BACKGROUND: Meniscus tears are commonly associated with anterior cruciate ligament (ACL) ruptures. It is essential to repair meniscal tears as much as possible to prevent early osteoarthritis and to gain additional stability in the knee joint. We evaluated the results of arthroscopic all-inside repair using the Meniscal Viper Repair System (Arthrex) on meniscus tears simultaneously with ACL reconstruction. METHODS: Nineteen out of 22 patients who were treated with arthroscopic all-inside repair using the Meniscal Viper Repair System for meniscus tear associated with ACL rupture were evaluated. ACL reconstructions were performed at the same period. The mean follow-up period was 16.5 months (range, 12 to 24 months). The clinical results of the meniscus repair were evaluated by symptoms (such as catching or locking), tenderness, effusion, range of motion limitation, and the McMurray test. Clinical success was defined by negative results in all five categories. The Hospital for Special Surgery (HSS) score was evaluated. Objective results were evaluated with secondary look arthroscopy or magnetic resonance imaging (MRI). The MRI results were categorized as completely repaired, incompletely repaired, and failure by Henning's classification. The results of second-look arthroscopy were evaluated with the criteria of meniscal healing. RESULTS: The clinical success rate was 95.4% and the HSS scores were 93.9 +/- 5.4 at the final follow-up. According to Henning's classification, 15 out of 18 cases showed complete healing (83.3%) and two cases (11.1%) showed incomplete healing. Seventeen out of 18 cases that underwent second-look arthroscopy showed complete healing (94.4%) according to the criteria of meniscal healing. Only one case showed failure and the failure was due to a re-rupture at the sutured area. Complications of ACL reconstruction or meniscus repair were not present. CONCLUSIONS: The results demonstrate that arthroscopic all-inside repair using the Meniscal Viper Repair System is an effective treatment method when it is performed simultaneously with ACL reconstruction.
Adolescent ; Adult ; Anterior Cruciate Ligament/*injuries/pathology/*surgery ; *Anterior Cruciate Ligament Reconstruction ; Arthroscopy/*methods ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Menisci, Tibial/*injuries/pathology/*surgery ; Middle Aged ; Rupture ; Second-Look Surgery ; Treatment Outcome ; Young Adult

This study is to evaluate thickness of lipid layer, NIBUT (non-invasive tear film break-up time), BUT and Schirmer value according to tearscopic pattern of lipid layer.The subjects are seventy-one eyes from seventy-one people without ocular diseases.The pattern of lipid layer is observed by Tearscope(r) (Keeler, U.K.)and the thickness of lipid layer is measured by interference generated from slit lamp microscope.The thickness of lipid layer, NIBUT and BUT are respectively measured three times and averaged.In the case of the pattern of lipid layer, eighteen eyes have the close meshwork type, twenty-nine eyes have the wave type, fifteen eyes have the amorphous type and nine eyes have the color fringe type.The average value of the thickness of lipid layer, NIBUT, BUT and Schirmer test were respectively 29.3 nm, 25.9 seconds, 12.0 seconds, 18.6 mm for close meshwork;47.2 nm, 33.6 seconds, 12.5 seconds, 16.9 mm for wave;66.2 nm, 39.7 seconds, 14.9 seconds, 18.7 mm for amorphous;and 74.4 nm, 30.9 seconds, 13.9 seconds, 18.9 mm for color fringe.The thickness of lipid layer was different significantly among the patterns.NIBUT showed significant difference between close meshwork and wave, and between close meshwork and amorphous.The Cronbach alpha, reproducibility of the test, is 0.84 in the thickness of lipid layer, 0.64 in NIBUT, 0.76 in BUT and 0.94 in Schirmer test.The reproducibility of the pattern of lipid layer observed by Tearscope(r) is 95.8%.
Tears*

While a sprain of the hamstring muscle is relatively common in athletes or those who participate in physically active sports, a complete rupture of the proximal hamstring is relatively rare. A rupture of the long head of the biceps femoris without rupture of the semimembranosus and semitendinosus muscles has rarely been reported. In this study, we saw relatively favorable outcomes after reattachment with a suture anchor at the ischial tuberosity in two patients who had a rupture of the long head of the biceps femoris.
Athletes ; Head ; Humans ; Muscles ; Rupture* ; Sports ; Sprains and Strains ; Suture Anchors

With the advent of checkpoint inhibitors, it has opened up opportunities for numerous cancer patients. However, as is the case with every treatment, complications need to be weighed. Gastrointestinal adverse effects, such as diarrhea and colitis are well-known complications for checkpoint inhibitors. In severe cases, colitis-induced colonic perforation may occur with an estimation of 1.0% to 1.5% in anti-CTLA-4 antibodies. However, only a handful of cases of such devastating complications have been reported in anti-PD-1 antibodies such as pembrolizumab and nivolumab. We here report a case of intestinal perforation in a patient treated with nivolumab.

