M-mode, pulsed Doppler and Doppler color flow mapping, in addition to two-dimensional echocardiography, have greatly improved imaging of the fetal heart through identification of abnormal cardiac anatomy and rhythm in utero. The early detection of cardiac disturbance in utero permits alteration in obstetric management such as delivery in a high-risk center for optimal neonatal care and/or decision in optimal delivery time. We report two cases of the neonatal arrhy-thmia which were observed by fetal echocardiography. In the first case, female baby showed neonatal arrhythmias including tachycardia and brady-cardia until 3 days after birth, and then turned to bradyarrhythmia due to non-conducted atrial bigeminy. These events lead us to review the fetal echocardiographs of the patient carefully. Premature atrial contractions were observed in her fetal echocardiography. At 2 months after birth, the patient's electrocardiogram showed normal sinus rhythm. Severe neonatal bradycardia of the second case was due to congenital complete heart block, identified clearly by electrocardiogram after birth. This case also showed complete heart block in her fetal echocardiography. After insertion of the temporary pacemaker, cardiomegaly was improved. Both the neonate and the mother had positive anti-SSA/Ro autoantibody. But any other symptoms and signs of neonatal lupus did not appear in the neonate. Patient's mother also did not show any symptoms and signs of systemic lupus erythematosus. Since the prognosis depends upon the cause of bradyarrhythmia in fetus and neonates, differential diagnosis is important in obstetric management and optimal neonatal treatment.
Arrhythmias, Cardiac* ; Atrial Premature Complexes ; Bradycardia ; Cardiomegaly ; Diagnosis, Differential ; Echocardiography* ; Electrocardiography ; Female ; Fetal Heart ; Fetus ; Heart Block ; Humans ; Infant, Newborn ; Lupus Erythematosus, Systemic ; Mothers ; Parturition ; Prognosis ; Tachycardia

Trichilemmal carcinoma is a rare malignant neoplasm of the hair follicle, which is derived from or differentiates towards cells of the outer root sheath. We report a case of trichilemmal carcinoma in an 83-year-old female patient. She presented with a tender dome-shaped crusted papule showing a feature of cutaneous horn on the forehead, which was first detected 6 months before. nstopathologically, lobular patterned tumor cells with peripheral palisade of basaloid cells, nuclear atypia, and clear or pale, PAS-positive, diastase-sensitive cytoplasm were observed beneath the marked hyperkeratosis. After the diagnosis, total excision was done. The patient has been free of recurrence or metastasis till now.
Aged, 80 and over ; Animals ; Cytoplasm ; Diagnosis ; Female ; Forehead ; Hair Follicle ; Horns* ; Humans ; Neoplasm Metastasis ; Recurrence

The pleurobiliary fistula was not common but sometimes it could occur after percutaneous transhepatic gallbladder drainage. This report describes the case of an 83-year-old Korean male diagnosed with a pleurobiliary fistula after percutaneous transhepatic gallbladder drainage. The patient was treated with endoscopic transpapillary gallbladder drainage under the guidance of the peroral cholangioscopy with SpyGlass DS system. It can decompress pressure within the gallbladder. Leakage from the gallbladder into the pleura was reduced. Finally, his condition got better and he recovered.

