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We report a 23-year-old woman who presented with generalized scaly erythematous rash predominately on the upper trunk and hemorrhagic stomatitis. The histopathologic and immunopathologic findings were consistent with the diagnosis of paraneoplastic pemphigus. Castleman’s tumor was diagnosed with computed tomography and exploratory laparotomy. A partial clinical improvement was observed after complete tumor removal and intravenous immunoglobulin administration. However, the patient died as a result of septicemia.

Progressive supranuclear palsy (PSP) is characterized by supranuclear gaze palsy, dystonic rigidity of the neck and upper trunk, frequent falls and mild cognitive impairment. Cerebellar ataxia is one of the exclusion criteria given by the National Institute of Neurological Disorders and Stroke and the Society for Progressive Supranuclear Palsy. As a result, pathologically proven PSP patients exhibiting cerebellar ataxia have often been misdiagnosed with spinocerebellar degeneration, specifically multiple system atrophy with predominant cerebellar ataxia (MSA-C). However, more recently, it has been recognized that patients with PSP can present with truncal and limb ataxia as their initial symptom and/or main manifestation. These patients can be classified as having PSP with predominant cerebellar ataxia (PSP-C), a new subtype of PSP. Since the development of this classification, patients with PSP-C have been identified primarily in Asian countries, and it has been noted that this condition is very rare in Western communities. Furthermore, the clinical features of PSP-C have been identified, enabling it to be distinguished from other subtypes of PSP and MSA-C. In this review, we describe the clinical and neuropathological features of PSP-C. The hypothesized pathophysiology of cerebellar ataxia in PSP-C is also discussed.

Eruptive tumor of the follicular infundibulum (TFI) is an extremely rare benign neoplasm that usually presents as asymptomatic multiple hypopigmented macules symmetrically distributed on the head, neck, and upper trunk. Herein, we report a case of eruptive TFI presenting as hypopigmented macules with central and slightly elevated erythematous papules at rarely involved locations of the four extremities, which has not been reported previously. The pathology showed characteristic features that were conclusive of the diagnosis of eruptive TFI. Because hypopigmentation is a common clinical manifestation and malignant transformation is possible with eruptive TFI, correct early diagnosis, and regular follow-ups are recommended.

When people walk on a treadmill, significant differences exist in postural control if compared to walking on the ground. In this paper, a method combining linear and nonlinear analysis is proposed to evaluate the walking postural control ability. In this method, the movements of the upper body and the feet are analyzed separately, because these parts have more capacity to reflect the characteristics of people’s gait. On this basis, the linear and nonlinear indicators of each part are analyzed, and the postural control ability is evaluated. The method is validated by three healthy subjects walking on both the treadmill and the ground. In treadmill walking case, the results show a smaller upper trunk acceleration (UTa) in the anterior-posterior (AP) direction. In the foot movement analysis, there are significant differences in the performance indexes related to the center of pressure (CoP) when people are walking on the treadmill and the ground. When walking on the treadmill, the velocity, acceleration, and jerk of the CoP in the AP direction are smaller than those in the ground walking case. Besides, when people walk on treadmills at uniform speeds, their feet accelerate is less in the vertical direction, and they have shorter stride length (SL) and longer stride time (ST). These results suggest that people have better postural control when walking on a treadmill. This method can be used as a means of assessing people’s behavior when walking on various situations by evaluating their control posture ability.

