Split-face comparison of the picosecond 1064-nm Nd:YAG laser using a microlens array and the quasi-long-pulsed 1064-nm Nd:YAG laser for treatment of photoaging facial wrinkles and pores in Asians.

Skin photoaging manifests deeper wrinkles and larger pore size. Various lasers have been tried for rejuvenation of photoaging skin, and the quasi-long-pulsed 1064-nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser is one promising treatment option. New types of laser device are emerging, including devices operating with picosecond pulse duration combined with a microlens array, which are regarded as a new breakthrough for skin rejuvenation. We aimed to evaluate the clinical effectiveness and safety of the picosecond 1064-nm Nd:YAG laser using a microlens array compared with the quasi-long-pulsed 1064-nm Nd:YAG laser in a split-face design. We designed a split-faced, prospective study and enrolled 25 subjects with photoaging facial wrinkles and enlarged pores. Each facial area was randomly assigned to undergo treatment with either the picosecond 1064-nm Nd:YAG laser (Pico-arm) or the quasi-long-pulsed 1064-nm Nd:YAG laser (Quasi-arm). We performed five laser sessions at 2-week intervals, and final results were assessed after 20 weeks after the initial laser session. We used a five-point global assessment scale, wrinkle and pore index derived from 3D camera analysis. We enrolled a total of 25 subjects (24 females and 1 male) with Fitzpatrick skin types III to IV and a mean age of 63.8 ± 5.7 years. After treatment, 54.2% of subjects in the Pico-arm reported at least moderate improvement in visible pores compared with 41.7% of the Quasi-arm (P = 0.001). A total of 12.5% of subjects in the Pico-arm showed moderate improvement in wrinkles versus 4.2% of the Quasi-arm (P = 0.125). There was a 41.3% reduction in the pore index in the Pico-arm compared to a 3.9% increase in the Quasi-arm (P = 0.048). There was a 16.4% reduction in the wrinkle index in the Pico-arm compared with a 0.5% reduction in the Quasi-arm (P = 0.01). Pain assessment score was higher in the Pico-arm than the Quasi-arm (3.65 ± 1.70 vs 1.28 ± 1.28, P = 0.001). No serious adverse events occurred during the study. Our findings suggest that the picosecond 1064-nm Nd:YAG laser with a microlens array is as effective as the quasi-long-pulsed 1064-nm Nd:YAG laser for treatment of photoaging wrinkles and pores.

Effect of Sulfide and Chloride Ions on Pitting Corrosion of Type 316 Austenitic Stainless Steel in Groundwater Conditions Using Response Surface Methodology.

This study investigates the corrosion resistance of Type 316 stainless steel as a candidate material for radioactive waste disposal canisters. The viability of stainless steel is examined under groundwater conditions with variations in pH, bisulfide ions (HS-), and chloride ions (Cl-) concentrations. Utilizing response surface methodology, correlations between corrosion factors and two crucial response variables, passive film breakdown potential and protection potential, are established. Cyclic potentiodynamic polarization tests and advanced analytical techniques provide detailed insights into the material's behavior. This research goes beyond, deriving an equation through response surface methodology that elucidates the relationship between the factors and breakdown potential. HS- weakens the passive film and reduces the pitting corrosion resistance of the stainless steel. However, this study highlights the inhibitory effect of HS- on pitting corrosion when Cl- concentrations are below 0.001 M and at equivalent concentrations of HS-. Under these conditions, immediate re-passivation occurs from the destroyed passive film to metal sulfides such as FeS2, MoS2, and MoS3. As a result, no hysteresis loop occurs in the cyclic polarization curve in these conditions. This research contributes to the understanding of Type 316 stainless-steel corrosion behavior, offering implications for the disposal of radioactive waste in geological repositories.

Localized Corrosion Occurrence in Low-Carbon Steel Pipe Caused by Microstructural Inhomogeneity.

