Removal of an intraosseous hemangioma of the frontal bone through an anterior hairline incision: a case report

An intraosseous hemangioma of the frontal bone is typically removed via a coronal incision. This procedure, while effective, can be lengthy and may result in complications such as a prominent scar and hair loss. An alternative approach involves a direct incision in the forehead, which leaves a less noticeable scar and allows a quicker recovery. However, in this specific case, the patient declined both coronal surgery and surgery through a direct forehead incision due to cosmetic concerns. Therefore, we proposed an anterior hairline incision. A 35-year-old woman presented with a firm, non-mobile, palpable mass on her right forehead. Preoperative non-contrast computed tomography revealed a heterogeneous osteolytic lesion. We performed an excisional biopsy through the anterior hairline. Postoperative non-contrast computed tomography was conducted 2 and 6 months after surgery. The wound was clean and free of complications, and there was no local recurrence. Partial resection can reduce scarring for patients who are concerned about cosmetic outcomes. However, the potential for recurrence remains a significant concern. We present this case of an anterior hairline incision for a hemangioma located in the forehead, evaluated using serial computed tomography for both preoperative and postoperative imaging.

Micropipette tip intubation in rats as a replacement for conventional endotracheal tube intubation

Endotracheal intubation is often necessary in the course of animal experiments, especially in craniofacial surgery. However, endotracheal intubation can be a major burden in this context. The authors performed simple and cost-saving method using a 200 μL yellow micropipette tip, and the success of this method was demonstrated by X-ray and autopsy. We used a total of 30 rats. After the rats were fixed with a plaster, the trachea and vocal cords were visualized with the tongue pulled back. Under direct visualization of the vocal cords, a curving micropipette tip was advanced into the trachea. This method can be learned quickly and applied successfully by general experimenters. We successfully intubated all 30 rats without any complications. The success rate of micropipette tip intubation was 100%. This procedure was performed by one experimenter within 2 to 3 minutes after induction of anesthesia. We demonstrated its superiority by X-ray and autopsy. Herein, we describe endotracheal intubation of rats using micropipette tips. To the best of our knowledge, this method is novel and represents the simplest and most efficient means of intubation in rats, providing an alternative to conventional endotracheal intubation.

Rabbit model for the study of nasal tip plasty: a comparative cephalometric analysis after rhinoplasty

Background@#Open rhinoplasty and septoplasty have emerged as popular surgical techniques for both functional and aesthetic procedures. To study open rhinoplasty with or without septoplasty, the use of animals is necessary. However, no reports have been published on radiologic methods for evaluating rhinoplasty or nasal tip plasty in animals using cephalometry. In this study, a validated model of open rhinoplasty and septoplasty was utilized in rabbits to establish radiographic guidelines for assessing the degree of tip plasty in these animals. @*Methods@#Eight adult New Zealand rabbits were used to establish an autologous septal extension graft (SEG) model. The rabbits underwent concurrent submucosal septal resection and open rhinoplasty. The SEG was implanted using nasal septal cartilage. To evaluate the results of nasal tip plasty, lateral-view X-ray images were obtained preoperatively, as well as 2 days, 2 months, and 12 months postoperatively. @*Results@#This open rhinoplasty rabbit model appears to be a practical tool for studying open rhinoplasty and tip plasty, demonstrating statistically significant results following SEG implantation. Furthermore, it is suitable for training purposes, specifically for the submucosal resection of septal cartilage. @*Conclusions@#This study presents a statistical analysis of the long-term (1-year) postoperative results of SEG implantation, using experimental procedures like those utilized in humans. Through a cephalometric comparison of rabbit noses, the effect of various SEG and tip plasty methods on the rabbit nose can be objectively measured.

