Biomedical subjects

H N Shih

Publications and source records attributed to H N Shih.

At least 19 recordsLinked to original sources

PubMed2001

Treatment of giant cell tumor of the distal radius.

The results of surgical treatment of giant cell tumors of the distal radius were reviewed in 12 patients between 1982 and 1995. All 12 patients had Grade III lesions. Six of the 12 patients were treated using intralesional curettage with local excision, and the other six patients underwent en bloc resection with total condyle (four of the six by osteoarticular allograft, and the other two by fibular autograft) reconstruction with the aim of preserving the functional joint. There were no early or late complications such as infection, graft fracture, implant failure, or nonunion. No local tumor recurrence was seen in either group during the average followup of 6 years (range, 3-16 years). The best functional result was seen in the patients treated with intralesional curettage. The functional result of the resection group was good, achieving an average of 69% (range, 56%-83%) of their range of motion and 70% (range, 63%-77%) of their grip strength on the contralateral side. Intralesional excision should not be excluded as a possible treatment of Grade III lesions, although en bloc resection was used more commonly for these lesions because of tumor surgery reasons. Grade III lesions were treated with curettage when the tumor did not invade the wrist, destroy more than 50% of the cortex, or break through the cortex with an extraosseous mass in more than one plane. Reconstruction with osteoarticular allograft after en bloc resection is recommended in this non-weightbearing joint when there is contraindication for curettage of the lesion.

Adolescent↗

PubMed2001

Osteoblastoma of the patella: case report.

A 34-year-old man came to our clinic because of left knee pain and mild swelling. Local tenderness over the peripatellar area was observed during physical examination. The range of motion of the knee was full. The radiographic presentation of the patella revealed an osteolytic lesion with a thin sclerotic rim without evidence of extra-articular involvement. The computed tomography revealed an upper pole intraosseous lesion. Intralesional curettage and allogeneic bone grafting were carried out. The pathologic examination demonstrated primitive osteoblasts, with osteoid features and many giant cells. A diagnosis of the osteoblastoma was made. Following surgery, the patient regained full range of motion and was pain-free. Complete healing of the lesion without evidence of recurrence was noted in follow-up radiographs 2 years postoperatively.

Adult↗

PubMed2000

Pulmonary lymphangitic sarcomatosis from cutaneous angiosarcoma: an unusual presentation of diffuse interstitial lung disease.

Pulmonary lymphangitic sarcomatosis (PLS) is not much recognized clinically although it shows similar pathological patterns and diagnostic features to pulmonary lymphangitic carcinomatosis (PLC). We report a case with hand angiosarcoma whose chest X-ray findings revealed a diffuse interstitial pattern consistent with lymphangitic spreading. The final diagnosis was made by open lung biopsy. The clinical, diagnostic and pathological features of this disease process are reviewed.

Adult↗

PubMed1999

Video-assisted thoracoscopic surgery to the upper thoracic spine.

BACKGROUND: The standard open technique for exposure of the upper thoracic spine, T1-T4, usually requires a difficult thoracotomy. From November 1, 1995 to June 30, 1997, eight patients underwent video-assisted thoracoscopic spinal surgery in our institute to treat their upper thoracic spinal lesions endoscopically. METHODS: A new approach, the so-called "extended manipulating channel method," was used in this series that allows the combined use of video-assisted thoracoscopy and conventional spinal instruments to enter the chest cavity freely for the procedures. Patients' ages ranged from 44 to 89 years (average, 60 years). Definitive diagnoses included two pyogenic spondylitis and six spinal metastases. Five patients presented initially with myelopathy. RESULTS: There were no deaths or neurologic injuries associated with this technique. The mean surgical time was 3.1 h. The mean duration of chest tube retention was 3.3 days. The mean total blood loss was 1,038 ml, and two patients had a blood loss of more than 2,000 ml owing to bleeding from epidural veins or raw osseous surfaces. Complications included one superficial wound infection and one subcutaneous emphysema that resolved spontaneously. In this series, there was no need of conversion to open thoracotomy for the patients. CONCLUSIONS: The thoracoscopy-assisted spinal technique using the extended manipulating channels, usually 2.5-3.5 cm, allows variable instrument angulations for manipulation. The mean surgical time (3.1 h) was considered no longer than for an open technique for the equivalent anterior procedure. Such an approach can achieve less procedure-related trauma and has proved to be a good alternative to other treatment modalities.