Purpose: This study aimed to analyze the profiles and mechanisms of injuries using online injury surveillance system (OISS) with match video files at 2017 World Taekowndo Championship (WTC) athletes. Methods: This study design was a prospective epidemiological study with video analysis. All injuries were recorded during the 2017 WTC using the OISS developed by the International Olympic Committee. A total of 971 athletes who participated in the 2017 WTC were enrolled. Each injury was recorded retrospectively by three cameras surrounding each court. Injury profiles and mechanisms were calculated as; percent injury rate, injury rate/100 athlete-exposures, injury location, type, and mechanism via the injury surveillance system and video analysis form. Results: There were 74 injuries, which corresponded to an overall incidence of 13.5 injuries (95% confidence interval, 11.2–15.8) per 100 athletes. The face (27.0%), hand/finger (23.0%), knee (14.9%), and ankle (10.8%) were most frequently injured parts. Contusions (37.8%), fracture and ligament sprains (20.3%) were the most frequently injury types. The main mechanism for contact injury is while attacking with the roundhouse kick (66.2%), or not used block (81.1%). There were also noncontact injuries (24.3%). Conclusion The incidence of injuries to the face, hand/fingers, knee, and ankle was relatively high. To prevent contact injuries, protective headgear and better shin guards and hand protectors need to be developed. As for the noncontact injuries, we recommend hamstring strengthening exercises, and neuromuscular training to strengthen the tendons and ligaments protecting the ankle and knee joints.

In rotator cuff repair, the long head of the biceps tendon (LHB) is commonly used as graft material. However, factors influencing LHB tear severity are poorly understood, and predicting grade II LHB tears is challenging. This study aimed to identify these factors preoperatively. Methods: The demographics, medical parameters, and pain severity of 750 patients who underwent arthroscopic surgery from January 2010 to February 2021 were evaluated to determine the factors associated with LHB tear severity and grade II tears. Both overall and largeto-massive rotator cuff tear (RCT) cohorts underwent ordinal and binary logistic regression analyses. Predictive accuracy for grade II LHB tears was determined using the area under the receiver operating characteristic curve (AUC). Results: In the overall cohort, high-sensitivity C-reactive protein (hs-CRP) >1 mg/L (P<0.001), subscapularis tear (P<0.001), hypothyroidism (P=0.031), and the tangent sign (P=0.003) were significantly associated with LHB tear severity, and hs-CRP>1 mg/L, subscapularis tear, and Patte retraction degree were significantly associated with grade II LHB tears (P<0.001). In the large-to-massive RCT cohort, hs-CRP>1 mg/L, hypertension, and age ≥50 years (P<0.05) were significantly associated with LHB tear severity, and hs-CRP>1 mg/L (P<0.001) and hypertension (P=0.026) were significantly associated with grade II LHB tears. In both cohorts, hs-CRP >1 mg/L demonstrated good predictive accuracy for grade II LHB tears (AUCs: 0.72 and 0.70). Conclusions: Serum hs-CRP >1 mg/L is associated with LHB tear severity and serves as a reliable predictor of grade II LHB tears, facilitating preoperative assessment of the LHB as potential graft material in arthroscopic rotator cuff repair. Level of evidence: III.

BACKGROUND: It is not known with certainty whether patients with persistently positive sputum smear results who have also had negative sputum culture results require prolongation of treatment for tuberculosis in order to avoid an increased risk of eventual relapse. The purpose of the present study was to retrospectively describe the treatment characteristics and evaluate the appropriate duration of treatment in these patients. METHODS: Sixty of 69 patients with sputum smear positive and culture negative tests at 5 months after first line anti-tuberculous chemotherapy from 2002 to 2003 were retrospectively analyzed. Exclusion criteria included incomplete treatment or resistance to rifampicin or two additional antibiotics, as determined by a drug susceptibility test (DST). RESULTS: Smear conversion of the study subjects was observed after 8.3+/-2.3 months treatment, and the patients were culture negative after 2.0+/-0.8 months. The relapse rates of the study subjects were 3.8, 10.0, and 25.8% after 1, 2, and 5 years of anti-tuberculosis chemotherapy, respectively. The relapse rates were not significantly affected by a series of risk factors such as age, sex, presence of diabetes, a sputum culture examination after 2 months treatment, previous treatment history, chest radiograph, and duration of the treatment (p>0.05). CONCLUSION: Regimen change is not required for patients with persistent smear positive but culture negative tests in the fifth month for first line antituberculous treatment. However, a further study will be needed to clarify the high relapse rate in this specific group of patients.
Anti-Bacterial Agents ; Drug Therapy* ; Humans ; Radiography, Thoracic ; Recurrence ; Retrospective Studies ; Rifampin ; Risk Factors ; Sputum* ; Tuberculosis ; Tuberculosis, Pulmonary

