• Title/Summary/Keyword: Failed primary treatment

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Spinal Dural Arteriovenous Fistulas : Clinical Experience with Endovascular Treatment as a Primary Therapeutic Modality

  • Park, Sung-Bae;Han, Moon-Hee;Jahng, Tae-Ahn;Kwon, Bae-Ju;Chung, Chun-Kee
    • Journal of Korean Neurosurgical Society
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    • v.44 no.6
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    • pp.364-369
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    • 2008
  • Objective : The aim of this study was to evaluate the efficacy of endovascular therapy as a primary treatment for spinal dural arteriovenous fistula (DAVF). Methods : The authors reviewed 18 patients with spinal DAVFs for whom endovascular therapy was considered as an initial treatment at a single institute between 1993 and 2006. NBCA embolization was considered the primary treatment of choice, with surgery reserved for patients in whom endovascular treatment failed. Results : Surgery was performed as the primary treatment in one patient because the anterior spinal artery originated from the same arterial pedicle as the artery feeding the fistula. Embolization was used as the primary treatment modality in 17 patients. with an initial success rate of 82.4%. Two patients with incomplete embolization had to undergo surgery. One patient underwent multiple embolizations, which failed to completely occlude the fistula but relieved the patient's symptoms. Spinal DAVF recurred in two patients (one collateral development and one recanalization) during the follow-up period. The collateral development was obliterated by repeated embolization, but the patient with recanalization refused further treatment. The overall clinical status improved in 15 patients (83.3%) during the follow-up period. Conclusion : Endovascular therapy can be successfully used as a primary treatment for the majority of patients with spinal DAVFs. Although it is difficult to perform in some patients, endovascular embolization should be the primary treatment of choice for spinal DAVF.

Primary Arthroplasty for Unstable and Failed Intertrochanteric Fractures: Role of Multi-Planar Trochanteric Wiring Technique

  • Javahir A. Pachore;Vikram Indrajit Shah;Sachin Upadhyay;Shrikunj Babulal Patel
    • Hip & pelvis
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    • v.35 no.2
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    • pp.108-121
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    • 2023
  • Purpose: The primary objective of the current study is to demonstrate the trochanteric wiring technique. A secondary objective is to evaluate the clinico-radiological outcomes of use of the wiring technique during primary arthroplasty for treatment of unstable and failed intertrochanteric fractures. Materials and Methods: A prospective study including follow-up of 127 patients with unstable and failed intertrochanteric fractures who underwent primary hip arthroplasty using novel multi-planar trochanteric wiring was conducted. The average follow-up period was 17.8±4.7 months. Clinical assessment was performed using the Harris hip score (HHS). Radiographic evaluation was performed for assessment of union of the trochanter and any mechanical failure. P<0.05 was considered statistically significant. Results: At the latest follow-up, the mean HHS showed significant improvement from 79.9±1.8 (at three months) to 91.6±5.1 (P<0.05). In addition, no significant difference in the HHS was observed between male and female patients (P=0.29) and between fresh and failed intertrochanteric fractures (P=0.08). Union was achieved in all cases of fractured trochanter, except one. Wire breakage was observed in three patients. There were five cases of limb length discrepancy, three cases of lurch, and three cases of wire-related bursitis. There were no cases of dislocation or infection. Radiographs showed stable prosthesis in situ with no evidence of subsidence. Conclusion: Use of the proposed wiring technique was helpful in restoring the abductor level arm and multi-planar stability, which enabled better rehabilitation and resulted in excellent clinical and radiological outcomes with minimal risk of mechanical failure.

If the Patient Complains Persistent Pain after the Operation, What Should We Do? (거골 골연골병변: 수술 후 지속적인 통증을 호소하는 경우 무엇을 해줄 수 있나?)

