Suction Drain Tip Cultures in Predicting a Surgical Site Infection

Materials and Methods@#This study retrospectively included 1,415 consecutive patients who underwent spinal surgery between January 2016 and December 2021. Patients diagnosed with infectious diseases were excluded. Prophylactic antibiotics were administered intraoperatively and 24 hours postoperatively. Drains were removed when the volume of postoperative fluid drainage was <50 mL and <100 mL in patients who underwent cervical and thoracic surgery and lumbar surgery in the preceding 24 hours, respectively, and cultures were made. We evaluated the correlation between the results of positive drain tip culture and SSI. @*Results@#Positive drain tip cultures were found in 51 cases (3.6%). SSI was identified in 34 cases (2.4%). The most frequently isolated microorganism was methicillin-resistant Staphylococcus epidermidis (61.8%). The sensitivity, specificity, and positive, and negative predictive values of drain tip culture were 50.0%, 97.4%, 32.1%, and 98.8%, respectively. The same bacteria were isolated from the surgical lesion in 16 of 17 SSI cases with a positive drain tip culture, thereby giving a bacteria matching rate between tissue culture and drain tip culture of 94.1%. The number of surgery levels, drain remaining period, and drain tip culture positivity were significantly increased in the SSI group. @*Conclusions@#Drain tip cultures might be useful for predicting SSI. Drain tip culture had a high positivity rate in the SSI group, and the coincidence rate for the causative pathogen was high.

Performance of Early Warning Scoring Systems Regarding Adverse Events of Unanticipated Clinical Deterioration in Complementary and Alternative Medicine Hospitals

Purpose@#This study aims to examine the performance of early warning scoring systems regarding adverse events of unanticipated clinical deterioration in complementary and alternative medicine hospitals. @*Methods@#A medical record review of 500 patients from 5-year patient data in two traditional Korean medicine hospitals was conducted. Unanticipated clinical deterioration events included unexpected in-hospital mortality, cardiac arrest, and unplanned transfers to acute-care conventional medicine hospitals. Scores of the Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), and National Early Warning Score 2 (NEWS2) were calculated. Their performance was evaluated by calculating areas under the receiver-operating characteristic curve for the event occurrence. Multiple logistic regression analyses were performed to determine the factors associated with event occurrence. @*Results@#The incidence of unanticipated clinical deterioration events was 1.1% (225/21101). The area under the curve of MEWS, NEWS, and NEWS2 was .68, .72, and .72 at 24 hours before the events, respectively. NEWS and NEWS2, with almost the same performance, were superior to MEWS (p = .009). After adjusting for other variables, patients at low-medium risk (OR = 3.28; 95% CI = 1.02–10.55) and those at medium and high risk (OR = 25.03; 95% CI = 2.78–225.46) on NEWS2 scores were more likely to experience unanticipated clinical deterioration than those at low risk. Other factors associated with the event occurrence included frailty risk scores, clinical worry scores, primary medical diagnosis, prescribed medicine administration, acupuncture treatment, and clinical department. @*Conclusions@#The three early warning scores demonstrated moderate-to-fair performance for clinical deterioration events. NEWS2 can be used for early identification of patients at high risk of deterioration in complementary and alternative medicine hospitals. Additionally, patient, care, and system factors need to be considered to improve patient safety.

Accuracy of one-step automated orthodontic diagnosis model using a convolutional neural network and lateral cephalogram images with different qualities obtained from nationwide multi-hospitals / 대한치과교정학회지

