Ruptured Epidermal Inclusion Cyst in the Axilla: A Case Report

Epidermal inclusion cysts, the most common type of simple epithelial cyst, are typically well-encapsulated, subepidermal and mobile nodules. They may occur anywhere, but are mostly found on the scalp, face, neck, trunk, and back. Less than 10% of epidermal inclusion cysts occur on the extremities, and even fewer are found on the palms, soles, and breasts. If epidermal inclusion cysts rupture, foreign body reaction, granulomatous reaction or abscess formation could follow. We described here the sonographic findings of ruptured epidermal inclusion cyst of the right axilla in a 33-year-old woman who presented with a palpable axillary mass forming an inflammatory abscess. Address for reprints : Hak Hee Kim, M.D., Department of Radiology, Asan Medial Center, University of Ulsan, College of Medicine 388-1 Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea.

Pattern Analysis of Defecography in Patients with Chronic Functional Constipation: Is It Predictable for the Responsiveness of Biofeedback Therapy?

PURPOSE: To determine if pattern analysis of defecography can predict the responsiveness of biofeedback therapy in patients with chronic functional constipation. MATERIALS AND METHODS: Over a two-year period, 104 patients with chronic functional constipation underwent defecography and biofeedback therapy. Two blinded readers analyzed the defecographic findings and classified them into six types; I = normal defecation, II = hypertonic lower anal sphincter (poor anal opening due to a persistent contraction of the lower anal sphincter), III = dyskinetic puborectal sling (inadequate laxity of the puborectal sling), IV = spastic pelvic floor syndrome (persistent contraction of both the puborectal sling and the lower anal sphincter), V = unclassified (including paradoxical contraction of the anal sphincter), VI = anatomical obstruction. In addition, the degree of rectal contraction during defecation was scored (grade 0 to 3). After biofeedback therapy, the differences in the defecography patterns or rectal contractions between the two groups, the responsive or non-responsive group, were analyzed. RESULTS: The defecograms revealed that the type IV of the spastic pelvic floor syndrome was most common (50 of 104 patients, 48%), followed by II (21/104, 20%), III (12/104, 11.5%), V (9/104, 9%) and VI (12/104, 11.5%). Biofeedback therapy showed a therapeutic response in 71 out of 104 patients (68%) but failed in 33 patients (32%). However, there were no significant differences in the defecographic pattern between the responsive and non-responsive groups (p=0.630). The defecograms revealed rectal contractions in 78 patients (75%) and moderate to vigorous contractions (more than grade 2) in 66 patients. Most of the biofeedback-responsive group showed rectal contractions (66 of 71 patients, 93%, p<0.001). CONCLUSION: In patients with chronic functional constipation, there was no significant difference in the morphological patterns of the defecogram between the responsive and non-responsive biofeedback groups. However, the presence of rectal contractions during defecation was strongly associated with the therapeutic response after biofeedback therapy.