Solitary fibrous tumor (SFT) is an uncommon tumor that typically originates in the pleural cavity but may also be found in extra-pleura sites like the head and neck, spine, lungs, mediastinum, peritoneum, and pelvis. There are few reports of SFT of the scalp, and malignant SFT of the scalp appears to be so rare that only two cases of it were reported previously. A 47-year-old woman was admitted to our institution with a large, rapidly growing mass on the left parietal scalp. An analysis of her scalp condition and imaging findings of the mass revealed two different appearances between the superior and inferior halves; the scalp of the inferior half looked normal, but that of the superior half did not. Also, computed tomography findings of the mass confirmed different patterns between the superior and inferior halves. The mass with the abnormal superior half scalp was removed totally. The pathological diagnosis was malignant SFT, but the inferior mass was revealed to have a benign nature. The patient underwent prophylactic radiotherapy and experienced no local recurrence or distant metastasis at the final follow-up at 12 months. We present a third case of malignant SFT originating on the scalp and describe our clinical and surgical experience managing malignant SFT of the scalp.

Objective: : A chronic subdural hematoma (CSDH) is a collection of bloody fluid located in the subdural space and encapsulated by neo-membranes. An inner subdural hygroma (ISH) is observed between the inner membrane of a CSDH and the brain surface. We present six cases of CSDH combined with ISH treated via endoscopy. Methods: : Between 2011 and 2022, among the 107 patients diagnosed with CSDH in our institute, six patients were identified as presenting with CSDH combined with ISH and were included in this study. Preoperative computerized tomography (CT) and magnetic resonance imaging (MRI) were performed simultaneously, and endoscopic surgery for aspiration of the hematoma was performed in all cases of CSDH combined with ISH. Results: : The mean age of patients was 71 years (range, 66 to 79). The patients were all male. In two cases, the ISH was not identified on CT, but was clearly seen on MRI in all patients. The inner membrane of the CSDH was tense and bulging after draining of the CSDH in endoscopic view due to the high pressure of the ISH. After fenestration of the inner membrane of the CSDH and aspiration of the ISH, the membrane was sunken down due to the decreasing pressure of the ISH. There was one recurrence in post-operative 2-month follow up. The symptoms improved in all patients after surgery, and there were no surgery-related complications. Conclusion : CSDH combined with ISH can be diagnosed on imaging, and endoscopic surgery facilitates safe and effective treatment.

PURPOSE: Although a fasciocutaneous perforator artery as a vascular pedicle has previously been shown to be predominant in the anterolateral thigh (ALT) flap, recent studies have shown that a myocutaneous perforator artery is predominant. We have attempted to attain a clinical understanding of the vascular variations in the ALT flap. MATERIALS AND METHODS: We confirmed the origin of a perforator artery in 11 cases of ALT flap. We then reviewed the variations of the descending branch of the lateral femoral circumflex artery, known as the major origin of the flap, and the overall variations associated with an ALT flap. RESULTS: In a total of 11 cases, there were 18 perforator arteries of the ALT flaps. In addition, there were 9 fasciocutaneous perforator arteries and another 9 myocutaneous ones. However, depending on the origin, there was great variability in the perforator artery. That is, there were unique variants in the descending branches of the lateral femoral circumflex artery, the major origin of the perforator artery, in 3 of the total 11 cases. CONCLUSION: Our results showed that (1) a perforator artery accounts for the high proportion of fasciocutaneous ones, (2) a perforator artery might not originate from the descending branch of the lateral femoral circumflex artery and (3) there might be unique variants in the descending branch. If considering this, surgeons would successfully elevate an ALT flap.
Arteries ; Perforator Flap ; Thigh