Adult↗

PubMed1999

Management of aggressive benign and malignant bone tumors of the shoulder region.

BACKGROUND: The shoulder girdle is one of the most common sites of aggressive malignant and benign bone tumors. Curative resections and sparing of the limb are possible. However, reconstruction methods remain a challenge and the functional results vary. METHODS: Fourteen patients with aggressive benign or malignant bone tumors about the shoulder girdle who were treated with surgical resection with possible need for reconstructions were retrospectively analyzed. There were 8 men and 6 women. Their ages ranged from 15 to 70 years; the mean age at operation was 36 years. Ten patients had malignant bone tumors and four had extensive giant-cell tumors. A variety of reconstructive procedures were performed after resection of the tumors. The choice of procedure depended on the type of resection and the needs of the patients. Supplementary chemotherapy or radiotherapy was undertaken after surgical procedures in 9 patients. RESULTS: The length of follow up ranged from 16 months to 10 years. The functional results were described and graded quantitatively according to the functional rating system of the Musculoskeletal Tumor Society. Overall, 6 patients achieved excellent and good shoulder functions at follow-up examination, while 8 acquired fair or poor functional results. Four patients died from lung metastasis, while 10 survived and are disease free. Resection of the glenoid cavity and the proximal part of the humerus with loss of the abductor mechanism resulted in poor function of the shoulder. CONCLUSION: The choice of treatment options depended upon the staging of tumors, the extent of resection, the needs of individual patients, the preservation and reconstruction of rotator cuff, the experience of surgeons, and the facilities at the hospital. The functional results were related to the area of involvement and the type of resection. The preservation of the abductor mechanism provided good functional results.

Adolescent↗

PubMed1998

Semistructural allografting in bone defects after curettage.

BACKGROUND AND OBJECTIVES: A variety of aggressive benign bone tumors often require wide bone and soft tissue excision for adequate local control, but this creates a large defect and a seriously weakened extremity. Restoration of limb function presents a difficult problem. METHODS: The treatment of 104 patients with space occupying lesions of the long bone were analyzed. Deep-frozen (-70 degrees C) cortical strut allografts with or without allogeneic cancellous bone graft were implanted into the defects after extensive intralesional curettage. Thirty-six patients had fibrous dysplasias, 29 unicameral bone cysts, 22 giant cell tumors, 12 aneurysmal bone cysts, 3 benign fibrous histiocytomas, and 2 ossifying fibromas. Fifty-six patients had pathologic fracture. The average volume after curettage was 210 ml (range 60-460 ml). The average follow-up period was 50 months. RESULTS: At follow-up evaluation, the radiographs demonstrated complete incorporation of the allogeneic implant and new bone formation in the cavity in 83% of the patients (86/104). All fractures healed. There was no local recurrence or fracture of the cortical graft; neither were there other serious complications except one avascular necrosis of the femoral head. Good or excellent functional results were found in 97% (101/104) of the patients. CONCLUSIONS: For large osseous defects, the reconstructive technique using cortical stent allograft provides increased strength, easy fixation, remodeling of the cystic defect, and healing of the fracture and prevents deformity. However, remodeling occurs slowly and may never be complete.

Adolescent↗

PubMed1998

Analysis of techniques for video-assisted thoracoscopic internal fixation of the spine.

Between November 1, 1995, and January 31, 1996, four separate thoracoscopic spinal fixation surgeries were performed via extended manipulating channels using the so-called three-portal technique. The diagnoses included three spinal metastases and one T11 burst fracture. All patients had myelopathy at presentation. Using the three-portal technique, the conventional spinal instruments and fixation devices could be passed freely through the extended manipulating channels (usually 3-4 cm) into the chest cavity and manipulated by techniques similar to those used in standard open procedures. A reduction-fixation spinal plate with variable screw and plate anchoring angles was successfully inserted in the procedures. The total length of the operation ranged from 3.5 to 5 h (average 4.3 h), and the total blood loss was 1000-2500 ml (average 1500 ml). There were no intraoperative deaths, and no patient showed neurological deterioration following the procedures. On the basis of these results, we believe that the combination of video-assisted thoracoscopy and conventional spinal instruments presented in this report would be an ideal method for performing these procedures. Throughout the operation, only one trocar was employed for introducing the thoracoscope. The thoracoports were used temporarily during tumor tissue retrievals. This technique makes thoracoscopy-assisted spinal fixation simple and easy. It allows greater control of intraoperative vessel bleeding and reduces the number of portals required during the procedure (on average to 3). In addition, the technique reduced the amount of endoscopic materials required for the procedure, thus reducing the cost of treatment.