  • Lee, Hyeon;Sung, Ki-Sun
    • Journal of Korean Foot and Ankle Society
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    • v.24 no.2
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    • pp.69-74
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    • 2020
  • Osteochondral lesions of the talus (OLT) can heal and remain asymptomatic, or they can progress to deep ankle pain on weight bearing and the formation of subchondral cysts. Treatment varies from nonoperative treatment to open and arthroscopic procedures. Operative procedures include marrow stimulation techniques (abrasion chondroplasty, multiple drilling, microfracture), osteochondral autografts or allografts, and autologous chondrocyte implantation. Among these treatments, arthroscopic marrow stimulation techniques have been the preferred initial surgical treatment for most OLT. Despite these treatments, many patients complain of persistent pain even after surgery, and many surgeons face the challenge of determining a second line of treatments. This requires a thorough re-evaluation of the patient's symptoms as well as radiological measures. If the primary surgical treatment has failed, multiple operative treatments are available, and relatively more invasive methods can be administered. On the other hand, it is inappropriate to draw a firm conclusion in which methods are superior.

Radiation Therapy for Brain Metastases (전이성 뇌종양의 방사선치료 성적)

  • Kim, Il-Han;Park, Charn-Il
    • Radiation Oncology Journal
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    • v.2 no.1
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    • pp.33-39
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    • 1984
  • One hundred and twenty patients with brain metastases were seen and evaluated in the Dept. of Therapeutic Radiology, Seoul National University Hospital between 1979 and 1983. Of these, 90 Patients received whole brain irradiation with 2,000 ra4 in 1 week or 3,000 rad in 2 weeks for Palliative Purpose and 30 patients failed to complete the planned treatment. Carcinoma of the lung(44 cases), choriocarcinoma(11 cases), breast(8 cases) were common Primary tumors of 90 patients receiving planned treatment. Symptomatic subjective response was obtained in $92\%$ of Patients and meurologic functional improvement was obtained in $42\%$ of patients. Median survival was 6.4 months in patients with complete treatment an·d less than 2 months in Patients with incomplete treatment, overall survival rate at 1 year and 2 year were $26\%,\;16\%$ in Patients with complete treatment and $8\%,\;0\%$ in patients with incomplete treatment. Primary site, extent of metastases and interval from diagnosis of primary tumor to brain metastases were identified as prognostic factors.

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Chemically Enhanced Primary Treatment at D Wastewater Treatment Plant (화학적 처리에 의한 1차 하수처리장의 처리효과 개선 -현장시험을 중심으로-)

  • Kwak, Jong W.;Kim, Seung H.;Lee, Chan W.
    • Journal of Korean Society of Water and Wastewater
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    • v.11 no.1
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    • pp.99-108
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    • 1997
  • This study examined the feasbility of upgrading D waste water treatment plant which treats incoming wastewater by primary sedimentation only. By adding 20-40 ppm of Hi-PAX into the outlet of the aerated grit chamber, BOD and SS removal efficiences were improved from 29% and 36% to 53 % and 73%,respectively. However, chemically enhanced primary treatment failed to meet the upcoming wastewater quality standard(BOD and SS <20 mg/l) consistently. This was suspected to result from the deteriorated plant return stream. The wastewater treatment by chemical treatment should have increased the amount of the sludge to be removed as the sludge production was increased. Chemically enhanced primary treatment is anticipated to consistently produce effluent of the 1996 standards quality by adjusting the amount of the sludge to be removed. Besides BOD and SS removal, chemically enhanced primary treatment resulted in the improved T-P removal from 30% to 64-74%. However, such benefit was not observed in T-N removal. Improved T-P removal will be expected to help control water pollution in Masan bay.

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Autologous Osteochondral Transplantation as a Secondary Procedure after Failed Microfracture for Osteochondral Lesion of Talus (거골 골연골 병변에 대한 미세골절술 실패 후 2차 치료로서 자가 골연골 이식술)

  • Bae, Su-Young
    • Journal of Korean Foot and Ankle Society
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    • v.19 no.2
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    • pp.47-50
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    • 2015
  • Microfracture procedure has been widely recognized as the primary surgical treatment for an osteochondral lesion of the talus. However, if symptoms persist after initial surgery, selection of a secondary procedure can be difficult. The author desciribes the advantage and value of autologous osteochondral transplantation as a secondary procedure after failed microfracture for osteochondral lesion with a review of sevral previous published articles.

