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Purpose@#To evaluate allergen sensitization in Koreans and assess regional differences in it using Geographic Information System (GIS)-based modeling techniques. @*Methods@#We retrospectively analyzed multiple allergen simultaneous test (MAST) results collected from 2,017 clinics and hospitals nationwide between 2018 and 2020. The AdvanSure™ AlloScreen (LG Chem, Seoul, Korea) was used to test for 47 allergens. Then, we created maps to visualize the sensitization prediction rate by using the ordinary kriging method. @*Results@#The total number of participants were 196,419; 104,371 (53.1%) were sensitized to one or more allergens. The most frequent allergen causing sensitization was Dermatophagoides farinae (34.0%), followed by Dermatophagoides pteronyssinus (32.3%), house dust (26.2%), cat dander (13.6%), Acarus siro (12.5%), rye grass pollen (8.8%), and birch tree pollen (8.2%), respectively. Perennial allergens, such as mites and cat dander, were more common than seasonal allergens. Sensitization rates to grasses were generally higher than those to tree and weed allergens. The sensitization rates to Hymenoptera venoms were 4.8% in honey bee and 2.2% in yellow jacket. The sensitization prediction rate against Dermatophagoides farinae calculated by GIS-based mapping showed geographical differences even within the same administrative district. @*Conclusion@#Dermatophagoides farinae and Dermatophagoides pteronyssinus were found to be the most prevalent sensitizing allergens throughout Korea. GIS-based spatial pattern analysis using MAST revealed different sensitization patterns between geographic areas and at the subdistrict level. These data could assist in prevention and management of allergic diseases and provide valuable evidence for environmental and public health policymakers.
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Objective@#To investigate the therapeutic efficacy of hyperthermic intraperitoneal chemotherapy (HIPEC) as consolidation treatment after completing first-line treatment in patients with advanced ovarian cancer. @*Methods@#A retrospective chart review was conducted on patients treated at the Comprehensive Gynecologic Cancer Center between January 2014 and 2019. Based on the inclusion criteria, 24 eligible patients who received HIPEC (paclitaxel 175 mg/m2, for 90 minutes, at 42°C) (HIPEC group) as consolidation treatment after terminating the adjuvant chemotherapy were identified. Another 24 patients who met the inclusion criteria and did not receive HIPEC were matched, representing the non-HIPEC group. Disease-free survival (DFS) and overall survival (OS) were examined between the two groups. @*Results@#The median DFS was 28.7 and 24.2 months in the HIPEC and non-HIPEC groups, respectively (P=0.688). The 3-year DFS rates in the HIPEC and non-HPEC groups were 39.5% and 32.6%, respectively. However, the median OS was not determined. The 5-year OS rates in the HIPEC and non-HIPEC groups were 86.2% and 81.3%, respectively (P=0.850). One patient developed grade 3 neutropenia. Other patients experienced mild adverse events after HIPEC. @*Conclusion@#This study suggests that consolidation HIPEC could not support the survival benefit after completing the first-line treatment for patients with advanced ovarian cancer, although no severe specific safety issues were found. Therefore, randomized trials evaluating consolidation HIPEC for the management of ovarian cancer are warranted.
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Objective@#To investigate the therapeutic efficacy of hyperthermic intraperitoneal chemotherapy (HIPEC) as consolidation treatment after completing first-line treatment in patients with advanced ovarian cancer. @*Methods@#A retrospective chart review was conducted on patients treated at the Comprehensive Gynecologic Cancer Center between January 2014 and 2019. Based on the inclusion criteria, 24 eligible patients who received HIPEC (paclitaxel 175 mg/m2, for 90 minutes, at 42°C) (HIPEC group) as consolidation treatment after terminating the adjuvant chemotherapy were identified. Another 24 patients who met the inclusion criteria and did not receive HIPEC were matched, representing the non-HIPEC group. Disease-free survival (DFS) and overall survival (OS) were examined between the two groups. @*Results@#The median DFS was 28.7 and 24.2 months in the HIPEC and non-HIPEC groups, respectively (P=0.688). The 3-year DFS rates in the HIPEC and non-HPEC groups were 39.5% and 32.6%, respectively. However, the median OS was not determined. The 5-year OS rates in the HIPEC and non-HIPEC groups were 86.2% and 81.3%, respectively (P=0.850). One patient developed grade 3 neutropenia. Other patients experienced mild adverse events after HIPEC. @*Conclusion@#This study suggests that consolidation HIPEC could not support the survival benefit after completing the first-line treatment for patients with advanced ovarian cancer, although no severe specific safety issues were found. Therefore, randomized trials evaluating consolidation HIPEC for the management of ovarian cancer are warranted.