Morning basal luteinizing hormone, a good screening tool for diagnosing central precocious puberty

PURPOSE: The standard method used to diagnose central precocious puberty (CPP) is the gonadotropin releasing hormone stimulation test (GnRHST). However, this test is inconvenient for children because it is time-consuming and requires multiple samples. This study aimed to determine the reliability of morning unstimulated luteinizing hormone (mLH) level when screening for CPP, with an emphasis on the influence of diurnal variation. METHODS: This study included 160 girls with signs of early puberty (SMR 2) under 8 years of age. They were classified as CPP or non-CPP based on their standard GnRHST. The auxological, biochemical, and hormonal characteristics of subjects were retrospectively evaluated. The prognostic value of single morning unstimulated gonadotropin level was examined for use in CPP screening. RESULTS: Of 160 patients, 121 (75.6%) presented with CPP, and 39 (24.4%) were determined to be prepubertal. The mLH/mFSH (morning unstimulated follicular stimulating hormone) ratio showed significant differences between the 2 groups (P<0.001). The mLH was correlated with GnRHST variables (r=0.532, P<0.001). The mLH cutoff point when screening for CPP was 0.22 IU/L, which had sensitivity and specificity of 69.4% and 82.1%, respectively. In regression analysis, bone age (BA) (odds ratio [OR], 1.018; 95% confidence interval [CI], 0.967–1.071; P=0.506) and body mass index (BMI) (OR, 0.874; 95% CI, 0.583–1.310; P=0.515) were not significant predictors. The mLH≥0.22 IU/L group (OR, 9.596; 95% CI, 3.853–23.900; P<0.001) was highly suggestive of CPP. CONCLUSIONS: In this study, single morning unstimulated luteinizing hormone had clinical efficacy for CPP screening, but BA advanced over chronological age and BMI was not useful for CPP screening.

A Case of Effective Treatment of a Patient with PCDH 19-Related Epilepsy using Corticosteroid / 대한소아신경학회지

An uncommon female-limited intractable epilepsy, protocadherin (PCDH) 19-related epilepsy, is characterized by mutations in the PCDH 19 gene, located on chromosome X. Clinical symptoms include early onset, fever sensitivity, focal seizures and psychomotor retardation. PCDH 19-related epilepsy is unresponsive to conventional antiepileptic drugs (AEDs), but corticosteroid is reported to be effective in a few cases. We report a case of a 25-month-old girl who was admitted to our hospital due to developmental regression, accompanied by aggravated seizures with fever. Although several conventional AEDs were administered, the frequency and severity of seizures increased with mild fever, and the symptoms did not improve. Considering possible immune, and inflammatory involvement in seizure generation, the patient was administered corticosteroid treatment during the acute phase. Corticosteroid dramatically improved seizures and her development gradually. The patient was finally diagnosed with PCDH 19-related epilepsy in genomic evaluation. We observed the effect of corticosteroid on intractable epilepsy in patient with PCDH 19 mutation. If a female patient whose seizures are resistant to conventional AEDs or easily provoked by mild fever, has developmental delay or developmental regression, this may be an important clinical clue to the early diagnosis of PCDH 19-related epilepsy.

Spontaneously Resolving of Huge Simple Hepatic Cyst / 대한소화기학회지

Simple hepatic cysts are common benign liver lesions that usually have no malignant capability. They are generally asymptomatic and are often found incidentally by abdominal imaging procedures. Treatment becomes necessary, however, when huge hepatic cysts cause symptoms and develop complications, such as hemorrhage, adjacent organ damage, and infection. Several therapeutic options have been performed for symptomatic and huge cysts, including the aspiration of cystic fluid, infusion of various sclerosing agents, and surgical intervention. The optimal management of huge hepatic cysts is controversial and each option has its complications and limitations. This paper reports a case of a 66-year-old woman diagnosed with a simple hepatic cyst 2 years earlier, who was referred to hospital due to abdominal pain. The diagnosis was a huge hepatic cyst with symptoms by abdominal imaging studies. During the follow-up period, the huge cysts resolved spontaneously without treatment.

A clinical review of reconstructive techniques for patients with multiple skin cancers on the face