Adult↗

PubMed1998

Excision curettage and allografting of giant cell tumor.

Between 1987 and 1994 we followed 22 patients with giant cell tumors involving the long bones. Their average age was 31 years (range 17-50 years). Five patients had grade II tumors and the other 17 grade III lesions. The average volume of lesions after curettage was 231 ml (range 56-450 ml). All of the patients underwent a modified excisional curettage, and the cavity was filled with deep-frozen allogenic corticocancellous bone graft with supplementary fixation. Two patients developed postoperative complications including a superficial wound infection in one case and a traumatic tibial plateau fracture in one case. The overall outcome was good or excellent in 91% of the patients (i.e., 20/22 cases). There was no degenerative joint arthritis and, surprisingly, no instance of tumor recurrence. Allograft infection and fracture were not present. An allogeneic cortical strut with cancellous bone graft can be used safely and is effective for grafting cavitary lesions created after complete removal of the tumor.

Adolescent↗

PubMed1998

Treatment of fibrous dysplasia involving the proximal femur.

Twenty-two patients with fibrous dysplasia in the femoral neck or trochanteric area were treated with curettage and bone grafting with a sliding hip compression screw and plate. Follow-up ranged from 2 to 6 years (average: 4 years). Fourteen patients had monostotic and 8 had polyostotic disease. Four patients had pathologic fractures. Bone grafting included a deep-frozen allogeneic cortical strut and cancellous bone. After implanting the lag screw and cortical strut, the remaining defect space was filled with iliac bone. Postoperatively, all patients had good bone healing and complete incorporation of the implanted graft. There were no recurrences or complications, and functional results were rated as good and excellent.

Adult↗

PubMed1998

Papillary and follicular thyroid carcinomas with bone metastases: a series of 39 cases during a period of 18 years.

BACKGROUND: Bone metastases can cause death in patients with papillary or follicular thyroid carcinoma. There is, however, limited information about the clinical presentations and prognoses of patients with papillary and follicular thyroid carcinomas with bone metastases in Taiwan. MATERIALS AND METHODS: A series of 39 patients with papillary or follicular thyroid carcinomas with bone metastases treated at our center from 1977 through 1995 was retrospectively reviewed to elucidate the clinical presentations and results of treatment of this disease. RESULTS: The occurrence rate of bone metastasis in papillary and follicular thyroid carcinomas was 4.3%. Of the 39 patients, whose mean age was 57.5 years, 28 (71.8%) had follicular and 11 (28.2%) had papillary carcinomas. Thirty-two patients (82.1%) were female and 7 (17.9%) were male. Twenty-nine patients (74.4%) presented with bone metastases before the thyroid cancers were diagnosed. Bone metastases were detected using radiography in 33 patients and using 131I scans in 28 patients. Thirty-one patients (79.5%) had multiple bone metastases. The spine was the most frequently involved site (53.8%). Three patients were disease-free and 14 patients died during the course of treatment. Using the Kaplan-Meier method, the 5-year survival rate was estimated to be 64.9%. CONCLUSION: Bone metastasis, although rare in patients with papillary carcinoma, was not very uncommon in patients with follicular carcinoma. Bone metastases occurred more often in older patients. Multiple bone metastases were noted more often than single bone metastasis. Most patients had symptoms and signs resulting from metastatic bone lesions. Although multimodality therapy was tried, the prognoses for most patients with bone metastases were poor.

Adenocarcinoma, Follicular↗

PubMed1998

Giant-cell tumor of the patella: report of two cases.

