The Treatment of Metastatic and Castration-Resistant Prostate Cancer Patients in Korea

The treatment of advanced prostate cancer has rapidly evolved. Androgen deprivation therapy is recognized as the first-line therapy for metastatic disease; however, a substantial proportion of patients will eventually progress to develop castration-resistance. For the past several years, docetaxel-based chemotherapy has shown significant therapeutic benefit in castration-resistant prostate cancer. Over the last 5 years, several new agents such as the enzalutamide, abiraterone, cabazitaxel, and 223radium have been developed which have all been associated with improved quality of life, pain palliation, and an increase in survival. Unfortunately, there are no Korean treatment guideline for metastatic prostate cancer and/or castration-resistant prostate cancer which has been developed based on adequate review and assessment of evidences. Thus, a guideline adequate for domestic circumstances is eagerly needed. The Korean Association for Clinical Oncology, the Korean Prostate Society, the Korean Urological Oncology Society, and the Korean Society of Pathologists reviewed and endorsed the guidelines.

Endoscopic Management of Upper Urinary Tract Urothelial Carcinoma

Upper urinary tract urothelial carcinoma (UTUC) is relatively uncommon. Radical nephroureterectomy with an ipsilateral bladder cuff excision has been the gold standard treatment for UTUC. However, recent advances in technology have made possible the increased use of endoscopic management for the treatment of UTUC. The definitive goal of endoscopic management of UTUC is cancer control while maintaining renal function and the integrity of the urinary tract. Endoscopic management includes both the retrograde ureteroscopic and antegrade percutaneous approaches. The endoscopic management of UTUC is a reasonable alternative for patients with renal insufficiency or a solitary functional kidney, bilateral disease, or a significant comorbidity that precludes radical surgery. Select patients with a functional contralateral kidney who have low-grade, low-stage tumors may also be candidates for endoscopic management. The careful selection of patients is the most important point for the successful endoscopic management of UTUC. It is crucial that patients are compliant and motivated, because a lifetime protocol of strict surveillance is necessary. Adjuvant topical therapy with Bacillus Calmette-Guerin or mitomycin C can be used after endoscopic management of UTUC in an attempt to reduce recurrence. In this article, we review current endoscopic techniques, indications for endoscopic treatment, clinical outcomes of endoscopic management, adjuvant topical therapy, and surveillance in patients with UTUC.

Extensive Enteritis with Rapid Onset of Massive Ascites as the Initial Presentation of Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disorder with protean manifestations. However, compared with articular, cutaneous, or renal involvement, gastrointestinal symptoms are far less common and are particularly unusual for the initial presentation of SLE. Gastrointestinal manifestations range from mild nonspecific symptoms to serious life-threatening complications, such as mesenteric vasculitis, intestinal pseudoobstruction, acute pancreatitis, and protein-losing enteropathy. Therefore, in order to improve the prognosis, early diagnosis and timely treatment are important. We describe a 45-year-old female patient who presented with extensive enteritis and peritonitis as the initial manifestation of SLE. Symptoms at presentation included severe abdominal pain and rapid development of massive ascites. After administration of high-dose corticosteroid therapy, her symptoms showed prompt improvement.

Rosai-Dorfman Disease: Report of a Case Associated with IgG4-Related Sclerotic Lesions

We describe a rare case of sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) associated with a six-year history of autoimmune pancreatitis, which was controlled by steroid treatment. The patient presented with multiple, cervical and thoracic lymphadenopathy and abnormal, nodular opacities in the lung. Histologically, Rosai-Dorfman disease with numerous IgG4-positive cells was identified in a subcutaneous lymph node in the patient's left forearm. The patient recovered uneventfully with steroid treatment.

