Lipogranuloma is a chronic inflammatory response to lipid material within tissues and may develop secondary to fat necrosis, trauma, or exogenous lipid exposure. We report a case of postoperative mid-sternal lipogranuloma with milky discharge in a 35-year-old man that occurred 6 months after surgery for gynecomastia performed through a periareolar incision with adjunctive liposuction. The patient presented with two firm, non-tender nodules at the sternal midline, distant from the operative site, and laboratory findings were unremarkable. Surgical exploration revealed milky white discharge, and histopathologic examination demonstrated lipid-laden macrophages, multinucleated giant cells, and fibrosis, consistent with lipogranulomatous inflammation. No evidence of malignancy or infection was identified, and no recurrence was observed during 2 years of follow-up. The proposed mechanisms include displacement of residual ductal epithelium or lipid material during surgical manipulation, as well as postoperative fat necrosis leading to secondary lipogranulomatous inflammation. This case highlights that postoperative lipogranulomatous inflammation may present at sites distant from the primary operative field. Recognition of this entity is important in the evaluation of postoperative chest wall masses to avoid misdiagnosis and unnecessary intervention.

Epidermoid and dermoid cysts are common congenital lesions of the pediatric periorbital region arising from ectodermal inclusion during embryologic development. Although these lesions originate in the soft tissue, chronic pressure from long-standing masses may induce cortical depression or remodeling of adjacent craniofacial bones, particularly in young children with malleable skeletal structures. We report a case of a 26-month-old girl presenting with a small periorbital epidermoid cyst associated with pressure-induced depression of the zygomatic surface. Radiologic evaluation revealed a well-circumscribed cystic lesion abutting the frontal process of the zygoma with smooth cortical indentation and no features suggestive of aggressive osseous pathology. Complete excision was performed through a lateral brow approach with preservation of the periosteum. Histopathologic examination confirmed an epidermoid cyst. Postoperative follow-up demonstrated progressive spontaneous restoration of the zygomatic contour without the need for bone grafting or alloplastic materials, reflecting the osteogenic potential of the pediatric periosteum. This case emphasizes the importance of distinguishing secondary pressure-related bone remodeling from true intraosseous lesions in the pediatric craniofacial region and highlights the capacity for natural osseous recovery following removal of the compressive source. A brief review of relevant embryologic and radiologic considerations is also provided.

Lomentospora prolificans is a rare opportunistic mold with high intrinsic resistance to most antifungal agents. It causes disseminated infections in immunocompromised patients and localized infections in immunocompetent hosts, often involving the bones, joints, or skin. However, prosthetic joint infections (PJI) due to L. prolificans have not been previously reported.Here, we describe the first case of L. prolificans PJI in an immunocompetent 51-year-old male patients, who had no significant comorbidities other than hypertension. The patient presented with right knee pain and swelling one year after total knee arthroplasty. Cultures of the joint fluid and periprosthetic tissue yielded L. prolificans, as confirmed by matrix-assisted laser desorption ionization–time-of-flight mass spectrometry (MALDI-TOF MS) and rRNA gene sequencing. Susceptibility testing showed high minimum inhibitory concentrations for most currently available antifungal agents, including azoles, amphotericin B, echinocandins, and terbinafine. Despite prosthesis removal, multiple surgical debridements, and prolonged antifungal therapy, including voriconazole and terbinafine, the infection persisted over a five-year period.Amputation was discussed as a potential curative measure; however, no consensus has been reached due to its long-term impact. This case highlights the clinical challenges of managing L. prolificans PJI and underscores the need for novel antifungal therapies to treat rare drugresistant fungal infections.

