Botulinum Toxin Type A for Facial Wrinkles and Benign Masseter Hypertrophy in Korean Patients / 대한피부과학회지

BACKGROUND: The utilization of botulinum toxin has rapidly expanded into various aesthetic applications. Achieving success with the aesthetic use of neurotoxins depends on several factors, including an understanding of the anatomy, the methods of dilution and the injection technique. Any guidelines representing a consensus for aesthetic treatments using botulinum toxin type A (BTA) have not been published in Korea. OBJECTIVE: We wanted to provide consensus recommendations on the treatment of facial wrinkles and benign masseter hypertrophy using BTA in Korean patients. METHODS: A panel of experienced Korean dermatologists was convened to develop a clinical consensus. The clinical consensus was comprised of the recommendations of the panel and the guidelines on general issues, such as the reconstitution and handling of the BTA, the procedural considerations, the dosing and injection-site standardizations, and the prevention and treatment of unwanted effects. Specific recommendations were provided according to the area of treatment, including glabellar lines, horizontal forehead lines, lateral periorbital wrinkles and benign masseter hypertrophy. RESULTS: The recommended final concentration of BTA was 50 units/ml (5 units/0.1 ml) after reconstitution with physiologic saline. For glabellar lines, the members recommend three injection points (a total of 8 units). For forehead wrinkles, the members recommend nine injections in two rows into the frontalis with 1 unit/point. For crow's feet, the members recommend three injections per side (7 units/side) at the lateral part of the orbicularis oculi. For benign masseter hypertrophy, three injections per side (24~30 units/side) were recommended. CONCLUSION: These consensus recommendations will provide a framework for Korean dermatologists who wish to perform safe and efficacious injection of BTA for facial rejuvenation.

Cultural Factors and Human Error in International Air Transportation Environment

Flightdeck behaviour and flight safety are influenced by the national, organizational, and professional cultures of crewmembers. National complexity of the operating environment ensure that error will be an inevitable occurrence. The influences of three cultures that are relevant to the cockpit are described; the professional culture of the pilots, organizational cultures, and the national cultures surrounding individuals and their organizations. This study review the cultural difference of crewmember in Korea based on Hofstede and Helmreich study. The study concludes with a suggestion of CRM in Korea as strategy necessary for a safety culture considering the multi-cultures cockpit.

Corneal Astigmatic Change in Corneal Topography After Upper Eyelid Surgery

PURPOSE: The study was conducted to determine if there is a corneal astigmatic changes after upper eyelid surgery by using corneal topography and if these changes are the reason why some patients note a decrease in visual acuity. METHODS: Twenty four eyes of 12 patients with dermatochalasis who had undergone upper eyelid blepharoplasty, and 24 eyes of 12 patients who had undergone aesthetic double fold formation were included. We performed corneal topography during the postoperative 3 months and also evaluated the corneal refractive index change on thirteen points of the central cornea, which were located in the center of the corneal apex and apart from it by 1.5, 2.5, 3.5 mm along each axis corresponding to the 0 degrees, 90 degrees, 180 degrees, 270 degrees respectively. RESULTS: Corneal topography demonstrated increase in with-the-rule astigmatism by 38, 33, and 12% for dermatochalasis patients at 1week, 1month, and 3months after surgery, and by 25%, 17%, and 13% for double fold patients. However the increase in with-the-rule astigmatism seemed to be temporary, showing gradual regression. The refractive index change of thirteen points of central cornea was not significant except a few eyes with astigmatic changes greater than 1D until 1 month after surgery. There was alsoincreased astigmatism after surgery in vector-corrected analysis. CONCLUSIONS: There was a tendency of increase in with-the-rule astigmatism and those changes were temporary and regressed gradually. No patient showed significant refractive index change on the 13 points of central cornea but some showed changes greater than 1 D in the early postoperative period, causing visually significant astigmatic changes temporarily.

