Rapidly growing juvenile xanthogranuloma in an adult: a case report

Juvenile xanthogranuloma is a benign tumor made up of non-Langerhans histiocytes that predominantly occurs in infancy and early childhood. Juvenile xanthogranuloma can be differentiated from xanthoma by the distribution of the lesions and the absence of lipid abnormalities. It usually develops on the trunk and upper and lower extremities. Histologically, xanthogranulomas show a mixed cellular dermal infiltration with histiocytes, lymphocytes, eosinophils and Touton-type multinucleated giant cells. Classically, juvenile xanthogranuloma is a disease that largely affects infants and children. We describe a rare case of juvenile xanthogranuloma that suddenly developed in the axillary region of a male adult.

Association of the First Antipsychotic Treatment Duration With the Re-Initiation of Treatment in Schizophrenia: A National Health Insurance Data-Based Study / 대한정신분열병학회지

Objectives@#The optimal duration of maintenance treatment for patients with first-episode schizophrenia (FES) remains unclear. We examined the first antipsychotic treatment duration and its association with re-initiation of treatment using a nationwide claim database. @*Methods@#Data from the Health Insurance Review and Assessment Service database in South Korea for 2007–2016 were used. Linear regression analysis and Cox proportional hazard models were used to evaluate the associations between the duration of the first antipsychotic treatment, time to re-initiation of treatment, and occurrence of treatment re-initiation. @*Results@#Of 30,143 patients with FES, 80.4% (n=24,231) received <2 years of the first antipsychotic treatment. In patients who discontinued treatment (n=23,030), the rate of treatment re-initiation was 74.2% (n=17,086). As the duration of the first antipsychotic treatment increased, the time to re-initiation of treatment decreased (β=-0.146, p<0.001); however, the rate of treatment re-initiation was relatively constant (hazard ratio=1.001, p<0.001). @*Conclusion@#Long-term antipsychotic treatment was not significantly associated with the rate of treatment re-initiation but showed a negative association with the time to re-initiation of treatment. Further research is needed to better understand the optimal treatment duration for FES.

Differentiation between Glioblastoma and Solitary Metastasis: Morphologic Assessment by Conventional Brain MR Imaging and Diffusion-Weighted Imaging

Purpose@#Differentiating between glioblastoma and solitary metastasis is very important for the planning of further workup and treatment. We assessed the ability of various morphological parameters using conventional MRI and diffusion-based techniques to distinguish between glioblastomas and solitary metastases in tumoral and peritumoral regions. @*Materials and Methods@#We included 38 patients with solitary brain tumors (21 glioblastomas, 17 solitary metastases). To find out if there were differences in the morphologic parameters of enhancing tumors, we analyzed their shape, margins, and enhancement patterns on postcontrast T1-weighted images. During analyses of peritumoral regions, we assessed the extent of peritumoral non-enhancing lesion on T2- and postcontrast T1-weighted images. We also aimed to detect peritumoral neoplastic cell infiltration by visual assessment of T2-weighted and diffusionbased images, including DWI, ADC maps, and exponential DWI, and evaluated which sequence depicted peritumoral neoplastic cell infiltration most clearly. @*Results@#The shapes, margins, and enhancement patterns of tumors all significantly differentiated glioblastomas from metastases. Glioblastomas had an irregular shape, ill-defined margins, and a heterogeneous enhancement pattern; on the other hand, metastases had an ovoid or round shape, well-defined margins, and homogeneous enhancement. Metastases had significantly more extensive peritumoral T2 high signal intensity than glioblastomas had. In visual assessment of peritumoral neoplastic cell infiltration using T2-weighted and diffusion-based images, all sequences differed significantly between the two groups. Exponential DWI had the highest sensitivity for the diagnosis of both glioblastoma (100%) and metastasis (70.6%). A combination of exponential DWI and ADC maps was optimal for the depiction of peritumoral neoplastic cell infiltration in glioblastoma. @*Conclusion@#In the differentiation of glioblastoma from solitary metastatic lesions, visual morphologic assessment of tumoral and peritumoral regions using conventional MRI and diffusion-based techniques can also offer diagnostic information.