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Background@#Problems associated with hallux valgus deformity correction using Kirschner-wire (K-wire) fixation include pin pullout and loss of stability. These complications are pronounced in the osteopenic bone, and few reports have focused on pin versus screw fixation. We examined the use of additional screw fixation to avoid these problems. The aim of this study was to compare outcomes of K-wire fixation (KW) and a combined K-wire and screw fixation (KWS). @*Methods@#Two groups with hallux valgus deformity, who were treated with a proximal chevron metatarsal osteotomy (PCMO), were compared based on the fixation method used. The KW group included 117 feet of 98 patients, and the KWS group included 56 feet of 40 patients. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain score, American Orthopedic Foot & Ankle Society (AOFAS) hallux score, and patient satisfaction score were evaluated. Radiographically, hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured. @*Results@#The mean VAS score decreased from 6.3 preoperatively to 1.6 postoperatively in the KW group and from 5.7 preoperatively to 0.5 postoperatively in the KWS group (p < 0.001). The mean AOFAS scores of the KW and KWS groups improved from 59.4 and 58.2, respectively, to 88.9 and 95.3, respectively (p < 0.001). Eighty-five percent in the KW group and 93% in the KWS group were satisfied with surgery. Clinical differences were not significant. The mean HVAs decreased from 34.7° to 9.1° in the KW group and from 38.5° to 9.2° in the KWS group (p < 0.001). The mean IMA decreased from 14.5° (range, 11.8°–17.2°) to 6.4° (range, 2.7°–10.1°) in the KW group and from 18.0° (range, 14.8°–21.2°) to 5.3° (range, 2.5°–8.1°) in the KWS group (p < 0.001). When IMA values at the 3-month postoperative and the final follow-up were compared, the IMA was significantly increased only in the KW group (p < 0.001) and no difference was found in the KWS group (p = 0.280). @*Conclusions@#We found a statistically significant difference in the decrease in IMA between the 2 groups. We recommend the combined pin and screw fixation in PCMO to enhance fixation stability and prevent potential hallux valgus correction loss.
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Purpose@#We evaluated the efficacy and safety of pembrolizumab in patients with recurrent gynecologic cancers in real-world practice. @*Materials and Methods@#We conducted a retrospective, single-institution study of patients with recurrent gynecologic malignancies treated with pembrolizumab. The primary endpoints were the objective response rate (ORR) and safety. @*Results@#Thirty-one patients treated with pembrolizumab were included. The primary disease sites were the uterine cervix (n=18), ovaries (n=8), and uterine corpus (n=5). Fifteen of the 31 patients (48%) had an Eastern Cooperative Oncology Group performance status of ≥2. The median number of prior chemotherapy lines was 2 (range, 1–6), and 14 of 31 patients (45%) had received ≥ 3 prior lines of chemotherapy. The overall ORR was 22.6%: specifically, 22.3% (4 of 18 patients), 12.5% (1 of 8 patients), and 40% (2 of 5 patients) for cervical, ovarian, and endometrial cancers, respectively. During a median follow-up of 4.7 months (range, 0.2–35.3), the median time to response was 1.9 months (range, 1.4–5.7). The median duration of response was not reached (range, 8.8-not reached).The median progression-free survival was 2.5 months (95% confidence interval, 1.7-not reached). Adverse events occurred in 20 patients (64.5%), and only 3 (9.7%) were grade ≥3. There was one case of suspicious treatment-related mortality, apart from which most adverse events were manageable. @*Conclusion@#In real-world practice, pembrolizumab was feasible and effective in heavily treated recurrent gynecologic cancer patients with poor performance status who may not be eligible for enrollment in clinical trials.
