Dong-Yeong Lee

The value of diagnostic ultrasonography in the assessment of a glomus tumor of the subcutaneous layer of the forearm mimicking a hemangioma: a case report

IntroductionA glomus tumor is a rare, benign tumor with atypical clinical symptoms. Because of its small size, it is difficult to diagnose and treat early; therefore, it leads to poor quality of life. Glomus tumors are known to commonly affect the hand and rarely manifest in other areas. Because they simulate neuromas, hemangiomas, and neurofibromatosis, the differential diagnosis is difficult. We performed marginal resection of a solitary forearm mass previously suspected to be a hemangioma or glomus tumor on the basis of ultrasound findings and histologically diagnosed to be a glomus tumor afterward. We report this case to demonstrate the good prognosis of the procedure we used, and we review the relevant literature.Case presentationA 68-year-old Asian man without a particular medical history visited our hospital with a mass with focal tenderness in his left distal forearm that had developed 8 years earlier. The tumor was observed with suspicion of being a hemangioma or glomus tumor based on the location, clinical symptoms, and ultrasound findings taken into consideration together. The biopsy results led us to conclude that the lesion was a glomus tumor.ConclusionsA glomus tumor located in the forearm is very rare. It is often clinically overlooked and is likely to be misdiagnosed as another disease. The patient’s quality of life deteriorates, and, though the disease is rare, it has serious sequelae. Therefore, a quick diagnosis and appropriate treatment must be conducted early. If a mass occurs with serious pain in subcutaneous soft tissue of not the hands but the limbs, it is important to conduct examinations with suspicion of a glomus tumor. Ultrasonography performed quickly may be useful for making the differential diagnosis.

A Review of the Literature on Culture-Negative Periprosthetic Joint Infection: Epidemiology, Diagnosis and Treatment

Purpose The prevalence of periprosthetic joint infection (PJI) has increased with the increasing incidence of arthroplasty surgery. Considering identification of causative microorganisms is crucial for treatment of PJI, culture-negative (CN) PJI is a significant clinical issue. The purpose of the present study is to describe epidemiology, diagnosis and treatment of CN PJI based on review of the literature to help prevent delayed diagnosis and improve clinical outcomes of CN PJI. Methods MEDLINE, EMBASE, Cochrane Library and Scopus databases were searched for articles on CN PJI. Only clinical studies written in English were included. Basic science studies, letters to the editor, case reports and review articles on PJI were excluded. Results Seven studies were included in this study. The prevalence of CN PJI ranged from 0% to 42.1%. The major risk factors for CN PJI were prior antibiotic use and presence of postoperative wound drainage. Vancomycin and cephalosporins were the most commonly used antibiotics for CN PJI. Two-stage revision arthroplasty followed by 6 weeks of antibiotic therapy produced the most successful treatment outcomes. Conclusions In most clinical studies on CN PJI, a definite diagnostic method for identifying causative microorganisms or optimal treatment strategy for CN PJI were not clearly described. Therefore, further studies are needed to establish standard diagnostic methods for identifying infecting organisms and treatment strategies for CN PJI.

Single-Bundle versus Double-Bundle Posterior Cruciate Ligament Reconstruction: A Meta-Analysis of Randomized Controlled Trials

Purpose This meta-analysis evaluated the benefits of single-bundle (SB) and double-bundle (DB) surgical techniques for posterior cruciate ligament reconstruction (PCLR) in terms of clinical outcomes. Methods Five electronic databases were searched for relevant articles published until September 2016. Clinical outcomes of both techniques were evaluated using Lysholm knee function scores, Tegner activity scores, side-to-side differences, and International Knee Documentation Committee (IKDC) objective grades. The results are presented as a risk ratio (RR) for binary outcomes and a weighted mean difference (WMD) for continuous outcomes with a 95% confidence interval (CI). Results Four randomized controlled trials (RCTs) were included. There were no significant differences in the Lysholm knee function scores (WMD=1.63; 95% CI, 0.00 to 3.27; I2=0%), Tegner activity scores (WMD=0.17; 95% CI, −0.08 to 0.43; I2=20%), side-to-side differences (WMD=−0.97; 95% CI, −2.41 to 0.47; I2=78%), and IKDC objective grades (RR=1.18; 95% CI, 1.00 to 1.39; I2=0%) at the final follow-up. Conclusions The present study demonstrates that both SB and DB techniques for PCLR are comparable in terms of restoration of knee stability and improvement of knee function. However, it is still unclear which technique yields better clinical outcomes. To verify and further corroborate our results, more larger-scale, high-quality RCTs are encouraged.

