Survival and Malignant Transformation of Pineal Parenchymal Tumors: A 30-Year Retrospective Analysis in a Single-Institution

Background@#This study aims to elucidate clinical features, therapeutic strategies, and prognosis of pineal parenchymal tumors (PPT) by analyzing a 30-year dataset of a single institution. @*Methods@#We reviewed data from 43 patients diagnosed with PPT at Seoul National UniversityHospital between 1990 and 2020. We performed survival analyses and assessed prognostic factors. @*Results@#The cohort included 10 patients with pineocytoma (PC), 13 with pineal parenchymaltumor of intermediate differentiation (PPTID), and 20 with pineoblastoma (PB). Most patients presented with hydrocephalus at diagnosis. Most patients underwent an endoscopic third ventriculostomy and biopsy, with some undergoing additional resection after diagnosis confirmation. Radiotherapy was administered with a high prevalence of gamma knife radiosurgery for PC and PPTID, and craniospinal irradiation for PB. Chemotherapy was essential in the treatment of grade 3 PPTID and PB. The 5-year progression-free survival rates for PC, grade 2 PPTID, grade 3 PPTID, and PB were 100%, 83.3%, 0%, and 40%, respectively, and the 5-year overall survival rates were 100%, 100%, 40%, and 55%, respectively. High-grade tumor histology was associated with lower survival rates. Significant prognostic factors varied among tumor types, with World Health Organization (WHO) grade and leptomeningeal seeding (LMS) for PPTID, and the extent of resection and LMS for PB. Three patients experienced malignant transformations. @*Conclusion@#This study underscores the prognostic significance of WHO grades in PPT. It is nec-essary to provide specific treatment according to tumor grade. Grade 3 PPTID showed a poor prognosis. Potential LMS and malignant transformations necessitate aggressive multimodal treatment and close-interval screening.

Micronized Cross-Linked Human Acellular Dermal Matrices: An Effective Scaffold for Collagen Synthesis and Promising Material for Tissue Augmentation

Micronized cross-linked human acellular dermal matrices (ADMs) contain the extracellular components necessary for cell integration and tissue remodeling, and have high tensile strength and durability. We hypothesized that such material could serve as a scaffold to enhance the survival of adipocytes in grafted fat. Nude mice (n = 15) were randomly assigned to three groups, each receiving different subcutaneous injections into two dorsal paravertebral areas: fat and saline (control), fat and micronizedADM(E1), and fat and diluted micronizedADM(E2). Digital photographs were taken at 2-week intervals, and the grafted fat volumes and weights were examined after 10 weeks. A histological analysis of the grafted fat was performed, and the expression of vascular endothelial growth factor (VEGF) was examined. The grafted fat volumes decreased over time in all groups; however, at 10 weeks, the grafted fat was better preserved in both experimental groups, with significantly greater weights than in the group C (both, p<0.001). In the experimental groups, there was more regular arrangement of collagen in the graft tissue, whereas relatively thin, disorderly collagen deposition was observed in the control group. In addition, VEGF expression was significantly greater in the experimental groups than in the control group (p<0.001). These results are the first to show that micronized cross-linked human ADMs are an excellent scaffold for promoting adipocyte survival and may be an option for maintaining or promoting the in vivo survival of grafted fat.

Differences in the clinical manifestations and short-term prognosis of acute cerebral infarction after exposure to Agent Orange

BACKGROUND: Agent Orange (AO) is the code name for one of the herbicides and defoliants used in the Vietnam War. Studies conducted thus far show a significant correlation between AO and the occurrence of cardiovascular diseases. But there is little data on the association between AO and stroke, and limited studies have targeted patient groups exposed to AO. METHOD: Bohun medical center Institutional Review Board (IRB) approved the study. (ID: 341) We studied patients with acute ischemic stroke within 7 days of onset in VHS medical center and 4 other general hospitals. Among them, 91 consecutive patients with previous exposure to AO were evaluated. For controlled group, 288 patients with no history of AO exposure were chosen. RESULT: There were 49 (44.0 %) DM patient with a higher frequency in the exposure group (93 (32.3 %) in control P = 0.045). There were 6 (6.6 %) hyperlipidemia in exposure group and 69 (24.0 %) in control. (P < 0.002). Small vessel occlusion was the most common subtype (36, 39.6 %) in exposure group but in control group, the large artery atherosclesosis was (120, 41.7 %) (P = 0.014). The NIHSS of the exposure group on admission showed lower scores (median values, 2 and 4, respectively; P = 0.003). The median mRS was 1 for the exposure group and 2 for the control group, at discharge and after 3 months. After 3 months of discharge, 55 (60.4 %) in the exposure group and 171 (59.4 %) in the control group showed below mRS 1 (P = 0.001). CONCLUSION: This study targeted patients who are Vietnam veteran. There is some difference in vascular risk factors and clinical manifestations suggest AO exposure has contributed to a certain extent to the stroke.

