Meningioma arises from arachnoid cap cells and is a common intracranial neoplasm; however, primary extracranial meningioma is rare, accounting for only 1%–2% of cases and is therefore frequently misdiagnosed. We report a case of primary extracranial meningioma arising in the temporal region without intracranial or dural involvement. A 66-year-old woman presented with a slowly enlarging mass in the left temporal region for approximately 10 years, without pain or limitation of mouth opening. Computed tomography revealed a 2.1× 2.7× 4.6 cm mass between the temporalis muscle and the skull, with no intracranial extension. Fine-needle aspiration suggested a spindle-cell neoplasm, and complete excision was performed via a coronal scalp incision for diagnosis and treatment. Histopathologic and immunohistochemical examination confirmed a World Health Organization grade II extracranial meningioma. The patient recovered without complications. Postoperative magnetic resonance imaging showed no residual tumor, and adjuvant radiotherapy was not administered. Surveillance imaging every 6 months demonstrated no recurrence over 3.5 years. This case highlights the importance of including extracranial meningioma in the differential diagnosis of temporal masses and supports complete excision as effective management. A brief literature review is included.

Pressure sores are frequently observed in chronically bedridden patients. When body position is not changed regularly, a single ulcer may develop in the area subjected to constant pressure, such as the sacral or trochanteric region; one habitual position usually results in one sore. The simultaneous presence of pressure sores on the sacrum and both trochanteric regions in a single patient is uncommon, and their reconstruction is challenging. A 48-year-old male paraplegic patient with three pressure sores on the pelvis was referred. The sores involved the sacral and bilateral trochanteric regions and were complicated by infection, including osteomyelitis. Serial flap coverage was staged according to wound readiness and the resolution of infection. First, the right trochanteric sore was reconstructed using a perforator-based island flap (PBIF). After 9 days, the sacral sore was reconstructed with another PBIF. After an additional 20 days, the left trochanteric sore was covered using a pedicled anterolateral thigh musculocutaneous flap. All flaps were selected based on lesion size and condition and survived without major complications. When reconstructing multiple sores in one patient, establishing a clear strategy is essential. The order of reconstruction, appropriate intervals between procedures, and optimal flap selection are key considerations.

Reconstructing Fournier’s gangrene is particularly challenging because it rapidly leads to soft tissue necrosis that requires extensive debridement. This often results in a large soft tissue defect with dead space due to structural irregularity. We report two cases of Fournier’s gangrene successfully reconstructed using a pedicled anterolateral thigh (ALT) flap with a chimeric pattern. A 61-year-old man with Fournier’s gangrene presented with extensive necrosis in the penoscrotal area. After radical debridement and infection control, the wound was reconstructed using a chimeric pattern pedicled ALT flap. The flap was composed of fasciocutaneous and muscle components supplied by branch vessels from the main pedicle. The fasciocutaneous component adequately resurfaced the defect, and the muscle component filled in the dead space between the two testes. A 58-year-old man with Fournier’s gangrene on the penoscrotal area also underwent reconstruction using the same method. In both cases, the flaps survived without any major complications and the reconstructions were successful with no recurrence of infection. When reconstructing Fournier’s gangrene, a trapezoidal-shaped dead space between the two testes is inevitable. Inadequate obliteration of this space may result in recurrent infection. An ALT flap with a chimeric pattern offers an adequate option for resurfacing and dead space obliteration.

The reconstruction of bilateral ischial pressure sores presents a formidable challenge in reconstructive plastic surgery. Adequate padding over the ischial tuberosity and proper resurfacing of the defect are critical in preventing recurrence after reconstruction. We present a case of bilateral ischial sores reconstructed using two different approaches. A 62-year-old paraplegic man with bilateral ischial sores and osteomyelitis of both ischial tuberosities presented to the plastic surgery department. After serial debridement, the 6×4 cm ischial sore on the left side was reconstructed using dual-plane flaps—two independent flaps consisting of a biceps femoris muscle flap and a perforator-based fasciocutaneous island flap. The 7×4 cm ischial sore on the right side was reconstructed using a single hamstring flap, a composite flap consisting of a semitendinosus muscle flap with a distally linked skin flap. Both defects were successfully reconstructed, and the patient regained wheelchair ambulation. Both approaches—the dual-plane flaps and the single hamstring flap—are effective options for ischial sore reconstruction, as they provide sufficient volume and adequate resurfacing. Given the hamstring flap’s capacity to significantly reduce operative duration, it may be considered the primary surgical option. However, in the absence of a reliable perforator between the hamstring muscle and the overlying skin, dual-plane flaps should be selected.

