Correlation of the Deformation of the Kyphotic Angle with the Fat Infiltration Rate of Multifidus and Erector Spinae in Patients with Acute Osteoporotic Fractures of the Lumbar Spine / 대한정형외과학회잡지

Purpose@#Verifying a reliable predictor of the progression of vertebral deformity in patients with acute osteoporotic fractures of the lumbar spine may be useful. A qualitative analysis of the muscle near the spine was performed using magnetic resonance imaging (MRI), and its correlation with a spinal deformity was determined under the hypothesis that the causes of the kyphotic deformity are associated with muscle reduction in the multifidus and erector spinae. @*Materials and Methods@#The study was performed in a retrospective manner using the electronic medical records of patients who presented to the author’s institution between January 2007 and March 2018, and were diagnosed with an acute lumbar fracture. The fat infiltration rates of the multifidus and erector spinae were measured using MRI taken at the time of injury, and the mean value was defined as the total fat infiltration rate (TFI). Based on lateral radiographs of the lumbar spine at the one-year follow-up, the loss of height of the vertebral body, the kyphotic angle and the wedge angle were measured. The statistical significance was confirmed by calculating the Pearson correlation coefficient. @*Results@#One hundred twenty-nine patients, of which 30 were male and 99 were female, were examined. The mean age was 71.28 years. The mean T-score was - 3.53±0.79 g/cm2 , and the mean fat infiltration was 15.20%±11.99%. TFI was positively correlated with age (R=0.373, p<0.001), compression rate (R=0.369, p<0.001), and Cobb’s angle (R=0.386, p<0.001) after a one year follow-up, but negatively correlated with the BMD score (R= - 0.252, p=0.004). As the fracture progressed to the lower lumbar level, the compression rate (R= - 0191, p=0.030) and wedge angle (R= - 0.428, p<0.001) at the time of injury tended to decrease. @*Conclusion@#In patients with osteoporotic vertebral fractures, the fat infiltration rate may be an important predictor of conservative treatment. The prognosis of patients with a high-fat infiltration rate should be explained during patient education, and the patients must be monitored closely through short-term outpatient follow-up.

Heterotrophic Ossification after Aggressive Rehabilitation in Patients with Trauma: A Case Report

Heterotrophic ossification (HO) is a reactive disease presenting the formation of mature lamellar bone in soft tissues. It is known to occur following surgery, soft tissue injury, or central nervous system anomalies. However, a definite cause has not yet been clearly addressed. During the process of approach, reduction, and fixation while conducting surgeries, partial injury of soft tissue is inevitable. Additionally, secondary injuries may be caused during the active and passive range of motion exercises that should be done for the recovery of joint motion after surgery. The authors experienced cases of HO that may occur during surgery and rehabilitation after surgery. The authors recognized that special care is required for patients complaining of severe pain during the early stage of rehabilitation immediately after surgery. This study aimed to reaffirm the principles of fracture treatment by reviewing the cases and to investigate the occurrence of HO after fracture surgery.

Use of Miniplate for Severe Comminuted Metadiaphyseal Fractures of the Distal Radius

PURPOSE: This study investigated the clinical and radiological outcomes of patients undergoing provisional fixation in conjunction with locking plate fixation. Miniplates were used as the reduction plates for the surgical treatment of severe comminuted metadiaphyseal fractures with an intra-articular fracture of the distal radius. MATERIALS AND METHODS: The radial length, radial inclination, volar tilt, and radial intra-articular step-off were measured preoperatively, postoperatively, and at one year after surgery in 12 patients (eight males, four females, mean age 55.4 years old). The patients underwent volar locking plate fixation with miniplate as a reduction plate for severe comminuted metadiaphyseal fractures with an intra-articular fracture of the distal radius. Clinical evaluations were conducted using the modified Mayo wrist score (MMWS). RESULTS: Bone union was achieved in all cases. The mean MMWS was 81.8 points, including two excellent, three good, and seven fair cases. Radiological improvements were observed in the average radial length (preoperative, 6.4 mm; postoperative, 11.8 mm), average radial inclination (10.2° to 22.4°), average volar tilt (−4.5° to 10.6°), and average radial intra-articular step-off (4.8–0.8 mm) (all, p0.05). CONCLUSION: Miniplate fixation can be an effective treatment option as a reduction plate for the treatment of distal radial fractures, which is challenging to reduce and maintain due to severely comminuted metadiaphysis fractures with the intra-articular fracture.

The efficacy of chemotherapy in the patients with stage II colon cancer associated with number of high-risk factors

PURPOSE: This study assessed the effect of chemotherapy over stage II colon cancer in terms of presence of high-risk factors.METHODS: Data were retrospectively reviewed for 364 patients with stage II colon cancer who underwent curative surgery between January 2007 and December 2012. High-risk factors of stage II colon cancer were examined, and the overall survival (OS) rates were analyzed. Survival benefit of adjuvant chemotherapy was also analyzed.RESULTS: One hundred and fifteen cases had exclusively single high-risk factor and 194 cases were negative for high-risk factors. Postoperative chemotherapy was performed in 262 of 364 patients (72.0%). The 5-year OS was 79.4% and 86.6% for patients without adjuvant chemotherapy and those with chemotherapy, respectively. The 5-year OS was 88.2% and 83.3% for patients having exclusively single high-risk factor with adjuvant chemotherapy and those without chemotherapy, respectively.CONCLUSION: Adjuvant chemotherapy for patients with stage II colon cancer having exclusively single high-risk factor could be omitted, weighing up the survival benefit and side effect of chemotherapy.

