We treated 21 patients with high-enrergy injured pelvic fracture from June 1986 to January 1999. Thirteen patients were male and 8 were female. Their mean age was 44.3 years (ranging from 16 to 72). They were followed up for 11 months to 14 years, and the mean follow-up period was 2.9 years. Cause of injury was traffic accident in 16 cases and falling in 3 cases, both of which are considered to be so called high-energy trauma. According to the Key and Conwell classification systems, 2 cases were classified as type II, 8 as type III, and 11 as type IV. Three cases were treated with traction, 5 with external fixation, 11 with internal fixation, and 1 with THA. One patient died of shock resulting from hemorrhage. In this study we evaluated complications, post-operative results on ambulation status, pain and arthritic changes of X-ray. 17 patients regained ability to walk. None of the type II or III patients suffered pain. In the type IV group, 4 cases experienced slight pain and 7 cases did not experience pain. Evaluation of arthritic changes in X-ray showed no change in types II and III. In type IV, 6 cases showed to no change, 2 cases slight, 1 case moderate, and 2 cases indicated severe osteoarthritis.
Fourteen patients with pelvic fracture treated in our hospital were reviewed. They were classified into three groups by Tile's classification. Five patients with Type A fracture were treated conservatively, five type B patients received external fixation. The remaining four patients with type C fracture needed both temporary external fixation and subsequent internal fixation. External fixation seems to be effective for controlling pain and bleeding. Our study results indicated that patients with unstable fracture classified as type C require radical treatment combined with transcatheter angiographic embolization.
It is well known that in femoral head osteonecrosis patients, necrosis and collapse are usually located in the anterosuperior portion of the femoral head. We evaluated the usefulness of a “look-up” plane X-ray view of osteonecrosis for early detection of femoral head collapse. We examined 20 joints in 17 patients. Osteonecrosis was classified into four stages according to radiographic signs (demarcation line, crescent line, collapse and joint space narrowing). Eight joints were classified as stage 2 and 12 joints as stage 3. Collapse, crescent line and demarcation line were evaluated on three types of radiographs; ordinary anteroposterior (AP) and lateral views and the “look-up” view. Seventeen of the 20 hips clearly showed more than 2mm collapse on the “look-up” view. The incidence of clear collapse was higher than that on the AP view. The incidence of crescent line was also higher. There were no significant differences in the demarcation line between the look-up view and AP view. Magnetic resonance imaging and tomography are useful and routinely used to define necrotic lesions. However, the “look-up” view is a simple and inexpensive method for the early detection of femoral head collapse in osteonecrotic patients.
In middle-aged patients with idiopathic osteonecrosis of the femoral head (ION), stripped cartilage of the femoral head is typically found in the final stage. The present study was conducted to investigate whether or not stripped cartilage of the femoral head is found in elderly patients with ION. Ten femoral heads with stripped cartilage, obtained during total hip arthroplasty, were investigated by roentgenographic, histologic, or both examinations. All patients were women, with an average age of 73 years ranging from 60 to 87. Besides patients with ION, stripped cartilage of the femoral head was also observed in patients with primary osteoarthrosis and rapidly destructive coxopathy.
We present two cases of pulmonary thromboembolism. One patient was a 47-year-old woman treated by transvenous pulmonary embolectomy using a catheter, while the other patient was an 84-years-old woman treated using thrombolytic therapy. The presence of any cardiopulmonary symptoms should alert the physician to the possibility of pulmonary thromboembolism and appropriate prophylaxis and early diagnosis are recommended for preventing pulmonary thromboembolism.
We observed lower extremity blood flow in deep venous thrombosis (DVT) patients using ultrasonography after orthopaedic hip joint operation. Between July 1999 and June 2000, four patients underwent total hip arthoplasty and hemi-surface arthroplasty was performed on one. We measured the flow volume of the femoral vein and the great saphenous vein using ultrasonography on all patients after venography. The patients consisted of one male and four females with a mean age of 67 years (age range: 47 to 74 years). Deep venous thrombosis was identified in two (40 percent) of the five patients. There was no significant difference in the flow volume of the femoral vein between the DVT (+) group and DVT (-) groups (129±33ml/m, 165±89ml/m). The flow volume of the great saphenous vein in the DVT (+) group increased significantly (189±108ml/m, 51±22ml/m p<0.01). Since measurement of the flow volume of the great saphenous vein was comparatively easy using ultrasonography, we concluded that it is useful for DVT screening.
