Dexmedetomidine Improves Locomotor Function and Alleviates Thermal Hyperalgesia Following Sciatic Nerve Crush Injury in Rats.

PURPOSE: The effects of dexmedetomidine on locomotor function and thermal hyperalgesia in sciatic nerve crush injury (SNCI) were investigated using rats. METHODS: After exposing the right sciatic nerve, the sciatic nerve was crushed for 1 minute by a surgical clip. One day after nerve injury, dexmedetomidine (5, 25, and 50 µg/kg) was directly applied to the injured sciatic nerve once a day for 14 days. Walking track analysis was used to assess locomotor function and plantar test was conducted to assess thermal pain sensitivity. Immunohistochemistry was performed to determine the expression of c-Fos in the ventrolateral periaqueductal gray (vlPAG) and paraventricular nucleus (PVN). Western blot was used to evaluate the expression level of nerve growth factor (NGF) and myelin basic protein (MBP) in the sciatic nerve. RESULTS: SNCI resulted in deterioration of locomotor function and increased thermal pain sensitivity. The level of c-Fos expression in the PVN and vlPAG was increased and the level of NGF and MBP expression in the sciatic nerve was enhanced by SNCI. Dexmedetomidine treatment improved locomotor function and upregulated expression of NGF and MBP in the sciatic nerve of SNCI. Dexmedetomidine treatment alleviated thermal hyperalgesia and downregulated expression of c-Fos in the vlPAG and PVN after SNCI. CONCLUSION: Dexmedetomidine may be used as a potential new treatment drug for recovery of locomotion and control of pain in peripheral nerve injury.

Comparison of Mohs micrographic surgery and wide excision for extramammary Paget's Disease: Korean experience.

BACKGROUND: Extramammary Paget's disease (EMPD) is an uncommon tumor that usually occurs on the genitalia. It almost always extends beyond clinically apparent margins and has a high rate of recurrence. OBJECTIVE: To establish treatment guidelines for EMPD in Asian patients. METHODS: A retrospective review was done on pertinent demographic data, tumor data, treatment characteristics, and follow-up data of 35 patients between 1996 and 2006. Review of literature for treatment modalities and recurrence rates of EMPD was also performed. RESULTS: Thirty-four of the 35 patients (30 men and 5 women) had lesions in the genital area and one patient in the axilla. Mean follow-up duration was 62.7 months (8-156 months) and two of 11 (18.2%) recurred after Mohs micrographic surgery (MMS), compared with eight recurrences of 22 (36.4%) after standard wide excision. Two patients treated with nonsurgical modalities did not achieve complete remission. Estimated 5-year tumor-free rate using Kaplan-Meier graph was 69.7% in all patients, with a rate of 81.8% for MMS and 63.6% for wide excision. CONCLUSIONS: MMS is more effective, with lower recurrence rate than wide excision, and should be regarded as the first-line treatment for nonmetastatic EMPD.

Development of Computerized Anthropometric Analysis Model in Cleft Lip Nasal Deformity Using 3D Laser Scanned Facial Cast Model

PURPOSE: The purpose of this study is to develop three-dimensional computerized anthropometry(3DCA) and to compare its reliability and accuracy 3DCA with manual anthropometry(MA) for measurement of lips and nasal deformities in unilateral cleft lips and palate(UCLP) patients. METHODS: Samples were consisted of six UCLP patients whose facial plaster models were available immediately before and 3 months after the cleft lip surgery. MA of the facial plaster models was carried out using an electronic caliper. In 3DCA, three-dimensional auto- measuring program was used to digitize landmarks and to measure three-dimensional virtual facial models (3DVFM), which was generated with a laser scanner and 3D virtual modeling program. Intraclass correlation coefficients(ICC) were calculated to evaluate reliability and reproducibility of the variables in both methods, and Wilcoxon's signed rank test was done to investigate the difference in values of the same variables of facial models of each patient between two methods. RESULTS: All ICC values were higher than 0.8, so both methods could be considered reliable. Although most variables showed statistical differences between two methods(p<0.05), differences between mean values were very small and could be considered not significant in clinical situation. CONCLUSION: In clinical situation, 3DCA can be an objective, reliable and accurate tool for evaluation of lips and nasal deformities in the cleft patients.

