recommend lesional treatment rather than whole body treatment to prevent the oral PUVA side effects.
Administration, Oral ; Ficusin ; Humans ; Skin ; Vitiligo*

The thoracolumbar fracture and fracture-dislocations are ever increasing today as the traffic accidents and industrial accidents frequently occur. But the controversy as to the relative values of early surgical instrumentation and conservative means has continued for well over a decade. The duration of this dispute without final resolution suggests an absence of significant differences in the results of surgical and non-surgical method. The purpose of this study is to review the results of conservative treament for 132 patients with thoracolumbar fracture and fracture-dislocations, who were admitted and treated at Yonsei University Severance Hospital from January, 1980 to December, 1984. And we obtained following results. l. In cases of stable fracture without neurologic deficit, especially when the wedging deformity of vertebral body is below 50%, it seems to be better to treat conservatively; that is, immediate postural reduction and after 2 or 3 weeks of bed rest, to start ambulation with back brace or cast. 2. In cases of stable fracture with neurologic deficit, operative treament is necessary when the frac-fragment is protruded into the spinal canal and neural compression sign is evident. But if not so, attempt to treat by conservative means may be done. 3. In cases of unstable fracture without neurologic deficit, it is more retional to treat conservatively by bed rest for a suffient time and then wearing back brace or cast. If the spinal deformity is so severe that it needs spinal fusion, the operation can be performed later on. 4. In cases of unstable fracture with neurologic deficit, spinal instrumentation and fusion do nothing to enhance neural recovery but are done to provide anatomic spinal alignment and stability to allow early the patient mobilization and rehabilitation.
Accidents, Occupational ; Accidents, Traffic ; Bed Rest ; Braces ; Congenital Abnormalities ; Dissent and Disputes ; Humans ; Methods ; Neurologic Manifestations ; Rehabilitation ; Spinal Canal ; Spinal Fusion ; Spine ; Surgical Instruments ; Walking

No abstract available.
Laryngeal Muscles*

INTRODUCTION: The fixation strength of transpedicular screw system in the vertebral hody relied on bone quality and anatomical characteristics of vertebral pedicle, designs of screw and types of connection(rod or plate) with screw. The purpose of this study is to verify the biomechanical nature of the transpedicular fixation in spine under various conditions with porcine vertebrae. MATERIAL AND METHOD: Fresh porcine vertebrae and the custom-made screws were used in this experiment. To reduce the errors caused by vertebral bodies of different size and quality, vertebral bodies having regular range of pedicular width(10.0 to 11.5mm) and hone density(more than 1.0 gm/cm2) were used. The pedicle screws were inserted in the same procedure and axial pull out test was performed with using the Material Testing System(lntron8511, Canton, USA). The experiments were performed in four types to assess the difference of strength accroding to designs of the screw hy using two group of screws. The first group of screw was designed according to the outer and inner diameter and the second group was designed according to the shape, pitch, and thread profile of screw. Experiment I was perfomed to evaluate the effect of screw diameters on the biomechanical pull-out strength hy using the first group of custom-made pedicle screw which fixed all other factors except the diameter of screw. Experiment I was to verify the effect of screw shape, experiment III to verify the effect of pitch and experiment IV to verify the effect of thread profile. RESULTS: The results of experiments were summarized as follows: Experiment I showed that the screw of larger outer diameter had greater holding strength. Experiment II showed that the holding strength of cylindrical shaped screw is superior to that of conical shaped screw. Experiment III showed that there is no statistical significance between different modes of pitch. Experiment IV showed that the holding strength of buttress shape of thread profile is superior to that of V-shape. CONCLUSION: It seemed that the fixation strength of the screw was more powerful with 1 mm increment of outer diameter in 4-7mm of outer diameter, 3mm of pitch and buttress shape of thread of the screw with the same operation technique.
Spine

To evaluate whether mast cells are involved in developing pathologic feature of psoriasis, 60 biopsy specimens of patients with psoriasis were analyzed. They had not been treated for at least 1 week before skin biopsy. Histological findings in early and fully developed lesions and numbers of mast cells in their dermal papillae were investigated. The results were as follows: 1. In epidermal changes of psoriatic lesions, parakeratosis and acanthosis revealed different findings between early lesions and fully developed lesions. While early lesions revealed mounds of parakeratosis and mild to moderate acanthosis, fully developed lesions revealed confluent parakeratosis and moderate to severe acanthosis. In dermal changes of psoriatic lesions, papillomatosis revealed different findings between early developed lesions and fully developed lesions. While early lesions revealed normal to moderate papillomatosis, fully developed lesions revealed moderate to severe papillomatosis. 2. Degree of acanthosis is related to the degree of papillomatosis. The more increase in the degree of acanthosis, papillomatosis, and parakeratosis, mast cell numbers in dermal papillae were more increased. 3. Mast cell numbers in dermal papillae were more increased in fully developed lesions than early lesions. 4. These findings suggest that mast cell may play an active role in developing pathologic finding of psoriasis.
Biopsy ; Humans ; Mast Cells* ; Papilloma ; Parakeratosis ; Psoriasis* ; Skin