Stroke System of Care: A Policy Statement from the Korean Stroke Society

No abstract available.

Current Status and Problems of Stroke Units in Korea: Results of a Nationwide Acute Care Hospital Survey by the Korean Stroke Society

BACKGROUND: The patients who received organized inpatient care are more likely to survive and to be independent. The benefit is most apparent in units based in a discrete ward, stroke unit (SU). The observed benefit is sufficiently large to warrant efforts of widespread implementation of SU care. The Korean Stroke Society surveyed acute stroke care hospitals to know the density and the distribution of SU in Korea. METHODS: One hundred-sixty one acute care hospitals were selected among those included in the 5th Quality Audit in 2014 by the Health Insurance Review and Assessment Service of Korea. A senior director of stroke service in each hospital was chosen and asked about the current status of acute stroke care including SU and major obstacles to establish SU in each hospital. RESULTS: The results of the questionnaire revealed the shortage of a total SU number and markedly uneven distribution of SU between rural and urban area. Most hospitals indicated the absence of the insurance reimbursement for medical service in SU, which served as the fundamental cause of lack of skilled manpower for establishing SU. CONCLUSIONS: The state-of-the-art SU, which is properly certified or designated, should be spread out more evenly in Korea for the optimal treatment of public regardless of a residential district. Government should encourage and support for the establishment of SU, which is an important first step toward making it reality.

Current Status and Problems of Stroke Units in Korea: Results of a Nationwide Acute Care Hospital Survey by the Korean Stroke Society

BACKGROUND: The patients who received organized inpatient care are more likely to survive and to be independent. The benefit is most apparent in units based in a discrete ward, stroke unit (SU). The observed benefit is sufficiently large to warrant efforts of widespread implementation of SU care. The Korean Stroke Society surveyed acute stroke care hospitals to know the density and the distribution of SU in Korea. METHODS: One hundred-sixty one acute care hospitals were selected among those included in the 5th Quality Audit in 2014 by the Health Insurance Review and Assessment Service of Korea. A senior director of stroke service in each hospital was chosen and asked about the current status of acute stroke care including SU and major obstacles to establish SU in each hospital. RESULTS: The results of the questionnaire revealed the shortage of a total SU number and markedly uneven distribution of SU between rural and urban area. Most hospitals indicated the absence of the insurance reimbursement for medical service in SU, which served as the fundamental cause of lack of skilled manpower for establishing SU. CONCLUSIONS: The state-of-the-art SU, which is properly certified or designated, should be spread out more evenly in Korea for the optimal treatment of public regardless of a residential district. Government should encourage and support for the establishment of SU, which is an important first step toward making it reality.

Treatment of Foreign Body Granuloma of the Hand Associated with Unregulated Material Injection for Aesthetic Purpose

Recently, rejuvenation of the aging hand has gained popularity. Various medical fillers have recently become popular, and patients have more options to rejuvenate their aging hands. However, in our country, unregulated material injections by unlicensed practitioners are still wide spread and its related complications have been considered as a serious problem. The aim of this retrospective study is to introduce our experiences regarding 17 cases of foreign body granuloma following hand rejuvenation using unregulated material. A retrospective review from December 2002 to October 2012 was performed. We analyzed data for 17 patients who underwent perilesional surgical excision for treatment of a foreign body granuloma of the hand associated with unregulated material injection by unlicensed practitioners. Injected materials include paraffin, silicone oil, and other unknown materials. Four patients were injected with paraffin, 3 patients with silicone oil, and remaining 10 patients with unknown materials. The main symptom was palpable mass and contour deformity. The patients were asked to rate their overall satisfaction following treatment. The average patient satisfaction score was 3.7. To prevent foreign body granuloma following unregulated medical practice, it is very important to inform the public about the disastrous consequence of unregulated material injections by unlicensed practitioners.

