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After an acupuncture treatment 24 times, the symptoms are recovered right shoulder both active and passive full range of movement in all directions, and pain‐free. Furthermore, no adverse effects were observed., After an acupuncture treatment 24 times, the symptoms are recovered right shoulder both active and passive full range of movement in all directions and pain‐free. Furthermore, no adverse effects were observed.

Aim The present study was conducted in order to clarify the effects of a warm hand bath at 40°C for 10 min on the blood flow in the shoulder, skin and deep body temperature, autonomic nervous activity, and subjective comfort in healthy women. Methods The study's participants were 40 healthy adult women who were randomly assigned to either a structured hand bath first and no hand bath second (Group A) or to no hand bath first and a hand bath second (Group B). The blood flow in the shoulder, skin and deep body temperature, autonomic nervous activity, and subjective comfort then were recorded in all the participants. Results A repeated-measures ANOVA revealed no significant difference in the blood flow in the right shoulder or deep body temperature between groups. The skin temperature of the hands, forearms, and arms was significantly increased, but not of the face and upper back. The skin temperature of the forearms was maintained at 0.5°C-1°C higher for 30 min in the hand bath group, compared with the no hand bath group. The hand bath group had a significantly higher heart rate while bathing and a significantly lower parasympathetic nerve activity level during bathing. No significant difference was seen in the sympathetic activity level between groups. The hand bath group had a significantly higher subjective comfort level. Conclusion Hand baths can improve the level of subjective comfort and increase the heart rate and might affect autonomic nervous activity. The skin temperature of the forearms was maintained for 30 min in the hand bath group.

Nevus sebaceus of Jadassohn, a congenital cutaneous hamartoma, has the potential to develop into various epidermal adnexal-origin neoplasms. While the most common neoplasms are trichoblastoma or syringocystadenoma, proliferating trichilemmal cysts are exceptionally rare. We report a case of a 63-year-old Cuban male with a giant proliferating trichilemmal cyst arising from a nevus sebaceus on the right shoulder which had been growing for 30 years. Proliferating trichilemmal cysts arising from nevus sebaceus cases are difficult to diagnose clinically and histologically as they are very rare and have not been defined by exact diagnostic criteria. Our case creates awareness of this particular tumor in nevus sebaceus and shares clinical and histological diagnostic information that can be used to make a proper diagnosis.

Objectives: This exploratory study compared the screening ability of a newly introduced radiation detection portal with a traditional Geiger counter for detection of radiation contamination in the setting of a mass casualty training exercise. Methods: Following a pretrial evaluation of interobserver reliability for Geiger counter use, 30 volunteers were randomly assigned to don gowns containing three disks, each of which was either a sham resembling the radioactive samples or an actual cesium-137 sample; each subject participated a minimum of four times with different gowns each time. Each subject underwent standard radioactivity screening with the Geiger counter and the portal. Results: Interobserver reliability was excellent between the two Geiger counter screeners in the pretrial exercise, correctly identifying 101 of 102 sham and radioactive samples (κ = 0.98; 95% confidence interval [CI] = 0.94 to 1.00). For radioactively labeled subjects across all bodily locations, the portal (43/61, or 70.5%; 95% CI = 58.1% to 80.5%) was less sensitive than the Geiger counter screening (61/61, or 100%; 95% CI = 92.9% to 100%), which resulted in a portal false-negative rate of 29.5%. For radiation detection in the posterior thorax, the portal radiation screening (4/19, or 21.1%; 95% CI = 8% to 43.9%) was less accurate than the Geiger counter (19/19, or 100%; 95% CI 80.2% to 100%). In contrast, there were no major differences between the portal and the Geiger counter for radiation detection at the left shoulder, right shoulder, or sham (nonradiation) detection. There were no false-positive detections of the sham-labeled subjects for either device, yielding a specificity of 100% for both screening modalities. Conclusions: Geiger counter screening was more sensitive than, and equally specific to, radiation detection portal screening in detecting radioactively labeled subjects during a radiation mass casualty drill. ACADEMIC EMERGENCY MEDICINE 2010; 17:1020–1023 © 2010 by the Society for Academic Emergency Medicine