Objective@#The purpose of this study was to investigate the accuracy of one-step automated orthodontic diagnosis of skeletodental discrepancies using a convolutional neural network (CNN) and lateral cephalogram images with different qualities from nationwide multi-hospitals. @*Methods@#Among 2,174 lateral cephalograms, 1,993 cephalograms from two hospitals were used for training and internal test sets and 181 cephalograms from eight other hospitals were used for an external test set. They were divided into three classification groups according to anteroposterior skeletal discrepancies (Class I, II, and III), vertical skeletal discrepancies (normodivergent, hypodivergent, and hyperdivergent patterns), and vertical dental discrepancies (normal overbite, deep bite, and open bite) as a gold standard. Pre-trained DenseNet-169 was used as a CNN classifier model. Diagnostic performance was evaluated by receiver operating characteristic (ROC) analysis, t-stochastic neighbor embedding (t-SNE), and gradientweighted class activation mapping (Grad-CAM). @*Results@#In the ROC analysis, the mean area under the curve and the mean accuracy of all classifications were high with both internal and external test sets (all, > 0.89 and > 0.80). In the t-SNE analysis, our model succeeded in creating good separation between three classification groups. Grad-CAM figures showed differences in the location and size of the focus areas between three classification groups in each diagnosis. @*Conclusions@#Since the accuracy of our model was validated with both internal and external test sets, it shows the possible usefulness of a one-step automated orthodontic diagnosis tool using a CNN model. However, it still needs technical improvement in terms of classifying vertical dental discrepancies.

The Effect of Stress on Internet Game Addiction Trends in Adults: Mindfulness and Conscientiousness as Mediators

Objective@#This study examined the mediating effect of mindfulness and consciousness among five factors on the effect of stress on Internet game addiction tendency. @*Methods@#An online survey was conducted on 400 men and women between their 20s and 40s across Korea. The scales used in the study were the Internet game addiction scale based on the DSM-5, Perceived Stress Scale, Mindfulness Scale, and Five-Factor Personality Scale. For data analysis, structural equation modeling was conducted, and Sobel verification was carried out to verify the significance of the mediating effects. @*Results@#The results of the study are as follows: Stress showed a positive correlation with Internet game addiction tendency, mindfulness mediated the effect of stress on Internet game addiction tendency. @*Conclusion@#Of the five personality factors, conscientiousness also mediated the effect of stress on Internet game addiction tendency. This study highlights the need for further research for individuals with game addiction tendency.

The Effect of Stress on Internet Game Addiction Trends in Adults: Mindfulness and Conscientiousness as Mediators

Objective@#This study examined the mediating effect of mindfulness and consciousness among five factors on the effect of stress on Internet game addiction tendency. @*Methods@#An online survey was conducted on 400 men and women between their 20s and 40s across Korea. The scales used in the study were the Internet game addiction scale based on the DSM-5, Perceived Stress Scale, Mindfulness Scale, and Five-Factor Personality Scale. For data analysis, structural equation modeling was conducted, and Sobel verification was carried out to verify the significance of the mediating effects. @*Results@#The results of the study are as follows: Stress showed a positive correlation with Internet game addiction tendency, mindfulness mediated the effect of stress on Internet game addiction tendency. @*Conclusion@#Of the five personality factors, conscientiousness also mediated the effect of stress on Internet game addiction tendency. This study highlights the need for further research for individuals with game addiction tendency.

The Effect of Stress on Compulsive Sexual Behavior Disorder: Active Coping Strategy and Self-Control as Mediators

Objective@#The aim of this study was to verify the effects of stress on compulsive sexual behavior disorder and the mediating effects of active coping strategies and self-control. @*Methods@#A self-reporting scale was administered to 300 adults aged 20 to 39, and the collected data were analyzed. The measures used for the study included a perceived stress scale, the way of coping checklist, a brief self-control scale, and an online compulsive sexual behavior disorder scale. @*Results@#The correlations between stress and active coping strategy, stress and lack of self-control, and lack of self-control and compulsive sexual behavior disorder were -0.18 (p<0.01), 0.38 (p<0.01), and 0.26 (p<0.01), respectively. @*Conclusion@#First, stress level was positively correlated with compulsive sexual behavior disorder. Second, self-control completely mediates the relationship between stress and compulsive sexual behavior disorder. Third, self-control and active coping strategies had sequential mediating effects in that order.