Prognostic Value of Immunohistochemical Biomarkers at Different Cut-off Values in Patients with Diffuse Large B-cell Lymphoma Treated with CHOP Chemotherapy

Many predictive models have been proposed for better stratification of diffuse large B-cell lymphoma (DLBCL). Hans' algorithm has been widely used as standard to sub-classify DLBCL into germinal center B-cell (GCB) and non-GCB origins. However, there have been disagreements in the literature regarding its prognostic significance. Here, we retrospectively analyzed Hans' algorithm and the individual immunohistochemical biomarkers at different cut-off values (5%, 30%, 50% or 75%) in 94 Korean patients with DLBCL treated with combination chemotherapy with cyclophosphamide, daunorubicin, vincristine, and prednisone. No significant differences were observed between the GCB (18 patients, 19.1%) and non-GCB (76, 80.9%) groups. Among individual biomarkers, CD10 negativity (cut point: 30%) and bcl-6 positivity (cut point: 5%) were independent good prognostic markers in progression-free survival (PFS), whereas bcl-6 (cut point: 5%) positivity was an independent good prognostic marker in overall survival irrelevant of international prognostic index. The present study showed the lack of predictability of Hans' algorithm in DLBCL patients, and that CD10, Bcl-6 may have diverse prognostic significance at different cut-off values. Our results suggest that the proposed cut-off value may not be applied universally, and that the optimal cut-off value may need to be optimized for individual laboratory.

Metastatic Tumors to the Breast from Extramammary Malignancies

BACKGROUND: Metastases to the breast from extramammary malignancies are very rare. We describe here the clinicopathologic features of the metastatic breast tumors that were identified in Korean patients at a single institute. METHODS: We analyzed the clinicopathologic data of the patients who were diagnosed between January 1989 and April 2009 at Asan Medical Center. RESULTS: Only 31 (0.21%) patients with metastases to the breast from extramammary malignancies were diagnosed over a 20-year period, and 29 of them had available data. The mean time to the diagnosis of metastasis after the diagnosis of the primary malignancy was 21 months (range, 0 to 102 months). The most common primary site was the stomach, followed by the uterus and lung. The most common histologic type was adenocarcinoma. A common clinical presentation was a unilateral palpable mass. Most metastatic tumors had morphological features that were similar to those of their respective primary tumors. However, in situ carcinoma, microcalcification and desmoplastic reactions were rarely observed. CONCLUSIONS: Metastatic breast lesions from extramammary sites are extremely rare, and the stomach, uterus and lung could be considered as the common primary sites in Korean patients. The clinical history and comparing the morphology of the primary tumor with the morphology of the metastatic tumor are important for achieving the proper diagnosis.

Intraductal Papillary Mucinous Tumor Simultaneously Involving the Liver and Pancreas: A Case Report

We describe here a 67-year-old man who was diagnosed with a rare case of intraductal papillary mucinous tumors that occurred simultaneously in the liver and pancreas. Abdominal computed tomography showed a tubular and cystic dilatation of the pancreatic duct in the pancreas tail, which suggested an intraductal papillary mucinous tumor (IPMT), and multiple intrahepatic duct stones. The patient underwent a distal pancreatectomy with splenectomy and a lateral segmentectomy of the liver. Microscopic examination showed an intraductal papillary mucinous neoplasms of borderline malignancy in the pancreas and a non-invasive intraductal papillary mucinous tumor with moderate dysplasia of the bile duct. Although several cases of intraductal papillary mucinous neoplasm of the liver (IPNL) without any pancreatic association have been described, the simultaneous presentation of both IPMT of the pancreas and IPNL is very rare. The patient has been doing well for 10 months postoperatively.

Acute Appendicitis Associated with Aspergillosis in a Leukemia Patient: A Case Report

Herein we describe a rare case of acute appendicitis associated with localized aspergillosis in an 8-year-old boy with acute lymphoblastic leukemia. During chemotherapy, the patient complained of mild abdominal pain in the peri-umbilical area and displayed an increased C-reactive protein level. Abdominal ultrasonography disclosed appendicitis and consequently an appendectomy was done. Histologically, acute appendicitis and Aspergillus hyphae were identified in the lumen and necrotic mucosa. However, there was no evidence of systemic aspergillosis. While aspergillosis is a common fungal infection in immunocompromised patients treated with chemotherapy, acute appendicitis associated with localized aspergillosis without systemic infection is a very rare occurrence.

