Orbital floor defect caused by invasive aspergillosis: a case report and literature review

Fungal sinusitis is relatively rare, but it has become more common in recent years. When fungal sinusitis invades the orbit, it can cause proptosis, chemosis, ophthalmoplegia, retroorbital pain, and vision impairment. We present a case of an extensive orbital floor defect due to invasive fungal sinusitis. A 62-year-old man with hypertension and a history of lung adenocarcinoma, presented with right-side facial pain and swelling. On admission, the serum glucose level was 347 mg/dL, and hemoglobin A1c was 11.4%. A computed tomography scan and a Waters’ view X-ray showed right maxillary sinusitis with an orbital floor defect. On hospital day 3, functional endoscopic sinus surgery was performed by the otorhinolaryngology team, and an aspergilloma in necrotic inflammatory exudate obtained during exploration. On hospital day 7, orbital floor reconstruction with a Medpor Titan surgical implant was done. In principle, the management of invasive sino- orbital fungal infection often begins with surgical debridement and local irrigation with an antifungal agent. Exceptionally, in this case, debridement and immediate orbital floor reconstruction were performed to prevent enophthalmos caused by the extensive orbital floor defect. The patient underwent orbital floor reconstruction and received intravenous and oral voriconazole. Despite orbital invasion, there were no ophthalmic symptoms or sequelae.

Intramuscular epidermal cyst in the masticator space: a case report

An epidermal cyst, also known as an epidermoid cyst or epidermal inclusion cyst, is the most prevalent type of cutaneous cyst. This noncancerous lesion can appear anywhere on the body, typically presenting as an asymptomatic dermal nodule with a visible central punctum. In the case presented herein, an epidermal cyst with uncommon features was misdiagnosed as a lymphatic malformation based on preoperative magnetic resonance imaging (MRI). A 61-year-old man came to us with a swollen left cheek that had been present for 11 months. The preoperative MRI revealed a 3 × 3.8 × 4.6 cm lobulated cystic lesion with thin rim enhancement in the left masticator space. The initial differential diagnosis pointed toward a lymphatic malformation. We proceeded with surgical excision of the lesion via an intraoral approach, and the specimen was sent to the pathology department. The pathological diagnosis revealed a ruptured epidermal cyst, indicating that the initial diagnosis of a lymphatic malformation based on preoperative MRI was incorrect. Epidermal cysts located under the muscle with no visible central punctum are uncommon, but should be considered if a patient presents with facial swelling.

Receptor binding motif surrounding sites in the Spike 1 protein of infectious bronchitis virus have high susceptibility to mutation related to selective pressure

Background@#To date, various genotypes of infectious bronchitis virus (IBV) have cocirculated and in Korea, GI-15 and GI-19 lineages were prevailing. The spike protein, particularly S1 subunit, is responsible for receptor binding, contains hypervariable regions and is also responsible for the emerging of novel variants. @*Objective@#This study aims to investigate the putative major amino acid substitutions for the variants in GI-19. @*Methods@#The S1 sequence data of IBV isolated from 1986 to 2021 in Korea (n = 188) were analyzed. Sequence alignments were carried out using Multiple alignment using Fast Fourier Transform of Geneious prime. The phylogenetic tree was generated using MEGA-11 (ver.11.0.10) and Bayesian analysis was performed by BEAST v1.10.4. Selective pressure was analyzed via online server Datamonkey. Highlights and visualization of putative critical amino acid were conducted by using PyMol software (version 2.3). @*Results@#Most (93.5%) belonged to the GI-19 lineage in Korea, and the GI-19 lineage was further divided into seven subgroups: KM91-like (Clade A and B), K40/09-like, QX-like (I-IV).Positive selection was identified at nine and six residues in S1 for KM91-like and QX-like IBVs, respectively. In addition, several positive selection sites of S1-NTD were indicated to have mutations at common locations even when new clades were generated. They were all located on the lateral surface of the quaternary structure of the S1 subunits in close proximity to the receptor-binding motif (RBM), putative RBM motif and neutralizing antigenic sites in S1. @*Conclusions@#Our results suggest RBM surrounding sites in the S1 subunit of IBV are highly susceptible to mutation by selective pressure during evolution.