Financiado para publicación en acceso aberto: Universidade da Coruña/CISUG [Abstract] Introduction: Phrenic nerve transfer has been shown to achieve good nerve regeneration in brachial plexus avulsion. Acellular nerve allografts (ANAs) showed inferior results to autografts, which is why its use with mesenchymal stem cells (MSCs) is currently being studied. The aim is to study the effect of BM-MSCs associated with ANAs in a rat model of phrenic nerve transfer to the musculocutaneous nerve in a C5-C6 avulsion. Material and methods: 42 Wistar-Lewis rats underwent a C5-C6 lesion in the right forelimb by excising a 3 mm segment from both roots, followed by a phrenic nerve transfer to the musculocutaneous nerve associated with the interposition of a three types of nerve graft (randomly distributed): control (autograft) group (n = 12), ANAs group (n = 12), and ANAs + BM-MSCs group (n = 18) After 12 weeks, amplitude and latency of the NAP and the compound motor action potential (CMAP) were measured. Biceps muscles were studied by histological analysis and nerve grafts by electron microscopy and fluorescence analysis. Results: Statistically significant reductions were found in latency of the CMAP between groups control (2.48 ± 0.47 ms) and experimental (ANAs: 4.38 ± 0.78 ms, ANAs + BM-MSCs: 4.08 ± 0.85 ms) and increases in the amplitude of the CMAP between groups control (0.04388 ± 0.02 V) and ANAs + BM-MSCs (0.02275 ± 0.02 V), as well as in the thickness of the myelin sheath between groups control (0.81 ± 0.07 μm) and experimental (ANAs: 0.72 ± 0.08 μm, ANAs + BM-MSCs: 0.72 ± 0.07 μm) and in the area of the myelin sheath between groups control (13.09 ± 2.67 μm2 ) and ANAs (10.01 ± 2.97 μm2 ) (p < .05). No statistically significant differences have been found between groups ANAs and ANAs + BM-MSCs. Conclusions: This study presents a model for the study of lesions of the upper trunk and validates the autologous graft as the gold standard.

A 55-year-old male presented with an eight-month history of erythematous papules and plaques with demarcated areas of spared skin on his trunk, upper extremities, neck, and face. Grover's disease is a rare, acquired disorder of unknown origin, which is classically characterized by the appearance of erythematous papules on the upper trunk that are usually transient. As in the present case, there are reports of atypical disease, with facial involvement, pityriasis rubra pilaris-like lesions, and a more chronic course.

A 2-year-old male child was brought by his mother to outpatient Department of Surgery with chief complains of a swelling in the upper back on left side since birth. Further history suggested, the swelling was small in size since birth with associated mild tenderness and it gradually started increasing in size. On clinical examination, the swelling was pulsatile in nature, soft in consistency with mild reddish discolouration and ulceration of the overlying skin; however, there was no local rise of temperature. The swelling was superficial to the muscle plane and measured approximately 5.5 x 4.7 cm in size. For further investigation, the child was referred to the Department of Radiodiagnosis for ultrasonography. On ultrasound, there were multiple anechoic cystic areas showing increased vascularity on colour Doppler.

Direct coaptation of contralateral C7 to the upper trunk could avoid the interposition of nerve grafts. We have successfully shortened the gap and graft lengths, and even achieved direct coaptation. However, direct repair can only be performed in some selected cases, and partial procedures still require autografts, which are the gold standard for repairing neurologic defects. As symptoms often occur after autografting, human acellular nerve allografts have been used to avoid concomitant symptoms. This study investigated the quality of shoulder abduction and elbow flexion following direct repair and acellular allografting to evaluate issues requiring attention for brachial plexus injury repair. Fifty-one brachial plexus injury patients in the surgical database were eligible for this retrospective study. Patients were divided into two groups according to different surgical methods. Direct repair was performed in 27 patients, while acellular nerve allografts were used to bridge the gap between the contralateral C7 nerve root and upper trunk in 24 patients. The length of the harvested contralateral C7 nerve root was measured intraoperatively. Deltoid and biceps muscle strength, and degrees of shoulder abduction and elbow flexion were examined according to the British Medical Research Council scoring system; meaningful recovery was defined as M3-M5. Lengths of anterior and posterior divisions of the contralateral C7 in the direct repair group were 7.64 ± 0.69 mm and 7.55 ± 0.69 mm, respectively, and in the acellular nerve allografts group were 6.46 ± 0.58 mm and 6.43 ± 0.59 mm, respectively. After a minimum of 4-year follow-up, meaningful recoveries of deltoid and biceps muscles in the direct repair group were 88.89% and 85.19%, respectively, while they were 70.83% and 66.67% in the acellular nerve allografts group. Time to C5/C6 reinnervation was shorter in the direct repair group compared with the acellular nerve allografts group. Direct repair facilitated the restoration of shoulder abduction and elbow flexion. Thus, if direct coaptation is not possible, use of acellular nerve allografts is a suitable option. This study was approved by the Medical Ethical Committee of the First Affiliated Hospital of Sun Yat-sen University, China (Application ID: [2017] 290) on November 14, 2017.

