The present study was intended to examine the spectrum of radiographic patterns of the stomach associated withacute and chronic pancreatitis and their complications. Subjects served for the study consisted of 70 cases ofpancreatitis (36 cases in acute stage and 34 cases in chronic stage). Intramural and perigastic permeation ofextravasated pancreatic enzymes and secondary inflammatory reacation that follows are responsible for theardiographic change observed. 1. Generalized rugal thickening and particularly selective mucosal prominences ingreater curvature of body and antrum are characteristically seen in acute(14 of 36 cases
Diagnosis ; Diagnostic Errors ; Pancreatitis, Chronic ; Stomach

Confluent and reticulated papillomatosis(CRP) is a rare dermatosis. The lesions are hyperkeratotic, verrucous papules and plaques, resulting in a confluence of lesions centrally and a reticulated pattern at the periphery. It is more common in women and during puberty. The histopathological findings show papillomatosis, hyperkeratosis and a sparse superficial perivascular lymphocytic infiltrate. We report a case of CRP that responded to oral etretinate in an 18-year-old man.
Acitretin* ; Adolescent ; Etretinate* ; Female ; Humans ; Papilloma* ; Puberty ; Skin Diseases

PURPOSE: In spite of the recognition of hyperfiltration injury after kidney donation, the function of the remaining kidney is considered relatively good. Few published reports have examined donor renal outcome after 10 years or later. We evaluated the effect of donor nephrectomy on donor renal outcome and the safety of the kidney donations. METHODS: From January 1991 to August 1994, 205 living donor nephrectomies were performed. 32 donors were available for evaluation at minimum 10 years after the operation. Preoperative laboratory findings included blood urea nitrogen (BUN), serum creatinine, 24-hour creatinine clearance (CCr) and 24-hour urine protein. The same indices were checked at one month after the operation and at the last follow up and was compared with preoperative indices. The CCr was compared with an age adjusted glomerular filtration rate (AGFR) for normal kidney. Blood pressure was checked and compared with general population. RESULTS: Mean patient follow up period was 11 years (10~15 years). BUN and serum creatinine increased, while CCr decreased from the preoperative levels, although still within normal limits. 24- hour urine protein was significantly increased from the preoperative level, and was higher than normal limits. CCr was not significantly different from AGFR. The incidence of hypertension was not higher than the general population. CONCLUSION: Most of the renal indices are well preserved within normal limits at 10 years after donor nephrectomy. Urinary protein excretion increases with marginal significance but seems to be of no clinical significance in most patients. Prospective and longer term follow-up of the donors after donor nephrectomies are needed to establish the safety for the kidney donation.
Blood Pressure ; Blood Urea Nitrogen ; Creatinine ; Follow-Up Studies* ; Glomerular Filtration Rate ; Humans ; Hypertension ; Incidence ; Kidney ; Kidney Transplantation ; Living Donors ; Nephrectomy* ; Tissue Donors*

BACKGROUND: Redundant and wrinkled face is a common finding in patients with long-standing leprosy, which is responsible for the appearance of premature aging. Chemical peeling plays a role in dermal regeneration in the treatment of wrinkles. However, the effect of chemical peeling has rarely been studied in patients with leprosy. OBJECTIVE: To investigate the effect of chemical peeling on dermal connective tissue components and clinical improvement of facial wrinkles in patients with leprosy. METHODS: Five patients with clinically and bacteriologically inactive lepromatous leprosy were treated with 70% glycolic acid plus 35% trichloroacetic acid (GA-TCA). Histologic and clinical changes were evaluated at 0 and 90 days postpeel. RESULTS: Histologically, collagen fibers and ground substance increased significantly but elastic fibers did not change at 90 days postepeel. Clinically, fine wrinkles improved considerably, whereas most deep wrinkles remained unchanged at day 90. CONCLUSION: This study demonstrates that chemical peeling with GA-TCA, or medium-depth peeling, causes an increase in collagen and ground substance but not in elastic fibers. These changes result in limited clinical improvement in the facial wrinkles of leprosy patients. Therefore, medium-depth chemical peeling may be insufficient to improve the premature aging appearance in patients with leprosy.
Aging, Premature ; Collagen ; Connective Tissue* ; Elastic Tissue ; Humans ; Leprosy* ; Leprosy, Lepromatous ; Regeneration ; Trichloroacetic Acid