In this study, the cause of failure of a low-carbon steel pipe meeting standard KS D 3562 (ASTM A135), in a district heating system was investigated. After 6 years of operation, the pipe failed prematurely due to pitting corrosion, which occurred both inside and outside of the pipe. Pitting corrosion occurred more prominently outside the pipe than inside, where water quality is controlled. The analysis indicated that the pipe failure occurred due to aluminum inclusions and the presence of a pearlite inhomogeneous phase fraction. Crevice corrosion occurred in the vicinity around the aluminum inclusions, causing localized corrosion. In the large pearlite fraction region, cementite in the pearlite acted as a cathode to promote dissolution of surrounding ferrite. Therefore, in the groundwater environment outside of the pipe, localized corrosion occurred due to crevice corrosion by aluminum inclusions, and localized corrosion was accelerated by the large fraction of pearlite around the aluminum inclusions, leading to pipe failure.

Natural history and progression factors of unilateral moyamoya disease in pediatric patients.

PURPOSE: Thirty-four pediatric age patients with unilateral moyamoya disease (MMD) were reviewed to analyze the natural history and the predictive factors for progression to bilateral MMD. METHODS: Forty out of 259 MMD patients cared for between January 2000 and June 2008 in the Severance Hospital had unilateral lesion. These patients were followed for a mean of 32.3 months for their symptoms and imaging studies. Thirty-four out of 40 patients were included in this study. Magnetic resonance angiography (MRA) and magnetic resonance perfusion (MR perfusion) images were taken for all patients for initial diagnosis and repeated at 6 months from the initial diagnosis and then at yearly basis. Clinical manifestations, the results of imaging studies, outcome of the indirect revascularization procedure, and the progression of the lesion were reviewed in this study. RESULTS: Of these 34 patients, contralateral progression was identified in 20 patients (58.8%). Fourteen (70%) out of the 20 patients presented with anterior cerebral artery abnormalities at diagnosis progressed to bilateral disease as well as did 5 (83%) out of 6 patients with middle cerebral artery lesions at the initial examination. Among the 34 patients, six exhibited familial history of MMD and all of them progressed to bilateral disease (100%, p < 0.005). CONCLUSION: Careful and long-term follow-up would be essential to evaluate the hemodynamic status and progression to bilateral disease in unilateral MMD patients to make prompt decision for a surgical revascularization.

Age-specific eNOS polymorphisms in moyamoya disease.

OBJECTIVE: We conducted a case-control study to investigate whether polymorphisms in eNOS are related to the age-specific onset of moyamoya disease. MATERIALS AND METHODS: Ninety-three Korean patients [mean age, 23.0 ± 16.1 years; 59 female (63.4%) and 34 male (36.6%)] with moyamoya disease were consecutively recruited for this study. Three hundred twenty-eight healthy subjects [mean age, 27.7 ± 16.2 years; 217 female (66.2%), 111 male (33.8%)] were consecutively included in the control group. The subjects were divided into pediatric (< 20 years) and adult (≥ 20 years) groups. We further divided the moyamoya group into ischemic and hemorrhagic groups based on clinical and MRI findings. The frequencies and distributions of four eNOS polymorphisms (eNOS -922A>G, -786T>C, 4a4b, and 894G>T) were assessed in pediatric and adult patients with moyamoya disease and compared to the frequencies and distribution in the control group. RESULTS: No differences in eNOS polymorphisms were observed between control and moyamoya disease group. However, we found that the 4a4b sequences was less frequent in the adult group (p = 0.029). Compared to the control group, there were differences in the haplotype distribution of the study group, specifically the A-4b-G haplotype, which was seen more frequently in the adult patient group. CONCLUSION: Our results suggest that pediatric and adult-onset moyamoya disease have different genetic backgrounds. These genetic differences can affect age-specific clinical characteristics, such as cerebral ischemia and hemorrhage.

Ventriculoperitoneal Shunt without Hair Shaving Using Absorbable Suture Materials.