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The supramalleolar osteotomy is a joint-preserving surgical procedure. It is a very good treatment option for the asymmetric varus ankle and medial compartment osteoarthritis. The primary objective of the procedure is to shift medial concentration of stress toward the lateral intact articular cartilage to redistribute the joint loads during ambulation. Several studies have shown that deformities of the ankle result in uneven load distribution in the ankle joint, which eventually leads to articular cartilage degeneration. Since the lateral articular cartilage is intact, joint-sacrificing procedures such as total ankle replacement or ankle arthrodesis are not the most appropriate treatment choices for medial compartment arthritis. Results of supramalleolar osteotomies are very promising in terms of functional outcome and pain relief. In younger patients with medial compartment varus ankle osteoarthritis or even with a normal tibial anterior surface angle, supramalleolar osteotomies can be performed to realign the ankle to promote regeneration of the asymmetrically damaged cartilage. In this review article, we will discuss the indications, complications, surgical techniques, and outcomes of the supramalleolar osteotomy reported in the current literature.
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Purpose@#In this study, we investigated the frequencies of mutations in DNA damage repair genesincluding BRCA1, BRCA2, homologous recombination genes and TP53 gene in ovarian highgradeserous carcinoma, alongside those of germline and somatic BRCA mutations, withthe aim of improving the identification of patients suitable for treatment with poly(ADPribose)polymerase inhibitors. @*Materials and Methods@#Tissue samples from 77 Korean patients with ovarian high-grade serous carcinoma weresubjected to next-generation sequencing. Pathogenic alterations of 38 DNA damage repairgenes and TP53 gene and their relationships with patient survival were examined. Additionally,we analyzed BRCA germline variants in blood samples from 47 of the patients forcomparison. @*Results@#BRCA1, BRCA2, and TP53 mutations were detected in 28.6%, 5.2%, and 80.5% of the 77patients, respectively. Alterations in RAD50, ATR, MSH6, MSH2, and FANCA were also identified.At least one mutation in a DNA damage repair gene was detected in 40.3% of patients(31/77). Germline and somatic BRCA mutations were found in 20 of 47 patients (42.6%),and four patients had only somatic mutations without germline mutations (8.5%, 4/47).Patients with DNA damage repair gene alterations with or without TP53mutation, exhibitedbetter disease-free survival than those with TP53 mutation alone. @*Conclusion@#DNA damage repair genes were mutated in 40.3% of patients with high-grade serous carcinoma,with somatic BRCAmutations in the absence of germline mutation in 8.5%. Somaticvariant examination, along with germline testing of DNA damage repair genes, has potentialto detect additional candidates for PARP inhibitor treatment.
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PURPOSE@#To compare the MRI findings of anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) injuries in chronic lateral ankle instability (CLAI) between surgical treatment groups.@*MATERIALS AND METHODS@#Fifty-two patients with CLAI were divided into the modified Broström procedure (MBP) (n = 31) and lateral ankle ligament reconstruction (LAR) (n = 21) groups. T2-weighted MRI findings between the groups were compared for caliber change, slope, signal intensity, and thickness measurements of the ligaments. Additionally, the talar tilt angles were measured on stress radiographs.@*RESULTS@#The injured ATFL (p = 0.002 vs. p = 0.001) and CFL (p = 0.008 vs. p = 0.039) were more commonly scarce or thin and had decreased slopes in the LAR group. The mean thickness of ATFL (P = 0.002) and CFL (p = 0.002) was 1.1 ± 0.9 mm and 1.3 ± 0.8 mm, respectively, in the LAR group and 2.2 ± 1.3 mm and 2.1 ± 0.9 mm, respectively, in the MBP group. The mean talar tilt angle was greater in the LAR group (13.4 ± 3.9°) than in the MBP group (9.5 ± 3.8°) (p = 0.001).@*CONCLUSION@#A qualitative analysis of the ligaments on MRI is valuable in selecting the surgical method.