BACKGROUND: Spacer graft is known to be a very effective surgical method in the treatment of paralytic ectropion. OBJECTIVE: This study was performed to evaluate deep temporal fascia as a spacer instead of Alloderm in spacer graft to correct paralytic ectropion. METHODS: In seven patients with the lower lid ectropion as a sequela of Hansen's disease, a strip of deep temporal fascia, 4.0cm long and 0.5cm wide, was obtained from the scalp. A separation between the tarsal plate and the capsulopalpebral fascia was made and the strip was inserted into the space. Two ends of the strip were fixed to the medial and lateral canthal ligaments respectively like a sling. RESULT: In all patients, immediate postoperative improvement was achieved, which was to the same degree in the patients treated with Alloderm previously reported. And no serious complications were observed in both donor and graft sites. CONCLUSION: As a spacer in spacer graft, patient's own deep temporal fascia shows good cost-effectiveness ratio and can be an alternative to Alloderm. However, further studies are neccessory to find out the long term efficacy, especially recurrence.
Ectropion* ; Fascia* ; Humans ; Leprosy ; Ligaments ; Recurrence ; Scalp ; Tissue Donors ; Transplants*

To affect the complete closure of the eyelids in leprosy patients with lagophthalmos, we have used various surgical methods to avoid using the temporalis transfer method. Although widely accepted as the most effective treatment for the chronic lagophthalmos patient, the temporalis transfer method creates a simultaneous involuntary closure of the eyelids while biting or chewing. This side effect creates a social stigmata which former leprosy patients wish to avoid. As a result, we have attempted to identify the most effective treatment which will also eliminate this involuntary closure of the eyelids during biting or chewing. In the upper eyelid, we performed gold plate implantation and levator muscle severing. In the lower eyelid, lateral tarsal strip, permanent medial tarsorrhaphy, horizontal shortening, cartilage grafting and alloderm graft have all been used in the treatment of ectropion. Based on our treatment of multiple patients, we now believe medial tarsorrhaphy supplemented with the various other methods mentioned above are insufficient to achieve the desired result of complete closure of the eyelids. As a result, we are now looking to a modified temporalis transfer procedure to ensure complete closure of the eyelids without the eye closing side effect.
Cartilage ; Christianity ; Ectropion ; Eyelids ; Humans ; Leprosy ; Mastication ; Transplants

Damages to the sensory, autonomic and motor nerves in leprosy patients are followed by anesthesia, dryness of the skin and muscular paralysis. Most plantar ulcers in leprosy patients are caused by repetitive moderate stress. Minor injuries such as bruising sustained as a result of the misuse of anesthetic limbs may lead to ulceration, scar formation and secondary infection. Cellulitis develops and destroys subcutaneous tissue, resulting in an infection which can reach the bone. As a result of osteomyelitis, bone is absorbed, sequestra are extruded and the architecture of the foot is destructed. The most common sites of the plantar ulceration are over the metatarsal heads, the base of the fifth metatarsal, the base of the proximal phalanx, and the calcaneus. During the past 9 years, we treated 85 patients with ulcers located on the sole and the dorsum of the foot, and lower third of the leg. To prevent osteomyelitis and amputation of the lower leg, we performed various treatment modalities such as free and pedicle flaps, skin grafts, and mechanical stretching devices of the skin (e.g., Sure Closure, Proxiderm, etc), as well as consistent vacuum-assisted closure. We obtained satisfactory results in most cases. We report detailed results and related references.
Amputation ; Anesthesia ; Calcaneus ; Cellulitis ; Cicatrix ; Coinfection ; Extremities ; Foot Ulcer* ; Foot* ; Head ; Humans ; Leg ; Leprosy* ; Metatarsal Bones ; Negative-Pressure Wound Therapy ; Osteomyelitis ; Paralysis ; Skin ; Subcutaneous Tissue ; Transplants ; Ulcer