It has been reported that deep vein thrombosis and pulmonary embolism may occur after total arthroplasty in the lower extremities. This paper concerns the changes with time of TAT, and D-Dimer in 28 patients on drug therapy after total arthroplasty. We report two cases: one patient developed a pulmonary embolism just after surgery, while the other developed a deep vein thrombosis after four weeks. The changes with time of TAT and D-Dimer in these two patients were characteristic compared with patients free of symptoms. The measurement of TAT and D-Dimer is considered useful for the diagnosis of pulmonary embolism and deep vein thrombosis, and for determining the need for therapy. Preventive drug therapy may also be necessary for proplylaxis of pulmonary embolism occurring immediately after operation.
We used fluoroscopy to study the kinematics of the knee in 37 patients with posterior cruciateretaining total knee arthroplasty (TKA) while performing successive deep passive knee bends manually. Posterior femoral rollback and tibial rotations were analysed using fluoroscopic photographs taken in the sagittal plane at full extension and flextion. In 40 knees (93.0%), posterior femoral rollback was observed. In 28 knees (65.1%), both posterior femoral rollback and tibial rotations were observed. The mean postoperative range of motion was greatest (121°) in the latter subgroup.
We clinically evaluated the results of 33 knees treated using MG II total knee systems. The average age was 71.5 years at the time of surgery. The mean follow up-period was 6 years and 6 months. Clinical evaluations besed on the Japanese Orthopedic Assosiation scoring system indicated significant improvements from preoperative to most recent follow up examination. There was no evidence of rentogenographic failure in the femoral and tibial componets. None of the knees required revision surgery. The average score at the time of follow-up was 82.2 points. These midterm results of cementless MG II TKAs proved satisfactory.
Three revision cases with metallosis after total knee arthroplasty are reported. All patients were females in their 70's. They were all diagnosed with osteoarthritis before undergoing primary total knee arthroplasty. Revision arthroplasty was performed 6 to 10 years (average 8 years) after the primary operation. In all cases, metal debris had invaded not only the synovial tissue but also the femoral, tibial and patellar bone, and osteolysis had occurred. Because there was large bone stock deficiency after the removal of the implants, we used stem-extension and augmentation in both the femoral and tibial components in all cases.
We report a case of cervical myelopathy due to vertebral hemangioma. A 74-year-old woman experienced gait disturbance and increasingly severe paraparesis. CT scans and MRI suggested vasucular hemangioma affecting C7 and a portion of C4, but CTM showed compression of the spinal cord at C7. Decompressive laminectomy at C7 and posterior fusion from C5 to Th2 were performed, and bleeding was slight. Post-operatively, the patient showed improvement of her symptoms.
We report a very rare case of hydrocephalus associated with meningitis after the resection of cervical cord tumor. A 40-year-old male received resection of the cervical intradural neurinoma and reconstruction by one-door-open laminoplasty. After the surgery, numbness in the upper limbs disappeared, but MRI revealed fluid accumulation with fistula where the tumor resection was performed. Four weeks after surgery he had high fever, and swelling and redness at the posterior neck. Inflammation improved through the administration of antibiotics; however, Gd-enhanced MRI revealed granulation tissue around the cerebrospinal fluid fistula. On the eighth week after surgery, disorientation occurred and MRI revealed ventricle expansion, indicating hydrocephalus. Cerebrospinal fluid pressure was 230mmH2O, cell count was 64 dominant in monocyte, and glucose level was within the normal limits. We suspected hydrocephalus caused by meningitis and performed debridement and continuous drainage of the cerebrospinal fluid from lower back. Culture was negative, however, disorientation caused by hydrocephalus recurred at 13 weeks after shunt. After V-P shunt, disorientation disappeared and the patient could return to the previous job.
Atlantoaxial subluxation (AAS) with os odontoideum is more unstable than AAS without it. We investigated the surgical results of symptomatic AAS with os odontoideum. Eleven males and 16 females (mean age: 38 years) underwent surgery. Fifteen patients showed myelopathy (mean JOA score: 9.4), and 12 had only local symptoms without myelopathy. Three parameters on the lateral radiographs (minimum diameter in flexion, maximum diameter in extension and atlanto-axial angle in flexion and extension) were measured preoperatively, and the instability index was calculated. Manipulation (18) or anterior release (3) reduced AAS in 21 patients. Posterior atlanto-axial fusion and bone graft were performed with wiring (9), transarticular screw fixation with wiring (9), and Olerud Cervical fixation (3). In 6 patients, AAS was not reduced and occipito-cervical fusion was performed. Correction loss and union rate were investigated on the postoperative lateral radiograph. The mean follow-up was 5 years and 4 months. There was no significant difference between preoperative radiological values and clinical symptoms. The mean JOA score improved to 13.0 after surgery, and the improvement rate was 52.3%. Four patients treated with wiring showed correction loss. Three of them developed non-union and required re-operation. Bone union was achieved with other fixations.