Spontaneous Unilateral Earlobe Keloid

Keloids result from excessive production of fibrous tissue during an abnormal wound healing process. Keloids can occur after trauma, and trauma can range from laceration, piercing, bites, surgery, and burns, to other skin conditions such as acne or folliculitis. We present a case of 68-year-old man, which was characterized with a relatively firm, non-tender, mild pigmented mass in his right earlobe. We performed a local excision, together with microscopic analysis. The mass was eventually diagnosed as a keloid scar in the right earlobe. Postoperative adjuvant pressure therapy using magnets was adopted and the postoperative follow-up was maintained without any recurrence. Auricular keloids should be considered in the differential diagnosis regardless of the cause or the age of patient.

Earrings Embedded within Earlobe Keloids

No abstract available.

Nodular Fasciitis of the Zygomatic Area: A Case Report and Its Aesthetic Considerations

Nodular fasciitis is the most common benign mesenchymal tumor that can be mistaken both clinically and pathologically for soft tissue sarcoma due to its infiltrative growth pattern. It most commonly appears in the extremities and trunk. However, occurrence in the zygomatic area is extremely rare. We present a case of 28-year-old man, who was characterized with a firm, tender, clearly visible mass in his left zygomatic area. We performed a local excision, together with microscopic and immunohistochemical analysis. The mass was eventually diagnosed as nodular fasciitis in the zygomatic area. No postoperative oncological treatment was done and the postoperative follow-up was maintained up to the present time without any tumor recurrence. Nodular fasciitis should be considered in the differential diagnosis when a rapid growing subcutaneous mass is detected in this area. Accurate diagnosis, appropriate treatment and follow-up are mandatory to avoid overly aggressive treatment and limit treatment-related morbidities. Moreover, the disease itself and its surgical treatment may cause aesthetic compromise and the aesthetic implications have been discussed.

Clinical Experiences with Foreign Body Granuloma of the Nose: 7-Year Experience with 18 Patients

PURPOSE: The injection of various materials, including medical fillers and unregulated products, is widespread, potentially causing the development of foreign body granulomas. Should this occur on the nose, the contour deformity and inflammatory signs that result from these granulomas are aesthetically undesirable to patients. The purpose of our study is to share our experiences using different surgical approaches, depending on the affected portion of the nose, to optimize management of this challenging problem and to evaluate patient's satisfaction using our in-house questionnaire along with degree of improvement by two independent plastic surgeons. METHODS: We treated 18 patients who underwent surgical excision of nasal foreign body granulomas via a perilesional approach to the lesion (n=12) or by transcolumellar incision (n=6) at our hospital over a period of seven years from March 2003 to October 2010. Nonparametric statistics were used and are presented as medians (25th-75th). Patient satisfaction was evaluated on a scale of 1 to 5 using an in-house questionnaire. All pre-and post-operative photographs were analyzed by two independent plastic surgeons. Post-operative outcomes were evaluated based on the surgeons' consensus ratings. RESULTS: All patients receiving the transcolumellar approach reported a high level of satisfaction with the results. All but two patients who received the perilesional approach were satisfied with the outcome. No outcomes were rated as no change or worse by the consensus ratings. CONCLUSION: For the upper two-thirds of the nose, perilesional surgical excision can lead to substantial patient satisfaction with modified contour deformity and infection control. The transcolumellar approach resulted in better outcomes and patient satisfaction for the lower one-third of the nose.