Malignant eccrine spiradenoma is an extremely rare skin tumor of sweat gland origin. In most cases, it arises in pre-existing benign eccrine spiradenoma. We report an additional case of malignant eccrine spiradenoma. The present case is of a 75-year-old man with malignant eccrine spiradenoma developed in the right shoulder. He had a 6-year history of a recurrent mass that was removed 2 years ago. The patient then underwent a complete excision. The gross pathologic specimen showed a large cutaneous and subcutaneous multinodular tumor, measuring 6 cm in maximal dimension. Microscopically, there were two distinct morphological components: a benign eccrine spiradenoma and a malignant eccrine spiradenoma of low grade with extensive necrosis. Different histologic patterns were observed such as cylindromatous features. Morphological differentiation in malignant eccrine spiradenoma is variable, sometimes with almost complete loss of eccrine differentiation. Extensive sampling to look for a probable previously benign component is necessary. In the other hand, malignant changes can be easily missed without adequate sampling.

We report a case of desmoid fibromatosis of the chest wall. A 70-year-old woman was referred to our hospital with right shoulder blade pain and paresthesia over the right upper breast. Chest X-ray and computed tomography demonstrated a 5 cm right apical mass in the chest. Biopsy of the mass demonstrated features of desmoid fibromatosis. The patient subsequently underwent surgical resection of the mass and received adjuvant radiation therapy for microscopic positive margins. In conclusion, although desmoid tumour of the chest is rare, it is worth considering in the differential diagnoses of chest wall tumours.

This paper reports on the disability resulting from the dislocation, later recurrent, of the right shoulder suffered by Winston Churchill in 1896. It considers the management principles enunciated by Hippocrates and their relevance to his situation and to contemporary practice.

A 15-year-old domestic long haired cat developed nodular cutaneous masses over the right shoulder that were removed surgically. Similar masses developed in multiple cutaneous sites over the following three years. In each case, the lesions were characterized by diffuse dermal infiltration by histiocytic cells with a low mitotic rate and evidence of epidermotropism. The neoplastic population uniformly expressed class II molecules of the Major Histocompatibility Complex, but did not express the T and B lymphoid markers CD3 and CD79. Perivascular aggregates of CD3+ T lymphocytes were located at the deep margins of the tumour nodules. The clinical, histopathological and immunohistochemical features of these tumours are consistent with cutaneous histiocytoma. This tumour has not been previously well-documented in the cat.

A 16-year-old girl complained of sensations of weight, swelling, warmth and frequent sweating from her right arm and hand. Varicose veins were seen on the dorsal aspect of her right hand, her right arm was longer than the left. Since birth she had a capillary hemangioma involving her right shoulder. Right arm and aortocervical arteriograms disclosed large arteriovenous fistulas. Cardiac output was markedly increased. No cardiac enlargement was seen at X-ray examination. The prognosis and future management of the patient are discussed.

Erythemal ultraviolet (UV)-radiation exposure to the right hand, mid-arm, shoulder, chin, nose and left and right sides of the face has been evaluated in a car from a large family class and a car from a small car class. In the small car, the site with highest exposure received 2.2 times more radiation than the site with the highest exposure in the larger car. In both cars, highest erythemal exposures were to the right shoulder, arm, and hand. Over a 6 h period, erythemal exposure to the right shoulder of a person in the driver's seat of the small car was 3.1 mJ x cm(-2).

A case of multiple agminated juvenile melanoma (MAJM) arising on a hyperpigmented macule is reported. The patient, a 1-year-old boy, had 9 small nodules on an irregular, hyperpigmented macule on the right shoulder. Histologically, the nodules contained nests of spindle-shaped cells in their epidermis and at the dermoepidermal junction, and the hyperpigmented macule exhibited increased melanin granules in the basal layer and small nests of epithelioid cells. We concluded that MAJM on a hyperpigmented macule is the subtype of the nevus spilus.

CASE 1: A 19-year-old woman presented with a black crust on one part of the tattoo on her right leg (Fig. 1) which appeared after laser-assisted hair removal by an alexandrite laser (755 nm). CASE 2: A 28-year-old man underwent laser-assisted hair removal from his back and shoulders by an alexandrite laser (755 nm), after which he developed a burn on part of the tattoo on his right shoulder and was left with an atrophic scar (Fig. 2).