Purpose: We examined the progression of experimental peri-implantitis in sites that underwent either alveolar ridge preservation (ARP) or spontaneous healing (SH), comparing infected teeth (IT) and non-infected teeth (NIT). This investigation is a secondary analysis of a preclinical study aimed at exploring the correlation between newly formed bone and implant stability quotient (ISQ), as well as the association between newly formed bone and the progression of experimental peri-implantitis. Methods: The bilateral mandibular third or fourth premolars of 6 beagle dogs were randomly assigned to 4 groups: IT/SH, IT/ARP, NIT/SH, and NIT/ARP. Following implant placement, core biopsies were retrieved from each site, and the ISQ value was measured. A 3-month period was allowed for peri-implantitis induction, followed by an additional 3 months for the spontaneous progression of peri-implantitis, with radiographs taken at each time point. Results: During the spontaneous progression of peri-implantitis, no statistically significant differences were observed among the groups in terms of mean ISQ values and radiographic marginal bone loss. Similarly, the percentages of bone substitute, newly formed bone, and fibrovascular connective tissue in core biopsies did not differ significantly among the groups.Linear regression analysis revealed no significant linear correlation between newly formed bone and ISQ in any group (P>0.05). However, a weak linear correlation between newly formed bone and marginal bone loss during the spontaneous progression of peri-implantitis was noted in the IT/SH group alone (P=0.036). Conclusions Within the limitations of this study, we were unable to demonstrate that ARP could improve newly formed bone or primary implant stability. Furthermore, neither ARP nor SH significantly influenced the spontaneous progression of experimental peri-implantitis.

Purpose: This study aimed to analyze the bone regeneration and biosorption patterns of different bone substitutes in a rabbit skull defect model. Methods: Four circular 8 mm-defects were created in the cranium of 12 New Zealand white rabbits, each weighing approximately 3 kg. Each defect was randomly assigned to one of 4 treatment groups: cortical deproteinized porcine bone mineral (DPBM), cancellous DPBM, biphasic calcium phosphate (BCP) with a 6:4 ratio of hydroxyapatite (HA) to β-tricalcium phosphate (β-TCP) (TCP4), and BCP with a 2:8 ratio of HA to β-TCP (TCP8). The rabbits were euthanized at either 6 weeks (n=6) or 12 weeks (n=6) post-surgery. The harvested specimens were then analyzed both radiographically and histomorphometrically. Results: In the micro-computed tomography analysis, no statistically significant differences were observed among the 4 groups, except in the bone graft volume/tissue volume (GV/TV) at 12 weeks. Cortical DBPM exhibited a higher GV/TV ratio than cancellous DBPM at the same time point. The histomorphometric analysis revealed increased biosorption in cancellous DBPM compared to cortical DBPM at 12 weeks. However, the percentage of newly formed bone did not significantly differ among the 4 groups. Conclusions All types of bone substitutes demonstrated similar patterns of bone regeneration at both 6 and 12 weeks of observation. However, cancellous DPBM exhibited a higher rate of bioabsorption compared to other bone substitutes, suggesting that it may have different indications or applications in guided bone regeneration protocols.

Hand injuries due to high-pressure paint gun devices are rare but may lead to serious outcomes. The authors describe a case of a high-pressure injury of the thumb that was managed promptly and later reconstructed successfully with minimal functional deficit. A 39-year-old man with a high-pressure paint gun injury of the right thumb was referred. Though the external wound was small, X-ray and computed tomography images showed extensive spread of paint inside. The paint was removed through a wide skin incision. After 6 weeks, the surgical wound had completely healed, except for a defect around the interphalangeal joint with bone exposure. A reverse thenar perforator-based island flap based on the princeps pollicis artery was elevated and moved to the defect. After defect reconstruction, the patient recovered pinch and grasp function through physiotherapy. High-pressure paint gun injuries of the thumb can lead to significant functional deficits of the hand. A small skin lesion may cause the actual extent of damage to be underestimated, as extensive penetration of paint can cause severe damage to the soft tissues. Thus, immediate surgical removal of the paint and coverage of the remnant wounds with an appropriate flap are necessary.