Staged Scar Revision of Angulated Facial Scar

Scar revision techniques are chief among the most important skills for facial plastic and reconstructive surgeons. In order to achieve the least amount of scarring following a surgical procedure, it is crucial that the surgeon always consider skin tension. In our hospital, staged scar revision was conducted on patients with angulated facial scars in order to reduce skin tension. We conducted a retrospective chart review of patients undergoing staged scar revision for angulated facial scars at our hospital from July 2002 to September 2010. The follow-up period was at least six months. All pre-and post-operative photographs were analyzed by two independent plastic surgeons. And the patients were asked to rate their overall satisfaction with their scar revision as very satisfied(5), satisfied(4), neutral(3), dissatisfied(2) or completely dissatisfied(1). Staged scar revision was used in 51 patients with angulated facial scars. Overall, a significantly improved scar and above(score > or =4), graded by an independent plastic surgerns, was notes in 47 patients(92.1%). And, 45 patients(88.2%) were satisfied with their scar revisions. In all cases, the postoperative clinical course was uneventful without any complications. In conclusion, staged scar revision is considered a good option for the treatment of angulated facial scar.

Cellular Blue Nevus of the Finger: A Case Report

We experienced an unusual case of the cellular nevus on the dorsal surface of the second metacarpophalangeal joint. We performed a local excision followed by immunohistochemical analysis. Cellular blue nevus should be considered in the differential diagnosis when a characteristic blue-black mass is found in the finger. Accurate diagnosis based on immunohistochemical analysis, appropriate surgical treatment and vigilant follow-up are mandatory to prevent any malignant transformation.

120 Cases of Facial Foreign Body Granuloma

PURPOSE: As the use of soft tissue fillers becomes more popular, complications such as foreign body granuloma (FBG) are increasing. We report 120 cases of facial FBG and review the available literatures. METHODS: 120 patients of facial FBG in our clinic from Mar. 2003 to Feb. 2008 were complied and analyzed. A retrospective chart review was done and patient satisfaction was evaluated with a questionnaire using 5 score scale. Patients with severe inflammation sign or bizarre deformity underwent surgical excision and those with minimal symptoms or a history of hyaluronic acid injection received injection therapy using hyaluronidase. RESULTS: 100 females and 20 males were observed. The average age was 43.7 years(from 16 to 74). 84 patients received surgical therapy and 36, injection therapy. Deformity of facial contour, foreign body sensation and inflammation sign were the three main chief complaints. 84 patients did not know what the injection materials were. The known materials are as follows: collagen, hyaluronic acid, silicone oil, paraffin. 92 cases were performed by unlicensed practitioners, 29 by physicians. Anatomical site most frequently affected by the foreign body granuloma was the cheek (25.8%), followed by forehead(19.2%), lips (15.8%), nose (9.2%), mentum(8.3%), eyelid and eyebrow (4.3%) and temple(0.8%). In 21 patients(17.5%), FBGs were found on multiple sites. Patients with inflammation sign got the highest satisfaction(3.19+/-0.73)(p=0.001) among 3 chief complaints. And patient satisfaction was statistically higher in surgical therapy group(3.43+/-0.72) than in injection therapy group(2.97+/-0.88)(p=0.003). CONCLUSION: We suggest that it may be beneficial to tailor the type of treatment for FBG relying on wound state and patient's chief complaints. In surgical therapy, resolute approach is necessary to correct facial deformity definitely and to minimize inflammation. Injection therapy could be another option for those with minimal symptoms or a history of hyaluronic acid injection. To prevent foreign body granuloma, not only plastic surgeons but also other physicians should inject soft tissue fillers with great caution and we should warn the public of disastrous consequences associated with illegal medical practice.

The three dimensional finite element analysis of stress distribution and deformation in mandible according to the position of pontic in two implants supported three-unit fixed partial denture