OBJECTIVE: Infection is one of most devastating complications in ventriculoperitoneal (VP) shunt surgery. Preoperative hair removal has traditionally been performed to reduce infectious complications. We performed VP shunt surgeries and evaluated the prevalence of infection in patients who were shaved and those who were unshaven. METHODS: A retrospective analysis was conducted of 82 patients with hydrocephalus of various pathologies who underwent VP shunt surgery, with or without having the head shaved, between March 2010 and March 2017. For patients in the non-shaved group (n=36), absorbable suture materials were used for wound closure, and Nylon sutures or staples were used in the shaved group (n=46). We evaluated the infection outcomes of patients in the two groups. RESULTS: There was no difference in the average age of patients in the two groups. In the non-shaved group, there were no infections, while two patients in the shaved group required revision because of shunt infection. CONCLUSION: Non-shaved shunt surgery may be safe and effective, with no increase of infection rate. We recommend that shunt procedures could be performed without shaving the hair, which may increase patients' satisfaction without increasing infection risk.

Is delayed gastric emptying associated with pylorus ring preservation in patients undergoing pancreaticoduodenectomy?

BACKGROUND/OBJECTIVE: A high incidence of delayed gastric emptying (DGE) is observed in patients undergoing pylorus-preserving pancreaticoduodenectomy (PpPD). However, DGE incidence after pancreaticoduodenectomy varied because of heterogeneity in surgical techniques, number of surgeons, and DGE definition. This study aimed to evaluate the difference in the incidence of DGE following PpPD and pylorus-resecting pancreaticoduodenectomy (PrPD) and to analyze the risk factor of DGE by a single surgeon to determine whether pylorus preservation was the main factor of DGE. METHODS: This retrospective study included 115 patients who underwent PpPD (with pylorus ring preservation) and PrPD (without pylorus ring preservation) with laparotomy by a single surgeon at a tertiary center. RESULTS: The overall incidence of DGE was 23.1%. For comparison, 20 patients (39.2%) in the PpPD group and 5 patients (8.8%) in the PrPD group had DGE, showing a significant difference (p < 0.001). On univariate analysis, hypertension, PpPD, operation time, intraoperative bleeding, packed red blood cell transfusion ≥500 mL, and clinically relevant postoperative pancreatic fistula were associated with DGE. Multivariate analysis identified pylorus preservation and clinically relevant postoperative pancreatic fistula as risk factors for DGE. CONCLUSION: Compared with PpPD, PrPD significantly reduced the incidence of DGE.

Effect of Benzotriazole on the Localized Corrosion of Copper Covered with Carbonaceous Residue.

Carbonaceous residues on copper pipes during the manufacturing process are known to be one of the main causes of pitting corrosion on copper pipes. This study examined the corrosion-inhibiting effect of benzotriazole (BTA) on C12200 copper pipes with carbonaceous film in synthetic tap water. In the absence of BTA, localized corrosion mechanisms due to galvanic corrosion, crevice corrosion, and oxygen-concentration cell were proposed in the boundary part of the carbonaceous film on the copper through X-ray photoelectron spectroscopy (XPS), scanning electron microscopy (SEM) with energy dispersive spectrometer (EDS) analyses. Electrochemical tests showed that BTA inhibits corrosion by forming Cu-BTA complexes on all over the copper surface where carbonaceous film is present. BTA mitigates galvanic corrosion and crevice corrosion at the boundary of the carbonaceous film and suppresses the formation of oxygen-concentration cells through the formation of a Cu-BTA complex.

A comparative study of postoperative outcomes after stapled versus handsewn gastrojejunal anastomosis for pylorus-resecting pancreaticoduodenectomy.