The Fornix: Functional Anatomy, Normal Neuroimaging, and Various Pathological Conditions

The fornix is the major white-matter outflow tract from the hippocampus; it has a significant role in cognitive function. It is readily imaged via magnetic resonance imaging; its main parts are the crura, commissure, body, and columns. In this pictorial essay, we describe and illustrate the functional and imaging anatomy of the fornix and limbic system, as well as various disease entities involving the fornix.

Differentiation between Glioblastoma and Solitary Metastasis: Morphologic Assessment by Conventional Brain MR Imaging and Diffusion-Weighted Imaging

Purpose@#Differentiating between glioblastoma and solitary metastasis is very important for the planning of further workup and treatment. We assessed the ability of various morphological parameters using conventional MRI and diffusion-based techniques to distinguish between glioblastomas and solitary metastases in tumoral and peritumoral regions. @*Materials and Methods@#We included 38 patients with solitary brain tumors (21 glioblastomas, 17 solitary metastases). To find out if there were differences in the morphologic parameters of enhancing tumors, we analyzed their shape, margins, and enhancement patterns on postcontrast T1-weighted images. During analyses of peritumoral regions, we assessed the extent of peritumoral non-enhancing lesion on T2- and postcontrast T1-weighted images. We also aimed to detect peritumoral neoplastic cell infiltration by visual assessment of T2-weighted and diffusionbased images, including DWI, ADC maps, and exponential DWI, and evaluated which sequence depicted peritumoral neoplastic cell infiltration most clearly. @*Results@#The shapes, margins, and enhancement patterns of tumors all significantly differentiated glioblastomas from metastases. Glioblastomas had an irregular shape, ill-defined margins, and a heterogeneous enhancement pattern; on the other hand, metastases had an ovoid or round shape, well-defined margins, and homogeneous enhancement. Metastases had significantly more extensive peritumoral T2 high signal intensity than glioblastomas had. In visual assessment of peritumoral neoplastic cell infiltration using T2-weighted and diffusion-based images, all sequences differed significantly between the two groups. Exponential DWI had the highest sensitivity for the diagnosis of both glioblastoma (100%) and metastasis (70.6%). A combination of exponential DWI and ADC maps was optimal for the depiction of peritumoral neoplastic cell infiltration in glioblastoma. @*Conclusion@#In the differentiation of glioblastoma from solitary metastatic lesions, visual morphologic assessment of tumoral and peritumoral regions using conventional MRI and diffusion-based techniques can also offer diagnostic information.

The Fornix: Functional Anatomy, Normal Neuroimaging, and Various Pathological Conditions

The fornix is the major white-matter outflow tract from the hippocampus; it has a significant role in cognitive function. It is readily imaged via magnetic resonance imaging; its main parts are the crura, commissure, body, and columns. In this pictorial essay, we describe and illustrate the functional and imaging anatomy of the fornix and limbic system, as well as various disease entities involving the fornix.

Effectiveness and Safety of Liraglutide Treatment in Patients with a Psychiatric Disorder / 신경정신의학

Objectives@#Liraglutide is a glucagon-like-peptide-1 receptor agonist which has been used as an anti-obesity drug. It was reported that patients might develop or worsen suicidal ideas and/or depression during liraglutide treatment, especially when it comes to patients with a psychiatric disorder. The purpose of this study was to evaluate the effectiveness and safety of liraglutide, especially in terms of the psychiatric adverse effects. @*Methods@#A retrospective chart review study was conducted on psychiatric patients prescribed liraglutide for more than one month from September 2018 to September 2020. Based on their medical records, we investigated the change in the weight and body mass index (BMI) of patients from the baseline to 6 months of receiving liraglutide treatment. Information on the adverse effects was also obtained, including psychiatric adverse effects such as insomnia, anxiety, depression, and suicidal ideation. A mixed linear model was used for assessing the time effect on change in weight and BMI. @*Results@#A total of 24 patients were included in the current study, and the most common psychiatric diagnosis included major depressive disorder (n=13, 54.2%). There was a significant change in weight (F=6.127, p=0.001) and BMI (F=6.749, p<0.001) during the liraglutide treatment. Worsening of depression and anxiety occurred in one patient but improved after the adjustment of psychiatric medications. @*Conclusion@#The current study found that liraglutide treatment in patients with a psychiatric disorder can be a safe and effective intervention for weight reduction.

