In case of severe blepharoptosis, frontalis muscle suspension with fascia or frontalis transfer has been popular for decades, but these static procedures have some disadvantages such as lagophthalmos, lid lag and remnant ptosis. Twenty-six patients with severe blepharoptosis who underwent frontalis suspension, frontalis transfer, or levator resection at Yonsei University Severance Hospital from 1980 to 1988 were studied. The follow-up period of patients ranged from 10 to 18 years with a mean of 12 years. Surveys and clinical results were obtained, In our review of postoperative complications, lagophthalmos persisted in sleep and even in forced eye closure in most patients 2 to 6 months after operation. But no recurrence was noted. In conclusion, undercorrection of ptosis is more desirable than overcorrection. As well levator resection can be considered in selected cases to prevent complications.
Blepharoptosis* ; Fascia ; Follow-Up Studies* ; Humans ; Postoperative Complications ; Recurrence

Adult wounds heal with scar-tissue formation, whereas fetal wounds heal without scarring and with a lesser inflammatory and cytokine response. The unique fetal wound repair process is not dependent on the sterile, aqueous intrauterine environment. The differences between fetal and adult wound healing appear to reflect processes intrinsic to fetal tissue, such as the unique fetal fibroblast, a more rapid and ordered deposition and turnover of tissue components, and, particularly, a markedly reduced inflammatory infiltrate and cytokine profile. Among these cytokines, the transforming growth factor-beta(TGF-beta) is a growth factor which plays an important role in the regulation of cell growth and differentiation. The fibrosis characteristic of adult wound repair may be associated with TGF-betaexcess. Recent experimental studies have focused on the specific anti-TGF-beta strategies for scarless wound healing. Decorin, a proteoglycan, is known to regulate TGF-beta. This factor antagonizes the action of TGF-betain tissues. However, little is known about the functions of this factor in vivo. The objects of the present study were to analyze the effects of TGF-beta, an important regulatory molecule in adult healing events, and the effects of decorin, known inhibitor against TGF-beta, on the fetal tissue response following wounding. Fetal cellular and extracellular matrix response to injury were evaluated by treating the wound with TGF-beta and decorin in fetal rat at 14 days gestation (term = 21 days). Histologic response and histomorphometric analysis two to eight weeks later were compared between TGF-betaonly treated wound and TGF-betawith decorin treated wound.The histologic finding of the TGF-beta treated wound was characterized by an early acute inflammatory response : by week 6 fibroblasts and collagen were predominant. In contrast, TGF-beta with decorin treated wound had no remarkable histologic evidence of acute inflammation or fibroblast penetration and few collagen was deposited. These observations demonstrate that the fetal response becomes adultlike with fibroblast proliferation and collagen accumulation when TGF-betais added, thus documenting the responsiveness of the fetal system to adult repair signals. Such responsiveness thus suggests a critical difference in the fetal wound environment. Fetal repair may proceed in the absence of trophic factors like TGF-beta, thus accounting for optimal "healing" in the absence of excessive fibrosis. And these observations also confirmed the inhibitory action of decorin against TGF-beta in rat fetus model. We can suggest that the decorin minimize the inflammatory response and subsequent cellular proliferation in wound healing process, thus eventually prevent collagen deposition and scar tissue formation.
Adult ; Animals ; Cell Proliferation ; Cicatrix ; Collagen ; Cytokines ; Decorin ; Extracellular Matrix ; Fetus ; Fibroblasts ; Fibrosis ; Humans ; Inflammation ; Pregnancy ; Proteoglycans ; Rats* ; Transforming Growth Factor beta ; Wound Healing* ; Wounds and Injuries*

Lateral osteotomy has been chosen as a part of rhinoplasty for modification of the nasal bony vault, alteration of the base width of the lateral walls, establishment of a new profile line of the nasal dorsum and lateral profile line, and closure of the open roof. Various methods of lateral osteotomy may be employed, however Orientals have characteristically broad and flat noses Compared to caucasians and for an esthetically satisfactory result, it is important to correct both in rhinoplasty. In this study, the authors performed their devised method of lateral osteotomy in 12 patients for the correction of broad, flat nasal dorsum and deviated noses. The operations could be broadly categorized into two groups: 1) short lateral osteotomy in which the lateral osteotomy line was incomplete and short, extending to the infraorbital rim; and 2) green-stick transverse osteotomy which was induced by in-siturotation fracture by osteotomy and, if considered necessary, augmentation rhinoplasty and nasal tip plasty were also performed simultaneously. Our nasal osteotomy has limited mobilization, where as the previous method has total mobilization, and it has the advantages of repositioning the broad and deviated nose in a preferable direction and shape, as well as the capability of narrowing the preferable area selectively. Especially if there is a necessity to correct both broad and flat noses such as in Orientals, our osteotomy methods have a synergistic effect in esthetic outcome when performed with augmentation rhinoplasty with a silastic implant. There were no complications such as relapse or air-way obstruction during the 4.5-month follow-up period. However, a long-term follow-up period is needed to evaluate the complications considering the physiologic aspect of the nose.
Follow-Up Studies ; Humans ; Nose ; Osteotomy* ; Recurrence ; Rhinoplasty*

