PURPOSE: The artificial erection is critical to chordee repair. We report the use of a natural erection induced by prostaglandin E(1)(PGE1) in the diagnosis and treatment of penile curvatu re as an alternative to artificial erection in children and adult patients. MATERIALS AND METHODS: Pharmacological erection was induced 14 children with a mean age of 5 years (range 1-10) and 8 adults with a mean age of 33 years (range 18-58) to diagnose and repair anomalies, such as simple penile curvature, chordee with or without hypospadias, webbed penis and Peyronie's disease. Alprostadil (1-16ng) as a agent for induce erection was used exclusively, but no agents were routinely given to reverse the erection was used exclusively, but no agents were routinely given to reverse the erections. The dose injected intracavernosally was dependent on the patient's age, penile size and response, and ranged from 0.5 to 10 micrograms. Time to and adequacy of erection, detumescence, changes in blood pressure and pulse rate were monitored. RESULTS: A dilatation of erectile tissue was achieved within 8 minutes and was judged adequate in 2 and excellent in 20. The mean duration of erection was 107 minutes, while a prolonged erection, for up to 2.5 hours, occured on 2 patients who were treated conservatively. Detumescence were occurred when the corpora were opened, but re-erected penis after closure of corpora in 7 cases who treated with Nesbit's corporeal plication or fibrous plaque excision and dermal graft. Although there were the impression of increased bleeding, there were no specific changes in blood pressure or pulse rate. CONCLUSIONS: Pharmacological erection in penile curvature is effective and reliable with no significant complications. Although PGE1 is expensive and induced slightly increased bleeding, pharmacological erection has the advantage of tumescence of the entire penis and consequently a constant and natural representation of chordee without corporeal or urethral injury. Therefore, the erection achieved by injecting PGE1 into the corpora cavemosa is a useful alternative to artificial erection in the diagnosis and treatment of penile anomalies.
Adult ; Alprostadil ; Blood Pressure ; Child ; Diagnosis ; Dilatation ; Female ; Heart Rate ; Hemorrhage ; Humans ; Hypospadias ; Male ; Penile Induration ; Penis ; Transplants

BACKGROUND: Chronic cutaneous lupus erythematosus(CCLE) is a well-known disease entity. But there has been no data about its clinical behavior and histopathologic features in Korea. OBJECTIVES: This study was conducted to elucidate the clinical, laboratory, and histopathologic features of CCLE, and the relationship between CCLE and SLE. MATERIALS AND METHODS: We investigated 48 cases of CCLE that visited the department of dermatology at the Seoul National University Hospital from January 1990 to June 1997. Medical records and biopsy slides were reviewed.
Biopsy ; Dermatology ; Korea ; Lupus Erythematosus, Cutaneous* ; Medical Records ; Seoul

The early ultrastructural changes of basement membrane thickening and degeneration of the pericyte were noted in retinal capillaries in diabetic patients. However no early ultrastructural changes were reported in diabetic iris capillary. The authors studied the ultrastructural features of basement membrane of iris capillaries which were obtained during cataract surgery in five diabetic patients and compared with those obtained in five nondiabetic patients. The endothelium basal lamina, pericyte basal lamina and membrane-like pericyte matrix in didabetic iris capillaries were thicker than those in nondiabetic Iris capillaries. The thickening of pericyte basal lamina is more prominant than the endothelium basal lamina in diabetes. The duration of diabetes had no relationship to endothelium basal lamina but, showed statistically significant relationship to thickness of pericyte bascal lamina and pericyte matrix.
Basement Membrane* ; Capillaries* ; Cataract ; Endothelium ; Humans ; Iris* ; Pericytes ; Retinaldehyde

