Tibial bone defects treated by internal bone transport using the Ilizarov method

We reviewed 27 cases of tibial bone defects treated by internal bone transport using the Ilizarov method. The causes of the bone defects were open fractures in 14 segments and infected non-unions in 13. The average length of the defects was 8.3 cm (range, 3–20 cm). There were 21 one-level tibial transports, 3 two-level tibial transports, 1 one-level tibial transport with fibular transport, and 2 fibular transports. At the docking site, 25 segments underwent bone grafting. Eleven of the 25 were Papineau-type open cancellous bone grafts. Acute shortening or docking was performed in 10 segments. Bone union was obtained in every instance. The average time of external fixation was 8 months and the average time to union was 7.1 months. Bone grafting at the docking site is recommended in order to shorten the duration of treatment and to prevent refracture and non-union.

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Résumé. Nous avons passé en revue 27 cas de perte de substance du tibia traités par ?transport osseux interne? conformément à la méthode Ilizarov. Ces anormalies provenaient de fractures ouvertes dans 13. La longeur moyenne des defect osseux était de 8,3 cm (entre 3 et 20 cm). On a effectué 21 ?transports tibiaux? de niveau 1, 3 ?transports tibiaux? de niveau 2, 1 ?transport tibial? avec ?transport du péroné?, ainsi que 2 ?transport du péroné?. Dans 25 cas une greffe osseuse a été pratiquée sur le site de réduction. 11 cas des 25 greffes pratiquées étaitent du type Papinau. D’importances réduction ont d?étre effectuées dans 10 cas. Des fusions ont été obtenues dans tous les cas. Le temps moyen de fixation externe était de 8 mois et celui de fusion de 7,1 mois. La greffe osseuse est recommandée sur le site de réduction afin de raccourcir la durée du traitement et de prévenir toute récidive de fracture ou de non-consolidation.

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Accepted: 7 November 1997     

Sagittal and coronal plane location of the popliteal artery in the open-wedge high tibial osteotomy

Purpose

The objectives of this study were (1) to evaluate the sagittal and coronal plane location of the popliteal artery during the advancement of open-wedge high tibial osteotomy and (2) to confirm the effect of osteoarthritis if it changes the relationship between the popliteal artery and posterior cortex.

Methods

Two hundred consecutive patients were enrolled, and we divided patients into two subgroups according to age and cartilage status in the radiologic report of magnetic resonance imaging (group I: 100 non-arthritic knees; group II: 100 arthritic knees). For prediction of the location of the popliteal artery during the operation, sagittal and coronal plane location along the osteotomy plane was evaluated.

Results

The distance between the posterior cortex of the osteotomy and popliteal artery was 13–14 mm on the sagittal plane, and the popliteal artery was located at an approximately 35 ± 5.5 mm portion from the starting point of the osteotomy on the coronal plane. The distance at the starting point of osteotomy was larger than at the end portion and prominent area. In comparison between groups I and II, group II showed a larger distance on the sagittal planes [osteotomy–vascular: 13.6 vs 14.4 (p = 0.01), fibula–vascular: 4.88 vs 6.5 (p < 0.01), and prominence–vascular: 4.3 vs 5.3 (p < 0.01)] compared to the group I.

Conclusions

Special caution and some protection should be given until the approximately 35 mm portion from the starting point of the posteromedial cortex with consideration for the approximity on the sagittal plane. In comparison between the non-arthritic and arthritic knee, differences were observed on the sagittal plane. However, the value was minimal, and the clinical relevance was questionable.

Level of evidence

Case series, Level IV.     

Comparison of anatomic ACL reconstruction between selective bundle reconstruction and double-bundle reconstruction

Purpose

The objective of this study was to compare the clinical and radiologic results of preserved ligament remnants in the selective bundle anterior cruciate ligament (ACL) reconstruction and totally sacrificed ligament remnant in the double-bundle ACL reconstruction in order to confirm the evidence of selective bundle reconstruction.