Contractures of the shoulder joint and glenohumeral joint dysplasia are well known complications to obstetrical brachial plexus palsy. Despite extensive description of these sequelae, the exact pathogenesis remains unknown. The prevailing theory to explain the contractures and glenohumeral joint dysplasia states that upper trunk injury leads to nonuniform muscle recovery and thus imbalance between internal and external rotators of the shoulder. More recently, another explanation has been proposed, hypothesizing that denervation leads to reduced growth of developing muscles and that reinnervation might suppress contracture formation. An understanding of the pathogenesis is desirable for development of effective prophylactic treatment. This article aims to describe the current state of knowledge regarding these important complications.

Background Poststroke shoulder pain (PSSP) could be due to proximal neuropathy or upper trunk brachial plexus lesion. Aim The aim was to detect any electrophysiological abnormality in the proximal nerves supplying shoulder structures that could contribute to PSSP. Settings and design Cross-sectional study at institution: a university hospital, tertiary level of clinical care. Materials and methods Nerve conduction studies of the axillary, musculocutaneous, suprascapular, and lateral antebrachial nerves were done on both sides. In addition, electromyography of the deltoid, biceps brachii and infraspinatus on the hemiplegic side was performed on 30 stroke survivors with PSSP. Statistical analysis used Statistical Package for the Social Sciences (SPSS ver.20). Description and analysis of the obtained data were done using appropriate tests. Results Axillary and musculocutaneous motor nerve latencies on the hemiplegic side were significantly prolonged compared with the normal side (P=0.012, 0.029, respectively). Moreover, axillary and suprascapular nerve amplitudes on the hemiplegic side were significantly lower than those on the normal side (P=0.008, 0.002, respectively). Twelve (40%) patients had electrophysiological abnormalities. Upper trunk brachial plexopathy was the most common abnormality which occurred in six (20%) patients. In addition, isolated axillary or suprascapular nerve lesion occurred at a similar frequency (10%). Conclusion Proximal nerve lesions are not uncommon in PSSP patients.

Background and objectives: Glenohumeral joint internal rotation deficit (GIRD) is commonly observed in the dominant arm of baseball pitchers and is limited by horizontal adduction motions. We inferred that when pitchers’ generation of internal shoulder rotation and horizontal adduction activity is limited, they may generate compensation movements in other body parts. This study aims to investigate whether pitchers with GIRD generates trunk compensation during pitching where pitching targets were on the lower corner of their non-dominant side. Design: Case-control study. Setting: Elite senior high school baseball. Participants: Twenty-five senior high school baseball pitchers participated in this study. Twelve pitchers with GIRD were assigned to the experiment group, and the remaining 13 participants to the control group. Main outcome measures: Glenohumeral internal/external rotation of both arms and internal/external rotation of the bilateral hip joints were measured. The kinematic values of the trunk when pitching to a target were measured using high-speed infrared cameras. Results: Pitchers with GIRD exhibited significantly greater upper trunk rotation toward the non-dominant side when a baseball was released from their hand (27.39 ± 6.62 degrees), compared with non-GIRD pitchers (20.42 ± 5.97 degrees) (p &lt, 0.05). The total rotation of the pivot leg of pitchers with GIRD (67.54 ± 7.84 degrees) was significantly smaller than that of pitchers without GIRD (74.00 ± 7.07 degrees) (p &lt, 0.05). Conclusions: GIRD in the dominant arm affected upper trunk rotation during pitching and was associated with the hip range of motion. Future studies could conduct a longitudinal study regarding the relationship between GIRD and other joint injuries of the lower limbs.