Myelodysplastic syndrome (MDS) is a clonal stem cell disorder characterized by ineffective hematopoiesis, multilineage dysplasia, peripheral cytopenias with normocellular or hypercellular marrow, and susceptibility to leukemic transformation. MDS represents a heterogenous group of disorders with a wide spectrum of clinical, morphological, biologic, and genetic characteristics. MDS is classified according to the World Health Organization criteria and the International Prognostic Scoring System. Risk-adapted treatment strategies have been developed in consideration of the advanced age of patients and to improve the clinical course of the disease. The pathophysiology, cytogenetic/molecular profiles, clinical characteristics and treatment modalities according to the prognostic groups will be described. In the future, a combination of treatment modalities to increase gene reactivation and to take advantage of increased expression of target genes may be critical to improve clinical outcomes. Multiple pathways may be involved in the MDS phenotype, and combination therapies, including novel agents, may be required to make further progresses in the treatment of this disease.
Bone Marrow ; Classification ; Diagnosis ; Hematopoiesis ; Humans ; Myelodysplastic Syndromes* ; Phenotype ; Stem Cells ; World Health Organization

Sacral pressure sores have been treated by a variety of surgical methods. complete treatment needs wide excision and coverage with healthy tissue which has constant and sufficient blood supply. Use of gluteus maximus muscle flap with or without overlying skin is a revolutionary method because of the reliability of blood supply. However, it is technically a little bit complicated, and future reconstruction for recurrent decubitus is especially limited in paraplegic patients. The development of gluteal perforator-based flap with para-sacral perforator introduce a new treatment modality for the sacral pressure sores. Total 10 cases of sacral pressure sores were treated with gluteal perforator-based flap. There were minimal postoperative complications except wound dehiscence in one case. This flap has a many advantage of no transection or sacrifice of the gluteus maximus muscle, elevation time for the flap is short, reliable blood flow of the perforator, large rotation arc and no post-operative hindrance to walking in patients who are not paraplegic. The disadvantages of this perforator-based flaps are the anatomical variation in the location of perforators and the need for technically careful dissection.
Humans ; Postoperative Complications ; Pressure Ulcer* ; Skin ; Walking ; Wounds and Injuries

BACKGROUND: 1. Conventional topical treatments of alopecia areata such as intralesional injection and topical application of glucocorticosteroids, and induction of conttact sensitivity using DPCP have had dieadvantages as follow 1) a time -consuming treatment perioed 2) various forms of discomfort during and after treatment 3) many side effects. 2. Though hair follicllee are easily damaged by intense cryo-application, we anticipate the regrowth of hair without damage to the tissue when applied to the scalp lightly OBJECT: We evaluated the efficacy of treatment and side effect of cryotherapy in patients with alopecia areata and whether this method can be used for the firstiline treatment of small alopecic patches, avoiding the above disadvantages of conventional methods METHOD: 19 patients witt alopecia areata lesion(s) confined within one fourth of the totaI scalp area were treated by dip-stick method with liquid nitrogen once a week luring the first 4 weeks, then at a two week interval. A cotten tip was lightly applied to the alopecic, patches for one to two seconds. We surveyed side effects and regrowth of hair during a periodic follow up. RESULT: The results can be summurized as follows : 1. Therapeutic responses were noted in 17(89%) of 19 patients studid. 2. In all the patients who responded, vellus hair appeared within 4 weeks of treatment, and terminal hair appeared within 6 weeks of treatment. 3. There were no specific fectors showing statistical significance between therapeutic responses. 4. There were no significanf, side effects except very faint pain during cryoapplication. 5. Recurrence was observed in only patieni during a 9-12 months follow-up CONCLUSION: Cryotherpy of the alopecia areata can be regarded as an effective mode of treatment with many advantages. These include relatively good therapeutic results, short-term treatment, a simple and convenient method, and nearly no side effects. We recommerld cryotherapy as a first-line mode of treatment of alopecia area.ta lesions which are small in size and few in number.
Alopecia Areata* ; Alopecia* ; Cryotherapy* ; Follow-Up Studies ; Hair ; Humans ; Injections, Intralesional ; Nitrogen ; Recurrence ; Scalp

