BACKGROUND: Vitiligo is a relatively common acquired depigmentating disorder that affects at least 1 % of the population. The mode of transmission has not been clearly,stablished, but either polygenic or autosomal dominant with incomplete penetrance and variable expresion has been proposed. OBJECTIVE: Our purpose was to evaluate the causative factor, variable clinical features and current teratment of generalized vitiligo patients. METHOD: This clinical in vestigation was made with 225 outpatiens of generalized type vitiligo who had visited the Department of Dermatology, Keirnyung Universitv Hospital from January 1987 till December 1991. Results & CONCLUSION: 1. There were 125 female, (55.5%) and 100 males(44.4%). 2. The mean age of onset was 21.4 years(male . 24.3, female: 19.1). 3. The mean age at the first visit was 27.5 years (male : 28.8, female : 26.5). 4. The mean duration of the disease was 10.7 years(male : 9.9, female : 10.9). 5. The mean interval between onset and visiting was 6.1 years (male : 4.5, female : 7.4). 6. The most common sites of involvernent at the first visit was tie face 11.7% (male : 11.4%, female : 11.8%). 7. The most common precipitating factor was trauma(8.8%). 8. The most common previous treatment was sunlight irradiaion after application of topical oxoralene(33.2%). 9. The most common degree of depigmented lesion was 5-10%(64.4%). 10. The most common occupations of the patients were students mals, and housewife females.
Age of Onset ; Dermatology ; Female ; Humans ; Occupations ; Penetrance ; Precipitating Factors ; Sunlight ; Vitiligo*

The incidence of uterine prolapse during pregnancy is rare. A 34-year-old G3P1 was initially presented at 16 weeks 5days of gestation with a prolapse of the uterine cervix. The cervix was edematous and protruding beyond introitus. Management included bed rest, and the patient was discharged after several days with a vaginal pessary to help maintain cervical placement. At 35 weeks of gestation, the patient did not experience any further prolapse after the removal of the pessary. Pregnancy progressed to term with no further prolapse. She was readmitted at 38weeks 5days of gestation with spontaneous labor. She delivered a 3.36kg male with an Apgar score at 1 minute and at 5 minutes of 7 and 8 respectively. The patient's cervix remained prolapsed in the early postpartum period; however it was easily reduced prior to discharge. After puerperium, the patient's cervix remained prolapsed. She was fitted with a vaginal pessary for uterine support. We reported this case with related literature.
Adult ; Apgar Score ; Bed Rest ; Cervix Uteri ; Female ; Humans ; Incidence ; Male ; Pessaries ; Postpartum Period ; Pregnancy* ; Prolapse ; Uterine Prolapse*

The free flaps have been used for reconstruction of the head and neck because of their superior results comparing with other types of flaps. Among them, radial forearm free flap has many advantages, its thinness, pliablilty, long vascular pedicle, large sensory flap, and compound flap including tendons and bone. We report 28 cases of head and neck reconstruction with radial forearm free flap between March 1991 and March 1997. Patient's age ranged from 21 to 76 years(mean 50.5 years). There were 23 men and 5 women. Mean follow-up period was 14 months. The most common cause was malignant tumor of the head and neck, especially squamous cell carcinomas(18 cases). We used this flap to reconstruct the oral cavity in 13 cases, the hypopharyngoesophagus in 6 cases, external surface of the head and neck in 7 cases, and the orbit in 2 cases. All of these flaps survived without complication. Two cases of fistula developed, in which forearm flaps were used for tongue and hypopharyngoesophageal reconstruction, and they were treated with conservative manners. Partial losses of skin graft at donor site of the forearm developed in 3 cases. They healed with split-thickness skin graft or local flap. The function of reconstructed upper aerodigestive tract and eye socket was good. The cosmetic result was not good in cases of reconstruction for external surface of the face with this flap, but it was better than other free flaps. So, we concluded the radial forearm free flap is available for reconstruction of the head and neck.
Female ; Fistula ; Follow-Up Studies ; Forearm* ; Free Tissue Flaps* ; Head* ; Humans ; Male ; Mouth ; Neck* ; Orbit ; Skin ; Tendons ; Thinness ; Tissue Donors ; Tongue ; Transplants