BACKGROUND: Cases of simultaneous multiple skin cancers in a single patient have become more common. Due to the multiplicity of lesions, reconstruction in such cases is more difficult than after a single lesion is removed. This study presents a series of patients with multiple facial skin cancers, with an analysis of the surgical removal, reconstruction process, and the results observed during follow-up. METHODS: We reviewed 12 patients diagnosed with multiple skin cancers on the face between November 2004 and March 2016. The patients’ medical records were retrospectively reviewed to identify the type of skin cancer, the site of onset, methods of surgical removal and reconstruction, complications, and recurrence during follow-up. RESULTS: Nine patients had a single type of cancer occurring as multiple lesions, while three patients had different skin cancer types that occurred together. A total of 30 cancer sites were observed in the 12 patients. The most common cancer site was the nose. Thirteen defects were reconstructed with a flap, while 18 were reconstructed with skin grafting. The only complication was one case of recurrence of basal cell carcinoma. CONCLUSION: Multiple skin cancers are removed by performing Mohs micrographic surgery or wide excision, resulting in multiple defect sites. The authors emphasize the importance of thoroughly evaluating local lesions surrounding the initially-identified lesions or on other sites when reconstructing a large defect which can not be covered by primary closure. Furthermore, satisfactory results can be obtained by using various methods simultaneously regarding the condition of individual patients, the defect site and size, and the surgeon’s preference.

Reconstruction of Large Facial Defects via Excision of Skin Cancer Using Two or More Regional Flaps

BACKGROUND: Free-flap surgery and skin grafting can be used to reconstruct large facial defects that may result after skin cancer removal by Mohs micrographic surgery (MMS). However, these two methods may produce low postsurgical patient satisfaction with aesthetics, and free-flap surgery may produce an undue burden for the majority of skin cancer patients, who are of advanced age. Hence, the authors examined outcomes of large facial defect reconstruction using multiple flaps. METHODS: Among patients undergoing MMS for skin cancer at Pusan National University Hospital between January 2013 and December 2015, we evaluated 7 patients (2 males, 5 females; average age, 73.14 years) treated for large facial defects from basal cell carcinoma. Based on operative and follow-up records, we investigated the number and type of flaps used, postsurgical complications, and patients' post-surgical satisfaction. RESULTS: Two and 3 types of flaps were used for 5 and 2 patients, respectively. Most frequently used were nasolabial flaps (7 times in 6 patients) and forehead flaps (once in each of 4 patients). The average follow-up period was 14 months, with no complications—including necrosis, hematoma, or wound dehiscence—observed. Post-surgical satisfaction averaged 4.4 out of a maximum of 5 points. CONCLUSIONS: Reconstruction using two or more flaps for large facial defects after skin cancer removal using MMS produced satisfactory outcomes while preventing aesthetic problems. Practitioners should consider using multiple flaps when choosing a reconstruction method for large facial defects following skin cancer removal.

Nutlin-3 enhances the bortezomib sensitivity of p53-defective cancer cells by inducing paraptosis

The proteasome inhibitor, bortezomib, is ineffective against many solid tumors. Nutlin-3 is a potent antagonist of human homolog of murine double minute 2/p53 interaction exhibiting promising therapeutic anti-cancer activity. In this study, we show that treatment of various p53-defective bortezomib-resistant solid tumor cells with bortezomib plus nutlin-3 induces paraptosis, which is a cell death mode accompanied by dilation of the endoplasmic reticulum (ER) and mitochondria. Bortezomib alone did not markedly alter cellular morphology, and nutlin-3 alone induced only a transient mitochondrial dilation. However, bortezomib/nutlin-3 co-treatment triggered the progressive fusion of swollen ER and the formation of megamitochondria, leading to cell death. Mechanistically, proteasomal-impairment-induced ER stress, CHOP upregulation and disruption of Ca²⁺ homeostasis were found to be critically involved in the bortezomib/nutlin-3-induced dilation of the ER. Our results further suggest that mitochondrial unfolded protein stress may play an important role in the mitochondrial dilation observed during bortezomib/nutlin-3-induced cell death. Collectively, these findings suggest that bortezomib/nutlin-3 perturbs proteostasis, triggering ER/mitochondria stress and irrecoverable impairments in their structure and function, ultimately leading to paraptotic cell death.

Erratum: Nocardia Brain Abscess in an Immunocompetent Patient / 감염과화학요법

We found an error in our published article. Author name should be corrected.