Serum level of visfatin can reflect the severity of inflammation in patients with acute cholecystitis

Purpose@#Visfatin is a key cytokine released from the pe ripheral blood mononuclear cells (PBMCs) as well as adipose tissue, and it is involved in immune response as well as inflammation. In this study, we investigated whether the serum visfatin level could be a prognostic factor for predicting the severity of inflammation in patients with acute cholecystitis. @*Methods@#We examined the blood samples and gallbladder specimens from patients who underwent laparoscopic cholecystectomy for either acute (n = 18) or chronic cholecystitis (n = 18). We determined the visfatin levels of these samples using various procedures such as real-time polymerase chain reaction, enzyme-linked immunosorbent assay, western blotting, and immunohistochemistry. @*Results@#The patients with acute cholecystitis exhibited higher mRNA expression of visfatin in PBMCs, higher serum levels of visfatin, and increased protein expression of visfatin in the gallbladder specimens than in patients with chronic cholecystitis. In the in vitro model of acute cholecystitis, the mRNA expression of visfatin showed the fastest increase among the other pro-inflammatory mediators studied, including interleukin (IL)-10, tumor necrosis factor-, IL-6, intracellular adhesion molecule-1, and ascular cell adhesion molecule-1. Inhibition of visfatin using siRNA abrogated the inhibitory effects of lipopolysaccharide (LPS) on the expression of ABCG1 in GBECs, suggesting that visfatin is significantly involved in the LPS-driven suppression of ABCG1. @*Conclusion@#Taken together, we concluded that visfatin is a pro-inflammatory mediators that is upregulated during acute cholecystitis and is expected to be increased within a short time after inflammation. Therefore, measuring the serum level of visfatin would be helpful in predicting the inflammatory severity in the patients with acute cholecystitis.

Change in Portal Pressure and Clinical Outcome in Cirrhotic Patients with Gastric Varices after Plug-Assisted Retrograde Transvenous Obliteration

Background/Aims@#Plug-assisted retrograde transvenous obliteration (PARTO) is widely used to manage gastric varices with a portosystemic shunt. It is not clear whether portal pressure and the incidence of complications increase after PARTO. The aim of this study was to determine the changes in portal pressure and the associated changes in liver func-tion, ascites, hepatic encephalopathy, and especially esopha-geal varix (EV) after PARTO. @*Methods@#From March 2012 to February 2018, 54 patients who underwent PARTO were analyzed retrospectively. The parameters collected included liver function and episodes of cirrhotic complications before and at 1 and 6 months after PARTO. @*Results@#The analysis of 54 patients showed improvement in liver function during the 6-month follow-up period (Model for End-Stage Liver Disease score: change from 11.46±4.35 to 10.33±2.96, p=0.021).Among these 54 patients, 25 patients were evaluated for their hepatic venous pressure gradient (HVPG) before and after PARTO (change from 12.52±3.83 to 14.68±5.03 mm Hg; p<0.001). Twenty-five patients with portal pressure mea-sured before and after PARTO were evaluated for risk factors affecting liver function improvement and EV deterioration. No factor associated with portal pressure was affected by liver function improvement. Post-PARTO portal pressure was a risk factor affecting EV deterioration (HVPG-post: odds ratio, 1.341; 95% confidence interval, 1.017 to 1.767; p=0.037). @*Conclusions@#The artificial blockade of the portosystemic shunt evidently leads to an increase in HVPG. Liver function was improved over the 6-month follow-up period. Portal pres-sure after PARTO was a significant risk factor for EV deterioration. Portal pressure measurement is helpful for predicting the patient’s clinical outcome.