Diseases of the upper cervical spine tend to cause severe instability, motor, sensory and respiratory disorders. We evaluated 27 patients who underwent upper cervical spine operations at our hospital to 1990. The patients consisting of 7 males and 20 females were followed up postoperatively for 3 months to 11 years (mean follow-up: 7 months and 3 years). Thirteen patients had rheumatoid arthritis, 5 congenital anomalies, 2 cerebral palsy, and 4 suffered traumatic injuries. We divided the atlanto-axial subluxation patients into 2 groups, H and V. The H group consisted of patients with horizontal dislocation. While the V group consisted of patients with vertical dislocation. Those in the H group were for the most part moderately young RA, congenital, traumatic patients, and those in the V group were old female RA patients. Most of the male patients were congenital and traumatic, with 6 belonging to the H group. In both groups, ADL and pain improved, but severe myelopathic symptoms did not improved significantly. After several days' halo-vest reducation, posterior spinal fusion, and bone graft were performed on each patients. In patients with vertical dislocation, C1 decompression was necessary; but because of instability after one fascet fusion and impossible to reduce, occipital fusion was performed. Both groups showed improvement inatlanto-axial instability. Improvement of ADI was better in the H group, which may be due to decreased pain.
Degenerative spondylolisthesis of the cervical spine is rare. A case of degenerative spondylolisthesis of C4 on C5 is presented. A 77-year-old female complained of neck pain and drop head with cervical spondylotic myelopathy. Plain radiographs showed 7mm anterolisthesis of C4 on C5. The slip was reduced by supine position. After reducing the slip, autologous bone grafts and instrumentation were performed. The patient had successful fusion and satisfactory results after operation.
We reviewed the postoperative results of anterior spinal fusion for 17 cases of cervical ossification of the posterior longitudinal ligament with disc lesion. The mean age at surgery was 56.9 years and the mean preoperative period was 15.6 months. The mean recovery rate according to Hirabayashi's method using the JOA score was 59.2%. We recommend anterior decompression and spinal fusion for cervical ossification of the posterior longitudinal ligament in which the main lesion is defined and related to disc herniation or other dynamic factor, i. e. disc instability.
We report two cases of spontaneous spinal epidural hematoma, one treated conservatively and the other treated by surgical decompression. The first case was a 68-years-old male who complained of sudden onset of severe back pain, followed by quadriplegia. MRI demonstrated hematoma in the right posterior epidural space in part of the spinal canal from C4 to Th1 vertebral level. He was not detected by conservatively, and the quadriplegia recovered completely. Three weeks later the hematoma was lost in MRI. The second case was a 17-years-old male who complained of sudden onset of severe left shoulder pain, followed by quadriplegia and difficulty urinating. MRI demonstrated hematoma in the left posterior epidural space in part of the spinal canal from C4 to C7 vertebral level. The quadriplegia did not improve. Laminoplasty with evacuation of the hematoma was thus performed. The quadriplegia gradually improved and he was discharged about 5 weeks after the operation. It is suggested that patients showing no signs of recovery require early term surgical decompression.
Doubting current treatments for acute spinal epidural hematoma, we conducted a study on multiple cases who had underwent these treatments. The subjects consisted of 37 cases who received conservative treatment and 297 cases who underwent operative treatment. Based on the results, we compiled a guideline for the treatments of acute spinal epidural hematoma.
We report a patient with intracranial hypotension who fell into a coma caused by liquorrhea after thoracic anterior decompression and fusion as a treatment for ossification of posterior longitudinal ligament (OPLL). A 47-year-old female complained of numbness of the bilateral lower limbs and gait disturbance. Images showed OPLL from T4 to T6, which extremely compressed spinal cord. Anterior decompression and fusion were performed after laminectomy and posterior fixation with ISOLA. 12 days after the surgery, headache and dizziness started upon movement. Four weeks later, adding to these symptoms, she showed consciousness disturbance. Computed Tomography (CT) of the brain showed narrow lateral ventricles and bilateral subdural hematomas. CT and X-ray of the chest showed intrapleural effusion on the right. These symptoms and findings suggested intracranial hypotension caused by continuous liquorrhea after surgery. Her conscious level worsened rapidly within 3 days and she fell into a coma. Eemergency surgery was performed to stop liquorrhea with autologous fat, collagen and fibrin glue. Her consciousness level improved gradually and recovered to normal after 5 days. However, pleural effusion was observed for 5 months.
