In the operative treatment of an indirect rupture of tendo calcaneus, we should consider difficult repair and postoperative adhesion with surrounding tissues. In this paper, the new surgical technique for indirectly ruptured tendo calcaneus was introduced and evaluated. From July 1994 to Sep. 1995, we experienced 10 cases of closed rupture of Achilles tendon which was treated with reversed tendon sheath wrapping of juncture site after direct repair. This technique consists of conventional core suture with strong suture material followed by fine tide up sutures around the ragged outer margin of the ruptured end. Then, we made a delicate incision on the synovial sheath of the tendon two inch proximal to the tendon juncture site and elevated it carefully and rolled it back reverse direction to wrap around the juncture site, then hooked it up with the synovial sheath of distal part of ruptured tendon. It was very helpful to prevent adhesion by lowering the endotendon cellular ingrowth between tendon proper and tendon sheath by wrapping the ragged end of rupture site. Their least follow-up period was 12 months. The clinical outcome of the patients was assessed according to the criteria of Hooker, and there were eight cases of excellent (80%), and two cases of satisfactory results. We report good results with the reversed tendon sheath wrapping around juncture site after direct repair of Achilles tendon, as a new technique the treatment of indirectly ruptured tendo calcaneus.
Achilles Tendon ; Calcaneus* ; Follow-Up Studies ; Humans ; Rupture* ; Sutures ; Tendons*

Generally, exposure and the operative technique are common difficulty encountered in the total knee arthroplasty of ankylosed knee due to old infection sequelae. Also the postoperative range of motion and relief of pain is poor due to deformity and excessive soft tissue contracture around knee. There have heen few reports, however, that address the reconstructive challenge of total knee arthroplasty in a previously infected ankylosed knee. We perfoined TKA in thirty six patients who had ankylosed knee between July l986 and Dec. 199S. After follow up of average five years and one month, we analysed the results. The definition of ankylosis was a knee ROM less than 90 degree. Average age of patients were 36.7 years old. Twelve patients were meii and twenty four patients were women. Sixteen patients of partial ankylosis and twenty patients of complete ankylosis were performed operation. There were nineteen cases of healed tubercuiosis knees and seventeen cases of healed pyogenic knees. For the release of soft tissue contracture in 9 cases, we lengthened quadrceps tendon with the method of modified V-Y advancement technique. Patella tendon was proximally reattached with staples and suture in 6 cases and tibial tubercle was proximally transferred in 3 cases. As results, the postoperative average range of motion was 79.3 (30 - l21') in complete ankylosis, 107 (60 - 135 ) in partial ankylosis. The average Hospital for Speciai Surgery knee rating score improved from 56.3 points preoperatively to 84.8 points postoperatively. Radiolucent line was observed in two Knees with less than 2mm width in three years and four months, and four years postoperatively, hut the patient had no pain. In five patients who had poor gain of range of motion after operation, we perfonned arthroscopic adhesiolysis. In conclusion, regarding patient selection, reasonable hony development, relative]y healthy extensor mechanism and adequate soft tissue condition are important for success of TKA in old intection sequelae. TKA of ankylosed knee in old infection sequelae is a successful procedui which can ohtain the restoration of function of the ankylosed knee.
Ankylosis ; Arthroplasty* ; Congenital Abnormalities ; Contracture ; Female ; Follow-Up Studies ; Humans ; Knee* ; Patellar Ligament ; Patient Selection ; Range of Motion, Articular ; Sutures ; Tendons

Thromboembolism is the most common serious complication following total hip arthroplasty and most common cause of death after total hip arthroplasty. A prospective randomized study in 170 cases of elective cementless total hip arthroplasty was carried out to examine the incidence of deep vein thrombosis and pulmonary embolism after cementless total hip arthroplasty from Aug. 1993 to May 1995. Laboratory study, clinical symptoms and signs, chest roentgenograph and precipitating factors were analysed. Venography and lung perfusion scan using radionuclide scan were used for this study. The weight, height, sex, habitus of alcohol and smoking, hypertension, diabetes mellitus, previous operation history of ipsilateral lower extremity, etiology of hip joint disease, and transfusion of blood were not precipitating factors, but the age over 40 and previous history of pulmonary embolism had a significant effect on the incidence of deep vein thrombosis. There was no significant relationship between the incidence of deep vein thrombosis and the laboratory assay, clinical symptoms and signs. Deep vein thrombosis was detected in 29 cases(17.0%), pulmonary embolism in 22 cases(12.9%), and fatal pulmonary embolism in 1 case(0.6%). The most common location of deep vein thrombosis was the popliteal area.
Arthroplasty, Replacement, Hip* ; Cause of Death ; Diabetes Mellitus ; Hip Joint ; Hypertension ; Incidence ; Lower Extremity ; Lung ; Perfusion ; Phlebography ; Precipitating Factors ; Prospective Studies ; Pulmonary Embolism* ; Smoke ; Smoking ; Thorax ; Thromboembolism ; Venous Thrombosis*

