background. It is difficult to reconstruct an entire alar defect. We report a case of an entire alar reconstruction carried out in two stages with a composite nasolabial flap lined with retroauricular skin and supported with the attached conchal cartilage. objective. A composite nasolabial flap was applied for reconstruction of entire alar defect in this patient. methods. The lining skin for the flap was obtained from retroauricular region acceptable to the patient, and the conchal cartilage was used simultaneously for support and as the attachment for the lining skin. The flap was then replaced and se-cured. Half a year later, the flap was flipped and transferred to the alar defect as a second step. results. The final shape and texture were satisfactory. All procedures were performed under local anesthesia. conclusion. Our design of composite flap has been successfully utilized to repair an entire alar defect with cosmetically and functionally good results, minimizing the donor area and the resulting operation scars. This composite nasolabial flap is thought to be the best choice of a flap for an entire alar defect reconstruction.H. Kakinuma, MD, U. Iwasawa, MD, M. Honjoh, MD, and T. Koura, MD have indicated no significant interest with commercial supporters.

To determine the function of Leydig cells in patients with varicocele, hCG-stimulated levels of progesterone (Prog), 17a-Hydroxy-4-pregnene-3,20-dione (170HP). 4-Androstene-3.17-dione (A-dione), testosterone (T), and estradiol-17P (5) in both spermatic and peripheral veins were measured.Seventy-two patients with idiopathic varicocele were divided into four groups: patients in group 1 were untreated, whereas patients in groups 2, 3, and 4 were given a single i.m. injection of 10,OOO IU hCG 24 h, 96 h, and 168 h before surgery, respectively. In the spermatic and peripheral veins, levels of Prog, 170HP, and & showed peaks at 24 h, whereas levels of A-dione and T showed peaks at 96 h.Significant increases in the ratios of spermatic veins 170HP to A-dione and 170HP to T, and a significant decrease in the ratio of T to &, was found 24 h following hCG treatment. These results demonstrate that, following hCG injection, there is a transient inhibition of testicular C,7_20-lyase activity, probably mediated by 5, even in subfertile males with varicocele.

Disseminated angiokeratoma were seen in a 14-year-old Japanese boy with an inherited deficiency for alpha-L-fucosidase. He had gargoylian features, psychomotor retardation, small stature, vertebral changes, pale nail beds, recurrent infections and hypohidrosis in addition to angiokeratoma.In the areas of angiokeratoma, we found thin-walled dilated capillaries in the upper dermis. Several nondistended small blood vessels and eccrine sweat glands of secretory coils and ducts appeared narrowed by swollen epithelial cells with a finely vacuolated cytoplasm. In the pale nail bed, we found thickened dermis without an increased number of blood vessels.Electron microscopic studies showed endothelial cells of dermal capillaries and eccrine sweat gland epithelium were extensively enlarged: their cytoplasm was occupied by numerous electronlucent, membrane-limited vacuoles containing scant, finely granular or electronlucent material. In the myoepithelial cells of sweat gland and in the cytoplasm of Schwarm cells, lamellar membranebound inclusions were seen.