Interscalene brachial plexus block is frequently utilized for anesthesia and analgesia of complex and painful shoulder surgeries. But unintentional phrenic nerve blockade is a bane to the existence of this technique. Single-injection upper trunk blockade has emerged as a promising approach that appears to preserve phrenic nerve function better than the interscalene approach. The purpose of this case series is to describe the sonoanatomy, technique, and utility of a continuous upper trunk block, not previously described in the literature.

We aimed to elucidate the dermoscopic vasculature of patients with Bowen Disease (BD) that was misdiagnosed as chronic eczema and had branched and/or reticular vessels after topical steroid application. The medical records of 19 patients with BD on the upper trunk were retrospectively reviewed for steroid use history, vascular structure observed in dermoscopy, and corresponding histological findings. Four patients treated with strong topical steroids showed remarkable branched and/or reticular vessels on dermoscopy. Histopathology showed partial epidermal atrophy with irregular thin elongation of the rete ridges, atypical keratinocyte proliferation in the epidermis, and vasodilation in the superficial dermis. We considered that vasodilation and partial epidermal atrophy may be induced by topical steroid application in BD-affected areas. In cases of suspected BD with reddish-brown plaque showing branched and/or reticulated vessels in dermoscopy, confirming a history of topical steroid use is helpful.

Infantile haemangiomas are very common benign tumours in the first months of life. They are mostly cutaneous; however, extracutaneous lesions are possible, and occur in very rare cases in the central nervous system. A European multicentre observational retrospective study was conducted in the last 5 years. Seven patients with intracranial or intraspinal infantile haemangiomas were selected and treated with oral propranolol. Propranolol was interrupted after complete or almost complete resolution of infantile haemangiomas. All patients tolerated the treatment well without side-effects. Central nervous system infantile haemangiomas are probably underestimated due to the frequent absence of symptoms and their spontaneous involution. However, they should be investigated in case of segmental cutaneous infantile haemangiomas, particularly on the head, neck, upper trunk, lumbar or sacral area in order to diagnosis intra-central nervous system involvement at an early stage.

Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder (PCSM-LPD) is a rare indolent disorder often associated with a favourable prognosis. It typically presents as a solitary skin lesion, mainly in the head, neck, or upper trunk region. Multifocal PCSM-LPD is a rare entity, with no standard treatment approaches available. In this article, we present the case of a 56-year-old male patient with multifocal biopsy-proven PCSM-LPD that was treated with methotrexate orally at 10 mg/m2 body surface area weekly and successfully achieved full clinical resolution by the 10th week of therapy. A review of the literature indicates the efficacy of combination chemotherapy. However, due to the indolent nature of this disorder and the undesired side effects from combination chemotherapy, our treatment method involved oral methotrexate alone, and it was successful. Oral methotrexate is a potential therapeutic option in the management of multifocal PCSM-LPD and it warrants further investigations.

Summary:. Anatomic variations in peripheral nerves and the perineural environment are common and can contribute to acute or chronic neuropathy in certain individuals. Awareness of these variants is relevant to understanding both the etiopathogenesis and the increased susceptibility to nerve injury in some patients. We present a 4-year-old boy who sustained a permanent injury to the upper brachial plexus from a relatively minor trauma. Surgical exploration revealed a variation in upper trunk anatomy that likely contributed to this outcome.

