A case of microinvasive Paget's disease of the vulva: Treatment of positive resection margin with topical 5-FU cream application / 대한산부인과학회지

Extramammary Paget's disease of the vulva is a rare lesion that accounts for 1~2% of vulvar neoplasms. Paget's disease often has a microscopic extension beyond the gross lesion and shows a multifocal distribution. Positive resection margin is common. We applied 5-FU cream on the lesion who had a positive resection margin. There was no residual lesion on multiple punch biopsies after 5-FU cream treatment three months later. And there has been no evidence of disease recurrence in the 12-month follow-up period. We experienced a case of effective treatment with 5-FU cream in microinvasive Paget's disease of the vulva with positive resection margin. We present it with a brief review of literatures.

Intradiscal Electrothermal Annuloplasty in Chronic Discogenic Low Back Pain / 대한마취과학회지

Chronic discogenic low back pain remains a difficult treatment challenge. Also, Internal disc derangement in the lumbar spine is a common yet difficult clinical condition to treat. The reported prevalence of chronic low back pain due to intrinsic disc mediated pain is at least 40%. Internal disc derangement has characteristics such as degeneration of the collagen of the disc annulus, fissures, global disc degeneration, and herniation with or without root compression. The common treatment for chronic discogenic low back pain has been conservative, including physical therapy and pharmacological management but the effectiveness remians controversial. Surgical fusion offers modest results at best, but often fails, and is associated with complications and postoperative continued pain. The intradiscal electrothermal annuloplasty has become known as a safe and effective treatment for patients suffering from discogenic pain and offers the advantage of potentially repairing the damaged disc while maintaining normal disc function. We applied a navigable catheter with a temperature controlled thermal resistive coil, deployed intradiscally through a percutaneous extrapedicular approach under two plane fluoroscopic guidance in chronic low back patients. The authors experienced two cases of chronic discogenic pain that had failed to respond to any kind of conservative treatment but which was successfully relieved by the intradiscal electrothermal annuloplasty.

Radiofrequency Rhizotomy of the Sacroiliac Joint with S2 Ganglionotomy / 대한마취과학회지

The sacroiliac joint possesses all the characteristics of a true joint and can produce symptoms quite similar to facet joint abnormalities. Pain originating from the sacroiliac joint usually causes buttock and referral pain: hip, groin, anterior thigh and calf. The second sacral nerve level contributes heavily to the innervation of the sacroiliac joint and a second sacral nerve ganglionotomy can be an important adjunct to sacroiliac joint rhizotomy. The fact that capsule and ligaments contain nociceptors suggests that the sacroiliac joint is a possible source of low back pain and also plays a role in somatic referred pain. The patient usually experiences buttock discomfort and referred posterior thigh pain following a sacroiliac joint rhizotomy. We can lessen the residual symptoms after a sacroiliac joint rhizotomy by applying a second sacral nerve ganglionotomy. We experienced a patient with the sacroiliac joint originated pain who was successfully treated with sacroiliac joint rhizotomy and second sacral ganglionotomy without any residual sequelae and tolerates well after 4 months.