A Case of Pneumatosis Cystoides Intestinalis and Portal Venous Gas Accompanied by Emphysematous Pyelonephritis in Type 2 Diabetes Mellitus / 임상당뇨병

Diabetes mellitus is a major risk factor for urinary tract infection (UTI); emphysematous pyelonephritis (EP), a complication of UTIs, often occurs in patients with underlying, poorly controlled diabetes mellitus. We report the case of an 87-year-old woman with EP in type 2 diabetes mellitus who developed pneumatosis cystoides intestinalis (PCI) with portal venous gas. PCI is a radiographic finding, which is found in a linear or cystic form of gas in the submucosa or subserosa of the bowel wall. PCI has two common presentations. Primary PCI is a benign idiopathic condition. Secondary PCI is associated with a wide variety of gastrointestinal and non-gastrointestinal diseases. PCI with portal venous gas in particular is associated with ischemic gastrointestinal disease. Initial pre-enhanced abdominopelvic computed tomography showed EP in the right kidney without PCI. Newly occurring PCI and hepatic portal venous gas were found in the right ascending colon after EP improved. This is a rare case of PCI accompanied by emphysematous pyelonephritis in type 2 diabetes mellitus. The patient's general condition improved with intravenous antibiotics and fluid therapy without a surgical approach. However, she was discharged without further treatment because the family refused any further evaluations and treatments.

Genetic Analysis of Multiple Endocrine Neoplasia Type 1 (MEN1) Leads to Misdiagnosis of an Extremely Rare Presentation of Intrasellar Cavernous Hemangioma as MEN1

BACKGROUND: Multiple endocrine neoplasia type 1 (MEN1) is a rare inherited disorder characterized by the simultaneous occurrence of endocrine tumors in target tissues (mainly the pituitary, endocrine pancreas, and parathyroid glands). MEN1 is caused by mutations in the MEN1 gene, which functions as a tumor suppressor and consists of one untranslated exon and nine exons encoding the menin protein. This condition is usually suspected when we encounter patients diagnosed with tumors in multiple endocrine organs, as mentioned above. METHODS: A 65-year-old woman who underwent surgery for a pancreatic tumor (serous cystadenoma) 5 years previously was referred to our hospital due to neurologic symptoms of diplopia and left ptosis. Brain magnetic resonance imaging revealed a 3.4-cm lesion originating from the cavernous sinus wall and extending into the sellar region. It was thought to be a nonfunctioning tumor from the results of the combined pituitary function test. Incidentally, we found that she also had a pancreatic tumor, indicating the necessity of genetic analysis for MEN1. RESULTS: Genomic analysis using peripheral leukocytes revealed a heterozygous c.1621G>A mutation in the MEN1 gene that was previously reported to be either a pathogenic mutation or a simple polymorphism. We pursued a stereotactic approach to the pituitary lesion, and microscopic findings of the tumor revealed it to be an intrasellar cavernous hemangioma, a rare finding in the sellar region and even rarer in relation to oculomotor palsy. The patient recovered well from surgery, but refused further evaluation for the pancreatic lesion. CONCLUSION: There is great emphasis placed on genetic testing in the diagnosis of MEN1, but herein we report a case where it did not assist in diagnosis, hence, further discussion on the role of genetic testing in this disease is needed. Also, in cases of pituitary tumor with cranial nerve palsy, despite its low prevalence, intrasellar cavernous hemangioma could be suspected.

Nocardia Brain Abscess in an Immunocompetent Patient / 감염과화학요법

Nocardia cerebral abscess is rare, constituting approximately 1-2% of all cerebral abscesses. Mortality for a cerebral abscess of Nocardia is three times higher than that of other bacterial cerebral abscesses, therefore, early diagnosis and therapy is important. Nocardia cerebral abscess is generally occur among immunocompromised patients, and critical infection in immunocompetent patients is extremely rare. We report on a case of a brain abscess by Nocardia farcinica in an immunocompetent patient who received treatment with surgery and antibiotics. This is the second case of a brain abscess caused by N. farcinica in an immunocompetent patient in Korea.

Laparoscopic Repair of Large Bladder Herniation Presenting as an Inguinal Hernia

The bladder is involved in 1% to 3% of all hernia cases. We report a case of a large paraperitoneal bladder hernia (BH) in a 59-year-old man who had a palpable scrotal mass. Several techniques and approaches have been described for managing BHs. We performed a laparoscopic partial cystectomy and herniorrhaphy. This is the first case report on the repair of a large BH by use of a laparoscopic technique in Korea.