With the advent of checkpoint inhibitors, it has opened up opportunities for numerous cancer patients. However, as is the case with every treatment, complications need to be weighed. Gastrointestinal adverse effects, such as diarrhea and colitis are well-known complications for checkpoint inhibitors. In severe cases, colitis-induced colonic perforation may occur with an estimation of 1.0% to 1.5% in anti-CTLA-4 antibodies. However, only a handful of cases of such devastating complications have been reported in anti-PD-1 antibodies such as pembrolizumab and nivolumab. We here report a case of intestinal perforation in a patient treated with nivolumab.

BACKGROUND/AIMS: Currently, a new over-the-scope clip (OTSC) system has been introduced. This system has been used for gastrointestinal perforations and fistulas in other countries. The aim of our study is to examine the therapeutic success rate of endoscopic treatment using the OTSC system in Korea. METHODS: This was a multicenter prospective study. A total of seven endoscopists at seven centers performed this procedure. RESULTS: A total of 19 patients were included, with gastrointestinal leakages from anastomosis sites, fistulas, or esophageal perforations due to Boerhaave’s syndrome. Among these, there were three gastrojejunostomy sites, three esophagojejunostomy sites, four esophagogastrostomy sites, one esophagocolonostomy site, one jejuno-jejunal site, two endoscopic full thickness resection site closures, one Boerhaave’s syndrome, two esophago-bronchial fistulas, one gastrocolonic fistula, and one colonopseudocyst fistula. The size of the leakage ranged from 5 to 30 mm. The median procedure time was 16 min. All cases were technically successful. Complete closure of the leak was achieved in 14 of 19 patients using OTSC alone. CONCLUSIONS: The OTSC system is a safe and effective method for the management of gastrointestinal leakage, especially in cases of anastomotic leakage after surgery.
Anastomotic Leak ; Esophageal Perforation ; Fistula ; Gastric Bypass ; Humans ; Korea ; Methods ; Prospective Studies

Injuries to the gallbladder are found in about only 2% of patients with blunt abdominal trauma, and isolated gallbladder perforation is even less common. The gallbladder is less accessible to trauma because it is partially embedded in the liver, cushioned by the surrounding omentum and bowel, and shielded by the rib cage. It is usually associated with other visceral injuries, especially the liver. The leakage of bile from a ruptured gallbladder may not immediately produce symptoms of peritonitis, making an early diagnosis difficult, and causes delays to treatment. A 47-year-old man presented to our emergency department complaining of diffuse abdominal pain after a pedestrian traffic accident, but his vital signs were stable. In the laboratory tests, his hemoglobin was normal, but his blood chemistry showed mild jaundice (bilirubin 3.6 mg/dl). An abdominal computed tomogram showed pericholecystic and a right paracolic fluid collection, with a collapsed gallbladder. The patient underwent an operation under a diagnosis of hemoperitoneum, and when the peritoneal cavity was entered, the gallbladder was ruptured at the fundus, and about 500 cc of bile had accumulated in the abdominopelvic cavity. The other visceral organs were non-specific. We report a case of an isolated rupture of the gallbladder, with a review of the associated literature.
Abdominal Pain ; Accidents, Traffic ; Bile ; Chemistry ; Diagnosis ; Early Diagnosis ; Emergency Service, Hospital ; Gallbladder* ; Hemoperitoneum ; Humans ; Jaundice ; Liver ; Middle Aged ; Omentum ; Peritoneal Cavity ; Peritonitis ; Ribs ; Rupture ; Vital Signs