We studied lower lumbar spine segments with posterior vertebral shifts (retrolisthesis) with respect to the orientation of facet joints, disc height, lordosis of the lumbar spine, kyphosis of the thoratic spine, sagittal vertical axis, and orientation of vertebral endplates. Standing total spine radiographs as well as MRI investigations were analyzed. Data from patients with retrolisthesis were compared to data from patients with degenerative spondy lolisthesis (DS), and from patients without signs of vertebral shifts. The orientation of facet joints in segments with retrolisthesis did not deffer from segments without shifts, whereas the facet joints in patients with DS were oriented more sagittally. Lordosis of the lumbar spine was reduced in patients with retrolisthesis, and significant correlation was found between lordosis and sacral inclination.
Multi-detector-row CT is called second stage helical CT because it produces multi-volume slices in a short time. We have observed sagittal, coronal images for spinal diseases by this CT. Thirtythree sagittal images out of 39 post-myelography for spinal diseases were good images of compression of the dural sac, and 8 coronal images post myelography were good images of compression of the dural sac and spinal nerve roots. We obtained 11 sagittal images for OPLL, and all images were nearly equal to that of tomography. However, spinal tumors and inflammatory diseases are more easily obtained using MRI. Multi-detector-row CT is useful for spinal degenerative diseases.
Both arms of fifty embalmed cadavers were evaluated for the following three variables; (1) The presence of the median artery, which was classified as two types: the palmar and antebrachial type after Rodriguez-Niedenfuhr. (2) The origin of the median artery. (3) The relations between the median artery and median and anterior interosseous nerve. The median artery was found in 98 (98%) of the 100 arms. The median artery terminates in the forearm within the median nerve or within the flexor digitorum superficialis, flexor digitorum profundus in 98 of the cases. The palmar type was not seen. The origin of the median artery was most frequently from the anterior interosseous artery (33%) and it was following from the common interosseous artery (24%), from the ulnar artery (22%) at the caudal angle between the ulnar artery and common interosseous artery (20%) and from the radial artery (1%). The median artery coursed distally to lie at the radial side of the median nerve in 95 cases (97%). Piercing of the median or anterior interosseous nerve by the median artery in the forearm was seen in three cases (3%). The median artery was intimately related with the anterior interosseous nerve. The anatomical relationship consisted of crossing in front of the nerve in 79 cases (80.6%), behind it in 10 cases (10.2%), between the branches of the nerve in 8 cases (8.2%) and the artery pierced the nerve in one case (1%). As a result, we believe the following conditions may increase the risk of median and anterior interosseous nerve compression.; (1) When the median artery pierces the median, anterior interosseous nerve or both, (2) When the median artery passes between the branches of the anterior interosseous nerve, and (3) When the anterior interosseous nerve passes between the median and ulnar artery.
We performed echo-guided brachial plexus block with auxillary approach on 6 patients. We used 7.5MHz transducers, avoiding nerve injury and intravascular injection. The block was done with 1% lidocaine (30ml) using a 23G needle. General anesthesia was not required in all patients. There was only one patient with nerve injury, and there were no complications from the intravascular injection. We recommend the echo-guided axillary approach for any type of surgery to the upper extremity.
The management of fractures of the fumeral shaft is still controversial. During the period from 1989 to 1998, we treated 17 patients with fractures of thehumeral shaft. There were 9 males and 8 females ranging in age from 15 to 80 years (average 49.4 years). Nine fractures were in category A of the AO classification, 5 in category B, and 3 in category C. Rush-pin was used in 5 cases, Rush-pin and external skeletal fixation in 1 case, external skeletal fixation only in 3 cases, plate in 2 cases, and interlocking nailing system in 6 cases. We assessed the period from the day of trauma to bone union. Results of shoulder function in all cses were assessed using the JOA score. The mean healing time of all the fractures was 13 weeks (range: 3 to 34 months). The final JOA score was 87 points in patients with Rush-pin, 97 points in those with the interlocking nailing system. Contracture of the shoulder joint was found in 3 patients with the Rush-pin. All cases with the interlocking nailing system had no damage to their shoulder function.
One case of displaced fracture separation of the medial condyle of the humerus with metaphyseal fragments is presented. Arthrography was used to diagnose medial condylar fracture of the humerus. In operative findings, the size of the fragment was 3×2cm, and it was displaced through 180°. This case involved Bensahel type III and Kifoyle type III.