Splenic Littoral Cell Angioma with Hepatitis C Associated Liver Cirrhosis

Littoral cell angioma (LCA) of spleen is an uncommon vascular neoplasm of littoral cell origin. It is well established that LCA may be associated with other malignancy or autoimmune disorders. We describe a 34-year-old woman with viral hepatitis C associated liver cirrhosis who presented with the incidental finding of LCA. She showed ascites, esophageal varix and drowsy mentality. Abdominal computed tomography (CT) showed multiple benign looking nodules in both hepatic lobes, but no abnormality in spleen. Liver transplantation and splenectomy were performed. Microscopic findings revealed narrow anastomosing vascular channels lined with plump cells that exfoliated into the lumen. Immunohistochemically the lining cells were positive for CD31, CD68 and negative for CD34, consistent with LCA. Herein, a second case of an incidentally detected LCA with cirrhosis, viral hepatitis C associated in Korea is reported.

Characterization of Histopathological Features that Differentiate Hepatitis B Virus Infection from Acute Cellular Rejection

BACKGROUND: Differentiation of viral hepatitis from acute cellular rejection (ACR) after liver transplantation can be difficult because of overlapping histological features. Here we investigated clinicopathologic characteristics of 311 liver allograft biopsies and searched for characteristic histopathological features that would facilitate the differential diagnosis between hepatitis B virus (HBV) infection and ACR. METHODS: A retrospective clinicopathologic examination of 311 liver allograft biopsies consisting of clinically proven ACR or HBV infection was performed. Immunohistochemical staining for HBcAg and HBsAg was done for 64 allograft biopsies showing HBV infection. RESULTS: Moderate to severe bile duct damage, diffuse centrilobular necrosis and centrilobular inflammation (p<0.000, for each) were more frequently observed in cases of ACR, whereas diffuse acidophilic bodies and spotty necrosis (p<0.000, for each) were more prevalent in cases of HBV infection. Immunopositivity for HBcAg (n=60, 93.8%) was higher than that for HBsAg (n=14, 21.9%) CONCLUSIONS: The presence of moderate to severe bile duct damage, diffuse centrilobular necrosis and centrilobular inflammation was a characteristic feature of ACR, whereas diffuse distribution of acidophilic bodies or spotty necrosis was the only characteristic feature of HBV infection. HBcAg was a more sensitive immunohistochemical marker than HBsAg for detecting HBV infection in liver allograft biopsies.

Delta Prostate Specific Antigen (PSA) Helps to Predict Prostate Cancer in Men with Serum PSA Level above 4 ng/ml / 대한남성과학회지