BACKGROUNDS/AIMS: A stapler is widely used in various surgeries, and there have been recent attempts to use it for performing duodenojejunostomy and gastrojejunostomy during pancreaticoduodenectomy. This study aimed to compare the postoperative results of handsewn gastrojejunostomy (HGJ) and stapled gastrojejunstomy (SGJ) limited to pylorus-resecting pancreaticoduodenectomy (PrPD) performed by a single surgeon. METHODS: This retrospective study was conducted between January 2014 and March 2020, and included 131 patients who underwent PrPD performed by a single surgeon. Of the total subjects, 90 were in the HGJ group and 41 in the SGJ group. RESULTS: The mean time of surgery was significantly shorter in the stapled group than in the handsewn group (450.4±75.4 min vs. 397.1±66.5 min, p<0.001). However, there were no significant differences between the groups in the rates of postoperative pancreatic fistula, bile leak, chyle leak, intra-abdominal fluid collection, postoperative bleeding, ileus, Clavien-Dindo, rate of reoperation, and 30-day mortality, including delayed gastric emptying (DGE) (n=11 vs. n=6, p=0.92). CONCLUSIONS: Gastrojejunostomy using a stapler in PrPD reduces the reconstruction time without any increase in the rate of complications, including DGE. Therefore, using a stapler for gastrojejunostomy in pancreaticoduodenectomy is feasible and safe.

Treatment of idiopathic onychodystrophy with a 1064 nm picosecond neodymium-doped:yttrium aluminum garnet laser: A retrospective study.

BACKGROUND: Laser treatment has emerged as a novel treatment modality for onychodystrophy. Only a few small series have assessed the efficacy of laser treatment in onychodystrophy, most of which were case reports. The therapeutic effect of the 1064 nm neodymium-doped:yttrium aluminum garnet (Nd:YAG) laser for onychodystrophy has been demonstrated. Recently, the picosecond Nd:YAG (PSNY) laser has been introduced to improve various skin disorders. AIMS: The aim of this study was to verify the efficacy of a 1064 nm PSNY in management of idiopathic onychodystrophy. METHODS: We present a case series of dystrophic nails treated with a PSNY for onychodystrophy improvement. Planimetry using ImageJ software was used to calculate lesion reduction and proximal clear nail growth. Clinical improvement was assessed using a 5-point Global Assessment Scale (GAS). Adverse events were also assessed. RESULTS: Twenty-five patients (11 males and 14 females) with a total of 128 nails (94 finger nails and 34 toe nails) were treated. The mean treatment number was 8.7 ± 6.2, and the mean total duration of treatment was 33.4 ± 34.6 weeks. The average proportion of the lesion area decreased significantly (from 65.9% to 46.6%) after PSNY treatment (P < .001). The mean GAS (3.16 ± 1.18) exhibited fair improvement, and there were no serious adverse events. CONCLUSION: The 1064 nm PSNY laser can provide fair improvement for onychodystrophy with a good prognosis at least during the follow-up period and optimal cosmetic results in Asian patients.

Gallbladder paraganglioma with hemorrhage: A case report and literature review.

Gallbladder paraganglioma (GP) is a rare tumor, with only 12 cases reported in the literature to date. Due to its rarity, clinical information of GP is insufficient. We present a case of GP in a 48-year-old female along with a literature review of all GP cases described to date. A 48-year-old female presented with intermittent right upper abdominal pain. Preoperative imaging revealed a hematoma in the gallbladder lumen without any definite etiology. Laparoscopic cholecystectomy was performed. Gross examination of the gallbladder revealed multiple small stones and a large hematoma as well as a 1.6-cm-sized polypoid mass at the gallbladder fundus. Microscopic study of the polypoid mass showed a zellballen appearance. Immunohistochemical analysis revealed that the mass was positive for synaptophysin, CD56, and chromogranin, suggesting GP. GP is difficult to diagnose because of non-specific clinical findings. Almost all GP cases are diagnosed based on histologic findings after cholecystectomy. Simple cholecystectomy was performed as a treatment in all reported cases of GP, including our case. There was no postoperative tumor recurrence or metastasis after surgery.