Background: Keloid scars occur idiopathically, and the ear is a common site of keloid scar formation after ear-piercing. Management is always challenging because of the high likelihood of recurrence. When treating a large keloid scar, surgical debulking is inevitable. Among various surgical options, the fillet flap is useful for very large scars with broad stalks that cannot be removed by simple excision and primary closure. Methods: From April 2016 to June 2021, scar revision with a fillet flap was performed on 24 auricular keloid scars. The operation was performed to debulk the scar as much as possible, while retaining a thin envelope of scar tissue. The patients were observed for 1 year postoperatively. Oral tranilast (a transforming growth factor-β suppressor) was administered to reduce the risk of recurrence during follow-up. When recurrence was observed, triamcinolone was injected into the scar. Results: All 24 cases were successfully treated without major problems such as flap loss. The postoperative contour and volume of the scars were appropriate when recurrence did not occur. During the follow-up period, there were nine cases of keloid recurrence, and the mean number of triamcinolone injections was 2.7. One patient experienced a second recurrence 10 months after the first recurrence and needed two more injections. Conclusion The fillet flap is an appropriate option for removing a large keloid scar with a broad stalk. Although it does not guarantee that recurrence will not take place, it provides a small and flat scar into which triamcinolone can be injected if the keloid scar recurs.

PURPOSE: Respiratory syncytial virus (RSV) can cause serious respiratory illnesses such as pneumonia, asthma, and bronchiolitis in infants and elderly or immunocompromised individuals. An RSV vaccine has yet to be developed; only prophylactic anti-RSV antibody is commercially available. So, we investigated whether our vaccine candidate is able to induce type 1 CD4+ T helper (Th1), CD8+ T-cell responses, and protective immunity without vaccine-enhanced disease (VED) against RSV. MATERIALS AND METHODS: We used RSV G protein fragment (Gcf A) with recombinant baculovirus capable of expressing the RSV M2 protein (Bac M2) as a vaccine candidate, and injected this vaccine (Gcf A/Bac M2) intramuscularly, and challenged with RSV intranasally into mice. Enzyme-linked immunosorbent assay, flow cytometry, plaque assay, and weight measurement were performed to confirm humoral immunity, cellular immunity, and protective immunity. RESULTS: The Gcf A/Bac M2 formulation induced a stronger IgG response to Gcf A than Gcf A inoculation alone, and the ratio of IgG1/IgG2a indicated that the responses shifted predominantly to Th1. In addition, both RSV G-specific Th1 responses and RSV M2-specific CD8+ T-cell responses were induced, and G protein-associated eosinophilic infiltration was suppressed compared to the control group. Moreover, the Gcf A/Bac M2 group showed effective protection after an RSV challenge. CONCLUSION: Bac M2 could serve as a vaccine with intrinsic adjuvant activity, and the Gcf A/Bac M2 shows promise as a vaccine candidate for inducing protective immunity without inciting VED.
Aged ; Animals ; Asthma ; Baculoviridae* ; Bronchiolitis ; Enzyme-Linked Immunosorbent Assay ; Eosinophils ; Flow Cytometry ; GTP-Binding Proteins* ; Humans ; Immunity, Cellular ; Immunity, Humoral ; Immunoglobulin G ; Infant ; Mice ; Pneumonia ; Respiratory Syncytial Viruses* ; T-Lymphocytes

PURPOSE: The association between liver enzymes and death from external causes has not been examined. We investigated the association between serum aminotransferase levels and external-cause mortality in a large prospective cohort study. MATERIALS AND METHODS: A total of 142322 subjects of 35-59 years of age who completed baseline examinations in 1990 and 1992 were enrolled. Mortalities were identified using death certificates. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were categorized into quintiles. Sub-distribution hazards ratios and 95% confidence intervals (CIs) were estimated using a competing risks regression model in which deaths from other causes were treated as competing risks. RESULTS: Of 8808 deaths, 1111 (12.6%) were due to external causes. Injury accounted for 256 deaths, and suicide accounted for 255. After adjusting for covariates, elevated ALT and AST were significantly associated with an increased risk of all external-cause mortalities, as well as suicide and injury. Sub-distribution hazards ratios (95% CIs) of the highest versus the lowest quintiles of serum ALT and AST were, respectively, 1.57 (1.26-1.95) and 1.45 (1.20-1.76) for all external causes, 2.73 (1.68-4.46) and 1.75 (1.15-2.66) for suicide, and 1.79 (1.10-2.90) and 1.85 (1.21-2.82) for injury. The risk of external-cause mortality was also significantly higher in the fourth quintile of ALT (21.6-27.5 IU/L) than in its first quintile. CONCLUSION: Elevated aminotransferase levels, even within the normal range, were significantly associated with increased risk of all external-cause mortalities, including suicide, and injury.
Adult ; Alanine Transaminase/*blood/metabolism ; Aspartate Aminotransferases/*blood/metabolism ; Female ; Humans ; Male ; Middle Aged ; *Mortality ; *Population Surveillance ; Proportional Hazards Models ; Prospective Studies ; Republic of Korea/epidemiology ; Risk