Effectiveness and Safety of Liraglutide Treatment in Patients with a Psychiatric Disorder / 신경정신의학

Objectives@#Liraglutide is a glucagon-like-peptide-1 receptor agonist which has been used as an anti-obesity drug. It was reported that patients might develop or worsen suicidal ideas and/or depression during liraglutide treatment, especially when it comes to patients with a psychiatric disorder. The purpose of this study was to evaluate the effectiveness and safety of liraglutide, especially in terms of the psychiatric adverse effects. @*Methods@#A retrospective chart review study was conducted on psychiatric patients prescribed liraglutide for more than one month from September 2018 to September 2020. Based on their medical records, we investigated the change in the weight and body mass index (BMI) of patients from the baseline to 6 months of receiving liraglutide treatment. Information on the adverse effects was also obtained, including psychiatric adverse effects such as insomnia, anxiety, depression, and suicidal ideation. A mixed linear model was used for assessing the time effect on change in weight and BMI. @*Results@#A total of 24 patients were included in the current study, and the most common psychiatric diagnosis included major depressive disorder (n=13, 54.2%). There was a significant change in weight (F=6.127, p=0.001) and BMI (F=6.749, p<0.001) during the liraglutide treatment. Worsening of depression and anxiety occurred in one patient but improved after the adjustment of psychiatric medications. @*Conclusion@#The current study found that liraglutide treatment in patients with a psychiatric disorder can be a safe and effective intervention for weight reduction.

Peritumoral Brain Edema after Stereotactic Radiosurgery for Asymptomatic Intracranial Meningiomas: Risks and Pattern of Evolution

OBJECTIVE: To investigate the risks and pattern of evolution of peritumoral brain edema (PTE) after stereotactic radiosurgery (SRS) for asymptomatic intracranial meningiomas. METHODS: A retrospective study was conducted on 320 patients (median age 56 years, range 24-87 years) who underwent primary Gamma Knife radiosurgery for asymptomatic meningiomas between 1998 and 2012. The median tumor volume was 2.7 cc (range 0.2-10.5 cc) and the median follow-up was 48 months (range 24-168 months). Volumetric data sets for tumors and PTE on serial MRIs were analyzed. The edema index (EI) was defined as the ratio of the volume of PTE including tumor to the tumor volume, and the relative edema indices (rEIs) were calculated from serial EIs normalized against the baseline EI. Risk factors for PTE were analyzed using logistic regression. RESULTS: Newly developed or increased PTE was noted in 49 patients (15.3%), among whom it was symptomatic in 28 patients (8.8%). Tumor volume larger than 4.2 cc (p4.2 cc), of hemispheric location, or with pre-treatment PTE. PTE usually develops within months, reaches its maximum degree until a year, and resolves within 2 years after SRS.

Short-Term Clinical Results of Amniotic Membrane Application to Endonasal Dacryocystorhinostomy

PURPOSE: To evaluate the short-term surgical results of Merocel(R) nasal packing wrapped with human amniotic membrane on the internal ostium during endonasal dacryocystorhinostomy (DCR). METHODS: Sixty patients who underwent endonasal DCR to treat nasolacrimal duct obstruction from October 2005 to April 2006 were enrolled in this prospective study. The patients were divided into two groups: 30 patients treated with Merocel(R) packing wrapped with amniotic membrane were assigned to group 1, and the remaining 30 patients were assigned to group 2. During the follow-up period, the authors evaluated surgical wound healing, the incidence of granuloma, and the patency of the internal ostium. RESULTS: Success rates at 6 months after surgery were higher in group 1 than in group 2, but these rates showed no statistically significant difference between the two groups (group 1: 93.3%, group 2: 86.7%, p=0.67). The time for mean wound healing in group 1 was significantly shorter than that in group 2 (group 1: 4.8+/-1.5 weeks, group 2: 7.3+/-1.5 weeks, p< 0.001). The incidence of granuloma in group 1 was lower than that in group 2 at 2 months after surgery (group 1: 13% (4/30), group 2:33% (14/30), p=0.04). However, there was no difference of granuloma formation between the two groups at 6 months postoperatively (group 1: 33% (11/30), group 2: 46% (14/30)). CONCLUSIONS: The authors believe that the use of Merocel(R) packing wrapped with amniotic membrane after endonasal DCR might decrease postoperative inflammation, accelerate wound healing, and decrease granuloma formation in the early postoperative period.