Delays in Intracerebral Hemorrhage Management Is Associated with Hematoma Expansion and Worse Outcomes: Changes in COVID-19 Era.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic disrupted the emergency medical care system worldwide. We analyzed the changes in the management of intracerebral hemorrhage (ICH) and compared the pre-COVID-19 and COVID-19 eras. MATERIALS AND METHODS: From March to October of the COVID-19 era (2020), 83 consecutive patients with ICH were admitted to four comprehensive stroke centers. We retrospectively reviewed the data of patients and compared the treatment workflow metrics, treatment modalities, and clinical outcomes with the patients admitted during the same period of pre-COVID-19 era (2017-2019). RESULTS: Three hundred thirty-eight patients (83 in COVID-19 era and 255 in pre-COVID-19 era) were included in this study. Symptom onset/detection-to-door time [COVID-19; 56.0 min (34.0-106.0), pre-COVID-19; 40.0 min (27.0-98.0), p=0.016] and median door to-intensive treatment time differed between the two groups [COVID-19; 349.0 min (177.0-560.0), pre-COVID-19; 184.0 min (134.0-271.0), p<0.001]. Hematoma expansion was detected more significantly in the COVID-19 era (39.8% vs. 22.1%, p=0.002). At 3-month follow-up, clinical outcomes of patients were worse in the COVID-19 era (Good modified Rankin Scale; 33.7% in COVID19, 46.7% in pre-COVID-19, p=0.039). CONCLUSION: During the COVID-19 era, delays in management of ICH was associated with hematoma expansion and worse outcomes.

What should we do with a discontinued shunt?

PURPOSE: The reported rate is up to 10% of shunt disconnection or fracture, either ventriculoperitoneal or subduroperitoneal. However, not all of shunt discontinuity is associated with shunt malfunction. We analyzed the discontinuity of the shunt system and related factors and tried to present a follow-up policy. METHODS: This is a retrospective study involving 22 patients who presented with shunt disconnection because of malfunction or other reasons between January 2003 and October 2008. To evaluate shunt function, we performed a shuntogram, temporary ligation, or intraoperative exploration. RESULTS: Nine (40.9%) of 22 patients had nonfunctioning shunts. The shunt system was removed in eight cases, and one patient refused surgical management. Of these 22 patients with disconnected shunts, 17 shunts placed in the occipital area were discontinued. The discontinuations were mostly fractured at neck (52%), not disconnected at connection site. CONCLUSION: Shunt disconnection has not been always represented a shunt malfunction. We thought many patients with disconnected shunt may be independent from shunt system, and it can be a good chance for patient to remove the shunt system.

The effect of concurrent elevation in CO2 and temperature on the growth, photosynthesis, and yield of potato crops.

Global climate change accompanied by continuous increases in atmospheric carbon dioxide (CO2) concentration and temperature affects the growth and yield of important crops. The present study investigated the effect of elevated temperature and CO2 concentrations on the growth, yield, and photosynthesis of potato (Solanum tuberosum L. cv. Superior) crops using Korean Soil-Plant-Atmosphere-Research chambers that allow the regulation of temperature and CO2 concentration under daylight conditions. Based on the average temperature from 1991 to 2010 in the Jeonju area, South Korea, potato plants were exposed to four different conditions: ambient weather (400 µmol mol-1, aCaT), elevated temperature (+4°C, aCeT), elevated CO2 concentration (800 µmol mol-1, eCaT), and concurrently elevated CO2 concentration and temperature (eCeT). Under aCeT conditions, the temperature exceeded the optimal growth temperature range towards the late growth phase that decreased stomatal conductance and canopy net photosynthetic rate and subsequently reduced biomass and tuber yield. Stomatal conductance and chlorophyll concentration were lower under eCaT conditions than under aCaT conditions, whereas late-growth phase biomass and tuber yield were greater. Compared to other conditions, eCeT yielded a distinct increase in growth and development and canopy net photosynthetic rate during tuber initiation and bulking. Consequently, biomass and canopy net photosynthesis increased, and tuber yield increased by 20.3%, which could be attributed to the increased tuber size, rather than increased tuber number. Elevated CO2 reduced chlorophyll, magnesium, and phosphorus concentrations; reducing nitrogen concentration (by approximately 39.7%) increased the C:N ratio. The data indicate that future climate conditions will likely change nutrient concentration and quality of crops. The present study shows that while elevated temperature may negatively influence the growth and yield of potato crops, especially towards the late-growth phase, the concurrent and appropriate elevation of CO2 and temperature could promote balanced development of source and sink organs and positively effect potato productivity and quality.

