The concept of personalized medicine for disease diagnosis, treatment, and management, considering individual variability, including susceptibility, clinical manifestations, and drug responsiveness, is a global emerging trend in medicine, which is also inevitable. However, clinical applications of personalized medicine in the real-world practice have been limited to certain cancers so far. Furthermore, this new concept to the diagnosis and treatment of adult asthma has not been applied to clinical use. Asthma is a multifactorial and heterogeneous disease. It seems to encompass a broad spectrum of clinical manifestations with different underlying pathophysiological mechanisms. Thus, it is not easy to categorize by their clinical features alone. Endotypical categorization that considering specific pathophysiological mechanisms will be more helpful in applying the concept of personalized medicine. The success of personalized medicine depends on patient selection for precise prescription of asthma medications. In the recent years, many investigators and physicians have devoted a lot of effort to the discovery of reliable biomarkers in asthmatic patients, which will be able to actualize the personalized medicine in near future. Despite such great efforts toward investigation of good biomarkers, few things have turned out to be practical in the clinic. Easily interpretable biomarkers of asthma are necessary to assess early detection, determination of treatment, prognosis prediction, and monitoring of exacerbation. Herein, we review recent studies regarding disease classifications and biomarkers of asthma.
Adult* ; Asthma* ; Biomarkers* ; Classification ; Diagnosis ; Humans ; Precision Medicine* ; Patient Selection ; Phenotype ; Prescriptions ; Prognosis ; Research Personnel

Spontaneous lateral sphenoid cephalocele (SLSC) is the herniation of intracranial contents through a bony defect in the lateral sphenoid, without predisposing factors. SLSC pathogenesis is associated with idiopathic intracranial hypertension (IIH); however, the relationship between IIH and SLSC is not fully understood due to the limited number of published case reports. Here, we report a unique case of SLSC in a 39-year-old female who presented with a combination of a lateral sphenoid cephalocele and multiple radiologic findings indicative of IIH, some of which have never been described in previously published case reports. This case highlights the possibility that chronically elevated intracranial pressure may be a determining factor in SLSC development.

Spontaneous lateral sphenoid cephalocele (SLSC) is the herniation of intracranial contents through a bony defect in the lateral sphenoid, without predisposing factors. SLSC pathogenesis is associated with idiopathic intracranial hypertension (IIH); however, the relationship between IIH and SLSC is not fully understood due to the limited number of published case reports. Here, we report a unique case of SLSC in a 39-year-old female who presented with a combination of a lateral sphenoid cephalocele and multiple radiologic findings indicative of IIH, some of which have never been described in previously published case reports. This case highlights the possibility that chronically elevated intracranial pressure may be a determining factor in SLSC development.

Spontaneous lateral sphenoid cephalocele (SLSC) is the herniation of intracranial contents through a bony defect in the lateral sphenoid, without predisposing factors. SLSC pathogenesis is associated with idiopathic intracranial hypertension (IIH); however, the relationship between IIH and SLSC is not fully understood due to the limited number of published case reports. Here, we report a unique case of SLSC in a 39-year-old female who presented with a combination of a lateral sphenoid cephalocele and multiple radiologic findings indicative of IIH, some of which have never been described in previously published case reports. This case highlights the possibility that chronically elevated intracranial pressure may be a determining factor in SLSC development.

We report a very rare case of unilateral blepharoptosis and swelling as an unusual complication of a filler injection. The patient received a filler injection into the forehead 4 years previously by an unlicensed practitioner. In the operation, an encapsulated yellowish cyst with inflammation was found to be adhered to the orbital septum and was excised. To prevent additional inferior migration of the remaining foreign body in the forehead, the retro-orbicularis fascia and preaponeurotic fat pad area were sutured, with the exception of the levator aponeurosis. This cyst-like mass was histopathologically proven to be a multiple pseudocyst. After excision, the swelling disappeared and the ptotic eyelid also improved. The galea is connected with the posterior orbicularis fascia. The galea and posterior orbicularis fascia layer can function as a pathway through which the injected material can migrate from the forehead to the upper eyelid. Weakening of the orbicularis retaining ligament and leakage of the foreign body through the supraorbital foramen may also cause filler migration. This case underscores the need for clinicians to be aware of the potential migration of filler even many years after an injection. We advise that filler injections should be performed by trained physicians and that it should be made known that migration is possible.
Adipose Tissue ; Blepharoptosis ; Dermal Fillers ; Eyelids* ; Fascia ; Forehead* ; Foreign Bodies ; Humans ; Inflammation ; Ligaments ; Orbit

We report a very rare case of unilateral blepharoptosis and swelling as an unusual complication of a filler injection. The patient received a filler injection into the forehead 4 years previously by an unlicensed practitioner. In the operation, an encapsulated yellowish cyst with inflammation was found to be adhered to the orbital septum and was excised. To prevent additional inferior migration of the remaining foreign body in the forehead, the retro-orbicularis fascia and preaponeurotic fat pad area were sutured, with the exception of the levator aponeurosis. This cyst-like mass was histopathologically proven to be a multiple pseudocyst. After excision, the swelling disappeared and the ptotic eyelid also improved. The galea is connected with the posterior orbicularis fascia. The galea and posterior orbicularis fascia layer can function as a pathway through which the injected material can migrate from the forehead to the upper eyelid. Weakening of the orbicularis retaining ligament and leakage of the foreign body through the supraorbital foramen may also cause filler migration. This case underscores the need for clinicians to be aware of the potential migration of filler even many years after an injection. We advise that filler injections should be performed by trained physicians and that it should be made known that migration is possible.
Adipose Tissue ; Blepharoptosis ; Dermal Fillers ; Eyelids* ; Fascia ; Forehead* ; Foreign Bodies ; Humans ; Inflammation ; Ligaments ; Orbit

