Ryosuke Sakata

Chondrosarcoma of sacrum presenting with a deep vein thrombosis.

Abstract Chondrosarcoma is the second most common primary malignant bone tumor [1]. It is often observed in the pelvis, femur, shoulder girdle and diaphysial portions of long bones [2]. Its incidence in the sacral lesion is very low, and it was reported that only 18 cases of chondrosarcoma were observed out of 900 tumor cases (0.2%) [3]. On the other hand, Ozdemir et al. [4] report that the frequent symptoms and signs of sacral malignant bone tumors including primary and metastatic malignant bone tumors are nonspecific low back pain, sensation of pelvic pressure or discomfort, and neurological symptoms when the tumor compresses the neural structures. Symptoms of deep vein thrombosis (DVT) due to a sacral tumor were not described in this series. Only two cases of a bone tumor initially presenting as DVT have been reported in the English literature. Tasci et al. [5] report a case of Ewing sarcoma of the fibula with venous thrombosis in the popliteal vein, and Hoekstra et al. [6] present a case of pelvic girdle chondrosarcoma with venous thrombosis in the iliac vein and inferior vena cava. However, to our knowledge, a case in which the initial symptom of sacral chondrosarcoma is DVT due to tumor embolism in the iliac vein has not been reported. In this report, we present a case of chondrosarcoma of the sacrum that initially presents as DVT, and discuss the mechanism of this phenomenon.

Application of Pain Quantitative Analysis Device for Assessment of Postoperative Pain after Arthroscopic Rotator Cuff Repair

Purpose : The PainVision™ system was recently developed for quantitative pain assessment. Here, we used this system to evaluate the effect of plexus brachialis block on postoperative pain after arthroscopic rotator cuff repair. Methods : Fifty-five patients who underwent arthroscopic rotator cuff repair were included in this study. First 26 cases received no plexus brachialis block (control group), and the next 29 cases received the plexus brachialis block before surgery (block group). Patients completed the visual analog scale at 4, 8, 16, and 24 hours after surgery, and the intensity of postoperative pain was assessed with PainVision™ at 16 hours. The postoperative use of non-steroidal anti-inflammatory agents was also recorded. Results : The pain intensity at 16 hours after surgery assessed by PainVision™ was significantly lower in the block group than in the control group (block, 252.0 ± 47.8, control, 489.0 ± 89.1, P < 0.05). However, there were no differences in the VAS values at 16 hours between the 2 groups (block, 4.3 ± 0.6, control, 5.7 ± 0.4, P = N.S.). The pain intensity and VAS at 16 hours after surgery were highly correlated (r = 0.59, P = 0.006 in the block group and r = 0.62, P = 0.003 in the control group). The effect size of the assessment by PainVision™ was bigger than that of VAS (r=0.31 in VAS and 0.51 in Pain vision). Conclusion : The PainVision™ system could be useful to evaluate postoperative pain because it enables the quantification and comparison of pain intensity independent of individual pain thresholds.

Carpal Tunnel Syndrome Caused by Tumoral Calcinosis.

We present a case of carpal tunnel syndrome caused by systemic tumoral calcinosis. A 54-year-old woman experienced hand numbness that persisted for nine months. She had no family history or medical problem. A plain radiograph of her right wrist showed a calcified mass on the volar side of the wrist joint. The patient also experienced pain in her contralateral wrist joint and both right and left shoulders, which had calcification on radiography around the joint. Her condition was diagnosed as carpal tunnel syndrome caused by systemic tumoral calcinosis and a resection biopsy was performed. Histopathological analysis of the biopsied specimen showed basophile deposition inside the fibrous connective tissue. At 14 months after the treatment, she no longer had pain or numbness in her fingers and there was no recurrence of the mass. This patients condition is considered as a case of nonfamilial, systemic primary tumoral calcinosis. Since incomplete resection leads to a recurrence of the lesion, a follow-up radiography examination is needed to monitor symptom recurrence.