A Case of Treatment with Methotrexate Local Injection on Intramural Pregnancy within a Previous Cesarean Scar / 대한산부인과학회지

Intramural pregnancy on a cesarean section scar is one of the rarest forms of ectopic pregnancy that may cause serious complications such as uterine rupture and massive bleeding. The common treatment in the past was laparotomy, but today early diagnosis is available thanks to the development of image diagnostic technology and, as a consequence, cases of less invasive conservative management are reported. Using vaginal ultrasonography and MRI, we made an early diagnosis on a case of intramural pregnancy on the scar of a previous cesarean section. We injected methotrexate locally into the gestational sac, and the intramural pregnancy was completely cured. Thus, here we report this case with a brief review of relevant literature.

Clinical Evaluation on 763 Cases of Laparoscopically Assisted Vaginal Hysterectomy (LAVH) / 대한산부인과학회지

OBJECTIVE: To report our clinical experience with 763 cases of laparoscopic assisted vaginal hysterectomy (LAVH) and to evaluate the efficacy and advantage of LAVH. METHODS: From Jan. 2000 to Feb. 2006, 763 cases of LAVH were performed at the Department of Obstetrics and Gynecology. we analyzed the results regard to the age, parity, surgical indication, previous abdominal surgery, operation time, weight of uterus, change of hemoglobin, hospital stay, concomitant procedures, and complication. RESULTS: The mean age was 45.7+/-7.1 years. The mean parity was 2.5+/-1.2. The average weight of patients was 58.59+/-9.5 kg. Leiomyoma was the most common surgical indication. Tubal ligation was the most common previous surgery. The mean operation time was 87.5+/-45.7 minutes. The mean hemoglobin change was 1.1+/-0.7 g/dL. The mean uterine weight was 251.34+/-131.5 gm. The mean hospital stay was 6.15+/-0.94 days. The complication rate was 3.4% (26 cases); bladder injury (7 cases), ureter injury (3 cases), vault bleeding (3 cases), trochar site bleeding (13 cases). CONCLUSIONS: LAVH is safe and effective surgical procedure for hysterectomy. The improvement of surgical skill and laparoscopic instrument can make more replace Total abdominal hysterectomy with LAVH.

A Histopathologic Study of Alopecia Using Transverse Sections / 대한피부과학회지

BACKGROUND: Conventional vertical sections of scalp biopsy specimens are often inadequate for the diagnosis of alopecia. Alternatively, a better approach can often be provided with the use of transverse sections continues, which is readily available and continues to grow in popularity. OBJECTIVE: The purpose of this study was to compare the histopathologic findings of transverse and vertical sections of scalp biopsy specimens in various types of alopecia. METHODS:A total of 27 scalp biopsy specimens obtained during the past 16 months for the evaluation of alopecia was processed for either transverse or vertical section, or for both. With these sections a quantitative morphologic study was done by counting a variety of follicular structures, and any specific histopathologic changes were recorded. RESULTS: Diagnostic features that were better seen in vertical sections included quantitative morphologic changes of a variety of follicular structures such as total number of follicles, catagen and telogen hairs, vellus hairs and follicular stele, as were anagen-telogen ratios and terminal-vellus ratios. Other histopathologic findings that were better demonstrated in transverse sections included peribulbar inflammatory infiltrate for alopecia areata, miniaturization for androgenetic alopecia, trichomalacia and pigment cast for trichotillomania, and fat atrophy for pressure alopecia. In some cases, especially for scarring alopecia, vertical sections also allowed for useful adjunctive diagnostic information such as follicular destruction, dermal fibrosis and sclerosis, and interface change. CONCLUSION: Transverse sections of scalp biopsy specimens provided many useful information in histopathologic diagnosis of alopecia. But, in some cases of scarring alopecia, vertical sections provided more diagnostic findings. To overcome the diagnostic limitation of transverse sections, therefore, observing both transverse and vertical sections at a time could be an alternative way of enhancing diagnostic yield of alopecia.

A Histopathologic Study of Alopecia Using Transverse Sections / 대한피부과학회지

BACKGROUND: Conventional vertical sections of scalp biopsy specimens are often inadequate for the diagnosis of alopecia. Alternatively, a better approach can often be provided with the use of transverse sections continues, which is readily available and continues to grow in popularity. OBJECTIVE: The purpose of this study was to compare the histopathologic findings of transverse and vertical sections of scalp biopsy specimens in various types of alopecia. METHODS:A total of 27 scalp biopsy specimens obtained during the past 16 months for the evaluation of alopecia was processed for either transverse or vertical section, or for both. With these sections a quantitative morphologic study was done by counting a variety of follicular structures, and any specific histopathologic changes were recorded. RESULTS: Diagnostic features that were better seen in vertical sections included quantitative morphologic changes of a variety of follicular structures such as total number of follicles, catagen and telogen hairs, vellus hairs and follicular stele, as were anagen-telogen ratios and terminal-vellus ratios. Other histopathologic findings that were better demonstrated in transverse sections included peribulbar inflammatory infiltrate for alopecia areata, miniaturization for androgenetic alopecia, trichomalacia and pigment cast for trichotillomania, and fat atrophy for pressure alopecia. In some cases, especially for scarring alopecia, vertical sections also allowed for useful adjunctive diagnostic information such as follicular destruction, dermal fibrosis and sclerosis, and interface change. CONCLUSION: Transverse sections of scalp biopsy specimens provided many useful information in histopathologic diagnosis of alopecia. But, in some cases of scarring alopecia, vertical sections provided more diagnostic findings. To overcome the diagnostic limitation of transverse sections, therefore, observing both transverse and vertical sections at a time could be an alternative way of enhancing diagnostic yield of alopecia.

