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  1. Yoo Y, Park S, Choi E, Sung SH
    Malays J Pathol, 2021 Dec;43(3):405-411.
    PMID: 34958062
    The preoperative diagnosis of infection during joint arthroplasty is important for clinical management. However, the evaluation of polymorphonuclear leukocytes (PMNs) during frozen section analysis is sometimes difficult due to frozen artifacts. In the present study, we sought to investigate the utility of intraoperative fresh frozen section (FFS) examination for diagnosis of infection and to evaluate whether the neutrophil-specific surface marker CD66b helps to improve the diagnostic accuracy of infection. A consecutive series of 65 original frozen sections at the time of resection arthroplasty was retrospectively reviewed compared with corresponding permanent sections. The presence of PMNs was determined using intraoperative FFS and permanent sections. Furthermore, CD66b staining was performed to identify PMNs clearly. The ratio of male to female patients was 21:42. The mean age was 70 years. Postoperatively, 25 of 65 cases were histologically diagnosed with infection (25/65; 39%). The sensitivity and specificity of intraoperative FFS relative to permanent section histology were 100% (25/25) and 95% (38/40), respectively. Among 40 patients without infection, two showed false-positive results during intraoperative FFS diagnosis (2/40, 5%). In addition, on CD66b staining, six cases (9%) experienced changes in results, which altered the sensitivity and specificity of intraoperative FFS compared with permanent histology only to 87% and 87%, respectively. In conclusion, the diagnostic performance of intraoperative FFS is high and comparable to yields of permanent section histology. Therefore, intraoperative FFS is highly suitable diagnostic method for detection of infection during joint arthroplasty. And CD66b immunostaining facilitates delicate identification of PMNs, especially in equivocal cases.
  2. Kim J, Yun M, Han AH, Pauzi MF, Jeong JH, Yoo Y, et al.
    Reg Anesth Pain Med, 2024 Jul 08;49(7):528-535.
    PMID: 37726196 DOI: 10.1136/rapm-2023-104624
    BACKGROUND: Thoracic sympathetic ganglion block (TSGB) is a procedure to manage sympathetically maintained upper extremity pain (sympathetically maintained pain). To date, only a few studies have evaluated the clinical effectiveness of TSGB in pain medicine. This study investigated (1) the relationship between technical success of TSGB and pain reduction in patients with chronic upper extremity pain and (2) relevant clinical factors for a positive TSGB outcome.

    METHODS: We retrospectively reviewed medical data in 232 patients who received TSGB from 2004 to 2020. Technical success and a positive outcome of TSGB were defined as a temperature increase of ≥1.5°C at 20 min and a pain reduction with ≥2 points on the 11-point Numerical Rating Scale at 2 weeks post-TSGB, respectively. Correlations were assessed using correlation coefficients (R), and multivariable regression model was used to identify factors relevant to TSGB outcomes.

    RESULTS: 207 patients were ultimately analyzed; among them, 115 (55.5%) patients positively responded to TSGB, and 139 (67.1%) achieved technical success after TSGB. No significant relationship existed between the pain reduction and the temperature increase after TSGB (R=0.013, p=0.855). Comorbid diabetes (OR 4.200) and adjuvant intake (OR 3.451) were positively associated, and psychiatric comorbidity (OR 0.327) and pain duration (OR 0.973) were negatively associated with TSGB outcome.

    CONCLUSIONS: We found no significant association between the temperature increase and pain reduction after TSGB. Further studies are warranted to identify significant factors associated with TSGB outcomes in patients with complex regional pain syndrome and neuropathic pain diseases.

  3. Kim J, Rho H, Yoo Y, Cha J, Park S, Kim H, et al.
    Reg Anesth Pain Med, 2025 Feb 17.
    PMID: 39961729 DOI: 10.1136/rapm-2024-106111
    BACKGROUND: Despite the significant role of impaired bone metabolism in complex regional pain syndrome (CRPS), the clinical implications of osteopenia remain a focal point of investigation. We examined the prevalence and risk factors of affected limb osteopenia in CRPS and its association with the response to sympathetic blockade.

    METHODS: 167 patients with CRPS who underwent CT of their affected limbs were retrospectively reviewed. After conducting univariable analyses where regional osteopenia determined by CT was dependent and other clinical factors were independent variables, the first multivariable analysis assessed risk predictors associated with regional osteopenia in CRPS. Next, after conducting univariable analyses where sympathetic block response was dependent and others, including regional osteopenia, were independent variables, the second multivariable model predicted factors associated with the response to sympathetic blockades, followed by receiver operating characteristic curve analysis.

    RESULTS: Among 116 patients, regional osteopenia was identified in 72.2% early (<1 year) and 52.5% persistent CRPS. In the first multivariable analysis adjusted for age, sex, body mass index (BMI), and other variables with p values<0.1 from initial univariable analyses, older age (OR 1.06; 95% CI 1.02 to 1.10) and positive three-phase bone scintigraphy (TPBS) (OR 3.94; 95% CI 1.46 to 10.66) were significantly associated with regional osteopenia. In the second multivariable model adjusted for age, sex, BMI, and other variables with p values<0.1 from univariable analyses, early phase (OR 5.49; 95% CI 1.44 to 20.88), regional osteopenia (OR 5.11; 95% CI 1.49 to 17.53), and positive TPBS (OR 6.30; 95% CI 2.21 to 17.93) were significantly associated with positive responses to sympathetic blockade in CRPS, showing excellent performance characteristics with a predicted probability>0.358 (sensitivity 0.86; specificity 0.76).

    CONCLUSION: Regional osteopenia in the affected limb can anticipate positive responses to sympathetic blockade when combined with TPBS in early CRPS.

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