Efficacy of Routine Internal Limiting Membrane Removal During Vitrectomy in Proliferative Diabetic Retinopathy

PURPOSE: To evaluate the efficacy of internal limiting membrane (ILM) removal during vitrectomy in proliferative diabetic retinopathy (PDR) patients. METHODS: Seventy-four eyes of 74 PDR patients who underwent vitrectomy were enrolled. All patients had been followed for at least one year. Thirty-three patients who underwent vitrectomy without ILM peeling from January 2004 to February 2005 were assigned to Group A and 41 patients who underwent vitrectomy with ILM peeling from March 2005 to October 2005 were assigned to Group B. Visual acuity (LogMAR), central macular thickness measured by optical coherent tomography (OCT), and presence or absence of macular edema were compared between the two groups at six months and one year after surgery. RESULTS: Postoperative mean best corrective visual acuity (BCVA; LogMAR) were improved significantly in both groups at six months and one year after surgery. However, the overall amount of improvement in vision was not different between the two groups. The mean central forveal thickness in Group B was significantly thinner than in Group A at six months and one year after surgery. There was no difference between the two groups in macular edema incidence at that time. There were no serious complications in Group B by one year after surgery. CONCLUSIONS: There was no difference in visual acuity between the Group A and Group B However, the central forveal thickness measured by OCT was thinner in the ILM peeling group, and there were no serious complications in ILM peeling group. Routine ILM peeling during vitrectomy in PDR will help to maintain the structural stability of the macula postoperatively.

The Usefulness of the Uniocular Drug Trial in the Glaucoma Eyes

PURPOSE: This study was undertaken to evaluate if the reduction of intraocular pressure (IOP) observed in a uniocular trial correlates with an IOP reduction observed in the fellow eye. METHODS: The study was performed on forty patients with bilateral glaucoma or suspect glaucoma who underwent a uniocular trial of 0.005% latanoprost and subsequently received the same drug in the fellow eye after 1 week. Inter-eye IOP variations were less than 3 mm Hg over two measurements, and were followed minimally for 4 weeks. The uniocular IOP reduction (IOP before medication - IOP after medication) and the net IOP reduction (IOP change in the trial eye after medication - IOP change in the fellow eye) were calculated. The uniocular IOP reduction and net IOP reduction in the trial eye was compared with the results from the fellow eye. RESULTS: The mean uniocular IOP reduction in the trial eye and the fellow eye were 3.6+/-2.42 mm Hg and 2.78+/-2.16 mm Hg, respectively (r=0.390, r2=0.152, P=0.013). The mean net IOP reduction in the trial eye and the opposing eye were 3.55+/-1.70 mm Hg and 3.15+/-1.83 mm Hg, respectively (r=0.782, r2=0.612, P=0.000). CONCLUSIONS: A uniocular drug trial in patients with similar IOPs between their eyes can adequately predict the IOP lowering effect of a medication.

Intravitreal versus Posterior Subtenon Injection of Triamcinolone Acetonide for Diabetic Macular Edema

PURPOSE: To compare the short-term effects of intravitreal versus posterior subtenon injection of triamcinolone acetonide for diabetic macular edema. METHODS: This is a prospective and interventional study. Sixty eyes of 60 patients who had diffuse diabetic macular edema were assigned to receive a single intravitreal injection (4 mg) or a single posterior subtenon injection (40 mg) of triamcinolone acetonide. The central retinal thickness was measured using optical coherent tomography before injection and at 1 and 3 months after injection. Visual acuity and intraocular pressure (IOP) were also measured. RESULTS: Both intravitreal and posterior subtenon injections of triamcinolone acetonide resulted in significant improvements in visual acuity at 1 month and 3 months after injection. Both groups resulted in a significant decrease in central macular thickness (CMT) at 1 month and 3 months post-injection. IOP in the intravitreal injection group was significantly higher than in the posterior subtenon injection group at 3 months after injection. CONCLUSIONS: The posterior subtenon injection of triamcinolone acetonide had a comparable effect to the intravitreal triamcinolone injection and showed a lower risk of elevated IOP. Posterior subtenon injection of triamcinolone acetonide may be a good alternative for the treatment of diffuse diabetic macular edema.

