Port-wine stains (PWSs) are benign congenital vascular malformations that most commonly occur as isolated lesions on the face, neck and trunk. The major indication for therapy in most patient, regardless of age, is psychological burden imposed by the PWSs. A Candela SPTL-1 flashlamp-pumped pulsed dy laser (Candela Corp. Wayland, Mass.) using the principle of selective photothermolysis was used. Selective cutaneous vascular damages are influenced by the wavelength. pulse duration and energy density of the laser. To evaluate histopathological changes according to energy densities are essential to treat cutaneous benign vascular lesion by the iaser. 5 patients with PWSs were treated with the Candela SPTL-1 laser. Lesions were biopsied and analized immediately after laser exposure. 2 days and 7 days after laser exposure. The results were as follows : 1. Depth of penetration The penetration depth was increased from .2mm to 1.9mm with energies ranging from 6J/cm(2) to 10J/cm(2) respectively. 2. Nonvascular damages of epidermis & dermis Focal epidermal vacuolization has been observed in biopsy specimens immediately after laser exposure with energy density 6J/cm(2). As energy densities increased from 6J/cm(2) to 10J/cm(2), histopathological changes got worsened with appearance of vesicles. subepi dermal seperations and epidermal necrosis. 2. Vascular damages of dermis Multiple foci of agglutinated RBC, fibrin and platelet thrombi within the dermal blood vessels have been observed in biopsy specimens immediately after laser exposure. There was a pattern of "acute vasculitis" in the upper dermis and a prominent perivascular neutrophilic responses in the mid-dermis 2 days after laser exposure. Dermal vessels with smaller lumen and granulation tissue have been observed in biopy specimens 7 days after laser exposure. In summary, penetration depth of laser beam and nonvascular epidermal and dermal damages were directly proportional ot the energy density of the laser. But 7 days after laser exposure, epidermis and dermis showed normal appearance without detectable scarring. This study suggested that Candela SPTL-1 laser is safe and has no scar formation on the treatment of PWSs.
Biopsy ; Blood Platelets ; Blood Vessels ; Cicatrix ; Dermis ; Epidermis ; Fibrin ; Granulation Tissue ; Humans ; Neck ; Necrosis ; Neutrophils ; Port-Wine Stain* ; Vascular Malformations

No abstract available.

BACKGROUND: Therapeutic drug monitoring (TDM) has been shown to be effective in minimizing the risk for toxicity and maximizing the efficacy of the drugs. The application of pharmacokinetics principles to indiviualization and optimization of dosage is necessary. We evolved interpretative report system of digoxin determination in a view of individual's pharmacokinetics. The alto of the present study is to validate the effectiveness of the interpretative report system in digoxin therapeutic monitoring service. METHODS: We reviewed 125 inpatients of two groups. 4 group, before interpretative reporting, had 86 inpatients from February 1996 to March 1996. B group included 39 inpatients from September 1996 to October 1996 after the practice of the sytem. Digoxin concentrations were measured in serum by TDxFlex (Abbott Laboratories, U.S.A.). Each patient's digoxin pharmacokinetics was determined by using the Abbott-base Pharmacokinetics system (Abbott Laboratories, U.S.A.) . The interpretation for the assayed digoxin level, the recommendation of maintenance dosage and the simulation graph with predicted serum levels were included in the report. The effectiveness of the reporting system was evaluated by comparing the appropriateness of digoxin level measurement between both groups. RESULTS: It revealed that appropriate measurements of digoxin level were 59.5 % of the tests in A group and 77.1% of those in B group (p=0.006). Evaluation of serum digoxin concentrations stratified by digoxin concentration showed also significant difference among the percentage of tests in each concentration range between both groups (p=0.011). CONCLUSIONS: Interpretative report system for the assayed results caused to increase in the appropriateness of digoxin measurement. The report system with some improvement which is achieved through the active approach to physician helps us use TDM effectively. The system can be applied to the other TDM drugs.
Digoxin ; Drug Monitoring* ; Humans ; Inpatients ; Pharmacokinetics