OBJECTIVE: The purpose of this study is to identify the risk factors associated with the development of germinal matrix-intraventricular hemorrhage (GM-IVH) and the relationship of the severity of disease and prematurity. METHODS: A total of 168 premature neonates whose birth weight < or =1500 g or gestational age < or =34 weeks were examined by cranial ultrasound (CUS) for detection of GM-IVH among the babies admitted between January 2011 and December 2012 in our medical center neonatal intensive care unit. The babies were divided into two groups : GM-IVH and non-IVH. Clinical presentations, precipitating factors of the patients and maternal factors were analyzed. RESULTS: In univariate analysis, gestational age, birth weight, delivery method, presence of premature rupture of membrane (PROM) and level of sodium and glucose were statistically meaningful factors (p<0.05). But only two factors, gestational age and presence of patent ductus arteriosus (PDA) were statistically meaningful in multivariate logistic regression (p<0.05). Delivery method [normal vaginal delivery (NVD) to Caeserean section] was borderline significant (p<0.10). CONCLUSION: Presence of PDA and gestational age were the important risk factors associated with development of GM-IVH.
Birth Weight ; Ductus Arteriosus, Patent ; Gestational Age ; Glucose ; Hemorrhage* ; Humans ; Infant, Newborn* ; Intensive Care, Neonatal ; Logistic Models ; Membranes ; Precipitating Factors ; Risk Factors* ; Rupture ; Sodium ; Ultrasonography

BACKGROUND: The authors analyzed whether the promoter hypermethylation of cancer-related genes was involved in the tumorigenesis of malignant gliomas. METHODS: A total of 29 patients received surgery and histologically confirmed to have malignant gliomas from January 2000 to December 2006. The promoter methylation status of several genes, which were reported to be frequently methylated in malignant gliomas, was investigated using methylation-specific polymerase chain reaction. RESULTS: All cases of malignant gliomas represented the promoter hypermethylation in at least 2 or more genes tested. Of 29 tumors, 28 (96.55%) showed concurrent hypermethylation of 3 or more genes. Ras association domain family member 1, epithelial cadherin, O-6 methyl guanine DNA methyltransferase, thrombospondin 1, p14 and adenomatous polyposis coli were frequently methylated in high grade gliomas including glioblastomas, anaplastic astrocytomas, and anaplastic oligodendrogliomas. CONCLUSION: Aberrant hypermethylation profile was closely related with malignant gliomas suggesting that epigenetic change may play a role in the development of malignant gliomas. Two or three target genes may provide useful clues to the development of the useful prognostic as well as diagnostic assays for malignant gliomas.
Adenomatous Polyposis Coli ; Astrocytoma ; Brain Neoplasms ; Carcinogenesis ; CpG Islands* ; DNA ; Epigenomics ; Glioblastoma ; Glioma* ; Guanine ; Humans ; Methylation ; Oligodendroglioma ; Polymerase Chain Reaction ; Thrombospondin 1

Total scalp avulsion is rare but a devastating injury. This condition burdens the patient with disfigured cosmetic appearance and permanent psychosocial trauma. Throughout history, this condition has been favored in women working with mechanics since the long hair function as a vector appliance for oblique pull of the hair into a stationary torque. We present our experience of the replantation of the total avulsed scalp in male, first to be reported in Korea. Warm ischemic time was exceeding 16 hours along with severe crushed condition of the detached margin, a relatively satisfactory result was obtained.
Cosmetics ; Female ; Hair ; Humans ; Korea ; Male ; Mechanics ; Replantation ; Scalp ; Torque ; Warm Ischemia

PURPOSE: Although lipoma is known as one of the most common soft tissue tumors, calcification in lipoma is very rare in its occurrence. This calcified lipoma has been reported by some as a result of regression of lipoma, but its genesis is not clearly known yet with various opinions being discussed regarding its possible metabolic relation to hypercalcemia or hyperphosphatemia to be considered as a regression phase of lipoma. The authors would like to present this unusual case of calcified lipoma. METHODS: A 50-year-old male patient visited our hospital with complaint of an enlarging mass on his right forehead which has been acknowledged for 5 years' period. On physical examination, a mass was observed on his forehead as palpable, non-tender, mobile and firm in its consistency. Ultra sonogram examination revealed a well-demarcated mass (1.92 cm) with central echoic zone at deep layer of forehead. Mass excision and biopsy were performed subsequently. RESULTS: According to the pathological report, the diagnosis confirmed the lipoma consisting of grown-up adipocyte and calcification. Neither growing lipoma nor relapse was observed for postoperative three years' follow-up of the patient. CONCLUSION: Now that the calcified lipoma was successfully removed and cured by a simple mass excision, authors hereby report the case of calcified lipoma on forehead.
Adipocytes ; Biopsy ; Follow-Up Studies ; Forehead ; Humans ; Hypercalcemia ; Hyperphosphatemia ; Lipoma ; Male ; Middle Aged ; Physical Examination ; Recurrence

