BACKGROUND: The laparoscopic adrenalectomy has become the standard procedure of adrenal surgery owing to its advantage of minimally invasive surgery and to rapid developments in the laparoscopic technique and apparatus. A posterior retroperitoneoscopic adrenalectomy is a new alternative to both the conventional open approach and a transperitoneal laparoscopic adrenalectomy. This technique is known to be technically difficult and is less frequently done than a transperitoneal laparoscopic adrenalectomy. However, recently, a number of acceptable results have been reported for this procedure. GOAL: We report our experience with and the results from 16 cases involving a retroperitoneoscopic adrenalectomy and evaluate the advantages and disadvantages of this technique. MATERIALS AND METHOD: Between November 1996 and November 1997, a total of 16 retroperitoneoscopic adrenalectomies were performed. All 16 cases had unilateral adrenal tumors(size 1.5-6 cm): 8 Conn adenomas, 4 Cushing adenomas, 2 neurogenic tumors, 1 nonfunctioning adenoma, and 1 vascular cyst. The operations were carried out in the prone position in all cases. Three trochars were inserted below the lower posterior costal margin. The balloon dilatation technique with a surgical globe was used to induce pneumoretroperitoneum in the first 10 cases but in the last 6 cases, the cavity was made only by blunt dissection with the scope and laparoscopic dissector. RESULTS: Fourteen adrenalectomies were completed endoscopically. One was converted to an open posterior approach due to severe skin emphysema and the other case was converted to an open anterior approach due to technical difficulty. The average operating time of the completed endoscopic adrenalectomies was 183 minutes (85-315 minutes) and the average time of the last 8 cases was 148 minutes. There was no operative morbidity or mortality. Immediate mobilization and food uptake was possible on the day of the operation in all cases. Postoperative analgesic injection was needed only one time on the day of the operation in 12 cases and was not needed in 2 cases. The average hospital stay was 4 days after the surgery.
Adenoma ; Adrenalectomy* ; Adrenocortical Adenoma ; Dilatation ; Emphysema ; Length of Stay ; Mortality ; Prone Position ; Retropneumoperitoneum ; Skin ; Surgical Procedures, Minimally Invasive

Background: We recently introduced the Barricor (BD, Franklin Lakes, NJ, USA) plasma separation tube, which uses a mechanical separator instead of a gel. We evaluated the effects of using the Barricor tube in a stat (statin) laboratory on the results and turnaround time (TAT) of routine chemical tests. We verified the impact of Barricor tube on reducing TAT and providing results similar to those obtained using serum separator tubes (SSTs). Methods: We collected venous blood samples from 166 outpatients in Barricor tubes and SSTs and measured 28 routine analytes using an AU5800 instrument (Beckman Coulter, Brea, CA, USA). TAT indexes were compared before and after using Barricor tube. Results: Mean percent differences were < 5%, except for alanine aminotransferase , total CO2, high-density lipoprotein, phosphate, total protein, and direct bilirubin. The median TAT decreased from 45 to 38 minutes, and the rate of a TAT > 60 minutes decreased from 7.84% to 2.66%, which was approximately one-third of that for SST. The reduction in TAT was attributable to a decrease in centrifugation time. Incomplete clotting and repeated centrifugation, which occurred frequently when using SST, also decreased after using the Barricor tubes. Conclusions The Barricor tube is an alternative to SST for routine chemical tests in institutions aiming to reduce TAT, with clinically allowable differences in test results.

Purpose: This study morphologically compared and analyzed various measurements from initial radiograph and computed tomography scans of posterior malleolar fractures (PMFs) in tibial spiral fractures and ankle fractures. Materials and Methods: The measurements of PMFs in 31 TSFs and 53 AFs were analyzed. PMFs were classified using Bartoníček’s classification. The initial displacement (ID), cross angle (CA), fragment length ratio (FLR), fragment width ratio (FWR), fragment height ratio (FHR), fragment height (FH), sagittal angle (SA), articular step-off (AS), and inter-fragment distance (IFD) were measured. The presence of intercalary fragments and articular incongruity were identified. Results: Bartoníček types 2 and 3 in the AF group, type 3 in the supination-external rotation (SER) group, type 2 in the pronation-external rotation (PER) group, and type 4 in the TSF group accounted for the largest proportion. In the TSF group, the mean ID, FWR, SA, AS, and IFD were significantly smaller than in the AF group (p<0.001, p=0.003, p<0.001, p<0.001, and p<0.001, respectively). The CA, FLR, FH, and FHR were significantly larger than the AF group (p<0.001, p=0.019, p<0.001, and p<0.001, respectively). Conclusion In TSFs, posterior malleolar fragments tend to have longer anteroposterior lengths and heights, but shorter horizontal lengths than AFs. Most have minimal displacement, congruous joint, and no intercalary fragments. Understanding these morphological differences is necessary for the clinical approach to PMFs in TSFs and AFs.

