Robot-Assisted Retroauricular Anterior Scalenectomy for Neurogenic Thoracic Outlet Syndrome

Background@#This study described the surgical technique of a robot-assisted retroauricular anterior scalenectomy and assessed clinical outcomes and complications for patients with neurogenic thoracic outlet syndrome (nTOS). @*Methods@#Between February 2014 and August 2016, 5 patients underwent robot-assisted retroauricular anterior scalenectomy using the da Vinci Xi system for nTOS. For clinical assessment, visual analog scale (VAS) symptom score, pinch and grip strength, and disabilities of arm, shoulder and hand (DASH) score were assessed to compare preoperative and postoperative outcomes. Postoperative complications were also reviewed. @*Results@#The VAS symptom, pinch and grip strength, and DASH scores improved 1 year after the operation. All patients were satisfied with the surgical scars. Temporary postoperative complications, which spontaneously resolved within 3 months, were noticed in 2 patients: one with vocal cord palsy and the other with upper brachial plexus palsy. @*Conclusions@#The robot-assisted retroauricular anterior scalenectomy for patients with nTOS seems feasible and safe, providing satisfactory cosmetic results.

Outcomes of Arthroscopic Scaphoid Excision and Lunocapitate Fusion for Advanced Traumatic Arthritis of the Wrist

Background@#Arthroscopic lunocapitate (LC) fusion can be an alternative surgical treatment for scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) of the wrist. We retrospectively reviewed patients who had arthroscopic LC fusion to estimate clinical and radiological outcomes. @*Methods@#From January 2013 to February 2017, all patients with SLAC (stage II or III) or SNAC (stage II or III) wrists, who underwent arthroscopic LC fusion with scaphoidectomy and were followed up for a minimum of 2 years, were enrolled in this retrospective study. Clinical outcomes included visual analog scale (VAS) pain, grip strength, active range of wrist motion, Mayo wrist score (MWS), and the Disabilities of Arm, Shoulder and Hand (DASH) score. Radiologic outcomes included bony union, carpal height ratio, joint space height ratio, and loosening of screws. We also performed group analysis between patients with 1 and 2 headless compression screws to fix the LC interval. @*Results@#Eleven patients were assessed for 32.6 ± 8.0 months. Union was achieved in 10 patients (union rate, 90.9%). There was improvmenet in mean VAS pain score (from 7.9 ± 1.0 to 1.6 ± 0.7, p = 0.003) and grip strength (from 67.5% ± 11.4% to 81.8% ± 8.0%, p= 0.003) postoperatively. The mean MWS and DASH score were 40.9 ± 13.8 and 38.3 ± 8.2, respectively, preoperatively and improved to 75.5 ± 8.2 and 11.3 ± 4.1, respectively, postoperatively (p < 0.001 for all). Radiolucent screw loosening occurred in 3 patients (27.3%), including 1 nonunion patient and 1 patient who underwent screw removal due to the screw migration encroaching the lunate fossa of radius. In group analysis, only the frequency of radiolucent loosening was higher in 1 screw (3 of 4) than 2 screw fixation (0 of 7) (p= 0.024). @*Conclusions@#Arthroscopic scaphoid excision and LC fusion for patients with advanced SLAC or SNAC of the wrist was effective and safe only in cases fixed with 2 headless compression screws. We recommend arthroscopic LC fusion using 2 screws rather than 1 to decrease radiolucent loosening, which might affect complications such as nonunion, delayed union, or screw migration.