BACKGROUND: Therapeutic drug monitoring (TDM) has been shown to be effective in minimizing the risk for toxicity and maximizing the efficacy of the drugs. The application of pharmacokinetics principles to indiviualization and optimization of dosage is necessary. We evolved interpretative report system of digoxin determination in a view of individual's pharmacokinetics. The alto of the present study is to validate the effectiveness of the interpretative report system in digoxin therapeutic monitoring service. METHODS: We reviewed 125 inpatients of two groups. 4 group, before interpretative reporting, had 86 inpatients from February 1996 to March 1996. B group included 39 inpatients from September 1996 to October 1996 after the practice of the sytem. Digoxin concentrations were measured in serum by TDxFlex (Abbott Laboratories, U.S.A.). Each patient's digoxin pharmacokinetics was determined by using the Abbott-base Pharmacokinetics system (Abbott Laboratories, U.S.A.) . The interpretation for the assayed digoxin level, the recommendation of maintenance dosage and the simulation graph with predicted serum levels were included in the report. The effectiveness of the reporting system was evaluated by comparing the appropriateness of digoxin level measurement between both groups. RESULTS: It revealed that appropriate measurements of digoxin level were 59.5 % of the tests in A group and 77.1% of those in B group (p=0.006). Evaluation of serum digoxin concentrations stratified by digoxin concentration showed also significant difference among the percentage of tests in each concentration range between both groups (p=0.011). CONCLUSIONS: Interpretative report system for the assayed results caused to increase in the appropriateness of digoxin measurement. The report system with some improvement which is achieved through the active approach to physician helps us use TDM effectively. The system can be applied to the other TDM drugs.
Digoxin ; Drug Monitoring* ; Humans ; Inpatients ; Pharmacokinetics

BACKGROUND: Methylmalonic aciduria can be caused by inherited defects in the methylmalonyl-CoA mutase enzyme, Inherited defects in the metabolism of vitamin Bl2 and acquired or inherited vitamin Bl2 deficiency. Quantitation of urinary methylmalonic acid (MMA) is very useful In diagnosis of methylmalonic acidemia and cobalamin deficiency. We evaluated a quantitation method of urinary MMA and determined reference values. METHODS: The method involved stable isotope dilution gas chromatographymass spectrometry (GC-MS) with (methyl 2H3)-MMA as the internal standard. We determined the detection limit, linearity and periodic variations of the assay. Urinary MMA levels were measured in 70 individuals of ages newborn to 58 years with no metabolic disorders. RESULTS: The lower limit of detection calculated from blank runs (mean+/-3SD) was 2.62nmo1/m1. One control urine tramp)e analyzed 23 times within 3 weeks game results of 7.83+/-1.09 (mean+/-SD, CV=13.8%) nmol/mL. The linearity at four different concentrations of MMA was acceptable (R2=0.9992). The concentration of urinary MMA in 70 individuals was 2.33+/-2.19 mmol/mol creatinine (mean+/-SD). Age related reference values which decreased with age were also reported (p=1.23x10-9). CONCLUSIONS: The described method is sensitive, specific and noninvasive, which is considered the gold standard method for measuring MMA. The method could be used as a screening test for cobalamin deficiency and inherited methyl malonic acidemia. On the basis of the narrow range of normal concentration, it is expected that the method would readily detect mild cobalamin deficiency.
Chromatography, Gas* ; Creatinine ; Diagnosis ; Gas Chromatography-Mass Spectrometry* ; Humans ; Infant, Newborn ; Limit of Detection ; Mass Screening ; Metabolism ; Methylmalonic Acid* ; Methylmalonyl-CoA Mutase ; Reference Values ; Spectrum Analysis ; Vitamin B 12 ; Vitamins