PURPOSE: Prostate biopsies have typically been performed on all patients with prostate specific antigen (PSA) levels above 4 ng/ml, however, the cancer detection rate is low. We would like to predict cancerous conditions of the prostate by developing a new PSA formula. MATERIALS AND METHODS: Between July 2004 and July 2006, 93 patients with serum PSA levels above 4 ng/ml received extended prostate biopsies. The medical records of all patients - age, total/free PSA after/before prostate massage, final diagnoses of prostate biopsies - were reviewed retrospectively. We developed a new formula to calculate the delta PSA: (total/free PSA after prostate massage - total/free PSA before prostate massage) / total/free PSA before prostate massage. RESULTS: The patients were divided into two groups, the prostate cancer group (39 patients) and the benign disease group (54 patients). Mean total/free PSA for the benign disease group were 9.35/1.49 ng/ml (before) and 16.66/5.06 ng/ml (after), while values for the data of prostate cancer group were 21.02/2.43 ng/ml (before) and 24.61/4.40 ng/ml (after). The positive predictive value of the patients with PSA levels between 4 and 10 ng/ml was 32%; the positive predictive value of the patients with PSA levels above 10 ng/ml was 75%. The mean delta total/free PSA values for the benign disease and prostate cancer groups were 0.92/2.42 and 0.28/1.14, respectively. The cut off value of delta total/free PSA was below 0.5/2.0. Sensitivity, specificity, and positive predictive values for delta total PSA were 90% (95% confidence interval (CI), 80.2~99.3), 54% (95% CI, 41.4~67.7) and 58% (95% CI, 45.9~70.8), respectively. Sensitivity, specificity, and positive predictive values based on delta free PSA were 87% (95% CI, 76.7~97.7), 48% (95% CI, 36.7~63.3), and 56% (95% CI, 43.3~68.2), respectively. CONCLUSIONS: We suggest that the use of delta total/free PSA in patients with serum PSA levels above 4 ng/ml may be helpful, not only to better detect prostate cancer, but also to reduce unnecessary prostate biopsies.

Predictive Factors Affecting Urethral Stricture Development after Transurethral Resection of the Prostate in Patients with Benign Prostatic Hyperplasia

PURPOSE: To evaluate possible factors affecting urethral stricture development after TURP in patients with BPH. MATERIALS AND METHODS: We reviewed retrospectively medical records of patients who underwent TURP for 6 years. All operations were performed by 2 experienced doctors who have minimum 200 practices. Patients were classified into 2 groups. Group A included patients with urethral stricture required periodic urethral dilation or urethrotomy. Group B included those without urethral stricture development after TURP. We analyzed all possible factors such as resection time, prostate volume, resection volume, resectoscope size, preoperative catheterization duration due to AUR, postoperative catheterization duration, preoperative pyuria, prostate needle biopsy performed preoperatively and PSA level, age and co-morbid systemic diseases. RESULTS: 595 patients underwent TURP between 2000 and 2005. 76 of them were excluded because of preexisting urethral stricture or secondary TURP. 110 were categorized into group A and 409 into group B. There was no statistical difference between group A and B with respect to age, preoperative catheterization duration in patients with AUR, postoperative catheterization duration, prostate volume, resection volume, preoperative PSA level, preoperative pyuria, preoperative biopsy history, resectoscope size(22F vs 24F) and anesthesia method (general vs spinal), respectively. However, there is significant difference between group A and B in comparison of resection time(58.5+/-21.6 min vs 48.5+/-23.2 min, p=0.02). CONCLUSION: Our data demonstrate that the shortening of resection time is the most important single factor to decrease urethral stricture formation after TURP in patients with BPH.

Short Term Results of Modified Ingelman-Sundberg Denervation Procedure for Female Mixed Urinary Incontinence

PURPOSE: We evaluated the clinical efficacy, safety and satisfaction of patients with modified Ingelman-Sundberg bladder denervation procedure for female mixed urinary incontinence. MATERIALS AND METHODS: Forty two women with mixed urinary incontinence were randomly assigned to the transobturator tape(TOT, n=20), or modified Ingelman-Sundberg bladder denervation procedure(MISD) with TOT (n=22) procedures, between August 2005 and July 2006. Preoperatively, the patients were evaluated with history taking, physical examination, urine analysis, urine culture, voiding diary, uroflowmetry, postvoid residual(PVR) and urodynamic evaluations. The procedures were carried out using a previously established method under spinal anesthesia for 36 patients and under general anesthesia for 6 patients. The postoperative evaluation included a questionnaire, uroflowmetry and PVR. The mean follow-up period was 8.2 months. RESULTS: 20 underwent TOT procedure alone and 22 underwent TOT procedure with MISD. Two groups were similar in their preoperative characteristics. The mean operation time was longer in the TOT procedure with MISD group compared to TOT procedure alone (36 min vs 26 min). There was significant difference between the 2 groups in terms of the success rate(cure+improvement, 30% vs 82%, p=0.03): cure(20% vs 50%), improvement(10% vs 32%), persistent(70% vs 18%) for TOT group and TOT with MISD group, respectively. In addition, the patient satisfaction rate was significantly different between TOT and TOT with MISD group(> or = Satisfied, 20% vs 64%, p=0.04). The main complication was voiding difficulty, including retention, was 10%(n=2) in the TOT group, versus 18%(n=4) in the TOT with MISD group, but this was improved by conservative treatment. CONCLUSION: Despite the short term follow-up period, the modified Ingelman- Sundberg bladder denervation procedure is simple, effective and less invasive for the treatment of mixed urinary incontinence, which is able to perform with TOT procedure in terms of the high success and the low complication rates.

