Percutaneous Cementoplasty For Acetabulum In Patients With Bone Metastasis.

The purpose of this study is to demonstrate the surgical technique and to show the results of percutaneous cementoplasty (PC) for acetabular metastases using lateral approach under regional anesthesia. Forty-two cases underwent PC for acetabular metastases. The PC was performed using spinal anesthesia, lateral approach and fluoroscopic guidance. We assessed visual analogue scale (VAS) and revised musculoskeletal tumor society (MSTS) rating system and maximum standardized uptake value (SUVmax) of the acetabular lesion using F-18-FDG PET/CT before and after the PC. The mean injected volume of polymethylmethacrylamide to the pelvis was 21±11.8 ml. The mean of regional VAS (6.2±1.1 vs. 3.1±2.7, p<0.001), MSTS (10.3±3.9 vs. 18.3±3.2, p<0.001) and local SUVmax (8.6±5.2 vs. 5.7±3.6 , p = 0.012) on PET/CT showed significant reductions after surgery. Twenty-three patients (55%) died of disease at mean 11.8±4.8 months after surgery. PC using lateral approach and regional anesthesia could be a simple and safe surgical method for relieving pain and maintaining skeletal stability against acetabular metastasis.

Development of a heat labile antibiotic eluting 3D printed scaffold for the treatment of osteomyelitis.

In general, osteomyelitis is treated with antibiotics, and in severe cases, the inflammatory bone tissue is removed and substituted with poly (methyl methacrylate) (PMMA) beads containing antibiotics. However, this treatment necessitates re-surgery to remove the inserted PMMA beads. Moreover, rifampicin, a primary heat-sensitive antibiotic used for osteomyelitis, is deemed unsuitable in this strategy. Three-dimensional (3D) printing technology has gained popularity, as it facilitates the production of a patient-customized implantable structure using various biodegradable biomaterials as well as controlling printing temperature. Therefore, in this study, we developed a rifampicin-loaded 3D scaffold for the treatment of osteomyelitis using 3D printing and polycaprolactone (PCL), a biodegradable polymer that can be printed at low temperatures. We successfully fabricated rifampicin-loaded PCL 3D scaffolds connected with all pores using computer-aided design and manufacturing (CAD/CAM) and printed them at a temperature of 60 °C to prevent the loss of the antibacterial activity of rifampicin. The growth inhibitory activity against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus), the representative causative organisms of osteomyelitis, was confirmed. In addition, we optimized the rifampicin-loading capacity that causes no damage to the normal bone tissues in 3D scaffold with toxicity evaluation using human osteoblasts. The rifampicin-releasing 3D scaffold developed herein opens new possibilities of the patient-customized treatment of osteomyelitis.

Outcomes after extracardiac Fontan procedure with a 16-mm polytetrafluoroethylene conduit.

OBJECTIVES: We evaluated the outcomes of patients who underwent extracardiac Fontan circulation procedures (ECFP) and received 16-mm polytetrafluoroethylene conduits. METHODS: From June 1997 to May 2015, among the 408 patients who underwent ECFP, 66 patients (Group S) also received 16-mm polytetrafluoroethylene conduits. To compare this patient cohort with similarly sized patients who received larger conduits, a matched cohort (66 patients, Group L) was selected according to age and body weight. RESULTS: The mean age, body weight and Nakata index at ECFP in Groups S and L were 2.9 ± 1.2 and 3.1 ± 1.2 years (P = 0.243), 13.0 ± 2.4 and 13.0 ± 2.3 kg (P = 0.101), 175.3 ± 59.0 and 236.1 ± 75.1 mm2/m2 (P = 0.005), respectively. The mean follow-up periods for Groups S and L were 7.8 ± 6.0 and 9.1 ± 4.9 years (P = 0.150), respectively. The conduit size of Group L was 19.2 ± 1.4 mm (P < 0.001). There was no significant difference in mortality between the groups (P = 0.109). The freedom from reoperation was 94.0 ± 3.4% in Group S and 79.3 ± 5.7% in Group L after 10 years (P = 0.070). Late-occurring morbidities included protein-losing enteropathy (2 in Group S, 4 in Group L; P = 0.491) and thromboembolism (0 in Group S, 4 in Group L; P = 0.206). There was a significant difference in conduit-related events between the groups (1 in Group S, 5 in Group L; P = 0.031). In a paired cohort from the 2 groups including patients who were followed-up for more than 10 years (15 patients from each group), the body mass index was 51.0 ± 33.2% in Group S and 30.3 ± 34.2% in Group L. The decreases in the conduit cross-sectional areas for the paired patients in Group S (n = 20) and Group L (n = 20) were 14.9 ± 19.7% and 24.5 ± 15.5% (P = 0.076), respectively. Coarse liver parenchyma was detected in 9 of 23 (39.1%) patients from Group S and in 7 of 18 (38.8%) patients from Group L upon ultrasonography. CONCLUSIONS: The 16-mm polytetrafluoroethylene conduit for ECFP showed acceptable outcomes and good haemodynamic status in small-sized patients. According to our results, small patients do not require large conduits to accommodate their growth potential.