We examined surgical treatments and clinical results for fracture of the radial head. The subject consisted of 9 men and 4 women with an average age of 32 years who were followed-up for 6 months to 6 years (mean: 1 year). These B fractures were treated by open reduction and internal fixation with Kirschner wire, mini fragment screw, and mini Herbert screw. We classified them according to the Morrey classification system and used the criteria for the assesment of clinical results described by Wheelers. Five cases were excellent, 5 cases were good, 2 were fair, and 1 was poor. Bone union was achieved in all cases.
Congenital dislocation of the radial head is a rare condition. We experienced a case of the bilateral dislocation which was first deagnosed at an advanced age. The patient had been engaged in manual labor and had had no subjective symptoms, After a contusion, he complained of unilateral elbow pain and impaired range of motion. Radial head excision was performed on the elbow and eventually he was able to return to work.
We present 16 distal radius fractures in children requiring surgical correction more than 2 weeks after injury. The angulation just before the operation ranged from 22 to 40 degrees in lateral view x-rays. Cases with epiphyseal plate injury (4 cases) showed a tendency to become dislocated within 3 weeks after injury. Colles type fractures (7 cases) included 3 cases of complete dislocation at initial x-ray, and 5 cases of isolated radius fracture. Distal shaft fractures (5 cases) showed the tendency to increase angulation with a relative longer interval from injury to surgical correction. Some cases showed limitation of forearm rotation. If surgical correction is planned, surgery should be performed within 4 weeks after fracture due to easier resection of the callus.
Nineteen cases with twenty-one metacarpal fractures were treated using mini-plate fixation followed by early mobilization. Open fractures with severe soft tissue injury were excluded from the current study. The average age was thiry (range 16 to 52). The follow-up period averaged 7.3 months (range 1 to 22 months) excluding one case, which was follwed up for four days after surgery. The average flexion angle of the MP joint was 75 degrees. No extension dificit was noted. Complications were seen in two cases: one experiencing stiff MP joint and the other non-union, which was treated using only screws and fixed again using both plate and screws.
Twenty patients (twenty-one wrists) with chronic ulnar wrist pain who had undergone radiocarpal arthrography and MRI before arthroscopic examination were evaluated to determine the usefulness of these preoperative diagnostic procedures (arthrography and MRI) for the detection of triangular fibrocartilage complex (TFCC) injury. Based on the arthroscopic findings, the sensitivity and specificity of arthrography were 63% and 100% respectively for detecting TFCC lesions, while they were 68% and 50% respectively for MRI. Arthough no significant superiority was pbserved between arthrography and MRI in this study, further improrumchts in the preoprative diagnostic procedures are situl needed in order to more accurately detect TFCC injuries.
We evaluated radiological findings after treatment for bone deficit with β-tricalcium phosphate (β-TCP). We used only β-TCP in most cases. The mean age at the time of surgery was 49.1 years (range: 7 to 89 years). The mean duration of follow-up was 9.3 months (range: 3 to 14 months). The mean quantity of β-TCP used was 3.5cm3 (range: 0.5 to 13cm3 ). In most of the cases, X-ray showed that bone formation occurred around β-TCP and that absorption of β-TCP occurred over 3 months after operation. All of the cases recovered well without side effects.
Thirteen cases with intra-articular fractures were treated surgically using β-tricalcium phosphate. All cases achieved good bone union, with no problems associated with the β-tricalcium phosphate. In all cases, the β-tricalcium phosphate was substituted for self-bone. β-tricalcium phosphate graft can be used to make up for insufficiencies of auto graft in intra-articular fractures.
The percutaneos suture technique for repairing the Achilles tendon was first reported by Ma and Griffith in 1977. The surure is crisscrossed through the tendon and tied on the tendon surface. This technique is simple and can be quickly carried out under local anaesthesia. We reviewed patients who underwent percutaneous suture for ruptured Achilles tendon. The follow-up period ranged from 3 months to 12.4 years, averaging 8 years. Clinical evaluations on muscle strength, calf circumference, and range of motion between injured and uninjured siders were carried out on all patients. Some patients underwent open surgical suture on the other side. A comparative study was also performed, and resalts. Showed no rerupture in the percutaneous group. No significant statistical differences were observed between the percutaneous side and uninjured side, and between the percutaneous side and open surgical suture side. From these findings, we recommend percutaneous suture for the repair of the Achilles tendon.