Effects of Cryoprotective Medium Composition, Dilution Ratio, and Freezing Rates on Spotted Halibut (Verasper variegatus) Sperm Cryopreservation.

The spotted halibut is species that has a high potential market value in Korea, but the supply of seed is unstable because of the limited milt production of males. The objective of this research was to explore different aspects, such as CPAs, diluents, dilution ratio, and freezing rates, to develop an optimal sperm cryopreservation. The parameters assessed were movable sperm ratio, sperm activity index, survival rate, and DNA damage. The CPAs tested in this research were propylene glycol, dimethyl sulfoxide (DMSO), methanol, ethylene glycol, and glycerol. Different diluents, including 300 mM sucrose, 300 mM glucose, Stain's solution, and Ringer's solution, were investigated. The previous experiment showed that the optimal CPA for cryopreservation was DMSO with a concentration of 15% with 300 mM as diluent. To determine the effect of the dilution ratio, sperm was diluted to 1:1, 1:2, 1:10, 1:100, and 1:1000 with 300 mM sucrose containing DMSO at a final concentration of 15%. Lastly, the optimal freezing rate of the sperm was evaluated with four different freezing rates (-1, -5, -10, and -20 °C/min). Post-thaw sperm motility was higher with a dilution ratio lower than 1:2, and the freezing rate was less than -5 °C/min. In conclusion, these findings represent the development of a cryopreservation protocol for spotted halibut.

Auricular keloid management in Asian skin: Clinical outcome of intralesional excision and postoperative triamcinolone acetonide intralesional injection.

BACKGROUND: Various options such as surgical excision, steroid injection, cryotherapy, pressure dressing, and radiation therapy are available for the treatment of auricular keloids. In particular, auricular keloid therapy using surgical excision is important because recurrence rates are low compared with keloids occurring in other parts of the body. AIMS: We aimed to evaluate the clinical outcomes of intralesional excision followed by postoperative triamcinolone acetonide intralesional injection (TA ILI) as auricular keloid treatments. METHODS: We conducted a surgery records and chart review of patients who underwent auricular keloid treatment with intralesional excision and TA ILI. Reduction in height and volume was assessed by two blinded dermatologists. We also analyzed the recurrence rate over a 2-year period and evaluated patient satisfaction using an 11-point questionnaire (0-10). RESULTS: Eighteen Korean patients (2 males and 16 females) with a mean age of 26.5 years and a total of 20 lesions were evaluated. Lesion types by descending frequency were lobular (n = 10, 50%), anterior/posterior button (n = 3, 15%), wrap-around (n = 3, 15%), dumbbell (n = 2, 10%), and sessile (n = 2, 10%). The total recurrence rate was 5% (1/20) within the 24-month follow-up period. Significant reduction (> 50%) in height and volume was achieved in 95% of patients. No serious or persistent adverse events were reported during the follow-up period. CONCLUSION: We confirmed that TA ILI after intralesional excision can be effective for auricular keloid management. A low recurrence rate similar to that of postoperative radiation therapy was obtained with an effective surgical procedure and minimal postoperative treatment.

Rapidly regrowing lipoma in lipomeningomyelocele: a case report.