Becker's nevus is a unilateral, hyperpigmented cutaneous hamartoma usually with hypertrichosis. It occurs predominantly in boys, becoming apparent during adolescence, although several cases of congenital Becker's nevus have been reported. Rarely it may be familial and as such is transmitted in an autosomal dominant pattern. We report a 16-month-old black boy with a hyperpigmented patch on his right shoulder and upper pectoral area that extended down his arm. The patient's father has a similar lesion with hair on his left shoulder which has been present since childhood. Histology of the child's lesion was consistent with Becker's nevus. We believe this to be the first reported case of a congenital Becker's nevus with a familial association.

The skin of a female Egyptian mummy, embalmed 100–300 A.D., was studied by transmission and scanning electron microscopy. After rehydration with cacodylate buffer containing sucrose, the ordinary technique for transmission electron microscopy was performed on skin of the right shoulder. In epidermal cells, mitochondria and their cristae were identified. Between epidermal cells, desmosomes, half the normal size, were found. In the dermis, collagen bundles and elastic fibres were observed. The collagen fibres had a diameter of 67–91 nm, and the band pattern showed 10–12 sub-bands per one period of 55–61 nm length. The elastic fibres had less amorphous substance than normal and a fibrillar beaded pattern. The dermal components of the skin were well preserved in spite of the mummification. Throughout the dermis and the subcutaneous fatty tissue, a number of bacterial spores were found showing a characteristic appearance. Scanning electron microscopy of hairs showed a layer of the preserving material surrounding hairs, and under it a normal cuticle was seen.

1. Bacterial colony counts on the right shoulder of the subject's scrub suits were lower after lunch when a. cover gowns were worn over scrub suits outside the OR during lunch, and b. when fresh scrub suits were put on after lunch. 2. Bacterial colony counts were higher after lunch when a. scrub suits were worn without cover gowns outside the OR during lunch, and b. when they were removed before lunch, stored in a locker, and put on again after lunch. 3. The thigh region can be assumed to be dirtier than the shoulder area on scrub suits. From this study, the researchers concluded that wearing cover gowns outside the OR exerts a protective effect against bacterial contamination as determined by samples taken from the right shoulder. Furthermore, this protective effect is comparable to that seen when subjects changed into fresh scrub suits after lunch.

— —A condition of dysplasia of the right shoulder is described in a 10-month-old Labrador bitch, involving an ununited scapula tuberosity. The left shoulder showed marked “looseness” (joint laxity) similar to that of congenital subluxation of the shoulder, whilst third degree hip dysplasia was present bilaterally. Shoulder dysplasia is compared with elbow dysplasia and hip dysplasia. A link between the looseness of the left shoulder joint and the maldevelopment of the right shoulder is considered. Resume— —L'auteur decrit une dysplasie de l'epaule droite, constatee chez une chienne Labrador âgee de 10 mois, la tuberosite de l'omoplate ne donnant pas attache. L'epaule gauche preente une laxitt marquee, comparable a celle qu'entraine la subluxation congenitale de l'epaule, et les hanches exhibent une dysplasie bilaterale du 3me degre. L'auteur compare la dysplasie de l'epaule, du coude et de la hanche. Il examine le rapport entre la laxite de l'articulation de l'epaule gauche et la malformation de l'epaule droite. Zusammenfassung— —Ein Fall von Dysplasie der rechten Schulter bei einer 10 Monate alten Labradorhundin wird beschrieben. Die Tuberositat hatte sich nicht mit dem Schulterblatt vereinigt. Die linke Schulter zeigte eine beachtliche “Lockering” (loses Gelenk), ahnlich wie bei angeborener Subluxation der Schulter, und es bestand eine beidseitige Huftdysplasie dritten Grades. Ein Vergleich zwischen Dysplasien der Schulter, des Ellbogens und der Hufte wird aufgestellt und die Moglichkeit erwogen, das die Lockerung des linken Schultergelenks mit der Unterentwicklung der rechten Schulter verbunden ist.