A 36-year-old female amateur cyclist developed mononeuropathy of the deep branch of the ulnar nerve due to nerve compression adjacent to the ulnar tunnel (type II Guyon’s canal syndrome) caused by prolonged bicycle riding.The patient’s signs and symptoms persisted even after refraining from cycling for 4 weeks; thus, she underwent decompression of the deep branch of the ulnar nerve in the palm and wrist. Three months postoperation, she recovered nearly full power and function of her left hand.

Acquired digital fibrokeratoma is very a rare, benign, fibrous, and hyperkeratotic skin tumor that develops most frequently on the finger or toe. The tumor usually occurs in adults as a solitary, dome-shaped lesion. Sometimes, it appears as a rudimentary supernumerary digit and may be misdiagnosed as an accessory nail (double nail) or verruca vulgaris. The pathophysiology of an acquired digital fibrokeratoma is unknown. On the other hand, trauma has often been proposed as a predisposing factor for an acquired type of digital fibrokeratoma. This paper reports a case of trauma-related acquired digital fibrokeratoma presenting as a supernumerary digit and nail in a 36-year-old male.This case is presented with a 0.5 cm×0.4 cm×1.3 cm sized, firm, hyperkeratotic, protruding mass over the left second finger nail.

Purpose: Epidemiological data on injuries resulting from ice hockey and their management are lacking in Korea. A comprehensive analysis of such data is crucial for the effective prevention and management of ice hockey injuries. This study aimed to determine the epidemiological profile of ice hockey injuries and their management among elite Korean players. Methods: The descriptive epidemiological study involved three semiprofessional male ice hockey teams and used a retrospective self-reported questionnaire for assessment. The data collected included demographic characteristics such as player positions and stick-side preferences, injured body parts, injury types, treatment methods, and the decision-maker for returning to sports. Results: A total of 68 players were included in the study, of whom 58 (85.3%) experienced moderate-to-severe orthopedic injuries. Among the reported injuries, 93 (77.5%) occurred during the games, with player-to-player contact being the most frequent cause of such injuries. The decision to return to sports in 53 cases (44.2%) was made by the medical staff, whereas players and nonmedical staff made that decision in 67 cases (55.8%). The decision-making process of the medical staff for allowing players to return to sports was significantly associated with the player’s position and whether the injury required surgery. Conclusion The study emphasizes the high prevalence of orthopedic injuries among elite ice hockey players in Korea and the importance of injury prevention strategies. It also highlights the need for increased involvement of medical staff in return-to-play decisions to ensure successful recovery of players and their reintegration into the competition.

BACKGROUND/AIMS: Unresectable malignant biliary obstruction has usually been treated by placement of a self-expandable metallic stent (SEMS). One of the major complications of SEMS is occlusion of the stent by the ingrowth and overgrowth of tumor. The optimal management of an occluded SEMS is still an unresolved problem. We performed this study to evaluate the usefulness of placing a second stent with using an uncovered SEMS or a covered SEMS in patients with stent occlusion. METHODS: From January 2006 to December 2007, a total of 163 patients were treated with the placement of an uncovered SEMS for treating malignant biliary obstruction, except for the cases with Klatskin's tumor. Thirty four patients were occluded and they underwent a second SEMS insertion. All the patients with an occluded uncovered SEMS were managed with placement of a covered SEMS or an uncovered SEMS by ERCP. RESULTS: The median patent duration after intervention was 98 days (range: 8~300 days) after the second covered SEMS insertion, and the median patent duration after intervention was 90 days (range: 10~643 days) after the second uncovered SEMS insertion. No significant difference in the patent period was observed between the covered SEMS group and the uncovered SEMS group (P=0.832). CONCLUSIONS: The covered SEMS group and the uncovered SEMS group had similar patent periods for the management of occluded uncovered metal stents.
Cholangiopancreatography, Endoscopic Retrograde ; Humans ; Klatskin's Tumor ; Stents

We report a case of aspergillosis of the central nervous system in patient with rheumatoid arthritis (RA). A 46-year-old woman with 20-year history of RA and on treatment with corticosteroid, hydroxychloroquine and methotrexate, was admitted because of drowsiness, dizziness and dysarthria. On admission, physical examination and laboratory data showed, among other findings, disappearance of pupil reflex, positive Babinski and Chaddock reflex. Magnetic resonance imaging (MRI) of brain showed multiple high signal intensity lesion on medulla, pons, midbrain, basal ganglia, internal capsule, thalamus and hypothalmus. Stereotactic brain biopsy was performed and biopsy specimen revealed an invasive Aspergillus.
Arthritis, Rheumatoid* ; Aspergillosis* ; Aspergillus ; Basal Ganglia ; Biopsy ; Brain ; Central Nervous System ; Dizziness ; Dysarthria ; Female ; Humans ; Hydroxychloroquine ; Internal Capsule ; Magnetic Resonance Imaging ; Mesencephalon ; Methotrexate ; Middle Aged ; Physical Examination ; Pons ; Pupil ; Reflex ; Sleep Stages ; Thalamus

