Taweechok Wisanuyotin

Prevalence of Known and Unknown Primary Tumor Sites In Spinal Metastasis Patients

Study Design: A retrospective study. Objectives: Three objectives have been designated for this study: (1) to determine the prevalence of identifiable and non-identifiable primary tumor sites in patients with spinal metastasis, (2) to identify the most common site of the known primary tumor sites, and (3) to identify the factors associated with survival time. Summary of Background Data: The spine is the third most common metastatic site for several primary visceral carcinomas. The primary tumor site could not be identified in 15% to 20% of patients who had been diagnosed of with a skeletal metastasis. Most of the previous studies on skeletal metastasis have not been limited to spinal metastasis alone. Methods: Between January 2007 and July 2011 reviews were done for 82 patients with spinal metastasis who had not received a previous diagnosis of carcinoma. The assessment parameters included the following: general demographic data, Karnofsky score, Frankel score, number of spinal vertebra affected, region of the spine affected by metastasis, other skeletal metastasis site, visceral metastasis, known or unknown primary sites of metastasis, histological cell type of metastasis, and the survival period. The log-rank test and Cox proportional hazard model were used to study the survival analysis. Results: Of the 82 patients included in the study, 56 were male. The mean age was 57 years. 86.6% had a known primary carcinoma site while the remaining 13.4% had none. The two most common known carcinoma sites were the lung and biliary systems. Among the 11 unknown primary sites, the most common histological finding was adenocarcinoma. The mean survival period was 8.7 ± 11.7 months. The survival analysis revealed two statistically significant factors: the primary tumor site’s aggressiveness (P<0.005) and the presence of visceral metastasis (P<0.05). Conclusion: The prevalence of identifiable primary site was 86.6% and the most common site was the lungs followed by the biliary system. The primary carcinoma site’s aggressiveness and the presence of visceral metastasis were the factors associated with patient survival.

Clinical results of primary malignant musculoskeletal tumor treated by wide resection and recycling autograft reconstruction using liquid nitrogen.

To evaluate the clinical results of primary malignant musculoskeletal tumors treated with wide resection and recycling autograft reconstruction using liquid nitrogen.

Prognostic factors and clinical outcomes in synovial sarcoma of the extremities

To evaluate the clinical outcomes and identify which prognostic factors influence the clinical outcomes of synovial sarcoma patients at a tertiary university hospital in Thailand.

Cholangiocarcinoma with spinal metastasis: Single center survival analysis.

The aim of this study was to perform a survival analysis of Cholangiocarcinoma (CCA) with spinal metastases. 55 cases of CCA with spinal metastases were retrospectively reviewed. We recorded age, sex, Kanofsky performance score, Frankel scale, number and region of affected vertebrae, presence of appendicular bone metastases, treatment received, and survival time; then performed a survival analysis. Overall median survival was 4months (95%CI, 2.89-5.11). Frankel A had the poorest survival (2months-95%CI, 1.15-2.85) compared to Frankel C and D (P=0.004 and <0.001, respectively). One-level spinal metastasis had the longest survival (8months-95%CI, 5.98-10.02) compared to two-level and more than two-level involvement (P=0.036 and 0.001, respectively). The higher Kanofsky score had the longer survival (11months-95%CI, 9.61-12.39) compared with the low and moderate score groups (P<0.001 and 0.012, respectively). Radiation therapy had a survival of 6months (95%CI, 3.41-8.59), significantly longer than the 3months for palliative spine surgery and 2months for palliative treatment alone. CCA resection and palliative spine surgery-when performed together and/or combined with other adjuvant treatment(s)-had a survival time of longer than 9months. In conclusion, CCA with spinal metastases had a poor median survival. A single level of affected spine, a Frankel scale of C or better, a moderate to high Kanofsky score, and radiation therapy were associated with significantly longer median survival. CCA resection and spinal surgery may play an important role in prolonging survival when used in conjunction with other adjuvant treatment modalities.