Early childhood eating behaviors associated with risk of overweight and its socio-ecological determinants in Korean preschool children

BACKGROUND/OBJECTIVES@#This study aimed to identify preschool children’s eating behaviors associated with early childhood obesity and its multi-level, socio-ecological determinants. @*SUBJECTS/METHODS@#In a cross-sectional study of 364 mothers of preschool children aged 3–5 years, these children’s healthy eating behaviors were assessed using a validated preschool nutrition quotient (NQ-P) questionnaire. The children’s overweight or obesity statuses were determined based on body mass index percentiles from the 2017 Korean National Growth Chart. The associations between the NQ-P score and risk of overweight or obesity were examined using multivariable logistic regression. The associations of individual, maternal, physical, and media environmental factors with the NQ-P score were also examined using multivariable linear regression. @*RESULTS@#Preschool children with greater NQ-P scores were at a significantly lower risk of overweight or obesity (P < 0.01). The NQ-P score had a significantly positive association with maternal body mass index and an inverse association with household income (all P < 0.05). Maternal parenting and feeding practices exhibited associations with the NQ-P score.Positive associations were observed with “warm,” “structured,” and “autonomy-supportive” parenting as well as monitoring feeding practices (all P < 0.05). In addition, the NQ-P score had a significantly positive association with the childcare center’s anti-obesogenic environment, such as the provision of nutritional and physical-activity support and vicinity of the built food environment to the home, including access to good-quality food, fruits and vegetables, and low-fat foods (all P < 0.05). Regarding media environments, the NQ-P score demonstrated more significant associations with viewing and eating and/or cooking content displayed on online video platforms (all P < 0.05) than with that on television. @*CONCLUSIONS@#Our findings confirm the significance of healthy eating behaviors in earlychildhood-obesity prevention and underscore the importance of multilevel maternal, physical, and media environmental interventions that effectively guide eating behaviors in preschool children.

Protective Effect of Locally Injected Polydeoxyribonucleotide in Ischemic Murine Random Skin Flaps / 대한이비인후과학회지

Background and Objectives@#This study aimed to investigate the protective effect of polydeoxyribonucleotide (PDRN) against skin flap necrosis in a murine skin flap model.Materials and Method Twenty mice with rectangular skin flaps on the dorsum were randomly divided into the PDRN (n=10) and pentobarbital sodium (PBS) (n=10) injection groups. PDRN (8 mg/kg) was subdermally injected at 12 different points immediately after the operation. After 7 days, the flap perfusions were evaluated using a laser speckle contrast imaging (LSCI) system, and specimens were collected for immunohistochemistry analysis. @*Results@#The percentage of survival area relative to the total flap area was significantly higher in the PDRN group (60.87%±7.63%) than in the PBS group (45.23%±10.72%) (p<0.05). The mean LSCI perfusion signal of the distal part of the skin flap in the PBS group was 0.57±0.12, and that in the PDRN group was 0.74±0.13 (p<0.05). The PDRN group had a significantly lower interleukin 1 beta expression than the PBS group and higher vascular endothelial growth factor α expression than the PBS group (p<0.05). @*Conclusion@#These findings suggest that subdermally injected PDRN is more effective in enhancing flap survival during necrosis.

Serological responses and protection levels in chickens administered with Newcastle disease vaccines

Vaccination against Newcastle disease (ND) is the most effective means of controlling the disease, and these vaccines are commercialized only after their safety and effectiveness have been verified through tests that comply with Korean Standards of National Lot Release for Veterinary Biologics. This study investigated whether a relatively convenient and safe serological test can be used in place of the challenge test using highly virulent ND virus. Hemagglutination inhibition (HI) assay and enzyme-linked immunosorbent assay (ELISA) were considered positive of log2 2 or more and cutoff value of 200 or more, respectively, in both live and inactivated vaccines. However, when the antibody levels of the live and inactivated vaccines induced using the Ulster 2C, KBNP-C4152R2L, and K148/08 strains were compared, the antibody titers for inactivated vaccines were significantly higher than those for live vaccines in both the HI assay and ELISA. A strong positive correlation was observed between HI and ELISA antibody titers. The live vaccines corresponded to a survival rates of ≥ 80% and the inactivated vaccines corresponded to 100% survival rates. This study confirmed that standard efficacy tests can serve as serological tests, and can replace the challenge test and that the vaccine approval process can be improved.