OBJECTIVE: To evaluate the changes of maximum fibrillation potential amplitude and root- mean-square (RMS) value of denervation potential after nerve injury using power spectrum analysis. METHODS: The sciatic nerve was transected in 8 rats, and was compressed in 6 rats. Denervation potentials were collected in gastrocnemius using monopolar needle weekly after nerve injury. The change of RMS value of 1 second epoch of denervation potentials with time was evaluated and compared with the change of maximun fibrillation potential amplitude. RESULTS: In nerve-transected rat, the RMS value declined linearly with time after injury. On the contrary, the amplitude of fibrillation potentials declined much rapidly during first 3 weeks. In nerve-compressed rat, both the RMS value and amplitude of fibrillation potential increased for 2 weeks after injury, and declined thereafter. As the result of simple regression analysis, the changes of RMS value correlated better than changes of fibrillation amplitude in all 8 nerve-transected rat. CONCLUSION: The RMS value of denervation potentials correlated well with time after nerve injury in animal experiments. Measurement of the RMS value might be helpful to evaluate the time after peripheral nerve injury, but long-term human data should be essential for clinical application.
Animal Experimentation ; Animals ; Denervation* ; Evaluation Studies as Topic* ; Humans ; Needles ; Peripheral Nerve Injuries ; Rats* ; Sciatic Nerve ; Spectrum Analysis*

BACKGROUND AND OBJECTIVES: Long-term right ventricular (RV) apex pacing has been associated with left ventricular (LV) systolic dysfunction. However, pacing in the RV outflow tract (RVOT) is associated with a narrower QRS duration and may have a more normal LV activation in comparison to RV apical (RVA) pacing. We hypothesized that RVOT pacing is associated with less mechanical dyssynchrony compared to RVA pacing and that it also more closely resembles mechanical activation in normal controls with a narrow QRS. SUBJECTS AND METHODS: We studied 9 patients with RV pacing, 9 with left bundle branch block (LBBB), and 15 normal controls with a narrow QRS. In the RV pacing group, we paced from the RVA and RVOT. At the end of each pacing train, we obtained echocardiographic images in the apical 4- and 2-chamber views and obtained the following parameters: the compression/expansion crossover point (CEP) for myocardial strain and the time from QRS onset to the CEP in the strain image. The degree of dyssynchrony was evaluated using the dispersion and standard deviation of CEP times in 12 segments of the LV. RESULTS: Significant dyssynchrony was observed in the RVOT pacing group compared to the group with normal QRS. No significant difference was observed in LV mechanical dyssynchrony among the RVOT pacing, RVA pacing, and LBBB groups. CONCLUSION: RVOT pacing is associated with significant LV dyssynchrony. Although the RVOT has been recommended as an alternative site for pacing, this approach may have adverse effects on long-term LV function.
Bundle-Branch Block ; Heart Ventricles ; Humans ; Sprains and Strains

PURPOSE: To determine how clinical and angiographic factors relate to the amount of subarachnoid blooddetected by computerized tomography in patients with a ruptured aneurysm. MATERIALS AND METHODS: Between January1996 and December 1997, 22 patients with a posterior communicating artery aneurysm were retrospectively evaluated. RESULTS: Oval(three of four cases), funnel(both cases), and daughter-sac (four of five cases) types of aneurysmalsac were found among the 13 patients with a large amount of subarachnoid blood ; eight of these had a past historyof hypertension or diabetes. Seven of eleven cases of cylindrical-type aneurysmal sac were found among the 9patients with a small amount of sularachnoid blood ; eight of these had no past history of hypertension ordiabetes. The average S/N ratio (ratio of maximum sac length to neck diameter) of patients with a small amount ofblood was higher than that of patients with a large amount of blood(2.72 vs 2.07). CONCLUSION: Although manyfactors influence the amount of subarachnoid blood in an aneurysmal rupture, we found that a large amount of bloodwas frequently present in the oval, funnel and daughter sac types of aneurysm, when S/N ratio was low, and when anunderlying disease such as hypertension or diabetes was present. Conversely, a small amount of blood was presentin the cylindrical type, when S/N ratio was high, and where there was no of underlying disease.
Aneurysm ; Aneurysm, Ruptured ; Humans ; Hypertension ; Intracranial Aneurysm* ; Neck ; Nuclear Family ; Retrospective Studies ; Rupture

The incidence of duodenal diverticulum found incidentally during upper gastrointestinal roentgenographicexamination varies between 2% and 5%. The majority of cases occur along the medial aspect of the second portion of the duodenum, within 2.5cm of the ampulla of Vater. The majority of duodenal diverticula are asymptomatic, but insome cases, complications such as diverticulitis, hemorrhage, perforation, and fistula formation occur in thethird and fourth portions of the duodenum. We describe a case of giant diverticulum of the transverse duodenum,revealed by UGI and angiography, massive gastrointestinal bleeding in a 80-year-old patient.
Aged, 80 and over ; Ampulla of Vater ; Angiography ; Diverticulitis ; Diverticulum* ; Duodenum* ; Fistula ; Hemorrhage* ; Humans ; Incidence

