Fibro-osseous pseudotumor of the digits is a heterotopic ossification closely related to myositis ossificans and occurs in the subcutaneous tissue of the digits. This lesion is considered a reactive fibroblastic proliferation with metaplastic bone formation. We report a case of fibro-osseous pseudotumor of left index finger in a 28-year-old woman. She had had an ovoid smooth subcutaneous mass with tenderness on the left index finger for one month. In gross, the specimen consisted of a relatively circumscribed, rubbery soft mass with grayish white cut surface measuring 2.0 1.7 1.5 cm. Upon microscopic examination the lesion showed irregular multinodular growth with considerably variable cellularity. Because of the focal hypercellularity, cellular atypia, and increased mitotic activity this lesion may be confused with extraskeletal osteosarcoma or parosteal osteosarcoma. This rare lesion is curable by complete local excision.
Adult ; Female ; Fibroblasts ; Fingers ; Humans ; Myositis Ossificans ; Ossification, Heterotopic ; Osteogenesis ; Osteosarcoma ; Subcutaneous Tissue

Total knee arthroplasty is a surgical treatment for end-stage osteoarthritis of the knee. Postoperative lower limb alignment is one of the factors determining the long-term prognosis after total knee arthroplasty. Navigation-assisted surgery can be used to achieve an accurate lower limb alignment. Particular situations, such as severe extra-articular deformity in the femur or tibia and retained hardware, are a good indication for navigation-assisted surgery. On the other hand, thorough preoperative planning and an understanding of each steps of surgery are necessary to perform total knee arthroplasty successfully in these special cases. In this review article, preoperative radiological measurements and surgical planning for extra-articular deformity correction will be elucidated. The surgical steps and necessary instruments for navigation-assisted total knee arthroplasty will be described in cases of extra-articular deformity or retained hardware. A literature review showed that the radiological and clinical results after total knee arthroplasty using navigation in osteoarthritis with extraarticular deformity were good. Therefore, it is essential to use navigation when performing total knee arthroplasty in patients with extraarticular deformity or retained hardware.

No abstract available.

Intraoperative neurophysiological monitoring (INM) is underutilized during the anteromesial temporal resection (AMTR) in epilepsy surgery. Herein we report a case with intraoperative capsular infarction which was early detected by INM. Among the modalities of INM, left motor evoked potentials (MEP) showed suddenly decreased amplitude of compound muscle action potentials, after the electrocoagulation in left mesial temporal areas. Postoperative neurologic and MRI findings were well correlated to the intraoperative MEP features. We also discuss the usefulness of INM during the AMTR.

Shoulder joint diseases such as rotator cuff tear, adhesive capsulitis, calcific tendinitis, shoulder instability, and glenohumeral osteoarthritis often require surgical treatment. Surgical outcomes can change significantly depending on whether the postoperative rehabilitation was appropriately performed.Current Concepts: The focus of postoperative rehabilitation should be to remove pain and restore functional movement through improving the dynamic stability of the rotator cuff and shoulder muscles. However, rehabilitation should not include activities that aggravate the injury. Therefore, rehabilitation treatment should be carried out with gradual increments in exercise intensity. Postoperative rehabilitation is not only related to exercise but may also include drug administration, such as steroid injection. In particular, many investigations have been performed to identify the clinical risks and benefits of steroid injection after rotator cuff repair. Notably, telemedicine can be used as a solution for the problematic situations that have been caused by coronavirus disease 2019 pandemic.Discussion and Conclusion: A thorough understanding and appropriate application of postoperative rehabilitation protocols are essential to improve surgical outcomes.

Lupus panniculitis is a rare disease that may present with similar clinical manifestations to an infection, such as cellulitis or abscess. This paper reports a case of a 25-year-old woman with systemic lupus erythematosus who underwent surgical intervention initially with the suspicion of an abscess but who was eventually diagnosed with lupus panniculitis. Despite the low incidence of lower leg involvement of panniculitis, clinicians should be aware of the possibility of an etiology other than infection when encountering patients with inflammatory diseases. Moreover, a skin biopsy and magnetic resonance imaging with a diffusion-weight image may be helpful.

Actinomycosis causes a chronic suppurative infection most commonly involving the cervico-facial region, thorax, and the abdomen. Thoracic infection results from an aspiration of contaminated material from mouth or oropharynx. Actinomyces was known to have a predilection for the periphery of the lung and the endobronchial lesion is extremely rare. We report two cases of actinomycosis presenting as an endobronchial mass which arose in 53-year-old and 44-year-old women. The first case presented with cough, sputum, weight loss and had a history of pulmonary tuberculosis 24 years ago. Chest CT revealed a right lobe collapse simulating mass and suggested carcinoma. The second case presented with hemoptysis for 2 years. Chest CT revealed cystic bronchiectasis of both lungs and intracystic soft tissue mass in the anterior segment of the right upper lobe which suggested aspergilloma. The gross features of them were similar to those of aspergilloma. Characteristic sulphur granules consisting of a granular basophilic center surrounded by a radiating zone of eosinophilic, hyaline, club-shaped projection were histologically confirmed in both cases. Granulomas containing P. westermani eggs were present in the second case. Staphylococcus, true fungal organism, nocardia, and streptomyces shoud be distinguished by analysing their morphologic characteristics in the appropriate stains. Actinomycosis should be included in the differential diagnoses of an endobronchial mass.
Abdomen ; Actinomyces ; Actinomycosis* ; Adult ; Basophils ; Bronchiectasis ; Coloring Agents ; Cough ; Diagnosis, Differential ; Eggs ; Eosinophils ; Female ; Granuloma ; Hemoptysis ; Humans ; Hyalin ; Lung ; Middle Aged ; Mouth ; Nocardia ; Oropharynx ; Ovum ; Sputum ; Staphylococcus ; Streptomyces ; Thorax ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary ; Weight Loss