Sensory change and recovery of infraorbital area after zygomaticomaxillary and orbital floor fractures

Background@#To compare the sensory change and recovery of infraorbital area associated with zygomaticomaxillary and orbital floor fractures and their recoveries and investigate the factors that affect them. @*Methods@#We retrospectively reviewed 652 patients diagnosed with zygomaticomaxillary (n= 430) or orbital floor (n= 222) fractures in a single center between January 2016 and January 2021. Patient data, including age, sex, medical history, injury mechanism, Knight and North classification (in zygomaticomaxillary fracture cases), injury indication for surgery (in orbital floor cases), combined injury, sensory change, and recovery period, were reviewed. The chi-square test was used for statistical analysis. @*Results@#Orbital floor fractures occurred more frequently in younger patients than zygomaticomaxillary fractures (p< 0.001). High-energy injuries were more likely to be associated with zygomaticomaxillary fractures (p< 0.001), whereas low-energy injuries were more likely to be associated with orbital floor fractures (p< 0.001). The sensory changes associated with orbital floor and zygomaticomaxillary fractures were not significantly different (p= 0.773). Sensory recovery was more rapid and better after orbital floor than after zygomaticomaxillary fractures; however, the difference was not significantly different. Additionally, the low-energy group showed a higher incidence of sensory changes than the high-energy group, but the difference was not statistically significant (p= 0.512). Permanent sensory changes were more frequent in the high-energy group, the difference was statistically significant (p= 0.043). @*Conclusion@#The study found no significant difference in the incidence of sensory changes associated with orbital floor and zygomaticomaxillary fractures. In case of orbital floor fractures and high-energy injuries, the risk of permanent sensory impairment should be considered.

Correction of a nasal soft triangle deficiency as a complication of augmentation rhinoplasty

The soft tissue triangle is an easily recognizable subunit of the nose. Therefore, deformities in this region resulting from trauma or complications after cosmetic surgery can have serious cosmetic impacts. Various reconstruction choices exist for deformities such as depression of the soft triangle but choosing the most appropriate treatment in each case remains a challenge. In the case described herein, a patient underwent augmentation rhinoplasty with a silastic implant and experienced implant exposure in the soft triangle area. After implant removal, the patient complained of depression in this area. The authors effectively solved this problem through a de-epithelialized composite tissue graft. In this report, we present this case and review similar cases of reconstruction of the soft triangle.

Correction of a nasal soft triangle deficiency as a complication of augmentation rhinoplasty

The soft tissue triangle is an easily recognizable subunit of the nose. Therefore, deformities in this region resulting from trauma or complications after cosmetic surgery can have serious cosmetic impacts. Various reconstruction choices exist for deformities such as depression of the soft triangle but choosing the most appropriate treatment in each case remains a challenge. In the case described herein, a patient underwent augmentation rhinoplasty with a silastic implant and experienced implant exposure in the soft triangle area. After implant removal, the patient complained of depression in this area. The authors effectively solved this problem through a de-epithelialized composite tissue graft. In this report, we present this case and review similar cases of reconstruction of the soft triangle.