Serum level of visfatin can reflect the severity of inflammation in patients with acute cholecystitis

Purpose@#Visfatin is a key cytokine released from the pe ripheral blood mononuclear cells (PBMCs) as well as adipose tissue, and it is involved in immune response as well as inflammation. In this study, we investigated whether the serum visfatin level could be a prognostic factor for predicting the severity of inflammation in patients with acute cholecystitis. @*Methods@#We examined the blood samples and gallbladder specimens from patients who underwent laparoscopic cholecystectomy for either acute (n = 18) or chronic cholecystitis (n = 18). We determined the visfatin levels of these samples using various procedures such as real-time polymerase chain reaction, enzyme-linked immunosorbent assay, western blotting, and immunohistochemistry. @*Results@#The patients with acute cholecystitis exhibited higher mRNA expression of visfatin in PBMCs, higher serum levels of visfatin, and increased protein expression of visfatin in the gallbladder specimens than in patients with chronic cholecystitis. In the in vitro model of acute cholecystitis, the mRNA expression of visfatin showed the fastest increase among the other pro-inflammatory mediators studied, including interleukin (IL)-10, tumor necrosis factor-, IL-6, intracellular adhesion molecule-1, and ascular cell adhesion molecule-1. Inhibition of visfatin using siRNA abrogated the inhibitory effects of lipopolysaccharide (LPS) on the expression of ABCG1 in GBECs, suggesting that visfatin is significantly involved in the LPS-driven suppression of ABCG1. @*Conclusion@#Taken together, we concluded that visfatin is a pro-inflammatory mediators that is upregulated during acute cholecystitis and is expected to be increased within a short time after inflammation. Therefore, measuring the serum level of visfatin would be helpful in predicting the inflammatory severity in the patients with acute cholecystitis.

Cauda Equina Syndrome after Percutaneous Balloon Kyphoplasty for Pathologic Compression Fracture / 대한정형외과학회잡지

Percutaneous balloon kyphoplasty is an option for pain relief in pathological vertebral compression fractures. Complications related to cement leakage through cortical defects have been reported. On the other hand, dural compression due to retropulsion of the tumor mass is rarely reported. The authors report a case of a 65-year female patient who had cauda equina syndrome after a percutaneous balloon kyphoplasty in a pathological vertebral fracture, even though epidural compression were not found prior to surgery. Magnetic resonance imaging revealed retropulsion of the tumor mass into the spinal canal through the disrupted posterior vertebral cortex.

Appropriate Hospital Discharge Timing after Laparoscopic Cholecystectomy: Comparison of Postoperative Day 1 vs. Day 2 Discharge Protocol

PURPOSE: The critical pathway (CP) was introduced as a means to provide quality healthcare service in many fields of surgery. CP may increase the patient's satisfaction rate and lowering hospital stay and medical cost also. We aimed to compare the two kinds of CP applied in laparoscopic cholecystectomy patients by different hospital stay length. METHODS: From March 2016 to October 2016, 71 patients were enrolled in this analysis among 241 patients who underwent elective laparoscopic cholecystectomy. Patients were divided into two groups, 38 patients in the 1-day CP group and 33 patients in the 2-day CP group. In a retrospective review, surgical outcomes and related hospital costs were analyzed. RESULTS: Preoperative characteristics were not different between two CP groups. In analysis of operative outcome, 2-day CP group showed longer operative time than 1-day CP (73.4 vs 54.1 min, p<0.001); otherwise, there was no significant difference in frequency of postop complications (6.1% vs 2.6%, p=0.474), numerical rating scale (NRS) pain score (1.82 vs 2.16, p=0.052), and count of analgesics injection (0.12 vs 0.16, p=0.754). Total admission cost and actual patient's expenditures were higher in 2-day CP group, but there was no statistically significant difference (347.04 vs 306.69×104 won, p=0.106; 147.85 vs 125.58×104 won, p=0.276). CONCLUSION: The length of hospital stay was shortened in 1-day CP group than in 2-day CP group, while there was no difference in other parameters. Therefore, it is feasible and safe practical policy the use 1-day CP in selected patients who undergo cholecystectomy according to our results.

