Cutaneous Polyarteritis Nodosa Presented with Digital Gangrene: A Case Report

Cutaneous polyarteritis nodosa (CPAN) is an uncommon form of vasculitis involving small and medium sized arteries of unknown etiology. The disease can be differentiated from polyarteritis nodosa by its limitation to the skin and lack of progression to visceral involvement. The characteristic manifestations are subcutaneous nodule, livedo reticularis, and ulceration, mostly localized on the lower extremity. Arthralgia, myalgia, peripheral neuropathy, and constitutional symptoms such as fever and malaise may also be present. We describe a 34-yr-old woman presented with severe ischemic change of the fingertip and subcutaneous nodules without systemic manifestations as an unusual initial manifestation of CPAN. Therapy with corticosteroid and alprostadil induce a moderate improvement of skin lesions. However, necrosis of the finger got worse and the finger was amputated.

Treatment of Femoral Intertrochanteric Fracture with Proximal Femoral Nail

PURPOSE: To evaluate the usefulness of proximal femoral nail in the treatment of intertrochanteric fracture. MATERIALS AND METHODS: The authors investigated the classificaton of fracture, operation time, the amount of intraoperative and postoperative bleeding, the amount of transfusion, postoperative ambulation status, bone union time and the complication among 45 cases who were treated with proximal femoral nail from Jan. 2001 to June 2002. RESULTS: The mean operation time was 116 minutes, and the amount of bleeding was 524 ml in average. The amount of intraoperative transfusion was 1.4 pints and that of postoperative transfusion was 1.1 pints. The complications were the intraoperative penetration of antirotational screw through the femoral neck in 2 cases, separation of the fracture fragment while inserting the nail in 4 cases, irritation of skin by retropulsion of antirotation screw in 2 cases, and penetration of antirotation screw through femoral head in 1 case. CONCLUSION: Proximal femoral nail was effective for the treatment of intertrochanteric fracture, however the surgeon should be carful about collision of the insertion handle against pelvis when the fracture line coincides with the insertion point of nail, especially in obese patients.

Treatment of a High Pressure Injection Hand Injury / 대한정형외과학회잡지

PURPOSE: To evaluate the serious effects of a paint gun injury and to determine the proper treatment. MATERIALS AND METHODS: The authors reviewed 30 cases of paint gun injuries of the hand that were treated from March, 1990 to September, 2000. We extended the original wound and removed the paint as soon as possible. The wound was left open, and debridementrepeated and delayed wound closure performed. The authors evaluated the results according to the Strickland evaluation method, and analysedthe results with respect to treatment delay and extent of injury. RESULTS: Delayed treatment, invasion of the paint along the neurovascular bundle and extensive injury resulted in a poor outcome. Amputationwas inevitable in 4 cases in which treatment had been delayed or when blood vessels had been invaded by the paint. CONCLUSION: Paint gun injury should be considered an emergency requiring immediate debridement. The surgeon should warn the patient that even after proper treatment, poor outcome can result.

Posterior Epidural Migration of Herniated Lumbar Intervertebral Disc: Two Cases Report / 대한척추외과학회지

STUDY DESIGN: case report and review of the literature OBJECTIVES: to report two cases of posterior epidural migration of herniated lumbar intervertebral disc and review the literature Summary of Background Data : Posterior epidural migration of herniated lumbar intervertebral disc is extremely rare. The large size of the fragment eventually exceeded the limits of the anterior epidural space and the fragment subsequently settled posterior the thecal sac because of spatial and size constraints. MATERIALS AND METHODS: Two cases of herniation of intervertebral disc which were caused by posteriorly migrated disc material were treated surgically with open discectomy. The magnetic resonance images, surgical treatment and related literature are reviewed. RESULTS: Preoperative magnetic resonance images of the posterior epidural migration of herniated lumbar intervertebral disc showed a large epidural mass. The mass was of intermediate signal intensity on T1-weighted images, was of low signal intensity on T2-weighted images and was enhanced marginally with gadolinium-DTPA on T1-weighted images. Immediately after operation, a significant reduction of symptoms were achieved. The patients recovered fully at two year follow-up. CONCLUSIONS: Lumbar disc herniation by posterior epidural migration of sequestered fragment can be diagnosed with clinical findings and MRI including Gadolinium-DTPA enhancement. It should be differentiated from epidural mass and could be managed surgically with good results.

Kummell's Disease Managed by Percutaneous Vertebroplasty / 대한척추외과학회지

STUDY DESIGN: Prospective study about fourteen consecutive patients with Kummell's disease who were treated by percutaneous vertebroplasty with bone cement. OBJECTIVES: To evaluate the results of percutaneous vertebroplasty using bone cement in the treatment of Kummell's disease. SUMMARY OF LITERATURE REVIEW: Kummell's disease is a rarely reported, poorly documented, and poorly understood phenomenon. It is associated with intravertebral vacuum phenomenon and clinically manifested by painful kyphosis. The treatment of the disease had been conservative or surgical reconstruction, but both conservative and operative treatment were not satisfactory in some patients. MATERIALS AND METHODS: A review was conducted of 14 patients with 18 vertebrae treated with percutaneous vertebroplasty from June 1999 to May 2000. They had posttraumatic vertebral collapse or Kummell's disease and had failed medical therapy. Immediate and long-term pain response and complications of percutaneous vertebroplasty with bone cement were evaluated. RESULTS: All patients reported complete relief of pain within the first 24 hours. Ten(71.5%) were evaluated as excellent; three(21.4%), good; one(7.1%), fair until 3 months postoperatively. Eight(57.2%) were evaluated as excellent; four(28.6%), good; fair(7.1%), one; poor(7.1%), one at final follow-up. Five(35.7%) patients had cement extrusion into the disc, paravertebral vessels and epidural space without significant systemic symptoms. CONCLUSIONS: For patients with posttraumatic vertebral collapse or Kummell's disease, percutaneous vertebroplasty technique using bone cement would be a minimally invasive treatment option to achieve immediate relief of pain and stabilization without significant side effects.