The Effect of Nonincisional Double Fold Formation Using Three Small Incisions, Two-stitch Method

PURPOSE: The aim of this study was to analyze the effects of using the nonincisional, double fold formation method with three small incisions and two-stitches. METHODS: This study included 39 patients who underwent double eyelid operation by a nonincisional technique and who were followed up for more than 6 months. On the desired double eyelid line, three points 6 mm apart were marked and three stab incisions made. A small amount of subcutaneous tissue was removed through the incisions, and orbital fat was removed through the lateral wound site-if necessary. Using double-armed 7-0 nylon or prolene, two buried sutures of 6 mm width were made. Sixteen patients also underwent surgery for epiblepharon, and three patients with unilateral double eyelid due to trauma had a contralateral eyelid operation for asymmetry correction. Five patients also had epicanthoplasty. RESULTS: Two patients lost their folds completely and reoperations were performed. Two patients showed cysts due to suture material and so the suture knots were removed; the double fold remained afterwards, so no other procedures were needed. In one case, the suture was seen subcutaneously, so suture removal and reoperation were performed. CONCLUSIONS: To minimize double fold loss, which is a disadvantage of the nonincisional double fold formation technique, we removed a portion of pretarsal tissue, muscle, and/or orbital fat and made two wide slings. Also, we corrected asymmetry due to traumatic unilateral double eyelid and epicanthal fold. In conclusion, we expect that our method could extend the applicability of nonincisional double fold formation.

The Effect of Nonincisional Double Fold Formation Using Three Small Incisions, Two-stitch Method

PURPOSE: The aim of this study was to analyze the effects of using the nonincisional, double fold formation method with three small incisions and two-stitches. METHODS: This study included 39 patients who underwent double eyelid operation by a nonincisional technique and who were followed up for more than 6 months. On the desired double eyelid line, three points 6 mm apart were marked and three stab incisions made. A small amount of subcutaneous tissue was removed through the incisions, and orbital fat was removed through the lateral wound site-if necessary. Using double-armed 7-0 nylon or prolene, two buried sutures of 6 mm width were made. Sixteen patients also underwent surgery for epiblepharon, and three patients with unilateral double eyelid due to trauma had a contralateral eyelid operation for asymmetry correction. Five patients also had epicanthoplasty. RESULTS: Two patients lost their folds completely and reoperations were performed. Two patients showed cysts due to suture material and so the suture knots were removed; the double fold remained afterwards, so no other procedures were needed. In one case, the suture was seen subcutaneously, so suture removal and reoperation were performed. CONCLUSIONS: To minimize double fold loss, which is a disadvantage of the nonincisional double fold formation technique, we removed a portion of pretarsal tissue, muscle, and/or orbital fat and made two wide slings. Also, we corrected asymmetry due to traumatic unilateral double eyelid and epicanthal fold. In conclusion, we expect that our method could extend the applicability of nonincisional double fold formation.

Statistical Analysis Used for the Studies in the Journal of the Korean Orthopaedic Association / 대한정형외과학회잡지

PURPOSE: To review the statistical analysis used for the studies in the Journal of the Korean orthopaedic Association. MATERIALS AND METHODS: We analysed the statistical analysis used for the studies in the Journal of the Korean Orthopaedic Association (JKOA) published in 1997 and compared that with the Journal of Bone and Joint Surgery (JBJS). RESULTS: In JKOA, 97 out of 205 papers (47.3%) used statistical analysis. Total number of analytic methods was 140 (1.44 per paper in an average). In JBJS, 109 out of 159 papers (68.6%) used statistical analysis and total number of analytic methods was 202 (1.85 per paper in an average). In JKOA, analysis of means was used 98 times (70.0%), analysis of regression and correlation 8 times (5.7%), analysis of categorical data 30 times (21.4%), analysis of survival data 3 times (2.1%) and other methods just once (0.7%). In JBJS, analysis of means was used 114 times (56.4%), analysis of regression and correlation 10 times (5.0%), analysis of categorical data 55 times (27.2%), analysis of survival data 21 times (10.4%) and other methods 2 times (1.0%). CONCLUSIONS: In both journals, t-test, chisquare test and analysis of variance were commonly used analytic methods. In JKOA, the results of 10 out of 97 papers (10.3%) were difficult to understand because of insufficient explanation of the analytic methods used.