Which Criterion Is More Reliable for Selecting the Distal Fusion Level in Cases of Adolescent Idiopathic Scoliosis with Structural Thoracolumbar/Lumbar Curves: Static or Dynamic? / 대한척추외과학회지

STUDY DESIGN: Retrospective comparative study.OBJECTIVES: To compare the reliability of 2 criteria to predict the radiological outcomes of corrective surgery in cases of adolescent idiopathic scoliosis (AIS) with structural thoracolumbar/lumbar (TL/L) curves.SUMMARY OF LITERATURE REVIEW: Distal fusion level selection in AIS with structural TL/L curves is debatable.MATERIALS AND METHODS: This study included 131 AIS patients with structural TL/L curves who underwent corrective surgery in which distal fusion was stopped at L3. Whole-spine standing radiographs and bending radiographs were obtained preoperatively. The patients were divided into 2 groups according to their findings on bending radiographs (dynamic criterion) and by the last touching vertebra and the lower end vertebra (static criterion). Radiological outcomes were assessed by reviewing postoperative radiographs. Reliability tests were conducted to compare the predictability of radiological outcomes using these 2 methods. In addition, radiological parameters were compared between both criteria.RESULTS: Among 131 patients, 25 showed radiologically poor outcomes (19.1%). The sensitivity of the dynamic and static criteria was 0.69 and 0.50, respectively. The specificity of each criterion was 0.49 and 0.64, respectively. Overall, the dynamic criterion showed superior reliability (p=0.03). However, no significant difference in radiological parameters could be found in a comparison of both criteria.CONCLUSIONS: Although the dynamic criterion was more sensitive for predicting poor radiological outcomes when stopping fusion at L3 in patients with structural TL/L curves, its specificity was lower than that of the static criterion. Thus, both dynamic and static criteria should be considered when selecting the distal fusion level in cases of AIS with structural TL/L curves.

Early Adjacent Vertebral Fractures after Balloon Kyphoplasty for Osteoporotic Vertebral Compression Fractures

STUDY DESIGN: Retrospective cohort study. PURPOSE: To evaluate the incidence and risk factors for early adjacent vertebral fractures following balloon kyphoplasty (KP). OVERVIEW OF LITERATURE: KP is a safe and effective treatment for pain alleviation in patients with osteoporotic vertebral compression fractures (OVCF). However, some studies have reported that the risk of newly developed fractures increases at the adjacent vertebra after KP. METHODS: Total 123 consecutive patients with painful OVCF who underwent KP were enrolled from January 2009 to June 2016. Early adjacent vertebral fractures were defined as new fractures that had developed within 3 months after surgery. Sex, age, body mass index (BMI), bone mineral density (BMD), vertebral height, kyphotic angle, Visual Analog Scale score, cement amount, and leakage were evaluated as risk factors for adjacent vertebral fractures. Only cement leakage into the disc space was included in this study. RESULTS: Early adjacent vertebral fractures were identified in 20 (16.2%) of the 123 patients. The mean time to diagnosis of fractures was 1.7±0.7 months after KP. The average patient age was 78.0±0.7 years, average BMI was 23.06±3.83 kg/m², and mean BMD was −3.61±1.22 g/m². Cement leakage was present in 16 patients, and fractures developed in 11 (68.7%). In contrast, fractures developed in nine patients (8.2%) without cement leakage. There were no significant differences in terms of age, BMI, BMD, kyphotic angle, or vertebral body height ratio between the fracture and control groups. CONCLUSIONS: Cement leakage into the disc increased the risk of early adjacent vertebral fractures after balloon KP.

Which Criterion Is More Reliable for Selecting the Distal Fusion Level in Cases of Adolescent Idiopathic Scoliosis with Structural Thoracolumbar/Lumbar Curves: Static or Dynamic?