Paralytic lagophthalmos and ectropion in the treatment of leprosy patients are serious complications of facial paralysis, which may lead to exposure keratitis and corneal ulceration, which can further lead to blindness. In 1995, 1997, 1999 and 2001, we reported in this journal on the surgical treatment of paralytic lagophthalmos and ectropion. In the 1st report, made in 1995, for lid closing, I (Ahn) performed various methods of traditional surgery such as temporal muscle transfer, medial and lateral canthoplasty, as well as gold implantation. In the 2nd report, made in 1997, we (Ahn and Park) presented a combination treatment of gold plate with minor changes of design and weight in the upper lid and medial canthoplasty with horizontal shortening in the lower lid. In the 3rd report, made in 1999, we described an additional graft of conchal cartilage in the lower lid. However, the lateral end of the cartilage would warp and create new partial ectropion several months later. Therefore, we shifted from cartilage to Alloderm(R), acellular dermal graft. In the 4th report, made in 2001, we reported that Alloderm(R) is a good substitute for the cartilage and is also an effective volume filler to the atrophic lower lid. The medial portion of the lower lid often presented with a recurrence of the ectropion, despite having tightened the bilateral plication of the medial and lateral canthal ligaments with an Alloderm(R) graft in the inferior border of the tarsus. In order to treat the recurring ectropion, a modified permanent tarsorrhaphy was performed. We have noted that a modified permanent tarsorrhaphy on the medial canthal area in Z-plasty successfully corrected the partial ectropion and resulted in decreased epiphora and increased esthetic satisfaction.
Ankle ; Blindness ; Cartilage ; Corneal Ulcer ; Ectropion* ; Facial Paralysis ; Humans ; Keratitis ; Lacrimal Apparatus Diseases ; Leprosy ; Ligaments ; Recurrence ; Temporal Muscle ; Transplants

Changes in the eye resulting from leprosy include lagophthalmos, ectropion and the eyelid retraction. In lagophthalmos, an interpalpebral gap(lid gap) of 2mm or less, which is most preferred after correction, does not have any adverse effect on the vision. However, a gap of 3mm or greater can cause or make the eye susceptible to the dryness of the cornea or other vision problems. Bell's phenomenon will adequately prevent eye damages, especially corneal damage when the lid gap is less than 3mm. Although static methods such as autogenous canthal sling, lateral tarsal strip, medial tarsorrhaphy and gold implant had a positive cosmetic effect when used in combination, the lid gap could hardly reduce to less than 3mm. Frequent recurrence of lagophthalmos and ectropion after static methods required further definite surgical treatment. We applied a dynamic method of modified Gillies to correct lagophthalmos and it was successful in reducing the lid gap to less than 2mm in most cases.
Cornea ; Cosmetics ; Ectropion ; Eye ; Eyelids ; Leprosy ; Recurrence ; Vision, Ocular

Recently, there has been a strong decrease in the number of temporalis muscle transfer(TMT) operations in cases of lagophthalmos. The primary cause of this decline is patient dissatisfaction with drawbacks of eye clinching in concert with mouth closure, ectropion and ptosis. This is mostly true of patients who are now more commonly exposed to urban social environments. In 1997, I discontinued the use of TMT as part of my combination treatment method reported in this journal. Since 1998, I have removed the fascia in 20 TMT cases due to complications in the upper and lower eyelid areas. I then corrected these complications using my combination method. I still use TMT in cases of lower lip drooping. Lagophthalmos patients are treated using my combination method of gold lid loading in the upper eyelid and Alloderm insertion in the lower eyelid through fixation of both ends to the medial and lateral canthal ligaments respectively. Previously, I recommended the use of conchal cartilage but noted the complication of cartilage warping which caused creating new partial ectropion several months later. Alloderm has shown no complications and the results of its use remain most satisfactory.
Cartilage ; Ectropion* ; Eyelids ; Fascia ; Humans ; Leprosy* ; Ligaments ; Lip ; Mouth ; Social Environment