Purpose: Endophytic gastric subepithelial tumors (SETs), especially those near the gastroesophageal junction (GEJ), present challenges in localization and resection. This study aimed to compare the outcomes of single-incision intragastric wedge resection (SIWR) and conventional multiport laparoscopic wedge resection (CWR) for endophytic gastric SETs, including a subgroup analysis of tumors located near the GEJ. Methods: This retrospective, single-center study included 124 patients who underwent laparoscopic wedge resection for endophytic gastric SETs between January 2016 and December 2024. Operative and postoperative outcomes were compared between the SIWR (n = 23) and CWR (n = 101) groups. Subgroup analysis was performed for tumors located within 2 cm of the GEJ. Results: The mean tumor size was smaller in the SIWR group than in the CWR group (2.03 ± 0.97 cm vs. 2.57 ± 1.14 cm, P = 0.038). The SIWR group showed a longer postoperative hospital stay (6.30 ± 6.55 days vs. 4.89 ± 1.29 days, P = 0.045) and a higher complication rate (21.7% vs. 4%, P = 0.003), but a shorter time to oral intake (1.43 ± 0.95 days vs. 1.98 ± 0.98 days, P = 0.016). In the GEJ subgroup, SIWR was more commonly performed and showed a shorter time to oral intake without increasing early complications. Late complications were observed only in the CWR group. Conclusion Both CWR and SIWR are feasible approaches for endophytic gastric SETs. SIWR may be preferable in selecting GEJ-proximal cases but requires cautious application due to its higher complication rate.

Objective: Since its development in 2002 by the Korean College of Neuropsychopharmacology and the Korean Society for Affective Disorders, the Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) has undergone five revisions. Methods: To improve survey efficiency, reflect general clinical practice, and facilitate comparisons with previous KMAP-DD revisions, the overall structure of the questionnaire was retained. The six sections of the questionnaire were as follows:1) pharmacological treatment strategies for major depressive disorder with and without psychotic features; 2) pharmacological treatment strategies for persistent depressive disorder and other depressive disorder subtypes; 3) consensus on treatment-resistant depression; 4) selection of an antidepressant in consideration of safety, adverse effects, and comorbid physical conditions; 5) treatment strategies for special populations (children/adolescents, elderly, and women); and 6) non-pharmacological biological therapies. First-, second-, and third-line treatment recommendations were statistically derived. Results: Compared to KMAP-DD 2021, only minor changes were noted, due to the limited introduction of new medications or treatment modalities. Nonetheless, notable shifts included an increased preference for atypical antipsychotics (AAPs), and higher preference of combination strategies involving AAPs and mood stabilizers, indicating a more proactive and intensive treatment trend in Korea. Conclusion KMAP-DD is expected to serve as a valuable clinical resource by providing expert consensus-based recommendations on specific treatment strategies and pharmacological options for major depressive disorders, thereby supporting the integration of real-world clinical practice with evidence-based medicine.

Purpose: We sought to report the results of 0.625%/0.1 mL of povidone–iodine (PI) intravitreal injection (0.013% PI vitreous concentration) for treating acute endophthalmitis after cataract surgery.Case summary: Case 1 developed acute endophthalmitis one day after cataract surgery. Prompt intervention with PI injection and vitrectomy led to full resolution of inflammation and a visual acuity of 0.8, and the patient remained stable at 10 months. Case 2, a patient with persistent post-cataract inflammation, was treated with PI injection and vitrectomy, resulting in complete resolution of inflammation and improvement of visual acuity to 0.6 by eight months. Case 3 was a diabetic patient who experienced severe acute endophthalmitis.The patient was treated with the above intervention, resulting in full resolution of endophthalmitis; however, he eventually lost vision due to neovascular glaucoma. Case 4 developed recurrent endophthalmitis caused by Achromobacter xylosoxidans after cataract surgery. This patient required multiple vitrectomies, PI injections, and intraocular lens removal, which led to a resolution of inflammation and restoration of visual acuity to 1.0 after 14 months. Conclusions 0.625%/0.1-mL IPI injection followed by vitrectomy was performed in four acute endophthalmitis patients after cataract surgery and were successfully treated.