Rosacea: Clinical Study of 67 Cases

BACKGROUND: Rosacea is a chronic skin disease which primarily affects the face. There have been many basic and clinical studies on rosacea in the West, but little in Korea. OBJECTIVE: This study was to investigate clinical features of rosacea in Korea and to compare them with those in the West. METHODS: During a 20-month period, 67 patients diagnosed as having rosacea were examined for their clinical presentations by means of personal interview. RESULTS: Erythema and telangiectasia were found in almost all of the 67 patients. Comparing with the results in the West, flushing and telangiectasia were more common whereas papules, pustules, and rhinophyma were less common with no case of ocular complaints or migraine. CONCLUSION: Because early detection and treatment is necessary to prevent the progression of rosacea, it is important to realize that rosacea is not uncommon in Korea and to recognize its somewhat different clinical manifestations from those in the West.

Treatment of Molluscum Contagiosum with Topical Tretinoin Therapy / 대한피부과학회지

BACKGROUND: Conventional treatment of molluscum contagiosum(MC) has been surgical curettage. This treatment is painful and not feasible in widespread lesions, particularly in infants and children. OBJECTIVE: We evaluated 30 children with MC for the clinical effectiveness and advantage of treatment with topical tretinoin therapy. METHODS: Thirty children with MC visited our clinic were asked to apply the tretinoin cream to each individual lesion, and followed up for 8 to 12 weeks. During these periods the assessment of therapeutic response was performed on a biweekly basis. RESULTS: Fifteen(50%) of 30 patients achieved complete clearance after a mean treatment period of 4.7 weeks. Partial clearance were observed in 5(16.7%) and no response in 1 children(3.3%). No patient dropped out because of the adverse effects. Twenty one children(66.7%) reported a mild itching and/or erythema, stinging, and temporary hyperpigmentation. CONCLUSION: Therapy with treatinoin cream was found to be effective, safe, and painless in the treatment of MC in children.

A Case of Fibrous Hamartoma of Infancy / 대한피부과학회지

Fibrous hamartoma of infancy (FHI) is an uncommon benign fibrous proliferation, usually presenting as a single nodule. A 17-month-old male patient had an asymptomatic fingertip-sized subcutaneous nodule on the right side of the back for 6 month. Histopathologic findings showed the typical feature of FHI, that is well defined intersecting fibrous trabeculae, small immature cells within loosely textured areas, and mature adipose areas in the lower dermis and subcutaneous layer. Immunohistochemically, vimentin positivity was present in both the trabecular and loosely textured areas, but desmin was not present in any components which is positive usually only in trabecular areas. The lesion was excised without recurrence. We experienced and report an uncommon case of fibrous hamartoma of infancy in a 17-month-old male patient.

A Case of Cephalic Brain-like Heterotopia / 대한피부과학회지

Cephalic brain-like heterotopias, so called nasal gliomas, are masses of mature glial tissue resulted from an error in embryonic development and are frequently located on the bridge of the nose. They often give rise to the clinical suspicion of dermoid cyst, hemangioma, or lipoma. Histologically, they are composed of fibrillary neuroglial cells, mainly large astrocytes, which are interlaced with a variable amount of fibrous and vascular connective tissue. Mitoses are rare. The possible tumor stalk is usually fibrous without glial elements. Due to the occasional presence of connection to the intracranial space it deserves a careful preoperative evaluation including imaging studies. We report a case of cephalic brain-like heterotopia. A sixteen day-old infant presented a mass which was suspended to the forehead by a fibrous stalk. Th excised lesion showed characteristic pathologic features of cephalic brain-like heterotopia.

A Case of Postoperative (Pressure) Alopecia

Postoperative (pressure) alopecia is the temporary or permanent loss of hair that occurs following a prolonged immobilization during and/or after general anesthesia and intubation. The cause is considered to be pressure-induced ischemia. Although not an uncommon condition, it is frequently overlooked as a minor complication relative to a causative surgical procedure. We report a 22-year-old woman who was presented with focal hair loss of two weeks' duration after a 9-hour operation for a left brachial plexus injury. Histopathologic examination showed that nearly all terminal follicles were in catagen phase with marked atrophic change of subcutaneous fat.

Four Cases of Hair Shaft Breakage Caused by Hair Care Cosmetics / 대한피부과학회지

Hair shaft breakage is a common condition frequently caused by physical or chemical trauma as well as intrinsic diseases. The hair can be modified both externally and internally through the cosmetically-used chemicals. Use of these products causes a decrease in the hair shaft's elastic properties, allowing increased hair breakage. Herein we report four cases of hair shaft breakage presented with features of alopecia caused by hair care cosmetics. Microscopic examination revealed abnormal hair shaft endings such as weathering, trichoptilosis and trichoclasis. Through these cases, we remind the fact that the dermatologist can better aid the patient with hair difficulties if he or she has an understanding of the formulation and the effects of products designed to modify the hair.

A Case of Childhood Granulomatous Perioral Dermatitis / 대한피부과학회지

Childhood granulomatous perioral dermatitis(CGPD) is a distinctive granulomatous form of perioral dermatitis of unknown cause with a benign and self-limited course and no associated systemic manif estations. It is characterized by an asymptomatic monomorphous papular eruption, with or without scale or pustules, around the mouth, nose, and eyes primarily in prepubertal children. This condition may resemble sarcoidosis both clinically and histologically. A 3-year-old boy first presented with a month-history of mildly pruritic rash around the mouth. When he returned for follow-up after an eight-week period of topical corticosteroid therapy, multiple new follicular papules and pustules developed. Histopathologic examination revealed that a granulomatous lesion consisted of nodular infiltration of multiple histiocytes admixed with lymphocytes in the dermis. The condition resolved in about three weeks after using an unknown topical agent prescribed by a private practicing dermatologist.