Long-term follow-up of a severely traumatized leg treated with ipsilateral fracture-united fibular transfer in a patient with amputation of the contralateral leg: a case report

Extensive bone loss associated with severe vascular injury remains a challenge for lower extremity reconstruction. The fibular free flap has been utilized for many decades to reconstruct long-segment tibial defects. We present an unusual scenario of unilateral weight-bearing, wherein we salvaged the sole lower extremity by transfer of the fractured ipsilateral fibula and a bipedicled skin flap. A 38-year-old man sustained a severe crush injury in the right leg with loss of circulation. His left lower leg had a soft tissue defect measuring 20×15 cm with an exposed comminuted fracture and a 17-cm tibial defect, along with a segmental fracture of the fibula. Subsequently, we reconstructed the tibial defect by transferring a 17-cm-long section of the ipsilateral fibula. We covered the soft tissue defect with a bipedicled skin flap. The patient eventually began to ambulate independently after surgery.

Urethroplasty of extensive penile urethral strictures with a longitudinal ventral tubed flap of penile skin (modified Orandi urethroplasty): 20 years of follow-up of two cases

The surgical treatment of extensive urethral strictures remains a controversial topic; although techniques have evolved, there is still no definite method of choice. Since 1968, when Orandi presented an original technique for one-stage urethroplasty using a penile skin flap, the Orandi technique has become the most prevalently used one-stage procedure for anterior urethral strictures. We present a 20-year follow-up experience with one-stage reconstruction of long urethral strictures using a longitudinal ventral tubed flap of penile skin, with some important technical changes to Orandi’s original technique to overcome the deficient vascularity caused by periurethral scar tissue. In 1997, a 55-year-old male patient complained of severe voiding difficulty and a weak urinary stream because of transurethral resection of the prostate due to benign prostatic hyperplasia. Another 47-year-old male patient had the same problem due to self-removal of a Foley catheter in 2002. In both patients, a urethrogram demonstrated extensive strictures involving the long segment of the anterior urethra. A rectangular skin flap on the ventral surface of the penis was used considering the appropriate length, diameter, and depth of the neourethra. The modified Orandi flap provided a pedicled strip of penile skin measuring an average of 8 cm. The mean duration of follow-up was 20.5 years. A long-term evaluation revealed stable performance characteristics without any complications.

Effects of hyperbaric oxygen on graft survival outcomes in composite grafting for amputated fingertip injury

Background@#Fingertip injuries are the most common type of traumatic injury treated at emergency departments and require prompt and adequate interventions for favorable wound survival outcomes. Hyperbaric oxygen (HBO2) therapy is well known for its many positive effects on wound healing. We hypothesized that treatment with HBO2 would improve the graft survival outcomes of amputated fingertip injuries treated with composite grafts. @*Methods@#This retrospective observational study included fingertip amputations that were treated between January 2013 and December 2017. A conventional group and an HBO2 therapy group were statistically compared to evaluate the effect of HBO2 treatment. Graft survival was categorized as either success or failure. @*Results@#Among 55 cases (digits), 34 digits were conventionally treated, while 21 digits were treated with HBO2. No statistically significant differences were observed between the groups with regard to general characteristics. Among patients with guillotine-type injuries, the composite graft success rate was statistically significantly higher in the group that received HBO2 therapy than in the conventional group (P=0.0337). Overall, the HBO2 group also demonstrated a statistically significantly shorter healing time than the conventional group (P=0.0075). As such, HBO2 treatment facilitates composite graft survival in cases of fingertip injury. @*Conclusions@#HBO2 treatment was associated with an increased composite graft survival rate in guillotine-type fingertip injuries and reduced the time required for grafts to heal.

Ectopic pleomorphic adenoma on subcutaneous plane of the cheek

Pleomorphic adenoma is the most common benign tumor of the salivary gland. Pleomorphic adenoma occurs most commonly in the parotid gland but it may involve other salivary gland such as submandible or lingual. We report an ectopic pleomorphic adenoma in the subcutaneous layer of the face. A woman presented with a mass of the nasolabial fold. After excision of the mass, it was revealed as an pleomorphic adenoma pathologically. An ectopic pleomorphic adenoma which was located in the subcutaneous layer of the face is very rare in medical literature.