This study investigates a novel approach to wound management that combines negative pressure wound therapy (NPWT) with the shoelace technique for closure of soft tissue defects. We retrospectively reviewed three cases treated between August 2022 and January 2023, where NPWT combined with the shoelace technique facilitated effective wound closure without general anesthesia. This approach shows significant potential in managing various wound etiologies, including pressure ulcers, postoperative dehiscence, and soft tissue defects resulting from hematomas. The outcomes demonstrated promising healing with minimal complications, suggesting a viable alternative for patients unable to undergo traditional surgical procedures. Despite the study’s limitations, such as a small sample size and subjective clinical judgments, the results advocate for further research and standardization of this technique.

Objective: Suicide is a significant public health issue, with South Korea having the highest suicide rate among Organisation for Economic Cooperation and Development countries. This study aimed to develop clinical guidelines for suicide prevention in psychiatric patients in Korea using the ADAPTE methodology. Methods: The development process involved a comprehensive review of literature, expert consultations, and consensus-building using the Nominal Group Technique and Delphi method. The guidelines focus on evidence-based psychiatric treatments, including both pharmacological and non-pharmacological approaches, tailored to the Korean context. Key findings underscoring the need for standardized treatment protocols for patients with major psychiatric disorders, including bipolar disorder, major depressive disorder, and schizophrenia. Results: The guidelines incorporate treatments like lithium, clozapine, atypical antipsychotics, electroconvulsive therapy, and cognitive behavioral therapy, which have shown effectiveness in suicide prevention. Applicability and acceptability within Korea’s healthcare system were addressed, ensuring feasibility given the country’s medical insurance coverage and accessibility. The guidelines were validated through expert reviews and Delphi rounds, achieving consensus on the final recommendations. Conclusion The developed guidelines provide a structured, evidence-based approach to reducing suicide rates among psychiatric patients in Korea. Future research will focus on expanding these guidelines to include screening protocols for high-risk groups.

Poly-D,L-lactic acid (PDLLA) is widely used in facial rejuvenation as a collagen stimulator, with a lower risk of granuloma formation compared to poly-L-lactic acid (PLLA). However, granulomas may still occur. In this case, a 58-year-old woman developed firm, non-tender, bilateral infraorbital granulomas 2 months after her third PDLLA injection for infraorbital hollowing. The lesions were unresponsive to intralesional trichloroacetic acid (TCA) and intense pulsed light therapy, necessitating surgical removal. Histopathological analysis confirmed foreign-body granulomas caused by the PDLLA filler. This case highlights the need for caution when injecting PDLLA into thin-skinned areas like the infraorbital region, where granulomas can be more visible due to limited tissue volume. Although PDLLA fillers are generally safe, granuloma formation remains a potential complication. Early diagnosis and treatment with non-surgical methods, such as intralesional TCA, should be prioritized. If these methods fail, surgical excision, aimed at preserving as much normal tissue as possible, may be necessary for optimal outcomes.

This paper presents a novel approach to the correction of zygomatic malposition and secondary reconstruction orbital floor fractures, highlighting the use of hydrated acellular dermal matrix (ADM), specifically CGDerm One-Step, in a case where traditional solid implants failed to maintain structural integrity and volume. A 27-year-old woman with persistent facial deformities following a traumatic incident underwent a transformative procedure that utilized ADM for volume correction and structural support, addressing significant challenges such as enophthalmos and facial contour depression. This approach was necessitated by the descent of the entire orbital floor and a previously placed implant (Medpor), leading to unsatisfactory volume correction. By integrating ADM with titanium-reinforced fan plates (Synpor), the surgery successfully restored the patient’s facial symmetry and addressed her functional concerns, including diplopia and limited eye movement. Postoperative evaluations demonstrated the long-term effectiveness of this method, with significant improvements in facial contour and eye symmetry. Our findings suggest that ADM, particularly in its hydrated form, offers a reliable alternative to traditional bone grafts and implants for correcting complex craniofacial deformities, providing both aesthetic and functional benefits. This case underscores the importance of adaptable, tissue-mimicking materials in facial reconstructive surgery, offering insights into their potential for broader application in post-traumatic facial corrections.