BACKGROUND: Extensive involvernent of alopecia areata seems to be different from the usual common type of alopecia areata in its damage to the patient and its pragnosis. The two forms are best dealt with differently. OBJECTIVE: We performed a clinical observation of a severe form of alopecia areata to understand to its course and therapeuic respones. METHODS: Clinical analysis of 68 cases of severe alopecia areata (37 alopecia totalis, 6 alopecia subtotalis, 13 alopecia universalis, 11 alopecia subtotal universalis, 1 ophiasis) was done for 9 years from 1985 to 1994. RESULTS: 1. The sex distribution was equal. The developrnent of hair loss started before the age of 30 in 67.6%(46/68). Twenty two patients(32.4%) developed the alopecia during the early twenties. The overall mean age was 26.4 years. 2. The duration from the initial hair loss to the involvement of the whole scalp was less than 3 months in 80%(40/50~) of patierits showing whole scalp baldness. 3. Exclamation mark hairs were seen in 85% (57/67) of severe alopecia areata. In 5 patients who were examined just at the start of the hair loss, exclamation mark hairs were found several weeks later. 4. When treated by methyl prednisolone pulse therapy, duration of the disease and type of involvement are the most important prognastic factors as follows. a) 71%(32/45) of patients with less than 6 months duration showed satisfyingly good results cosmetically, but this figure dropped to 30.4% (7/23) in patients with longer than 6 months duration. b) 83.7% (36/43) of patients with alopecia totalis or subtotalis showed good results but this figure dropped to 12%(3/25) in patients with alopecia universalis, subtotal universalis or ophiasis. 5. Methyl prednisolone pulse therapy seemed to be recommended in the acute stage of extensive involvement of alopecia areata. CONCLUSION: Severe alopecia areata has predilection for young adults and seems to show extensive involvement frorn its early stage. Exclamation mark hairs need some time to appear even in their early active stage of hair hedding. Pulse methyl prednisolone therapy is thought to be recommended when the disease is in its early active stage.
Alopecia Areata* ; Alopecia* ; Hair ; Humans ; Prednisolone* ; Scalp ; Sex Distribution ; Young Adult

BACKGROUND: Extensive involvernent of alopecia areata seems to be different from the usual common type of alopecia areata in its damage to the patient and its pragnosis. The two forms are best dealt with differently. OBJECTIVE: We performed a clinical observation of a severe form of alopecia areata to understand to its course and therapeuic respones. METHODS: Clinical analysis of 68 cases of severe alopecia areata (37 alopecia totalis, 6 alopecia subtotalis, 13 alopecia universalis, 11 alopecia subtotal universalis, 1 ophiasis) was done for 9 years from 1985 to 1994. RESULTS: 1. The sex distribution was equal. The developrnent of hair loss started before the age of 30 in 67.6%(46/68). Twenty two patients(32.4%) developed the alopecia during the early twenties. The overall mean age was 26.4 years. 2. The duration from the initial hair loss to the involvement of the whole scalp was less than 3 months in 80%(40/50~) of patierits showing whole scalp baldness. 3. Exclamation mark hairs were seen in 85% (57/67) of severe alopecia areata. In 5 patients who were examined just at the start of the hair loss, exclamation mark hairs were found several weeks later. 4. When treated by methyl prednisolone pulse therapy, duration of the disease and type of involvement are the most important prognastic factors as follows. a) 71%(32/45) of patients with less than 6 months duration showed satisfyingly good results cosmetically, but this figure dropped to 30.4% (7/23) in patients with longer than 6 months duration. b) 83.7% (36/43) of patients with alopecia totalis or subtotalis showed good results but this figure dropped to 12%(3/25) in patients with alopecia universalis, subtotal universalis or ophiasis. 5. Methyl prednisolone pulse therapy seemed to be recommended in the acute stage of extensive involvement of alopecia areata. CONCLUSION: Severe alopecia areata has predilection for young adults and seems to show extensive involvement frorn its early stage. Exclamation mark hairs need some time to appear even in their early active stage of hair hedding. Pulse methyl prednisolone therapy is thought to be recommended when the disease is in its early active stage.
Alopecia Areata* ; Alopecia* ; Hair ; Humans ; Prednisolone* ; Scalp ; Sex Distribution ; Young Adult