Fasciotomy in compartment syndrome from snakebite

BACKGROUND: Local symptoms and signs of snake envenomation mimic the clinical features of compartment syndrome. It is important to measure the intracompartmental pressure to diagnose compartment syndrome. In this study, we present our experiences of confirming compartment syndrome and performing fasciotomy in snakebite patients based on high intracompartmental pressure findings. METHODS: The medical records of patients who visited the trauma center of Wonju Severance Christian Hospital from January 2010 to December 2015 for the management of venomous snakebite were retrospectively reviewed. Starting in 2014, fasciotomy was performed in patients with an intracompartmental pressure of more than 40 mmHg in addition to the clinical symptoms of compartment syndrome. RESULTS: A total of 158 patients with snakebite came to the hospital within 48 hours for treatment. Most patients (110 patients) were bitten at the upper extremities (69.6%). Since 2014, 33 out of 59 patients were suspected to have compartment syndrome, and their intracompartmental pressures were measured. Seventeen of those patients had a high intracompartmental pressure (average, 49.6 mmHg; range, 37–88 mmHg), and fasciotomy was performed. CONCLUSIONS: In this study, as many as 10.8% of all cases were in need of fasciotomy when compartment syndrome was diagnosed by measuring the intracompartmental pressure. Previously, it was reported that fasciotomy was not required in many cases of compartment syndrome originating from snakebite. However, some patients may develop very severe compartment syndrome, requiring fasciotomy.

Epidemiologic study of hand and upper extremity injuries by power tools

BACKGROUND: Hand injuries caused by chain saws, electric saws, and hand grinders range from simple lacerations to tendon injuries, fractures, and even amputations. This study aimed to understand the distribution of various types of hand and upper extremity injuries caused by power tools, in order to help prevent them, by investigating the incidence and cause of power tool injuries treated over a 4-year period at a single institution in Korea. METHODS: We reviewed the medical records of patients who visited a single institution for power tool-induced injuries from 2011 to 2014. The distribution of sex, age, injured body part, type of injury, and mechanism of injury sustained by patients who received hand and upper extremity injuries from using an engine saw, electric saw, or hand grinder was evaluated. RESULTS: Among 594 subjects who were injured by power tools, 261 cases were hand and upper extremity injuries. The average age was 53.2 years. Tendon injury was the most common type of injury. An electric saw was the most common type of power tool used. More injuries occurred in non-occupational settings than in occupational settings. CONCLUSIONS: In this study, power tool-induced hand and upper extremity injuries were mostly caused by direct contact with electric saw blades. More injuries occurred due to non-occupational use of these tools, but the ratios of amputations and structural injuries were similar in the non-occupational and occupational groups.

Minimizing tissue damage due to filler injection with systemic hyperbaric oxygen therapy

Recently, there is a growing interest of hyperbaric oxygen therapy in many fields of medicine. We had a 43-year-old female patient presented with severe necrosis of the nose, philtrum, and upper lip due to retrograde arterial occlusion after nasolabial fold hyaluronic acid filler injection. Our patient went through 43 sessions of systemic hyperbaric oxygen therapy from December 2, 2017 to January 18, 2018. We administered 2.8 atmosphere absolute (ATA) for 135 minutes in the first session and the remaining sessions consisted of 2.0 ATA for 110 minutes. In reporting this case, we wish to provide a warning regarding the latent risk of filler injections and share our experience about minimizing soft tissue damage in the early stages with systemic hyperbaric oxygen therapy.

Trigeminal somatosensory evoked potential test as an evaluation tool for infraorbital nerve damage

BACKGROUND: Neurosensory changes are frequently observed in the patients with mid-face fractures, and these symptoms are often caused by infraorbital nerve (ION) damage. Although ION damage is a relatively common phenomenon, there are no established and objective methods to evaluate it. The aim of this study was to test whether trigeminal somatosensory evoked potential (TSEP) could be used as a prognostic predictor of ION damage and TSEP testing was an objective method to evaluate ION injury. METHODS: In this prospective TSEP study, 48 patients with unilateral mid-face fracture (only unilateral blow out fracture and unilateral zygomaticomaxillary fracture were included) and potential ION damages were enrolled. Both sides of the face were examined with TSEP and the non-traumatized side of the face was used as control. We calculated the latency difference between the affected and the unaffected sides. RESULTS: Twenty-four patients recovered within 3 months, and 21 patients took more than 3 months to recover. The average latency difference between the affected side and unaffected side was 1.4 and 4.1 ms for the group that recovered within 3 months and the group that recovered after 3 months, respectively. CONCLUSION: Patients who suffered ION damage showed prolonged latency when examined using the TSEP test. TSEP is an effective tool for evaluation of nerve injury and predicting the recovery of patients with ION damage.