Rupture of the triceps tendon is a rare injury, and has been reported as the least common of all tendon injuries. We report 2 cases, reconstructed by use of the fascia of the extensor muscle in the forearm combined with additional free tensor fascia lata tendon graft. The patients were a 43-year-old male and a 18-year-old male complaining of insufficient elbow extension after trauma. They could not extend the elbow against gravity. Surgical exposure revealed a complete rupture of the triceps tendon and a defect at the insertion. The proximal end of the tendon did not assume a normal appearance. The scar at the defect and the proximal end of the triceps tendon was refected. A flap of fascia was raised from the extensor muscle of the forearm, left attached to the base of the olecranon, reflected from distal to proximal, and sutured to the distal triceps tendon. We additionally covered it with the free tensor fascia lata tendon to reinforce the strength and smooth the gap. About one year after surgery, both patients recovered sufficient strength of elbow extension. One of the patients, who is a farmer, is now capable of vigorous push-ups. Both patients have returned to work as a farmer and a cook. This method is useful for rupture of the triceps tendon with defect.
Repture of the hamstring tendon is a rareinjury. The patient a 66-year-old male, sustained injury at a slope. He complained of severe posterior thigh pain and limped at the injured lower extrimity. Physical examination showed marked loss of power of left hamstrings and defective muscle. We operated on this patient at diagnosis of rupture of hamstring. Findings during the operation indicated avulsion fracture of ischial tuberosity are contruction of the muscle toward the distal part. Fragment was sutured original position. He recovered muscle function three months after the operation. In clinical practice, MRI and tangential view of ischial tuberosity should be perfomed. Surgical treatment is essential for cases with complete rupture of the hamstring.
Giant cell tumor of (GCT) tendon shearh is rarely seen in finger joint. We report a case of giant cell tumors occurring in the matacarpo-phalangeal joint (MPJ) of right index finger. A 32-years-old woman accidentally struck her right index finger with a flower-pot. After the episode she noticed, she couldn't fully extend the MPJ of right index finger. She visited our clinic 1.5 months after the accident. On examination a round small tumor on dorsal side of the MPJ of right index finger. She told us, she had received operation for giant cell tumor of the same finger several years ago. At that time this tumor had not been removed and left. Active and passive extension of the MPJ of right index finger was -25°. Diagnosis of locking of the MPJ of right index finger and GCT of tendon sheath was made and operation was carried out. The tumor was excised. On exploration of the joint a 0.6×0.4cm oval, yellowish-brown tumor sprung out, an another smaller tumor was found in the joint. After these tumors were excised the joint was unlocked by partial resection of cartilage of medial edge of the second metacarpal head. The post operative course was uneventful. The pathologic diagnosis of the tree tumors was GCT of tendon sheath.
We report a very rare case of bone metastasis of the clavicle from collecting duct carcinoma. A 28-year-old female had a growing tumor on the left clavicle. Resection biopsy was performed, and the first diagnosis was pigmented villonodular synovitis. She was refered to us. Examination revealed mild anemia (Hb10.6g/dl) and high ESR (85mm/h). Other serological examinations and urinalysis were normal. Tumor markers were within normal limits. Synovial sarcoma was suspected upon re-examination of the previously biopsied speciemen; however, the SYT-SSX gene was negative. Despite chemotherapy and irradiation, the tumor rapidly doubled in size in 8 weeks. Marginal resection of the tumor including a part of the sternum, clavicle, and pleura was performed. Pathological diagnosis was malignant hemangioendothelioma. Two months after surgery, bone metastasis at L3 was found. CT and MRI revealed a tumor at the left kidney. This tumor was resected and pathological diagnosis was collecting duct carcinoma, identical to the pathology of bone lesion of the clavicle.
We report two cases of suspected massive osteolysis Case 1 was a 63-year-old man who experienced pain in his left buttock six years ago and was walking with a limp the following year. X-ray showed resorption of the left coxal bone and pubic bone. Suspecting a malignant tumor, biopsy was performed. The findings showed massive osteolysis which had destroyed bone trabeculaes, and replaced granulomatous fibrosis including blood vessels. Eracatonin may be effective for stopping the activity of the osteoclast and relieving pain. Case 2 was a 66-year-old man who noticed a large mass on his left shoulder one year ago. The growing tumor limited his shoulder R. O. M. Radiography, especially 3DCT scan, showed marked resorption of the left scapula and ribs. Hematological and pathological findings revealed a multiple myeloma. Massive osteolysis is a very rare tumor-like lesion characterized by progressive osteolysis. The diagnosis must be confirmed by the microscopic finding of an intramedullary angioma-like vascular structure. Therefore, it is necessary to distinguish this disease from others having osteolysis.
