BACKGROUND: This study was performed to evaluate the therapeutic effects of sympathetic block in management of reflex sympathetic dystrophy (RSD); renamed complex regional pain syndrome (CRPS) Type I, according to the duration of RSD, and to evaluate predictable factors responding to sympathetic block in patients suffering from RSD. METHODS: Prospectively designed this study was divided thirty patients with upper extremity RSD into three groups according to the duration of RSD; Group I (< or = 3 months), Group II (4 to 6 months) and Group III (>or = 7 months). All patients were received repeated stellate ganglion blocks (SGB) with 12 ml of 0.2% bupivacaine by paratracheal approach. We compared the therapeutic effects of SGB between the groups and the clinical signs on initial examination to receive the first SGB at pain clinic. RESULTS: Response rates to SGB were 84.6% in Group I, 62.5% in Group II and 44.4% in Group III. The early treatment less than 6 months was better prognosis (p<0.05). Presence of edema (p<0.001), temperature differences between both hands (hot>cold>no difference, p<0.001), and allodynia (p<0.05) were favorable prognostic factors responding to sympathetic block. Especially, warm skin and edema in RSD were near-perfect predictors of sympathetic blocks. CONCLUSIONS: We conclude that SGB is effective in management of upper extremity RSD, and the duration and the clinical signs of RSD are important to the prognosis and responsibility to sympathetic block. If patients suffering from RSD visit pain clinic before 6 months, and they have edematous warm hands with allodynia, majority of them will be improved from their pain after sympathetic block.
Bupivacaine ; Edema ; Hand ; Humans ; Hyperalgesia ; Pain Clinics ; Prognosis ; Prospective Studies ; Reflex Sympathetic Dystrophy* ; Reflex* ; Skin ; Stellate Ganglion* ; Upper Extremity*

No abstract available.
Classification*

We report 14 cases of dellen in 2000 blepharoplasties. The purpose of this article is to report rare complication of corneal dellen that developed after blepharoplasties. We observed 6 cases (0.5%) of dellen among 1200 patients who underwent upper blepharoplasty, and 8 cases (1%) among 800 lower blepharoplasty cases. Most patients who developed dellen were in their forties and fifties. All dellen were observed at temporal limbus, and accompanied conjunctival bleb. Most of the dellen developed in dry season (from November to March) and were frequently found in the middle-aged neurotic women who lived in apartments where room temperature is relatively high. Patching to the eyes, artificial tear and steroid eye ointment were applied to the dellen patients, who usually healed without corneal opacity within 2 weeks. In conclusion, we think that the cause of the conjunctival bleb and dellen are obstruction of small lymphatic vessels due to too meticulous hemostasis and too tight key suture in case of lower blepharoplasty.
Blepharoplasty* ; Blister ; Corneal Opacity ; Eye, Artificial ; Female ; Hemostasis ; Humans ; Lymphatic Vessels ; Seasons ; Sutures ; Tears

The purpose of this article is to introduce author's method of double fold operation by using skin-tarsal plate-muscle-skin fixation. Three thousand patients were operated during last ten years. The incision line is 7 to 10mm above the ciliary margin while the skin is pulled upward. Excess skin and orbicularis oculi muscle is removed. Orbital septum is opened on its lateral part and orbital fat is removed. 1) Skin of the lower flap, 2) tarsal plate and/or levator aponeurosis, 3) orbicularis oculi muscle of the upper flap, and 4) skin of the upper flap are sutured with removable suture material. The fixations are performed at three points of each eyelids(midpupillary line, medial and lateral margin of the tarsal plate). Additional nine stitches of skin-levator-skin fixation are put on each eyelid. Sutures were removed on third to 6th postoperative-day. Most of the patient were satisfied with the result. Only 30 patient complained loss of fold. However, 150 patients had conjunctival bleb and 15 patient suffered from dellen. This method is unique method which can avoid triple fold by fixating the orbicularis muscle of the upper flap.
Blepharoplasty ; Blister ; Eyelids ; Humans ; Orbit ; Skin ; Sutures