The linear IgA bullous dermatosis is a rare chronic vesicobullous disease resembling dermatitis herpetiformis or bullous pemphigoid. We report a case of linear IgA bullous dermatosis developed in a 16 year old female, whose cutaneous lesions were unusually acute. The urticarial wheals started on her buttock and spread to her entire body in two hours and generalized blistering de veloped within four days, The response by dapsone was also dramatic. Routine histological and both direct and indirect immunofluorescent microscopic findings were typical of linear IgA bullous dermatosis.
Adolescent ; Adult* ; Blister ; Buttocks ; Dapsone ; Dermatitis Herpetiformis ; Female ; Humans ; Linear IgA Bullous Dermatosis* ; Pemphigoid, Bullous

Leg length discrepancy or short stature is a significant problem to patient psychosocially, cosmetically, and there has been many efforts for limb lengthening. There are many report about lower limb lengthening since the first description of femoral lengthening by Codivilla in 1905. Although limb lengthening using external fixator was popularized by Anderson, the result was poor because of many difficulties in techniques and complications. Recently, a great progress in lower limb lengthening was made by distraction osteogenesis by llizarov and callotasis by De Bastiani. But as such exter- nal fixator has some problem in technique, cosmesis or complications. Therefore gradual elongation intrameduilary nailing(Albizzia) developed by Guichet in 1986 has gained attention for more stability and relatively less discomfort. We reviewed 18 cases in 11 patients(5 males and 6 females) who visited the department of Orthopedic Surgery of Severance Hospital at Yonsei University with limb leg length discrepancy due to sequeale of poliomyelitis, familial short stature and Turner syndrome. They all underwent lower limb lengthening using Albizzia technique between December 1995 and January l997. The average age at the time of the operation was 22.7 year. Famiiial short stature was in 12 cases(67%), Turner syndrome in 2 cases(11%), and leg length discrepancy due to the sequelae of poliomyelitis in 4 cases(22%). The site of lengthening were 5 cases of femur(28%) and l3 cases of tibia(72%). The latency period was average of 7 days. During the distraction period, 15 ratchetings per day(1 mm/day) were performed. In case of bilaterai femoral lengthenings, average length of gain(LG) was 6.0cm and percentage of increase(PI) l6.8%(16.2-17.4), lengthening index(LI) 1.2 month/cm(0.75-2.2). In case of unilateral femoral lengthening, LG was 3.8cm, Pl 7.8 %, Ll 1.3 month/ cm. In case of bilateral tibial lengthening, average LG was 5.5cm(3.5-6.0~) and Pl 18.8%(12.0-22.9), LI 1.3month/cm(0.67-2.3). In case of unilateral tibial lengthening, LG was 2.9cm(2.3-3.5), P1 9.4 %(7.7-11.7), LI 2.8 month/cm(2.2-3.1). Lengthening index in poliomyelitis by llizarov was 3.l month/cm, but it was 1.3 in femur and 2.8 in tibia hy Albizzia method. There are some advantages and disadvantages or contraindications and indications of the Albizzia technique. We suggest that the Albizzia technique is more stahle, more comfortable and no longer lengthening time compared to external fixator such as Ilizarov.
Albizzia ; External Fixators ; Extremities* ; Femur ; Humans ; Latency Period (Psychology) ; Leg ; Lower Extremity ; Male ; Orthopedics ; Osteogenesis, Distraction ; Poliomyelitis ; Tibia ; Turner Syndrome

No abstract available.
Extremities* ; Ilizarov Technique*

We evaluated the results following the use of hinged Ilizarov and free tissue transfer to correct the eqinus deformity of the foot associated with extensive scarring of the leg and ankle in nine patients. The deformity was secondary to ischemic and neuropathic changes after trauma to the leg, ankle and foot. The average age of the patients was seventeen years (range, thirteen to thirty-four years). The average duration of follow-up was twenty-one months (range, twelve to thirty-eight months). Free tissue transfer was done in all cases, parascapular flap was done in seyen cases, groin flap was done in two cases. Among the nine cases, free tissue transfer and hinged Ilizaov were done at the same time in four cases, The average interval of the other five patients between free tissue transfer and hinged Ilizaov was three months (range, two to four months). The duration of distraction was four to six weeks, and the apparatus was kept in place for an additional two months after the desired position of correction had been achieved. The results were evaluated using two criteria, dorsiflexion and range of motion of ankle joint. Criteria on dorsiflexion of ankle, the results were good in seven cases, fair in two cases. Criteria on range of motion of ankle, one case being performed ankle fusion was not evaluated. Total eight cases were evaluated for range of motion of ankle. The results were good in six cases, fair in two cases. On the basis of our results, we believe that severe eqinus deformities of the foot associated with extensive scarring of the leg and ankle can be corrected with heel cord lengthening, free tissue transfer and hinged Ilizarov.
Ankle Joint ; Ankle* ; Cicatrix* ; Congenital Abnormalities ; Equinus Deformity* ; Follow-Up Studies ; Foot ; Groin ; Heel ; Humans ; Leg* ; Range of Motion, Articular