In this study, we report a rare case of multiple intramuscular hemangioma. A 30-year-old man complained of right elbow joint pain. Magnetic resonance imaging showed abnormal shadows within the supinator muscle and the triceps muscle. We removed the two tumors completely. The pathological diagnosis was intramuscular hemangioma. Later, five lesions of hemangioma in the right hemiarm and hemitorso were detected by MRI or microscopic examination: medial upper arm, M. pectoralis major, M. deltoid and M. serratus anterior (two lesions). We diagnosed this case as multiple intramusclar hemangioma.
The vastus medialis muscle is very important for the function of the knee joint. We report three cases of a tumor in the muscle accompanied by pain and functional disorders. Two cases had pain on flexion and one case had an obvious limitation of flexion of the knee. The tumor was excised in all three cases. Histological diagnosis of each tumor were lymphangioma, intramuscular ganglion, and intramuscular hemangioma. The pain disappeared in all patients after the excision. However, pain recurred in the patient with lymphangioma and another operation was performed, which helped alleviate the pain again.
To assess the diagnostic significance of the fluid-fluid level (FFL), we reviewed CT and MRI findings of bone and soft tissue tumors exhibiting FFL literature. For the past 10 years, the formation of FFL was reported in 14 of 110 cases of bone and soft tissue tumors. These 14 cases consisted of 8 case of bone tumors (5 of 6 cases of aneurysmal bone cyst, 1 case of chondroblastoma, 1 of 3 cases of intraosseous ganglion, and 1 of 2 cases of fibrous dysplasia) and 6 cases of soft tissue tumors (2 of 21 cases of malignant fibrous histiocytoma, 1 of 14 cases of schwannoma, 1 of 13 cases of hemangioma, 1 of 5 cases of pigmented villonodular synovitis). FFL was most frequently detected by T2-weighted MR images. When FFL is formed by hemorrhagic contents of the cyst, the upper layer showed a higher intensity than the lower layer. Because FFL was observed in various types of bone and soft tissue tumors regardless of their benignancy or malignancy, the diagnostic significance of FFL may be limited. However, FFL was a characteristic feature of aneurysmal bone cyst, because it was observed in 5 of 6 cases of these cysts.
The extranodal malignant lympnoma of bone or soft tissue is a rare disease. Three cases of malignant lymphomas originating in bone and soft tissue are reviewed. Case 1 was a 64-year-old man complaining of pain and swelling in his right leg. Radiograph showed a diffuse destructive lesion and pathological fracture in his tibia. Magnetic resonance imaging revealed a large mass in the tibia and surrounding soft tissue. Above knee amputation was performed, and postoperativechemotherapy was carried out. The patient is alive and disease-free now. Case 2 was a 63-year-old woman complaining of pain and swelling in her lef tinguinal region. MRI showed a large mass in the sartorius muscle. Marginal excision was performed, and postoperative chemotherapy was carried out. The patient is alive and disease-free now. Case 3 was a 55-year-old man complaining of pain and swelling in his left knee. MRI showed a large mass in his vastus intermedius muscle. Treatment with chemotherapy and radiotherapy effectively reduced clinical symptoms and the tumor. However, several months later, the tumor recurred, and a new lesion occurred. He died as a result of this. Operative treatment is considered effective for the prognosis of some patients including the first two cases in this report.
We reported a case with a large forearm myxoid liposarcoma which could be treated with marginal resection after preoperative chemotherapy. A 78-year-old man developed a painless tumor in his right forearm. Pathological diagnosis of the needle biopsy indicated possible myxoid liposarcoma. We performed neo-adjuvant chemotherapy, including ADM and CDDP (i. a) whigh reduced the size of the tumor. We then performed marginal resection of the tumor maintaining the neurovascular structures. Local recurrence of the tumor was not seen for five years, though abdominal metastasis was found.
We report nine cases with pathological fracture of metastatic bone tumor in the long bone. They consisted of 6 males and 3 females, with a mean age of 69.8 years. All cases underwent curettage of the bone metastases, and reconstruction by internal fixation with bone cement supplementation. All the patients ragained stability of the affected limb after surgery. Pain was relieved in most patients and they were able to start early rehabilitation. Results of the surgical treatment were excellent or good for the function of affected limbs, and showed improved quality of life (QOL). This treatment is useful for patients who are not able to receive radical operation.
