Eosinophilic Granuloma in a Patient with Marked Improvements of Social Activity as well as Clinical Manifestations

A twenty-year-old male started to have low-back pain. On X-ray survey, unusual shadows of the right humerus and sacrum were found. An open biopsy confirmed a histological diagnosis of eosinophilic granuloma in the 5th lumbal spine and sacrum, followed by the second biopsy of the same diagnosis on the right humerus. A local radiation therapy was performed with 2 Gy for 3 times on the right humerus, along with low-dose continuous cyclophospamide administration for about 17 months. As to pain and performance status (PS) of the patient, there are complete disapperarance of pain and a marked improvement of PS, producing a great success in the therapy and an excellent social life i.e. a good quality of life (QOL) in the present patient

The Usefulness of Ultrasonography as a Guide for the Treatment of Delayed Diagnosed Tendon Injury in a 2-Year-Old Child

In children, flexor pollicis longus (FPL) tendon injuries are uncommon. In delayed diagnosed cases, CT and MRI are hard to perform, even though to confirm the location of the lacerated proximal tendon end is preferable for the planning of operation procedure. In such condition, ultrasonography is suitable because of its characteristic feature of easy-to-perform procedure even in children. In this report, preoperative ultrasonography was practical in the delayed diagnosis of FPL tendon in a 2-year-old child to schedule the primary repair because the precise location of both FPL proximal and distal ends was identified. In addition, routine postoperative ultrasonography was also useful to track its healing process without concern about mutual communication due to the patient’s age, which helped to promote active motion

Management of Intolerance to Casting the Upper Extremities in Claustrophobic Patients

Introduction. Some patients showed unusual responses to the immobilization without any objective findings with casts in upper extremities. We hypothesized their that intolerance with excessive anxiety to casts is due to claustrophobia triggered by cast immobilization. The aim of this study is to analyze the relevance of cast immobilization to the feeling of claustrophobia and discover how to handle them. Methods. There were nine patients who showed the caustrophobic symptoms with their casts. They were assesed whether they were aware of their claustrophobis themselves. Further we investigated the alternative immobilization to casts. Results. Seven out of nine cases that were aware of their claustrophobic tendencies either were given removable splints initially or had the casts converted to removable splints when they exhibited symptoms. The two patients who were unaware of their latent claustrophobic tendencies were identified when they showed similar claustrophobic symptoms to the previous patients soon after short arm cast application. We replaced the casts with removable splints. This resolved the issue in all cases. Conclusions. We should be aware of the claustrophobia if patients showed unusual responses to the immobilization without any objective findings with casts in upper extremities, where removal splint is practical alternative to cast to continue the treatment successfully

Safety and Efficacy of FIT039 for Verruca Vulgaris: A Placebo-Controlled, Phase I/II Randomized Controlled Trial

TRIAL DESIGN: Human papillomavirus infection causes verruca vulgaris. CDK9 inhibitor FIT039 inhibits DNA virus proliferation in animal models. We conducted a multicenter, single-blind, placebo-controlled, randomized phase I/II clinical trial evaluating the safety and efficacy of FIT039 against verruca vulgaris. METHODS: Target lesions were treated with liquid nitrogen once, and a FIT039 patch or placebo patch was applied for 14 days. The primary endpoint was lesion disappearance. The secondary endpoints were safety and changes in dimension, cross-sectional area, and the number of petechial lesions. RESULTS: A total of 24 participants were randomly allocated to the FIT039 (n = 13, median age, 54 years) and placebo (n = 11, median age, 62 years) groups. Verruca vulgaris did not disappear. FIT039 decreased the dimension to 76% of the initial value on day 29, followed by an increase to 98% on day 57. Placebo showed a monotonic increase to 107% on day 57. Changes in the cross-sectional area and petechiae number were comparable between the groups. CONCLUSIONS: No drug-related adverse reactions occurred. FIT039 efficacy was not determined in this study

The Role of Electrophysiological Severity Scales for Decision-making with Regard to Surgery in Idiopathic Carpal Tunnel Syndrome

The distribution of electrophysiological severity of carpal tunnel syndrome (CTS) in an outpatient setting and whether electrophysiological severity could be an objective tool for decision-making regarding choice of surgery were investigated. During conservative treatment, 1079 outpatients with idiopathic CTS were classified according to the electrophysiological severity scale (Stage 1-5). The results were provided to the patients and explained, but they were not indicated a treatment protocol intentionally. We recommended surgery to those outpatients who presented with difficulty in pinching due to severe thenar atrophy and/ or showing poor response to conservative treatment. However, the decision-making of surgical or nonsurgical treatment remained with patients. In the distribution of severity stages, Stage 4 was the most common (34%). Two hands were not classifiable. Surgery was chosen in 443 of 1077 hands (41.1%): The operation selection rate increased with severity of the stage and the patients with Stage 5 showed the greatest preference among Stage 1-5 (p<0.0001). This was shown in both female and male groups in gender analysis, and in both ≤ 69 y.o. and ≥70 y.o. groups in the age analysis. There was no significant difference between female and male hands, and ≤ 69 y.o. and ≥70 y.o. hands. Among varied reasons for the decision-making process for surgical treatment in CTS, electrophysiological severity scale plays an important role as an objective tool without being influenced by subjective elements; gender and age

Recurrence of Enchondroma in a Middle Finger after Curettage and Back-filling with Calcium Phosphate Bone Cement: a Case Report

We report a case of recurrence of enchondroma in a middle finger after curettage and back-filling with calcium phosphate bone cement (CPC). The radiograph showed a lytic lesion around the CPC filling which showed no signs of absorption after 12 years. The tumor was curated easily, however, a steel bar was needed to remove the CPC mass in a carefully manner not to break the cortex. CPC has an advantage of immediate biomechanical stability, on the other hand, a disadvantage of being unabsorbed inside of bone. Although enchondroma has a low recurrence rate after surgery generally, in consideration of recurrence, we recommend the use of absorbable materials when a use of artificial bone substitute to fill the defect is planned

Medial Pelvic Migration of the Lag Screw after Intramedullary Nailing for Trochanteric Femoral Fracture

Internal fixation with intramedullary nails has gained popularity for the treatment of trochanteric femoral fractures, which are common injuries in older individuals. The most common complications are lag screws cut-out from the femoral head and femoral fracture at the distal tip of the nail. Herein, we report a rare complication of postoperative medial pelvic migration of the lag screw with no trauma. The patient was subsequently treated by lag screw removal via laparoscopy. This case suggests that optimal fracture reduction, adequate position of the lag screw, and careful attention to set screw insertion are important to prevent complications. Additionally, laparoscopic surgery might be able to remove the lag screw more safely than removal from the femoral side