Excessive concentration of stress which is occurred in occlusion around the implant in case of the implant supported fixed partial denture has been known to be the main cause of the crestal bone destruction. Therefore, it is essential to evaluate the stress analysis on supporting tissue to get higher success rates of implant. The purpose of this study was to evaluate the effects of stress distribution and deformation in 3 different types of three-unit fixed partial denture supported by two implants, using a three dimensional finite element analysis in a three dimensional model of a whole mandible. A mechanical model of an edentulous mandible was generated from 3D scan, assuming two implants were placed in the left premolars area. According to the position of pontic, the experiments groups were divided into three types. Type I had a pontic in the middle position between two implants, type II in the anterior position, and type III in the posterior position. A 100-N axial load was applied to sites such as the central fossa of anterior and posterior implant abutment, central fossa of pontic, the connector of pontic or the connector between two implants, the mandibular boundary conditions were modeled considering the real geometry of its four-masticatory muscular supporting system. The results obtained from this study were as follows; 1. The mandible deformed in a way that the condyles converged medially in all types under muscular actions. In comparison with types, the deformations in the type II and type III were greater by 2-2.5 times than in the type I regardless of the loading location. 2. The values of von Mises stresses in cortical and cancellous bone were relatively stable in all types, but slightly increased as the loading position was changed more posteriorly. 3. In comparison with type I, the values of von Mises stress in the implant increased by 73% in Type II and by 77% in Type III when the load was applied anterior and posterior respectively, but when the load was applied to the middle, the values were similar in all types. 4. When the load was applied to the centric fossa of pontic, the values of von Mises stress were nearly 30~35% higher in the type III than type I or II in the cortical and cancellous bone. Also, in the implant, the values of von Mises stress of the type II or III were 160~170% higher than in the type I. 5. When the load was applied to the centric fossa of implant abutment, the values of von Mises stress in the cortical and cancellous bone were relatively 20~25% higher in the type III than in the other types, but in the implant they were 40-45% higher in the type I or II than in the type III. According to the results of this study, musculature modeling is important to the finite element analysis for stress distribution and deformation as the muscular action causes stress concentration. And the type I model is the most stable from a view of biomechanics. Type II is also a clinically acceptable design when the implant is stiff sufficiently and mandibular deformation is considered. Considering the high values of von Mises stress in the cortical bone, type III is not thought as an useful design.

The three dimensional finite element analysis of stress distribution and deformation in mandible according to the position of pontic in two implants supported three-unit fixed partial denture

Excessive concentration of stress which is occurred in occlusion around the implant in case of the implant supported fixed partial denture has been known to be the main cause of the crestal bone destruction. Therefore, it is essential to evaluate the stress analysis on supporting tissue to get higher success rates of implant. The purpose of this study was to evaluate the effects of stress distribution and deformation in 3 different types of three-unit fixed partial denture supported by two implants, using a three dimensional finite element analysis in a three dimensional model of a whole mandible. A mechanical model of an edentulous mandible was generated from 3D scan, assuming two implants were placed in the left premolars area. According to the position of pontic, the experiments groups were divided into three types. Type I had a pontic in the middle position between two implants, type II in the anterior position, and type III in the posterior position. A 100-N axial load was applied to sites such as the central fossa of anterior and posterior implant abutment, central fossa of pontic, the connector of pontic or the connector between two implants, the mandibular boundary conditions were modeled considering the real geometry of its four-masticatory muscular supporting system. The results obtained from this study were as follows; 1. The mandible deformed in a way that the condyles converged medially in all types under muscular actions. In comparison with types, the deformations in the type II and type III were greater by 2-2.5 times than in the type I regardless of the loading location. 2. The values of von Mises stresses in cortical and cancellous bone were relatively stable in all types, but slightly increased as the loading position was changed more posteriorly. 3. In comparison with type I, the values of von Mises stress in the implant increased by 73% in Type II and by 77% in Type III when the load was applied anterior and posterior respectively, but when the load was applied to the middle, the values were similar in all types. 4. When the load was applied to the centric fossa of pontic, the values of von Mises stress were nearly 30~35% higher in the type III than type I or II in the cortical and cancellous bone. Also, in the implant, the values of von Mises stress of the type II or III were 160~170% higher than in the type I. 5. When the load was applied to the centric fossa of implant abutment, the values of von Mises stress in the cortical and cancellous bone were relatively 20~25% higher in the type III than in the other types, but in the implant they were 40-45% higher in the type I or II than in the type III. According to the results of this study, musculature modeling is important to the finite element analysis for stress distribution and deformation as the muscular action causes stress concentration. And the type I model is the most stable from a view of biomechanics. Type II is also a clinically acceptable design when the implant is stiff sufficiently and mandibular deformation is considered. Considering the high values of von Mises stress in the cortical bone, type III is not thought as an useful design.