Thirteen Polio patients with leg length inequality were undergone Ilizarov lengthening procedures and have been followed along for an average two years(range, 1-3.8 years) after removal of the fixator. The age of patients(M:F=7:6) ranged from 18.0 to 32.2 years(average 26.4 years). The difference of true leg length averaged 2.1cm with the tibia being 3.3cm the femur, 1.2cm. The corticotomy was done at the proximal tibia and distal fibula in all case. The fixation period of the Ilizarov apparatus averaged 9.3 months. The length gain averaged 3.0cm for an average 3.8cm inequality. The healing index averaged 3.1mon/cm. Two out of thirteen patients complained of pain in the operated leg. The limping gait was improved in all patients except one. According to Paley's classification, there were ten cases of problems, one obstacle and four true complications. The problems were pin site infection controled with local antibiotics injection. There was one case of obstacle; tibial valgus deformity developed during lengthening. True complications included peroneal nerve injury, aggravation of preexsiting equinovalgus and claw toe deformities, aggravation of preexsiting valgus deformity of ankle and tibial valgus deformity. The complications execpt in one case of peroneal nerve palsy were solved out by the secondary procedures. In summery, the bone healing by distraction osteogenesis with the Ilizarov technique was relatively delayed in polio patients and it seems necessary to modify the technique to shorten the prolonged external fixation period.
Ankle ; Anti-Bacterial Agents ; Classification ; Congenital Abnormalities ; Femur ; Fibula ; Gait ; Hammer Toe Syndrome ; Humans ; Ilizarov Technique ; Infection Control ; Leg Length Inequality ; Leg ; Osteogenesis, Distraction ; Paralysis ; Peroneal Nerve ; Poliomyelitis ; Socioeconomic Factors ; Tibia

There are many difficult problems and various methods in the treatment of difficult fractures of the femur. Form May 1991 to August 1994, 9 cases of difficult fractures of the femur were treated with Ilizarov external fixator. We obtained good result for all cases as follow : 1. There were 1 case of severely segmental and comminuted fracture with bone loss, 3 cases of infected nonunion after internal fixation(2 cases combined with bone loss), 2 cases of non-union after internal fixation and 3 cases of severely segmental and comminuted fractures. The traffic accident injury was in 6 cases and the falling down injury was in 3 cases. 2. The bone union was obtained in all cases and the duration of Ilizarov external fixator application was minimum 7.7 months up to 19 months with an average of 1.3 months and full weight bearing was possible in all cases after removal of the Ilizarov external fixator. 3. We experienced 9 complication; there were 6 cases of pin tract infection which were controlled by antibiotic injection at that site and there were three cases of limitation of motion of knee. So we conclude that the Ilizarov external fixation technique is one of the effective methods for the treatment of difficult fracture of the femur(ex. segmental, comminuted fracture, bone defect, osteomyelitis and nonunion) in spite of having experienced only few cases.
Accidental Falls ; Accidents, Traffic ; External Fixators ; Femur ; Fractures, Comminuted ; Knee ; Osteomyelitis ; Weight-Bearing

No abstract available.
Congenital Abnormalities* ; Ilizarov Technique*

Legg-Calve-Perthes disease is a hip disorder of undetermined etiology, occurring in children and characterized by necrosis and repair of the proximal femoral epiphysis. Many methods of the treatment were reported with good result and the goals of them were prevention of deformity of femoral head and secondary osteoarthritis of femoral head with concept of containment. The purpose of this study is to determine the significance of soft tissue release operation in patient of Legg-Calve-Perthes disease, whose prognosis will be poor by clinical and rsdiological evaluation at diagnosis. Soft tissue release operation was carried out 21 hips of 19 patients of Legg-Calve-Perthes disease at Severance Hospital from January 1986 to October 1987 and satisfactory result was obtained. We consider our method as new, effective treatment modality and its significance is to reduce abnormal pressure to femoral head, to restore normal range of motion, to avoid recurrent ischemia, and, finally, to avoid progression of deformity by soft tissue release operation.
Child ; Congenital Abnormalities ; Containment of Biohazards ; Diagnosis ; Epiphyses ; Head ; Hip ; Humans ; Ischemia ; Legg-Calve-Perthes Disease ; Methods ; Necrosis ; Osteoarthritis ; Prognosis ; Reference Values