BACKGROUND: It is currently thought that tissue valve degeneration is related to an animal's immune response, which is mainly due to cell surface alpha-Gal epitopes. Cell surface alpha-Gal epitopes are known to be degraded by the enzyme called green coffee bean alpha-galactosidase. It is also well known that alpha-Gal epitopes are immunologically stained by Griffonia Simplicifolia isolectin type B4. We know that many commercially available tissue valves are made of aortic valves and pericardial tissue of pig. So, we investigated whether alpha-Gal epitopes of the aortic valve and pericardial tissue of a pig can be removed by green coffee bean alpha-galactosidase, and we did so by comparing immunologic staining of the tissues before and after the enzyme treatment. MATERIAL AND METHOD: After treating fresh porcine aortic valve and pericardial tissue with green coffee bean alpha-galactosidase at concentrations of 0.5 unit/mL, 1.0 unit/mL, 2.0 unit/mL, respectively, under the condition of pH 6.5, temperature 4degrees C and 24 hours of incubation, each sample was stained with Griffonia Simplicifolia isolectin type B4 immunofluorescent labeling. We then examined whether the alpha-Gal epitopes were reduced or abolished in each consecutive concentration of green coffee bean alpha-galactosidase by comparing the degree of the Griffonia Simplicifolia isolectin B4 staining in each sample. RESULT: In the pig aortic valve tissue, a 1.0 unit/mL concentration of green coffee bean alpha-galactosidase at pH 6.5, 4degrees C and reaction for 24 hours was enough for complete removal of alpha-Gal epitopes from the cell surface on the immunostaining with Griffonia Simplicifolia isolectin B4. On the other hand, more alpha-Gal epitopes were present in the pig pericardial tissue on Griffonia Simplicifolia isolectin B4 staining before the enzyme treatment, and 1.0 unit/mL of galactosidase was not sufficient for complete removal of alpha-Gal from the tissue. 2.0 units/mL of green coffee bean alpha-galactosidase was needed to completely remove the alpha-Gal epitopes from the pericardial tissue on immunostaining. CONCLUSION: The alpha-Gal epitopes of the pig's aortic valve and pericardial tissue were successfully stained with Griffonia Simplicifolia isolectin B4. We could remove nearly all the alpha-Gal epitopes using green coffee bean alpha-galactosidase at the concentration of 1.0 unit/mL in the aortic valve of pig, and 2.0 unit/mL was need to nearly completely remove all the alpha-Gal epitopes in the pericardial tissue of pig under the condition of pH 6.5, 4degrees C and 24 hours of reaction time. In the near future, removal of alpha-Gal epitopes in the pig's aortic valve and pericardial tissue will become a powerful tool for the improvement of the tissue valve durability. It needs to be determined if alpha-galactosidase treated pig tissue is immune to human anti-Gal antibody or anti-Gal monoclonal antibodies.
alpha-Galactosidase ; Aortic Valve ; Coffee ; Epitopes ; Galactosidases ; Griffonia ; Hand ; Humans ; Hydrogen-Ion Concentration ; Lectins ; Pericardium ; Plant Lectins ; Reaction Time ; Tissue Transplantation

BACKGROUND: Most patients with malignant esophageal stricture are surgically incurable at the time of presentation. The aim of this study was to determine the safety and efficacy of endoscopic expandable metal stent for palliation of dysphagia caused by malignant stricture. METHODS: From January 2000 to December 2001, thirty-two expandable metal stents (Nitis(R) Taewoong Med. Co. Korea, 6 uncovered, 12 covered, 14 double stents for antimigration, 18 mm diameter) were placed in 28 consecutive patients with dysphagia caused by malignancy. Dysphagia score, complications, reintervention, survival length after stent placement were evaluated. RESULTS: This study consisted of 23 men and 5 women. The patients were composed of 13 esophageal carcinomas, 11 gastro-esophageal junction cancers or cardiac cancers, 3 lung cancers, 1 breast cancer. Immediate improvement of dysphagia symptom was seen after initial stent placement in 27 patients (96%). Dysphagia score decreased from 3.0 (+/-0.51) to 1.06 (+/-0.77) after stent placement. There was one death due to hemorrhage after the procedure. There was no stent migration. Restenting was required in 4 cases due to tumor ingrowth (1/4) and overgrowth (3/4) and average interval to restenting was 95 days. Mean survival length was 109 days. CONCLUSION: Expandable metal stents offer excellent rapid palliation of malignant dysphagia. In a small subset of patients who received chemoradiation before stent placement, major complications such as bleeding, perforation, were observed.
Breast Neoplasms ; Constriction, Pathologic ; Deglutition Disorders ; Esophageal Stenosis ; Female ; Heart Neoplasms ; Hemorrhage ; Humans ; Korea ; Lung Neoplasms ; Male ; Stents*