Operative Treatment for Extensor Carpi Ulnaris Tendon Dislocation / 대한정형외과학회잡지

PURPOSE: Extensor carpi ulnaris (ECU) subluxation has a low incidence rate, to date, there has only been a few studies evaluating the operative treatment for type of injury. The purpose of this study was to retrospectively analyze 11 patients with ECU subluxation who underwent operative treatment. MATERIALS AND METHODS: Between March 2005 and February 2015, 11 patients received operative treatment. Magnetic resonance imaging and dynamic ultrasound were used to make the diagnosis. ECU subluxation patterns were classified by the Inoue's classification system. There were two cases of type A, one case of type B, five cases of type C, and three cases unfit for Inoue's classification. We also found two cases of radial subluxation and one case of ulnar locked subluxation. In type A and B cases, ECU tendons were relocated then sheaths repair was performed, and the extensor retinaculum reconstruction was performed. In type C cases, the fibro-osseous sheaths were fixed. In the three unclassified cases, extensor retinaculum reconstruction was performed. In all cases, fibro-osseous sheaths were fixed using the anchor suture technique. We compared the clinical results based on the following: motion range of the wrist joint; grip strength; visual analogue scale (VAS) score; quick disabilities of the arm, shoulder and hand (Q-DASH) score; and Mayo wrist score. RESULTS: The median age of patients at the time of the operation was 32 years, and the average follow-up period was 11.2 months. There were five cases of triangular fibrocartilage complex tear, two cases of distal radioulnar joint instability, three cases of ECU split tear as accompanying injury. There were significant differences in the clinical results. The average motion range of the wrist increased compared with the preoperative value (84.7% to 92.4% compared to contralateral normal side). The postoperative VAS score, Q-DASH score and Mayo wrist score showed better results compared with the respective preoperative values (6.0 to 1.1, 40.9 to 12.4, 75.9 to 86.4). CONCLUSION: ECU subluxation is a rare occurrence. Dynamic ultrasound is useful in diagnosing ECU tendon subluxation. Satisfactory results can be obtained with the use of a proper technique, which depends on the type of subluxation.

Factors Influencing Outcomes after Ulnar Nerve Stability-Based Surgery for Cubital Tunnel Syndrome: A Prospective Cohort Study

PURPOSE: Simple decompression of the ulnar nerve has outcomes similar to anterior transposition for cubital tunnel syndrome; however, there is no consensus on the proper technique for patients with an unstable ulnar nerve. We hypothesized that 1) simple decompression or anterior ulnar nerve transposition, depending on nerve stability, would be effective for cubital tunnel syndrome and that 2) there would be determining factors of the clinical outcome at two years. MATERIALS AND METHODS: Forty-one patients with cubital tunnel syndrome underwent simple decompression (n=30) or anterior transposition (n=11) according to an assessment of intra-operative ulnar nerve stability. Clinical outcome was assessed using grip and pinch strength, two-point discrimination, the mean of the disabilities of arm, shoulder, and hand (DASH) survey, and the modified Bishop Scale. RESULTS: Preoperatively, two patients were rated as mild, another 20 as moderate, and the remaining 19 as severe according to the Dellon Scale. At 2 years after operation, mean grip/pinch strength increased significantly from 19.4/3.2 kg to 31.1/4.1 kg, respectively. Two-point discrimination improved from 6.0 mm to 3.2 mm. The DASH score improved from 31.0 to 14.5. All but one patient scored good or excellent according to the modified Bishop Scale. Correlations were found between the DASH score at two years and age, pre-operative grip strength, and two-point discrimination. CONCLUSION: An ulnar nerve stability-based approach to surgery selection for cubital tunnel syndrome was effective based on 2-year follow-up data. Older age, worse preoperative grip strength, and worse two-point discrimination were associated with worse outcomes at 2 years.

Ligament Reconstruction in Congenital Absence of the Anterior Cruciate Ligament: A Case Report

Congenital absence of the cruciate ligament is an extremely rare condition that was first reported in Giorgi's radiographic study in 1956. The authors report on a case of anterior cruciate ligament reconstruction performed on a 21-year-old female patient with congenital anterior cruciate ligament absence. We also discuss radiographic evidence that could provide clues to the congenital absence and possible difficulties that may be encountered during surgery with a review of the relevant literature.

Intermittent Parathyroid Hormone Treatment for Stimulation of Callus Formation on Distal Femoral Fracture in Elderly Patients: Case Report

Fracture healing is the ongoing process but it is often delayed in elderly patients. Because the fractures in elderly patients with osteoporosis are severely comminuted and their quality of bone is poor, the associated delay of fracture healing is likely to lead to surgical failure. Recently, as a way to promote healing fractures, intermittent systemic parathyroid hormone treatment has been actively researched. Although the effect of parathyroid hormone, which is demonstrated by animal experiments, is well known, there are not many clinical applications. The authors report 2 cases which had the time-shortened callus formation by intermittent parathyroid hormone (teriparatide) administration after surgical treatment, maximum preservation of periosteum as possible, in elderly patients who have supracondylar fracture on distal femur.

Treatment of Multiple Ligaments Injuries

Multiple ligament injury, which means disruption of at least 3 of the 4 major ligaments, generally occurs due to high energy trauma. Knee dislocation usually leads to the multiple ligament injury, and the terms 'knee dislocation' and 'multiple ligament injury' are used interchangeably. In some cases, a dislocated knee may have been spontaneously reduced immediately after the trauma. This is the reason why we should consider the possibility of knee dislocation and carry out a thorough vascular and neurologic evaluation when a patient with multiple ligament injury presents to an emergency department. Multiple ligament injury, when not properly treated, may lead to instability of the knee joint, resulting in posttraumatic arthritis. Though treatment and rehabilitation of multiple ligament injury is difficult, we should pursue full recovery of the knee joint through precise examination and proper treatment. There is controversy about conservative vs. surgical treatment, early vs. delayed surgeory, and repair vs. reconstruction, but surgical treatment and early reconstruction are now preferred.