Comparison of the Two-stage Procedure with the One- stage Procedure for Percutaneous Nephrolithotomy / 대한비뇨기과학회지

PURPOSE: We evaluated the advantages of the two-stage procedure for percutaneous nephrolithotomy (PNL) for the management of renal calculi. MATERIALS AND METHODS: Between November 1999 and November 2003, 49 patients with renal calculi were treated with one-stage or two-stage PNL. The medical records of all the patients were retrospectively reviewed for complications associated with percutaneous nephrostomy (PCN), stone size, operation time, success rate, treatments for the postoperative remnant stones, the hospital stay and the complications associated with operation. RESULTS: Thirty cases underwent two-stage PNL and 19 cases underwent one-stage PNL. The mean age of the one-stage PNL group and the two- stage group were 55.6+/-14.7 years old and 58.9+/-12.5 years old, respectively. There were no significant differences between the two-stage PNL and one-stage PNL for the complications associated with the PCN procedure, stone size, the success rate and the hospital stay. The total operative time was significantly different between the two-stage and one stage PNL groups (136.1+/-51.6 min vs 191.1+/-56.9 min, respectively, p=0.02). Eleven total patients with postoperative remnant stones underwent additional extracorporeal shock wave lithotripsy in 8 cases, ureteroscopic removal of stone in 2 cases and PNL in 1 case. The complications associated with two-stage and one-stage PNL were fever, ureteral obstruction by fragmented stones, A-V fistula and discharge through the percutaneous nephrostomy catheter. CONCLUSIONS: Two-stage PNL is a more effective approach for the patients with renal calculi comparing to one-stage PNL in terms of the operation time, the operation-associated complications and the psychological and physical pressures on the patients and operators.

Evaluation of Complementary and Alternative Medicine for Treating Patients with Erectile Dysfunction / 대한비뇨기과학회지

Purpose: The aim of this study was to evaluate complementary and alternative medicines (CAM) employed for treating patients with erectile dysfunction. Materials and Methods: A total of 204 patients with erectile dysfunction who completed a questionnaire between January and June 2005 were evaluated. The questionnaire was composed of 13 questions. This survey employed a broad definition for CAM, including acupuncture, biofeedback, folk remedies, chiropractic, homeopathy, hypnosis, massage, psychotherapy, relaxation, energy healing, imagery, special diet, spiritual healing and herbal medicine. The CAMs used by the patients with erectile dysfunction were divided into processed health foods, natural health foods and other therapies, and these were all analyzed. Results: The mean age was 57.9+/-10.1 years. 78 of the total patients with erectile dysfunction had employed at least one CAM. CAM users were more likely to be high school educated, nonsmokers and exercisers. The CAMs used were processed health foods 62% (48/78), natural health foods 15% (12/78), and other therapies 66% (52/78). The processed health foods were soy 25%, ginseng 23% and mushroom 19%. Of the natural health foods, tomato was 42%, soy was 25% and ginseng was 17%. Of the other therapies, herbal medicine was 45%, acupuncture was 25%, moxibustion and cupping a boil were 17%. 35% (27/78) of the patients with erectile dysfunction had employed more than one of the processed health foods, natural health foods and other therapies. Conclusions: Patients with erectile dysfunction had mainly employed processed health foods more than the natural health foods, herbal medicine and acupuncture. We think that more research is required about the effects and benefits of CAM in association with ED.

