Ectopic pregnancy is a common medical problem that is difficult to diagnose and potentially may lead to significant mortality or morbidity. The incidence of ectopic pregnancy is definitely increasing due to the rise in pelvic inflammatory disease (PID), pelvic surgery, intrauterine device (IUD), and assisted reproductive technologies, such as in vitro fertilization and embryo transfer (IVF-ET). Combined ectopic gestations are much rare and their true incidence is unknown. Multiple ectopic gestations may occur in a variety of locations. The majority involve one or both fallopian tubes. We report a case of combined tubal and cervical pregnancies, and discuss their management.
Embryo Transfer ; Fallopian Tubes ; Female ; Fertilization in Vitro ; Incidence ; Intrauterine Devices ; Mortality ; Pelvic Inflammatory Disease ; Pregnancy* ; Pregnancy, Ectopic ; Reproductive Techniques, Assisted

Myotonic dystrophy is a multisystemic disorder inherited as an autosomal dominant trait. The characteristic clinical features include the presence of myotonia, atrophy of the muscles of the face and the sternocleidomastoids and numerous nonmusclar manifestations such as cataracts, frontal baldness, gonadal dysfunctions and cardiac abnormalities. We experienced one case of myotonic dystrophy with prolonged atrial flutter in 30-year-old male who was admitted because of palpitation. We present this case with reviewing literatures.
Adult ; Alopecia ; Atrial Flutter* ; Atrophy ; Cataract ; Gonads ; Humans ; Male ; Muscles ; Myotonia ; Myotonic Dystrophy*

No abstract available.
Femur*

No abstract available.

Fibromatosis is generally a benign tumor that arises from the musculoaponeurotic tissues of the body, rarely occurring in the head and neck region. This can be treated with a good prognosis, but sometimes recurs as a local invasion. Preoperative core needle biopsy and MR images are necessary to diagnose preoperatively and outline the tumor extent. The mainstay of treatment is complete surgical excision. Nonetheless, an excision is often difficult because of the complex anatomy or proximity of the tumor to vital structures in the head and neck region. We report a rare case of desmoid-type fibromatosis that occurred in the neck, closely attached to the transverse process of the cervical vertebra. The present article covers an extensive analysis of the case with a review of the related literature.
Biopsy, Large-Core Needle ; Cervical Vertebrae ; Female ; Fibroma* ; Fibromatosis, Aggressive ; Head ; Neck ; Prognosis ; Spine*

Background: Owing to limited experience with the new vaccine platforms, discussion of vaccine safety is inevitable. However, media coverage of adverse events of special interest could influence the vaccination rate; thus, evaluating the outcomes of adverse events of special interest influencing vaccine administration is crucial. Methods: We conducted regression discontinuity in time analysis to calculate the local average treatment effect (LATE) using datasets from Our World in Data and Johns Hopkins University Center for Systems Science and Engineering. For the United States, the United Kingdom, and Europe, the cutoff points were April 23rd and June 23rd, April 7th, and the 14th week of 2021, respectively. Results: The LATE of the Advisory Committee on Immunization Practices (ACIP) meeting held on April 23rd was −0.249 for all vaccines, −0.133 (−0.189 to −0.076) for Pfizer, −0.064 (−0.115 to −0.012) for Moderna, and −0.038 (−0.047 to −0.030) for Johnson & Johnson. Discontinuities were observed for all three types of vaccines in the United States. The June 23rd meeting of the ACIP (mRNA vaccines and myocarditis) did not convene any discontinuities. Furthermore, there was no significant drop in the weekly average vaccination rates in Europe following the European Medicines Agency (EMA) statement on April 7th. Conversely, there was a significant drop in the first-dose vaccination rates in the United Kingdom related to the EMA report. The first-dose vaccination rate for all vaccines changed by −0.104 (−0.176 to −0.032). Conclusion Although monitoring and reporting of adverse events of special interest are important, a careful approach towards public announcements is warranted.

