Talc sclerodhesis of persistent Morel-Lavallée lesions (posttraumatic pseudocysts): case report of 4 patients.

Large posttraumatic pseudocysts are infamous for their tendency to recur despite repeated aspiration. The standard practice has been repeated extensive surgical debridement. To avoid the need for such treatment, talc was used to sclerose the lesion in 4 patients treated between 2000 and 2003. The patients were between the ages of 20 and 73 and had thigh and buttock pseudocysts that persisted for an average of 3 months. Talc was administered under fluoroscopic guidance and suction drainage (wall suction followed by a bulb vacuum drainage system) was applied for an average of 12 days. The patients were followed for an average period of 27 months after talc sclerodhesis. All persistent pseudocysts showed an immediate cessation of fluid accumulation in the treated space without reccurence. One case which was complicated by infection, had to be treated twice with talc to cease the accumulation. In this case, the infection recurred, although fluid accumulation did not recur. Talc sclerodhesis proved to be a simple and rapid method of treatment in posttraumatic cases classically treated by repeated and aggressive surgical methods.

Assessing the outcomes of spine surgery using global positioning systems.

STUDY DESIGN: Pilot study. OBJECTIVE: To examine whether surgical outcomes can be assessed objectively by advanced tracking technology, based on Global Positioning Systems (GPS). SUMMARY OF BACKGROUND DATA: Outcome studies are the commonest way to assess the results of surgical procedures. The success of these efforts is impeded by a number of factors, including the lack of valid outcome measures, difficulty in assessing changes in patients' expectations (response shift) and confounding effects of secondary gains. METHODS: The measurement of walking speed, distances, and number of walking events per day, claudication index (maximal walking distance), characteristics during motorized trips, and the amount of time spent outdoors were monitored in 2 patients undergoing spine surgery for several weeks using advanced tracking technologies. RESULTS: In 1 patient, all parameters increased progressively from the time of surgery to the end of the recording period. These findings were consistent with her recovery from surgery. In a second patient, tracking showed the patient's difficulty in mobilizing, leading to the diagnosis of another orthopedic problem, and to total hip replacement surgery. CONCLUSION: The technology presented in this pilot appears to be useful in understanding a patient's level and breathe of activity. These data will assist in better understanding the limitations imposed by specific musculoskeletal pathology and in monitoring perioperative function and complications and their related causes. Spatial data may indirectly reflect a patient's social and mental conditions. This interdisciplinary pilot may lead to the development of valid outcome measures for a range of medical conditions. Studies comparing questionnaires to this new outcome measure may shed light on issues like response shifts and secondary gain. Norms and clusters of spatial behaviors in different pathologies may enable better patient selection for medical, mental, and surgical interventions.