OBJECTIVES@#To compare the reliability of 2 criteria to predict the radiological outcomes of corrective surgery in cases of adolescent idiopathic scoliosis (AIS) with structural thoracolumbar/lumbar (TL/L) curves.SUMMARY OF LITERATURE REVIEW: Distal fusion level selection in AIS with structural TL/L curves is debatable.@*MATERIALS AND METHODS@#This study included 131 AIS patients with structural TL/L curves who underwent corrective surgery in which distal fusion was stopped at L3. Whole-spine standing radiographs and bending radiographs were obtained preoperatively. The patients were divided into 2 groups according to their findings on bending radiographs (dynamic criterion) and by the last touching vertebra and the lower end vertebra (static criterion). Radiological outcomes were assessed by reviewing postoperative radiographs. Reliability tests were conducted to compare the predictability of radiological outcomes using these 2 methods. In addition, radiological parameters were compared between both criteria.@*RESULTS@#Among 131 patients, 25 showed radiologically poor outcomes (19.1%). The sensitivity of the dynamic and static criteria was 0.69 and 0.50, respectively. The specificity of each criterion was 0.49 and 0.64, respectively. Overall, the dynamic criterion showed superior reliability (p=0.03). However, no significant difference in radiological parameters could be found in a comparison of both criteria.@*CONCLUSIONS@#Although the dynamic criterion was more sensitive for predicting poor radiological outcomes when stopping fusion at L3 in patients with structural TL/L curves, its specificity was lower than that of the static criterion. Thus, both dynamic and static criteria should be considered when selecting the distal fusion level in cases of AIS with structural TL/L curves.

Arthroscopic Excision of Delayed Diagnosed Intra-articular Osteoid Osteoma of the Elbow: A Case Report

An intra-articular osteoid osteoma is a very rare cause of elbow pain, and its diagnosis and treatment remain challenging. Delayed diagnosis may lead to arthritic change of the joint. In this study, the authors present the occurrence of intra-articular osteoid osteoma in the right elbow of a 15-year-old male patient who presented with prolonged pain and limited motion owing to delayed diagnosis. After confirming the nidus of osteoid osteoma from radiographic evaluation, the lesion was completely removed arthroscopically. The patient presented a complete relief of symptoms and full range of motion. This is the first domestic report of successful arthroscopic treatment of an intra-articular osteoid osteoma of the elbow.

High Tibial Osteotomy versus Unicompartmental Knee Arthroplasty for Medial Compartment Arthrosis with Kissing Lesions in Relatively Young Patients

PURPOSE: The purpose of this study is to compare the clinical and radiographic outcomes of high tibial osteotomy (HTO) and unicompartmental arthroplasty (UKA) in advanced medial compartment arthritis accompanied by kissing lesions in relatively young patients. MATERIALS AND METHODS: Forty-five patients were divided into the HTO (n=23) and UKA (n=22) groups. Clinically, we evaluated the Lysholm knee scoring scale, visual analogue scale, Hospital for Special Surgery, and Western Ontario and McMaster Universities Osteoarthritis index scores preoperatively, 6 and 12 months postoperatively, and at the final follow-up. Radiographically, we measured the femoral-tibial angle and mechanical axis deviation preoperatively and at the final follow-up. RESULTS: All clinical outcomes gradually improved in both groups from the postoperative period to the final follow-up. At the final follow-up, all clinical outcomes were slightly better in the UKA group than in the HTO group; however, differences were not statistically significant. CONCLUSIONS: HTO is comparable to UKA in terms of clinical outcomes. Thus, the results of this study suggest that HTO might be a good alternative treatment to UKA for medial unicompartmental arthritis accompanied by kissing lesions in relatively young patients.