Histometric and histochemical analysis of the effect of trichloroacetic acid concentration in the chemical reconstruction of skin scars method.

BACKGROUND: Atrophic scars can be induced by various causes, including severely inflamed acne, chicken pox, and trauma. Many treatment modalities are used for reconstructing and improving the appearance of scars with various treatment results. OBJECTIVE: A recent report shows the clinical efficacy of the chemical reconstruction of skin scars (CROSS) method, which consists of the focal application of trichloroacetic acid (TCA) in a higher concentration. Histometric analysis of the CROSS method, however, has not yet been established. METHODS: In this study, five hairless mice were used to evaluate the effect of the CROSS method and to analyze the difference between the CROSS method and simple TCA application. RESULTS: Similar histologic changes were observed in the two methods, including epidermal and dermal rejuvenation with new collagen deposition. These changes, however, were more prominent in the CROSS method-treated areas, particularly when 100% TCA was used. CONCLUSION: The results of this study suggest that treatment of atrophic scars using the CROSS method is more effective than simple application of TCA in activating fibroblasts in the dermis and increasing the amount of collagen.

Small molecule-based reversible reprogramming of cellular lifespan.

Most somatic cells encounter an inevitable destiny, senescence. Little progress has been made in identifying small molecules that extend the finite lifespan of normal human cells. Here we show that the intrinsic 'senescence clock' can be reset in a reversible manner by selective modulation of the ataxia telangiectasia-mutated (ATM) protein and ATM- and Rad3-related (ATR) protein with a small molecule, CGK733. This compound was identified by a high-throughput phenotypic screen with automated imaging. Employing a magnetic nanoprobe technology, magnetism-based interaction capture (MAGIC), we identified ATM as the molecular target of CGK733 from a genome-wide screen. CGK733 inhibits ATM and ATR kinase activities and blocks their checkpoint signaling pathways with great selectivity. Consistently, siRNA-mediated knockdown of ATM and ATR induced the proliferation of senescent cells, although with lesser efficiency than CGK733. These results might reflect the specific targeting of the kinase activities of ATM and ATR by CGK733 without affecting any other domains required for cell proliferation.

Treatment of Molluscum Contagiosum with High Dose Cimetidine Therapy / 대한피부과학회지

BACKGROUND: Molluscum contagiosum is often a difficult problem for dermatologists to treat. Cimetidine is a H2 histamine receptor antagonist that has been used mainly to treat peptic ulcer disease. The use of cimetidine in the treatment of molluscum contagiosum has been reported previously using a dose of 40 mg/kg/day, and has the advantage of being painless and easy to administer, especially for recurrent, extensive, facial and eyelid lesions. OBJECTIVE: The purpose of this study was to evaluate the clinical effects of high dose cimetidine therapy for molluscum contagiosum. METHODS: Twenty patients with molluscum contagiosum were treated using high dose cimetidine therapy (14 females, 6 males; age range 2~16 years). RESULTS: Of the 20 patients who completed the study, 12 patients (60%) showed complete remission, 3 patients (15%) showed partial remission and 5 patients (25%) showed no response. Five out of 8 patients with atopic dermatitis showed complete remission and one showed partial remission. Of the 12 patients without atopic dermatitis, 7 showed complete remission and 2 showed partial remission. CONCLUSION: High dose cimetidine therapy is an effective treatment modality for molluscum contagiosum, and has no severe adverse effects.