Refinements of Adipofascial flap for Small Defects of Fingers and Toes: Indication and Surgical Tips

PURPOSE: Reconstruction of small defects of the dorsal fingers and toes is a challenging task. Although adipofascial flap is widely used for these areas, additional refinements are warranted. In this paper, we define the appropriate defect size in the finger and toes that can be treated with the adipofascial flap, refine its surgical indications and present a few surgical tips. MATERIALS AND METHODS: Twelve patients with dorsal defects of the fingers and toes were treated with a random-type adipofascial turn-over flap and skin graft. If the defect area exceeded the size that could be covered by a conventional design, the flap base was designed in oblique or curvilinear fashion to lengthen the flap. For accurate defect coverage, the width of the flap base was designed in an asymmetrical shape depending on the defect configuration, varying the width from 0.3 to 1.0 cm, as opposed to the standard 0.5 to 1.0 cm width. Moreover, the lateral limit of the flap was defined as the lateral axial line. The size of the defect ranged from 3.0×1.7 cm to 1.5×1.3 cm. RESULTS: All flaps survived completely. Gliding function of the hand was well preserved and there was no evidence of tendon adhesion. CONCLUSION: The small defect in the dorsal finger and toe can be defined as less than one phalanx-length, measuring about 3.0×2.0 cm in size. If the defect exceeds this dimension, it is recommended that a different option be considered. We believe the adipofascial flap is an excellent option for treating small defects.

Primary Cutaneous Mucinous Carcinoma Treated with Narrow Surgical Margin

Primary cutaneous mucinous carcinoma (PCMC) is a rare malignant tumor of eccrine origin. Clinically, the carcinoma presents as a solitary, slow growing, and painless nodule. For this reason, this tumor is often considered to be a benign mass in the preoperative setting. The lesion is, however, malignant in nature and has a tendency for local recurrence and infrequent metastasis. Wide local excision is the treatment of choice. However, few reports exist with information regarding surgical margins and clinical outcomes. Herein, we report a case of PCMC excised with a narrow surgical margin and review the relevant literature. A 49-year-old man presented with a small cutaneous nodule of the right cheek. The mass was excised without any margin, but pathologic examination revealed histology of mucinous carcinoma. Because of this, the operative site was re-excised with a 5-mm margin, and the wound was closed using a V-Y advancement flap. Systemic work-up did not reveal other potential metastatic primary, for a final diagnosis of PCMC. We report this case of PCMC, treated with relatively narrow margin in a patient with good prognostic factors.

Treatment of Leukocytospermia in Male Infertility: A Systematic Review

Male factors account for 20% to 50% of infertility cases, and infection in the genitourinary tract may play a contributing role in up to 15% of male infertility. Leukocytospermia is a well-known indicator of infection or inflammation in the male sex glands and the urogenital tract. Although great deal of effort has been expended to elucidate definite management strategies in infertile men with leukocytospermia, the gold standard of treatment remains unclear. Until recently, broad spectrum antibiotics and antioxidants have been used in the treatment of leukocytospermia for male infertility to eliminate infection and reduce reactive oxygen free radicals produced inside cellular mitochondria as a result of inflammation. The present review reveals that antibiotics might improve sperm parameters, the rate of resolution of leukocytospermia, the bacteriologic cure rate, and even the pregnancy rate, although some reports conflict. Antioxidants might also have clinical benefits for sperm function as shown by in vitro studies. However, the data are insufficient to conclude whether antibiotics and antioxidants for the treatment of infertile men with leukocytospermia are effective or not. Better designed investigations into leukocytospermia are needed.