Late-Developing Metastatic Malignant Melanoma in the Thoracic Spine Originating from Choroidal Melanoma

A 54-year-old woman visited Gangnam Severance Hospital for left side flank pain. She had a history of total removal of malignant melanoma on the left eye ball 20 years prior. No evaluation had been performed since then. A paravertebral mass at thoracic ninth level (T9) was discovered on spinal magnetic resonance imaging, and pathology confirmed malignant melanoma. Following positron emission tomography-computed tomography, no other metastasis was discovered. After removal of the paravertebral mass, palliative chemotherapy (dacabarzine + tamoxifene) was administered in 3 cycles over 2 months. Radiotherapy with simultaneous integrated boost technique was performed at 4,350 cGy total over 15 days, 290 cGy per delivery, and was administered with the first cycle of palliative chemotherapy. Despite this treatment, multiple metastases developed throughout her body 7 months later, and the patient is continuing chemotherapy.

Venous Anastomosis with Dorsal Veins Using Additional Incisions after Wound Closure in Metacarpophalangeal Joint Level Replantation

In cases of replantation, accurate closure of all structures, including bone, tendons, arteries, nerves, and veins is essential. Among these, the vein is a weaker structure and is damaged severely in most amputation cases. After fixation of bone, repair of tendons, nerves, and arteries, surgeons often experience difficulty in performing venous anastomoses. We found that in such cases, venous anastomosis is easy to perform using an additional incision after closure of the original wound. In a 33-year-old male patient with amputation of all four fingers at the metacarpophalangeal joint level, venous anastomoses were performed with dorsal veins using additional incisions after completion of the fixation of bones and repair of all other structures and closure of the skin due to surgical site tension.

Olecranon Nonunion after Operative Treatment of Fracture

PURPOSE: Olecranon nonunion after surgical management is relatively rare, but it leads to limitation of motion of joint or instability. This retrospective study was conducted in order to analyze the cause and result of treatment. MATERIALS AND METHODS: We analyzed 11 cases treated for nonunion of olecranon fractures. Nonunion was classified according to the spot of the lesion and the extent of articular surface damage. Evaluation was performed using Mayo elbow performance score (MEPS), Oxford elbow score (OES), Disabilities of the Arm, Shoulder and Hand (DASH) scores, and the range of motion. RESULTS: According to the spot of the lesion and the extent of articular surface damage, nonunion was categorized as IA (2 cases), IIA (5 cases), and IIIA (4 cases). One case of IA underwent nonunion fragment excision and the remaining cases were treated by bone grafting. A plate was used in seven cases and the other three cases had both plate and tension band wiring fixation. All nonunions finally became union. The 11 patients with one year follow-up had average MEPS of 87.7 points (range: 60-100 points), average OES of 43.2, and average DASH score of 18.8 points. Complications included limitation of motion (2 cases) and ulnar nerve symptoms (3 cases). CONCLUSION: Bone grafting and fixation by plate may be beneficial. In addition, excision can be useful in type I.

Extension Type Locked Metacarpophalangeal Joint of the Little Finger due to Hyperextension Injury / 대한정형외과학회잡지

The extension type locked metacarpophalangeal joint of the little finger is an extremely rare condition characterized by loss of flexion with little or no loss of extension. The most common cause for locking is entrapment of a strap of the ruptured palmar plate. We treated a locked metacarpophalangeal joint of the little finger due to a hyperextension injury. The mechanism of locking was a torn part of the palmar ligament that forcefully rides across the prominence of the radial condyle of the metacarpal bone together with the accessory collateral ligament. These dislocated parts of the ligament formed a constricting bundle that prevented closed reduction. Locking was released successfully by an open reduction using the dorsal approach of the metacarpophalangeal joint without complication.

Relationship between Change of Median Nerve Cross-Sectional Area Measured by Ultrasonography and Prognosis after Carpal Tunnel Release / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate cross-sectional area of the median nerve using ultrasound in patients with carpal tunnel syndrome before and after endoscopic intervention, and to verify the level at which it can be used in prediction of outcome. MATERIALS AND METHODS: A prospective study was conducted in 21 patients who underwent endoscopic carpal tunnel release from March 2011 to March 2012. Median nerve cross-sectional area was measured before the operation and three months after the operation at the level of lunate, pisiform and hamate. The Boston questionnaire was evaluated before the operation and three months after the operation, and then allocated as two groups (group I: symptom improvement of more than 25%, group II: symptom improvement less than 25%). Then, differences of cross-sectional area between preoperative measurement and postoperative measurement on three levels were compared between the two groups. RESULTS: Nineteen patients were females and two were males ranging in age between 35-79 years (mean, 55.4 years). Significant differences were observed between the two groups at the lunate level. However, at the level of pisiform and hamate, no differences were observed between the two groups. CONCLUSION: Measurement of median nerve cross-sectional area at the lunate level showed significant correlation with outcome of carpal tunnel release.

Patient Safety in Spine Surgery: Regarding the Wrong-Site Surgery

Patient safety regarding wrong site surgery has been one of the priority issues in surgical fields including that of spine care. Since the wrong-side surgery in the DM foot patient was reported on a public mass media in 1996, the wrong-site surgery issue has attracted wide public interest as regarding patient safety. Despite the many wrong-site surgery prevention campaigns in spine care such as the operate through your initial program by the Canadian Orthopaedic Association, the sign your site program by the American Academy of Orthopedic Surgeon, the sign, mark and X-ray program by the North American Spine Society, and the Universal Protocol program by the Joint Commission, the incidence of wrong-site surgery has not decreased. To prevent wrong-site surgery in spine surgeries, the spine surgeons must put patient safety first, complying with the hospital policies regarding patient safety. In the operating rooms, the surgeons need to do their best to level the hierarchy, enabling all to speak up if any patient safety concerns are noted. Changing the operating room culture is the essential part of the patient safety concerning spine surgery.

Four Cases of Trichuris Trichiura Infection in the Colon / 대한소화기내시경학회지

Trichuris trichiura (whipworm) is a ubiquitous parasite that resides in the human intestinal tract, and it is known as whipworm because of its whip-like appearance. Trichuriasis is rare in developed countries, but it is more prevalent in tropical countries and areas with suboptimal sanitation. In most patient, whipworm infection is asymtomatic but patient with heavy infection present with anemia, diarrhea, trichuris dysentery syndrome, abdominal pain, weight loss, appendicitis and rectal prolapse. It is characterized by the invasion of the colonic mucosa by the adult Trichuris and produces minor inflammatory changes at the sites of localization. Its diagnosis is usually made by identification of football-shaped eggs in the stool or by confirming adult whipworm during colonoscopy. We report four cases of whipworm infection that were incidentally diagnosed on colonoscopy.