Summary Background After massive weight loss (MWL), female patients often develop upper trunk laxity and severe breast deformities. Usually several procedures are required to address upper body contouring issues. Objectives To achieve better breasts and improve upper body contour, the authors employed a combined approach, associating lateral chest wall perforator propeller flaps with an upper bodylift (UBL). Methods Between September 2015 and March 2017, nine post-bariatric patients underwent simultaneously an UBL and autologous augmentation breast reshaping with lateral chest wall perforator propeller flaps. The authors analyzed the clinical indications, results and complications of this procedure. Results Eighteen lateral perforator propeller flaps for autologous breast augmentation-mastopexy associated with an UBL were performed successfully. Mean pre-MWL body mass index (BMI) was 54.3 ± 10.9 kg/m2, with a mean preoperative pre-UBL BMI of 28.7 ± 3.6 kg/m2. The average weight loss before surgery was 67.7 ± 22.4 kg. The flaps were harvested on intercostal and/or lateral thoracic arteries. All donor sites had been closed primarily. Following the classification of Dindo and Clavien, four minor complications (I, II), and two major complications (IIIb), including two hematomas requiring reoperation, were reported. No flap necrosis occurred. Follow-up averaged 27.9 ± 8.4 months. The patients’ satisfaction with their improved breast shapes and chest wall contours was “good”, with an aesthetic outcome mean ranked 3.8 ± 0.8 (out of 5). Conclusions After MWL, upper body deformities can be treated safely and reliably by a combined approach, associating an UBL and autologous lateral chest wall perforator flaps to provide more natural and durable breast shapes, as well as an upper circumferential reshaping.

Measuring physical activity using wearable sensors is essential for quantifying adherence to exercise regiments in clinical research and motivating individuals to continue exercising. An important aspect of wearable activity tracking is counting particular movements. One limitation of many previous models is the need to design the counting for a specific exercise. However, during physical therapy, some movements are unique to the patient and also valuable to track. To address this, we create an automatic repetition counting system that is flexible enough to measure multiple distinct and repeating movements during physical therapy without being trained on the specific motion. Accelerometers, using smartphones, were attached to the body or held by participants to track repetitive motions during different exercises. 18 participants completed a series of 10 exercises for 30 seconds, including arm circles, bicep curls, bridges, sit-ups, elbow extensions, leg lifts, lunges, push-ups, squats, and upper trunk rotations. To count the repetitions of each exercise, we apply three analysis techniques: (a) threshold crossing, (b) threshold crossing with a low-pass filter, and (c) Fourier transform. The results demonstrate that arm circles and push-ups can be tracked well, while less periodic and irregular motions such as upper trunk rotations are more difficult. Overall, threshold crossing with low-pass filtering achieves the best performance among these methods. We conclude that the proposed automatic counting system is capable of tracking exercise repetition without prior training and development for that activity.

Introduction Brachial plexus injuries are common and result in significant disabilities. This study evaluated the outcome of triple neurotization as a single procedure for upper trunk brachial plexus injury. Patients and methods Some 25 adult consecutive patients with injured upper trunk brachial plexus who underwent microscopic reconstructive surgery using triple neurotization technique in the authors' institute were recruited in this study. Data on operative and functional outcomes were captured. Modified Narkas scale was used to evaluate the shoulder function in addition to Waikakul scale which was used to evaluate the elbow function. Data were analyzed with respect to short and long term with a median follow-up duration of two years. Results Assessment of the recovered shoulder abduction was excellent in 48% (n=12), good in 24% (n=6), fair in 16% (n=4), and poor in 12% of cases (n=3). Shoulder external rotation recovery was excellent in 48% (n=12), good in 12% (n=3), fair in 12% (n=3), and poor in 28% of cases (n=7). Recovery of elbow flexion was excellent in 60% (n=15), good in 12% (n=3), fair in 12% (n=3), and poor in 16% of cases (n=4). The mean value of recovered shoulder abduction was 111.26 degrees (range: 70-150). The mean value of restored shoulder external rotation was 57.5 degrees (range: 45-70). The mean value of restored elbow flexion was 75 degrees (range: 55-120). Conclusion Triple neurotization technique can be effective to restore elbow flexion, shoulder abduction, and external rotation in adult patients with upper trunk brachial plexus injury.

