Lipomas, the most common soft-tissue mesenchymal neoplasms in adults, are characterized by the proliferation of mature white adipocytes without cytologic atypia. Lipomas are rarely observed in the head and neck region. We present a case of resection and orthognathic surgical removal of an intramuscular lipoma of the mandible with involvement of the mandibular ramus and condylar head and neck. An 18-year-old female patient was referred to our hospital for orthognathic surgery for the management of facial asymmetry and mandibular prognathism. The patient did not present with facial swelling, pain, or temporomandibular dysfunction; however, on radiographic examination, including cone-beam computed tomography and magnetic resonance imaging, an infiltrative fatty lesion was observed in the masticator space inside the right mandible, and the adjacent mandible exhibited bone thinning and deformity. Resection of the lipoma was performed along with orthognathic surgery, including a Le Fort I osteotomy for the maxilla and bilateral sagittal split ramus osteotomy (BSSRO). In this case, because the ramus was split using BSSRO, accessing the lipoma intraorally was easy.Consequently, aesthetic scarring was avoided, and no complications, such as unfavorable splitting or pathologic fracture, occurred. Although recurrence has not been observed about 1 year, long-term follow-up should be performed.

Purpose: The purpose of the study was to validate the Korean version of Patient-Reported Outcomes Measurement Information System 29 Profile v2.1 (K-PROMIS-29 V2.1) among cancer survivors. Materials and Methods: Participants were recruited from outpatient clinics of the Comprehensive Cancer Center at the Samsung Medical Center in Seoul, South Korea, from September to October 2018. Participants completed a survey questionnaire that included the K-PROMIS-29 V2.1 and the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30). Principal component analysis and confirmatory factor analysis (CFA) and Pearson’s correlations were used to evaluate the reliability and validity of the K-PROMIS-29 V2.1. Results: The mean age of the study participants was 54.4 years, the mean time since diagnosis was 1.2 (±2.4) years, and 349 (87.3%) completed the entire questionnaire. The Cronbach’s alpha coefficients of the seven domains in the K-PROMIS-29 V2.1 ranged from 0.81 to 0.96, indicating satisfactory internal consistency. In the CFA, the goodness-of-fit indices for the K-PROMIS-29 V2.1 were high (comparative fit index, 0.91 and standardized root-mean-squared residual, 0.06). High to moderate correlations were found between comparable subscales of the K-PROMIS-29 V2.1 and subscales of the EORTC QLQ-C30 (r=0.52-0.73). Conclusion The K-PROMIS-29 V2.1 is a reliable and valid measure for assessing the health-related quality of life domains in a cancer population, thus supporting their use in studies and oncology trials.

Purpose: To report a case of diplopia caused by restrictive strabismus developing after conjunctivodacryocystorhinostomy (CDCR).Case summary: A 61-year-old female presented with persistent epiphora after failure to repair ipsilateral canalicular lacerations of the left eye caused by trauma occurred 25 years ago. CDCR was performed and the epiphora improved. Four months later, the patient presented with diplopia on the left gaze. An abduction limitation of -4 and a supraduction limitation of -3 were observed in the left eye. Therefore, Jones tube removal was performed 5 months after CDCR surgery. Two weeks later, as the limitations persisted, adhesiolysis of the conjunctiva and an amniotic membrane transplantation (AMT) were performed. This exposed a subconjunctival adhesion at the inferonasal conjunctiva; histopathological examination revealed fibrotic tissues. Three months later, the adhesions recurred and the patient was transferred to another hospital. Conjunctival adhesiolysis, AMT, and a 6.5 mm recession of medial rectus (MR) muscle were performed. One week later, exotropia occurred in the primary position, and the MR muscle of the left eye was advanced by 2 mm. Nine months after the final surgery, the primary gaze was orthotropia. The diplopia within the central 20° of visual field had disappeared. However, a levoelevation limitation of -1.5 remained in the left eye. Conclusions CDCR is the only treatment method for patients with occlusion of both the upper and lower proximal lacrimal canaliculi. However, rare complications such as restrictive strabismus with diplopia may occur. As preventing adhesion is difficult, sufficient patient notice is required prior to surgery.

