Right Basal Ganglia Germinoma: Case Report and Literature Review

Background: Among intracranial germinomas, germinoma of basal ganglia has been rarely reported. We discuss a new case of basal ganglia germinoma(BGG) and perform the literature review over the last two decades, with the aim of emphasizing the diagnosis and treatment in early-stage BGG.Case presentation: A seven years old Chinese boy presented with 4 months history of left limb movement disorder and oblique right mouth corner. The human chorionic gonadotropin(HCG) level in cerebrospinal fluid(CSF) was slightly increased. Magnetic resonance imaging(MRI) showed ipsilateral brain and brainstem atrophy. Susceptibility weighted imaging(SWI) revealed obvious hypointensity in right globus pallidus. Pathological diagnosis on biopsy was confirmed with germinoma. The patient had a favorable relief of symptoms after chemoradiotherapy.Conclusion: Intracranial germinoma, a potentially curable tumor, the early diagnosis is essential for the prognosis. An elevated HCG level of CSF or serum can be used as a reference indicator. MRI, especially SWI, plays an important role in early diagnosis. Patients should be treated with standardized chemoradiotherapy early rather than surgery.

Acute Management Should Be Optimized in Patients with Less Specific Stroke Symptoms: Findings from a Retrospective Observational Study

Anterior circulation stroke (ACS) is associated with typical symptoms, while posterior circulation stroke (PCS) may cause a wide spectrum of less specific symptoms. We aim to assess the correlation between the initial presentation of acute ischemic stroke (AIS) symptoms and the treatment timeline. Using a retrospective, observational, single-center study, the set consists of 809 AIS patients treated with intravenous thrombolysis (IVT) and/or endovascular treatment (EVT). We investigate the impact of baseline clinical AIS symptoms and the affected vascular territory on recanalization times in patients treated with IVT only and EVT (±IVT). Regarding the IVT-only group, increasing the National Institutes of Health Stroke Scale (NIHSS) score on admission and speech difficulties are associated with shorter (by 1.59 ± 0.76 min per every one-point increase; p = 0.036, and by 24.56 ± 8.42 min; p = 0.004, respectively) and nausea/vomiting with longer (by 43.72 ± 13.13 min; p = 0.001) onset-to-needle times, and vertigo with longer (by 8.58 ± 3.84 min; p = 0.026) door-to-needle times (DNT). Regarding the EVT (±IVT) group, coma is associated with longer (by 22.68 ± 6.05 min; p = 0.0002) DNT, anterior circulation stroke with shorter (by 47.32 ± 16.89 min; p = 0.005) onset-to-groin time, and drooping of the mouth corner with shorter (by 20.79 ± 6.02 min; p = 0.0006) door-to-groin time. Our results demonstrate that treatment is initiated later in strokes with less specific symptoms than in strokes with typical symptoms.

Thread Migration After Polydioxanone Thread Lift

Background: The thread-lift has gained popular interest as a minimally invasive procedure because it is simple and reliable. Additionally, it has shorter recovery time and fewer complications than facelift surgery. However, complications including hematoma, infection, facial asymmetry, thread exposure, thread migration, dimpling, alopecia, parotid gland injury, and scarring can occur. We report a case of thread migration after a polydioxanone (PDO) thread lift.Case presentation: A 40-year-old woman underwent a thread lift using a PDO cogged thread. Insertion sites were marked along the temporal hairline. The expected distal ends of threads were marked at least 1.5 cm apart from the nasolabial and marionette folds and 2.5 cm apart from the mandibular border. All threads were inserted into the deep subcutaneous plane. After 1 month, she complained of a foreign body sensation and pain just lateral to the left mouth corner. She showed a linear elevation with oblique direction, and a linear material was palpated with little mobility. The removed material was confirmed to be a part of the inserted thread.Conclusion:During thread lift, it is important to remove the cannula gently and straightly to avoid breaking the thread. Also, it is better to avoid strong manual massage on the path of the thread.

