BACKGROUND: It is a recent trend in Korea that the uses of trichloroacetic acid(TCA) have been increased as the usual chemical peeling agent for treating abnormal pigmentation like solar lentigo, freckle, melasma, or actinic keratoses, rhytides, acne scar and other facial problems. We made an experiment to see how the different concentrations of TCA affect the guinea pig skin histologically. OBJECTIVE: The purpose of this study was to evaluate the histologic changes using various concentrations(35%, 50%, 90%) of TCA. METHODS: At first, 35%, 50% or 90% of TCA was applied to the each right ear of guinea pigs. After the application, we checked these specimens in intervals - one hour after (D1hr), the following day(D1), the third(D3), fourth(D4), fifth(D5) day, one week(D1wk), two weeks(D2wks), six-teen weeks(D16wks) later. The specimens were processed and stained with hematoxylin and eosin (H & E), Verhoeff elasic, and alcian blue stain. RESULTS: 1. In Do1hr of 35% and 50% TCA treated groups, some keratinocytes with eosinophilic cytoplasm and pyknotic nuclei were scattered in the epidermis. The higher the concentration of TCA, the more evidence of homogenization of the epidermis. The homogenization of epidermis and dermis was most prominent in 90%. 2. In D1 and D3, necrosis of the epidermis was proportional to the concentrations of TCA. We could see infiltrates of inflammatory cells in the whole dermis-when 90% of TCA was tried. 3. Desquamation of the necrotic epidermis appeared in each group between 3 and 7 days after the treatment. 4. In groups treated with 50% and 90% TCA, reepithelialization arising from skin appendages was prominent. 5. Hyperplasia of epidermis appeared in every group between the second and sixteenth weeks but dermal hyperplasia was prominent only in the group of 90% TCA at sixteen weeks. CONCLUSION: While thirty-five per cent TCA solution produced partial destruction of the epidermis, 50% and 90% of TCA destroyed the entire epidermis and upper dermis. Regeneration of epidermis from skin appendage is a signficant base of deep chemical peeling. Epidermal hyperplasia was found in 50% and 90% of TCA, but dermal hyperplasia was only found in 90% of TCA.
Acne Vulgaris ; Alcian Blue ; Animals ; Cicatrix ; Cytoplasm ; Dermis ; Ear ; Eosine Yellowish-(YS) ; Eosinophils ; Epidermis ; Guinea Pigs* ; Guinea* ; Hematoxylin ; Hyperplasia ; Keratinocytes ; Keratosis, Actinic ; Korea ; Lentigo ; Melanosis ; Necrosis ; Pigmentation ; Regeneration ; Skin*

Histiocytic necrotizing lymphadenitis that causes unusual lymphadenopathy is a newly recognized disease of unknown etiology and may be mistaken for other conditions such as malignant lymphoma and tuberculosis, in which specific treatment will be required. Local lymph node enlargement especially in neck is the only characteristic feature, sometimes accompanied by pain, tenderness, fever and chill like a cold, nausea, vomiting. Laboratory investigations are usually noncontributory with an occasional case showing leukopenia or an elevated erythrocyte sedimentation rate. For further understanding of this disease and helping make diagnosis, clinical features were reviewed in 15 patients (29 lymph node enlargement), who were diagnosed as histiocytic necrotizing lymphadenitis on clinical evaluation (9 patients) or excisional biopsy (6 patients). The results are as follows; Disease was more common in female(1:2) and young patient. It involved left sided neck nodes frequently (67%) and the most common site was suboccipit-al triangle (62%). 47% of patient showed multiple enlargement of lymph nodes and the size of nodes were varied from 8 to 23 mm (mean: 12.4 mm). Most nodes were movable and showed oval in shape. Fever (47%), pain (33%), tenderness (53%), recent history of upper respiratory infection (33%), leukopenia (47%) and increased erythrocyte sedimentation rate (67%) were showed in many cases. Ultrasonogrphic and CT scan showed well defined oval to round lymph nodes enlargement with inhomogenous enhancement. All affected nodes are resolved spontaneously within 3-10 weeks (mean 5.1 weeks) without specific treatment. After reviewing all of above results, it is concluded that histiocytic necrotizing lymphadenitis is self-limiting disease without characteristic clinical features, but some factors like fever, pain, tendrness, leukopenia and increased erythrocyte sedimentation rate with cervical lymphadenopathy in young female patient are thought to be very helpful in diagnosis and in these circumstances, lymph node biopsy must be delayed for 2-3 months.
Biopsy ; Blood Sedimentation ; Diagnosis ; Female ; Fever ; Histiocytic Necrotizing Lymphadenitis* ; Humans ; Leukopenia ; Lymph Nodes ; Lymphatic Diseases ; Lymphoma ; Nausea ; Neck ; Tomography, X-Ray Computed ; Tuberculosis ; Vomiting