A 58-year-old male patient with chronic hepatitis B infection and hypertension was referred for the evaluation of a skin rash. The skin biopsy showed multiple hyaline thrombi in small blood vessels, red blood cell extravasation, and epidermal atrophy. The CBC, chemistry, UA, and radiological studies were unremarkable except for elevated AST/ALT on liver function tests. The hepatitis B virus markers were compatible with the diagnosis of acute replicative phase chronic hepatitis B; HBeAg 86,646 cpm (count per minute), anti-HBeAb (-), HBV PCR (Quantitative) >1.10x108 IU/mL, and >640,200,000 copies/mL. Rouleaux formation was seen on the peripheral blood smears. Serum PEP/IEP demonstrated an M-spike (27.53%) in the gamma region and abnormal bowed arcs in IgG, kappa light chain with Cryoglobulin (+), ANCA (+), FANA (-), and rheumatoid factor (-) on the serological test. The percent of plasma cells on the bone marrow biopsy was approximately 15%. Type I cryoglobulinemia is a rare disease that can be associated with hematologic disorders, but smoldering myeloma or/and hepatitis B has not been reported in association with Type I cryoglobulinemia. Here, we report a case of Type I cryoglobulinemia that showed multiple skin ulcers due to vascular occlusion related to the monoclonal cryoglobulin with smoldering myeloma and acutely reactivated chronic hepatitis B.
Antibodies, Antineutrophil Cytoplasmic ; Atrophy ; Biopsy ; Blood Vessels ; Bone Marrow ; Cryoglobulinemia ; Erythrocytes ; Exanthema ; Hepatitis B ; Hepatitis B e Antigens ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Hyalin ; Hypertension ; Immunoglobulin G ; Light ; Liver Function Tests ; Male ; Middle Aged ; Plasma Cells ; Polymerase Chain Reaction ; Rare Diseases ; Rheumatoid Factor ; Serologic Tests ; Skin ; Skin Ulcer

Purpose: This study examined the outcomes of additional medial locking plate fixation and autogenous bone grafting in the treatment of nonunions that occurred after initial fixation for distal femoral fractures using lateral locking plates. Materials and Methods: The study involved eleven patients who initially underwent minimally invasive lateral locking plate fixation for distal femoral fractures between January 2008 and December 2020. The initial procedure was followed by additional medial locking plate fixation and autogenous bone grafting for clinically and radiographically confirmed nonunions, while leaving the stable lateral locking plate in situ. A clinical evaluation of the bone union time, knee joint range of motion, visual analog scale (VAS) pain scores, presence of postoperative complications, and functional evaluations using the lower extremity functional scale (LEFS) were performed. Results: In all cases, bone union was achieved in an average of 6.1 months after the secondary surgery. The range of knee joint motion, weight-bearing ability, and VAS and LEFS scores improved at the final follow-up compared to the preoperative conditions. All patients could walk without walking assistive devices and did not experience pain at the fracture site. On the other hand, three patients complained of pain in the lateral knee joint caused by irritation by the lateral locking plate; hence, lateral hardware removal was performed. One patient complained of mild paresthesia at the anteromedial incision site.Severe complications, such as deep infection or metal failure, were not observed. Conclusion For nonunion with stable lateral locking plates after minimally invasive lateral locking plate fixation of distal femur fractures, additional medial locking plate fixation and autogenous bone grafting, while leaving the lateral locking plate intact, can achieve successful bone union.

Purpose: To describe the clinical outcome of retrobulbar injection of synthetic fillers to correct enophthalmos associated with phthisis bulbi or anophthalmos. Methods: We retrospectively reviewed the medical records of patients who underwent enophthalmos correction using retrobulbar filler injections at Asan Medical Center between January 2015 and October 2019, and who were followed for at least 6 months. We evaluated the number of injections and amount of filler injected, improvement in enophthalmos, interval between injections, and adverse effects of filler injection. Results: The study enrolled five patients (four females and one male). Two patients had anophthalmos after evisceration and three had phthisis bulbi. Two patients received hyaluronic acid (HA) filler only, one had collagen-polymethylmethacrylate (PMMA) filler only, and two had both fillers. The HA and collagen-PMMA filler volumes per injection were 1.0–1.4 and 0.75–1.0 mL, respectively. The average degree of enophthalmos, compared to the contralateral eye, was 1.8 mm; the amount of enophthalmos correction per 1 mL of filler injection was 1.5 mm for HA filler and 1.4 mm for collagen-PMMA filler. The longest duration of enophthalmos correction was 15 months for HA filler and 25 months for collagen-PMMA filler. There were no significant adverse effects, but anterior migration of HA filler was observed in one case that resolved with hyaluronidase injection. Conclusions Retrobulbar filler injection is a safe, effective, minimally invasive procedure for correcting enophthalmos in patients with anophthalmos or phthisis bulbi. If HA filler injection shows good outcomes without adverse effects, semi-permanent fillers can be used for long-term maintenance of enophthalmos correction. Further studies with more patients and long-term follow-up are needed to compare the effectiveness of various fillers.