Maspin is a recently described gene with tumor suppressor activity. The gene product is a 42 kD protein with homology to the serpin family of protease inhibitors and may play a role as an inhibitor of tumor cell invasion. The prior observation that invasive breast cancers and their metastases showed decreased maspin protein expression by immunostaining supports this speculation. However, the role of maspin in breast cancer progression has not been studied in detail. We, therefore, studied maspin protein expression in a series of hyperplasia, atypical ductal hyperplasia, intraductal carcinoma and invasive carcinomas. Immunohistochemical staining (IHC) for maspin was performed on paraffin sections of 136 breast specimens using a commercially available monoclonal antibody. Among the 106 cases studied were 36 moderate/florid ductal hyperplasia, 11 atypical ductal hyperplasia (ADH), 29 intraductal carcinoma (IDC) (4 low grade, 13 intermediate grade, 12 high grade) and 30 invasive ductal carcinomas. Thirty cases of normal breast were also studied as control group. IHC stains were scored using a semiquantitative scoring system. The mean IHC scores for maspin for normal, moderate/florid hyperplasia, atypical ductal hyperplasia, intraductal carcinoma, and invasive carcinoma were 5.51 1.30, 7.36 0.72, 3.82 1.60, 4.48 2.69, 3.97 3.30, respectively. These scores for each category were statistically significant (p<0.05), except between ADH and IDC. Maspin protein expression was increased in most cases of moderate/florid hyperplasia, while maspin expression was more heterogeneous in ADH and IDC. In high grade IDC, maspin protein expression was stronger than low and intermediate grade IDC, and this suggests the possibility of a compensatory cellular response against the forces driving further tumor progression. Two thirds of invasive ductal carcinomas expressed maspin protein weakly and focally. All metastatic carcinomas of lymph nodes were negative for maspin. It is possible that high grade IDC with strong maspin expression may represent a subset less likely to progress to invasive cancer. This speculation merits investigation in clinical outcome studies.
Breast Neoplasms ; Breast* ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Coloring Agents ; Humans ; Hyperplasia* ; Lymph Nodes ; Neoplasm Metastasis ; Outcome Assessment (Health Care) ; Paraffin ; Protease Inhibitors

The purposes of this study were (1) to understand how customers trade off one attribute against another when they choose a pizza restaurant, (2) to compare the importance of individual attributes with their relative importance and (3) to compare customers' brand choice patterns with the prediction of pizza restaurant operators. Empirical data for this study were collected from the customers (n = 307) and operators (n = 273) of four famous pizza franchise restaurants in Korea, Pizza Hut, Mister Pizza, Domino's Pizza and Pizza Mall. The attributes and attribute levels for the hypothetical profiles were decided from the focus group discussion. A total of 16 profiles was selected from fractional factorial designs. The SPSS conjoint procedure was used to calculate utility scores and simulate profiles. The overall group statistics showed the relative importance of all attributes compared with one other. Taste was the most important attribute (32.48%) in choosing a pizza restaurant, followed by service (21.87%), atmosphere (17.23%), price (15.17%) and speed of delivery (13.26%). There was a difference between the customers' ratings of the importance of the individual attributes and the ranking of the same attributes' relative importance as derived from the conjoint analysis. The operators rated service (26.54%) as also being important, as well as taste (27.76%), in choosing a pizza restaurant. The rankings of relative importance for pizza taste, service and price were statistically different in the customers' and operators' data (p < .001, p < .01, p < .05). Operators who want to differentiate themselves from their competitors should make decisions based on an increased understanding of their customers' brand choice decision process and measure the hidden needs of their customers.
Atmosphere ; Focus Groups ; Korea ; Restaurants*

Lateral compartment syndrome of the lower leg is rarely observed. Hence, there may be difficulty in diagnosis as its clinical patterns are different and more complicated than usual. We report two rare cases of a 20-year-old and a 28-year-old diagnosed with isolated lateral compartment syndrome who had either a surgical or conservative treatment. The comparison was done by analyzing the progression of neurological manifestation, electromyography, and nerve conduction study for two years. In the final follow-up, the patient who underwent the surgical treatment showed a shorter recovery time. However, both patients showed a full recovery from neurologic deficits.