PURPOSE: The aim of this study is to evaluate the effect of radiotherapy for the patients with Graves' orbitopathy who were intolerable to corticosteroid therapy. METHODS: From December 1995 to June 2000, We reviewed medical records of thirteen patients who had received orbital radiation delivering 2000 cGy in 10 fractions over 2 weeks. RESULTS: Compressive optic neuropathy was improved in 3 of 4 patients (75%), and soft tissue swelling was improved in eight of 9 patients (88%). Proptosis was reduced in 3 of 13 (30%) patients. However, diplopia and ocular motility responded poorly and was improved only in 2 of 10 (20%) patients. No adverse effects of radiotherapy occurred in any patient. Specifically there was no sign of radiation-induced injury to optic nerve, retina, or lens. CONCLUSIONS: Radiotherapy was successful in patients with acute Graves' orbitopathy especially who had compressive optic neuropathy or soft tissue swelling. This modality was useful for those who showed intolerable side effects from the use of corticosteroid or the recurrence with corticosteroid treatment.
Diplopia ; Exophthalmos ; Humans ; Medical Records ; Optic Nerve ; Optic Nerve Diseases ; Orbit ; Radiotherapy ; Recurrence ; Retina ; Thyroid Gland*

PURPOSE: With its increasing popularity, several complications, such as infection, exposure, and extrusion have been reported in the use of the porous orbital implants. Exposure of the implants is one of the most difficult complications to treat. We evaluate the effect of treatment in exposed porous orbital implants with various techniques. METHODS: From January 1995 to December 2000, 15 patients visited our clinic with exposure of implant after porous orbital implantation. The following procedures were used to cover the implants: observation with delayed prosthesis fitting and posterior vaulting of the prosthesis, burring away the anterior surface of the hydroxyapatite implant and placing dermis fat graft, removing infected implants and dermis fat graft, and removal and 180degrees rotation and replacement of porous implants according to the degree of exposure. RESULTS: Porous implants exposures occurred 1 to 12 weeks after implantations (mean, 5.2 weeks). Small areas of exposure (<3mm) closed spontaneously (2 cases), remained stationary (2 cases), and increased the exposure area requiring dermis fat graft (1 case). During the follow-up period (mean, 19 months), no porous orbital implant was exposed again except 1 case who received previous orbital irradiation therapy. CONCLUSIONS: Small exposure of porous orbital implants less than 3 mm in diameter may be closed with nonsurgical methods. In the case of exposure larger than 4 mm, dermis fat graft or removal and 180degrees rotation and replacement of porous implants were effective in the treatment of exposure.
Dermis ; Durapatite ; Follow-Up Studies ; Humans ; Orbit* ; Orbital Implants* ; Prostheses and Implants ; Prosthesis Fitting ; Transplants

No abstract available.
Leiomyosarcoma ; Vena Cava, Inferior

The purposes of operative treatment in unstable thoracolumbar and lumbar spine fractures are anatomical reduction and stabilization of the fractures and thus promote neurological recovery and early rehabilitation. To achieve these goals, complete preoperative assessment and recognition of the fracture pattern is necessary in addition to good surgical technique. The authors analyzed 47 cases of thoracolumbar and lumbar spine fractures operated from Jan. 1989 to Dec. 1991 at the Department of Orthopaedic Surgery, National Medical Center. All cases were classified according to Denis classification and in deciding the appropriate surgical approach, fracture type, stability, neurologic status and degree of deformity were all considered. Anterior approaches were performed in 23 cases of burst fracture and 3 cases of fracture-dislocation, and posterior approaches were performed in 1 case of compression fracture, 7 cases of burst fracture, 4 cases of seat-belt type injury and 5 cases of fracture-dislocation, In 3 cases of burst fracture and 1 case of fracture-dislocation, both anterior and posterior approaches were combined. With the analysis of postoperative changes in sagittal and coronal angle, translation and degree of rotation, we evaluated the results of operative reduction in terms of restoring normal anatomical configuration of injured spinal segments. So we tried to find the attributing factors in the operative reduction of the thoracolumbar and lumbar spine fractures and suggest the proper surgical approach that provides better reduction and stabilization.
Classification ; Congenital Abnormalities ; Fractures, Compression ; Rehabilitation ; Spine