Sebaceous neoplasms are rare adnexal tumors that can present a challenge to clinicians. Only four cases of sebaceous carcinoma with sebaceoma have been reported in the literature. Herein, we describe the case of a sebaceous carcinoma originating from a sebaceoma in a solitary nodule of the posterior neck. Immunohistochemically, the tumor cells were strongly positive for epithelial membrane antigen and p53. It is possible that adnexal carcinomas may arise from malignant transformation of their benign counterparts as well as de novo. Malignant transformation was likely in this case because the lesion was composed of distinct benign and malignant components, and the benign component showed the typical histopathological features of sebaceoma. This case underscores the fact that partial and superficial biopsies sometimes may not provide the correct diagnosis. If a surgeon suspects malignancy based on a clinical examination, then it is mandatory to perform a deep biopsy.

Sebaceous neoplasms are rare adnexal tumors that can present a challenge to clinicians. Only four cases of sebaceous carcinoma with sebaceoma have been reported in the literature. Herein, we describe the case of a sebaceous carcinoma originating from a sebaceoma in a solitary nodule of the posterior neck. Immunohistochemically, the tumor cells were strongly positive for epithelial membrane antigen and p53. It is possible that adnexal carcinomas may arise from malignant transformation of their benign counterparts as well as de novo. Malignant transformation was likely in this case because the lesion was composed of distinct benign and malignant components, and the benign component showed the typical histopathological features of sebaceoma. This case underscores the fact that partial and superficial biopsies sometimes may not provide the correct diagnosis. If a surgeon suspects malignancy based on a clinical examination, then it is mandatory to perform a deep biopsy.

BACKGROUND: The latissimus dorsi (LD) flap is widely used in breast cancer reconstruction, but donor-site morbidity is one of the major limitations of this surgery. Donor-site seroma is the most common complication. To prevent seroma formation, we consider the use of a fibrin sealant (FS) because of its hemostatic and sealing effects. In this study, we investigate the effect of a FS on seroma prevention and as a hemostatic agent at the LD donor site. METHODS: A retrospective study was conducted from 2011 to 2015. Herein, we analyzed the preoperative status, changes in the hemoglobin (Hb) level according to the postoperative day, postoperative drain amount, and the drain removal time. RESULTS: The decline in the Hb level was not statistically significantly less in the FS group than in the control group. Further, the difference in the drain amount between the 2 groups was not statistically significant either. The seroma rate and the drain removal time between the 2 groups also did not show any statistically significant difference. CONCLUSIONS: The FS does not have hemostatic effect and the drain amount reduction in the early phase of recovery and does not prevent seroma. Therefore, an empirical use of the FS alone is no longer recommended to prevent seroma. In contrast, the quilting suture has been reported to be effective in seroma prevention. Therefore, it is necessary to study the effects of a combination of quilting sutures and the FS on seroma and the other risk factors of this surgical complication.
Breast Neoplasms ; Breast* ; Female ; Fibrin Tissue Adhesive* ; Fibrin* ; Humans ; Mammaplasty* ; Retrospective Studies ; Risk Factors ; Seroma* ; Superficial Back Muscles* ; Sutures ; Tissue Donors

BACKGROUND: The latissimus dorsi (LD) flap is widely used in breast cancer reconstruction, but donor-site morbidity is one of the major limitations of this surgery. Donor-site seroma is the most common complication. To prevent seroma formation, we consider the use of a fibrin sealant (FS) because of its hemostatic and sealing effects. In this study, we investigate the effect of a FS on seroma prevention and as a hemostatic agent at the LD donor site. METHODS: A retrospective study was conducted from 2011 to 2015. Herein, we analyzed the preoperative status, changes in the hemoglobin (Hb) level according to the postoperative day, postoperative drain amount, and the drain removal time. RESULTS: The decline in the Hb level was not statistically significantly less in the FS group than in the control group. Further, the difference in the drain amount between the 2 groups was not statistically significant either. The seroma rate and the drain removal time between the 2 groups also did not show any statistically significant difference. CONCLUSIONS: The FS does not have hemostatic effect and the drain amount reduction in the early phase of recovery and does not prevent seroma. Therefore, an empirical use of the FS alone is no longer recommended to prevent seroma. In contrast, the quilting suture has been reported to be effective in seroma prevention. Therefore, it is necessary to study the effects of a combination of quilting sutures and the FS on seroma and the other risk factors of this surgical complication.
Breast Neoplasms ; Breast* ; Female ; Fibrin Tissue Adhesive* ; Fibrin* ; Humans ; Mammaplasty* ; Retrospective Studies ; Risk Factors ; Seroma* ; Superficial Back Muscles* ; Sutures ; Tissue Donors