Objective: Chronic subdural hematoma (CSDH) is a neurological complication following clipping surgery. However, the natural course and ideal approach for the treatment of clipping-related-CSDH (CR-CSDH) have not been clearly established. We aimed to investigate the course of CR-CSDH using chronological radiological findings. Methods: We performed a retrospective analysis of 28 (3.8%) patients who developed CSDH among 736 patients who underwent surgical clipping using pterional approach for unruptured aneurysms at our institution between December 2010 and December 2018. Patients underwent follow-up CT scan 6–8 weeks after clipping surgery and decision to pursue surgical intervention rests upon the patient’s symptom based on the Markwalder’s grading scale (MGS) and numeric rating scale (NRS). Results: Of the 28 patients, 3 patients (10.7%) underwent surgery, while 25 (89.2%) showed spontaneous resolution of CR-CSDH. Eighteen patients (64.2%) had mild headache with MGS of 0–1. The mean maximum hematoma volume was 41.9±30.9 ml (5.8–135 ml), and 26 patients (92.8%) had homogeneous hematoma. The mean time to hematoma resolution was 126.7±52.9 days (46–228 days). Comparing group of CR-CSDH volume ≥43 ml or a midline shift ≥5 mm, the difference in presence of linear low-density area (p=0.002) and age (p=0.026) between the conservative and operative groups were found to be statistically significant. Conclusions Most CR-CSDH cases spontaneously resolved within 4 months. Therefore, we suggest that close observation should be performed if patient’s symptoms are mild and special radiologic findings are present, despite its relatively large volume and midline shifting.

Nontuberculous mycobacteria are ubiquitous environmental organisms that are rare pathogens in immunocompetent individuals. However, cutaneous nontuberculous mycobacteria infections have been increasingly associated with invasive procedures, including surgery, liposuction, filler injection, intramuscular injection, mesotherapy, piercing, acupuncture, and cupping therapy. Herein, we report the first case of cutaneous nontuberculous mycobacteria infection caused by the East-Asian traditional treatment ‘Gua Sha’, also known as scraping, coining or spooning in English. A 35-year-old healthy female presented with widespread, painful skin nodules and pustules on her upper and lower extremities that had developed after Gua Sha treatment for body contouring. Histopathologic examination of the lesions revealed granulomatous inflammation in the dermis and the culture isolates were identified as Mycobacterium massiliense with molecular identification. The patient was successfully treated with intermittent incision and drainage of persistent nodules and oral clarithromycin based on antimicrobial susceptibility testing. We recommend implementation of a standard safety protocol for Gua Sha practitioners to minimize the risk of infection transmission.

No abstract available.
Humans ; Keratoderma, Palmoplantar ; Pityriasis Rubra Pilaris ; Pityriasis ; Siblings

No abstract available.
Aged ; Dermoscopy ; Diagnosis ; Female ; Humans

Purpureocillium lilacinum, formerly Paecilomyces lilacinus, is a saprophytic fungus found in soil and rotting vegetation and rarely pathogenic to humans. Only 4 cases of cutaneous infection caused by Purpureocillium lilacinum have been reported in the name of Paecilomyces lilacinus. Herein, we report a case of localized cutaneous infection due to Purpureocillium lilacinum. A healthy 81-year-old immunocompetent male presented with an erythematous scaly and pustular plaque on his left dorsal hand that had begun 3 months ago. Histopathologic examination showed suppurative granulomatous inflammation with hyphae and round spores in the dermis. Periodic acid-Schiff and methenamine silver stain revealed fungal spores. Fungus culture from the biopsy specimen revealed velvety pink to white colonies after 15 day-incubation period. The slide culture stained with lactophenol-cotton blue showed typical long hyphae and flask-shaped phialides with oval conidia in chains. The result of DNA sequencing from the colony was identical to that of Purpureocillium lilacinum.
Aged, 80 and over ; Biopsy ; Dermis ; Fungi ; Hand ; Humans ; Hyphae ; Inflammation ; Male ; Methenamine ; Paecilomyces ; Sequence Analysis, DNA ; Skin* ; Soil ; Spores ; Spores, Fungal

Angiomyxolipoma is a recently described and rare variant of lipoma that is characterized by the proliferation of adipose tissue with a myxoid stroma and multiple thick and thin-walled blood vessels. A 51-year-old man presented with a tender subcutaneous nodule on his right arm. The tumor was completely removed by excisional biopsy, and the histopathologic features revealed a thin fibrous capsule with incomplete fibrous septa extending into the lesion, dividing it into lobules of different sizes. The fat cells were mature, with a single vacuole and an eccentric nucleus. The vascular component consisted of groups of capillaries and occasional vessels of larger caliber. Erythrocytes were present within the lumen, and myxoid stroma was found. He was diagnosed as having angiomyxolipoma. Herein, we report a rare case of subcutaneous angiomyxolipoma of the arm. We also review and discuss such cases in the literature.
Adipocytes ; Adipose Tissue ; Arm ; Biopsy ; Blood Vessels ; Capillaries ; Erythrocytes ; Humans ; Lipoma ; Middle Aged ; Vacuoles

No abstract available.
Breast Neoplasms, Male* ; Humans ; Male ; Male* ; Neoplasm Metastasis*

No abstract available.
Herpes Zoster* ; Intestinal Pseudo-Obstruction*