A 78-year-old female patient was initially treated with laparoscopic radical cholecystectomy for gallbladder cancer (pT2aN1M0, stage IIIB). The patient then received adjuvant chemotherapy with gemcitabine. After completion of adjuvant chemotherapy, multiple lymph node metastases were observed in follow-up computed tomography (CT) scan, but the patient refused to go through further chemotherapy. One year after the recurrence, carbohydrate antigen 19-9 (CA19-9) level was 1,925 U/mL with follow-up high-resolution CT/abdomen-pelvic CT showing the increased size of multiple lymph node metastases, and the patient began to undergo Viscum album therapy (0.2 mg, subcutaneously, three times a week). After the V. album therapy was initiated, a decrease in the size of metastatic lymph nodes and CA19-9 level, which was decreased to 252 U/mL, was observed. Seventeen months after continuous V. album therapy, the patient agreed to have palliative chemotherapy. The patient underwent gemcitabine plus cisplatin chemotherapy and showed stable disease during follow-up. This case report suggests that V. album therapy showed anticancer effects and may act as a bridge to palliative chemotherapy for patients with inappropriate general conditions to undergo chemotherapy for recurrent gallbladder cancer.

PURPOSE: To analyze the clinical results of treatment for infected TKA and find a reasonable method of treatment. MATERIALS AND METHODS: Between March 1988 and August 1997, 34 patients with infection after total knee arthroplasty were treated at Kyung Hee University Hospital. The average follow-up period was 4 year 8 months. At-the time of infection management, the average age was 59 years (range, 20 to 79 years); there were 31 women and three men. Infected patients were managed with several methods. Twenty patients were treated with one-stage or two-stage reimplantation, and arthrodesis was done in 12 cases. Two cases were treated conservatively. We assessed knee function before and after revision, according to the knee rating system of The Hospital for Special Surgery. RESULTS: Prior to revision operation, the average knee score in 20 reimplantation cases was 52 points, and the average range of motion was 76. After revision, the average knee score was 84 points, and the average range of motion was 90. All patients had complete union at an average 5.3 months after arthrodesis. There were no recurrences of infection after one-stage or two-stage reimplantation, or fusion. CONCLUSIONS: Thoughtful method of treatment should be decided in managing infected total knee arthroplasty.
Arthrodesis ; Arthroplasty* ; Female ; Follow-Up Studies ; Humans ; Knee* ; Male ; Range of Motion, Articular ; Recurrence ; Replantation

PURPOSE: To evaluate the clinical and radiological results of periprosthetic fracture treatments following total knee arthroplasty (TKA) . MATERIALS AND METHODS: Between Jan. 1991 and Jun. 1998, 16 knees in 15 patients were treated for periprosthetic fractures following TKA. Average age of the patients were 56 years (26-69 years) , and 14 patients were women and one was a man. The average follow-up period after fracture was 2 years 5 months (1 year - 8 years 2 months) . We analyzed clinical results according to the knee rating score of Hospital for Special Surgery (HSS) , bony union time and femorotibial angle. RESULTS: Among 980 knees in 633 patients with primary total knee arthroplasty, 16 knees in 15 patients developed periprosthetic fractures. The incidence was 1.6%. Three knees were treated with closed reduction and cast immobilization, seven knees were treated with Ender nailing, and six knees were treated with open reduction and internal fixation. Range of motion was 113 degrees on an average before fracture and 94 degrees at the last follow up, and HSS knee rating score averaged 88 points before fracture and 83 points at the last follow up. Radiologically, 15 knees had complete union and one knee had nonunion. CONCLUSION: The authors think that conservative management was not effective due to prolonged immobilization and late start of ROM exercise. Open reduction with internal fixations provided a better reduction of the fracture, preserving the alignment of fragment and restoring function. Also, Ender nailing was an alternative option of treatment considering less morbidity and satisfactory functional results.
Arthroplasty ; Female ; Follow-Up Studies ; Humans ; Immobilization ; Incidence ; Knee ; Periprosthetic Fractures* ; Range of Motion, Articular

This study shows a case of neoadjuvant chemotherapy application for the management of a 34-year-old male patient diagnosed with invasive intraductal papillary mucinous neoplasm (IPMN), for which curative margin-negative resection initially seemed challenging. Five cycles of the FOLFIRINOX regimen (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) were administered preoperatively, resulting in a significant reduction of the intraductal mass size and deformity of the main vessels. The patient subsequently underwent a successful robotic pylorus-preserving pancreatoduodenectomy. Postoperatively, the patient received adjuvant chemotherapy with FOLFIRINOX, and after 5 months, showed no signs of tumor recurrence or specific complications. These findings suggest that neoadjuvant therapy can be a potentially effective strategy even in advanced invasive IPMN. Further research is necessary to establish guidelines for its application.