Visual Acuity and Quality of Life: KNHANES IV

PURPOSE: To evaluate the health-related quality of life (QOL) in Koreans according to visual acuity. METHODS: The fourth Korea National Health and Nutrition Examination Survey (KNHANES IV) is a nationwide survey. The present study included 11,022 Koreans who completed the KNHANES IV. The relation of visual acuity and QOL was verified, and EuroQoL 5D (EQ-5D) was identified using the adjusted mean based on linear regression analysis. RESULTS: As visual acuity decreased, QOL decreased. QOL in mobility, usual activities, and pain/discomfort were affected by the vision gradient, while self-care and anxiety/depression were less influenced by the vision gradient. In particular, QOL in usual activities was significantly affected by the visual gradient. Subjects with a visual acuity of 1.6-3.0 were less likely to have a low QOL in usual activities compared to subjects with a visual acuity of 0.0-0.5 as a reference group (adjusted Odds Ratio = 23.6, 95% CI, 4.8-115.5). QOL in usual activities was statistically low in subjects older than 65 years of age, with low household monthly income, low education, and living without a spouse. CONCLUSIONS: As visual acuity decreased, QOL in the aspect of mobility, usual activities, and pain/discomfort decreased severely, which resulted from activity limitation. Considering that the risk group with increasing age, low income, low education, and living without a spouse had lower QOL, the most important is to increase activity, which can induce the improvement of QOL in Koreans who have low visual acuity and related risk factors is.

A Predictive Factor in Overactive Bladder Symptoms Improvement after Combined Anterior Vaginal Wall Prolapse Repair: A Pilot Study

PURPOSE: We aimed to determine whether a preoperative urodynamic parameter is a valuable predictor for the persistence of OAB symptoms after the AVP repair. MATERIALS AND METHODS: 65 OAB patients with concomitant POP-Q stage III, IV anterior vaginal wall prolapse underwent a surgical repair were involved. All the patients were subjected to a preoperative urodynamic study, for whom the OABSS on questionnaire were preoperatively recorded. We firstly analyzed the correlation between the BOOI and the OABSS, then randomly divided patients into two groups: the group A (high PdetQmax, BOOI> or =20) and the group B (low PdetQmax, BOOI<20). In each group, the OABSS was repeatedly measured post-operatively and the change were analyzed. RESULTS: 31 patients were classified as the group A and 34 patients were classified as the group B. The group B showed significant decrease of symptom score in daytime frequency (p<0.01), urgency (p=0.04), urge incontinence (p=0.03), nocturnal frequency (p=0.01) and total score (p=0.01). The group A showed no significant decrease of symptom score in daytime frequency (p=0.42), urgency (p=0.61), urge incontinence (p=0.3), total score (p=0.15) except nocturnal frequency (p=0.01). CONCLUSIONS: A preoperative pressure-flow study can be a valuable tool in predicting the OAB symptoms change after the combined AVP repair. While the AVP repair leads to the improvement of OAB symptoms generally, some patients with a higher preoperative PdetQmax are still in need of the additional medical treatment.

Comparison of Anterior Chamber Parameter and Refractive Change between Three-Piece and Single-Piece Aspheric Intraocular Lenses

PURPOSE: To compare the anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA) and refractive change after cataract surgery between 3-piece and 1-piece aspheric intraocular lens (IOL) implantation. METHODS: The present study consisted of 16 patients (25 eyes) having 3-piece aspheric Tecnis(R) ZA9003 IOL and 21 patients (30 eyes) having 1-piece aspheric Tecnis(R) ZCB00 IOL. The ACD, ACV, and ACA were measured using an anterior eye segment analysis system (Pentacam, Oculus, Wetzlar, Germany) preoperatively and postoperatively 1 week and 1 month. Refractive outcomes were evaluated using an autokeratometer. RESULTS: When comparing the 3-piece (Tecnis(R) ZA9003) and 1-piece (Tecnis(R) ZCB00) IOL with the same optic, ACD, ACV, and AVA increased significantly after cataract surgery. The 1-piece IOL showed deeper ACD than the 3-piece IOL at postoperative 1 week and 1 month. Postoperative refraction showed slight myopic shift compared with target diopter, but was stable in both groups. CONCLUSIONS: There was significant increase in ACD, ACV, and ACA after cataract surgery in both IOL-inserted groups. Results showed stable refraction after cataract surgery in both groups. Consideration of the A-constant will be needed because of myopic change with the 1-piece IOL.