PURPOSE: To assess the diagnostic accuracy and clinical efficacy of noncontrast spiral CT in patients withsuspected acute appendicitis. MATERIALS AND METHODS: Over a six-month period, 100 patients with suspected acuteappendicitis were prospectively evaluated with noncontrast spiral CT. All scans were obtained from the lower bodyof L3 to the symphysis pubis, with 5mm or 10mm collimation and pitich of 1 or 1.5, and without intravenous or oralcontrast material. Diagnosis was established by means of surgical or clinical follow-up. Prospective diagnosisbased on CT findings was compared with surgical results and clinical follow-up. RESULTS: Acute appendicitis wasconfirmed in 47 of 100 patients. On the basis of the basis of the CT findings, SI patients were prospectivelyinterpreted as positive for appendicitis, but in six the diagnosis was false-positive. Two of the 47 with acuteappendicitis were prospectively interpreted as normal. The preoperative diagnosis of acute appendicitis was, thus,45 true-positive, 47 true-negative, six falsepositive and two false-negative, yielding a sensitivity of 96%, aspecificity of 89%, an accurace of 92%, a positive predictive value of 88%, and a negative predictive value of96%. Using CT, an alternative diagnosis was established in 14 patients. CONCLUSION: Noncontrast spiral CT is auseful technique for diagnosing acute appendicitis.
Appendicitis* ; Diagnosis ; Follow-Up Studies ; Humans ; Prospective Studies ; Tomography, Spiral Computed*

OBJECTIVES: The purpose of study was to report the current role of transnasal esophagoscopy (TNE) in Korea. METHODS: One hundred thirty-seven patients who underwent TNE at Soonchunhyang University Bucheon Hospital (n=69) and Korea University Anam Hospital (n=68) from July 2007 to February 2009 were prospectively analyzed. Laryngopharyngeal reflux disease (LPRD) patients without any response to proton-pump inhibitor (n=102), and patients with complaints that require esophagoscopy as part of their evaluation (n=35) were included in this study; investigation of metachronous lesions or routine follow-up screening of head and neck cancer patients, n=17; dysphagia, n=9; blood tinged saliva, n=4; to determine the cause of vocal fold paralysis as screening tool, n=4; suspicious esophageal foreign body, n=1. RESULTS: Fifty-three patients (38.7%) had positive findings on TNE. Positive finding ratio was highest in group of dysphagia (7 among 9 patients, 78%). Forty-two patients (41.1%) were found to have pathology (esophagitis, n=41; esophageal diverticulum, n=1) during the screening examination for LPRD. There were no significant complications in any of the patients. CONCLUSION: TNE is a high-yield diagnostic and therapeutic modality available to otolaryngologists for use on awake patients in the office setting.
Deglutition Disorders ; Diverticulum, Esophageal ; Esophagoscopy* ; Esophagus ; Follow-Up Studies ; Foreign Bodies ; Gyeonggi-do ; Head and Neck Neoplasms ; Humans ; Korea ; Laryngopharyngeal Reflux ; Mass Screening ; Paralysis ; Pathology ; Prospective Studies* ; Saliva ; Tolnaftate ; Vocal Cords

Endomyocardial biopsy (EMB) is a valuable diagnostic procedure for the surveillance of cardiac allograft rejection. Interpretation of individual cases is still problematic due to variations of findings for grading of rejection and other associated lesions. We reevaluated an experience on endomyocardial biopsies to develop better diagnostic criteria for rejection and other complications. Immunohistochemical studies against cytokines were performed to assess the usefulness of the method for the diagnosis or researches. A total of 249 EMBs taken from 33 cardiac allograft recipients were reviewed. There were 25 males and 8 females. Dilated cardiomyopathy was present (24 cases) and valvular heart disease (4 cases), restrictive cardiomyopathy (3 cases) were also common conditions. We applied the grading system of the International Society for Heart Transplantation (ISHT) for the assessment of acute cellular rejection. Grades of 0, 1A, 1B, 2, 3A and 3B were 39.0%, 28.1%, 11.2%, 11.5%, 12.4% and 1.6% respectively, but 3.2% were inadequate. Thirty five episodes of grade 3A or 3B were present in 17 patients. The response to therapy was assessed using a next follow up biopsy, which revealed resolving or resolved rejection in 85% of patients. The intensity of immunohistochemical stains for IL-6 and TNF-alpha was increased in proportion to the histologic grade but Quilty lesion and cardiomyopathy also showed a positive reaction. The other pathologic findings were ischemic change, previous biopsy site, interstitial edema and fibrosis, and Quilty lesion. These findings showed usefulness of endomyocardial biopsy not only for the evaluation of cardiac allograft rejection but also for the diagnosis of associated cardiac lesions. Immunohistochemical study of the cytokines was related to the degree of inflammation rather than degree of rejection.
Allografts ; Biopsy* ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Cardiomyopathy, Restrictive ; Coloring Agents ; Cytokines ; Diagnosis ; Edema ; Female ; Fibrosis ; Follow-Up Studies ; Heart Transplantation* ; Heart Valve Diseases ; Heart* ; Humans ; Inflammation ; Interleukin-6 ; Male ; Tumor Necrosis Factor-alpha