BACKGROUND: Although there have been many studies on the risk factors for coronary artery disease, the etiology and risk factor of coronary artery spasm has not yet been determined. The objective of this study was to examine the risk factors for coronary vasospasm through a comparison of patients with angiographically determined vasospastic angina and patients without vasospasm and normal coronary artery. METHODS: Intracoronary injection of acetylcholine in order (20microg, 50microg, 100microg) were administered to all patients (Total 81:34 males, 47 females : mean age 50 years) who had a history of chest pain with normal or near normal coronary arteriographic fingings. After documentation of vasospasm in major epicardial coronary arteries by acetylcholine (Ach)-provocated dcoronary angiography, various risk factors (smoking, hypertension, diabetes, drinking and hyperlipidemia) were compared between patients with vasospasm and patients without vaspasm. RESULTS: 24 patients showed significant luminal narrowing (> or =75%)(Vasospasm group) and 57 patients showed no significant change (Control). Vasospasm group were suffered from typical chest pain in 92% of patients but control complained typical chest pain in 51% of subjects. The sites of vasoconstriction induced by Ach were LAD (11 cases), LCX (4 cases), RCA (11 cases) and vasoconstriction occurred 2 vessels (LAD and LCx) at the same time in two cases. The amount of Ach to provocate vasoconstriction was 20~50microg (90%) and there were no difference between left and right coronary arteries. The ratio of smoker was more frequent in the vasospasm group than control (58.3% vs 30.4%, p=0.046). But total cholesterol, low density lipoprotein, high density lipoprotein, triglycerides, apolipoprotein A, apolipoprotein B, lipoprotein (a), diabetes and body mass index, drinking were not statistically significant between two groups. CONCLUSION: Smoking appears to be a major risk factor for vasospastic angina by endotheilal dysfunction without significant coronary artery narrowing. But other fisk for coronary artery disease may not contribute to coronary vasospasm.
Acetylcholine* ; Angiography ; Apolipoproteins ; Body Mass Index ; Chest Pain ; Cholesterol ; Coronary Artery Disease ; Coronary Vasospasm ; Coronary Vessels* ; Drinking ; Female ; Humans ; Hypertension ; Lipoprotein(a) ; Lipoproteins ; Male ; Phenobarbital ; Risk Factors* ; Smoke ; Smoking ; Spasm* ; Triglycerides ; Vasoconstriction

PURPOSE: To analyze functional gains after TKA in patients with hemophilic arthropathy. MATERIALS AND METHODS: From January 1989 to December 1996, 16 total knee replacements were performed in 11 patients with hemophilia. The average age at operation was 30 years and nine months. The average follow-up period was 3.2 years (range, 1 to 7 years). There were 14 knees of hemophilia A and 2 knees of hemophilia B. Preoperatively, all patients complained of severe pain and had marked knee joint deformity of grade IV or V by Arnold and Hilgartner classification. The knee rating scale of Hospital for Special Surgery was used for clinical assessment. RESULTS: The average preoperative range of motion was 87.9 degrees (range, 25-125 degrees) and 94 degrees (range, 70-125 degrees) postoperatively. The average flexion contracture was 20.7 degrees (range, 0-40 degrees) preoperatively and 4.7 degrees (range, 0-15 degrees) postoperatively. The knee rating scale improved from 44.3 points (range, 40-76) to 88.8 points (range, 81-97). There was one case of superficial necrosis of skin. CONCLUSIONS: The range of motion was not improved significantly after total knee replacements in hemophilic patients. However, knee pain and bleeding episodes have decreased prominently.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Classification ; Congenital Abnormalities ; Contracture ; Follow-Up Studies ; Hemophilia A ; Hemophilia B ; Hemorrhage ; Humans ; Knee Joint ; Knee* ; Necrosis ; Range of Motion, Articular ; Skin

PURPOSE: To evaluate the clinical and histological results after microfracture surgery for degenerative arthritis of the knee. MATERIAL AND METHOD: Thirty-five patients, who had moderate to severe pain with no improvement after conservative treatment, moderate osteoarthritic change in standing AP radiogram, and no severe angular deformity, underwent microfracture surgery. Their mean age at the time of operation was 56 years (range, 33-75 years) and mean follow-up period was 1 year (range, 6-17 months) . In the 14 cases, 'second-look' arthroscopies and biopsies were performed at 6 months following microfracture for full thickness chondral lesions. At the last follow up clinical results were evaluated with Baumgaertner's scale. The specimens were stained with H-E, Safranin-O, and Masson's trichrome. RESULTS: Most of the patients showed significant improvement clinically. 'Second-look' showed that the chondral defect areas were covered with newly grown grayish white tissues. Histologically, the regenerated tissue appears to be a hybrid of hyaline cartilage and fibrocartilage. There are viable chondrocytes in lacunae with a uniform matrix. CONCLUSION: Microfracture surgery can induce chondral resurfacing for full thickness defects of osteoarthritic knee. However, the exact nature and fate of regenerated cartilagenous tissues need further long term follow-up study.
Arthroscopy ; Biopsy ; Cartilage* ; Chondrocytes ; Congenital Abnormalities ; Fibrocartilage ; Follow-Up Studies ; Humans ; Hyaline Cartilage ; Knee* ; Osteoarthritis* ; Regeneration*