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

PURPOSE: Median nerve entrapment syndrome within carpal tunnel is usually called carpal tunnel syndrome and it is the most common form of peripheral nerve entrapment syndrome. Many factors such as diabetes mellitus, hypothyroidism, hormonal replacement theraphy, corticosteroid use, rhematoid arthritis and wrist fractures may cause carpal tunnel syndrome. To the best of our knowledge, this is the first case report of median nerve entrapment syndrome due to adhesion of laceration wound after suicidal attempt. METHODS: A 28-year-old woman presented with a sensory change and thenar hypotrophy on her left hand. On her history, she attempted suicide by slashing her wrist. Initial electromyography (EMG) showed that the nerve conduction velocities of median nerve was delayed. Therefore, we performed surgical procedures. When exploration, Fibrous scar tissue observed around the median nerve but nerve had not been injured. Transcarpal ligament was completely released and adjacent fibrous tissue was removed to decompress the median nerve. RESULTS: The postoperative course was uneventful until the first year. Opposition difficulty and thenar hypotrophy were improved progressively after the surgery. Sensory abnormality was slowly improved over one year. CONCLUSION: We report a case of median nerve entrapment syndrome that was caused by adhesion of laceration wound after suicidal attempt. This is an unusual cause of median nerve entrapment syndrome, the symptoms were relieved after transcarpal ligament release and fibrous scar tissue removal.
Adult ; Arthritis ; Carpal Tunnel Syndrome ; Cicatrix ; Diabetes Mellitus ; Electromyography ; Female ; Hand ; Humans ; Hypothyroidism ; Lacerations ; Ligaments ; Median Nerve ; Neural Conduction ; Peripheral Nerves ; Suicide, Attempted ; Wrist

BACKGROUND AND OBJECTIVES: The incidence of postoperative atrial fibrillation after noncardiothoracic surgery is known to be very rare; there have been few prior studies on this topic. We evaluated the incidence, predictors, and prognosis of atrial fibrillation after noncardiothoracic surgery. SUBJECTS AND METHODS: Patients who underwent noncardiothoracic surgery at our medical center under general anesthesia were enrolled. We reviewed medical records retrospectively and evaluated whether the atrial fibrillation developed postoperatively or was pre-existing. Patients who had a previous history of atrial fibrillation or atrial fibrillation on the pre-operative electrocardiogram were excluded. RESULTS: Between January 2005 and December 2006, 7,756 patients (mean age: 69 years, male: 46%) underwent noncardiothoracic surgery in Samsung Medical Center and 30 patients (0.39%) were diagnosed with newly-developed atrial fibrillation. Patients who developed atrial fibrillation were significantly older and had significantly lower body mass indexes. Newly-developed atrial fibrillation was detected in 0.53% of the male patients and 0.26% of the female patients. The incidence of postoperative atrial fibrillation after an emergency operation was more frequent than that of elective operations (p<0.001). According to the multivariate analysis, age and emergency operations were independent predictors for new onset atrial fibrillation after noncardiothoracic surgery. Postoperative atrial fibrillation developed after a median of 2 days after the noncardiothoracic surgery and was associated with a longer hospitalization and increased in-hospital mortality. Four (13.3%) patients died and the causes of death were non-cardiovascular events such as pneumonia or hemorrhage. CONCLUSION: Postoperative atrial fibrillation after noncardiothoracic surgery is a rare complication and is associated with older age and emergency operations. Patients who develop atrial fibrillation have longer hospitalizations and higher in-hospital mortality rates.
Anesthesia, General ; Atrial Fibrillation ; Body Mass Index ; Cause of Death ; Electrocardiography ; Emergencies ; Female ; Hemorrhage ; Hospital Mortality ; Hospitalization ; Humans ; Incidence ; Male ; Medical Records ; Multivariate Analysis ; Pneumonia ; Postoperative Complications ; Prognosis ; Retrospective Studies