Purpose: The aim of this study was to explain the patient assessment experiences of the medical staff responsible for customer satisfaction and quality improvement at their respective medical institutions. Methods: This was a qualitative study using a focus group with quality improvement or custom service department managers. Participants were selected using purposive sampling. Data collection was conducted with seventeen participants divided into three focus group interviews from July 3 to 5, 2017. Each interview took an average of 1 hour and 40 minutes. Transcribed data were analyzed using qualitative thematic analysis. Results: Base on the analysis, four categories and eight themes were derived. The categories were: 1) what is the quality of hospital service? 2) between directionality and timeliness, 3) variations in recognition and application, and 4) changing in hospital culture Conclusion The assessment of patient's experience has spread a patient-centered culture and elicited significant changes in the behavior of medical and hospital staff. However, the survey instruments and procedures for assessing patient experiences need to be continuously improved, and additional research is required to secure evidence related to patient experiences.

Background: and Purpose: Blood pressure (BP) control is strongly recommended, but BP control rate has not been well studied in patients with stroke. We evaluated the BP control rate with fimasartan-based antihypertensive therapy initiated in patients with recent cerebral ischemia. Methods: This multicenter, prospective, single-arm trial involved 27 centers in South Korea. Key inclusion criteria were recent cerebral ischemia within 90 days and high BP [systolic blood pressure (SBP) >140 mm Hg or diastolic blood pressure (DBP) >90 mm Hg]. BP lowering was initiated with fimasartan. BP management during the follow-up was at the discretion of the responsible investigators. The primary endpoint was the target BP goal achievement rate (<140/90 mm Hg) at 24 weeks. Key secondary endpoints included achieved BP and BP changes at each visit, and clinical events (ClinicalTrials.gov Identifier: NCT03231293). Results: Of 1,035 patients enrolled, 1,026 were included in the safety analysis, and 951 in the efficacy analysis. Their mean age was 64.1 years, 33% were female, the median time interval from onset to enrollment was 10 days, and the baseline SBP and DBP were 162.3±16.0 and 92.2±12.4 mm Hg (mean±SD). During the study period, 55.5% of patients were maintained on fimasartan monotherapy, and 44.5% received antihypertensive therapies other than fimasartan monotherapy at at least one visit. The target BP goal achievement rate at 24-week was 67.3% (48.6% at 4-week and 61.4% at 12-week). The mean BP was 139.0/81.8±18.3/11.7, 133.8/79.2±16.4/11.0, and 132.8/78.5±15.6/10.9 mm Hg at 4-, 12-, and 24-week. The treatment-emergent adverse event rate was 5.4%, including one serious adverse event. Conclusions Fimasartan-based BP lowering achieved the target BP in two-thirds of patients at 24 weeks, and was generally well tolerated.

Purpose: To present a case of a cystic solitary fibrous tumor (SFT), the first report of its kind in Korea, along with a review of the literature of SFTs affecting the orbit.Case summary: A 71-year-old male was referred to our practice due to diplopia for 2 years and 6 months. On ophthalmologic examination, 10-mm proptosis and inferolateral globe displacement were observed in the left eye, and extraocular movements were limited in all directions of gaze. A facial computed tomography scan and magnetic resonance imaging showed a lobulated, well-enhanced mass in the superonasal extraconal space. The tumor appeared to be heterogeneous; cystic tissue was suspected. An excisional biopsy was performed through anterior orbitotomy to remove the mass (dimensions, 43 × 30 × 28 mm3). Histological examination showed the tumor to be composed of spindle cells in collagenous tissue. Immunohistochemical staining was positive for CD34, CD99, and orbital SFT with cystic changes. Conclusions SFT arising in the orbit is extremely rare but should be considered in the differential diagnosis of progressing unilateral proptosis, keeping in mind that this condition may be accompanied by cystic changes.

Purpose: To evaluate the efficacy of the Icare ic200 in clinical practice by comparing the intraocular pressure (IOP) measured with the Icare ic200 rebound tonometer to the IOP measured with the Goldmann applanation tonometer (GAT). Methods: A total of 294 eyes of 294 Korean patients were included. IOP was measured with the Icare ic200 and then measured again with a GAT in all patients. We evaluated the degree of IOP agreement between the two tonometers and analyzed the diagnostic ability of the Icare ic200 for a reading ≥ 22 mmHg with the GAT. We also analyzed whether clinical factors including biometry affected the difference in IOP measured by the two tonometers. Results: The IOP values measured with the Icare ic200 and GAT were strongly correlated (r = 0.875, p < 0.001). The IOP measured with the Icare ic200 was lower than the IOP measured with GAT. The mean difference was 3.07 ± 2.67 mmHg, and 95.24% of patients were distributed within the 95% limits of agreement (-2.16 to 8.30 mmHg) on Bland-Altman plots. The diagnostic ability of the Icare ic200 for IOP ≥ 22 mmHg was 0.959 (area under the receiver operating characterisitic). In multivariate regression analyses, older age (β = 0.034, p = 0.020) and greater corneal curvature (β = 0.213, p = 0.030) were correlated with larger IOP differences between the two tonometers. Conclusions Although the Icare ic200 was more consistent than the GAT with reasonable diagnostic ability for ≥ 22 mmHg, the IOP measured 3 mmHg lower than the GAT. Therefore, the Icare ic200 might be more useful as a screening test to increase IOP rather than replacing GAT in clinical practice.