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Ankle sprain is one of the most common musculoskeletal injuries. Although most ankle sprains respond well to conservative measures, chronic instability following an acute sprain has been reported to occur in 20% to 40% of patients. Some individuals are eventually indicated for a lateral ankle ligament reconstruction due to persistent ankle instability. More than 80 surgical procedures have been described to address lateral ankle stability. These range from direct repair of the anterior talofibular ligament (ATFL) and of the calcaneofibular ligament (CFL) to reconstructions based on the use of autograft or allograft tissues. However, the best surgical option remains debatable. The modified Broström procedure is most widely used for direct ligament repair, but not always possible because of the poor ATFL or CFL quality or deficiency of these ligaments, which prevents effective shortening imbrication. Furthermore, the importance of a CFL reconstruction has been emphasized recently. On the other hand, it is difficult to achieve an efficient CFL reconstruction during the Broström procedure. Others have reported that an anatomic reconstruction of injured ligaments restores the normal resistance to anterior translation and inversion without restricting subtalar or ankle motion, and as a result, anatomic reconstructions for lateral ankle instability utilizing an autograft or allograft tendon have gained popularity.
Subject(s)
Humans , Allografts , Ankle Injuries , Ankle , Autografts , Hand , Lateral Ligament, Ankle , Ligaments , Sprains and Strains , TendonsABSTRACT
The original article contained errors.
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OBJECTIVE: The aim of this study was to evaluate the clinicopathological features of minimal deviation adenocarcinoma (MDA) and to analyze its prognostic factors. METHODS: We retrospectively analyzed the medical records of 17 patients who were diagnosed with MDA at a single institution between January 2005 and December 2015. RESULTS: The median age of the patients was 47.7 years (33–75 years). MDA was diagnosed in 7 patients (41.2%) before performing definitive surgery. Stage IB disease was diagnosed in 12 patients (70.6%) and advanced stage disease (stage II: 3, stage III: 2) in 5. MDA was incidentally diagnosed following hysterectomy for benign conditions in 6 patients. Adjuvant therapy was administered to 13 patients (76.5%). During median follow-up over 33.6 months (7–99 months), 11 patients (64.7%) showed no evidence of disease, 6 (35.3%) showed persistent or recurrent disease and 5 died of the disease. Peutz-Jeghers syndrome was not suspected in any patient, and no mutation was detected in the 3 patients who underwent genetic testing. Univariate analysis showed that advanced stage disease (P=0.016) and lymphovascular space invasion (P=0.002) demonstrated a statistically significant association with poor overall survival (OS) rates. Advanced stage disease continued to show a significant association with poor OS rates (hazard ratio, 2.92; 95% confidence interval, 1.097–7.746; P=0.032) even after multivariate analysis. CONCLUSION: Early diagnosis is important to manage MDA. Clinicians should consider MDA among the differential diagnoses in patients with a suspicious clinical presentation even with negative cervical screening tests.