PURPOSE: Sebaceous carcinoma is a rare malignant tumor derived from the adnexal epithelium of sebaceous glands. This tumor usually occurs on the eyelids, but uncommonly it may occur on the extraocular sites. It is characterized by a tendency of local recurrence and occasional metastasis. Surgical excision is appropriate treatment for patients with sebaceous carcinoma. While this kind of case is rare, we report two cases of sebaceous carcinoma developed on scalp. METHODS: Case 1 was a 69-year-old woman. She visited the hospital with a 1.5 x 2.5 cm sized reddish yellow-colored, slowly growing mass on the left parietal scalp. The mass began at birth and started growing 5 years ago. Case 2 was a 67-year-old woman. She had 2.5 x 3.0 cm sized yellow-colored mass on the right parietal scalp. It occurred at birth and started growing 3 years ago. And the masses had erythematous ulcer with sanguineous discharge. In the beginning, the masses were miliary nodule. RESULTS: CT scan and fine needle biopsy were done. Case 1 and 2 were diagnosed as sebaceous carcinoma. Wide excision with safety margin of 10 mm and split thickness skin graft was done. Histological examination revealed well demarcated, irregular, variable sized tumor lobules. Each lobule was composed of sebaceous and undifferentiated cells. Postoperatively, the patients did well and the lesion did not recur. CONCLUSION: Sebaceous carcinoma is an aggressive malignant tumor. It is often confused with other skin tumors. Authors experienced two rare cases of sebaceous carcinoma developed on scalp. We recommend early wide excision with enough safety margin as treatment of sebaceous carcinoma.
Aged ; Biopsy, Fine-Needle ; Epithelium ; Eyelids ; Female ; Humans ; Neoplasm Metastasis ; Parturition ; Recurrence ; Scalp ; Sebaceous Glands ; Skin ; Transplants ; Ulcer

Warthin's tumor is a benign neoplasm that most frequently occurs in the parotid gland. Warthin's tumor shows a tendency of bilateral occurrence, but most of bilateral tumors occur at different time. It usually affects older man and grows slowly. Surgical excision is appropriate treatment for patients with Warthin's tumor and rarely recurs after removal. We report a rare case of bilateral Warthin's tumor which detected at the same time. A 54-year-old man had painless, slowly growing masses on the both mandibular angles. The masses were detected ten years ago. CT scan, ultrasonographic evaluation and fine needle biopsy was performed for preoperative diagnostic study. Superficial parotidectomy was done one after the other at ten-day intervals. After excision, histological examination revealed a mixture of ductal epithelium and a lymphoid stroma. The overlying surface of lymphoid tissue was covered with epithelial cells that was abundant of eosinophilic cytoplasm. Both masses were diagnosed as Warthin's tumor. Postoperatively, the patient did well and had no evidence of recurrence of tumor for 2 years follow-up period. Authors experienced a rare case of bilateral Warthin's tumor which detected at the same time. We recommend stepwise superficial parotidectomy at one or two-week intervals as treatment of bilateral Warthin's tumor.
Biopsy, Fine-Needle ; Cytoplasm ; Eosinophils ; Epithelial Cells ; Epithelium ; Follow-Up Studies ; Humans ; Lymphoid Tissue ; Middle Aged ; Parotid Gland ; Recurrence

BACKGROUND: Evaluating left ventricular (LV) contractile function in patients with mitral regurgitation (MR) is a difficult clinical problem. Although LV dP/dt measured by Doppler echocardiography has been shown to be a good marker for LV contractility, it is limited clinically due to the complexity of the measurement and the difficulty in obtaining appropriate Doppler tracings in patients with eccentric MR. We hypothesized that systolic mitral annulus velocity (S') can be a good marker of LV dP/dt. METHODS: We studied 62 patients (25 men, age: 47+/-15 years) who had 3+ or 4+ MR with normal LV systolic function (ejection fraction >50%). Two-dimensional and Doppler echocardiography was performed. LV dP/dt-Doppler was measured using MR jet tracing as previously reported. S' velocity was measured at the septal annulus using Doppler tissue imaging. In 10 patients undergoing mitral surgery, LV pressure was measured with micromanometer-tipped catheter and peak dP/dt-cath was calculated. RESULTS: Mean LV ejection fraction was 60+/-6% and regurgitant fraction was 59+/-15%. S' velocity correlated well with LV dP/dt-Doppler (r=0.50, p<0.01). In 10 patients who underwent LV catheterization, LV dP/dt-Doppler correlated well with peak dP/dt-cath (r=0.68, p=0.03). Whereas S' velocity could be measured in all patients, LV dP/dt-Doppler could not be measured in 31 patients (50%) due to eccentric jet direction. CONCLUSION: Systolic mitral annulus velocity is a simple and feasible marker of LV dP/dt and, therefore, may be useful for assessing myocardial contractile function in patients with MR.
Catheterization ; Catheters ; Echocardiography, Doppler ; Humans ; Male ; Mitral Valve Insufficiency

Varix of the digit is generally defined as an enlarged, tortuous palmar digital vein with or without thrombus within it. It usually presents as a firm, blue mass on the volar aspect of the finger. Mechanical compression or chronic trauma to veins on the volar surface of a digit appears central to the pathogenesis of this lesion. Aging phlebectasia has also been considered as a cause of this lesion in the elderly. A tourniquet test may be useful in demonstrating the presence of a digital varix, but it is confirmed by postoperative microscopic examination. Excision of a symptomatic lesion has proven to be curative. We report two cases of symptomatic digital varix which developed in the fourth finger with a review of literatures.
Aged ; Aging ; Fingers ; Humans ; Thrombosis ; Tourniquets ; Varicose Veins ; Veins