A case of extrahepatic bile duct hepatocellular carcinoma with no detectable primary hepatic tumor / 대한내과학회지

Obstructive jaundice associated with hepatocellular carcinoma (HCC) is an uncommon symptom caused by intraductal tumor growth, the migration of tumor necrosis, blood clots within the biliary tract, or compression of the biliary tract by the tumor. Most cases of icteric-type HCC involve a main tumor in the liver parenchyma. Bile duct HCC without a primary hepatic tumor is extremely rare, but because it shows similar clinical manifestations and imaging results to extrahepatic bile duct cancer, it is possible to misdiagnose this condition as a primary bile duct tumor or choldocholithiasis. Recently, we experienced a case of obstructive jaundice associated with an extrahepatic bile duct tumor in a 69-year-old woman. Upon radiologic studies and endoscopic cholangiography, the cause of obstructive jaundice was initially attributed to the bile duct tumor itself. However, subsequent analysis indicated that the condition was, in fact, due to bile duct thrombi associated with extrahepatic bile duct HCC.

A case of relapsing polychondritis with ankylosing spondylitis / 대한내과학회지

Relapsing polychondritis is a rare condition of unknown etiology in which recurrent episodes of inflammation are followed by the destruction of cartilaginous structures, which predominantly include the nose, ears, and tracheobronchial tree. Although many autoimmune disorders, such as systemic vasculitis, rheumatoid arthritis, lupus erythematosus, Sjogren's syndrome, and Behcet's disease, are commonly found in patients with relapsing polychondritis, ankylosing spondylitis is rarely associated with this disease. We report a case of relapsing polychondritis with ankylosing spondylitis in the same patient.

Unusual Presentation of Cystic Lymphangioma of the Gallbladder

Cystic lymphangioma of the gallbladder is quite a rare tumor with only a few cases having been reported in the literature. We describe here a rare case of cystic lymphangioma of the gallbladder, which was unusual in that the patient presented with biliary pain and an abnormal liver test. Ultrasonography and computed tomography of the abdomen showed a multi-septated cystic mass in the gallbladder fossa and an adjacent compressed gallbladder. Endoscopic retrograde cholangiography showed there was no communication between the bile tract and the lesion, and there were no other abnormal findings with the exception of a laterally compressed gallbladder. After performing endoscopic sphincterotomy, a small amount of sludge was released from the bile duct. The histological findings were consistent with a cystic lymphangioma originating from the subserosal layer of the gallbladder. This unusual clinical presentation of a gallbladder cystic lymphangioma was attributed to biliary sludge, and this was induced by gallbladder dysfunction that was possibly from compression of the gallbladder due to the mass.

A Case of Neuroleptic Malignant Syndrome (NMS) with Myoglobulinemic Acute Renal Failure and Lithium Intoxication due to Lithium-olanzapine Combination / 대한신장학회잡지

We report a patient developed neuroleptic malignant syndrome (NMS) with myoglobulinemic acute renal failure and lithium intoxication due to lithium-olanzapine combination, who was successfully treated by hemodiafiltration. A 34-year-old woman with a 14-year history of bipolar disorder had been treated with lithium-olanzapine during last four days. She was admitted to our hospital for muscular rigidity, hyperthermia and altered consciousness. On admission, rhabdomyolsis was demonstratd by biochemical methods and serum level of lithium was 3.78 mEq/L which was far above toxic level. After the diagnosis of NMS with acute renal failure and lithium intoxication, olanzapine and lithium were discontinued and conservative measures and continuous venovenous hemodiafiltration were instituted. She recovered without any neurologic sequelae.

Two Cases of Bronchiolitis Obliterans Organizing Pneumonia treated with Steroid and Cyclosporine therapy / 결핵및호흡기질환

A rapid response to corticosteroid treatment and a generally favourable outcome are characteristic features of BOOP (Bronchiolitis obliterans organizing pneumonia). However, with increasing experience of the clinical spectrum of this disease, it is now recognized that some patients are refractory to steroid, which is associated with a poor prognosis. Here, two cases of BOOP initially treated with predinisone and antibiotics without effects, but subsequently responded to secondary cyclosporine treatment, are reported.