Subject(s)
Female , Humans , Adenocarcinoma , Cervix Uteri , Diagnosis, Differential , Early Diagnosis , Follow-Up Studies , Genetic Testing , Hysterectomy , Mass Screening , Medical Records , Multivariate Analysis , Peutz-Jeghers Syndrome , Retrospective Studies , Uterine Cervical NeoplasmsABSTRACT
OBJECTIVE: The aim of the present study was to assess the frequency of germline mutations in patients with peritoneal carcinoma (PC) or the fallopian tube carcinoma (FTC), using a multi-gene panel. METHODS: Twenty-six patients diagnosed with either PC or FTC between January 2013 and December 2016 were recruited consecutively. Germline DNA was sequenced using a 6-gene next generation sequencing (NGS) panel following genetic counseling. Surgico-medical information was obtained from hospital records. Genetic variations were detected using the panel and were cross-validated by Sanger direct sequencing. RESULTS: Germline BRCA1/2 mutations were identified in 6 patients (23.1%). Four were detected in patients with PC and 2 were in FTC patients. No mutations were detected in TP53, PTEN, CDH1, or PALB2. We identified 11 variant of uncertain significance (VUS) in 9 patients; 2 in BRCA1, 3 in BRCA2, 2 in TP53, and 4 in CDH1. We also detected a CDH1 c.2164+16->A VUS in 3 patients. CONCLUSION: The prevalence of germline BRCA1/2 mutations in patients with PC or FTC is comparable to that of BRCA1/2 mutations in epithelial ovarian cancer patients.
Subject(s)
Female , Humans , DNA , Fallopian Tube Neoplasms , Fallopian Tubes , Genes, BRCA1 , Genes, BRCA2 , Genetic Counseling , Genetic Variation , Germ-Line Mutation , Hospital Records , Ovarian Neoplasms , Peritoneal Neoplasms , Peritoneum , PrevalenceABSTRACT
We present a case of an endometrial cancer patient with germline mutation in MutS homolog 6 (MSH6), associated with Lynch syndrome. A 60-year-old Korean woman had a personal history of colon cancer 23 years ago. She also had a family history of endometrial cancer and colon cancer of her sisters and brothers. Immunohistochemistry was negative for MutL homolog 1 (MLH1) and positive for MutS homolog 2 (MSH2). Based on these findings, she underwent genetic counseling and testing that revealed a frameshift germline mutation at MSH6 (c. 3261dupC).
Subject(s)
Female , Humans , Middle Aged , Colon , Colonic Neoplasms , Colorectal Neoplasms, Hereditary Nonpolyposis , Endometrial Neoplasms , Genetic Counseling , Germ-Line Mutation , Immunohistochemistry , Korea , SiblingsABSTRACT
PURPOSE: The purpose of this study was to evaluate the radiographic and clinical outcomes of subtalar arthroereisis as a method of treatment for pediatric flexible flatfoot. MATERIALS AND METHODS: We retrospectively investigated 14 feet among 10 patients with flexible flatfoot, who were treated with a subtalar arthroereisis using a sinus tarsi implant between March 2007 and June 2012. Radiographically, the talo-1st metatarsal angle, talar declination, and calcaneal pitch angle have all been measured on lateral radiographs. The talo-navicular coverage angle and talo-1st metatarsal angle was measured on anteroposterior (AP) radiographs and tibio-calcaneal angle was assessed by hindfoot alignment view. Visual analogue scale (VAS) pain scores and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were used for clinical evaluation. RESULTS: The mean follow-up was 48.7 months (16–98 months), and the mean age was 11.6 years (6–19 years). Radiographically, the mean pre-operative and postoperative values measured by the lateral foot radiograph were −25.1° and −7.5° for talo-1st metatarsal angle, 37.4° and 23.2° for talar declination, and 8.3° and 15.0° for calcaneal pitch angle, respectively. The mean preoperative and postoperative values measured by foot AP radiograph were 23.0° and 11.9° for talo-navicular coverage angle and 17.2° and 9.0° for talo-1st metatarsal angle, respectively. Moreover, tibio-calcaneal angle improved from valgus 17.4° on average to 4.5° on average. Clinically, the VAS score and AOFAS score was improved from 5.8 to 1.5 and from 61.8 to 90.4, respectively. Complication was sinus tarsi pain that occurred in 5 cases (35.7%). CONCLUSION: We achieved a satisfactory correction of pediatric flexible flatfoot deformities via subtalar arthroereisis, using a sinus tarsi implant with favorable radiographic and clinical measures. However, high potential complication rate of postoperative sinus tarsi pain on weight-bearing should carefully be considered.