Corneal Topographic Changes after Surgery in Epiblepharon Children

PURPOSE: This study was designed to evaluate the postoperative changes of astigmatism and corneal refractive power after surgical correction of epiblepharon using computerized topography. METHODS: The surgical data were investigated retrospectively before surgery and 1 month, 3 month after surgery in 23 patients who had undergone surgery for epiblepharon. We evaluated 8 points of the corneal refractive index, the corneal center and nasal, temporal, inferior 1.0 and 2.0 mm and superior 1.0 mm respectively. And the incidences and types of astigmatism were evaluated before and after surgery. RESULTS: After surgery, we observed corneal flattening at all points according to corneal topography, but corneal refractive changes were statistically insignificant except for inferior 1.0mm point (P< 0.05). Mean astigmatism was decreased after surgery and statistically significant 3 month after surgery (P< 0.05). Mean corneal refractive change on vetical meridian was prominent compared to horizontal meridia and statistically significant 3 month after surgery (P< 0.05). CONCLUSIONS: In epiblepharon, children corneal topographic changes were observed due to reduction of corneal irritation and pressure by cilia and lower eyelid after surgery. Astigmatic changes were progressed 3 month after surgery and with-the-rule astigmatism was observed mainly before and after surgery. But corneal refractive changes were prominent on vertical meridian, and therefore there was a tendency toward improvement of with-the-rule astigmatism.

Loss of Best Corrected Visual Acuity after LASIK

Loss of best corrected visual acuity(BCVA)is a landmark of safety, as one of important complications of refractive surgery. To evaluate causes of 2 lines or more loss of BCVA after laser in situ keratomileusis(LASIK), 206 eyes of 139 patients, who had undergone LASIK and had been followed up for 6 months or more, were included in this study. During the follow-up, nineteen eyes(9.2%, 19/206)showed 2 lines or more loss of BCVA postoperatively. The causes of BCVA were irregular astigmatism(15 eyes, 7.3%), retinal complications(3 eyes, 1.5%), and infectious keratitis(1 eye, 0.5%). All irregular astigmatisms had occured within 1 month postoperatively and 13 eyes of all 15 eyes spontaneously recovered after postoperative 3 months. The persistent loss of BCVA occurred in 5 eyes(2.4%, 5/206). Three cases of all 5 persistent losses of BCVA were due to retinal complications. In conclusion, our results suggest that the most common cause of loss of BCVA after LASIK is irregular astigmatism. Irregular astigmatism is a temporary situation which has a tendancy of spontaneous recovery. Thus careful observation is recommended in irregular astigmatism after LASIK. The retinal complications of LASIK may lead to permanent loss of BCVA. Therefore it is needed to examine preoperative fundus closely and to explain possible postoperative complicaitons to the patients and their family.

Clinical Results of Laser In Situ Keratomileusis Using Different Types of Excimer Laser: LaserScan LSX(R) versus OmniMed II(R)

PURPOSE: This study was retrospectively conducted to evaluate the clinical results of consecutive 167 myopic eyes of 117 patients undergoing laser in situ keratomileusis(LASIK) for myopia with either of the two excimer lasers, which differ in the method of laser delivery: flying spot scanning versus broad beam. METHODS: According to the laser used, the treated eyes were divided into two groups: Group I, 84 eyes of 58 patients with LaserScan LSX(R)(Lasersight Inc., USA); Group II, 83 eyes of 59 patients with OmniMed II(R)(Summit, USA). Each patient had been followed up for more than 6 months after surgery. Only single procedure outcomes were included. Mean preoperative spherical equivalents(SE) were -5.67+/-1.79 D(range:-1.50~-9.75 D) in group I and -6.40+/-1.79 D(range:-3.50~-9.75 D) in group II. RESULTS: At postoperative 6 months, mean uncorrected visual acuity increased to 0.94 in group I and 0.88 in group II. Uncorrected visual acuity of 20/40 or better occurred in 100% of group I and 96.4% of group II, and of 20/20 or better, in 57.2% and 48.2%, respectively. No eye in either group lost more than 1 line of best-corrected visual acuity. Mean SEs at postoperative 6 months were -0.28+/-0.50 D in group I and -0.55+/-0.60 D in group II(P<0.05). Manifest SEs were within +/-1.00 D in 97.6% of group I and 84.3% of group II, and +/-0.50 D in 73.8% and 60.2%, respectively. Intra- or postoperative complications were subconjunctival hemorrhage(4 eyes, group I; 5 eyes, group II), Sands of Sahara syndrome(7 eyes, group I; 5 eyes, group II), epithelial ingrowth(1 eye, group II only) and infectious keratitis(1 eye, group II only). No case had a central island or irregular astigmatism postoperatively. CONCLUSIONS: Our study suggests that LASIK using the LaserScan LSX(R)excimer effectively reduces myopia compared with OmniMed II(R). However, its predictability decreased as the attempted correction increased. LASIK for myopia less than -10 D with the LaserScan LSX(R)provided satisfactory refractive results that compare well with other reports in the literature.