PURPOSE: The prognosis of advanced colorectal cancer patients may be different even for the same TNM staging. The characteristic features of tumors, such as tumor budding, tumor nodules, and extracapsular extension (ECE) of lymph nodes, can influence the disease progression and the outcome for patients. Tumor budding occurs what at the invasion front of colorectal adenocarcinomas, tumor cells, singly or in small aggregates, become detached from the neoplastic glands, and it can be divided it into two groups, low grade (0~16 foci in a field) and high grade (17 or more foci in a field). A tumor nodule is histologically identified within the fatty tissue or the detached fatty tissue around the dissected lymph nodes, or is a place picked up as lymph nodes from resected specimens which contain no lymph node components. ECE is defined as a tumor extension beyond the node capsule. The aims of this study were to evaluate the clinical significance of tumor budding, tumor nodules, and ECE of lymph nodes as prognostic factors in Stage III colorectal cancer patients. METHODS: We analyzed the disease-free and overall 5-year survival rates and recurrence rates in 94 Stage-III colorectal cancer patients according to tumor the budding intensity, the tumor nodules, and the lymph node ECE status. RESULTS: Of the entire group, the 5-year disease-free and overall survival rates were 49%, and 50%, respectively. The 5-year disease-free and overall survival rates were higher in the low-grade tumor budding group than in the high-grade group (58% vs 33%, P=0.045, 61% vs 39%, P=0.003). The 5-year disease-free and overall survival rates in patients with tumor nodules were lower than those in patients without one (44% vs 69%, P=0.086, 47% vs 77%, P=0.018). The recurrence rate was also higher in the group with tumor nodules than without one (80% vs 52%, P=0.045). The 5-year disease-free and overall survival rates were higher in the ECE negative group than in the positive one (68% vs 37%, P=0.018, 75% vs 42%, P=0.001). The recurrence rate was also higher in the ECE positive group than in the negative group (78% vs 46%, P=0.008). The existence of ECE and tumor nodule were strongly related to systemic recurrence (P=0.006, P=0.033), but not to the local recurrence (P=0.777, P=0.611). Considering the analysis of the recurrence pattern by N stage classification, there is no statistical difference in the N2 patient group, but there was in the existence of ECE and tumor nodule were strongly related to the systemic recurrence in N1 group (P=0.019, P=0.028). These three factors were scored according to the existence, and the score range was divided into two prognostic groups, high risk group (> or =2) and low risk group (<2). The high risk group was significantly associated with systemic recurrence (P= 0.004) rather than recurrence (P=0.865), and these score value were only significant in the N1 patient group (P=0.007) rather than in the N2 group (P=0.927). The high risk group also showed poor overall survival rate compared with the low risk one in only the N1 group (P=0.002), but nof in the N2 group (P=0.193). On multivariate analysis, UICC stage and ECE were two significant factors for tumor recurrence and the 5-year disease-free survival rate. CONCLUSIONS: These data showed that even if similar lymph node metastasis existed in advanced colorectal cancer patients, there was a different 5-year disease-free survival rate and overall survival rate according to the tumor budding, tumor nodule, and ECE status. On multivariate analysis, UICC stage and ECE were two significant factors for the tumor recurrence and the 5-year disease-free survival rate. Our results suggest that tumor budding, tumor nodule, and ECE of lymph node are excellent parameters to provide a confident prediction of clinical outcome.
Adenocarcinoma ; Adipose Tissue ; Classification ; Colorectal Neoplasms* ; Disease Progression ; Disease-Free Survival ; Humans ; Lymph Nodes* ; Multivariate Analysis ; Neoplasm Metastasis ; Neoplasm Staging ; Prognosis ; Recurrence ; Survival Rate

PURPOSE: Despite the similar lymph node metastasis observed in patients with advanced colorectal cancer (CRC), there was a different clinical outcome. The relationships between tumor-related gene expression and prognostic factors such as tumor budding, tumor nodule and extracapsular extension (ECE) of lymph nodes in patients with CRC remain unclear yet. The purpose of this study was to evaluate the relationship between expression of molecular markers such as vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), matrix metalloproteinases (MMPs) and E-cadherin and the tumor budding, tumor nodule and ECE of lymph nodes in patients with stage III CRC. METHODS: The tissue of 87 patients with stage III CRC were investigated for expressions of molecular markers using immunohistochemical methods. RESULTS: VEGF and MMP-9 expression in tumor tissue were positively associated with the colorectal cancer prognostic factors such as tumor budding, tumor nodule and extracapsular lymph node extension (P<0.05). But, MMP-2, EGF and E-cadherin expression were of no value with regard to them. CONCLUSION: Our results suggest that molecular markers, in particular VEGF and MMP-9, may provide additional prognostic information regarding tumor budding, ECE and tumor nodule.
Cadherins ; Colorectal Neoplasms ; Epidermal Growth Factor ; Gene Expression ; Humans ; Lymph Nodes ; Matrix Metalloproteinases ; Neoplasm Metastasis ; Vascular Endothelial Growth Factor A

STUDY DESIGN: A case report. OBJECTIVES: To report a rare case of epidermoid cyst in the spinal canal. SUMMARY OF LITERATURE REVIEW: Epidermoid cyst in the spinal canal is rare. Idiopathic epidermoid cyst in the spinal canal not associated with a trauma or infection is even rarer. MATERIAL AND METHODS: A 73 year-old female presented with a 1 year history of progressive paresthesia and motor weakness of both lower extremeties. MRI showed a cystic mass on the 7th thoracic canal. We performed total laminectomy at the T6-T8 level. The cystic mass was excised after durotomy using a posterior approach. RESULTS: We confirmed the presence of an epidermoid cyst for histopathology. CONCLUSION: Idiopathic epidermoid cyst in the spine is very rare and requires accurate differential diagnosis. Preoperative MRI scans are necessary to differentiatie epidermoid cysts from other intradural masses. Confirmative diagnosis can be done by histopatholoty.
Diagnosis ; Diagnosis, Differential ; Epidermal Cyst* ; Female ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Paresthesia ; Spinal Canal ; Spine