Gadolinium-enhanced MR Angiography in Preoperative Renal Vasculature Evaluation of Living Renal Transplantation: Comparison with Conventional Angiography / 대한비뇨기과학회지

PURPOSE: This study evaluated the accuracy of three-dimensional gadolinium-enhanced MR angiography (Gd-MRA) in the preoperative evaluation of living renal transplant donors (LRTDs) for visualizing the renal vascular anatomy, with an emphasis on identifying the number of renal arteries and veins and the presence of small branch anomalies. MATERIALS AND METHODS: Between April 1999 and October 2003, a total of 42 LRTDs were evaluated with conventional renal angiography (CRA) or three-dimensional Gd-MRA. The three-dimensional Gd-MRA was performed in 20 cases and CRA in 22. All candidates then underwent a donor nephrectomy. The intraoperative findings of the renal vessels were compared between the CRA and three-dimensional Gd-MRA, and the complications and side effects also examined. RESULTS: The overall accuracies for predicting the numbers and abnormalities of renal arteries and veins by comparing the intraoperative findings were 85 and 95% for the three-dimensional Gd-MRA, and 91 and 98% for the CRA. The three-dimensional Gd-MRA missed 3 accessory renal arteries, while the CRA missed 1, as well as 1 renal artery bifurcation. There were three complications; one contrast anaphylaxis and two hematomas at the puncture site, in the 22 CRA cases, but there were no significant complications in the three-dimensional Gd-MRA. CONCLUSIONS: Three-dimensional Gd-MRA appears to be as accurate as CRA for visualizing the renal vascular anatomy in the preoperative assessment of potential LRTDs. Three-dimensional Gd-MRA is a noninvasive and noncontrast technique, which would be a good alternative to CRA for assessing potential LRTDs.

Total Hip Arthroplasty with Hydroxyapatite-coated ABG(R) Hip Prosthesis: Minimum 5 Year Follow-up / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical and radiological results of total hip arthroplasty (THA) with a hydroxyapatite (HA)-coated ABG(R) (AnatomicalBenoist Giraud, Howmedica, Europe) hip prosthesis. MATERIALS AND METHODS: From March 1992 to December 1996, we performed 204 total hip arthroplasty with HA-coated hip prosthesis. This study included 142 hips. The causes of THA were osteonecrosis of the femoral head (122 hips), osteoarthritis (16 hips) and infectionsequalae (4 hips). Clinical results were evaluated using Harris hip score. We observed osteointegration, cortical hypertrophy, reactiveline around femoral stem, subsidence, polyethylene wear, osteolysis and radiolucent line around acetabular cup on the follow-up radiographs. RESULTS: Harris hip score was an average of 84.5 points at last follow-up. Only one femoral stem was revised for loosening. Reactive lines around uncoated portion of femoral stem was observed in 70 hips. The cortical hypertrophy was observed at zone 2, 3, 5 and 6 in 46hips. Forty-five acetabular cups (31.7%) were revised. The causes of cup revision were polyethylene liner wear and osteolysis (24 hips), loosening (19 hips) and recurrent dislocation (2 hips). CONCLUSION: We found that the HA-coated ABG(R) femoral stem had high survival rate at minimum 5 years follow-up after THA, but acetabularcup had high revision rate for loosening and osteolysis.