Subject(s)
Humans , Ankle , Congenital Abnormalities , Flatfoot , Follow-Up Studies , Foot , Metatarsal Bones , Methods , Retrospective Studies , Weight-BearingABSTRACT
OBJECTIVE: To compare the oncologic and obstetric outcomes in reproductive-age females with borderline ovarian tumors (BOTs) treated with cyst enucleation (CE) or unilateral salpingo-oophorectomy (USO). METHODS: The medical records of patients with BOTs treated between 1998 and 2014 were retrospectively reviewed. The recurrence rates in the USO and CE groups were compared, and the postoperative obstetric outcomes were assessed via telephone survey. RESULTS: Eighty-nine patients with BOTs underwent USO, and 19 underwent CE. Of these, six patients had recurrent BOTs. The recurrence rate was significantly lower in the USO group (3/89, 3.4%) than in the CE group (3/19, 15.8%) (P=0.032). All patients with recurrent disease were successfully treated with further surgery. Of the 76 patients interviewed by telephone, 71 (93.4%) resumed regular menstruation after surgery. Twenty-six of the 32 patients (81.3%) who attempted to conceive had successful pregnancies. USO (19/24, 79.2%), like CE (7/8, 87.5%), resulted in favorable pregnancy rates for patients with BOTs. CONCLUSION: USO is a suitable fertility-preserving surgery for women with BOTs. CE is also an acceptable option for select patients.
Subject(s)
Female , Humans , Pregnancy , Fertility Preservation , Medical Records , Menstruation , Pregnancy Rate , Recurrence , Retrospective Studies , TelephoneABSTRACT
Flatfoot deformity, defined as loss of medial longitudinal arch, sometimes involves symptoms such as medial arch pain or Achilles tendon tightening, etc. Whether the etiology of deformity is congenital or acquired, i.e., posterior tibial tendon dysfunction, symptoms are largely resolved with conservative treatment including medication, orthoses, and activity modification. Surgery should be considered in cases of failure of conservative treatment and clinicians can select an appropriate technique among many surgical options including calcaneal osteotomy or flexor digitorum longus tendon transfer. Principles of corrective surgery include the recovery of alignment and the preservation of joint motion.
Subject(s)
Achilles Tendon , Congenital Abnormalities , Flatfoot , Joints , Orthotic Devices , Osteotomy , Posterior Tibial Tendon Dysfunction , Tendon TransferABSTRACT
BACKGROUND AND OBJECTIVES: Correction of deviated nose is considered one of the most difficult and serious surgical operations in rhinoplasty. The correction of bony deviation, in particular, requires osteotomy. Although there are individual differences in the shapes or features of bony deviations of each patient, the techniques of osteotomy are limited. Therefore, for proper correction of bony deviation, it is necessary to set up a precise pre-surgical plan. SUBJECTS AND METHOD: We categorized 187 patients with bony deviated nose into 5 types based on the analysis of preoperative nasal bone 3D computer tomography, and studied surgical method for each type. RESULTS: Of 187 patients, 92 (49%) patients are categorized into type I, 62 (36%) patients into type II, 12 (6%) patients into type III, 2 (1%) patients into type IVa, 7 (4%) patients into type IVb and 7 (4%) patients into type V. Only did eight patients (5%) undergo revision surgery due to unsuccessful outcomes. Major complications like infection, abscess, arteriovenous fistula, epiphora, and saddle deformation did not occur at all. CONCLUSION: Preoperative planning under the analysis and categorization using 3D CT is considered helpful for the precise and individualized surgery in corrective rhinoplasty.