Accessory Talar Facet Impingement due to Accessory Anterolateral Talar Facet Misdiagnosed as Sinus Tarsi Syndrome / 대한족부족관절학회지

PURPOSE: To evaluate the clinical and radiographic results of surgical treatment for patients with sinus tarsi pain due to accessory talar facet impingement. MATERIALS AND METHODS: Between July 2013 and July 2015, nine patients who underwent surgery for the accessory talar facet impingement were reviewed. The mean follow-up period was 18.6 months (12~36 months), and the mean age was 33.1 years (19~60 years). Previous trauma history, duration of symptom, and types of surgery were analyzed. The clinical results were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale (VAS). Radiographic results were assessed using Meary's angle, calcaneal pitch angle, heel alignment angle, and heel alignment ratio. RESULTS: All patients had evident trauma history prior to the initial symptom. The mean duration of symptoms was 25.6 months (6~120 months). Four patients received only accessory anterolateral talar facet (AALTF) excision, and four patients received medial sliding calcaneal osteotomy (MSCO). One patient underwent both AALTF excision and MSCO. The AOFAS ankle-hindfoot score was significantly improved from 73 (62~77) preoperatively to 93 (67~100) postoperatively. The VAS score was decreased from 6 (5~7) preoperatively to 1 (0~5) postoperatively. The Meary's angle and calcaneal pitch angle showed no significant difference after surgery. The heel alignment angle and ratio increased from −3.6° (−10°~5°) and 0.22 (−0.15~0.6) preoperatively to 2.8° (1°~5°) and 0.42 (0.3~0.6) postoperatively, respectively. CONCLUSION: If there is persistent sinus tarsi pain in patients with hindfoot valgus, accessory talar facet impingement caused by AALTF could be considered as a cause of chronic sinus tarsi pain.

Medial malleolar fracture associated with deltoid ligament rupture following ankle pronation injury / 영남의대학술지

Concurrent injury of medial malleolus and deltoid ligament is difficult to occur considering the injury mechanism. When the concurrent injury comes about, the deltoid ligament injury could be missed and it may lead to medial ankle instability. There are few reported cases of the concurrent injury and domestic case of concurrent failure of both structures over the medial side has been reported just once; however, the injury mechanism is different from this case. The authors report a case of medial malleolus fracture with deltoid ligament rupture following pronation injury with a review of necessity of repairing deltoid ligament for ankle stability.

Intramuscular hemangioma in buccal cheek: a case report

Hemangioma is the most common benign tumor of a vascular origin, and is characterized by the abnormal proliferation of blood vessels. Intramuscular hemangioma (IMH) usually involves the skeletal muscles of the trunk or limbs, but rarely occurs in the head and neck region. This case report presents a patient with IMH showing multiple phleboliths in the buccal cheek. A 13-year-old boy was referred for the evaluation and management of painful swelling of the left cheek that had gradually increased in size over a 6 year duration. The examination revealed a palpable firm mass. Reddish-blue buccal mucosa color was observed with an aciniform shape. Preoperative magnetic resonance imaging (MRI) showed a vascular tumor in the left side adjacent to the buccinator and depressor orbicularis oris muscles. Surgical resection under general anesthesia was performed via the intraoral approach. The mass and phleboliths were extracted successfully. A histopathological examination confirmed the diagnosis of IMH. In conclusion, clinicians should be aware of the possibility of IMH in cases of a palpable mass with multiple nodules deep within the muscle in the buccal cheek. Among the several diagnostic tools, MRI provides essential information on the extent and surrounding anatomy of IMH.

Unhealed Wound of the Lower Leg due to Synovial Fistula of the Ankle Joint / 대한족부족관절학회지

Synovial fistula of the ankle joint is an uncommon complication from an ankle sprain. This may likely result in an unhealed wound around the ankle joint due to continuous leakage of joint fluid. However, in the event of an open wound on the lower leg, and not on the joint, it may be difficult to consider synovial fistula as a cause of the open wound. We experienced an interesting case with an unhealed open wound on the lower leg due to a synovial fistula of the ankle joint following an ankle sprain. We obtained good results after a treatment using a self-produced suction drainage device on the unhealed open wound.