Iliac and tibial bone harvesting for implant surgery under local anesthesia

Strain Differentiation of Trichophyton rubrum Isolated from 2 Sites of the Same Patients by Analysis of Ribosomal DNA Nontranscribed Spacer / 대한의진균학회지

BACKGROUND: In Korea, Trichophyton (T.) rubrum is the most common dermatophyte and occupied more than 80% of all isolates. Although strains differentiation is essential for epidemiologic studies, differentiation of T. rubrum is difficult. OBJECTIVE: The aim of this study was determined if 2 strains of T. rubrum, obtained from 2 different infection sites of the same patient, are the identical. METHOD: Amplification of tandemly repetitive subelements TRS-1 and TRS-2 of ribosomal DNA nontranscribed spacer (rDNA NTS) was performed on 20 strains of T. rubrum. They were isolated from skin lesions of tinea cruris and tinea pedis or tinea unguium in 10 patients. RESULTS: Twenty strains were cultured on Sabouraud dextrose agar slant plate and all strains showed the portwine strain. The amplification of TRS-1 from 20 strains resulted in 15 strains (75%) with type 1 (434 bp), 2 strains (10%) with type 2 (634 bp), 2 strains (10%) with type 3 (834 bp) and 1 strain (5%) with type 6 (434 bp + 634 bp). Each strains from 4 of 10 (40%) patients had different types of TRS-1: one patients had type 2 (groin) and type 1 (sole), one patient had type 6 (groin) and type1 (sole), one patient had type 3 (groin) and type 2 (sole), and one patient had type 1 (groin) and type 3 (sole). The infected sites or disease duration did not have noticeable difference in type of TRS-1. The amplification of TRS-2 resulted in all 20 strains with type II (502 bp), since differentiation was not possible. CONCLUSION: The patient with different type of strains present on infected sections of the body, indicated the possibility of different fungal transmission routes. Specific amplification of subrepeat elements in rDNA NTS was simple and reproducible method for typing of T. rubrum and was useful for epidemiologic studies.

A Case of Self-healing Langerhans Cell Histiocytosis / 대한피부과학회지

Langerhans cell histiocytosis is a proliferative disease in which Langerhans cells accumulate in various body sites and cause damage to the affected organs. We report a 7-month-old infant who had only cutaneous lesions and healed spontaneously without treatment. There were rice grain to corn sized erythematous papules and crusted lesions in the chest, abdomen, and back for 2 months. The histologic finding of the lesion showed that the dyscohesive infiltrate, predominantly of histiocytes, were present and extravasated erythrocytes and eosinophils were also found in edematous papillary dermis. Careful examination showed histiocytes with coffee bean or kidney-shaped nucleus which was positive for S-100 protein. The infant had no systemic involvement, and healed spontaneously after 1 month without relapse.

A Clinical Observation of Cutaneous Premalignant and Malignant Tumors / 대한피부과학회지

BACKGROUND: There has been a concern about the incidence of the cutaneous premalignant and malignant tumors. It has increased recently and has varied according to social and environmental influence. OBJECTIVE: The purpose of our study was to clarify the recent trends in cutaneous premalignant and malignant tumors, and to compare them with other reports. METHODS: The 175 cases out of the total number of 34,333 new outpatients were diagnosed cutaneous premalignant and malignant tumors from January, 1990 to December, 2000 at the Department of Dermatology, Yeungnam University Hospital. Incidence and its change, age and sex distribution, and anatomical site were investigated. RESULT: 1. The incidence of cutaneous premalignant and malignant tumors was 0.51%, and increased lately. 2. Among the 175 cases of premalignant and malignant tumors, basal cell carcinoma(30.9%) was the most common, followed by squamous cell carcinoma(22.9%), actinic keratosis(12.6%), Bowen's disease(10.9%). 3. The premalignant lesions were increased and outnumbered squamous cell carcinoma since 1996. 4. Basal cell carcinoma was the most common skin cancer that had markedly increased in comparison with squamous cell carcinoma. 5. Actinic keratosis, Bowen's disease, basal cell carcinoma, squamous cell carcinoma, malignant melanoma on sun exposed areas were much more increased than on non exposed areas. 6. The mean age of patients was 65.3+/-15.0 years, and the age of the majority of cases(94.3%) was over 40 years. 7. The ratio of male to female was 1.01 : 1. The number of females increased relatively in comparison with previous reports. 8. The most common site was the face(55.4%), followed by scalp(12.0%), trunk (12.0%).

A Case of Apocrine Adenocarcinoma associated with Basal Cell Carcinoma / 대한피부과학회지

Apocrine adenocarcinoma is rarely reported in the world and only 4 cases are reported in Korean literature. We encountered a case of apocrine adenocarcinoma associated with basal cell carcinoma in a 76-year-old female. Excisional biopsy showed well demarcated basophilic cell mass in the upper dermis and glandular structure in the lower dermis. Basophilic cell mass consisted with basaloid cells and had peripheral palisading arrangement. Glandular structures characterized by cells with abundant eosinophilic cytoplasm showed decapitation secretion. The cells showed nuclear atypicality, plemorphism and prominent nucleoli. The cytoplasm contained PAS-positive, diastase-resistant granules and stains for lysozyme and GCDFP-15(Gross Cystic Disease Fluid Protein-15) were positive.

Comparison of Compliance and Cure Rate of Systemic Antifungal Therapy vs. Combination Therapy with Systemic and Topical Agent in Toenail Onychomycosis / 대한의진균학회지

BACKGROUND: Treatment of toenail onychomycosis requires long term oral medication of antifungal agent and its compliance was about 30% in outpatient base. OBJECTIVE: The objective of this study was to evaluate the efficacy and compliance of combined treatment with systemic and topical antifungal agent in toenail onychomycosis. METHOD: Medical records of 402 patients with toenail onychomycosis were analysed. They were diagnosed by positivity in KOH or fungus culture. Two hundred forty patients took systemic antifungal agent (terbinafine or itraconazole) only (oral treatment group). One hundred sixty two patients took combined treatment with systemic antifungal agent and topical antifungal agent (ciclopirox 8% nail lacquer) (combined treatment group). Compliance, complete cure rate, revisiting rate and follow up period were compared between oral treatment group and combined treatment group. RESULTS: Completely treated rate was higher in combined treatment group (48.2%, 78 out of 162) than in oral treatment group (20.8%, 50 out of 240) (p=0.000, c2). Complete cure rate after complete treatment was higher in combined treatment group (34.6%, 43 out of 78) than in oral treatment group (22.0%, 11 out of 50) (p=0.127, c2). Revisiting rate after complete treatment was higher in combined treatment group (60.5%, 43 out of 71) than in oral treatment group (22.2%, 10 out of 45) (p=0.000, c2). CONCLUSION: All these findings suggested that combined treatment with systemic and topical agent in toenail onychomycosis can increase compliance and cure rate.

A Case of Desmoplastic Trichilemmoma / 대한피부과학회지

Desmoplastic trichilemmoma is a rare variant of trichilemmoma and usually occurs as small solitary papules on the face. We report a case of desmoplastic trichilemmoma on the right nostril. The histologic findings revealed well-demarcated lobular growth with central desmoplastic stroma. Periphery of the lesion showed the typical feature of trichilemmoma, whereas the center of the lesion was replaced by dense fibrous stroma.

Pigmented Spindle Cell Nevus in an Infant / 대한피부과학회지

Pigmented spindle cell nevus (PSCN) was first described by Reed et al. in 1975 as a distinctive form of nevocellular nevus. Although some authors consider PSCN to be a pigmented variant of Spitz nevus, most classify it as a separate disease. We encountered a two year old boy with deeply pigmented macule on the left foot dorsum. It's histologic features were sharply demarcated lateral margin, confinement above reticular dermis and entirely composed of heavily pigmented spindle cells. There were no atypical mitotic fugures or nuclear pleomorphism, and cell size was uniform. The pathologic features were consistent with PSCN.

A Case of Cutaneous Cryptococcosis Clinically Mimicking Keratoachantoma / 대한의진균학회지

Cutaneous involvement of patient with systemic cryptococcosis occur in 10% to 15% of the case reported in literature. We report a case of cutaneous cryptococcosis clinically mimiking keratoacanthoma in a 70-year-old male. The lesions showed multiple erythematous papules and elevated central crusted nodules with peripheral telangiectasia on the face, and he had been treated with chemotherapy for peripheral T-cell lymphoma. The skin biopsy specimen showed granulomatous reaction with lympohistiocytic infiltration and many round spores. The fungus culture from skin lesion showed mucoid creamy colored colonies and revealed microscopically thick encapsulated spores in India ink preparation. The culture on Christensen urea agar at 25degrees C for 1 week was positive. The patient was treated with intravenous administration of fluconazole 200 mg/day for a week with partial improvement. But he refused further treatment, and died after a month of discharge.

A Case of Nevoid Basal Cell Carcinoma Syndrome / 대한피부과학회지

Nevoid basal cell carcinoma syndrome (basal cell nevus syndrome) is characterized by multiple basal cell carcinomas, cysts of jaw and several other congenital anomalies on skeletal, neurologic and reproductive system. It is inherited as an autosomal dominant trait. We found a 12-year-old girl with multiple basal cell carcinomas, bifid ribs, palmar pits, ophthalmic hypertelorism, ectopic calcification of falx cerebri and medulloblastoma and diagnosed it as nevoid basal cell carcinoma syndrome. Her 2-year-old younger sister showed no specific abnormality. We dessicated the basal cell carcinomas and nevi which were suspected to perform malignant transformation with carbon dioxide laser, and are to continue the follow-up study and treatment for patient and her family members.

THE EFFECT OF ERBIUM: YAG LASER OSTEOTOMY ON BONE HEALING

Presently, Erbium:YAG laser, which is known as laser for osteotomy, is considered to have good resection effects and to bring about minimum thermal damage. Since studies on this has never been done within the country and left as a field still unexplored, I expect to use this study as experimental data on future use of laser on hard tissue. In this report, both surgical bur(diameter 0.5mm carbide roun bur) and Erbium:YAG laser(100mJ/pulse, 10pulse/sec) was used each on the femur of white mouse and after the same amount of osteotomy, the effect of bone healing on the light microscope was observed and comparative study was made histology. The results are as follows : 1. In the first group (1st day, 3rd day), the osteotomic bone portion of the experimental group was irregular with bone resorption and showed more blood cell infiltration, compared with the control group. 2. At 1 week, bone matrix and immature bone was formed in the peripheral and center of the resection area in the control group. But inthe experimental group, more bone formation was initiated in the peripheral than in the center and showed more infiltration of blood cells and inflammatory cells. 3. At 2 week, bone matrix became mature to have similar density with compact bone and showed new formed vessels in the control group. But in the experimental group, bone formation with decreased density was initiated and new formed vessels together with mature bones was observed. 4. At 3 week, mature bone with equal density and regular trabecular pattern was observed in the control group. But in the experimental group, the continuity between the new bone and old bone was rather loose with decreased maturity, but on the other hand, had even bone formation pattern. 5. At 4 week, both the control and experimental group showed perfect bone healing features. From the results above, I can observe that in osteotomy with Erbium:YAG laser bone healing is rather delayed in each step but if, effective percentage of resection could obtained it would be valuable to substitute mechnical bur or saw and bring about much progress and development in the area of oral and maxillofacial surgery. For this, more studies on bone resection and biomechanical strength of bone tissue after bone healing should be done on various animals.