Cadaveric Dissections to Determine Surface Landmarks Locating the Facial Artery for Filler Injections

Background The facial artery is a high-risk structure when performing filler injections at the nasolabial fold, buccal, and mandibular regions. Objectives This study aimed to establish reference landmarks locating the course of the facial artery and its essential branches. Methods Thirty-one embalmed cadavers were enrolled in this study. The course of the facial artery was observed in regard to the following reference points: masseter insertion, oral commissure, and common bony landmarks. The corner of the mouth was utilized as the landmark to measure the turning point of the facial artery. Results Seven points were established to identify the course and turning point of the facial artery. These included the anterior masseteric, lateral mental, infraorbital, medial canthal, basal alar, post-modiolar (PMP), and supra-commissural (SCP) points. The course of the facial artery deviates at least twice at the lateral mental points and at the SCP or PMP. The facial artery appeared more medially when the artery turned at the PMP and SCP. It presented through the lateral channel if the turning point was solely at the PMP. Wherever the facial artery deviates, it can be divided into 3 segments: the mandibular, buccal, and nasolabial segments. The arterial course may deviate laterally from the mouth corner towards PMP. The nasolabial segment may also deviate laterally to the basal alar point at the alar grove for 0.5 to 1 cm. Conclusions The deviation of facial artery closely relates with mandibular, buccal, and nasolabial segments. It is essential in avoiding arterial injury for physicians and surgeons who perform procedures in these areas.

Effects of Facial Threading on Female Skin Texture: A Prospective Trial with Physiological Parameters and Sense Assessment

Background. Facial threading is a common tradition in Taiwan, Southeast Asia (called “Bande Abru”), Middle East (called “Khite”), and Egypt (called “Fatlah”). In addition to the ability to remove facial vellus hairs, facial threading can make the skin fairer and shinier. However, there has been a lack of hard evidence regarding the effects of facial threading on the skin. Objective. To examine the effects of facial threading on skin physiology as well as visual and touch senses by using scientific instruments. Methods. A total of 80 participants were allocated to receive facial threading, application of powder only, exfoliation, and shaving. Prior to and following the assigned treatment, a noninvasive skin condition detection device was used to measure skin coarseness, hydration, melanin, and erythema index. Sense assessment and image analysis were also performed. Results. This study showed that facial threading was found to improve the facial skin roughness indices with significant decreases by 30.4%, 35.9%, and 16.7%, respectively, for the participants’ forehead, cheek, and mouth corner skin. No significant adverse changes in moisture levels and skin pigment indices were detected. In addition, there was improvement in subjects’ touch sense of their skin and feelings about skin color. Conclusions. Traditional facial threading can remove facial vellus hairs and lower skin roughness levels, thereby improving the skin texture. However, pricking sensation appeared during the facial threading process, which might cause concerns about irritation.

A Case of Inconspicuous Recurrent Herpes Labialis Mimicking Unilateral Angular Cheilitis Unilateral Angular Cheilitis

Recurrent herpes labialis (RHL) is a common manifestation of herpes simplex virus (HSV) reactivation in immunocompetent individuals, whereas angular cheilitis is an inflammatory lesion occurring on one or both lip commissures and is induced by local and/or systemic conditions. We describe a case of RHL eruption on the corner of the mouth, easily mistaken as angular cheilitis. Case Report: A 21-year-old male presented to our dental hospital with a 3 day history of a painful, unilateral lesion on the left corner of his mouth. The lesion featured an erythematous base with a yellowish crust that extended outward. We diagnosed the lesion as RHL. We prescribed chlorhexidine solution and topical acyclovir to be applied onto the lesion. At 2 weeks follow-up, the lesion was resolved. An RHL lesion that erupts on the corner of the mouth may initially resemble angular cheilitis. However, the typical clinical presentation, history of recurrence, and the absence of predisposing factors for other lesions suggested an infection caused by HSV. Conclusion: RHL which occurred at one side of the mouth corner can be similar with unilateral AC. But, detailed history taking and clinical observation led to correct diagnosis and management.