Steatocystoma multiplex is a hamartomatous malformation of the pilosebaceous duct junction. It is not common and inherited in an autosomal dominant pattern. But numerous non-hereditary cases have been reported. It is characterized by asymptomatic numerous, skin-colored to yellowish cystic papules and nodules principally located on the anterior chest, epigastrium, axillae, groin, and proximal part of the extremities. We experienced two cases of steatocystoma multiplex localized on the face. The face is an unusual site in steatocystoma multiplex. One case is that of 33-year-old male with a family history, the other case is that of 66-year-old female. We report these two cases with the review of the previous literature.
Adult ; Aged ; Axilla ; Extremities ; Female ; Groin ; Humans ; Male ; Steatocystoma Multiplex* ; Thorax

Scapulothoracic bursitis causes snapping scapular syndrome, which is characterized by shoulder pain accompanying bony crepitation during shoulder motion, or as an isolated entity causing shoulder discomfort. The pathogenesis of scapulothoracic bursa formation is thought to be related to chronic repetitive mechanical stress on the periscapular tissue, usually from the result of a bone abnormality (a protrusion of the scapula or rib cage). Scapulothracic bursitis is treated with conservative management and the result can be successful. Accurate diagnosis is important because surgery is not necessary except for cases with pain, excessive friction, or dysfunction. We report a patient with rapidly developed bilateral scapulothoracic bursitis without pain and snapping, which can be confused with a soft tissue sarcoma. In this case, conservative management was used to treat the patient.
Bursitis ; Friction ; Humans ; Ribs ; Sarcoma ; Scapula ; Shoulder ; Shoulder Pain ; Stress, Mechanical

Internal carotid-posterior communicating artery aneurysms are frequently related to third nerve palsy which is reversible after the clipping of aneurysm. The authors had analyzed 61 cases in 52 patients who have posterior communicating artery aneurysm and evaluated the factors affecting the development of third nerve palsy and its recovery after clipping of the aneurysm. The results are followings 1) Oculomotor nerve palsy was noticed in 10 patients(16.4%) among 61 cases of posterior communicating artery aneurysm, of which 6 had complete and 4 had partial palsies. 2) Posteriolateral inferior direction of the aneurysm seemed to be closely related to the development of ophthalmoplegia. 3) Development of ophthalmoplegia was not related to the clinical status of the patient on admission, but to the amount of subarachnoid hemorrhage on initial CT scan and size of the aneurysm. 4) Preoperative degree of third nerve palsy and the timing of operation are not definitely related to the recovery of ophthalmoplegia. 5) The recovery of third nerve palsy are normalization of ptosis, normalization of EOM limitation and normalization of papillary change in order.
Aneurysm* ; Arteries* ; Humans ; Intracranial Aneurysm ; Oculomotor Nerve Diseases* ; Oculomotor Nerve* ; Ophthalmoplegia ; Paralysis ; Subarachnoid Hemorrhage ; Tomography, X-Ray Computed

Adnexal torsion is not a common surgical emergency in Obstetrics and Gynecology. and is not observed frequently during pregnancy with its incidence being one out of about 5,000 pregnancies: Pregnancy is a factor that encourages torsion. The traditional treatment for ischemic and twisted adnexa consists of oophorectomy or salpingo-oophorectomy. with early diagnosis, a conservative approach is recommended in cases of young women to assure future fertility. with a brief review ofliterature, we report a case of unilateral salphingo-oophorectomy during pregnancy due to adnexal torsion with the delivery of a normal baby.
Early Diagnosis ; Emergencies ; Female ; Fertility ; Gynecology ; Humans ; Incidence ; Obstetrics ; Ovariectomy ; Pregnancy*