INTRODUCTION: Although it is widely accepted that lipomas in lipomeningomyelocele (LMMC) are anatomically stable lesions, we present a case of rapidly growing intradural lipoma accompanied by neurological deterioration. An 8-year-old girl with rapidly regrowing LMMC was admitted to our neurosurgical clinic. She was delivered by cesarean section, and at 47 days old, she underwent detethering surgery because of aggravating weakness. We performed her detethering operation immediately rather than at 3 months as had been previously scheduled because of the rapidly growing lipoma. The second operation was performed at age 8 years because of a regrowing intradural lipoma and aggravating leg deformity. Even if LMMC is expected to be surgically corrected at 2 or 3 months after birth, lipomas could grow rapidly beyond expectation. DISCUSSION: Close monitoring and follow-up before and after surgery is needed for optimum surgical timing, in order to avoid deteriorating neurological symptoms. The possibility of the rapid growth of intradural lipomas offers additional support for early prophylactic surgery in patients with LMMC. CONCLUSION: The potential for rapid growth of spinal lipomas should be considered during first few months of life or even long after surgery. Early diagnosis and optimal surgery are still essential for the treatment of patients with LMMC since there is a high likelihood that residual neurological functions can be preserved.

Treatment and outcomes of primary intracranial teratoma.

PURPOSE: Until recently, postoperative adjuvant treatment for intracranial teratomas has remained controversial because of the rarity of the tumors and the heterogeneity of histologic types. To define optimal therapy modalities, we retrospectively analyzed the treatment of patients with intracranial teratomas. METHODS: Between 1979 and 2007, 31 patients with intracranial teratomas were treated at our institution. The median age of the 31 patients was 14.8 years. The median follow-up time was 72.7 months (range 11 approximately 291 months). Perioperative radiochemotherapy was done in 19 patients. Proper chemotherapy regimens were followed, such as PE (cisplatin and VP-16), PVB (cisplatin, VP-16, and bleomycin), ICE (carboplatin, VP-16, and ifosfamide), and NGGCT (etoposide, carboplatin, bleomycin, and cyclophosphamide with mesna). RESULTS: Eight patients experienced recurrence, and a second operation was carried out in six patients. Fifteen patients survived for more than 5 years without recurrence, irrespective of having received adjuvant therapies. The 5-year survival rate of the 31 patients was 74%. CONCLUSION: Treatment of intracranial teratomas is very difficult because of the heterogeneity of the tumor cells from totipotent origins. Accurate histological diagnosis of teratoma subtypes is the most important factor for adequate treatment, and proper therapeutic protocols are needed to cure teratomas.

Insular epilepsy surgery under neuronavigation guidance using depth electrode.

OBJECTIVES: The unfavorable surgical results that have been reported with insular epilepsy surgery may be related to inadequate monitoring. Insular epilepsy surgery requires the precise monitoring and tailored removal of the epileptic zone. The purposes of this study were to precisely monitor the hidden cortex and determine the effectiveness of using different monitoring methods, including subpial depth electrodes. MATERIALS AND METHODS: This is a study of a single center series of six patients (three men, three women) who underwent insular surgery between May 2006 and December 2007. All patients had experienced medically intractable seizures without any evidence of a tumorous condition based on previous examination. We used strip electrode implantation in one patient and stereotactic depth electrode insertion in two patients, which resulted in partial removal of the insular. The other three patients underwent open direct subpial depth electrode insertion, which resulted in total removal of the insular cortex. RESULTS: There were no surgery-related complications with the insulectomy after insertion of the subpial depth electrodes, regardless of the monitoring method or extent of removal. All patients except for one showed considerable improvement in epilepsy (83.3% Engle class I, 16.5% Engle class II). In the three patients who had open direct subpial depth electrodes inserted, we achieved total insulectomy without increasing the surgical morbidity, while in the other three patients, the insular removal was only partial. CONCLUSION: We demonstrate that image-guided insular surgery with safe and accurate depth electrode guidance results in an optimal outcome and complete resection of the insular cortex.

Squamoid eccrine ductal carcinoma of the ear helix.

Chronic cutaneous ulcer on the ear helix of 80-year-old male was diagnosed with squamoid eccrine ductal carcinoma (SEDC). SEDC is characterized by both atypical squamous and ductal differentiation. SEDC frequently appears on sun-exposed areas. It could show local recurrence despite complete resection. These characteristics demand cautious attention to SEDC.