Although the incidence of leprosy is decreased considerably, the deformity and disability of it is serioues. In the hand, combined median and ulnar nerve affection is most common, and it leads to many problems including opposition dysfunction and claw hand deformity. And opposition dysfunction is most significant disability in the hand function, so its correction or reconstruction is mandatory We performed 20 cases of opponensplasty from Oct. 91 to Apr. 94 at National Medical Center, and analyzed its results according to new assessment criteria invented by authors, and evaluated the efficacy of the operative treatments. The results were as follows: 1. The patients were 9 males and 11 females, average age was 48 years old, and average duration of paralysis was 28 years. The mean follow-up period was 2.8 years. And most common type of nerve affection was combined low median and high ulnar nerves. 2. We performed 18 cases of Burkhalter opponensplasty using extensor indicis proprius and 2 cases of Riordan opponensplasty using ring finger sublimis at the leprosy hands. 3. According to authors assessment criteria for leprosy hand, the result of operative treatment was excellent in two, good in ten, fair in seven, and poor in two patients. So we obtained more than good results in 50% patients. 4. We could obtain good result with Burkhalter opponensplasty in leprosy hand, especially when combined with proper preoperative physical therapy and adjuvant operation for release of contracture and joint stiffness.
Animals ; Congenital Abnormalities ; Contracture ; Female ; Fingers ; Follow-Up Studies ; Hand ; Hand Deformities ; Hoof and Claw ; Humans ; Incidence ; Joints ; Leprosy ; Male ; Paralysis ; Tendon Transfer ; Ulnar Nerve

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare and recently recognized disease of unknown etiology, characterized by remission and exacerbation of multiple bone lesions which radiologically and pathologically have the appearance of hematogenous osteomyelitis. The natural history appears to be slow and spontaneous resolution of the osseous lesions without specific treatment. And antimicrobial agents seem to have no beneficial effect. In proper clinical setting, CRMO should be considered, because recognition of this entity would help us to avoid costly and potentially harmful diagnostic and therapeutic interventions. We report a case of a 48-year-old adult who had chronic recurrent multifocal osteomyelitis.
Adult ; Anti-Infective Agents ; Humans ; Middle Aged ; Natural History ; Osteomyelitis

The subject of ankle injuries has for a long time been embedded in controversy. The injuries to the ankle joint complex include not only injuries that cause disruption of the bone architecture of the ankle joint but often significant ligamentous and soft tissue components. Strong differences of opinion exist regarding the preferred method of treatment, the length of time immobilization is necessary, the postreduction management and the criteria of what constitutes an acceptable reduction. Follow up of 52 cases was possible which were admitted to the department of orthopedics, Kyung- pook University Hospital during the period of January, 1974 to december 1983. The results obtained from this study were as follows; 1. Among the 51 patient, male was 45 (88.2%) patients and female 6 (11.8%) patients. Most of the patient were in the ages between 20 and 30. 2. Of the 52 cases, the main cause of fractures were traffic accident 33 (63.5%) cases and the other causes were falling from a height 9 (17.5%), slipping down 3 (5.7%) and sport injury 1 (1.9%) in order. 3. Open fracture was 16 (31%) and closed fracture was 36 (69%). 4. According to the classification of Lauge-Hansen, the supination-external rotation type 18 (34.6%) was the commonest type. 5. Among the 52 cases, 32 cases were treated by open reduction and 20 cases by closed reduction. 6. The average peried of the cast immobilization after the open reduction was 6Wks. but the closed reduction was 8Wks. 7. According to clinical and radiological accessment of the result of treatment for bimalleolar Fx, internal fixation of both medial & lateral malleolus was better than medial malleolus only. 8. The fibular fracture involving lateral malleolus and the diastasis of the distal tibiofibular syndesmosis were very important in ankle stability and were treated by internal fixation for accurate anatomical reduction.
Accidental Falls ; Accidents, Traffic ; Ankle Fractures ; Ankle Injuries ; Ankle Joint ; Ankle ; Classification ; Clinical Study ; Female ; Follow-Up Studies ; Fractures, Closed ; Fractures, Open ; Humans ; Immobilization ; Ligaments ; Male ; Methods ; Orthopedics ; Sports

Dislocation of the metacapophalangeal joint of the finger is apparently rare except thumb. The mecchanism of injury seems to be direct injury that produces hyperextension of metacapophalangeal joints. In 1957, Kaplan advocated the triple incision, that is release of the volar fibrocartilaginous plate, the natatory ligament, and the superficial transverse metacapal ligament, expose the operation field through palmar approach. In 1975. Becton advocate direct dorsal longitudinal incision. The advantages of this approach as compared with the volar approach are 1. There is full exposure of the fibrocartilaginous volar plate, the main structure blocking reduction. 2. Digital nerves are not as apt to be damaged. 3. Accurate reduction and fixation of the osteochondral fracture of the metacarpal head is possible. We exprenced 6 cases of index metacarpophalangeal dislocation and treated with dorsal approach.
Dislocations ; Fingers ; Head ; Joints ; Ligaments ; Metacarpophalangeal Joint ; Thumb