Decannulation Difficult (기관 캐뉼 발거 곤란증)

  • 봉정표;임구일;유기원;이준규;박성원;홍기수
    • Korean Journal of Bronchoesophagology
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    • v.4 no.2
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    • pp.165-170
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    • 1998
  • Background and Objectives : Decannulation failure may result from factors such as inadequate ability 0 clear secretion, mucosal induration, granulation tissue, restenosis, tracheal wall depression and vocal cord palsy. We were to evaluate the effectiveness of surgical treatment on the basis of site and type of stenosis. Materials and Method : A series of 44 cases of decannulation difficulty between 1993 and 1997 were reviewed. The following data were collected on each of these patients : primary disease, indication for tracheostomy, site of stenosis, endoscopic findings of stenosis, surgical techniques used for treatment. Results : Primary diseases were 30 head trauma, 4 neck injury, 10 other diseases. Indication for tracheostomy were 37 prolonged intubation, 4 emergency tracheostomy, 3 laryngeal trauma. Endoscopic findings of stenosis were 24 granulation tissue, 16 laryngotracheal collapse, 4 combined with granulation tissue and collapse. Site of stenosis were 3 glottic, 9 subglottic, 24 stomal, 1 substomal, 7 mixed. 22 of 24 cases were decannulation using endoscopic treatment. Conclusion : The most common cause of failed decannulation was sternal granulation tissue. The most effective treatment of granulation tissue was endoscopic technique.

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Redomicrofracture as a Treatment for Osteochondral Lesion of Talus after the Failure of Arthroscopic Microfracture (관절경적 미세골절술이 실패한 거골의 골연골 병변에 대한 치료로서의 재차 미세골절술)

  • Choi, Woo Jin;Park, Kwang Hwan;Lee, Moses;Chung, Kwangho;Lee, Jin Woo
    • Journal of Korean Foot and Ankle Society
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    • v.19 no.2
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    • pp.43-46
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    • 2015
  • Arthroscopic treatment has been reported to provide effective improvement of ankle function when used in treatment of small osteochondral lesion of talus; however, favorable long-term results have been less predictable for large osteochondral lesion of talus. In cases in which primary arthroscopic treatment fails, the decision regarding which subsequent technique to choose has become increasingly difficult, as good clinical outcomes may be unlikely for such patients irrespective of the surgical technique used. Redomicrofracture should be used judiciously for treatment of osteochondral lesion of talus in which arthroscopic treatment has failed.

Revision Anterior Cruciate Ligamnet Reconstruction (전방 십자 인대 재재건술)

  • Ahn, Jin-Hwan;Lee, Sang-Hak
    • Journal of the Korean Arthroscopy Society
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    • v.9 no.2
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    • pp.115-122
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    • 2005
  • With the increasing number of primary ACL reconstructions, revision surgery has become more frequent. Despite arthroscopic technique and treatment advancements, the current methods of reconstruction are far from perfect that a significant number of patients have an unsatisfactory. This article discusses the multiple mechanisms of failure of primary intra-articular ACL reconstruction and provides the orthopaedic surgeon with a systematic approach to the evaluation and treatment of failed ACL reconstructions.

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A case report of primary infertility caused by polycystic ovarian syndrome (다낭성난소증후군을 동반한 원발성 불임환자 1례의 임상보고)

  • Shin, Sun-Mi;Lim, Hyun-Jung;Lee, Jung-Eun;Yoo, Dong-Youl
    • Journal of Haehwa Medicine
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    • v.17 no.1
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    • pp.173-180
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    • 2008
  • Purpose : The purpose of this paper is to report the effect of oriental medicine to primary infertility caused by polycystic ovarian syndrome. Methods : The patient in this case, 29 years-old female was treated with oriental treatment for 3 month. Before oriental treatment, she had been diagnosed as primary infertility caused by polycystic ovarian syndrome and treated medication and injection for IUI(intrauterine insemination) in 4 times. But she had failed in gestation. Results : After lasting oriental treatments, she became pregnant. Conclusion : According to this result, we concluded the oriental medicine could improve fertility rate. After this paper, further study and clinical approach based on oriental medicine will be needed about infertility caused by polycystic ovarian syndrome.

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