Methods

This retrospective comparative study was conducted for comparison between preserved ligament remnants in the selective bundle ACL reconstruction and totally sacrificed ligament remnant in the double-bundle ACL reconstruction. From 2008 to 2010, 16 patients (group I) underwent selective bundle ACL reconstruction and 30 patients (group II) underwent double-bundle ACL reconstruction. Clinical, stability and radiologic results (tunnel locations of femoral tunnels using 3-D computed tomography and graft signal intensity using magnetic resonance imaging) were compared.

Results

In comparison with functional results, no statistical differences in the Lysholm, Tegner and International Knee Documentation Committee scores were observed between the two groups (n.s.). In comparison with stability results between the two groups, no statistical differences were observed in the Lachman, pivot shift and anterior drawer stress tests using a Telos^® device at 30° and 90° flexed positions (n.s.). In evaluation of the femoral tunnel location, no statistical significant differences in the tunnel position were observed between the groups (n.s.). No statistically significant differences in signal intensity were observed between the two groups (n.s.).

Conclusions

Compared to the double-bundle ACL reconstruction, selective bundle ACL reconstruction produced comparable clinical and radiologic results. Selective bundle ACL reconstruction could be performed instead of double-bundle ACL reconstruction if some intact bundle exists.

Level of evidence

Comparative study, Level III.     

Peliosis Hepatis Shows Isometabolism on 18F-FDG PET/CT: Two Case Reports

Peliosis hepatis (PH) is a rare benign disease that is characterized by multiple blood-filled cystic spaces in the hepatic parenchyma. It is also characterized by a range of radiologic findings that might mimic various diseases, including metastatic liver disease and hepatocellular carcinoma. The findings of PH on ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) are not well reported. We here report two cases of biopsy-proven PH. Both patients had been treated for cancer (advanced gastric carcinoma and rectal adenocarcinoma), and follow-up CT of both cases revealed hepatic lesions with the possibility of metastasis. Examination of ¹⁸F-FDG PET/CT images suggested that the lesions were isometabolic, having metabolism similar to that of adjacent hepatic parenchyma. The outcomes of hepatic core-needle biopsies were consistent with peliosis hepatis.     

Clinical Significance of Diffuse Intrathoracic Uptake on Post-Therapy I-131 Scans in Thyroid Cancer Patients

Purpose

The purpose of this study was to identify the frequency and possible cause of diffuse intrathoracic uptake on post-therapy I-131 scans in thyroid cancer patients.

Methods

We retrospectively reviewed 781 post-therapy scans of 755 thyroid cancer patients who underwent total thyroidectomy and radioactive iodine therapy between January and December 2010. Diffuse intrathoracic uptake on post-therapy scans was examined, and clinical patient characteristics including sex, age, regimen for thyroid-stimulating hormone (TSH) stimulation (thyroid hormone withdrawal or recombinant human TSH injection), TSH, thyroglobulin (Tg) and anti-thyroglobulin antibody (anti-Tg Ab) levels, therapeutic dose of radioactive iodine therapy and prior history of radioactive iodine therapy were recorded.Scan findings were correlated with chest CT, chest radiographs, laboratory tests and/or clinical status. Diffuse intrathoracic uptake without evidence of pathologic condition was categorized as indeterminate. The association between clinical characteristics and intrathoracic uptake were analyzed for negative intrathoracic uptake and indeterminate uptake groups.

Results

Diffuse intrathoracic uptake on post-therapy scans was demonstrated in 39 out of 755 (5.2 %) patients, among which 3 were confirmed as lung metastasis. The 14 patients that showed high Tg or anti-Tg Ab levels were considered to be at risk of having undetected micrometastasis on other imaging modalities. The remaining 22 were indeterminate (2.9 %).Upon comparison of negative intrathoracic uptake and indeterminate uptake groups, TSH stimulation by thyroid hormone withdrawal was shown to be significantly correlated with diffuse intrathoracic uptake (p < 0.05).

Conclusion

The frequency of diffuse intrathoracic uptake on post-therapy scans was 5.2 % and could be seen in thyroid cancer patients with underlying lung metastasis as well as those without definite pathologic condition. In the latter, there was a higher frequency for diffusely increased intrathoracic uptake in those who underwent thyroid hormone withdrawal rather than recombinant human TSH injection.     

