Removal of a retained acupuncture needle in the paraspinal muscle using a neuronavigator

Navigation-Assisted Bone Grafting for Blowout Fracture

BACKGROUND

Treatment of orbital floor fracture accompanied by extensive bone defect requires orbital floor reconstruction using a bone graft, but graft may deviate into the maxillary sinus when no bone capable of supporting the graft remains around the defect. In such cases, it is necessary to fix the grafted bone to the orbital margin, but the grafted bone placement site is subjectively decided based on inspection through a small incision in many cases, being dependent on the experience of operators, and it has been difficult to accurately determine the placement angle.

METHODS

The authors applied a navigation system in 4 patients with orbital blowout fracture, and evaluated for the exact bone graft placement angle and orbital floor form during surgery.

RESULTS

The bone graft placement angle was evaluated by comparison with a mirror image of the nonaffected side. The angle could be confirmed during surgery, as well as the lateral symmetry of the orbital form. On postoperative computed tomography, the grafted bone was retained at a favorable placement site.

CONCLUSIONS

The navigation system may be useful to support the treatment of orbital blowout fracture, as it facilitates safe dissection around orbital floor bone defects, confirmation of the positional relationship between the bone fragment and orbital tissue and bone graft fixation position, and evaluation of lateral symmetry of the orbital floor form during surgery.

An acupuncture needle remaining in a lung for 17 years: case study and review

The case of a 67-year-old patient with an acupuncture needle remaining in his left lung is described. This foreign body was a remnant of a procedure performed by a doctor 17 years previously for osteoarthritic back pain. On the basis of this case, a review was performed of literature available in the PubMed database dealing with acupuncture needles remaining in a patient's body. A total of 25 articles were found. The articles describe needles found in the bladder, shoulder girdle, spinal cord, right ventricle, L5 nerve root, medulla oblongata, skin, carpal tunnel, nuchal and occipital area, calf and paraspinal muscle. Migration of needle fragments to the liver, pancreas, stomach, colon, breast, kidney, muscles, and spinal cord has been reported in the literature. In cases where patients were operated on, the needles were removed without subsequent complications and the patients recovered fully.

Systematic review of adverse events following acupuncture: the Japanese literature

CONTEXT

Many Japanese cases of adverse events after acupuncture are not listed in medical databases such as Medline. Therefore, they are not easily accessible to researchers outside Japan.

OBJECTIVE

To complement existing reviews of adverse events after acupuncture in the West and to provide more detailed discussion and analysis.

DATA SOURCES

Literature search using 'Igaku Chuo Zasshi (Japana Centra Revuo Medicina) CD-ROM version' covering the period of 1987-1999.

STUDY SELECTION

Case reports of adverse events, which were suspected to be due to acupuncture treatment, were included. Experimental studies, surveys, and news articles were excluded.

DATA EXTRACTION

Two independent reviewers extracted data from located articles in a pre-defined structured way, and assessed likelihood of causality in each individual case.

DATA SYNTHESIS

89 articles which reported 124 cases were located. The most frequent adverse events were: pneumothorax (25 cases), spinal cord injury (18 cases), acute hepatitis B (11 cases), and localized argyria (10 cases). There were two fatalities from infections. Forty-eight events were caused by needle breakage including 26 cases of intentionally embedded needle and 16 cases of accidental breakage. There were also 10 cases of injury from self-treatment.

CONCLUSION

Although it has already been demonstrated that severe adverse events seem to be uncommon in standard practice, many serious cases of negligence have been found in the present review, suggesting that training system for acupuncturists (including medical doctors) should be improved and that unsupervised self-treatment should be discouraged.