Background: Although the effectiveness of acromioplasty is controversial, it is commonly performed during rotator cuff repair to reduce external impingement. During follow-up, osteolysis under the acromion (acromial cupping) could be observed. However, this phenomenon has been rarely addressed in the literature. The purpose of this study was to compare the prevalence and severity of acromial cupping after rotator cuff repair depending on the concomitant performance of acromioplasty and evaluate the influence of acromial cupping on clinical and radiological outcome. Methods: This is a retrospective study involving patients who underwent arthroscopic rotator cuff repair for small-to-large fullthickness rotator cuff tears from October 2015 to March 2019 and clinical follow-up and magnetic resonance imaging at least 1 year postoperatively. A total of 110 patients were enrolled and divided into two groups depending on whether acromioplasty had been performed (group A) or not (group N). The prevalence of acromial cupping was evaluated in each group. In addition, we stratified patients according to the severity of acromial cupping to investigate its influence on healing and functional scores (visual analog scale [VAS], American Shoulder and Elbow Surgeons [ASES] score, simple shoulder test [SST], and Constant-Murley score). Results: There were 85 patients in group A and 25 patients in group N. The prevalence of acromial cupping and acromial cysts was as follows: 36.4% (40 patients) and 6.4% (7 patients), respectively, in the total subjects; 43.5% (37/85) and 5.9% (5/85), respectively, in group A; and 12.0% (3/25) and 8.0% (2/25), respectively, in group N. The prevalence of acromial cupping was significantly different between the two groups (p = 0.012). However, functional outcomes were not significantly different between groups stratified by the severity of acromial cupping (VAS, p = 0.464; ASES score, p = 0.902; SST, p = 0.816; and Constant-Murley score, p = 0.117). The difference in healing rate was statistically insignificant between groups (p = 0.726). Conclusions The incidence and severity of acromial cupping were significantly greater in patients who underwent rotator cuff repair with acromioplasty. It was a relatively common phenomenon, especially after acromioplasty. However, neither the existence nor the severity of acromial cupping affected functional outcomes or healing.

BACKGROUND: Alopecia areata (AA) is a T cell-mediated autoimmune disease that targets hair follicles and interrupts hair regrowth. The microenvironment of the effector T cells and their related cytokines may affect immunopathogenesis around the hair bulb/bulge. OBJECTIVE: To determine the contributory roles of the effector T cell subsets and related cytokines to the pathogenesis of AA. METHODS: We investigated the correlation between histopathological grades and four clinical prognostic factors in 331 patients with AA, and analyzed the topography of T cell infiltrates and related cytokines around the hair bulb/bulge according to histopathological grades through immunohistochemical and double immunofluorescence studies on a subset of AA specimens. RESULTS: First, the groups with more severe histopathological grades were associated with earlier onset, longer duration, more hair loss, as well as poorer therapeutic outcomes. Second, the pattern of CD4 and CD8 expression around the hair bulb/bulge varied by histopathological grade, with staining density decreasing in the following order: type 1>type 2>type 3. In addition, interferon-γ and transforming growth factor-β1 expression appeared denser in the peribulbar area. Interestingly, the denser CCR6⁺ cells (Th17 cells) showed more infiltration than CCR5⁺ cells (Th1 cells) around the hair bulb/bulge as histopathological grade worsened. CONCLUSION: The insidious destruction of bulge stem cells and hair bulb matrix stem cells results in more severe hair loss in patients with chronic AA, which is mediated by Th17 lymphocyte and cytotoxic T lymphocyte infiltration. Furthermore, Th17 lymphocytes may play an even more important role than cytotoxic T cells in the development of AA.
Alopecia Areata* ; Alopecia* ; Autoimmune Diseases ; Cytokines ; Fluorescent Antibody Technique ; Hair Follicle ; Hair* ; Humans ; Lymphocytes* ; Stem Cells ; T-Lymphocyte Subsets ; T-Lymphocytes ; Th17 Cells