We report a 71-year-old male presenting with painful growing mass on his left thumb. The patient had received iliac bone graft on his left thumb 20 years ago, and removed all the grafted bone 8 years ago due to recurrent ulcer. Biopsy revealed multiple eidermal inclusion cysts on the dorsal surface of the bone graft site. Surgeon should be aware of epidermal inclusion cyst occurred at the previous bone graft site of the finger.
Aged ; Biopsy ; Fingers ; Humans ; Male ; Thumb ; Transplants ; Ulcer

The authors report a case of 21-year-old, neurologically normal female who presented with a teratoma contained in a cervical meningocele. The concurrence of a congenital neoplasm within the spine associated with spina bifida cystica seems to be a very rare event. The radiographic studies, histological examinations, treatment and follow up findings in this case are presented with a review of the literature.
Female ; Follow-Up Studies ; Humans ; Meningocele* ; Spina Bifida Cystica ; Spine ; Teratoma* ; Young Adult

Posttransplant erythrocytosis (PTE) is a common complication of renal transplantation. It afflicts 5-15 % of renal transplant recipients with good renal function and is associated with an increased incidence of thromboembolic events. Traditional therapies for PTE include serial phlebotomy and native nephrectomy, neither of which has proved optimal. Recently, angiotensin converting enzyme (ACE) inhibitors have been developed as an alternative for PTE treatment. The aim of the study was to evaluate the therapeutic effect of an ACE inhibitor, enalapril, on PTE by the measurement of serum erythropoietin (EPO) level. Ninety consecutive cyclosporine (CsA)-treated recipients who have received living donor kidneys were investigated during the first two years. Eleven recipients (12.2%) had developed PTE, and ten of them were prospectively treated with enalapril (5-10 mg/day) for 1 year for PTE. The average age for the nine men and one woman was 32+/-7.8 years . All retained their native kidneys. Seven recipents were hypertensive, 5 on diuretics, and 2 were smokers. Serum creatinine was 1.4+/-0.3 mg/dl. Onset of PTE occured 9.8+/-5.5 months posttransplant. Duration of PTE was 7.7+/-6.8 mos (range 1-24 mos). Three had undergone 1-2 phlebotomies during the previous year. None had experienced thromboembolic event. In 10 recipients, hematocrit (HCT) during 3 clinic visits before treatment was 55.8+/-3.4 %. After the application of enalapril, HCT in all recipients decreased. Mean HCT at 3 months was decresed to 44.1+/-3.3 % (p<0.001 vs. pre-enalapril values). One patient became anemic (HCT<40 %). One patient who had initially responsed to enalapril stopped using the drug due to dry cough and suffered a recurrence of PTE. Serum EPO levels (RIA) decresed significantly, from a mean of 15.6+/-6.7 to 8.7+/-3.8 mU/ml at 2 month (p<0.05), although the values were within the normal range for our laboratory. Regardless of pre-enalapril EPO level, the HCT normalized in all patients. Mean arterial pressure decreased (105.2+/-14 vs. 97.2+/-12 mmHg, p<0.05) at 12th month. Serum creatinine did not change (1.4+/-0.3 vs. 1.5+/-0.4 mg/dl) during the study period. No patient required phlebotomy after starting enalapril. We conclude that enalapril administration resulted in a reversible decline of HCT to normal levels in renal transplant recipients with PTE. Clinically, enalapril is a safe and effective alternative to traditional treatment of PTE.
Ambulatory Care ; Arterial Pressure ; Cough ; Creatinine ; Cyclosporine ; Diuretics ; Enalapril* ; Erythropoietin ; Female ; Hematocrit ; Humans ; Incidence ; Kidney ; Kidney Transplantation* ; Living Donors ; Male ; Nephrectomy ; Peptidyl-Dipeptidase A ; Phlebotomy ; Polycythemia* ; Prospective Studies ; Recurrence ; Reference Values ; Transplantation