The role of isolated posterior cruciate ligament reconstruction in knees with combined posterior cruciate ligament and posterolateral complex injury

PurposeThis is a meta-analysis comparing biomechanical outcomes to determine whether an isolated posterior cruciate ligament (PCL) reconstruction can restore normal knee kinematics in a combined PCL/posterolateral complex (PLC) injury and whether double-bundle (DB) PCL reconstruction is superior in controlling posterior and rotational laxity compared with single-bundle (SB) PCL reconstruction in a PCL/PLC-deficient knee.MethodsA number of electronic databases were searched for relevant articles published through August 2016 that compared biomechanical outcomes of PCL reconstruction in patients who underwent reconstruction for combined PCL/PLC deficiencies. Data were searched, extracted, analysed, and assessed for quality according to Cochrane Collaboration guidelines, and biomechanical outcomes were evaluated using various outcome values. The results are presented as relative ratios for binary outcomes and standard mean differences for continuous outcomes with 95% confidence intervals.ResultsFive biomechanical studies were included in this meta-analysis. There were significant differences in laxities such as posterior tibial translation (PTT), external rotation, varus rotation, and PTT coupled with external rotation in the isolated PCL reconstruction group compared with the native PCL group. Furthermore, there were no significant differences in laxities such as PTT, external rotation, or varus rotation between the SB and DB PCL reconstruction groups.ConclusionIsolated PCL reconstruction, whether SB or DB, could not restore normal knee kinematics in the PCL/PLC-deficient knee. In such cases, residual laxity after isolated PCL reconstruction can be controlled successfully with PLC reconstruction. Therefore, simultaneous PCL and PLC reconstruction is recommended for patients with combined PCL/PLC injury.

Risk Factors for Posterior Cage Migration after Lumbar Interbody Fusion Surgery

Study Design A retrospective clinical case series. Purpose To determine the strength of association between cage retropulsion and its related factors. Overview of Literature Lumbar interbody fusion with cage can obtain a firm union and can restore the disc height with normal sagittal and coronal alignment. Although lumbar interbody fusion procedures have satisfactory clinical outcomes, peri- and postoperative complications regarding the cage remain challenging. Methods From January 2006 to June 2016, 1,047 patients with lumbar degenerative disc disease who underwent posterior lumbar interbody fusion or transforaminal interbody fusion at Gyeongsang National University Hospital were enrolled. Medical records and pre- and postoperative radiographs were reviewed to identify significant cage retropulsion-related factors. The associations between cage retropulsion with various risk factors were evaluated by calculating odds ratios (ORs) and 95% confidence intervals (CIs) using multiple logistic regression analysis. Results Of 1,229 disc levels, 16 cases (1.3%, 10 men and 6 women) had cage retropulsion. Univariate analysis revealed no significant differences between the cage retropulsion group and the no cage retropulsion group with regard to demographic data such as age, sex, weight, height, body mass index (BMI), smoking habits, presence of osteoporosis, and duration of follow-up. Multivariate analysis revealed that low BMI (OR, 0.875; 95% CI, 0.771–0.994; p=0.040), presence of screw loosening (OR, 27.400; 95% CI, 7.818–96.033; p<0.001), and pear-shaped disc (OR, 9.158; 95% CI, 2.455–34.160; p=0.001) were significantly associated with cage retropulsion. Conclusions This study demonstrated that low BMI, loosening of posterior instrumentation, and pear-shaped disc were associated with cage retropulsion after lumbar interbody fusion. Therefore, when performing lumbar interbody fusion with a cage, surgeons should have skillful surgical techniques for firm fixation to prevent cage retropulsion, particularly in non-obese patients.