Stereopsis after Surgery in Longstanding Adult Horizontal Strabismus

Binocular function is not easy to obtain after strabismus surgery in adults with longstanding strabismus. In this study, postoperative binocular function was evaluated in 60 adults with longstanding horizontal strabismus. The subjects were eighteen years older and had developed strabismus before the age of eight. They were composed of 15 esotropes and 45exotropes without history of strabismus surgery. Pre-and postoperative stereopsis was assessed with Titmus-fly and Randot stereopsis tests. Visual acuity of the deviating eye, duration of deviation, angle of deviation, and status of stereopsis were compared according to the type of deviation. Stereopsis was shown in 20.0% of esotropes and 71.1% of exotropes before surgery. After surgery, only 46.7% of esotropes showed stereopsis in contrast with 91.1% of exotropes. In cases with congenital origin, 22.2% of esotropes and 83.3% of exotropes had stereopsis, while in those of acquired origin, 83.3%, and 92.3%, respectively. This study shows that stereopsis of good quality can be obtained and improved after surgery in adlts with longstanding horizontal strabismus except congenital esotropes. Higher gain of good postoperative stereopsis was related to better visual acuity of the deviating eye and shorter duration of deviation.

Coexistence of Porokeratosis of Mibelli with Linear Porokeratosis

We report a case of porokeratosis of Mibelli coexistence with linear porokeratosis in a 28-year old male. He had multiple discrete reddish to brownish annular plaques with peripheral keratotic ridges on the left side of the neck and axilla, and such lesions extended in a linear fashion on the left side of the upper arm and posterior aspect of the lower extremity. The cutaneous lesions started on the left neck and axilla about 6 years prior to consultation. Two years after that, new lesions developed on the left side of the upper arm and lower extremity in a linear fashion. There was no family history of similar skin disorders. A histological examination showed cornoid lamellae in the horny layer. Hypogranulosis, dyskeratotic cells and perivascular mononuclear in-filtrations were also seen beneath the cornoid lamella.

A Case of Infantile Digital Fibromatosis

We report a case of infantile digital fibromatosis in a 34 month-old boy, who presented with a painless subcutaneous tumor on the medial aspect of the left third toe. A histological examination showed scattered small, round eosinophilic inclusion bodies in the cytoplasm of the tumor cells, which was consistent with infantile digital fibromatosis. A'immunohistochemical study revealed that desmin, a-smooth muscle actin, and vimentin were clearly positive in the cytoplasm of the tumor cells, but the inclusions themselves showed negative staining, thus indicating a hollow-like staining pattern. Electron microscopy showed either well-defined or ill-demarcated dense bodies in the cytoplasm of the tumor cells. In some areas, small vesicles and intracellular organells were observed' in the inclusions. In the course of conservative treatment, a new lesion developed on the lateral aspect of the left third toe, seven months after the appearance of the initial lesion.

Preservation of Anterior Ciliary Vessels in Strabismus Surgery

Anterior segment ischemia syndrome is caused by disruption of anterior ciliary vessels at surgery on multiple rectus muscles in strabismus. Staging surgery has been recommended when more than 3 rectus muscles are to be tenotomized. The purpose of this study is to prevent anterior segment ischemia syndrome using the technique of anterior ciliary vessels under the surgical microscope, and correct paralytic and complicated strabismus at one surgery. Six patients underwent preservation of anterior ciliary vessels. Five patients had sixth nerve palsy in one eye. First, superior and inferior rectus muscles were transposed, then medial rectus was recessed with preservation of anterior ciliary vessels. Four were successful, but one was failed and needed second operation. Another patient showed exotropia and hypetropia of amblyopic eye, in which recession of lateral rectus and resection of medial rectus, and recession of superior rectus with preservation of its anterior ciliary vessels were performed. All the patients showed orthoporia without anterior segment ischemia. This study suggests that the preservation of anterior ciliary vessels of rectus muscles is a very delicate and time-consuming procedure, but effective in preventing anteior segment ischemia syndrome and reducing the number of surgery.

The Expression of Keratinocyte Growth Factor mRNA in Dendritic Epidermal T Cell / 대한피부과학회지

BACKGROUND: The keratinocyte growth factor(KGF) is a recently identified mitogen for epithelial cells produced by nomal stromal fibroblasts. ln the skin, KGF has been shown to stimulate keratinocyte proliferation and differentiatian. Dendritic epidermal T cells(DETC) are skin-specific members of the epithelial y 8 T-cell family that reside normally in the murine epidermis. The DETCs recognize antigen expressed by damaged or diseased neighboring keratinoctyes and consequently secrete cytokines sueh as IFN- y, lL-2, IL-4, GM-CSF. OBJECTIVE: The purpose of this study was to observe the expression of KGF mRNA in keratinocyte and DETC as well as to investigate the cytokine-mediated intercellular communication between kerati- nocyte and DETC. METHODS: Using a RT-PCR(reverse transcription-polymerase chain reaction), we examined the expression of KGF mRNA in keratinocyte and DETC, and compared the level of KGF mRNA between resting and activated DETC with Con-A (concanavalin A).