BACKGROUND: The pathogenesis of confluent and reticulated papillomatosis(CRP) is still unknown, although many theories have been suggested. It is stressed that abnormal host response to colonization of pityrosporum orbiculare might play a role in the pathogenesis of CRP, but is not completely understood. Frequently, we have observed bacterial colonies in the stratum corneum and, especially, within the hair follicles from biopsy specimens of patients with CRP. In addition, successful treatment for CRP with minocycline, a derivative of tetracyclines, has been reported continuously. OBJECTIVE: The purpose of this study was to document the possible association of bacterial factors in the pathogenesis of CRP and to elucidate the effectiveness of minocycline. METHODS: We performed Brown and Brenn gram staining in 12 biopsy specimens, bacterial cultures, identification of microorganisms and antibiotics sensitivity testing including minocycline. We administered oral minocycline with an initial dose of 100mg per day for 1 to 3 months and a maintenance dose 50mg per day for I to 2 months, then evaluated the response of treatment. RESULTS: 1. On Brown and Brenn staining, the gram positive bacterial colonies that stained dark bluish or nearly black were observed within the infundibulum of hair follicles in 10 out of 12 biopsy specimens(83.3%) and on the keratotic invagination of stratum corneum in 11 out of 12 biopsy specimens(91.7%). 2. Histological features of regions where bacterial colonies were observed showed, hyperkeratosis and keratotic invagination on the stratum corneum in all cases. Hyperkeratosis(66.7%), parakeratosis(16.7%), inflammatory cell infiltration(25.0%), perifollicular fibrosis(33.3%), and abnormal keratin in sebaceous ducts(50.0%) were shown in hair follicles. 3. In anaerobic cultures, no bacteria was grown. In aerobic cultures, staphylococcus species were identified in 6 cases, streptococcus viridans in one case, sternotrophomonas maltophilia in one case. In the susceptibiliity test, minocycline was sensitive in 7 from 8 cases. 4. The therapeutic response to minocycline was observed within one month in all cases, and the time to clear the lesions was 1/2 month in 2 cases, 1 month in 4 cases, 2 months in 5 cases, 3 months in one case, respectively. CONCLUSION: Form these results, we suggest that bacterial factors may play an important role in the pathogenesis of CRP and that the action mechanism of minocycline in the treatment of CRP may be due to antibacterial effects.
Anti-Bacterial Agents ; Bacteria* ; Biopsy ; Colon ; Hair Follicle ; Humans ; Malassezia ; Minocycline ; Papilloma* ; Staphylococcus ; Tetracyclines ; Viridans Streptococci

A 26-year-old Korean man had an erythematous scaly plaque on his right thigh for fifteen years. He was diagnosed with chronic eczema and treated with topical steroid, but no clinical improvement was obtained for 15 years. Laboratory studies including complete blood cell count, urinalysis, liver and renal function test, and peripheral blood smear were normal. A biopsy specimen showed hyperkeratosis, acanthosis, and mononuclear cellular infiltration in the epidermis. These cells had a perinuclear halo and showed a Pautrier's microabscess like configuration. In the dermis, there was a band like infiltration of inflammatory cells. Infiltrates of the epidermis were negative for leukocyte common antigen(CD45) and positive for Pan T cell(CD45RO). He was treated with topical PUVA twice a week for twelve weeks. Clinical and pathological improvements were obtained. We propose PUVA may be a useful therapeutic modality to treat Woringer Kolopp disease.
Adult ; Biopsy ; Blood Cell Count ; Dermis ; Eczema ; Epidermis ; Humans ; Leukocytes ; Liver ; Pagetoid Reticulosis* ; Thigh ; Urinalysis

We report the clinical evolution of two male patients with generalized granulama annulare(GGA) who were controlled with hydroxychloroquine. In the first case, a 3-year-old boy was treated with systemic steroid, and in the second case, a 68-year-old man was treated with prednisolone, niacin, and retinoic acid. But, remission and recurrence of the skin lesions were repeated. A good clinieal response was achieved in both cases after administration of hydroxychloroquine without side effects or any signs of recurrence. Hydroxychloroquine may be helpful to treat the GGA that have side effects to the systemic corticosteroid or resistence to other therapeutic modalities.
Aged ; Child, Preschool ; Granuloma Annulare* ; Granuloma* ; Humans ; Hydroxychloroquine* ; Male ; Niacin ; Prednisolone ; Recurrence ; Skin ; Tretinoin

Pneumatic retinopexy is a new procedure that is effective in treating the uncomplicated cases of rhegmatogenous retinal detachments. The procedure of pneumatic retinopexy is composed of cryotherapy(photocoagulation), intraocular gas injection and postoperative positioning. The advantages of this procedure are less tissue damage, no hospitalization, reduced expense and minimal complication. For these reasons, this procedure has become popular retinal detachment surgeons. Peports of associated complications are still limited. The authors experienced one case of choroidal detachment after intraocular gas(SF6 gas) injection in rhegmatogenous retinal detachment in pseudophakic eye.
Choroid* ; Hospitalization ; Retinal Detachment

