CT-guided radiofrequency ablation of osteoid osteoma: established concepts and new ideas

Osteoid osteoma is a painful benign bone tumour of children and young adults with characteristic clinico-radiological features depending upon the location of the lesion. Intraoperative visualisation of the nidus is difficult and therefore curative surgery is often associated with excessive bone removal, significant perioperative morbidity and potential need of bone grafting procedures. With advancement in cross-sectional imaging and radiofrequency ablation (RFA) technology, CT-guided RFA has emerged as the treatment of choice for the osteoid osteoma. This procedure involves accurate cannulation of the nidus and subsequent thermocoagulation-induced necrosis.Multidisciplinary management approach is the standard of care for patients with osteoid osteoma. Appropriate patient selection, identification of imaging pitfalls, pre-anaesthetic evaluation and a protocol-based interventional approach are the cornerstone for a favourable outcome. Comprehensive patient preparation with proper patient position and insulation is important to prevent complications. Use of spinal needle-guided placement of introducer needle, namely, "rail-road technique" is associated with fewer needle trajectory modifications, reduced radiation dose and patient morbidity and less intervention time. Certain other procedural modifications are employed in special situations, for example, intra-articular osteoid osteoma and osteoid osteoma of the subcutaneous bone in order to reduce complications. Treatment follow-up generally includes radiographic assessment and evaluation of pain score. Dynamic contrast-enhanced MRI has been recently found useful for demonstrating post-RFA healing.

The fate of gallstones: traditional practice questioned

AIMS

Gallstones are traditionally handed back to patients as a souvenir of their cholecystectomy. The aim of this study was to review the potential hazards of this practice, the final fate of gallstones and the patients' perception of the risks.

PATIENTS AND METHODS

A total of 86 consecutive patients undergoing cholecystectomy for cholelithiasis were surveyed prospectively. An unrestricted Medline database search was performed to gather pertinent literature.

RESULTS

Of the 86 patients studied, 64% took their gallstones home, out of whom 29% actually handled the stones. In 9%, gallstones were accessible to children. Of all patients surveyed, 19% thought that the stones could be harmful. No patient received any information about the potential risks. Of the study group, 35% had discarded their stones by 6 weeks and 16% were planning to discard them. The rest were unsure or had decided to keep the stones.

CONCLUSIONS

Available literature establishes the presence of viable pathogenic bacteria in gallstones, but their infective potential is unknown. These bacteria are possibly more pathogenic than similar gut flora. This study has shown that gallstones are handled by a significant number of patients and are even accessible to children. The majority of patients do not consider them harmful and no information is provided to them. In this age of increasing health awareness, we recommend that patients taking their gallstones home should be informed of the potential risks.

Conservative management of splenic rupture in a haemophiliac adult

The recognition of the grave risk of overwhelming sepsis in splenectomized individuals has led to the search for alternatives to splenectomy. Conservative management, first tried successfully in children and later extended to adult patients, has become the accepted form of treatment and has also been tried with success in haemophiliac children. The case presented here is important because this is the first report of a successful outcome of non-operative treatment of a ruptured spleen in a haemophiliac adult.