Diagnostic Value of Early Inflammatory Reaction in Postoperative Infection of the Lumbar Spine

OBJECTIVE: Our aim is to evaluate the early changes of biologic markers such as white blood cell(WBC) count, erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) in early diagnosis of postoperative infection and to differentiate infection from inflammatory reaction in lumbar spine surgery. METHODS: We reviewed 330patients who had undergone spinal operations between May 1999 and October 2001. For this study, the patients were classified into two groups, which include a group that underwent spinal decompressive surgery without instrumentation(SD), and the other group that underwent fusion surgery with spinal instrumentation(SI). And each group was also subdivided into two groups respectively, one with infection and the other without infection. We retrospectively analyzed the WBC count, ESR and CRP preoperatively and postoperatively, according to their operation type and postoperative infection history. RESULTS: Inflammatory indices were physiologically affected by instrumentation itself. But ESR and CRP elevations were more prolonged and sustained under infection. In SD patients without infection, ESR and CRP were stabilized 5 days after surgery. In SI patients without infection, CRP was stabilized about 7days after surgery, but ESR showed sustained and variously elevated. In both SD and SI groups, the stabilization of CRP was the most reliable behavior of surgery without infection. CONCLUSION: C-reactive protein is most sensitive parameter for postoperative spine infection. The knowledge of the inflammatory indices and their relatively uniform patterns with or without infection offers surgeons the ability to infer the state of surgical wound.

Two Cases of Venous Lakes / 대한피부과학회지

Venous lakes are small, bluish-purple, slightly-raised, soft papules or nodules occurring on the exposed skin of elderly people. The lips and ears are the most common sites. Histopathologically, large, dilated and irregular thin-walled venules are located on the upper and mid-dermis. Venous lake is not a rare disease, however, there has been no report of this condition in Korean literature. We report two cases of venous lake together with a review of the pertinent papers.

Concurrent Severe Alopecia Areata in Dizygotic Twins / 대한피부과학회지

A recent genetic study of alopecia areata shows that the patients with early onset, severe, familial group could be separated from the patients with later onset, milder severity with good prognosis in their genetic background. We have experienced an intractable clinical course of alopecia areata in dizygotic twin brothers and have come to sympathise with the genetic influence of the disease. The alopecia areata of the two brothers began for both at about 10 years of age and became severe and persistent over the twenties up to the present times. All treatments failed. The patients were thought to be an example showing the importance of genetic influences in the treatment of alopecia areata.

DPCP (Diphenylcyclopropenone) Immunotherapy in Severe Alopecia Areata: Clinical study of 36 cases / 대한피부과학회지

BACKGROUND: The treatment of alopecia areata is still only symptomatic and, depends on the clinical severity of the disease. The wider and longer the lesion, the more difficult the treatment is. Diphenylcyclopropenone (DPCP) topical immunotherapy has been tried in such severe cases but the methodology is not fully standardized and not legalized in this country. OBJECTIVE: Because of its different cutaneous reactions by different individuals, we want to know a safer methodology for the treatment of alopecia areata using DPCP, and rates of the hair regrowing and the cutaneous side effects of the agent in Korean people. METHODS: A total of 58 cases of extensive alopecia areata who had failed in previous treatments were subjected in this study. After sensitization of the patients with 2% DPCP in acetone, the subsequent on-going treatments were done with 0.001% to 2% with the interval of 3 to 14 days by the patients themselves in their home, after appropriate instruction. We evaluated the therapeutic efficacy of DPCP immunotherapy in 36 patients who were treated at least for more than 20 weeks and up to 2 years. Side effects were observed in all 58 subjects including the ones who gave up the treatment after being sensitized. RESULTS: In the 36 patients who were treated for more than 20 weeks period, a total of 27 (75%) of the patients showed a regrowth of hairs, a complete recovery was seen in 12 patients (33.3%) and a partial recovery in 15 patients (41.7%). Side effects were observed in 70.7% of patients (41/58). These were contact dermatitis, symptomatic lymphadenopathy, generalized pruritus, dermographism, dyschromia in confetti, trichoptilosis, in order of frequency. CONCLUSIONS: The DPCP immunotherapy appeared to be valuable, especially in such extensive cases resistant to more popular local or systemic corticosteroid treatment, despite its high incidency of allergic cutaneous side effects. Careful sensitization procedure and patient's education for selftreatment were stressed.

A Case of Molluscum Contagiosum Occurring in Epidermal Cyst / 대한피부과학회지

We present an unusual case of molluscum contagiosum occurring in epidermal cyst on back of a 5-year-old girl. Histology showed an intradermal cyst containing lamellated horny materials and typical molluscum cells. In Korean literature, 5 such cases were reported. We report an additional case of molluscum occurring in epidermal cyst.

A Case of Syringocystadenoma Papilliferum, Sebaceous Epithelioma, and Basal Cell Carcinoma Arising from Nevus Sebaceus / 대한피부과학회지

Nevus sebaceus is a congenital cutaneous hamartoma which has a potential to develop both benign and malignant neoplasm in late life. The most common benign tumor developed within the nevus is syringocystadenoma papilliferum and the most common malignant tumor basal cell epithelioma. Although two different tumors often develop simultaneously on the lesion, it is rare to see more than two different tumors developing on the lesion of nevus sebaceus. In Korean literatures only three such cases were reported. We report an additional case of nevus sebaceus developing three different tumors, syringocystadenoma papilliferum, sebaceous epithelioma, and basal cell carcinoma, in a 67-year-old female patient.

The Comparison of Therapeutic Effectiveness Between Lesional and Whole Body Exposure on Oral PUVA for Generalized Vitiligo

BACKGROUND: For the treatment of generalized vitiligo patients with oral PUVA, we can use two different methods; one is to treat the lesions while the whole body is exposed. Another one is to treat the lesions while only the lesions are exposed. PURPOSE: This study was performed to determine whether lesional and whole body exposure in oral PUVA for generalized vitiligo show any therapeutic differences in effectiveness. METHODS: The vitiligo lesions were distributed over the whole body skin of the subjects and the lesion area was less than 6% of the whole skin area. PUVA was done to the subjects more than 20 times after oral administration of psoralen. The patients were classified into two different groups. One is the lesional exposure group in which the patient exposed only the vitiligo lesion. The other is the whole body exposure group in which the patient exposed almost their whole body. RESULTS: Our results show that there is no statistical difference of the therapeutic effectiveness between the two methods. CONCLUSIONS: We recommend lesional treatment rather than whole body treatment to prevent the oral PUVA side effects.