Two patients with giant-cell tumors of the patella are presented in this report. Both patients were young females who were noted to have had nonspecific anterior knee pain and mild swelling of 1 to 12 months' duration prior to admission to our hospital. Local tenderness over the peripatellar area and slight limitation of full flexion were noted during physical examination. The radiographic presentation of each patella appeared as an expansile and lytic lesion with a thin cortex, without evidence of intra-articular involvement. Chest radiography and routine laboratory examination results were normal. After biopsy, intralesional curettage with phenol cauterization and allograft reconstruction was the preferred treatment in these two patients, with both tumors considered to be stage 2 according to Enneking's staging system. Following surgery, range of motion exercise was started after 6 weeks of immobilization with a long leg splint. Both patients regained full range of motion and were pain free. Radiographically, bone remodeling without evidence of recurrence was noted in both patients 2 years postoperatively.

Adolescent↗

PubMed1997

Technique of video-assisted thoracoscopic surgery for the spine: new approach.

Although video-assisted thoracoscopy has only recently been applied to treat a variety of thoracic spine lesions, many problems and difficulties are encountered with this technique owing to limited trocar space and lack of suitable endoscopic instruments. Between November 1995 and March 1996, we practiced a new approach for video-assisted thoracoscopic surgery, the "extended manipulating channel method," for treating 18 patients with thoracic spinal lesions endoscopically. The thoracoscopic portals were made larger (usually 3-4 cm) and placed slightly more posterior than usual, which allows use of a combination of conventional spinal instruments and video-assisted thoracoscopy to enter the chest cavity and be manipulated similar to that with techniques used for standard open surgical procedures. In our series the endoscopic spinal procedures included biopsy only (n = 1), thoracic discectomy (n = 1), multilevel anterior discectomy and fusion (n = 1), corpectomy for decompression (n = 4), decompressions and interbody fusions (n = 10), and internal instrumentations (n = 4). Throughout the operation only one trocar was used for introducing the thoracoscope. There were no intraoperative deaths, and no patients showed neurologic deterioration due to the procedures. We conclude that such a technique makes thoracoscopy-assisted spinal surgery simpler and easier and has proved to be an effective, promising procedure. It does not appear to compromise the therapeutic goals set for the patients. The intraoperative vessel bleeding can be easily controlled, and the number of portals for the procedures can be reduced (on average, three portals are enough). Few endoscopic materials were used with our patients, and thus the total economic cost to the patients was reduced.

Adolescent↗

PubMed1997

Video-assisted thoracoscopic treatment of spinal lesions in the thoracolumbar junction.

BACKGROUND: The endoscopic treatment of spinal lesions in the thoracolumbar junction (T11-L2) poses a great challenge to the surgeon. From November 1, 1995 to December 31, 1996, we successfully used a combination of video-assisted thoracoscopy and conventional spinal instruments to treat 38 patients with anterior spinal lesions. Twelve of them had lesions in the thoracolumbar junction. METHODS: The so-called extended manipulating channel method was used to perform vertebral biopsy, discectomy, decompressive corpectomy, interbody fusions, and/or internal fixations in these patients. The size of the thoracoscopic portals was greater than usual in order to allow conventional spinal instruments and a thoracoscope to enter the chest cavity freely and be manipulated by techniques similar to those used in standard open surgical procedures. In this series, the procedures were performed by using either a three-portal approach (2. 5-3.5 cm) or a modified two-portal technique involving a 5-6 cm larger incision and a small one for introducing the scope. RESULTS: None of the operations resulted in injury to the great vessels, internal organs, or spinal cord. The total time for the operation ranged from 1.5 to 4.5 h (average, 3); and the total blood loss ranged from 50 to 3000 cc (average, 1050). One patient was converted to an open procedure due to severe pleural adhesion. Complications included two instances of transient intercostal neuralgia, one superfical wound infection, and one residual pneumothorax. CONCLUSIONS: The video-assisted technique with the extended manipulating channel method presented in this report simplifies thoracoscopic spinal surgery in the thoracolumbar junction and makes it easier. It avoids division of the diaphragm, removal of the rib, and wide spread of the intercostal space, and it allows greater control of intraoperative vessel bleeding. Using this technique, the number of portals required during the procedure can be reduced. In addition, the technique reduces the endoscopic materials required, thus lowering overall cost. It is an effective and promising approach.