The clinical study was performed to 28 patients with the pericardiac effusion who were admitted in Busan university Hospital and Paik Hospital, In-Je Medical College, Busan, korea during March 1976 and July 1981. The results were as following; 1) 12 cases(42.9%) of total 28 pericardiac effusion occured in 3rd decade, 8(28.5%) in 2nd decade and 5 cases(17.9%) in 4th decade. Sex distribution showed male to female 2.5:1. 2) With etiological distribution there were 15 cases(53.6%) tuberculous, 5(17.9%) nonspecific, 3(10.7%) malignant, 2(7.1%) pyogenic, 2 traumatic and 1(3.6%) rheumatic. 3) On admission 28 cases(100%) complained of dyspnea, 24(85.7%) distant heart sound, 20(71.4%) each engorged jugular vein and edema, 18(64.3%) each cough and abdominal fullness, 17(60.7%) each sputum and chest discomfort and pain, 12(42.9%) fever, 11(39.1%) orthopnea, 10(35.7%) chilling, 7(25%) oliguria, 4(14.6%) palpitation and 3(17.2%) headache. Increased cardiac dullness was observed in 26 cases(71.4%), hepatomegaly 18(64.3%), pulmonary rales 17(60.7%), ascites 13(46.1%), fever 12(42.9%), pericardiac friction rub 10(35.7%), splenomegaly 7(25%), paradoxical pulse 6(21.4%) and jaundice 2(7.1%). 4) On amission SGOT and SGPT level was increased each in 15(53.6%) and 13(46.7%), TTT and CCF abnormal in 10(35.7%), and 8(28.5%), serum NPN, BUN, creatinine increased in each 10(35.7%), 11(39.1%), 8(28.5%), WBC increased in 6(21.4%), RBC decreased in 8(28.5%) and ESR increased in 16(57.1%). 5) Characteristics of pericardiac effusion showed hemorrhagic 17(60.7%), serosangeous 6(21.4%), sangeous 3(17.2%) and pyogenic 2 cases(7.1%). 6) The ECG on admission revealed low voltage in 25(89.1%), depressed ST segment in 13(46.1%) and inverted T wave in 12(42.9%). 7) Chest X-ray showing cardiomegaly 28(100%), pleural effusion in 20(71.4%), and pulmonary congestion in 16(57.1%). 8) The m mode and 2-D Echocardiogram showed echo free space in 28 cases and after pericardiocentesis the space was reduced or disappeared. 9) 19 cases of 28(67.5%) were improved clinically, while 5 cases(17.9%) were not improved and 4 cases(14.6%) died.
Alanine Transaminase ; Ascites ; Aspartate Aminotransferases ; Busan ; Cardiomegaly ; Cough ; Creatinine ; Dyspnea ; Edema ; Electrocardiography ; Estrogens, Conjugated (USP) ; Female ; Fever ; Friction ; Headache ; Heart Sounds ; Hepatomegaly ; Humans ; Jaundice ; Jugular Veins ; Korea ; Male ; Oliguria ; Pericardiocentesis ; Pleural Effusion ; Respiratory Sounds ; Sex Distribution ; Splenomegaly ; Sputum ; Thorax

BACKGROUND: This study was performed in order to investigate the changes of Na+ transport system in the red blood cells of patients with essential hypertension. METHODS: Na(+)-Li(+) countertransport and Na(+)-K(+) pump activity were measured in 30 cases of essential hypertension and 20 healthy normal controls. And these measurements were analyzed in terms of some important clinical parameters in the patients, i.e., body mass index(BMI), status of hypertension and plasma lipids. RESULTS: Na(+) and K(+) contents of red cells in hypertensive patients were 16.9+/-1.4 and 77.8+/-2.1mmol/L cells, respectively, and no significant difference was found compared with respective value of normal control(14.2+/-0.9 and 82.2+/-2.8mmol/L cells). Na(+)-Li(+) countertransport in the patients group was significantly ancreased compared with control group(62.5+/-4.5 and 46.8+/-3.0umol/L cells.hr), and Na(+)-K(+) pump activity was also showed a significant depression(8.72+/-0.80 and 12.79+/-0.52umol Pi/mg.hr). In the analysis regarding the relationship between Na(+) transport system and some important clinical parameters of the patients with essential hypertension, Na(+)-Li(+) countertransport was related to BMI, and the level of triglyceride. On the other hand, Na(+)-K(+) pump activity was related to the WHO stage and the levels of total cholesterol and triglyceride. But level of blood pressure did not show a significant correlation with either are of the two Na(+) transport system. CONCLUSION: These resluts suggest that Na(+)-Li(+) countertransport and Na(+)-K(+) pump activity in patients with essential hypertension were significantly altered compared with heathy normal controls, and these Na(+) transport system were also influenced by BMI, WHO stage, and the levels of cholesterol and triglyceride. And the individual variation in Na(+) transport system were also suggested by the findings being overlapped between hypertensive patients and controls.
Blood Pressure ; Cholesterol ; Erythrocytes* ; Hand ; Humans ; Hypertension* ; Plasma ; Triglycerides

A 15-year-old female patient had malignant atrophic papulosis(Degos' disease) that affected the skin and probably intestinal tract. She had multiple erythematous papules with porcelain-white atrophic centers on the trunk and extremities. Also she suffered from intermittent nausea, vomiting and abdominal pain. She received appendectomy for abdominal pain 2 months ago. Histopathologic studies showed atrophic epidermis and necrobiotic dermis. There were endothelial thickening, fibrinoid necrosis of bload vessels, perivascular lymphocytic infiltation in the lower dermis. She was treatd with acetyl salicylic acid and dipyridamole, but there was no improvement.
Abdominal Pain ; Adolescent ; Appendectomy ; Dermis ; Dipyridamole ; Epidermis ; Extremities ; Female ; Humans ; Malignant Atrophic Papulosis* ; Nausea ; Necrosis ; Salicylic Acid ; Skin ; Vomiting

No abstract available.
Adenosine Triphosphatases* ; Animals ; Langerhans Cells* ; Mice* ; Oxygen*

Annular elastolytic giant cell granuloma(AEGC(3) has been called as atypical necrcibiosis lipoidica, Mieschers granuloma of the face and scalp, and actinic granu- Joma and needs differen(iation from granuloma annulare, elastosis perforans serpiginosa and nerrobiosis lipoidica. We report a case of AECCG occurring in a 53-year-old male. The patient. had an annular erythematous plaque measuring 4 cm in diameter with serpiginous raised edges and slightly atrophic centers on the right forearm for 5 years. The histopathologic finding showed patchy dermal infiltration of lymphocytes, histiocytes, and multinucleated giant cells engulfing elastic fibers. The. skin lesion cleared after intrader mal injection cf cortieosteroids.
Actins ; Elastic Tissue ; Forearm ; Giant Cells* ; Granuloma ; Granuloma Annulare ; Granuloma, Giant Cell* ; Histiocytes ; Humans ; Lymphocytes ; Male ; Middle Aged ; Scalp ; Skin

No abstract available.
Hepatitis B e Antigens* ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis*