Analysis of Cooperation Project for Early Diagnosis of Leprosy from 2009 to 2018 / 대한피부과학회지

Background@#Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. As leprosy has a long disease course, various dermatoses must be considered in the differential diagnosis. @*Objective@#In Korea, due to the low incidence rate of leprosy and lack of doctors with experience of leprosy, it is difficult to make an early diagnosis. Therefore, we evaluated the importance of cooperation projects in the diagnosis of leprosy. @*Methods@#A retrospective study was performed on 137 patients who were referred by other hospitals to the Institute for Leprosy Research, Korean Hansen Welfare Association, to make an early diagnosis of leprosy from 2009 to 2018. @*Results@#Among 137 patients, 19 were diagnosed with leprosy, which accounted for approximately 37% of new cases of leprosy in Korea during the 10 years. By nationality, 15 were Korean, and 4 were foreigners. The most common type was lepromatous leprosy. All multibacillary patients were positive for phenolic glycolipid-1 antibody, M. leprae-specific gene polymerase chain reaction, and acid-fast bacilli stain. Among the four paucibacillary patients who showed both negative acid-fast bacilli stain and phenolic glycolipid-1, three were positive for polymerase chain reaction. Of the 55 skin biopsy specimens that were not diagnosed with leprosy, granulomatous skin disease was the most commonly diagnosed condition. @*Conclusion@#In this study, we diagnosed patients with leprosy who were referred from other hospitals due to the suspicion of leprosy, which enables early treatment of leprosy. Finally, we believe that our project has public health significance in preventing the spread of leprosy in the community.

The study of glucose-6-phosphate dehydrogenase deficiency from persons affected by Hansen's disease in Korea / 나학회지

Background@#Glucose-6-phosphate dehydrogenase deficiency is the most common enzyme deficiency disease. Drugs that cause deficiency-related hemolytic responses include dapsone, which is taken as a therapeutic drug for Hansen's disease. Due to the hemolytic adverse effects, the deficiency test should be performed before the dapsone administration, but it is not conducted on the basis of low incidence in Korea. Thus, the monitoring of deficiency in patients with Hansen's disease was needed and the study was undertaken. @*Objective@#The aims of this study were to determine the prevalence of deficiency and gene mutations from persons affected by Hansen's disease in Korea. @*Methods@#Hemanalysis and activity test by venipuncture were performed against the 339 persons affected by Hansen's disease. All subjects were tested for detection of mutations by the polymerase chain reaction. @*Results@#The prevalence of anemia was 45.5% and the prevalence of deficiency was 1.2% from persons affected by Hansen's disease. 2 gene mutations, Mahidol and Mediterranean, were detected in foreign participants (Myanmar and Nepal). @*Conclusion@#In this study, we detected that the prevalence of deficiency and gene mutation was low, thus inferred that anemia was relatively less relevant to deficiency in persons affected by Hansen's disease. However, the number of participant in our study is small, and many studies reported that deficiency test should be performed before the dapsone administration, therefore, we suggest that continuous monitoring of patients with Hansen's disease is necessary.

The Study of Association between Leprosy's Type and Apolipoprotein E Gene in Korean Persons Affected by Leprosy / 나학회지

Background@#Apolipoprotein E protein is a family of apolipoproteins that play an important role in lipid metabolism. Apolipoprotein E genotype and single-nucleotide polymorphisms of genes are known to induce neurodegenerative diseases and cardiovascular diseases. Recently, it has been reported that apolipoprotein E is related to Hansen's disease by regulating genes related to lipid metabolism. @*Objective@#In this study, we investigated that relationship of apolipoprotein E genotype with leprosy type and single-nucleotide polymorphism in korean persons affected by leprosy. @*Methods@#The Apolipoprotein E genotype was confirmed using the polymerase chain reaction from korean persons affected by leprosy. Real-time polymerase chain reaction using probes confirmed the rs405509 and rs439401 of Apolipoprotein E. The identified genotype was cross-analyzed with each single-nucleotide polymorphism results and leprosy type by chi-squared test. @*Results@#The distribution of apolipoprotein E genotypes was E3/E3 76.7%, E3/E4 17.4%, E2/E2 2.3%, E2/E3 2.3%, E2/E4 1.2% were in order. The frequencies of the apolipoprotein E allele were identified in the order of ε2 4.1%, ε3 86.6%, and ε4 9.3%. By type of leprosy, ε2 allele increased 2.2 times in multibacillary than pauacibacillary(4.8% vs 2.2%), and ε4 allele decreased 2.8 times in multibacillary than pauacibacillary(6.3% vs 17.4%). ApoE genotype was cross-analyzed with rs405509·rs439401, and there was a statistically significant association. @*Conclusion@#Apolipoprotein E genotype is associated with leprosy types in korean persons affected by leprosy. The research for apolipoprotein E gene is thought to be helpful in basic research on the pathogenesis of leprosy.who underwent surgery.

Approach Using Multiple Biomarkers for Diagnosis of Hansen's Disease / 나학회지

Background@#The prevalence of leprosy has almost reached the goal of World Health Organization. Accordingly, attention to leprosy and the number of skilled doctors who can diagnosis the leprosy upon clinical manifestations were decreased which caused the delayed diagnosis of leprosy. @*Objective@#Serum C-reactive protein, interferon gamma-induced protein 10, anti-phenolic-glycolipid-1 IgM are biomarkers associated with multi-bacillary leprosy. Therefore, we investigated whether the use of multiple biomarkers has diagnostic value. @*Methods@#The samples were collected from August 2012 to December 2019 at our institute. Through various statistic methods, multiple biomarkers and equation were compared in multi-bacillary patients, pauci-bacillary patients, contacts and different skin disease. @*Results@#Samples were collected from 21patients (17 multi-bacillary, 4 pauci-bacillary) and 17 from non-patients (7 from contacts, 10 from other skin disease). Serum level of C-reactive protein, interferon gamma-induced protein 10, anti-phenolic-glycolipid-1 IgM and equation showed statistical significance compared from patients to non-patients. Comparing multi-bacillary patients to pauci-bacillary patients, only anti-phenolic-glycolipid-1 IgM showed statistical significance. Each area under receiver operating characteristic curve of those biomarkers and equation was ≥0.70 and p≤0.05. The results of Equation using 3 indicators showed higher area under receiver operating characteristic curve and lower P value compared when each indicator was used. Also sensitivity and specificity of them presented meaningful data. @*Conclusion@#We confirmed that using integrated analysis of three biomarkers is more significant than the single indicator in the diagnosis of leprosy. In addition, the use of multiple biomarkers is thought to contribute to the management of leprosy in the community.

An Easy Method of Masseter muscle sling for lower lip paralysis in senile Hansen Patients / 나학회지

Background@#One of the Sequelae of facial nerve paralysis in leprosy patients is severe eye and lip deformity. Eye deformities are most common, followed by unilateral lip deviation. When there is bilateral failal nerve paralysis, the lower lip drooping may occur. The lower lip drooping makes mouth closure incomplete, so the fluid or saliva may flow out when eating. And the teeth may be exposed or even the gum may be visible, which causes serious cosmetic and functional impairments. @*Objective@#It is to evaluate the masseter muscle sling (MMS) method in the treatment of the recurrent lower lip drooping in patients with Hansen's disease. @*Methods@#In the case of masseter muscle sling, there is a traditional method of detaching, separating and raising anterior masseter muscle in half from the mandibular jaw line and fixing it to the lip muscle. However, the authors observed a 3cm gap between the anterior border of masseter muscle and the lateral edge of orbicularis oris muscle. Under the local anesthesia the nasolabial line was incised and 3-4 places were pulled up between both musle edges and plicated with a 2/0 PDS??threads the gap-space. @*Results@#During 5 years (2016-2020), there were 17 recurrent lower lip palsy patients. The mean age was 71.3 years and the ratio of male and female was 9:8. Of 17 patents, 12 received temporal muscle transfer (TMT) attached with tensor fascia lata (TFL), 2 received temporal muscle transfer attached with Alloderm, and 3 received masseter muscle sling alone. The postoperative results of corrective masseter muscle sling were satisfactory in all 17 patients and there were no serious complication and recurrence during follow-up. @*Conclusion@#Masseter muscle sling is effective method in correction of recurrent lower lip drooping in patient with leprosy who treated previously with temporal muscle transfer attached with tensor fascia lata or temporal muscle transfer attached with Alloderm. In addition, masseter muscle sling may be considered as the first-line treatment in the lower lip paralysis.

The study of glucose-6-phosphate dehydrogenase deficiency from persons affected by Hansen's disease in Korea / 나학회지

Background@#Glucose-6-phosphate dehydrogenase deficiency is the most common enzyme deficiency disease. Drugs that cause deficiency-related hemolytic responses include dapsone, which is taken as a therapeutic drug for Hansen's disease. Due to the hemolytic adverse effects, the deficiency test should be performed before the dapsone administration, but it is not conducted on the basis of low incidence in Korea. Thus, the monitoring of deficiency in patients with Hansen's disease was needed and the study was undertaken. @*Objective@#The aims of this study were to determine the prevalence of deficiency and gene mutations from persons affected by Hansen's disease in Korea. @*Methods@#Hemanalysis and activity test by venipuncture were performed against the 339 persons affected by Hansen's disease. All subjects were tested for detection of mutations by the polymerase chain reaction. @*Results@#The prevalence of anemia was 45.5% and the prevalence of deficiency was 1.2% from persons affected by Hansen's disease. 2 gene mutations, Mahidol and Mediterranean, were detected in foreign participants (Myanmar and Nepal). @*Conclusion@#In this study, we detected that the prevalence of deficiency and gene mutation was low, thus inferred that anemia was relatively less relevant to deficiency in persons affected by Hansen's disease. However, the number of participant in our study is small, and many studies reported that deficiency test should be performed before the dapsone administration, therefore, we suggest that continuous monitoring of patients with Hansen's disease is necessary.

The Study of Association between Leprosy's Type and Apolipoprotein E Gene in Korean Persons Affected by Leprosy / 나학회지

Background@#Apolipoprotein E protein is a family of apolipoproteins that play an important role in lipid metabolism. Apolipoprotein E genotype and single-nucleotide polymorphisms of genes are known to induce neurodegenerative diseases and cardiovascular diseases. Recently, it has been reported that apolipoprotein E is related to Hansen's disease by regulating genes related to lipid metabolism. @*Objective@#In this study, we investigated that relationship of apolipoprotein E genotype with leprosy type and single-nucleotide polymorphism in korean persons affected by leprosy. @*Methods@#The Apolipoprotein E genotype was confirmed using the polymerase chain reaction from korean persons affected by leprosy. Real-time polymerase chain reaction using probes confirmed the rs405509 and rs439401 of Apolipoprotein E. The identified genotype was cross-analyzed with each single-nucleotide polymorphism results and leprosy type by chi-squared test. @*Results@#The distribution of apolipoprotein E genotypes was E3/E3 76.7%, E3/E4 17.4%, E2/E2 2.3%, E2/E3 2.3%, E2/E4 1.2% were in order. The frequencies of the apolipoprotein E allele were identified in the order of ε2 4.1%, ε3 86.6%, and ε4 9.3%. By type of leprosy, ε2 allele increased 2.2 times in multibacillary than pauacibacillary(4.8% vs 2.2%), and ε4 allele decreased 2.8 times in multibacillary than pauacibacillary(6.3% vs 17.4%). ApoE genotype was cross-analyzed with rs405509·rs439401, and there was a statistically significant association. @*Conclusion@#Apolipoprotein E genotype is associated with leprosy types in korean persons affected by leprosy. The research for apolipoprotein E gene is thought to be helpful in basic research on the pathogenesis of leprosy.who underwent surgery.

Approach Using Multiple Biomarkers for Diagnosis of Hansen's Disease / 나학회지

Background@#The prevalence of leprosy has almost reached the goal of World Health Organization. Accordingly, attention to leprosy and the number of skilled doctors who can diagnosis the leprosy upon clinical manifestations were decreased which caused the delayed diagnosis of leprosy. @*Objective@#Serum C-reactive protein, interferon gamma-induced protein 10, anti-phenolic-glycolipid-1 IgM are biomarkers associated with multi-bacillary leprosy. Therefore, we investigated whether the use of multiple biomarkers has diagnostic value. @*Methods@#The samples were collected from August 2012 to December 2019 at our institute. Through various statistic methods, multiple biomarkers and equation were compared in multi-bacillary patients, pauci-bacillary patients, contacts and different skin disease. @*Results@#Samples were collected from 21patients (17 multi-bacillary, 4 pauci-bacillary) and 17 from non-patients (7 from contacts, 10 from other skin disease). Serum level of C-reactive protein, interferon gamma-induced protein 10, anti-phenolic-glycolipid-1 IgM and equation showed statistical significance compared from patients to non-patients. Comparing multi-bacillary patients to pauci-bacillary patients, only anti-phenolic-glycolipid-1 IgM showed statistical significance. Each area under receiver operating characteristic curve of those biomarkers and equation was ≥0.70 and p≤0.05. The results of Equation using 3 indicators showed higher area under receiver operating characteristic curve and lower P value compared when each indicator was used. Also sensitivity and specificity of them presented meaningful data. @*Conclusion@#We confirmed that using integrated analysis of three biomarkers is more significant than the single indicator in the diagnosis of leprosy. In addition, the use of multiple biomarkers is thought to contribute to the management of leprosy in the community.

An Easy Method of Masseter muscle sling for lower lip paralysis in senile Hansen Patients / 나학회지

Background@#One of the Sequelae of facial nerve paralysis in leprosy patients is severe eye and lip deformity. Eye deformities are most common, followed by unilateral lip deviation. When there is bilateral failal nerve paralysis, the lower lip drooping may occur. The lower lip drooping makes mouth closure incomplete, so the fluid or saliva may flow out when eating. And the teeth may be exposed or even the gum may be visible, which causes serious cosmetic and functional impairments. @*Objective@#It is to evaluate the masseter muscle sling (MMS) method in the treatment of the recurrent lower lip drooping in patients with Hansen's disease. @*Methods@#In the case of masseter muscle sling, there is a traditional method of detaching, separating and raising anterior masseter muscle in half from the mandibular jaw line and fixing it to the lip muscle. However, the authors observed a 3cm gap between the anterior border of masseter muscle and the lateral edge of orbicularis oris muscle. Under the local anesthesia the nasolabial line was incised and 3-4 places were pulled up between both musle edges and plicated with a 2/0 PDS??threads the gap-space. @*Results@#During 5 years (2016-2020), there were 17 recurrent lower lip palsy patients. The mean age was 71.3 years and the ratio of male and female was 9:8. Of 17 patents, 12 received temporal muscle transfer (TMT) attached with tensor fascia lata (TFL), 2 received temporal muscle transfer attached with Alloderm, and 3 received masseter muscle sling alone. The postoperative results of corrective masseter muscle sling were satisfactory in all 17 patients and there were no serious complication and recurrence during follow-up. @*Conclusion@#Masseter muscle sling is effective method in correction of recurrent lower lip drooping in patient with leprosy who treated previously with temporal muscle transfer attached with tensor fascia lata or temporal muscle transfer attached with Alloderm. In addition, masseter muscle sling may be considered as the first-line treatment in the lower lip paralysis.

The Analysis of Anemia in Persons affected leprosy / 나학회지

BACKGROUND@#The anemia still remains the most common hematologic disorder in the world despite improvements in general health and nutrition. Recently, the prevalence of anemia in the persons affected leprosy aged over 60 years in Korea was reported 22.4% in 60–69 years and 47.4% in 70 years or older in male and was reported 33.8% in 60–69 years and 46.0% in 70 years or older in female.@*OBJECTIVE@#In the meantime, the studies were limited to the subjects in a specific region, and the number of subjects was not enough, so it was not enough to evaluate the of anemia of persons affected by leprosy in Korea. So this study was conducted to evaluate it's prevalence, types, & presumed causes in settlement villages nationwide.METHOD: This study was conducted that the mobile team visited the resettlement villages nationwide from 2009 to 2019 and conducted on persons affected by leprosy and residents residing in resettlement village. Obtained bloods & serums were assayed (hemoglobin, mean corpucular volume, red blood cell distribution width, serum ferritin, serum iron, TIBC, serum vitamin B12, serum folate).RESULT: The prevalence of anemia was 34.31%(male 36.49%, female 32.97%), the proportion of the anemia classified by MCV was 2.6%(microcytic), 66.3%(normocytic), and 31.1%(macrocytic). Among micro- & normocytic anemia, a cause of the anemia was attributed 12.5% to anemia of iron deficiencies, 7.5% anemia of iron deficiencies with anemia of chronic diseases, and 5% to anemia of chronic diseases, among normo- & macrocytic anemaia, was attributed 8.6% to anemia of vitamin B12 deficiency(< 211 pg/ml) and 23.8% to anemia of folate deficiency(< 5.38 ng/ml).@*CONCLUSION@#In this study, we found that the prevalence of anemia in the persons affected leprosy aged over 60 years was higher than other past reports of general population over 60 years in Korea. So we will consider about the evaluation of higher prevalence of anemia in persons affected leprosy, causes of anemia, especially dapsone-related & other underline disease and management plan for anemia in them by the in-depth studies.

Easy method for Upper lid blepharoplasty in elderly Hansen affected persons / 나학회지

BACKGROUND@#The average age of Korean Hansen affected persons who have become less than 10,000 is 76 years old.The upper eyelid lesions of these patients coexist with senile lesions and paralytic lesions due to facial paralysis.This senile change includes skin laxity, eyebrow drooping, eyelid drooping, medial and lateral canthal relaxation and paralytic changes include wrinkle disappearance in the forehead, eyebrows asymmetry, eyelash drooping in the upper eyelid, and simultaneously symptoms of lower eyelid such as ectropion and lapophthalmos.@*OBJECTIVE@#Authors want to present a prescribed method of treatment that makes it easier to fix changes in senile and paralytic eyelids in elderly Hanson affected persons.@*METHODS@#For senile blepharochalasis, if the distance between eye blow and eyelash (brow-lash distance) is to the 2.5 cm or more the sub-brow resection should be done.However, if brow-lash distance is less than 2.5 cm, the supra-brow resection should be done. For paralytic cases if there is a difference in height on the eyebrow. the skin is removed to create the same level as the eyebrow height on the healthy side.if both eyes are paralyzed the supra blow skin excision are done with prudence not to make the lagophthalmos.RESULT: In recent 2 years of 2018–2019we treated 32 cases of blepharochalasis, Blephnaroptosis, paralylic eyebrow droping and lash-laden eyelid margin excision for trichiasis correction. Satisfactory results were obtained in all patients who underwent surgery.@*CONCLUSION@#The authors report our experience of treating various upper eyelid lesions in the past 2 years in 32 cases of Hansen affected persons a history of Hansen's disease, together with literature review.

Comparison of Effective DNA Extraction method for Molecular biological study of Mycobacterium leprae / 나학회지

BACKGROUND@#Leprosy is an important health problem in many geographical areas yet. It is caused through a cough or contact with fluid from the nose of a person infected by Mycobacterium leprae. Study of DNA from M. leprae is important to understand essentiality for leprosy. However, there is no standard in many parts, so various studies are needed.OBJECTS: In this study, DNA extraction method were confirmed for the effective detection of M. leprae. And restriction enzyme fragment length polymorphism typing and high resolution melt (HRM) analysis were performed for comparison with sequencing analysis.@*METHODS@#Compared with three DNA extraction methods (BB, SM and SP) with real-time polymerase chain reaction (PCR). Analysis single nucleotide polymorphism (SNP) genotype and tandem repeats by PCR amplification, and then compare with sequence.@*RESULTS@#BB method was effective when measuring the concentration and threshold cycle (Ct) compared with SM and SP methods. When compared with restriction fragment length polymorphism typing method and sequence analysis, all methods were suitable for SNP1 and 3 type classification. Tandem repeats values of BB method were correspond to sequence analysis than SM and SP methods in HRM analysis.@*CONCLUSIONS@#The DNA extraction method by bead is useful approach for studying of M. leprae.

Effect of temperature and medium on the viability of Mycobacterium leprae during long term-storage / 나학회지

BACKGROUND@#Mycobacterium leprae (M. leprae) is pathogenic bacterium with polymorphic, acid-fast properties and causes leprosy that it is called Hansen's disease. Leprosy can be completely cured using multidrug therapy (MDT), but it is not easy to eradicate leprosy and M. leprae on the planet.OBJECT: We still do not understand the exact pathogenesis mechanism of leprosy. The main reason is that we cannot grow bacteria in vitro. Therefore, quantitative measurement and damage-free storage of live M. leprae are very important.@*METHODS@#Here, we generated bacteria stocks of M. leprae using HBSS with 0.05% tween 80 or freezing solution 11 months ago and evaluated conditional survival of bacteria by Propidium monoazide (PMA) staining, real-time PCR.@*RESULTS@#There were assessed for bacteria viability under the conditions of each temperature or medium by delta-Ct level of real-time PCR. We also observed that frozen-stored M. leprae (2.14) compare to refrigerated-stored M. leprae (1.03) was significant decreased delta-Ct in HBSS (P<0.05). However, frozen-stored M. leprae (1.14) was not difference refrigerated-stored M. leprae (0.84) in freezing solution (P=NS). Real-time PCR with SYBR green method was reliable for results and statistical significance, but data for real-time PCR with probe method were unreliable.@*CONCLUSIONS@#Taken together, these results indicated that freezing solution regardless of temperature increase much more bacterial survival. In addition, if use not freezing solution, M. leprae must be stored frozen.

Relapsed Leprosy with Multiple Ulcerative Skin Lesions: A Case Report / 나학회지

Leprosy is a chronic infectious and granulomatous disease caused by Mycobacterium leprae. It is treated with a multidrug therapy (MDT), which is consisted of dapsone, rifampicin, and clofazimine. However, there were relapsed leprosy associated with various predisposing factors; persisting organism, multiple involved skin lesions and nerves, HIV infection, monotherapy, inadequate and irregular therapy. Early or late relapses were observed in leprosy. Early onset relapses may occur due to insufficient treatment, and late relapses are probably with persistent bacilli and drug resistant organisms. Herein, we report on an interesting case of a 78-year-old man presented with relapsed leprosy associated with ulcerative skin lesions. The patient was diagnosed with lepromatous leprosy about 40 years ago, and he was treated with dapsone monotherapy and MDT. Our case is thought to have occurred due to persistent bacilli related to irregular therapy.

Two cases of calcinosis cutis treated with surgical excision / 나학회지

Calcinosis cutis is an uncommon disorder and defined as the deposit of insoluble calcium salts in the skin. It is classified as dystrophic, metastatic, idiopathic, and iatrogenic according to etiology. The dystrophic type is the most common and occurs in the previously damaged tissue, including connective tissue diseases, panniculitis, inherited disorders, benign and malignant tumors, a variety of scarring caused by burn, radiation, trauma, surgery, and keloid. Treatment options are limited. Whereas medical therapy is usually not very effective, surgical intervention has shown to be beneficial and is indicated when painful masses, recurrent infection, ulcerations, functional impairment, and cosmetic concerns exist. Herein, we report two cases of dystrophic calcinosis cutis associated with longstanding, painful, ulcerated cutaneous lesions in the extremities successfully treated with surgical excision.

Seropositivity of Hepatitis C Virus among Persons affected Leprosy in Korea / 나학회지

BACKGROUND: Leprosy is a contagious chronic granulomatous disease and is a disease that is associated with defects in cellular immunity. A high prevalence of hepatitis C virus infection in leprosy patients has been reported in several African countries, Yemen, Brazil and Japan. In Korea, it's seropositivity was reported as 8.33%(2001), 39.3%(2002), 35.1%(2009) and 16.0%(2009) on Korean Leprosy Bulletin. OBJECTIVE: In the meantime, the studies were limited to the subjects in a specific region, and the number of subjects was not enough, so it was not enough to evaluate the hepatitis C virus seropositivity of persons affected by leprosy in Korea. So this study was conducted to evaluate the it's seropositivity in settlement villages nationwide. METHOD: This study was conducted that the mobile team visited the resettlement villages nationwide from 2009 to 2017 and conducted on persons affected by leprosy and residents residing in resettlement village. Obtained serums were assayed by the ADVIA Centaur HVC(IgG antibodies to Hepatitis C Virus) reagent using a Siemens ADVIA Centaur CP instrument. The results of persons affected by leprosy and residents were compared, and the difference of seropositivity among the groups(male and female, multibacillary and paucibacillary, locations of resettlement villages) was evaluated. RESULT: The results of hepatitis C virus antibody positivity of 1669 persons affected by leprosy subjects and 185 residents of resettlement villages were 28.46% in persons affected by leprosy and 6.49% in residents(Pearson's Chi-Square test, P = 0.00). In persons affected by leprosy, that were 31.99%(male) and 26.84%(female)(Pearson's Chi-Square test, P = 0.06) and were 29.97%(multibacillary) and 25.36%(paucibacillary)(Pearson's Chi-Square test, P = 0.05). That of Seoul(48.28%), Busan(43.78%) and Chungbuk Province(35.94%) were highly positive and that of Gangwon Province(20.34%) was lowly positive(Fisher's Exact test P = 0.002). CONCLUSION: In this study, we found that hepatitis C virus antibody positivity rate was high in persons affected by leprosy in Korea. In order to explain the high positive rate, further studies will be needed. Also, through various approaches including assessment of HCV RNA to the subjects who were judged to be positive for antibody test in the future, a comprehensive evaluation of hepatitis C and its countermeasures are needed.

New patient of Hansen's disease in young Korean man / 나학회지

Hansen's disease (leprosy) is a chronic infectious disease caused by Mycobacterium leprae which affect mainly skin and nerve systems. Currently the incidence of leprosy reached the goals set by WHO in the year 2000. In recent 10 years, only 47 new patients were found in Koreans and their average age was over 70. A 21 year-old young man showed multiple erythematous papules, macules and plaque at face, extremities and trunk. In family history, his grandfather was diagnosed with leprosy at young age and leprosy was recurred when the patient was 7 years old. The patient lived with grandfather from birth to 7 years old. Clinico-pathologically he was diagnosed with a lepromatous leprosy. We performed VNTR both at the skin tissue of grandfather and patient to find out the infection pathway of the patient and found some consistent. Herein, we report a new case of young Korean male transmitted from grandfather.

Aesthetic Surgical Treatment of the Peri-orbital area in Hansen's Patients / 나학회지

BACKGROUND: Upper eyelid blepharoplasty has become one of the commonly practiced aesthetic operation. This upper eyelid blepharoplasty primarily conducted in aged person, while also addressing aesthetic concerns, include methods to rejuvenate the peri-orbital area and provide unobstructed eyesight. OBJECTIVE: Methods to affect rejuvenation of the peri-orbital area are variable and depend heavily on the patients. This makes evaluation of the patient a critically important component of the treatment process. Upper eyelid blepharoplasty requires treatment of the anterior and posterior lamella structures. Anterior lamella undergone a resection of the skin and orbicularis muscle to reduce the sagging appearance on the anterior surface of the upper eyelid. The retractor structures of the posterior lamella, especially the levator aponeurosis and the Müller's muscle, are advanced, tucked and plicated to the tarsus to add tension as needed to correct the blepharoptosis. This procedure, while also addressing aesthetic concerns, primarily adds tension to reduce or eliminate eyesight obstruction. Methods & Conclusion: These operation methods include : The plication procedures of posterior membranous septum and turn-over orbital septum to 2mm below the tarsus and traditional levartor complex tucking including levator aponeurosis and Müller muscle added. In addition to blepharoplasty and blepharoptosis in aged persons the brow-ptosis may also experience. This drooping of the eyebrow also contribute to eyesight obstruction and should be corrected. In general, treatment consists of a subbrow resection when the brow-lash distance is 25mm or more. When the brow-lash distance is less that 25mm, a supra-brow excision is required to prevent an angry or harsh appearance. However, when using the supra-brow method the possibility of an unwanted visible scar is more likely, a short incision direct brow-lift could be another alternative. But short incision brow-lift procedure can only use under the normal forehead muscle function.

Molecular Epidemiology of Mycobacterium leprae as Determined by Structure-Neighbor Clustering in Korea found cases / 나학회지

BACKGROUND: It has proven challenging to investigate the molecular epidemiology of Mycobacterium leprae, the causative agent of leprosy, due to difficulties with culturing of the organism and a lack of genetic heterogeneity between strains. Recently, A panel of variable-number tandem-repeat (VNTR) markers and an alternative method, structure-neighbor clustering, which assigns isolates with the most similar genotypes to the same groups and, subsequently, subgroups, without inferring how the strains descended from a common ancestor have been developed. METHODS: A total of 29 samples from Korea found cases were studied by 14 VTRN typing and an alternative method, structure-neighbor clustering with 13 and 14 VNTRs by Structure Program(k=10). RESULTS: Only 286 cases of 522 total cases(including database of Bellingham Research Institute) showed p>0.8(in 13 and 14 VNTRs). Almost Korea found cases(18 cases) were included in group 3(13 VNTRs), in group 9(14 VNTRs)(by Structure Program, k=10). CONCLUSIONS: The structure-neighbor clustering by Structure Program with panels of VNTR is a useful approach for investigating the molecular epidemiology of Mycobacterium leprae.

An effect of Masseter muscle transfer in recurred cases following temporalis transfer for lower lip paralysis / 나학회지

BACKGROUND: Facial nerve palsy in patients with leprosy brings a variety of discomfort functionally and cosmetically. Although the distortion of the lips is less frequent than that of the eyes, when it occurs, it happens either unilaterally or bilaterally and shows a different dynamic from that in eyes. The lower lip droop causes saliva to flow out of the mouth when eating and exposes the gum and teeth. MATERIALS AND METHODS: All patients were previously treated using the TMT procedure yet symptoms recurred within an unacceptable timeframe. Therefore, we retreated patients using the masseter muscle plication. We performed the masseter muscle plication to the lateral portion of the lower lip muscle to give it power without dividing the anterior segment of masster muscle from mandibular border. RESULTS: Complete closure of the mouth was observed in 6 patients with a moderate degree of lower lip droop. One patient that presented with severe lower lip droop bilaterally showed only partial closure. CONCLUSIONS: Without dividing anterior half segment of masseter muscle from mandibular border, the direct plication of the anterior border of masseter muscle and lower lip muscles was very effective method to correct the lower lip droop and to close the mouth in recurrent patients after temporal muscle transfer.