BACKGROUND/AIMS: The caudal anesthsia is most commonly used for benign anorectal surgery, The combination of long-acting anesthetics and opiates has been used for longer duration and successful control of postoperative pain. But the side effects of peridural anesthesics and morphine have commonly occured in caudal anesthesia. This study was performed to assess the difference in clinical effects between peridural mepivacaine and bupivacaine with morphine. METHODS: We evaluated the clinical effects in 60 patients who had anal operation with Jack-Knife position under caudal anesthesia. We divided randomly these 60 patients into two groups, M and B groups (in each group, 30 patients included). Group M (n=30) was given 2% mepivacaine 20 ml with morphine 2 mg caudally, and Group B (n=30) was given 0.5% bupivacaine 20 ml with morphine 2 mg in the same manner. We measured the onset time, duration, postoperative analgesia, and side effects including urinary retention. RESULTS: The onset time for analgesia was significantly shorter in group M than in group B. The duration of postoperative pain complaints was significantly longer in group M than in group B. The postoperative analgesic effects and side effects were not significantly different between two groups. CONCLUSIONS: Caudal mepivacaine and morphine mixture is effective for control of postoperative pain without significant side effects.
Analgesia ; Anesthesia, Caudal* ; Anesthetics ; Bupivacaine* ; Humans ; Mepivacaine* ; Morphine* ; Pain, Postoperative ; Urinary Retention

Antiseptics are substances that kill or prevent the growth of microorganisms when applied to living tissue. They must be effective against microorganisms but must also retain their activity in presence of body fluids without being harmful locally or systemically. Among many antiseptics, Betadine(R) has been widely used because of its low toxicity and high germicidal efficacy. We reported 2 cases of allergic contact dermatitis to Betadine(R) in surgical patients. They had eczematous eruption along the Betadine(R) applying sites. Path tests Betadine(R) confirmed the diagnosis.
Anti-Infective Agents, Local ; Body Fluids ; Dermatitis, Allergic Contact* ; Diagnosis ; Humans

We report 2 cases of pediatric DNTs which presented with intractable seizures and no other associated neurologic abnormalities. They showed typical appearance of DNTs on neuroimaging and histopathology. Most patients with DNT can be cured by surgical treatment with exellent outcome and do not need ratio- or chemotheraphy. This study indicates that it is quite important to consider DNTs as one of differential diagnoses in patients with intractable seizures especially when they present only with seizures without other neurologic symptoms.
Child* ; Diagnosis, Differential ; Humans ; Neoplasms, Neuroepithelial* ; Neuroimaging ; Neurologic Manifestations ; Seizures*

PURPOSE: It is the purpose of this paper to study the long-term results of surgically treated intermittent exotropia of 25 prism diopters (PD) of preoperative deviation. METHODS: We analyzed and compared 364 patients (376 cases) with at least 6 months of postoperative follow-up. Two surgical methods were done : 6 mm bilateral recession of lateral rectus muscle in 190 patients (190 cases) and unilateral 4 mm recession of lateral rectus muscle combined with 3 mm resection of medial rectus muscle in 174 patients (186 cases). RESULTS: The average age of operation was 6.2 years, ranging from 3 to 16 years, and the follow-up period after surgery ranged 6 to 128 months (mean 27.3 months). The satisfactory surgical result defined as orthophoria and deviation between 5 PD esodeviation and 10 PD exodeviation. The final success rates were 75.3% in bilateral recession group and 64.5% in unilateral recession-resection group. This difference in success rates between the two groups was statistically significant (P=0.023), and the age at operation did not influence the surgical results. Those cases who were over-corrected 6 to 10 PD had a higher success rate and there was a statistically significant relationship between alignment immediately after surgery and on the final postoperative day in the two surgical groups (P=0.0001). CONCLUSIONS: The outcome of the bilateral recession is better than that of the unilateral recession-resection for correction of 25 PD intermittent exotropia in any age group.
Esotropia ; Exotropia* ; Follow-Up Studies ; Humans

Spontaneous spinal epidural hematoma is a rare entity. Various definitions for spontaneous epidural hematoma have been reported in the literature. The expression of nontraumatic spinal epidural hematoma seems to be less ambiguous and includes idiopathic hematomas and hematomas secondary to coagulopathy, vascular malformations, and tumors. We report three cases of nontraumatic spinal epidural hematomas observed from 1991 to 2000. The causes of the spinal epidural hematomas were not clear in two cases among them, but in the another one case, the cause was determined to be an acquired coagulopathy. We reviewed 24 cases reported in the Korean Journal of Neurosurgery and our three cases with particular emphasis on the various causes such as coagulopathy, vascular malformations and tumors. Among the 27 cases, numerous causes were detected such as three cases of vascular malformation, one case of anticoagulant treatment, five cases of combined lumbar disc herniation, two cases associated with pregnancy and postpartum, one case associated with hypertension, and one case associated with ossification of ligamentum flavum. No causes were detected in the ten cases. The authors reviewed the literature.
Hematoma ; Hematoma, Epidural, Spinal* ; Hypertension ; Ligamentum Flavum ; Neurosurgery ; Postpartum Period ; Pregnancy ; Vascular Malformations