Comparison of Anterior Chamber Parameter and Refractive Change between Three-Piece and Single-Piece Aspheric Intraocular Lenses

PURPOSE: To compare the anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA) and refractive change after cataract surgery between 3-piece and 1-piece aspheric intraocular lens (IOL) implantation. METHODS: The present study consisted of 16 patients (25 eyes) having 3-piece aspheric Tecnis(R) ZA9003 IOL and 21 patients (30 eyes) having 1-piece aspheric Tecnis(R) ZCB00 IOL. The ACD, ACV, and ACA were measured using an anterior eye segment analysis system (Pentacam, Oculus, Wetzlar, Germany) preoperatively and postoperatively 1 week and 1 month. Refractive outcomes were evaluated using an autokeratometer. RESULTS: When comparing the 3-piece (Tecnis(R) ZA9003) and 1-piece (Tecnis(R) ZCB00) IOL with the same optic, ACD, ACV, and AVA increased significantly after cataract surgery. The 1-piece IOL showed deeper ACD than the 3-piece IOL at postoperative 1 week and 1 month. Postoperative refraction showed slight myopic shift compared with target diopter, but was stable in both groups. CONCLUSIONS: There was significant increase in ACD, ACV, and ACA after cataract surgery in both IOL-inserted groups. Results showed stable refraction after cataract surgery in both groups. Consideration of the A-constant will be needed because of myopic change with the 1-piece IOL.

Disparities of Socio-Demographic Factors between Visually Disabled People and Other Disabled People: KNHANES III

PURPOSE: To identify the disparities of socio-demographic factors between visually disabled people and other people with disabilities. METHODS: The fourth Korea National Health and Nutrition Examination Survey (KNHANES III) is a nationwide survey. The present study included 25,125 people who completed the KNHANES III. For analysis, the participants were divided into 3 groups: subjects without disabilities, subjects with disabilities but without visual disabilities, and subjects with visual disabilities. The gender, age, monthly house income, occupation, education, residential area, and health insurance were investigated. Multivariate logistic regression analysis was used to determine the most differentiating factor. RESULTS: Visually disabled people were proportionally older (40 to 64 years), were male, living in a non-metropolitan area except Seoul/Pusan/Gyunggi compared to other disabled people and also had a higher proportion of the above factors, as well as lower education compared to non-disabled people. CONCLUSIONS: Socio-demographic factors showed disparities in visually disabled people and people with other disabilities. Ophthalmologists should understand these disparities and be involved in establishing policies to reduce the disparities. Ophthalmologists also need to provide holistic and comprehensive medical care using the Blindness is Preventable! Korea Foundation for the Prevention of Blindness, consultation with social work teams in hospitals and other institutions, as well as evaluating the visual impairment.

Disparities of Socio-Demographic Factors between Visually Disabled People and Other Disabled People: KNHANES III

PURPOSE: To identify the disparities of socio-demographic factors between visually disabled people and other people with disabilities. METHODS: The fourth Korea National Health and Nutrition Examination Survey (KNHANES III) is a nationwide survey. The present study included 25,125 people who completed the KNHANES III. For analysis, the participants were divided into 3 groups: subjects without disabilities, subjects with disabilities but without visual disabilities, and subjects with visual disabilities. The gender, age, monthly house income, occupation, education, residential area, and health insurance were investigated. Multivariate logistic regression analysis was used to determine the most differentiating factor. RESULTS: Visually disabled people were proportionally older (40 to 64 years), were male, living in a non-metropolitan area except Seoul/Pusan/Gyunggi compared to other disabled people and also had a higher proportion of the above factors, as well as lower education compared to non-disabled people. CONCLUSIONS: Socio-demographic factors showed disparities in visually disabled people and people with other disabilities. Ophthalmologists should understand these disparities and be involved in establishing policies to reduce the disparities. Ophthalmologists also need to provide holistic and comprehensive medical care using the Blindness is Preventable! Korea Foundation for the Prevention of Blindness, consultation with social work teams in hospitals and other institutions, as well as evaluating the visual impairment.