Four Cases of Subungual Exostosis Treated with Complete Excision / 대한피부과학회지

Subungual exostosis is a benign, acquired tumor of cartilaginous bone which occurs beneath the nail of the distal phalanx, and can often lead to displacement and deformity of the overlying nail. Complete surgical excision is a curative treatment for subungual exostosis. Since there have been no case reports of complete surgical removal of subungual exostosis in the Korean dermatologic literature, we report four cases of subungual exostosis that were successfully treated through complete excision or excision in combination with additional curettage.

Ocular Findings in Patients with Fibrous Dysplasia

PURPOSE: Fibrous dysplasia is an uncommon disease that replaces normal bone tissue with fibrous and osteoid tissue. We evaluated patients with fibrous dysplasia involving orbital bones to identify the ocular characteristic findings. METHODS: We recruited 6 patients with fibrous dysplasia of the craniofacial bone. Best corrected visual acuity and facial asymmetry were measured. Slit lamp biomicroscopy, tonometry, strabismus examination, and funduscopy were performed. RESULTS Strabismus, exophthalmos and optic neuropathy were found in 5, 4, and 2 patients, respectively. One patient underwent a strabismus surgery. One patient had McCune-Albright syndrome, exhibiting a cafe-au-lait spot of the skin and precocious puberty. All 6 patients had facial asymmetry and higher superior orbital rims of the affected side in 5 patients. CONCLUSIONS: Ophthalmologic examination may be mandatory for patients with fibrous dysplasia involving the orbit, especially to prevent optic neuropathy. If optic atrophy, strabismus or exophthalmos is found in patients with facial asymmetry, the possibility of fibrous dysplasia must be considered.

Ocular Findings in Patients with Fibrous Dysplasia

PURPOSE: Fibrous dysplasia is an uncommon disease that replaces normal bone tissue with fibrous and osteoid tissue. We evaluated patients with fibrous dysplasia involving orbital bones to identify the ocular characteristic findings. METHODS: We recruited 6 patients with fibrous dysplasia of the craniofacial bone. Best corrected visual acuity and facial asymmetry were measured. Slit lamp biomicroscopy, tonometry, strabismus examination, and funduscopy were performed. RESULTS Strabismus, exophthalmos and optic neuropathy were found in 5, 4, and 2 patients, respectively. One patient underwent a strabismus surgery. One patient had McCune-Albright syndrome, exhibiting a cafe-au-lait spot of the skin and precocious puberty. All 6 patients had facial asymmetry and higher superior orbital rims of the affected side in 5 patients. CONCLUSIONS: Ophthalmologic examination may be mandatory for patients with fibrous dysplasia involving the orbit, especially to prevent optic neuropathy. If optic atrophy, strabismus or exophthalmos is found in patients with facial asymmetry, the possibility of fibrous dysplasia must be considered.

A Case of Syringoid Eccrine Carcinoma Successfully Treated with Mohs Micrographic Surgery / 대한피부과학회지

Syringoid eccrine carcinoma is a rare adnexal tumor of eccrine origin, and has metastatic potential and high recurrence rate following conventional surgical excision. Mohs micrographic surgery has been commonly used for various malignant skin cancers to minimize the defect after surgery, and to decrease the recurrence rate. We present a case of syringoid eccrine carcinoma successfully treated by Mohs micrographic surgery.

Fluorodeoxyglucose positron emission tomography in cutaneous squamous cell carcinoma: retrospective analysis of 12 patients.

BACKGROUND: Whole-body 18F-fluorodeoxyglucose positron emission tomography (FDG PET) has been used for whole-body imaging modality in detecting malignancy in clinical oncology. However, only a few reports of FDG PET in skin cancers have been described, except for melanoma and lymphoma. OBJECTIVE: To report on the usefulness of FDG PET as a baseline workup study for patients with cutaneous squamous cell carcinoma (SCC). METHODS: There were 12 cases of SCC (9 cases with high-risk SCC). Of the 12, FDG PET was performed for staging in 11 patients and for restaging in 1 patient 1 year after wide excision. RESULTS: Primary lesions were detected in nine cases (83.3%), lymph node involvement in three cases (25.0%), and distant. organ (lung) involvement in one case (8.3%). In one patient whose primary lesion was positive, stomach cancer with involvement of adrenal glands, omentum, and lymph nodes was incidentally detected. All of the patients with high-risk SCC showed FDG uptakes of the primary lesions, and the patients with FDG uptakes in lymph nodes and distant organ had high-risk SCC. CONCLUSION: There have been no comparative studies on the cost-effectiveness between sentinel lymph node biopsy and FDG PET in SCC patients. However, considering the noninvasiveness and thoroughness in checking the whole body, including distant organs, FDG PET may have clinical value as a baseline workup study for patients with high-risk SCC.

