Contralateral Pedicular Fracture with Unilateral Spondylolysis

Although most authors regard contralateral pedicular fracture with unilateral spondylolysis as an unstable condition and recommend surgical management when immobilization fails in promoting bony healing of the fracture, few researchers have investigated the natural history of pedicle fracture or the causal relationship between symptoms and the fracture. In addition, there are no detailed guidelines that address the management of this disease. We report a rare case of contralateral pedicular fracture associated with unilateral spondylolysis at the L5 level which was successfully treated by rehabilitation with activity modification.

Evaluation of the Lesions of Synovial-lined Clefts in the infrapatellar Hoffa's Fat Pad with MR imaging

PURPOSE: Within Hoffa's infrapatellar fat pad there are two synovial clefts, horizontal and vertical, whichcommunicate with the intra-articular space. Intra-articular lesions can also occur in these clefts, and are oftendifficult to differentiate from extra-articular lesions. The purpose of this study is to evaluate, using MRimaging, the lesions occurring in these synovial lined clefts, as well as associated abnormalities. MATERIALS AND METHODS: Thirty-one knees of 31 patients with lesions in horizontal and vertical clefts in Hoffa's infrapatellarfat pad were retrospectively evaluated. Using a 1.5T MR imager, axial, sagittal, and coronal MR images of kneeswere obtained. Lesions in clefts, degree of joint effusion and associated knee abnormalities were analyzed. RESULTS: Horizontal cleft lesions were noted in 21 cases ; there were 17 cystic dilatations, two loose bodies,one synovial chondroma, and one case of pigmented villonodular synovitis(PVNS). Vertical cleft lesions were notedin 15 cases ; these comprised 11 cystic dilatations, two loose bodies, one synovial osteochondromatosis, and onePVNS. Among all cases, three cystic dilatations, one loose body, and one PVNS occurred in both horizontal andvertical clefts. Among 25 knees with cystic dilatations of clefts, five showed grade I joint effusion, ten gradeII, and ten grade III. Associated abnormalities were meniscal tear in 16 cases, osteoarthritis in 13, cruciateligament tear in five, osteochondritis dissecans in three, osteochondral fracture in two, osteonecrosis in one,loose body in one, and synovitis in one. CONCLUSION: Among synovial-lined clefts in Hoffa's fat pad, the mostcommon lesion was cystic dilatation ; there were various associated abnormalities and a close relationship tojoint effusion. An awareness of the types of lesions found in clefts is helpful for narrowing the differentialdiagnosis of lesions occurring in the area of Hoffa's fat pad.

Transcatheter Arterial Embolization of Ruptured Hepatocellular Carcinoma: Effectiveness and Long-term Follow-up

PURPOSE: To evaluate the effectiveness of emergent transcatheter arterial embolization(TAE) in the treatmentof bleeding from ruptured hepatocellular carcinoma(HCC) and long-term follow-up. MATERIALS AND METHODS: Twentypatients with ruptured HCC underwent emergent TAE; diagnosis was based on clinical and radiologic findings.Mesoportography was used to determine the presence of portal vein thrombosis, and celiac angiography to determinethe presence of hypervascular mass and extravasation of contrast material. All patients underwent TAE; a mixtureof adriamycin, mitomycin, lipiodol, and gelfoam particles was used. In four of the 20 patients, adjuvantembolization was performed, using stainless steel coils. After three week of follow-up CT, follow-up TAE wasperformed between two and ten times. RESULTS: Technical and clinical success was up to 100%. Mesoportographyshowed the presence of portal vein thrombosis in nine patients and its absence in 11. In 15 patients, three weeksof follow-up by CT showed lipiodol uptake by the mass and the disappearance of highly attenuated peritoneal fluid.Within one week of embolization, four of the 20 patients died of sepsis, shock, and hepatic failure, and withinone month of this procedure, one died of renal failure. Three-month, six-month, and one-year survival rates afterTAE were repectively 50%, 45%, and 30%; the mean duration of survival was 260 days. In nine patients with portalvein thrombosis, the one-year survival rate was 11%, while in 11 patients not suffering from this condition, therate was 70%; the difference between the two groups was statistically significant(p < 0.05). CONCLUSION: As thefirst choice of treatment for patients with hemoperitoneum from ruptured HCC, emergent TAE is an effective,life-saving therapeutic procedure; in these patients, portal vein thrombosis may be a factor influencing risk andprognosis.