Morphological Study of Subaxial Cervical Pedicles by Using Three-Dimensional Computed Tomography Reconstruction Image

Malpositioning of cervical screws risks neurovascular injury. A cervical screw fixation system can provide proper rigidity, alignment correction, and high rates of fusion afforded by high pullout biomechanical strength. The objective is to assess the dimensions and axis of the C3–C7 cervical pedicles. A 1-mm slice thickness computed tomography (CT) scan of the cervical spine of 30 patients (15 males, 15 females) were analyzed and reconstructed in three-dimensions using Mimics® 10.01 software. We measured pedicle axis length (PAL), pedicle and lateral mass length (PL-LM), pedicle length (PL), outer pedicle width (OPW), and pedicle transverse angle (PTA) from the axial image and outer pedicle height (OPH) and pedicle sagittal angle (PSA) from the sagittal image. The OPH and OPW at all subaxial cervical spines were suitable for insertion of 3.5 mm cervical pedicle screws. PSA was directed cranially at C3 to C5 (13.84, 7.09, and 2.71) and directed caudally at C6 and C7 (–4.55, –6.94). PTA was greatest at C5 and smallest at C7. The respective difference between the left and right side for nearly all parameters was not statistically significant (except for C6 PL and C7 OPH). Females had a significantly smaller OPH and OPW than males at nearly all levels. The PTA was not significantly different between the sexes. Cervical pedicle screw fixation in the Thai population can be safely performed and guidelines for insertion at each vertebra documented. Appropriate preoperative planning is necessary to achieve safe and accurate placement of the screws.

SAT0476 Efficacy of 14% Plai vs. Placebo Creams for Symptomatic Control of Patients with Knee Osteoarthritis

Background Non-operative treatments for mild to moderate knee osteoarthritic (OA) is recommended. Plai (Zingibercassumunar Roxb.) belongs to the ginger family. It is a Thai herb used in Thai traditional medicine for relieving muscle and joint pain (1–2). Plai has anti-inflammatory activities due to compounds found in its extracts (1–4). These findings suggest that topical plai cream is a potentially useful drug for the treatment of painful OA of the joints. Since there have not been any studies on the efficacy of plai cream alone for relieving symptoms of OA knee joint, we aimed to test its value. Objectives To assess the efficacy of topical plai cream for the treatment of primary osteoarthritis (OA) knee. Methods This was a 9-week (4 weeks treatment + 1 week wash-out + 4 weeks placebo) phase III randomized, double-blind, controlled, cross-over, community trial of Plai vs. placebo, in adults with OA of the knee. This study aimed to determine whether Plai cream was more effective at reducing pain than a placebo cream, as measured using a visual analog scale (VAS) plus the Western Ontario McMaster (WOMAC) score. Results A total of 120 pairs of subjects were enrolled. The mean different VAS favoring Plai varied between 0.46 and 1.4 (p<0.05). The respective percentage of patients in the Plai group who reached MCII of VAS, WOMAC pain, stiffness and function was 37.9%, 40.10%, 26.45% and 54.58%. The respective percentage of patients in the Plai group who experienced 50% improvement of VAS, WOMAC pain, stiffness and function was 33.33%, 31.77%, 41.66% and 24.68%. The respective number of cases needed to treat to reduce pain of Plai based on MCII and 50% improvement of VAS was 2.63 (95% CI; 2.44, 2.84) and 3 (95% CI; 2.75, 3.29). Four cases in the Plai group had a mild skin reaction. Conclusions This cross-over, randomized, controlled, communit, trial demonstrated that Plai cream is an effective topical agent for relieving the symptoms of mild to moderate OA knee. References Panthong A, Kanjanaponthi D, Niwatananun V, Tuntiwachwuttikul P, Reutrakul V. Anti-inflammatory activity of compounds isolated from Zingiber cassumunar. Planta Med. 1990;56:655. Han AR, Kim MS, Jeong YH, Lee SK, Seo EK. Cyclooxygenase-2 inhibitory phenylbutenoids from the rhizomes of Zingiber cassumunar. Chem Pharm Bull (Tokyo). 2005;53(11):1466–8. Chaiwongsa R OS, Tangyuenyong S, Kongtawelert P, Panthong A, Reutrakul V. Chondroprotective potential of bioactive compounds of Zingiber cassumunar Roxb. Against cytokine-induced cartilage degeneration in explant culture. J Med Plants Res. 2012;6 (39):5204–13. Leelarungravub D SM. Potential antioxidant and anti-inflammatory activity of Thai plai (Zingiber cassumunar Roxb.) essential oil. International Journal of Essential Oil Therapeutics. 2009;3(1):25–30. Disclosure of Interest None declared