BACKGROUND AND OBJECTIVES: Most reports about coronary angiographic findings in acute myocardial infarction were done after thrombolytic therapy or several days after onset of symptom. The aim of this study is to evaluate coronary angiographic findings in patients with AMI within 24 hours after onset of symptoms and without thrombolytic therapy. Also we evaluated the correlation between the risk factors and severity of coronary artery disease. MATERIALS AND METHODS: We studied 70 patients with acute myocardial infarction admitted to Kyungpook National University Hospital (KNUH) from November 1997 to January 1999, and evaluated the clincial and coronary angiographic findings. We analyzed risk factors of coronary artery disease: age, total cholesterol, tiglyceride, high density lipoprotein (HDL)-cholesterol, low density lipoprotein (LDL)-cholesterol, hypertension, smoking, diabetes and family history of CAD. Coronary angiography was done immediately after the arrival at emergency room (door-to- angiography time). Exclusion criteria were delayed arrival (more than 24 hours after symptom onset), previous history of anticoagulation or medication of antiplatelet agents. RESULTS: 1) Among 70 patients (M/F: 53/17), 59 patients had Q wave myocardial infarction (QMI) (84%), 11 patients had non-Q wave-MI (NQMI) (16%). 2) The mean age was 61+/-12.2 years (range: 26 to 82 years). 3) The mean time from the onset of chest pain to angiography was 6.2+/-4.7 hours. 4) Twenty eight patients (40%) had one-vessel disease, 25 (36%) had two-vessel disease and 17 (24%) had three-vessel disease. 5) The location of infarct related arteries were as follows: LAD in 33 (47%), LCX in 13 (19%) and RCA in 24 (34%). 6) The mean diameter stenosis of infarct related artery (IRA) was 95+/-10.9%. According to the American College of Cardiology/American Heart Association (ACC/AHA) classification of IRA, type B lesion occurred most commonly in 56 patients (80%). 7) Thrombus was observed in 44 patients (63%) with QMI versus 3 patients (27%) with NQMI (p=0.006). 8) Calcifications of the wall of coronary arteries were observed in 28 patients (40%) and correlated with ages of patients. 9) History of cigarette smoking was present in 73%, hypertension in 31% and hypercholesterolemia in 15% of patients. The mean number of risk factor for each patient was 1.3. 10) Multivessel disease was significantly more frequent in patients who had two more risk factors. 11) The frequency of cigarette smoking was greater and the level of plasma triglyceride were higher in patients under 50 years of age. 12) One patient died during coronary angiography and another 2 patients died at 5 and 8 days after coronary angiography due to cardigenic shock. CONCLUSION: In immediate coronary angiographic findings in patients with AMI, multivessel disease and thrombus, and severe stenosis of IRA were observed more frequently than other studies after thrombolytic therapy or after several days of delay. Multivessel disease was significantly more frequent in the patients who had two or more risk factors of atherosclerosis.
Angiography ; Arteries ; Atherosclerosis ; Chest Pain ; Cholesterol ; Classification ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Emergency Service, Hospital ; Gyeongsangbuk-do ; Heart ; Humans ; Hypercholesterolemia ; Hypertension ; Lipoproteins ; Myocardial Infarction* ; Plasma ; Platelet Aggregation Inhibitors ; Risk Factors ; Shock ; Smoke ; Smoking ; Thrombolytic Therapy ; Thrombosis ; Triglycerides

BACKGROUND AND OBJECTIVES: The intracoronary stent may be useful in the preventing of abrupt closure and coronary restenosis after coronary angioplasty, and recently primary stenting has been one of therapeutic modalities. We assessed the clinical and angiographic results of primary NIR stenting in patients with acute myocardial infarction (AMI). MATERIALS AND METHODS: Between November 1997 to January 1999, 55 stentings with NIR stents were done in 51 patients with acute myocardial infarction. Angiographic follow-up was available at 7+/-2.3 days in 35 patients. RESULTS: 1) Among 51 patients (M/F: 37/14), 44 patients had Q-wave MI (86%), 7 patients had non-Q-wave MI (14%). 2) The mean age was 61+/-12.4 years (range: 26 to 82 years). 3) The mean time from the onset of chest pain to the arrival at emergency room was 4.6 +/- 4.2 hours. The mean door-to-balloon time was 93+/-46 minutes 4) Treated vessels were as follows: 28 in LAD, 17 in RCA, 10 in LCX. 5) The indications for stent implantation were suboptimal angiographic results after PTCA in 38 lesions (69%), dissection in 9 lesions (16%), abrupt vessel closure in 1 lesion and elective in 7 lesions (13%). 6) Single stent implantation was done in 47 patients. Overlapping stents were done in 4 patients. 7) A procedure related complication occurred in one patient, peri-stent dissection without flow limitation. 8) Full expansion of the stent failed in three lesions with coronary calcifications and the residual stenosis was 35, 40, 50% in each case. In these cases, in-stent thrombus was not demonstrated in follow up angiography. 9) The minimal lumen diameter increased from 0.11+/-0.39 to 2.96+/-0.40 mm. 10) Angiographic follow-up on 38 stents in 35 patients demonstrated in-stent thrombus in 3 stents, in-stent restenosis in 1 stent. But in-stent flow limitations were not found in these 4 cases and TIMI III flow were maintained. Patients with Q-wave MI and coronary thrombus on initial angiography were more prone to subacute thrombosis. CONCLUSION: The NIR stent could be used successfully in primary coronary stenting in acute myocardial infarction. The present study shows relatively low risk of subacute stent thrombosis. The rate of restenosis needs to be confirmed by long term study.
Angiography ; Angioplasty ; Chest Pain ; Constriction, Pathologic ; Coronary Restenosis ; Emergency Service, Hospital ; Follow-Up Studies ; Humans ; Myocardial Infarction* ; Stents* ; Thrombosis