Arthroscopic treatment for acute septic arthritis of the hip joint in adults

Purpose

The purpose of our study was to evaluate the efficacy and safety of the arthroscopic management of septic arthritis of the hip joint.

Methods

From October 2009 to October 2010, nine patients with septic arthritis of the hip were treated with arthroscopic debridement and drainage and systemic antibiotics according to bacterial sensitivity or with empiric antibiotics if no bacteria was isolated from the cultures. All patients were placed in the supine position on a fracture table, and two or three arthroscopic portals were used. The medical records were retrospectively reviewed to determine the efficacy and safety of hip arthroscopy for septic arthritis.

Results

There were 4 men and 5 women, with a mean age of 49.8 years (SD 12.1). No major complication related to arthroscopy of the hip was encountered. Staphylococcus aureus was identified in 4 patients. Average follow-up was 19.4 months (SD 4.1). Septic arthritis relapsed in one patient, but the other 8 patients experienced no recurrence during the follow-up period.

Conclusions

Arthroscopic lavage and debridement is a safe and effective procedure for septic arthritis of the hip joint.

Level of evidence

IV.     

Outcome of hepatic resection for metastatic gastric cancer

The role of hepatic resection for metastatic gastric cancer is less well defined due to the tendency of gastric cancer to widely metastasize. The purpose of this study is to examine the beneficial effect of hepatic resection in patients with metastatic gastric cancer. The clinicopathologic features and long-term results of 11 patients who underwent hepatic resection for metastatic gastric cancer from January 1988 to December 1996 at Seoul National University Hospital were analyzed retrospectively. All resected hepatic metastases were solitary lesions. Among eight patients with synchronous hepatic metastases, one patient with early gastric cancer and lymph node metastases (T1N2M1) remained alive for 8 years 6 months after hepatic resection without recurrence. Among three patients with metachronous hepatic metastases, two patients with advanced gastric cancer and lymph node metastases (T3N2MO, T2N1MO at the initial operation, respectively) survived 8 years 6 months and 3 years after hepatic resection, respectively. Median survival times of synchronous and metachronous hepatic metastases were 13.0 and 74.3 months, respectively. In solitary hepatic metastatic lesions from gastric cancer, surgical resection should be considered as one of the treatment options.     

Clinicopathologic analysis of early ampullary cancers with a focus on the feasibility of ampullectomy

OBJECTIVE: The purpose of this study was to evaluate whether ampullectomy can substitute for pancreatoduodenectomy (PD) in early ampullary cancer by clinicopathologic study. SUMMARY BACKGROUND DATA: Although ampullectomy has been attempted in early ampullary cancer (pTis, pT1), the indication and extent of resection have not been established. METHODS: Of 201 patients who had undergone PD for ampullary cancer between 1986 and 2002, 67 patients with a histologic diagnosis of pTis (n = 5) or pT1 (n = 62) cancer were analyzed retrospectively. Pathologic PD specimens were reviewed to analyze the cancer spread pattern, and medical records were reviewed for clinical outcomes. RESULTS: The 5-year survival rate of the 66 patients with early ampullary cancer (excluding one mortality) was 83.7%. Recurrence was confirmed in 12 patients (18.2%) and all died because of the recurrence. Pathologic review showed that 22 patients (32.8%) had at least one risk factor for failure after ampullectomy: lymph node metastasis (n = 6, 9.0%), perineural invasion (n = 1), or mucosal tumor infiltration along the CBD or P-duct (n = 15, 22.4%). Mean lengths of invasion into the CBD or the P-duct beyond the sphincter of Oddi were 7.7 mm (range, 1-25 mm) or 6.3 mm (range, 2-18 mm), respectively. Moreover, these risk factors were not correlated with tumor size, histologic grade, or the gross morphology of the primary tumor, although pTis cancer or pT1 cancer sized 1.0 cm or less was found to be least associated with risk factors. CONCLUSIONS: Ampullectomy for early ampullary cancer should not be considered an alternative operation to PD because of the high possibility of recurrence. PD should be preferably performed for adequate radical resection, even in early ampullary cancer, and ampullectomy should be reserved for those who have pTis or pT1 cancer sized 1.0 cm or less with high operative risk.