Drowning is one of the most common causes accidental death worldwide, but its diagnosis remains a challenging task in forensic pathology. Several authors have suggested that diatom analysis be conducted via an enzymatic digestion method that uses proteinase K to provide objective evidence for drowning; we employed this method in our study because of its superior applicability as compared to the conventional disorganization methods. The purpose of this study was to examine the reclaiming ratio of diatoms from experimentally drowned animal organs, which could be influenced by diatom morphology. The authors injected 3 diatoms species (Cyclotella striata, Navicula incerta, and Pleurosigma angulatum) into a rat's airway and compared the detection rate to investigate the factors that influence the sensitivity of diatom analysis. The results are as follows: (1) Average reclaiming ratio in the lungs was 81.07 for Navicula incerta, 48.26 for Cyclotella striata, and 5.35 for Pleurosigma angulatum. (2) The detection rates from the closed organs in 15 experimental animals were highest in the kidney (73%, 11/15), followed by the heart (67%, 10/15), brain (60%, 9/15), and liver (53%, 8/15). (3) Two Cyclotella striata was detected in the kidney of postmortem control group which suggest the possibility of contamination during laboratory procedure. In conclusion, the authors propose that diatom size could be a significant influencing factor for diatom extraction from the organs of drowned bodies; therefore, the results of diatom analysis must be interpreted after considering the diatom population of the drowning medium at the scene and the possibility of contamination during the laboratory procedure.
Animal Structures ; Animals ; Brain ; Diatoms ; Digestion ; Drowning ; Endopeptidase K ; Forensic Pathology ; Heart ; Kidney ; Liver ; Lung

No abstract available.
Drug Therapy, Combination* ; Ulcer*

Silicone gel sheeting is widely used to manage the hypertrophic or keloid scars. Since first reported in 1982 to be an effective treatment for burn scars and contractures, many authors reported its efficacy to treat scars. Chemically silicone gel sheet composed of cross-linked dimethy1 and vinyl enblocked polydimethylsiloxane polymer. The exact mechanism of silicone gel sheet to treat hypertrophic scar was still unknown, but decreasing the water vapor transmission was supposed to level the scar. During out clinical experience, a few patients suffered from skin problems by silicone gel sheeting. So we designed a study to determine the severity of skin hypersensitivity of silicone gel sheeting. Four types of silicone gel sheets were applied to upper arms of 140 healthy voluntees. Resultant skin lesions were analysed 48 and 96 hours later to differentiate the irritation and the true hypersensitivity. About 30 percent of voluteers represented mild skin irritability(48 hours later), but true skin hypersensitivity was not found(96 hours later). The site to be applied with silicone gel sheet is very critical area, so pretesting the irritability of silicone gel sheeting to individuals is an important step to control the hypertrophic scar.
Arm ; Burns ; Cicatrix ; Cicatrix, Hypertrophic ; Contracture ; Humans ; Hypersensitivity* ; Keloid ; Patch Tests* ; Polymers ; Silicone Gels* ; Skin* ; Steam

No abstract available.
Choledochal Cyst* ; Cholestasis*

BACKGROUND: The purpose of this study was to assess the results of arthroscopic bridging repair using a human dermis allograft in the treatment of massive irreparable rotator cuff tears. METHODS: From November 2009 to April 2011, 12 patients underwent arthroscopic bridging repair using a human dermis allograft in the treatment of massive irreparable rotator cuff tears. Patients were followed for an average of 33.9 months. Clinical outcome was evaluated preoperatively and postoperatively using the mean University of California, Los Angeles (UCLA) score and the Korean Shoulder Scoring System (KSS). Magnetic resonance imaging (MRI) was performed postoperatively at an average of 6.5 months. RESULTS: At a mean follow-up of 33.9 months (range, 25 to 42 months), 11 out of 12 patients were satisfied with their procedure. Patients showed significant improvement in their mean modified UCLA score from 15.9 preoperatively to 29.4 postoperatively (p=0.001). The mean KSS score improved from 45.6 preoperatively to 80.5 postoperatively (p=0.002). In MRI studies, 9 out of 12 patients had full incorporation of the graft into the native rotator cuff remnant. To date, there has been no intraoperative or postoperative complication from the graft procedure, such as infection or allograft rejection, in any patient. CONCLUSIONS: Arthroscopic bridging repair using a human dermis allograft can be considered as an option in treatment of select cases of massive irreparable rotator cuff tears, resulting in high patient satisfaction.
Allografts* ; California ; Dermis* ; Follow-Up Studies ; Humans* ; Magnetic Resonance Imaging ; Patient Satisfaction ; Postoperative Complications ; Rotator Cuff* ; Shoulder ; Tears* ; Transplants