Two Cases of Twenty-Nail Dystrophy

Twenty-nail dystrophy is an idiopathic nail dystrophy in which all twenty nails are uniformly and simultaneously affected with excess longitudinal ridging and loss of lustre. The pathogenesis is controversial, and the treatment is unsuccessful. It is thought to have a self-limiting and reversible nature when it develops in childhood, but in adults, it is unusual and exists persistently. We re-port here two cases of adult patients with dystrophy of all twenty nails, whose ages were 58 and 55. The disease had been present for one year and may be associated with alopecia areata in the 58 year old and an idiopathic condition in the 55 year old. Negative results were obtained on mycological studies. Biopsies taken from the nail bed revealed marked hyperkeratosis consistent with nail dystrophy.

The Comparisons of Clincal Results of Ac rySof and PMMA Intraocular Lens Implantation in Diabetic Cataract: Six Months Follow-up

To compare the clinical results of AcrySof intraocular lens (IOL)and Polymethyl methacrylate(PMMA)IOL implantation in diabetic patients,a total of 58 eyes(48 patients)were analyzed.AcrySof IOL was implanted in 24 eyes with small incision technique,and PMMA IOL was implanted in 34 eyes with enlarged scleral wound.Posterior capsular opacity(PCO)developed in only 2 eyes in AcrySof group,while it occurred in 4 eyes in PMMA group.Anterior capsular fibrosis developed in 4 eyes and IOL-iris synechiae developed in 2 eyes in PMMA group after follow-up of 6 months.No statis-tically significant difference was found in the incidence of PCO between two groups(p>0.05). AcrySof IOL leads to faster visual rehabilitation than PMMA lens. Therefore,use of AcrySof IOL can be more beneficial in diabetic cataractpatients who might need laser photocoagulation or pars plana vitrectomy in the future.

A Comparison Study of Prick Test and Chemiluminescent Assay / 대한피부과학회지

BACKGROUND: Prick test is most frequently used in clinical procedures because its simplicity and safety of application and better correlation with clinical history as well as specificity and high reproducibility. The chemiluminescent assay(CLA) is a new in vitro non-radioactive modification of radioallergosorbent test(RAST). The CLA permits quick, simultaneous detection of total and specific IgE in human serum. The CLA has shown good sensitivity, specificity, and a good correlation with the RAST and skin prick test. OBJECTIVE: The purpose of this study was to find causative allergens and to evaluate the clinical significance of CLA comparing the results of the CLA with those of the prick test in dermatologic outpatients. METHODS: We performed the prick test with 51 allergens(Bencard Ltd. Brentford, England) in 448 patients, and CLA with 35 allergens(Boehringer mannheim Korea. green cross inc.) in 280 patients with dermatologic diseases. RESULTS: 1. The positive reaction rate was highest in third decade and decreased over the age of 40 in prick and CLA. 2. The positive reaction rate of prick test(52.8%) was higher than that of CLA(25.0%). 3. The positive reaction rate to single allergens and compound allergens was 14.2% and 38.6% in the prick test and 2.5% and 22.5% in the CLA respectively. 4. In the prick test, the positive allergens, in descending order, were House dust 114(25.4%), D. farinae 88(19.6%), D. pteronyssinus 79(17.6%), Mixed inhalants 61(13.6%), and Threshing 47(10.5%). In the CLA Thistle 35(12.5%), Dandelion 31(11.1%), D. farinae 30(10.7%), D. pteronyssinus 29(10.4%), and Cat fur 12(4.3%). 5. The results of the CLA to common 2 allergens showed a concordance rate of 84.6%, sensitivity of 58.9%, and specificity of 86.1% compared with those of prick test. CONCLUSION: CLA may be a useful alternative method and shows a good correlation with the prick test. Combination of the two method results in a high diagnostic accuracy for the cause of allergic diseases.