Background: We regularly use Angle of Trunk Rotation (ATR) measurements for scoliosis screening and also for clinical follow-up of our scoliosis patients under treatment. In some patients, when ATR measurements exceed the screening threshold but without a significant degree of curvature on the X-ray (Cobb angle), a Hemidystrophic Thorax (HDT) is diagnosed. The purpose of this paper was to present a case series of patients with this kind of thoracic deformity because this may be mimicking scoliosis to a significant degree. Materials and Methods: This case series is a consecutive series of patients where the first author detected a hemidystrophic thorax instead of or in combination with scoliosis. A 3D scan of the trunk was made and adjusted to the coordinates in order to achieve an upright orientation of the upper trunk. The scan was scaled in order to determine certain anatomic landmarks, as performed in preparation for bracing. The scan was cut horizontally at the xiphoid level and the plane at this level was analysed visually in order to detect deformations that were different to the typical scoliotic deformations in the horizontal plane. Results: Seven cases were analysed and described in more detail. Conclusion: The condition of HDT may lead to significant rib humps that mimic scoliosis. According to our case series, mild scoliosis can also be associated with HDT. HDT, according to the cases presented in this study, seems to be a relatively benign deformity. Long-term observations are necessary before a final conclusion can be drawn with respect to prognosis.

Dermatomyofibroma is a rare cutaneous mesenchymal tumor of benign fibroblastic and myofibroblastic derivations. It predominantly affects young women, and it usually presents as a reddish-brown plaque or nodule, which is commonly located over the upper trunk. We report the case of a 41-year-old female patient who presented with progressive linear dermatomyofibroma over the nape of her neck. This case report expands the knowledge about the clinical and histopathological features of this rare, benign and cutaneous tumor.

Dermatofibromas (DFs) can manifest as atrophic, depressed papules on the upper trunk and proximal upper extremities. Histologically, DFs may demonstrate sebaceous induction in the upper dermis, particularly if they occur on the shoulder [1]. On dermoscopy, these glands are readily visible as discrete pale yellow clods, reminiscent of so-called “popcorn-like” structures present in sebaceous hyperplasia. However, this finding is rarely cited as a dermoscopic feature in DFs. Here we detail a series of DFs presenting as atrophic papules with dermoscopic findings of yellow clods.

Treadmills are widely used to recover walking function in the rehabilitation field for those patients with gait disorders. Nevertheless, the ultimate goal of walking function recovery is to walk on the ground rather than on the treadmill. This study aims to determine the effect of treadmill walking on gait and upper trunk movement characteristics using wearable sensors. Eight healthy male subjects are recruited to perform 420-m straight overground walking (OW) and 5 min treadmill walking (TW), wearing 3 inertial measurement units and a pair of insole sensors. In addition to common linear features, nonlinear features, which contains sample entropy, maximal Lyapunov exponent and fractal dynamic of stride intervals (detrended fluctuation analysis), are used to compare the difference between TW and OW condition. Canonical correlation analysis is also used to indicate the correlation between upper trunk movement characteristics and gait features in the aspects of spatiotemporal parameters and gait dynamic features. The experimental results show that the treadmill can cause a shorter stride length, less stride time and worsen long-range correlation of stride intervals. And the treadmill can significantly increase the stability for both gait and upper trunk, while it can significantly reduce gait regularity during swing phase. Canonical correlation analysis results show that treadmill can reduce the correlation between gait and upper trunk features. One possible interpretation of these results is that people tend to walk more cautiously to prevent the risk of falling and neglect the coordination between gait and upper trunk when walking on the treadmill. This study can provide fundamental insightful information about the effect of treadmill walking on gait and upper trunk to support future similar studies.