Treatment of Verruca Plana with High Dose Cimetidine Therapy / 대한피부과학회지

BACKGROUND: It is often a difficult problem for dermatologists to treat verruca plana. Cimetidine is a H2 histamine receptor antagonist that has been used mainly to treat peptic ulcer disease. The successful use of cimetidine in the treatment of viral warts has been reported previously using doses of 40mg/kg/day and has the advantage of being painless and easy to administer. OBJECTIVE: The purpose of this study was to evaluate the clinical effects of high dose cimetidine therapy for verruca plana. METHODS: Thirty-six patients with verruca plana were treated with high dose cimetidine therapy (22 females, 14 males; age range 7-56 years). RESULTS: Of the 36 patients who completed the study, 15 patients (41.7%) showed complete remission. 8 patients (22.2%) showed partial remission. There was no significant differences among the complete remission, the partial remission and the no response groups. There were a few adverse effects including transient liver enzyme elevation and gynecomastia which were normalized after the cimetidine was discontinued. CONCLUSION: High dose cimetidine therapy is an effective treatment modality for verruca plana without severe adverse effects.

Therapeutic Effect of Sclerotherapy on Venous Malformations / 대한피부과학회지

BACKGROUND: Although surgical excision is the standard method for the treatment of venous malformations, this procedure often leads to massive bleeding and cosmetic problems. Sclerotherapy for venous malformations has recently been reported, whereas sclerotherapy for varicose veins, leg telangiectasias and hemorrhoids has well been established. PBJECTIVE: To assess the usefulness of sclerotherapy for venous malformations. METHOD: Fourteen patients who had venous malformation were treated with sclerotherapy using sodium tetradecyl sulfate (Thromboject(R), Omega Laboratories, Ltd., Montreal, Canada). Clinical efficacy was evaluated by physical examination and comparison of photographs. RESULTS: In patients with venous malformations, 71.4% of the eases showed moderate to marked improvement. Side effects were noted in 6 patients, however, they were trivial and transient and no treatment was needed. CONCLUSION: Sclerotherapy can be recommended as an effective method for the treatment of venous malformations. It has milder and fewer side effects than other treatment modalities, and it also yields superior cosmetic results.

Simple Classification of Foot Polydactyly Based on The Status of Metatarsal Bone and Varus Deformity

Polydactyly is a most common congenital anomaly of the foot. As is in the hand, it's classification systems and operative methods are various and complicated, but not much attention is given. We reviewed 129 foot polydactylies of 96 patients since the last 10 years(1993- 2003). Cases were classified morphologically and radiologically by previous classification systems(Wassel's classification, Hirase's classification) and then operative methods, complications, residual deformities were reviewed. Cases from the complications related to surgery including residual deformities were the major concern and 20 cases of unfavorable results were mainly due to varus deformity and metatarsal bone status. Based on our study, cases were reclassified by metatarsal bone status and varus deformity, and in conclusion we found that the new classification system is more helpful in deciding surgical method, predicting complications and residual deformities. Therefore, we suggested a new simple classification system based on the status of metatarsal bone and varus deformity, which is a more suitable system to planning operative method and predicting complication and residual deformity than the previous classification system.