Educational Benefits of Intraoperative Indocyanine Green Angiography for Surgical Beginners During Laparoscopic Colorectal Surgery

PURPOSE: The aim of this study is to evaluate the safety and usefulness of indocyanine green (ICG) angiography in laparoscopic colorectal surgery and to explore its educational benefits in surgical beginners. METHODS: From July to October of 2015, a total of 21 patients with colorectal cancer underwent laparoscopic surgery using the fluorescence-guided imaging system, IMAGE1 S™ (Karl Storz, Germany). Real-time ICG fluorescence images and red inversion images were juxtaposed with standard white-light images for assessment of colonic perfusion. A surgical beginner group comprised of medical students (n=11) and surgical residents (n=11) were then questioned postoperatively about the colonic transection line and mesenteric vascular integrity across various image modes to determine the most proper view for surgical decision. RESULTS: A total of 21 patients underwent laparoscopic colorectal surgery using ICG angiography. Mean patient age was 69.7 years (52~77 years). Mean time-to-detection for the marginal arteries and colonic wall were 26.7 (range, 4~45) and 47.3 (range, 20~77) seconds, respectively. No injection-related adverse events were observed. Rate of change in the colonic transection line across modes was 59.9% (33.3~66.7%) in the surgical beginners. Decisions made by surgical beginners on the transection line were varied with the standard image, but converged to 81.8% in the ICG with red inversion mode. Surgical beginners preferred ICG with red inversion mode for assessment of mesenteric vascular integrity. CONCLUSION: ICG angiography seems to be safe and useful in evaluating colonic perfusion for transection decisions and could have educational benefits for surgical beginners in training to make surgical decisions.

Clinical Outcomes of Splenic Injury

PURPOSE: The management of splenic injuries has shifted from a splenectomy to splenic preservation owing to immunity. The purpose of this study was to assess the kinds of management and outcomes through a review of our experience with splenic injuries. METHODS: We retrospectively reviewed 47 patients with traumatic splenic injuries using by electronic medical records from Jan. 2007 and Dec. 2011. Splenic injuries were classified according to the American Association for the Surgery of Trauma (AAST) grading system. RESULTS: There were 11 falls, 11 traffic accidents, 10 motorcylcle accidents, 10 pedestrian accidents and 5 abdominal blunt traumas. Low-grade injured patients ( or =Grade IV) were 18 of 43(38.3%). In 34 patients, non-surgical treatment was performed, and 14 patients underwent a splenectomy. There were relatively more high-grade in older patients, and the highgrade-injury group showed need for a transfusion (p=0.002), more need for a splenectomy (p<0.001), a longer mean hospital stay (p=0.036), a longer ICU stay (p=0.045) and more combined organ injury (p=0.036). CONCLUSION: Conservative treatment should be considered in low-grade-injury patients (< or =Grade III). A Splenectomy was performed on 56% of the patients with Grade IV injuries, so a splenectomy should be considered carefully in such patients. In patients with a grade V injury, we think surgical treatment may be needed.

Prognostic Factors for Survival in the Renal Cell Carcinoma with Tumor Thrombus / 대한비뇨기과학회지

Purpose: To analyze various prognostic factors and surgical outcomes in patients who underwent radical nephrectomy and thrombectomy of a renal cell carcinoma with renal vein or inferior vena caval thrombosis. Materials and Methods: Among 44 patients with confirmed renal cell carcinomas and renal vein or inferior vena caval thrombosis, between December 1993 and June 2000, 42 having undergone radical nephrectomy and thrombectomy were retrospectively studied. 2 patients were excluded due to no operation performance. The 5-year disease-specific survival rates were analyzed according to various prognostic factors, including age, gender, clinical symptoms, tumor side (Rt. vs. Lt.), thrombus position (renal vein vs. IVC), histopathological cell type, lymph node involvement, pT stage irrespective of thrombus, Fuhrmann nuclear grade and invasion to perinephric fat, vessel, renal pelvis or adrenal gland. Results: The overall 5-year disease-specific survival rate of all the patients was 55%. A univariate analysis of the 42 patients showed that the position of the tumor thrombus, histopathological cell type and invasion to the adrenal gland had a significant impact on the survival. On multivariate analysis, the tumor thrombus location and histopathological cell type were independent prognostic factors for the survival. The 5-year disease-specific survival rates of the patients with a renal vein thrombus (n=23) and with IVC (inferior vena cava, n=20) were 75 and 20%, respectively. The 5-year disease-specific survival rate of the patients with a conventional cell type (n=32) was 68%, and patients with other pathologic cell types had no significant follow-up periods. Conclusions: The tumor thrombosis position, histopathological cell type and invasion to the adrenal gland are considered as clinically significant prognostic factors in patients with a renal cell carcinoma with vein thrombosis after radical nephrectomy with a thrombectomy. Meticulous radical nephrectomy with thrombectomy will be beneficial to the survival of patients with a renal cell carcinoma and vein thrombus.

Spontaneous Testicular Hemorrhagic Necrosis Masquerading as a Testis Tumor / 대한비뇨기과학회지

Spontaneous testicular hemorrhagic necrosis is a rare disease usually associated with testicular torsion. Partially involved and suspicious testis tumor cases are also defined from orchiectomy specimens. Herein, a spontaneous hemorrhagic necrosis, without any testicular torsion, but with involvement of the whole testicle and epididymis, is reported. A 21 year old patient, who presented with a painless left testicular enlargement of several days duration was believed, based on physical examination, ultrasonography and elevation of serum LDH, to have a testicular tumor. Diagnosis was made only after radical orchiectomy and histopathological examination.