Background: We compared the risk factors for cardiovascular diseases (CVDs) among Koreans who did and did not participate in national periodic health check-ups, after adjustment for demographic factors, socioeconomic status, and lifestyle factors. Methods: This cross-sectional study used data from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2007 to 2018. Study subjects were classified as participants or non-participants in health check-ups, based on attendance at national periodic health check-ups during the previous two years. Results: Comparison of participants and non-participants in health check-ups indicated statistically significant differences in age, gender, region, education level, monthly income, employment status, obesity, smoking, alcohol consumption, exercise, and marital status. After adjustment for demographic, socioeconomic factors, and health-related behaviors, woman non-participants were more likely to have metabolic syndrome, pre-hypertension, hypertension, prediabetes, and diabetes, and man non-participants were more likely to have pre-diabetes and diabetes. Conclusion Subjects who participated in periodic health check-ups had fewer CVD-related risk factors than non-participants. Thus, health care providers should encourage nonparticipants to attend periodic health check-ups so that appropriate interventions can be implemented and decrease the risk for CVDs in these individuals.

Purpose: To present a case of a cystic solitary fibrous tumor (SFT), the first report of its kind in Korea, along with a review of the literature of SFTs affecting the orbit.Case summary: A 71-year-old male was referred to our practice due to diplopia for 2 years and 6 months. On ophthalmologic examination, 10-mm proptosis and inferolateral globe displacement were observed in the left eye, and extraocular movements were limited in all directions of gaze. A facial computed tomography scan and magnetic resonance imaging showed a lobulated, well-enhanced mass in the superonasal extraconal space. The tumor appeared to be heterogeneous; cystic tissue was suspected. An excisional biopsy was performed through anterior orbitotomy to remove the mass (dimensions, 43 × 30 × 28 mm3). Histological examination showed the tumor to be composed of spindle cells in collagenous tissue. Immunohistochemical staining was positive for CD34, CD99, and orbital SFT with cystic changes. Conclusions SFT arising in the orbit is extremely rare but should be considered in the differential diagnosis of progressing unilateral proptosis, keeping in mind that this condition may be accompanied by cystic changes.

Purpose: To evaluate the efficacy of the Icare ic200 in clinical practice by comparing the intraocular pressure (IOP) measured with the Icare ic200 rebound tonometer to the IOP measured with the Goldmann applanation tonometer (GAT). Methods: A total of 294 eyes of 294 Korean patients were included. IOP was measured with the Icare ic200 and then measured again with a GAT in all patients. We evaluated the degree of IOP agreement between the two tonometers and analyzed the diagnostic ability of the Icare ic200 for a reading ≥ 22 mmHg with the GAT. We also analyzed whether clinical factors including biometry affected the difference in IOP measured by the two tonometers. Results: The IOP values measured with the Icare ic200 and GAT were strongly correlated (r = 0.875, p < 0.001). The IOP measured with the Icare ic200 was lower than the IOP measured with GAT. The mean difference was 3.07 ± 2.67 mmHg, and 95.24% of patients were distributed within the 95% limits of agreement (-2.16 to 8.30 mmHg) on Bland-Altman plots. The diagnostic ability of the Icare ic200 for IOP ≥ 22 mmHg was 0.959 (area under the receiver operating characterisitic). In multivariate regression analyses, older age (β = 0.034, p = 0.020) and greater corneal curvature (β = 0.213, p = 0.030) were correlated with larger IOP differences between the two tonometers. Conclusions Although the Icare ic200 was more consistent than the GAT with reasonable diagnostic ability for ≥ 22 mmHg, the IOP measured 3 mmHg lower than the GAT. Therefore, the Icare ic200 might be more useful as a screening test to increase IOP rather than replacing GAT in clinical practice.