Extraspinal Percutaneous Osteoplasty for the Treatment of Painful Bony Metastasis

BACKGROUND: Extraspinal percutaneous osteoplasties (POPs) are novel techniques for the treatment of painful bony metastasis, which is often the cause of both persistent and incidental breakthrough pain. This retrospective study explored the efficacy and complications of extraspinal POPs. METHODS: The origin of the cancer metastasis, performed POP sites, necessity of adjacent joint injections, pain and Karnofsky Performance Scale (KPS) scores, complications related to the POPs, and life expectancy were evaluated from the medical records from 2009 to 2016. RESULTS: A total of 47 (M/F = 28/19) patients had received 54 POPs, including costoplasty, scapuloplasty, ilioplasty, humeroplasty, ischioplasty, femoroplasty, sternoplasty, and puboplasty, in order of frequency. The most common sites for the origin of the cancer, in order of frequency, were the lung, liver, breast, colon, and kidney. All patients receiving POPs including scapuloplasty, ilioplasty, humeroplasty, and femoroplasty needed adjacent joint injections before or after the POPs. Pain due to metastatic lesions was reduced significantly immediately after the POPs and the reduction was sustained until the end of their lives. The median KPS was increased from 35.4% to 67.7% immediately after the POPs. There were no complications related to the procedures. The mean life expectancy after performing the POPs, for 35 patients which died afterwards, was 99.3 days, ranging from 1 to 767 days. CONCLUSION: Even though pain in the isolated POP sites may be difficult to measure due to overlapping systemic pain, the POPs provided immediate local pain relief, and the patients showed better physical performance without procedure-related complications.

Evaluation of an Experimentally Designed Stereotactic Guidance System for Determining Needle Entry Point during Uniplanar Fluoroscopy-guided Intervention

BACKGROUND: In discography performed during percutaneous endoscopic lumbar discectomy (PELD) via the posterolateral approach, it is difficult to create a fluoroscopic tunnel view because a long needle is required for discography and the guide-wire used for consecutive PELD interrupts rotation of fluoroscope. A stereotactic system was designed to facilitate the determination of the needle entry point, and the feasibility of this system was evaluated during interventional spine procedures. METHODS: A newly designed stereotactic guidance system underwent a field test application for PELD. Sixty patients who underwent single-level PELD at L4-L5 were randomly divided into conventional or stereotactic groups. PELD was performed via the posterolateral approach using the entry point on the skin determined by premeasured distance from the midline and angles according to preoperative magnetic resonance imaging (MRI) findings. Needle entry accuracy provided by the two groups was determined by comparing the distance and angle measured by postoperative computed tomography with those measured by preoperative MRI. The duration and radiation exposure for determining the entry point were measured in the groups. RESULTS: The new stereotactic guidance system and the conventional method provided similarly accurate entry points for discography and consecutive PELD. However, the new stereotactic guidance system lowered the duration and radiation exposure for determining the entry point. CONCLUSIONS: The new stereotactic guidance system under fluoroscopy provided a reliable needle entry point for discography and consecutive PELD. Furthermore, it reduced the duration and radiation exposure associated with determining needle entry.

A Case of Bilateral Postauricular Sinuses

Preauricular sinuses are common congenital malformations that usually occur at the anterior margin of the ascending limb of the helix. There are rare cases in which the location of the preauricular sinus is posterior to the tragus, and the direction of the sinus tract is toward the posterior. This variant type of preauricular sinus is called, 'postauricular sinus'. Postauricular sinus is uncommon. Thus, diagnosis and treatment may be delayed due to its location of its opening and atypical clinical symptoms. Typical treatment is a single stage operation through bidirectional skin incision. However, we found out that according to the length and invasion depth of the sinus tract, there was an option between unidirectional and bidirectional skin incisions that we may choose from.

Therapeutic Effects of Carbogen Inhalation and Lipo-Prostaglandin E1 in Sudden Hearing Loss

PURPOSE: Vascular disorders and viral infections are considered the main causes of sudden hearing loss (SHL), although its pathogenesis remain unclear. Treatments include carbogen inhalation and lipo-prostaglandin E1 (lipo-PGE1), both of which have circulation-enhancing effects. We investigated the effectiveness of carbogen inhalation and lipo-PGE1 in SHL. MATERIALS AND METHODS: This retrospective review included 202 patients with idiopathic SHL who visited our clinic within 14 days of symptom onset between January 2006 and June 2010. All patients received oral prednisolone for 10 days. Of the 202 patients, 44 received no additional treatment, 106 received additional carbogen inhalation, and 52 received additional lipo-PGE1. Hearing improvement was measured using Siegel's criteria. RESULTS: Overall recovery rates were 67.9% in the carbogen group, 53.8% in the lipo-PGE1 group, and 52.3% in the steroid-only control group (p=0.097). Limited to type 1 and type 2 categories of Sigels's criteria, the carbogen group had a significantly higher recovery rate (53.8%) than the lipo-PGE1 group (26.9%) and the steroid-only control group (38.6%) (p=0.005). CONCLUSION: Carbogen inhalation added to steroid was a more effective treatment than lipo-PGE1 added to steroid or steroid alone in patients with SHL.

A Case of Fungal Sphenoid Sinusitis with Visual Loss / 대한의진균학회지

The maxillary sinus is the most commonly affected in the fungal infection of the sinus, but sphenoid sinus is only occasionally occurred. Because of the adjacent structures in sphenoid sinus, however, its complication may cause fatal outcome. Visual loss due to optic neuritis, which is defined as an inflammatory neuropathy of the optic nerve, is extremely rare, which may occur via direct spread of fungus. We experienced a case of fungal sphenoid sinusitis, which damaged the optic nerve and led to visual loss in a 74 year-old male. It was treated by endoscopic sinus surgery with steroid therapy. We present this case with a brief review of these disease's entities.

Early Results of MIS-QS Total Knee Arthroplasty: A Comparison with Conventional Procedure for the Same Patient / 대한정형외과학회잡지

PURPOSE: This study assessed the early clinical and radiological results of Minimally Invasive Surgery- Quadriceps sparing total knee arthroplasty (MIS-QS TKA), and compared these results with those of conventional TKA. MATERIALS AND METHODS: Between August 2004 and March 2005, 17 patients with bilateral TKA on their one side using a regular procedure and the other using the MIS-QS technique were evaluated and compared. The clinical assessment was performed by measuring the range of motion, Knee Society Score, and a radiological evaluation by standing anteroposterior, supine lateral, and Merchant view preoperatively, 2 weeks, 6 weeks, 3 months and 1 year after surgery. Statistical analysis was performed using a paired t-test. RESULTS: The average range of knee motion was slightly larger in the MIS-QS group at all periodsbut there was no statistical difference between the two groups. The Knee Society Score was similar at the 3 month and 1 year periods. The alignment of the implants was satisfactory in both groups and postoperative patellar alignment checked in the Merchant view was better in the MIS-QS group at all periods. CONCLUSION: There were no differences in the clinical aspects at 1 year period between the two groups. However, the MIS-QS group showed better patellar alignment than the conventional group for up to 1 year.