BACKGROUND/AIMS: Endoscopic biliary drainage (EBD) has been used effectively as the palliative treatment for malignant biliary obstruction. In high grade strictures, endoscopic stenting can be achieved by dilating devices such as dilating or balloon catheters. Subgroup of malignant biliary obstructions are too stenotic to allow passage of plastic or metal stents. In cases of failure of conventional stenting, we evaluated the efficacy and safety of the 7-Fr Soehendra stent retriever (SSR) used as a dilator. METHODS: From January 1999 to September 2001, 14 patients with malignant pancreaticobiliary stirictures (2 pancreatic, 12 biliary) that could not be traversed with plastic or metal stents, underwent stricture dilation with SSR. An endoscopic sphincterotomy was performed and a guide wire was inserted beyond the stricture. Then the SSR was introduced over the guide wire via duodenoscope. Then the stricture was traversed by torquing the SSR clockwise while pushing it. The SSR was removed and then the plastic or metal stents were inserted above the stricture. RESULTS: Of the 14 patients, 13 patients (93%) underwent successful stenting using SSR. Symptom relief was observed in all patients after endoscopic biliary stenting. One patient (7%) went on to percutaneous biliary drainage because we failed to insert the metal stent into the stenotic left hepatic duct after traversing the stricture with SSR. There were no significant complications such as bile duct or duodenal perforation and bleeding. CONCLUSIONS: The Soehendra stent retriever is useful and safe for dilation with subsequent stent placement of malignant pancreaticobiliary stirictures resistant to conventional stenting. However, this device may be difficult to pass a tortuous or small-diameter hilar stricture.
Bile Ducts ; Catheters ; Constriction, Pathologic* ; Drainage* ; Duodenoscopes ; Hemorrhage ; Hepatic Duct, Common ; Humans ; Palliative Care ; Plastics ; Sphincterotomy, Endoscopic ; Stents*

Thyroid cancer is the fourth most common malignant tumor in Korean women. It has been acknowledged for a long time that differentiated thyroid cancers have two basic ways of dissemination, lymphtic and hematogenous. Though lymphatic spread to regional lymph nodes is the typical presentation of papillary thyroid cancer of young patients, pulmonary metastasis are not uncommon in this age group. And it is interesting that almost all the patient with metastases to lung showed metastases to the regional neck lymph node. Abnormal chest X-ray of the patient of pulmonary metastasis shows only nonspecific diffuse micronodular pattern which is not easy to be differentiated. And here we report a case of pulmonary metastasis of thyroid papillary carcinoma which was mistaken for pulmonary miliary tuberculosis. It is suggested that more intensive consideration will be necessary for the diagnosis of pulmonary miliaria of children who shows neck mass.
Carcinoma, Papillary* ; Child ; Diagnosis ; Female ; Humans ; Lung ; Lymph Nodes ; Miliaria ; Neck ; Neoplasm Metastasis* ; Thorax ; Thyroid Gland* ; Thyroid Neoplasms ; Tuberculosis, Miliary*

Backgroud/Aims: Endoscopic stent placement is widely used to treat an unresectable malignant gastric outlet obstruction. The covered stent has the disadvantage of an increased risk of migration, and the uncovered stent has an increased risk of ingrowth. This study examined the technical and clinical efficiency of stent placement of a double-layered combination pyloric stent that was newly designed to reduce tumor ingrowth and stent migration. METHODS: Fifteen patients with a gastric outlet obstruction caused by unresectable stomach cancer were treated with the endoscopic placement of a double-layered combination pyloric stent (an outer uncovered stent to reduce migration and an inner PTEF-covered stent to prevent tumor ingrowth). The technical success, clinical success, and complication especially tumor ingrowth and stent migration were analyzed. RESULTS: Technical success was achieved in 15 out of 15 (100%) patients. Among the 15 patients in whom endoscopic stenting was placed successfully, the clinical success rate was 93.3%, the incidence of tumor ingrowth was 0%, the rate of migration was 6.7%, and tumor overgrowth was observed in 13.3%. The median stent patency period was 105 days. CONCLUSIONS: The placement of a double- layered pyloric combination stent appears to be effective in overcoming the disadvantage of the increased migration observed for a covered stent and the increased ingrowth observed for the uncovered stent.
Gastric Outlet Obstruction* ; Humans ; Incidence ; Stents* ; Stomach Neoplasms* ; Stomach*