The Effects of Radiofrequency Energy on Human Articular Cartilage: The Effect of Power Setting and Mode of Treatment on Chondrocyte Viability / 대한정형외과학회잡지

PURPOSE: The objective of this study was to investigate the effects of radiofrequency energy on human chondrocyte viability, and to correlate confocal laser microscopy fluorescence to sulfate uptake and to the histological integrity of articular cartilage. MATERIALS AND METHODS: The chondroplasty procedure for chondromalacic articular cartilage was performed using a 3.0-mm ArthroWand (Arthroscopic Electrosurgery System, ArthroCare Corporation) on fresh human articular cartilage. Radiofrequency energy was applied to the cartilage surface through the probe at a velocity of 10-mm per second in contact and non-contact mode. Three power settings were used. The treated cartilage was analyzed for chondrocyte viability by confocal laser microscopy and (35)S uptake. RESULTS: Confocal laser microscopy demonstrated partial-thickness chondrocyte death irrespective of treatment method. No mode of treatment or radiofrequency energy power setting resulted in full-thickness chondrocyte death. The depth of cartilage ablation was increased in the treated areas in contact mode in proportion to the power level and the time of treatment. No statistically significant difference in radiolabeled sulfate uptake of the specimens was observed with respect to the treatment modes and power settings. CONCLUSION: The extent of chondrocyte death by radiofrequency energy was not as significant as reported previously when the probe was moved at the speed of 10 mm/sec. Radiofrequency energy may be useful to treat chondromalacic cartilage in a contact mode using a proper energy level and delivery time.

Reconstruction of Diabetic Foot Ulcers by Regional Flap Surgery / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the value of regional flap surgery for diabetic foot ulcers combined with infection or bone and tendon exposure. MATERIALS AND METHODS: We reviewed eight patients, nine cases of diabetic foot ulcers, which were treated by regional flap surgery. There were two Wagner's grade 2 ulcers and six Wagner's grade 3 ulcers. We performed four reversed sural artery neurocutaneous flaps, two lateral supramalleolar flaps, two medial plantar artery flaps and one first dorsal metatarsal artery flap. RESULTS: Seven of nine flaps completely survived after regional flap surgery. One partial and one complete flap necrosis occurred. One partially necrotized flap needed an additional skin graft. One completely necrotized flap needed free rectus abdominis myocutaneous flap surgery. There were two new ulcers, which were treated by free flap surgery. No patient needed amputation above the ankle joint. CONCLUSION: Satisfactory results were obtained by regional flap surgery for diabetic foot ulcers. Regional flap surgery is regarded as an effective treatment modality for diabetic foot ulcer combined with bone and tendon exposure with infection.

Dural Tears Secondary to Operations of the Lumbar Spinal Disorders / 대한척추외과학회지

STUDY DESIGN: A retrospective study. PURPOSE: To review the results of the treatment of dural tears, sustained during operations on the lumbar spinal disorders. MATERIALS AND METHODS: From Jan. 1991 to Dec. 2000, 694 consecutive patients had a decompression of the lumbar spine, 35(5%) patients sustained a dural tear during the operations. Of 32 patients who were followed up for more than one year, 29 patients were detected dural tear intraoperatively. 24 patients were treated with primary repair, 4 patients with fibrin glue and one patient with dural reconstruction and fibrin glue. Postoperative management consisted of closed wound drainage for an average of 3.3 days and bed rest for an average of 9.3 days. RESULTS: The total subfascial drains averaged an output of 626(18-1698) milliliters of 32 patients. Clinical symptoms were complained of headache in 12 patients, nausea in 7 patients, dizziness and vomiting in 2 patients postoperatively, but all had resolution of these symptoms after conservative treatment. A superficial wound infection occurred in one of these patients, managed with antibiotic therapy. Whereas the deep wound infection occurred in one, managed with wound debridement and antibiotic therapy successfully. A mean follow up of 34 months was available and showed satisfactory clinical results for 29 of the patients(91%). CONCLUSION: Closed wound drainage can be used safely in the presence of a dural repair and the patient needs to keep on bed rest while the drainage into a sterile bag is performed.