Radiation safety: a focus on lead aprons and thyroid shields in interventional pain management

C-arm fluoroscopy is useful equipment in interventional pain management because it helps to guide correct needle targeting for the accurate injection and drug delivery. However, due to increased use of C-arm fluoroscopy in various pain procedures, the risk of radiation exposure is a significant concern for pain physicians. The harmful biological effects of ionizing radiation on the human body are well known. It is therefore necessary to strive to reduce radiation exposure. Lead aprons with thyroid shields are the most fundamental radiation protective devices for interventional procedures, and are very effective. However, the operator's radiation safety cannot be guaranteed because pain physicians seem to lack sufficient interest, knowledge, and awareness about radiation safety. Also, inappropriate care and use of radiation protective devices may result in a higher risk of radiation exposure. The purpose of this article was to review the literature on radiation safety with a focus on lead aprons and thyroid shields and present recommendations related to those devices during C-arm fluoroscopic-guided interventions by pain physicians.

The Surgical Outcomes of Olecranon Fracture Dislocation of the Elbow / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the surgical outcomes of olecranon fracture dislocation in accordance with the direction of the dislocation. MATERIALS AND METHODS: From December 2006 to February 2016, the surgical outcome in patients who had been followed-up for a minimum of 6 months accompanied with olecranon fracture and elbow instability were reviewed retrospectively. We classified olecranon fracture as either the anterior type or the posterior type. Moreover, we evaluated the clinical results by the Mayo elbow performance scores (MEPS) and checked for any associated injury, age, injury mechanism, and complication. RESULTS: Fourteen patients had anterior transolecranon fracture dislocation, with an average age of 46 years. The associated lesions were radial head fractures found in 2 patients (14.3%) and coronoid process fracture found in 5 patients (35.7%). Patients with anterior transolecranon fracture showed an average MEPS of 93.2 (70–100). Eight patients with posterior olecranon fracture dislocation had an average age of 66 years (22–87 years). The associated lesions were radial head fractures in 6 patients (75.0%) and coronoid process fracture in 8 patients (100%). Patients with posterior olecranon fracture dislocation showed an average MEPS of 94.4 (80–100). In comparison with the anterior type, posterior type occurred more frequently in elders and showed a greater association with injuries, such as radial head fracture and coronoid process fracture. However, there was no significant difference between the two groups with respect to the clinical outcome. CONCLUSION: There were differences in frequency of associated injuries and age in accordance with the direction of olecranon fracture dislocation. Moreover, good clinical outcomes were achieved by surgical treatment.

Surgical Treatment of Recalcitrant Wart

PURPOSE: A wart is caused by epidermal infection with the human papilloma virus. Although wart naturally disappears in some cases, it require treatment because of pain, aesthetic problem, and the possibility of malignant change. Conventional non-surgical treatment cannot be a fundamental solution for the pain and has such disadvantages as frequent recurrence and difficulties in achieving a satisfactory outcome. A surgical procedure was performed on patients with wart and the procedure had a good outcome. METHODS: We investigated the gender, age, lesion site, mean treatment duration, and presence or absence of recurrence in 21 patients with a wart within the period of January 2007 to July 2011. For local lesions, primary closure, including subcuticular suture after the excision, was performed. If the defect size was too big to do primary closure, we performed rotation flap. For wide multiple lesions, a split thickness skin graft was performed. RESULTS: Among the 21 patients, 12 patients were male and 9 patients were female, and their mean age was 42 years(SD=17.38, range: 11~75 years). The lesion site was the foot in 10 patients, the hand in 8 patients, the face in 2 patients, and the scalp in 1 patient. The mean treatment duration was 13.5 days(SD=4.36, range: 6~15 days) for the primary closure or rotation flap, and 18.5 days(SD=2.12, range: 17~20 days) for the skin graft. 20 patients were cured without recurrence. No recurrence was observed in the patients who underwent primary closure or rotation flap. One of the two patients who underwent a skin graft of their wart that had covered their entire palm had local recurrence in part of her finger tips. CONCLUSION: We performed surgical procedure on recalcitrant wart. As a results, we can treat it with short treatment duration, low recurrence rate and less scarring and get high patient satisfaction.

Refinement of Deep Nasolabial Fold by Soft Tissue Augmentation

A nasolabial fold is one of the most typical process on an aged face. Face lifting, one of the frequent methods of correcting nasolabial folds, involves innate burdens as it is a form of surgery and involves many difficulties related to the surgical procedure in improving the nasolabial fold. Therefore, soft tissue augmentation is increasingly being performed on nasolabial folds. We achieved a good outcome and a high level of patient satisfaction after correcting a nasolabial fold using Surederm(TM), AlloDerm(R), and a autologous fat strip. From October 2002 to December 2010, a total of 19 patients have inserted Surederm(TM), AlloDerm(R) and a autologous fat strip in nasolabial fold using our special instrument. Sex, age, patient's satisfaction, and side effects were examined and the outcome was assessed by two plastic surgeons, excluding these authors, in a blind manner by comparing the nasolabial fold in the pre- and post- treatment pictures. Of the 19 patients, 1 was male and 18 were female. Their mean age was 45 years(range: 21~61 years). They showed a relatively high level of satisfaction with the outcomes. In one patient, although the Surederm(TM) was removed due to infection, the patient's deep nasolabial fold was corrected even after the Surederm(TM) removal. The two plastic surgeons judged that the nasolabial folds of the 19 patients improved considerably. Our procedure is more invasive than filler or fat injection. But with this procedure, augmentation effect can be lasting longer. So, the outcome was satisfactory.

Cases of Chemical Burn by Aesthetic Phenol Peel

PURPOSE: Recently there are upgrowing public interest of cosmetics and anti-aging and also public request of chemical peel and its complications. It is a strong chemical agent and can occur severe chemical burn. METHODS: This research surveyed from August 2008 to March 2010 by 3 patients who had gotten chemical burn by phenol peel. We investigated age, sex, site, size and treatment. RESULTS: The average age of cases was 43 years old. They were all female. Damaged area was all on face. Wound size was 3.3% in average. Wound depth was deep second degree in 2 cases and mid second degree in 1 case. In one case, ectropion on both lower eyelids was occurred by scar contracture. We did release and thick split thickness skin graft to resolve ectropion. To other milder cases, we managed conservatively. CONCLUSION: People who had gotten chemical burn by phenol therapy didn't get proper therapy instantly. We suggest that phenol peel must be performed very carefully and by professional and experienced surgeon.