The Various Reconstruction with Hydroxyapatite Powder(Bonesource(R))

Necessity of more biocompatible bone graft material had brought due to the problems of autologous bone graft & synthetic bone substitute materials. Bonesource(R) is a new biomaterial which can be replaced by natural bone when it is implanted. We reviewed our experience with Bonesource(in various reconstruction of bone defect for wide application. From March 2000 to March 2002 at Seoul National University Hospital, we performed various 7 cases of operation with Bonesource(R). These cases were bony depression after mass excision, alveolar cleft, frontal and supraorbital rim fracture, orbital deformity, facial asymmetry, bone defect after cranioplasty, depressive scar. In all cases, results were satisfactory without migration, extrusion, resorption during the follow up period (average 14 months). In 1 case, wound healing was delayed due to redissolution of Bonesource(R) by seroma. This was resolved by drainage without significant loss of volume. Its biocompatibility, excellent bony adhesion(osseointegration) and tendency to be replaced by natural bone(osteoconduction) may make it widely used in plastic surgery. The result of long term follow up and practical technique handling this material effectively are needed to evaluate it further.

Ultravist(R) Test in Postoperative Small Bowel Obstruction

PURPOSE: To determine whether Ultravist(R) test can enable the surgeon to differentiate complete from partial small bowel obstruction in patients with adhesive small bowel obstruction and whether partial small bowel obstruction can be treated nonoperatively. METHODS: Ninety-two patients who had postoperative small bowel obstructions without any toxic signs underwent Ultravist(R) test. Ultravist(R) (40 ml) mixed with 40 ml of distilled water was administrated either orally or via nasogastric tube to each patient. Serial plain abdominal radiographs were taken 4, 6, and 8 hours later. RESULTS: A total of 58 patients (63%) whose contrast medium reached the colon within the first 8 hours were considered to have partial obstruction (test positive) and were successfully treated with intravenous hydration and nasogastric decompression. The remaining 34 patients (36.9%), in whom the contrast medium failed to reach the colon within the first 8 hours (test negative), were regarded as having complete obstruction. Twenty-three of those patients (67.6%) underwent surgery and the other 11 (32.4%) received conservative treatment. Adhesion bands with complete bowel obstruction were observed in all 23 surgical patients during laparotomy. All the patients with partial bowel obstruction were treated successfully with nonoperative methods. Positive Ultravist(R) test as an indicator for nonoperative treatment had a sensitivity of 84.5%, a specificity of 100%, an accuracy of 88% and a false negative rate of 12%. CONCLUSION: Ultravist(R) can be used to differentiate partial from complete intestinal obstruction. All patients with evidence of Ultravist(R) reaching the colon within 8 hours were treated successfully with non-operative methods.

Focal treatment of acne scars with trichloroacetic acid: chemical reconstruction of skin scars method.

BACKGROUND: Acne scarring is a common complication of acne and yet no appropriate and effective single treatment modality has been developed. We suggest a technique consisting of the focal application of higher trichloroacetic acid (TCA) concentrations by pressing hard on the entire depressed area of atrophic acne scars. This technique is called chemical reconstruction of skin scars (CROSS) by the authors. OBJECTIVE: To evaluate the clinical effects of CROSS on atrophic acne scars in dark-complexioned patients. METHODS: An analysis was conducted of 65 patients with atrophic acne scars who were treated with CROSS in our hospitals between July 1996 and July 2001. Thirty-three patients were treated with 65% TCA CROSS and 32 patients were treated with 100% TCA CROSS. All patients had Fitzpatrick skin types IV-V. RESULTS: Patient treatment data indicated that 27 of 33 patients (82%) (the 65% TCA group) and 30 of 32 patients (94%) (the 100% TCA group) experienced a good clinical response. All patients in the 100% TCA group who received five or six courses of treatment showed excellent results. Good satisfaction rates in the 65% and 100% TCA groups were recorded. There were no cases of significant complication. CONCLUSION: CROSS is a safe and very effective single modality for the treatment of atrophic acne scars with no significant complications.