PURPOSE: Hook nail deformity is caused by inadequately supported nail bed due to loss of distal phalanx or lack of soft tissue, resulting in a claw-like nail form. A composite graft from the foot bencath the nail bed gives adequate restoration of tip pulp. METHODS: From September of 1999 to March of 2004, six patients were treated for hook nail deformity and monitored for long term follow up. Donor sites were the lateral side of the big toe or instep area of the foot. We examined cosmetic appearance and nail hooking and sensory test. The curved nail was measured by the picture of before and after surgery. RESULTS: In all cases, composite grafts were well taken, and hook nail deformities were corrected. The curved nail of the 4 patients after surgery were improved to average 28.7 degrees from average 55.2 degrees before surgery. The static two point discrimination average was 6.5mm and the moving two point discrimination average was 5.8mm in the sensory test. CONCLUSION: Composite graft taken from foot supports the nail bed with the tissue closely resembling the fingertip tissue, making it possible for anatomical and histological rebuilding of fingertip.
Congenital Abnormalities* ; Discrimination (Psychology) ; Follow-Up Studies ; Foot ; Humans ; Tissue Donors ; Toes ; Transplants*

INTRODUCTION: While uncommon, humeral head osteonecrosis is an indication for arthroplasty when the humeral head collapse is advanced. The current authors report the short-term clinical results of 7 hemiarthroplasties to treat humeral head osteonecrosis. MATERIALS AND METHODS: This study focused on 7 reconstructed shoulders of 5 patients whose humeral head osteonecrosis was treated with hemiarthroplasty. The postulated causes were alcohol-induced (4 cases) and steroidinduced (3 cases). The minimum follow-up was 12 months. This study compared the preoperative and postoperative shoulder pain, range of motion, and ASES scores. The postoperative patient satisfaction was assessed. RESULTS: The level of pain during exercise was reduced from a preoperative average of 7.6 to a postoperative average of 1.9. The range of motion, in terms of forward flexion, abduction, and external rotation, improved from preoperative averages of 105.7degrees, 80degrees, and 22.1degrees to postoperative averages of 146.6degrees, 139.3degrees, and 44.3degrees, respectively. The ASES scores increased from a preoperative mean of 39.0 to a postoperative mean of 84.1. The patients' ratings of the outcomes were excellent (5 cases) and good (2 cases). CONCLUSIONS: These short-term results indicate that hemiarthroplasty is a reliable treatment method for humeral head osteonecrosis improving shoulder pain, range of motion, and patient satisfaction.
Arthroplasty ; Follow-Up Studies ; Hemiarthroplasty* ; Humans ; Humeral Head* ; Osteonecrosis* ; Patient Satisfaction ; Range of Motion, Articular ; Shoulder ; Shoulder Pain

Radiographic research was performed to know the frequency of two-phalanged fifth toe and its relation to presence of the ossification centers in normal Korean children. Previous study showed more than 74% of the incidence in adulthood and less than 30% in childhood. Fifty children (33 male and 17 female, aged 2 to 15; mean age 9.6) were studied by plain foot radiographs focused on the fifth toe. In the 3~8 yr old 20 subjects, secondary ossification center of distal phalangeal bone was seen as a ossicle (small bone) placed at proximal to the distal phalanx. Secondary ossification center of middle phalangeal bone and the bony shaft of the phalanx was hard to distinguish. So keeping up the objectivity, regardless of distinguishable ossification center or the bony shaft of phalanges, ossicles seen on the 5th toe was counted to classify the presumptive type of the toe. Epiphyseal ossification center of proximal phalanx was excluded from the count. There were three types of the fifth toe which has 2 ossicles to 4 ossicles. Overall incidence of the type of 2 ossicles was 24% (12/50). Above 12 yr old group the incidence was 61% (11/18), and above 13 yr old group the incidence was 75% (9/12). The incidence of biphalangism came closer to the adult's after late childhood. This finding represent that progress of biphalangealization completed after late childhood. It seems that the progress starts earlier than 3 yr old. We made the hypothesis by the incidence of 30% (6/20) of the type which has 4 ossicles on the fifth toe at 3~8 yr old group. Four ossicles might be a secondary ossification center of distal phalanx and the bony shaft of distal, middle and proximal phalanx. They might form a distal interphalageal joint and the triphalangeal toe. To know more about the morphogenesis of biphalalngeal 5th toe, further progressive study in childhood is needed.
Child* ; Female ; Foot ; Humans ; Incidence ; Joints ; Male ; Morphogenesis ; Toes*