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.

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.

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

Purpose: This study investigated the clinical and radiologic outcomes of partial trapeziectomy and suspensionplasty with a suture button for thumb carpometacarpal (CMC) joint osteoarthritis over a 2-year follow-up period. Methods: This retrospective study involved 17 patients with thumb CMC joint osteoarthritis (Eaton and Littler stage II or III) treated with partial trapeziectomy and suspensionplasty using a suture button. Clinical outcomes were evaluated using a visual analog scale for pain, the Quick DASH score, pinch and grip strength, and thumb range of motion. The trapezial space ratio (TSR) was used as a radiologic parameter to evaluate radiologic outcomes immediately postoperatively, at 6 months, and at the final follow-up. Results: The study included 17 patients (female, 16 and male, 1) with an average age of 63.2 years (range, 56–70 years). Surgery was performed on the dominant hand in nine cases and the nondominant hand in eight. Significant improvements were observed in clinical outcomes. The TSR significantly decreased up to 6 months postoperatively, but there was no significant change from 6 months onward. Complications included button irritation (n=1), a metacarpal fracture (n=1), and flexor carpi radialis tendon rupture (n=1), which were subsequently treated. At the last follow-up, significant improvements in functional outcomes were observed in comparison to the preoperative status. Conclusion The procedure demonstrated significantly improved clinical outcomes over a 2-year follow-up. This method is less invasive than other surgical techniques because it preserves part of the trapezium, making it a favorable surgical option in patients with early basal thumb arthritis (below Eaton stage III).

Purpose: This study investigated the clinical and radiologic outcomes of partial trapeziectomy and suspensionplasty with a suture button for thumb carpometacarpal (CMC) joint osteoarthritis over a 2-year follow-up period. Methods: This retrospective study involved 17 patients with thumb CMC joint osteoarthritis (Eaton and Littler stage II or III) treated with partial trapeziectomy and suspensionplasty using a suture button. Clinical outcomes were evaluated using a visual analog scale for pain, the Quick DASH score, pinch and grip strength, and thumb range of motion. The trapezial space ratio (TSR) was used as a radiologic parameter to evaluate radiologic outcomes immediately postoperatively, at 6 months, and at the final follow-up. Results: The study included 17 patients (female, 16 and male, 1) with an average age of 63.2 years (range, 56–70 years). Surgery was performed on the dominant hand in nine cases and the nondominant hand in eight. Significant improvements were observed in clinical outcomes. The TSR significantly decreased up to 6 months postoperatively, but there was no significant change from 6 months onward. Complications included button irritation (n=1), a metacarpal fracture (n=1), and flexor carpi radialis tendon rupture (n=1), which were subsequently treated. At the last follow-up, significant improvements in functional outcomes were observed in comparison to the preoperative status. Conclusion The procedure demonstrated significantly improved clinical outcomes over a 2-year follow-up. This method is less invasive than other surgical techniques because it preserves part of the trapezium, making it a favorable surgical option in patients with early basal thumb arthritis (below Eaton stage III).

Purpose: This study investigated the clinical and radiologic outcomes of partial trapeziectomy and suspensionplasty with a suture button for thumb carpometacarpal (CMC) joint osteoarthritis over a 2-year follow-up period. Methods: This retrospective study involved 17 patients with thumb CMC joint osteoarthritis (Eaton and Littler stage II or III) treated with partial trapeziectomy and suspensionplasty using a suture button. Clinical outcomes were evaluated using a visual analog scale for pain, the Quick DASH score, pinch and grip strength, and thumb range of motion. The trapezial space ratio (TSR) was used as a radiologic parameter to evaluate radiologic outcomes immediately postoperatively, at 6 months, and at the final follow-up. Results: The study included 17 patients (female, 16 and male, 1) with an average age of 63.2 years (range, 56–70 years). Surgery was performed on the dominant hand in nine cases and the nondominant hand in eight. Significant improvements were observed in clinical outcomes. The TSR significantly decreased up to 6 months postoperatively, but there was no significant change from 6 months onward. Complications included button irritation (n=1), a metacarpal fracture (n=1), and flexor carpi radialis tendon rupture (n=1), which were subsequently treated. At the last follow-up, significant improvements in functional outcomes were observed in comparison to the preoperative status. Conclusion The procedure demonstrated significantly improved clinical outcomes over a 2-year follow-up. This method is less invasive than other surgical techniques because it preserves part of the trapezium, making it a favorable surgical option in patients with early basal thumb arthritis (below Eaton stage III).

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

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*

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*