Adult↗

PubMed1997

A rare neurological presentation due to ossification of the posterior longitudinal ligament of the thoracic spine and ankylosing spondylitis: case report.

Ossification of the posterior longitudinal ligament (OPLL) may be associated with certain rheumatic conditions including ankylosing spondylitis (AS), diffuse idiopathic skeletal hyperostosis (DISH) or spondylosis. More than 95% of all OPLL are localized at the cervical spine. Herein, we report a case of OPLL at the thoracic spine in an HLA-B27-positive female patient with ankylosing spondylitis. The patient was presented to use with spastic paraparesis. The imaging studies included plain roentgenograms, tomograms, myelo-CT and magnetic resonance imaging (MRI). A continuous rod-like ossification along the posterior aspects of the fourth to sixth thoracic vertebrae with spinal cord compression was noted. The patient underwent a laminectomy from T4 to T6. At the second year follow-up examination, residual upper back soreness and mild left thigh pain were noted. However, the patient had resumed a full daily schedule and could walk freely without any support.

Female↗

PubMed1997

Tuberculosis of the long bone in children.

From 1985 to 1994, there were 24 cases of long bone solitary tuberculosis. They were 18 boys and 6 girls with an average age of 18 months. All of the patients were treated by open biopsy and curettage and antituberculosis therapy (isoniazid and rifampin) for 6 months. Two patients had incomplete administration of the drug therapy. The lesions were in the metaphysis. Epiphyseal involvement was not significant. The tuberculin skin test was negative in 3 children and the culture was negative in 17 cases. After 2 years and 8 months' followup, there was radiographic evidence of good bone remodeling. Although there uncommonly is not a delay in diagnosis of skeletal tuberculosis despite prolonged symptoms, diagnostic biopsy with curettage of the lesion is indicated for isolated lesions, especially when the diagnosis is in doubt. It is significant that surgical debridement can shorten the duration of antituberculosis therapy and lead to improved results.

Antitubercular Agents↗

PubMed1997

Total knee arthroplasty in a rheumatoid arthritic knee with large geode: a case report.

Geodes (subchondral cysts) are a well-known manifestation of rheumatoid arthritis. Solitary cysts or cysts larger than 2 cm are not generally found in the knee joint of patients with rheumatoid arthritis (RA). We report a case of RA involving both knees with a giant geode over the right proximal tibia. Surgical treatment was performed including synovectomy, cyst enucleation and packing of autogenous bone chips followed by primary total knee arthroplasty. The postsurgical result was excellent with the knee restored to good function and complete healing of the cystic lesion.

Aged↗

PubMed1996

Treatment of the femoral neck amd trochanteric benign lesions.

Thirty-five patients with a benign lesion of the femoral neck or trochanter were treated and seen in followup at the authors' institution from 1988 to 1991. Sixteen men and 19 women between the ages of 18 and 54 years (average, 27 years) were seen at an average followup of 3 years 6 months (range, 2-5 years). Eight patients had aneurysmal bone cyst; 14 had monostotic fibrous dysplasias; 2 had giant cell tumors; and 11 had simple bone cysts. Eleven patients had pathologic fractures. All patients were treated with curettage and bone grafting in conjunction with a sliding hip compression screw and plate. The bone grafting included a combination of a deep frozen allogenic cortical strut with autogenous iliac cancellous bone to fill the remaining defect space after lag screw and cortical strut had been implanted. At followup, all patients had good bony healing and incorporation of the implanted graft. There were no complications and no local recurrences. All of the functional results were excellent.

Adolescent↗

PubMed1996

Fracture of the entire posterior process of talus associated with subtalar dislocation: a case report.

This is a case report of a 52-year-old woman who sustained a medial subtalar dislocation with fracture of the posterior process of the talus in a traffic accident. After closed reduction of the subtalar dislocation, tomography demonstrated that the talus fracture involved the entire posterior process and the posterior portion of the talar body. The fracture of the talus was treated with an open reduction and miniscrew fixation. At follow-up examination 32 months later, the functional and radiographic results were graded as good. The proposed mechanism of this case was a forced plantarflexion and inversion acting simultaneously on the subtalar joint. This was different from an isolated medial subtalar dislocation, which was caused by an inversion.

Biomechanical Phenomena↗