Sonographically assisted minimally invasive release (interventional microadhesiolysis) of the A1 pulley to treat trigger digit

BACKGROUND: We developed a sonographically assisted minimally invasive release technique (entitled as interventional microadhesiolysis) of the A1 pulley to treat trigger digit. This paper introduces the procedure and evaluates the efficacy of the intervention for trigger digit. METHODS: Eleven trigger digits in nine patients were treated with a specially designed needle using ultrasonographic assistance. The technique includes subcutaneous and intrasheath release. Subcutaneous release was performed by obliquely inserting the needle into the interdigital space and advancing it to release the subcutaneous tissue overlying the affected area. If the A1 pulley was not completely released, intrasheath release was performed by advancing the needle into the flexor tendon sheath, and the operator fixed the needle while the digit was passively flexed and extended. RESULTS: After the patients underwent the technique, all of the patients reported a reduction in pain and improved range of motion. CONCLUSIONS: This study suggests that interventional microadhesiolysis is an effective treatment for trigger digit.

Subcutaneous botulinum toxin type a injection for chronic medial knee pain with ostheoarthritis

BACKGROUND:This study was designed to evaluate the efficacy of subcutaneous Botulinum toxin type A (BoNT-A) injection for treating chronic medial knee pain with osteoarthritis. METHODS:A randomized, double-blind, placebo-controlled clinical trial was conducted at a university hospital in Korea.The subjects suffering from chronic medial knee pain with osteoarthritis were randomly allocated to either the BoNT-A (treatment, n = 23) group or the normal saline (placebo, n = 27) group.Injections were given to 10 points per unilateral knee along the course of the saphenous nerve.A total of 90 units of BoNT-A (60 units at baseline and 30 units after 1 week) was given for treating unilateral knee pain and a total of 180 units of BoNT-A was given for treating bilateral knee pain.The placebo group received the same volume of normal saline. RESULTS:The Visual Analog Scale (VAS) pain score was significantly decreased in both the BoNT-A and normal saline groups 1, 4 and 12 weeks after injection.After adjusting for covariates, BoNT-A had a 0.788 times higher effect to decrease the VAS score than did normal saline, but the effect was marginally significant (P = 0.050). CONCLUSIONS:Subcutaneous injection along the course of the saphenous nerve significantly reduces chronic medial knee pain. The pain reduction effect of BoNT-A is higher than that of placebo, but the effect is marginally significant

Subcutaneous botulinum toxin type a injection for chronic medial knee pain with ostheoarthritis

BACKGROUND:This study was designed to evaluate the efficacy of subcutaneous Botulinum toxin type A (BoNT-A) injection for treating chronic medial knee pain with osteoarthritis. METHODS:A randomized, double-blind, placebo-controlled clinical trial was conducted at a university hospital in Korea.The subjects suffering from chronic medial knee pain with osteoarthritis were randomly allocated to either the BoNT-A (treatment, n = 23) group or the normal saline (placebo, n = 27) group.Injections were given to 10 points per unilateral knee along the course of the saphenous nerve.A total of 90 units of BoNT-A (60 units at baseline and 30 units after 1 week) was given for treating unilateral knee pain and a total of 180 units of BoNT-A was given for treating bilateral knee pain.The placebo group received the same volume of normal saline. RESULTS:The Visual Analog Scale (VAS) pain score was significantly decreased in both the BoNT-A and normal saline groups 1, 4 and 12 weeks after injection.After adjusting for covariates, BoNT-A had a 0.788 times higher effect to decrease the VAS score than did normal saline, but the effect was marginally significant (P = 0.050). CONCLUSIONS:Subcutaneous injection along the course of the saphenous nerve significantly reduces chronic medial knee pain. The pain reduction effect of BoNT-A is higher than that of placebo, but the effect is marginally significant

Relationship between the Metabolic Syndrome and Colorectal Polyps

BACKGROUND: With increased prevalence of colorectal cancer, it is important to establish the risk factors of colorectal cancer. The prevalence of the metabolic syndrome (MS) is also increasing. Insulin resistance may play an important role in the pathogenesis of MS and colorectal polyps. The aim of this study was to assess the relationship between MS and colorectal polyps. METHODS: A total 558 subjects underwent colonoscopic examination from April 2004 to July 2005 at the health promotion center of Bundang CHA Hospital. According to the National Cholesterol Education Program (NCEP) Adult Treatment Panel III definition of MS, the waist circumference, blood pressure (BP), fasting blood glucose (FBG), triglyceride (TG) and HDL cholesterol were measured. Alcohol consumption, smoking and other confounding factors were assessed by a self-administered questionnaire. RESULTS: The incidence of MS and colorectal polyps was 16.3% and 33.0%, respectively. In subjects with polyps, the number of men, smokers and drinkers were higher than in subjects without polyps. In subjects with polyps, BP, FBG and TG were also higher than in subjects without polyps. After adjustment for possible confounding factors, MS was associated with increased risk of colorectal polyps (odds ratio, 1.74; 95% confidence interval, 0.94~3.22). MS strongly increased the risk of colorectal polyps in men (odds ratio 2.19; 95% confidence interval, 1.07~4.45), but not in women. CONCLUSION: We concluded that MS is a risk factor for colorectal polyps in asymptomatic Korean adults and this suggests that insulin resistance may play an important role in the development of colorectal polyps.

A Case of Rowell's syndrome / 대한피부과학회지

Rowell's syndrome is believed to be a distinct and rare clinical entity originally descrived as lupus erythematosus associated with erythema multiforme-like skin lesions, immunologic findings of speckled antinuclear antibodies, anti-La antibodies and a positive test for rheumatoid factor. We report a case of systemic lupus erythematosus in a 31-year-old woman with annular erythematous patches on both hands, feet and back. Also, she presented abnormal serologic and immunologic findings. We believed that our patient meets the criteria for this rarely reported entity.