The most common head injury in sports is concussion and experiencing multiple concussions in a short period of time sometimes can cause severe brain damage. In this paper, we investigate severe brain damage due to repeated head injury in sports and discuss the pathophysiology of repeated sports injury. The majority of these severe cases are usually male adolescents or young adults that suffer a second head injury before they have recovered from the first head injury. All cases that could be confirmed by brain CT scan after the second injury revealed brain swelling associated with a thin subdural hematoma. We suggested that the existence of subdural hematoma is one of the major causes of brain swelling after repeated head injury in sports. Since repeated concussions occurring within a short period may have a risk for severe brain damage, the diagnosis for initial cerebral concussion should be done appropriately. To prevent catastrophic brain damage, the player who suffered from concussion should not engage in any sports before recovery. The american Academy of Neurology and Colorado Medical Society set a guideline to return to play after cerebral concussion. An international conference on concussion in sports was held at Prague in 2004. The summary and agreement of this meeting was published and the Sports Concussion Assessment Tool (SCAT) was introduced to treat sports-related concussion. In addition, a number of computerized cognitive assessment tests and test batteries have been developed to allow athletes to return to play. It is important that coaches, as well as players and trainers, understand the medical issues involved in concussion.

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Trans-anal rectal foreign body is rare disease in clinical practice. Therefore, it is difficult sometimes to diagnose and treat. Herein, we report five cases of trans-anal rectal foreign body in our hospital over the past 6 years and review the literature over the past 10 years. Trans-anal rectal foreign body was most often reported in males in their 40s and 50s with sexual deviation. Most of their chief complaints were nonextraction of the rectal foreign body. Abdominal X-ray and computed tomography (CT) was useful for the diagnosis of rectal foreign body. In our cases, the extraction methods of the foreign body were trans-anal extraction in 3 cases, open surgery in 1 case, trans-anal with laparotomy in 1 case, and most large foreign bodies required general or lumbar anesthesia. We suggested that it is necessary to determine the indication for the operation and anesthesia after accurately diagnosing the size, the kind and the position of the foreign body by X-ray or CT.

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The osteogenic potential of hydroxyapatite (HA) impregnated with iliac bone marrow aspirate (BM) and fibronectin (FN) was examined using rabbits. Stick typed HA was used as a scaffold. Two types of HA sticks permeated with/without iliac bone marrow were implanted into the subcutaneous muscle of rabbits. As a result, an increase of histological osteogenesis and mechanical strength was demonstrated in the HA stick with iliac bone marrow. Five groups of posterolateral spinal fusion were treated with 5 different bone grafts. After 6 weeks, although the group with the HA sticks permeated with iliac bone marrow aspirate was less strong compared with the group of autogenous iliac bone graft, the group with HA sticks permeated with FN and iliac bone marrow exhibited no significant difference in the strength, and histologically displayed more active osteogenesis in the interface. HA sticks grafting with FN and bone marrow will improve osteogenesis and the strength of the fusion.

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We report a case of appendicitis diverticulum. A 55-year-old man was admitted to our hospital because of high fever and right lower abdominal pain. His past history included acute appendicitis at the age of 45 years, which was cured by conservative therapy. On admission his temperature was 37.7°C and he experienced tenderness with Blumberg′s sign at McBurney′s point and with muscular defense. Enhanced abdominal CT showed swelling of the appendix and a high density of fatty tissue. Under the diagnosis of acute appendicitis, appendectomy was performed. At the center of the appendix pseudodiverticulum was evident, and the appendix was perforated in that region. After an uneventful operative course the patient was discharged from our hospital on postoperative day 7. It has been reported that if appendix diverticulum becomes inflamed, abscess or perforation can easily occur. We evaluated that appendectomy should be performed in this case of appendix diverticulum.

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Hepatic angiomyolipoma (AML) is an uncommon benign mesenchymal tumor of the liver. Most AMLs of the liver are asymptomatic and are discovered incidentally, but the diagnosis remains difficult. We report a case of a 33-year-old woman who had an abdominal mass and in whom diagnosis remained unidentified after imaging and needle biopsy. On dynamic CT, a heterogeneous enhanced hepatic lesion was revealed in the arterial phase with washout in the portal phase. On MRI, it was shown as a hypointense tumor on T1 weighted images and hyperintense on T2 weighted images. Because hepatocellular carcinoma was suspected as a result of the needle biopsy, hepatic segmentectomy was performed. The final pathological diagnosis was AML due to positive HMB45. AML needs to be considered as a condition that may display the atypical images consistent with liver tumor. In cases such as this, we should request the examination of immunohistochemical staining especially for HMB45 on biopsy specimens.

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A 32-year-old man who suffered from abdominal pain and vomiting was referred to our hospital urgently. He had been diagnosed with Peutz-Jeghers syndrome (PJS) in his childhood, and has undergone partial resection of small intestine due to intussusception at 13 years old. He was diagnosed with intussusception by abdominal computed tomography that showed the target sign in the right side abdomen. An emergency operation was performed because of the diagnosis of ileus due to intussucseption. Operative findings revealed intussusception of the small intestinal type. Manipulation of the intestinal invagination and partial resection of the necrotic intestine were undergone. A pedunculated polyp was found in the apical portion of the intestine, and three other polyps were found in the jejunum. The pathological findings revealed hamartomatous polyps of PJS type. It is possible that the recurrence of intussusception, malignant alteration of polyps, and malignant tumor except for alimentary tract can occur in PJS. Therefore it considered that long-term follow up is important for patients with PJS.

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