Developmental Differences in NMDA Neurototoxicity and the Expression of NMDA Receptor 2B Subunit of Rat Hippocampus

BACKGROUND: The developing brain has a distinctive set of characteristics that make it have different susceptibility to excitotoxins. Using primary tissue cultures of rat hippocampus, we investigated the developmental susceptibility to N-methyl-D-aspartic acid (NMDA)-induced cell death at various days in vitro in relation to the appearance of Bcl-2 protein and NMDA receptor 2B subunit. METHODS: Six, 12, and 18 days-in-vitro (DIV) hippocampal tissue cultures derived from 7-day-old Sprague-Dawley rat pups were used. Each group was treated with 100 micrometer NMDA in 5% CO2 incubator at 36 degrees C for 30 min. A western blot was then performed for the NeuN, Bcl-2 and NMDA receptor 2B subunit and propidium Iodide (PI) staining. RESULTS: The NeuN and Bcl-2 were most highly expressed in 12 DIV tissues. The reductions of the NeuN and Bcl-2 protein expressions by NMDA were significant at the 12 and the 18 DIV tissues, but less at 6 DIV tissues (p<0.05). The PI staining showed that the area of fluorescence of the 7 DIV tissues after NMDA exposure was less than the DIV 13 and 19 tissues. Without NMDA treatment, the NMDA receptor 2B subunit protein expressions at the 6 DIV tissues were highest and decreased with maturation. CONCLUSIONS: These results suggest that the immature tissues were more resistant to NMDA toxicity than the mature tissues, and further studies are needed to establish its relationship with the Bcl-2 protein and NMDA receptor 2B subunit.

Histomorphometric study of dental implants with double acid-etched and anodic oxidized surface in the rabbit tibia

Cerebral Lesions with Shortened Silent Period after Transcranial Magnetic Stimulation in Stroke

BACKGROUND: A silent period (SP), recorded with transcranial magnetic stimulation (TMS) reflects the cortical inhibition of the central motor pathway. In most previous reports involving unilateral cerebral lesions, prolonged cortical SPs recorded with TMS on the affected side compared with SPs on the contralateral hemisphere were observed. However, in only a few studies, a shortened SP has been observed. In the present study, we assumed a shortened SP mechanism in the association with stoke. METHODS: We studied cortical SPs of both first dorsal interossei muscles evoked by TMS in 21 normal subjects and 13 patients with single focal cerebral lesions (lacunar infarct or small hemorrhage). We divided lesions into two groups with prolonged and shortened SP. Interside differences of SP recorded in both groups were compared with that of normal subjects. RESULTS: Shortened SP was observed in 3 thalamic, 3 motor cortical, and 1 caudate nucleus head lesions. Four thalamic and 2 putamenal lesions showed prolonged SP. In patients with thalamic lesions, SPs were shortened in ventrolateral thalamic lesions and prolonged in dorsomedial lesions. Interside differences of both the shortened and prolonged groups were 85.8+/-47.6 msec, and 99.3+/-49.7 msec, respectively (normal control, 7.3+/-5.9 msec). CONCLUSIONS: These results suggest that shortened SP is related to anatomical sites of lesions including motor cortex, caudate nucleus, and ventrolateral thalamus. Divergent results obtained from thalamic lesions also suggest that the thalamocortical pathway plays a significant role in cortical SP induced by TMS.

Clinical Usefulness of Silent Period after Transcranial Magnetic Stimulation in Stroke Patients

Background Transcranial magnetic stimulation(TMS) of the motor cortex is well established as a valuable method for noninvasive examination of the central motor system. The purposes of this study are to establish technical method and normal data and to evaluate clinical usefulness of silent period(SP) study in stroke patients. Methods Central motor conduction time(CMCT) and SP were measured from the first dorsal interossei muscle by TMS. The subjects were 41 normal persons and 15 stroke patients, who were proven radiologically to have unilateral infarction or hemorrhage at various regions of brain. Patients group had lateralizing neurologic signs clinically, but most of them showed no definite motor weakness. Results In the control group we found no statistically significant interside difference in CMCT and duration of the SP, which showed a marked interindividual variation. In patients with prior stroke who showed minor neurologic deficits, there was a significant increase in the interside difference of SP. However, that of CMCT wasn't a sensitive parameter in determining the abnormality. Conclusion These findings suggest that the SP elicited by transcranial magnetic stimulation is a useful and sensitive neurophysiological parameter in the evaluation of stroke, particularly for the detection of subclinical motor dysfunction.