Becker nevus syndrome refers to a rare disorder comprising the typical pigmented lesion and its associated developmental abnormalities. Becker nevus itself is typically localized on the upper trunk, scapular or upper arm unilaterally; however, it can occasionally occur as multiple or bilateral lesions on any parts of the body. In this report, a rare case of multiple Becker nevi arranged in a unique checkerboard-like pattern is presented. More uniquely, the associated abnormalities found in this patient, breast hypoplasia and leg lipodystrophy, seem to be regionally correlated with the nevi. In closing, we would like to raise an easy-to-remember 6B’s mnemonic, which stands for Becker, Breast, Bone, Bowen’s disease, Basal cell carcinoma, and Beta-actin, for the cases of Becker nevus syndrome.

Tufted Angiomas, also known as angioblastomas/Angioblastoma of Nagakawa, are rare vascular neoplasms of both sexes localised to the skin and subcutaneous tissues with the upper trunk and neck being the most common sites. They are more common in children but a few cases in juveniles and adults have been reported. Typically, Tufted Angioma remains stable or can show rarely a spontaneous regression. This article wants to evaluate the efficacy of current treatment modalities for tufted angioma (TA). A review was performed using PubMed database (Medline) for clinical studies. We report our case, a 29-year-old female who presented with a second finger of the left hand, painful, slowly progressive, firm swelling diagnosed as Tufted Angioma on histopathology and immunohistochemistry after complete surgical excision.

Multibody models have not yet been evaluated for reconstructing head kinematics during sports impacts. Accordingly, the goal of this study was to utilise whole-body motion data from twenty upper and mid/lower trunk rugby shoulder tackles recorded in a marker-based 3D motion analysis laboratory to assess the MADYMO human body passive ellipsoid model for head kinematic reconstruction. Head linear and angular velocity during the tackle for the multibody model predictions and 3D motion laboratory measures were recorded for the ball carrier. Examined were the linear and angular velocity, as well as the absolute and percentage differences. For upper trunk tackles, the median percentage error (with quartiles) for the MADYMO predictions were 10% (6% to 45%) and 23% (16% to 39%) for change in head linear and angular velocity, respectively. For mid/lower trunk tackles, the median percentage error (with quartiles) for the MADYMO predictions were 46% (33% to 63%) and 60% (53% to 123%) for change in head linear and angular velocity, respectively. In conclusion, the model is currently unsuitable for reconstruction of head kinematics during individual rugby union tackle cases.

[Purpose] This study investigated changes in neck and upper trunk muscle activities according to the angle of movement of the neck in subjects with Forward Head Posture. [Subjects and Methods] Twenty subjects with forward head postures were recruited. The activities of the sternocleidomastoid muscle, splenius capitis and splenius cervicis muscles, upper trapezius muscle, and middle trapezius muscle during flexion and extension were assessed. [Results] The activity of the sternocleidomastoid muscle showed significant differences between the 30° flexed position and the full range of motion position, and between the neutral position and the full ROM position. The activity of the middle trapezius muscle showed a significant reduction in the 30° extended position and the full ROM position as compared to the neutral position. [Conclusion] In the full flexed position, sternocleidomastoid muscle activity increased significantly, and during extension position, the middle trapezius muscle reduced its activities.

Winer's dilated pore is an infrequent appendageal tumor characterized by a giant comedone on the face, neck, and upper trunk in adults. We report a 57-year-old woman who developed multiple asymptomatic black papules on both labia majora. Histopathology showed grouped dilated follicles lined by keratinizing squamous epithelium in the superficial dermis. The superficial lining epithelium and interfollicular epidermis were atrophic, while the deep epithelium showed mild proliferation and melanin pigmentation with a few short projections extending into the surrounding dermis. We diagnosed multiple Winer's dilated pores based on late-onset lesions and pathological features. This patient may represent the first case of multiple vulvar Winer's dilated pores. We suggest that electrocautery may be effective for treating this type of superficial entity.