Posterior Cruciate Ligament Reconstruction With Transtibial or Tibial Inlay Techniques: A Meta-analysis of Biomechanical and Clinical Outcomes

Background: Transtibial (TT) or tibial inlay (TI) techniques are commonly used for posterior cruciate ligament reconstruction (PCLR). However, the optimum method for PCLR after PCL injury remains debatable. Hypothesis/Purpose: The hypothesis was that TT and TI techniques would not show significant differences for all outcome measures. The purpose was to determine the biomechanical and clinical outcomes of TT and TI surgical techniques for PCLR. Study Design: Meta-analysis; Level of evidence, 3. Methods: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and SCOPUS electronic databases for articles published up until August 2016 were searched to find relevant articles comparing outcomes of TT versus TI techniques for PCLR. Data searching, extraction, analysis, and quality assessment were performed according to Cochrane Collaboration guidelines. Biomechanical outcomes and clinical outcomes of both techniques were compared. Results are presented as risk ratio (RR) for binary outcomes and weighted mean difference (WMD) for continuous outcomes with 95% confidence intervals (CI). Results: Five biomechanical and 5 clinical studies were included. No significant biomechanical differences were found regarding posterior tibial translation (PTT) at a knee flexion angle of 90° or PTT after cyclic loading between the 2 groups. However, a stronger in situ force in the graft was detected in the TT group (WMD = 15.58; 95% CI, 0.22-30.95; I2 = 10%). Although no significant differences were found in clinical outcomes such as Lysholm knee function score, Tegner activity score, side-to-side difference, or posterior drawer test at final follow-up between the 2 groups, the TT technique tended to entail fewer perioperative complications than the TI technique (RR = 0.60; 95% CI, 0.35-1.00; I2 = 0%). Conclusion: TT and TI techniques for PCLR can both restore normal knee kinematics and improve knee function. However, the issue of which yields better improvement in stability and functional recovery of the knee remains unclear. More high-quality trials and randomized controlled trials are needed. Although PCLR via the TT technique resulted in higher graft forces, determining whether this is clinically significant will require further studies. When performing the TI technique, surgeons should inform patients of the risk of complications.

Acute lumbosacral hemorrhagic ganglion cyst after transforaminal epidural steroid injection

Epidural steroid injection is one of the most commonly used non-surgical treatments for degenerative lumbar vertebral disease. Its use has increased as degenerative lumbar vertebral disease has increased in frequency. Concomitant complications are being reported more often. In this report, we report a rare case of iatrogenic hemorrhagic cyst following epidural steroid injection. The patient underwent operative treatment with complete resolution of his symptoms

Cytotoxic effects of delphinidin in human osteosarcoma cells

Introduction The aim of this study was to evaluate whether delphinidin is cytoprotective or cytotoxic in osteosarcoma cell lines, and to elucidate the underlying mechanisms. Materials and methods The present study investigated whether apoptosis or autophagy is induced by delphinidin in human osteosarcoma cell lines. Delphinidin was used as the antioxidant, along with two autophagy inhibitors: 3-methyladenine and bafilomycin A1. Cell viability and known autophagic markers, such as LC3-II expression, were evaluated. Reactive oxygen species (ROS) formation and cell cycle analysis were also investigated. Results Delphinidin showed concentration-dependent cytotoxicity to osteosarcoma cell. Delphinidin is closely associated with apoptotic cell death mechanisms and pathways related to ROS accumulation. In addition, we observed delphinidin-induced autophagosome formation and increasing levels of LC3-II conversion. However, in spite of delphinidin induced autophagy, the cytotoxic effects induced in the osteosarcoma cells may not be operating via autophagic cell death mechanisms. Conclusions Delphinidin compromises the cellular protective mechanisms by inhibiting autophagy, permitting ROS to accumulate and finally enhance apoptotic cell death. Our results indicate that delphinidin may play a critical role as a chemotherapeutic agent by preventing the development and progression of osteosarcoma cells.

Brown-Sequard syndrome caused by hyperextension in a patient with atlantoaxial subluxation due to an os odontoideum

Brown-Sequard syndrome is an uncommon complication of atlantoaxial arthrodesis. A 50-year-old female visited our emergency department after falling from a ladder. Radiologic evaluations revealed chronic C1-2 instability with acute spinal cord injury. The day after atlantoaxial fusion was performed, she developed left-sided motor weakness and the loss of right-sided pain and temperature sensation. Based on physical examination and radiologic findings, we diagnosed her as having Brown-Sequard syndrome. Spine surgeons performing this procedure should therefore consider Brown-Sequard syndrome if a patient displays signs of postoperative hemiplegia.