Miescher syndrome comprises congenital acanthosis nigricans, hypertrichosis, failure to thrive and short stature, dysmorphism especially of the jaws and oral cavity, insulin-resistant diabetes mellitus, and a characteristic general appearance. This report concerns a rare case of 12-year-old girl having insulin resistant diabetic mellitus with Miescher syndrome. The relevant literature was reviewed.
Acanthosis Nigricans ; Child ; Diabetes Mellitus* ; Failure to Thrive ; Female ; Humans ; Hypertrichosis ; Insulin ; Jaw ; Mouth

Surgical excision of the subcutaneous tissues, with or without skin excision in the axillary hair-bearing area, has been the treatment of choice for Treating axillary a osmidrosis for the several decades. However, long periods of postoperative immobilization of a shoulder joint, partial necrosis of skin flaps or hematoma and the possibility of unsightly scars are frequent complications. For the purpose of reducing these complications, we performed ultrasonic aspiration of subcutaneous fat of the axilla, including the apocrine gland, using ultrasonic liposuction technique under confirmation of endoscopy via one small skin incision. From November 1997 to December 1998, a total of 134 patients (93 women and 41 men) received surgery for bilateral axillary osmidrosis on an outpatient basis. Sixty patients were evaluated more than 6 months after surgery. Among these patients, 6patients complained of a persistent foul odor(10%). Five patients received secondary ultrasonic aspiration for persistent foul odor and were then cured. We concluded that our method has several advantages such as 1) preservation of skin flap vascularity for the prevention of flap necrosis and axillary hair, 2) minimal scarring and bleeding, 3) shorter operation time and postoperative immobilization of the shoulder joint, 4) increased patient comfort, and 5) a safer operative method for recurred cases as a secondary method.
Apocrine Glands ; Axilla ; Cicatrix ; Endoscopy ; Female ; Hair ; Hematoma ; Hemorrhage ; Humans ; Immobilization ; Lipectomy ; Necrosis ; Odors ; Outpatients ; Shoulder Joint ; Skin ; Subcutaneous Fat ; Subcutaneous Tissue ; Ultrasonics*

Benzoyl peroxide has been known to have bacteriostatic activity against Corynebacterium acnes and to have comedolytic action in patients with acne vulgaris. The present study was undertaken to evaluate the therapeutic effect of Renoxal, a 5% benzoyl peroxide lotion, in patients with acne vulgaris. A total of 35 patients entered this study at the Department of Dermatology, Seoul National University Hospital during the five months period from March to July, 1978. All patients were instructed to apply Benoxal on their affected sites once or twice daily; and the number of lesions on three fixed areas were counted before and every week for four weeks after the treatrnent. Two female patients stopped the application due to developrnent of contact dermatitis to Benoxal The results observed in the 33 patients were as follows: 1. The percentage decrease in total number of lesions in four weeks after treatment was 51.1% 2. Closed and open comedones were gradually eliminated; and their numbers were decreased in four weeks after treatment by 45. 8% and 55. 3% respectively. The papules were decreased. by 59. 1 @2 after the first week of treatment, but showed. a transient lag around tbe second week and then marked 61. 5% in four weeks after treatment. 3. Observed side effects included burning sensation,(3 cases), tightness (3 cases), itching sensation (2 cases) and scaling (1 case). All were tolerable without any specific measure or discontinuance of the application. The authors concluded througb this experiment that Benoxal (5% benzoyl peroxide lotion) is a very effective local therapeutic agent in the treatment of acne vulgaris patients.
Acne Vulgaris* ; Benzoyl Peroxide ; Burns ; Dermatitis, Contact ; Dermatology ; Female ; Humans ; Propionibacterium acnes ; Pruritus ; Sensation ; Seoul ; Thiram

Contact Urticaria is a wheal-and-flare response to chemicals applied to the skin. Contact urticaria due to bee sting therapy has never been reported in Korea. A 45-year-old male was seen for erythematous plsques and patches with the duration of 3 days. Histologicall, the skin biopsy specimen showed necrosis and dyskeratotic cells in the epidermis. Collagen degenerati in and perivascular lymphocytic infiltrates were seen in the upper dermis.
Bees* ; Biopsy ; Bites and Stings* ; Chronic Pain* ; Collagen ; Dermis ; Epidermis ; Humans ; Korea ; Male ; Middle Aged ; Necrosis ; Skin ; Urticaria*