Tangential vitreoretinal traction around fovea is known to be the principal cause in the pathogenesis of idiopathic macular holes. According to the recent study, the internal limiting membrane(ILM) may provide a scaffold for fibroblast proliferation and contraction, therefore play an important role in the enlargement of macular hole. We removed the ILM during macular hole surgery and assessed the anatomical and functional outcome of the macular hole surgery. Twelve consecutive patients with full-thickness macular hole were enrolled in this study. They were examed for best-corrected vision, fundus photography, fluorescein angiography, Humphrey automated perimetry, focal eletroretinogram, before and after surgery. After surgery, vision was improved in 8 eyes(67%), hole was closed in 10 eyes(83%). Macular thresholds on visual field was increased in 8 eyes and peripheral scotomas developed in 3 eyes postoperatively. The amplitude increased in 7 eyes and the implicit time decreased in 8 eyes on focal electroretinograms postoperatively. Out results suggested that the complete removal of ILM should be attempted to improve vision and to close holes during the full-thickness macular hole surgery.
Fibroblasts ; Fluorescein Angiography ; Humans ; Membranes* ; Photography ; Retinal Perforations* ; Scotoma ; Traction ; Visual Field Tests ; Visual Fields

BACKGROUND: There are many rating scales for assessment of geriatrics. But each of these scales were not sufficient to evaluate comprehensive geriatric assessment, physical and psychologic efforts for care. METHODS: We developed new scales to comprehensive geriatric assessment for care of geriatric patients. The Geriatrics Physical Support Scale(GPSS) evaluates physical effort consists of 10 areas and the Geriatrics Global Support Scale(GGSS) evaluates general condition of patients consist of 6 areas. Eighty probable and possible AD patients received the Clinical Dementia Rating Rating Scale(CDR), Korearn version of Mini-Mental State Examination(K-MMSE), Barthel Activity of Daily Living Index(B-ADL) GPSS, GGSS. We tested internal consistency, correlation among dementia rating scales. RESULTS: The GPSS correlated to CDR -0.63(p<0.01), B-ADL -0.90(p<0.01) and the GGSS correlated to CDR -0.60(p<0.01), B-ADL -0.75(p<0.01). The internal consistency were 0.69(GGSS), 0.92(GPSS). CONCLUSION: The Geriatrics Global Support Scale evaluate general condition of patients and the Geriatrics Physical Support Scale evaluate physical efforts needed for care of geriatric patients. These scales an also brief and easy rating scales to grade degree of caregiver`s burden.
Dementia ; Geriatric Assessment ; Geriatrics* ; Humans ; Physical Exertion ; Reproducibility of Results* ; Weights and Measures

PURPOSE: To clarify the chracteristic sonographic features of benign soft tissue tumors and to evaluate the usefulness of sonographic imaging. MATERIALS AND METHODS: We retrospectively reviewed ultrasonographic images of 70 cases in 68 patients with histologically proved benign soft tissue tumors. RESULTS: The tumors included 33 lipomas, 11 hemangiomas. 11 lymphangiomas, 7 neurilemmomas, 4 epidermold cysts, 2 fibromas, 1 mesenchymoma, and 1 myxoma. The SOhographic appearances of the lesions were mainly solid in 53 cases(33 lipomas, 8 hemangiomas, 2 lymphangiomas, 7 neurilemmomas, 2 fibromas and 1 mesenchymoma), mainly cystic in 14 cases(1 hemangioma, 8 lymphangiomas, 4 epidermoid cysts, and 1 myxoma), and mixed in 3 cases(2 hemangiomas and 1 lymphangioma). Although an accurate histologic prediction could not be made in most cases, certain patterns appeared to be characteristic of specific tumor types. 26 cases(78%) of lipoma were seen as lentiform, iso- or hyperechoic, solid mass. Hemangioma had variable appearance and chacteristic calcifications were seen in 3 cases. Unicameral or multiseptated cystic mass with variable thickness of echogenic septa and solid portion was the characteristic finding of lymphangioma. Neurilemmoma showed Iobulated, oval to round, relatively hypoechoic mass with or without internal cystic portion. CONCLUSION: Sonographic evaluation of benign soft tissue tumros is useful in demonstrating the location, size, extent, and internal characteristics of the mass. A relatively confident diagnosis can be made when the characteristic features of the benign soft tissue tumor are present on sonographic imaging.
Diagnosis ; Epidermal Cyst ; Fibroma ; Hemangioma ; Humans ; Lipoma ; Lymphangioma ; Mesenchymoma ; Myxoma ; Neurilemmoma ; Retrospective Studies ; Ultrasonography