A Case of Subacute Cutaneous Lupus Erythematosus / 대한피부과학회지

We present a case of subacute cutaneous lupus erythematosus which fulfilled the criteria of systemic lupus erythematosus in a 52-year-old woman with annular and polycyclic erythematous patches on the neck and upper part of the anterior chest. She complained malar of resh, arthralgia, general weakness, and severe headache. Laboratory findings showed hematologic, serologic, central nervous system, and nephrologic abnormalities. Serologic abnormalities of this patient were positive anti-nuclear antibody, anti-La antibody, rhematoid factor, anti-RNP antibody and anti-platelet antibody, but anti-dsDNA and anti-Ro antibody test were negative. She was treated with oral prednisolone and intravenous cyclophosphamide. In the course of treatment, sepsis developed and she died from multi-organ system failure.

A Case of Cutaneous Metastasis from Esophageal Carcinoma

We report a case of cutaneous metastatic carcinoma from an esophageal carcinoma in a 54-year-old male who complained of several pinhead-sized erythematous tender papules on the up-per chest. He had been admitted to the department of internal medicine for esophageal carcinoma. Radiological examinations revealed a luminal narrowing below the level of carina on esophagography, and a mass on the mid esophagus, left atrium and pulmonary vein on the chest CT scan. On endoscopy, about 30cm from the central incisor, a huge polypoid mass with a central ulceration and dirty surface margin was noted. Histopathological examination of the skin and esophageal biopsies showed the same atypical squamous cells with distinctive nucleoli, nuclear membrane and intercellular bridge, which were consistent with the squamous cell carcinoma of nonkeratinizing large cell type, suggesting these cutaneous lesions were metastasized from the esophageal carcinoma.

The Irritancy of Hand Dishwashing Liquids on the Skin

BACKGROUND: The regular use of soaps and synthetic detergents has been associated with skin dryness and aggravation of dermatological conditions. OBJECTIVE: Our purpose was to investigate the irritancy of 10 hand dishwashing liquids on normal skin. METHODS: The skin changes, responding to repeat patch testing with 10 hand dishwashing liquids, were measured by visual scoring. RESULTS: The results are summarized as follows; 1. Of the 16 healthy volunteers 8 had reactions. 5 women and 3 men, but there was no significant difference in irritancy between men and women. 2. The mean irritancy scores of the 10 hand dishwashing liquids ranged from 0.06 to 0.88. 3. A prominent increase in the degree of erythema in the first 24 hour patch test did not persist beyond exposure day 5, but after day 5, augmented responses of the erythema and scales, even fissuring occurred. 4. The pH of the test solutions of the hand dishwashing liquids ranged from 5.0 to 6.0, but there appeared to be no correlation between pH and irritancy in the dishwashing liquids tested. CONCLUSION: Our data suggests that regular exposure to hand dishwashing liquids may cause disturbances of the skin in a substantial proportion of individuals, and workers should use hand dishwashing liquids in lower concentrations than recommended and only for short periods with protective measures.

A Case of Maffucci's Syndrome Associated with Spindle-cell Hemangioendothelioma

A case of a 21-year old female with Maffucci's syndrome is presented where the patient developed multiple cutaneous spindle-cell hemangioendotheliomas. She had multiple pea to walnut sized, non-tender, normal skin colored or slight bluish nodules and bony mass-like lesions on the left upper extremity and hand. A histological examination of the lesions showed that they were composed of irregularly dilated, thin walled cavernous blood spaces containing phleboliths and collapsed vascular spaces separated by spindled fibroblastic cells. Radiologically, the bony lesions showed radiolucent densities with calcified spots within the second proximal phalanx and metacarpal bone of the left hand, which were consistent with enchondromas.

A Case of Disseminated Cutaneous Metastatic Carcinoma from Stomach Carcinoma

We report a case of disseminated cutaneous metastatic carcinoma from stomach carcinoma in a 66-year-old male who complained chiefly of widespread cutaneous nodules. He had been admitted to the Department of Internal Medicine for stomach carcinoma. A radiological examination revealed a diffuse stomach wall thickening from the fundus to the antrum, and enlargement of paraaortic and pericaval lymph nodes during an abodominal CT scan. The clinical findings manifested above may suggest cutaneous metastasis from stomach carcinoma. A histological examination of the skin and stomach biopsies showed atypical cells with pleomorphic, hyperchromatic nuclei and bubble-like cytoplasm, which are consistent with poorly differentiated adenocarcinoma. Immunohistochemical stainings showed that these cells were positive for epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA) and low molecular weight cytokeratin.

Two Cases of Pityriasis Versicolor on the Scalp in the Course of Treatment for Alopecia Totalis / 대한의진균학회지

No available abstract.