Subject(s)
Humans , Abscess , Arteriovenous Fistula , Individuality , Lacrimal Apparatus Diseases , Nasal Bone , Nose , Osteotomy , RhinoplastyABSTRACT
PURPOSE: Several studies have reported on the biomechanical advantages of a locking compression plate (LCP) for treatment of lateral malleolar fracture. However, few studies have reported clinical outcome after treatment of lateral malleolar fracture using a LCP in elderly patients. Thus, this study investigated the trends of lateral malleolar fractures in elderly patients and evaluated the clinical and radiological outcome of treating them using a 'locking compression distal fibula plate'. MATERIALS AND METHODS: Twenty-one patients (male: 3, female: 18) over 65 years old, who were followed-up for at least one year were enrolled in this study. They were treated surgically with open reduction and internal fixation using a LCP for lateral malleolar fracture from 2011 to 2014. Lauge-Hansen and Danis-Weber classification were used for preoperative classification of fractures. Visual analog scale (VAS) pain scores, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores, 4-graded subjective satisfaction and post-operative range of motion were used for the clinical evaluation. Time to bone union, non-union, mal-union, metal failure and implant loosening were assessed for radiographic outcomes. RESULTS: The mean age of patients was 71.2 years old, pain VAS and AOFAS score was 1.6 points and 94.2 points, respectively and 18 cases (85.7%) showed more than satisfaction in subjective satisfaction. Comminuted fracture was observed in 8 cases (38.1%) and lag screw insertion was performed in 7 ankles (33.3%). The mean bony union period was 3.6 months. There were 5 cases of mal-union, no case of non-union and metal failure. CONCLUSION: Satisfaction level of elderly patients with lateral malleolar fracture was significantly associated with only pain at the final follow-up. Fixation with a LCP distal fibula plate can sometimes lead to metal irritation but largely resulted in good clinical outcome without serious complication.
Subject(s)
Aged , Female , Humans , Ankle , Ankle Fractures , Classification , Fibula , Follow-Up Studies , Foot , Fractures, Comminuted , Range of Motion, Articular , Visual Analog ScaleABSTRACT
Pneumorrhachis or epidural emphysema is an uncommon finding observed in the spinal epidural space. Pneumorrhachis could be occasionally associated with pneumomediastinum or pneumothorax or subcutaneous emphysema. Probably this results from air that leaks from the mediastinum, which traverses through the fascial planes and intervertebral neural foramina. In particular, without any causes, these conditions rarely appear simultaneously with trauma, surgery, malignancy, anesthesiological interventions, or Valsalva maneuvers. We report a case of pneumorrhachis accompanied by spontaneous pneumomediastinum and subcutaneous emphysema that was resolved after conservative treatment.
Subject(s)
Emphysema , Epidural Space , Mediastinal Emphysema , Mediastinum , Pneumorrhachis , Pneumothorax , Subcutaneous Emphysema , Valsalva ManeuverABSTRACT
<p><b>OBJECTIVE</b>To examine the effect of acupuncture on Zhubin (KI9) in reducing alcohol craving in alcohol-dependent patients.</p><p><b>METHODS</b>Twenty male alcohol-dependent patients were randomly assigned to two groups, a treatment group (10 cases, age 43.0±6.8 years) and a placebo group (10 cases, age 44.5±7.9 years). The treatment group was treated with real needle acupuncture on Zhubin (KI9) twice a week for 4 weeks, and the control group was treated with placebo needle acupuncture. Both groups were given acupuncture treatment using Park Sham Device (PSD). Alcohol craving was measured by the Visual Analogue Scale (VAS) before treatment to establish a baseline, and after 1, 2, and 4 weeks of treatment. Repeated measures ANOVA was used to determine the main and interaction effects of time and on the outcome measure (VAS).</p><p><b>RESULTS</b>There was a significant effect of time on VAS score (df=3, F=13.3, P<0.01). Main effect of group on VAS score was significant (df=1, F=10.9, P<0.01) and the time×group interaction was also significant (df=3, F=4.7, P<0.01).</p><p><b>CONCLUSIONS</b>Real-needle acupuncture therapy on Zhubin (KI9) showed effectiveness in reducing alcohol craving. These results strongly suggest the usefulness of acupuncture therapy on Zhubin (KI9) in preventing a relapse in alcohol dependent patients.</p>