We evaluated postoperative results in fifteen patients with metastatic spinal tumor who underwent surgical treatment between 1989 and 2000. There were eleven males and four females with a mean age of sixty-four years (range: forty-eight to seventy-seven). The primary tumor was prostate cancer in five, lung cancer in four patients, etc. The level of spinal metastases was cervical in three and thoracic spine in eleven. We treated the patients surgically with anterior procedure in three and posterior procedure in twelve. For fixation, spinal instrumentation was employed in five patients. As a result, five of the fifteen patients recovered from their paralysis and twelve of fifteen patients attained pain relief. The rate of survivl was 42.9 percent at three months, 30.8 percent at six months, and 23.1 percent at one year. Surgical treatment for spinal metastases is effecticve for improving the quality of life in patients with severe pain of progressive paralysis. However, the indication of surgical treatment for spinal metastases must be determined carefully, taking into consideration their general condition, variety of primary cancer, and prognosis of each patient.
Chordomas are rare neoplasms which arise from ectopic remnants of the embryonic notochord. They occur primarily in the sacro-coccygeal region or in the spheno-occipctal clival synchondrosis. We report two chordoma cases at unusual sites of the cervical and lumbar spine. The first case was a 73-year-old male who complained of aphagia for the first time in October 1997. Spine neoplasm was suspected on MRI, and the patient was diagnosed with chordoma in the cervical spine as the result of histopathological inspection. The tumor recurred and led to tetraplagia in January 1998. Although another resection was carried out, he died from respiratory muscle paralysis in February 2000. The second case was a 64-year-old woman. She complained of right inferior limb pain in 1983. Spinal neoplasm was suspected, and the patient was diagnosed with chordoma in the lumber spine through pathological inspection. She underwent two operations. In the first operation, resection and anterior fusion were performed, and secondary posterior fusion was added to increase support of the lumber vertebra. The tumor has not recurred for 7 years postoperatively. Chordoma should be extracted completely in one piece, otherwise the prognosis will be poor.
Six patients with spinal tumor were operated on using titanium mesh cages. Four patients were male and two were female. The average age of the patients was 54 years (range: 40 to 65 years). Three cases were of the cervical level and the others were thoracic. All patients had severe neck or back pain, and one patient had nerve pain. The follow-up ranged from 4 to 17 months (mean: 9.2 months). Four patients received the anteroposterior approach, and two the anterior approach. The operative time was 150 to 255 minutes (mean: 195 minutes). The mean intraoperative blood loss came to 330g (range: 70 to 750g). All patients reported that their pain decreased or disappeared. No cage failure or extrusion was observed.
Chromomycosis usually occurs in cutaneous or subcutaneous tissue. Many case reports are found in dermatology. Rarely does it occur in deep soft tissue. We report a case of granuloma caused by Phialophora Verrucosa between the left Achilles tendon and tibia. Magnetic Resonance Imaging disclosed a low intensity signal on T1-and T2-weighted images, and high intensity on Gd-enhanced, otherwise known as the dark ring sign. We believe that MRI is useful for the diagnosis of chromomycosis.
It is said that early diagnosis is important in spinal infection, and MRI is useful for such diagnoses, because the disease often progresses rapidly, with late diagnosis leading to large epidural abscess and palsy. We report a 75-year-old man who had vertebral osteomyelitis (Th8-9) with diffuse epidural abscess compressing the Th6-9 region. Because he had dimentia, and was in a septic shock state, we managed only laminectomy and debridement by the posterior approach, after which irrigation was performed. The infection was difficult to control with antibiotics, and he died of multiple organ failure after six months.
Tuberculous spondylitis has become relatively rare in recent years. Furthermore, the incidence of tuberculous spondylitis involving the atlas and axis comprises only 0.3% of all tuberculous spondylitis. We successfully treated a patient with tuberculous spondylitis of the atlas and axis without pulumonary lesion. A 29-year-old female, suspected of a cervical disc hernia, was refered to us because conservative treatment induced little improvement. She had symptoms indicating cervical tuberculous spondylitis, such as febricula, malaise, neck pain, headache, and dysphagia. Serological exams indicated acute inflammation (ESR: 95mm/h, CRP: 4.6mg/dl). Roentgenograms of her chest and cervical spine did not show any pathological findings. However, CT revealed the pathological fracture of the atlas and MRI revealed fluid collection around the atlanto-axial region and middle thoracic spine. Needle aspiration of cervical lesion was performed under CT guide. Tuberculous infection was determined using the PCR method. Clinical symptoms subsided and ESR and CRP were reduced to normal range 4 weeks after the start of antituberculous medications. After 14 weeks, we confirmed thebone union of the pathological fracture of the atlas and disappearance of the abscess by MRI.