A retained surgical drain in the operation site is a rare complication that may cause clinical problems and result in medical disputes.The discovery of a retained drain is most often reported after abdominal and pelvis surgery but drain migration in the prevertebral space after anterior cervical spine surgery has not been reported. This paper reports a case of drain retained and migrated into the thorax level following anterior cervical spine surgery with a review of the relevant literature.

PURPOSE: Total knee arthroplasty using the extramedullary technique for alignment has some difficulty for detecting the center of the femoral head intra-operatively. In this study we tried to evaluate the usefulness and accuracy of a newly developed Mechanical Axis Marker that synchronizes the center of the knee joint and femoral head with the mechanical axis for the distal femoral cutting and femoral prosthesis alignment. MATERIALS AND METHODS: Between October 2008 and January 2009, 255 knees in 156 patients underwent total knee arthroplasty. We measured the distance between each centers of the femoral head using the PACS system and we applied the distance to the newly developed Mechanical Axis Marker. Subsequently, we applied the new marker to patients to align the centers of knee, the femoral head and the marker in line with the mechanical axis intra-operatively. The accuracy of the marker was validated with C-arm fluoroscopy pre-operatively in 20 patients. Post-operatively we measured and analyzed the frontal femoral component angle to evaluate the coronal alignment of the femoral implant. The accuracy was rated as excellent when the alignment was <3degrees, as good when the alignment was 3-5degrees, and as poor when the alignment was >5degrees. RESULTS: The pre-operative validation study with the C-arm fluoroscopy showed that the distance between the femoral head center and the metal peg of the marker was within 5 mm in 95% of the patients, which implied acceptable accuracy. The average frontal femoral component angle against the mechanical axis was 89.0degrees+/-1.1 (range 86degrees-96.6degrees). The proportion of excellent, good, and poor alignments was 90.6% (231 cases), 8.6% (22 cases), and 0.8% (2 cases), respectively. The intraclass correlation coefficient between the two observers for the frontal femoral component angle was 0.972 which showed high concordance. CONCLUSION: Our results indicate that the extramedullary technique assisted by our new Mechanical Axis Marker can easily identify the center of femoral head and improve the accuracy of frontal femoral component alignment with the proper mechanical axis.
Arthroplasty ; Axis, Cervical Vertebra ; Fluoroscopy ; Head ; Humans ; Knee ; Knee Joint ; Prostheses and Implants

PURPOSE: Partial nephrectomy has a similar oncologic outcome to radical nephrectomy while reducing cardiac and metabolic morbidity. However, previous studies reported that partial nephrectomy had been underutilized. The purpose of this study is to analyze trends in the use of partial nephrectomy in Korea and evaluate which individual factors and hospital factor influenced the operative approach. MATERIALS AND METHODS: Using URO-PDS database, 11560 patients underwent nephrectomy for renal cell carcinoma between 2006 and 2010 were identified. International Classification of Disease (ICD-9) diagnosis codes were applied to target subject of interest. Logistic regression was applied to identify determinants of partial nephrectomy. RESULTS: Over the study period, the proportion of partial nephrectomies has steadily increased from 9.4% in 2006 to 30.4% in 2010 (p<0.001). Deviation of utilization in partial nephrectomy has been observed based on the area (p<0.001) and type of surgery (p<0.001). Individual of younger age, as well as male, were more likely to be treated with partial nephrectomy (p<0.001 for each). Furthermore, Patient treated at hospitals with higher nephrectomy volume were more prone to be treated with partial nephrectomy (p<0.001 for each). CONCLUSIONS: Partial nephrectomies have been increasingly performed over the study period but are still underutilized.
Carcinoma, Renal Cell* ; Classification ; Diagnosis ; Humans ; Korea* ; Logistic Models ; Male ; Nephrectomy*

PURPOSE: Current clinical data support a safe warm ischemia time (WIT) limit of 30 minutes during laparoscopic partial nephrectomy (LPN) or robot-assisted partial nephrectomy (RPN). We evaluated independent factors predicting prolonged WIT (more than 30 minutes) after LPN or RPN. MATERIALS AND METHODS: A retrospective data review was performed for 317 consecutive patients who underwent LPN or RPN performed by the same surgeon from October 2007 to May 2013. Patients were divided into two groups: group A was defined as prolonged WIT (> or =30 minutes) and group B as short WIT (<30 minutes). We compared clinical factors between the two groups to evaluate predictors of prolonged WIT. RESULTS: Among 317 consecutive patients, 80 were in the prolonged WIT group. Baseline characteristics were not significantly different between the groups. In the univariable analysis, PADUA (preoperative aspects and dimensions used for an anatomical) score (p=0.001), approach method (transperitoneal or retroperitoneal approach; p<0.001), and surgeon experience (p<0.001) were significantly associated with prolonged WIT. In the multivariable analysis, PADUA score (p=0.032), tumor size (> or =25 mm; odds ratio, 2.98; 95% confidence interval, 1.48-5.96; p=0.002), and surgeon experience (p<0.001) were independent predictors of prolonged WIT. CONCLUSIONS: Surgeon experience, tumor size, and PADUA score predicted prolonged WIT after RPN or LPN. Among these factors, increasing surgical experience with LPN or RPN is the most important factor for preventing prolonged WIT.
Adult ; Aged ; Carcinoma, Renal Cell/pathology/*surgery ; Clinical Competence ; Female ; Humans ; Intraoperative Period ; Kidney Neoplasms/pathology/*surgery ; Laparoscopy/methods ; Male ; Middle Aged ; Nephrectomy/*methods ; Pneumoperitoneum, Artificial/*methods ; Retrospective Studies ; Risk Factors ; Robotic Surgical Procedures/methods ; Warm Ischemia/*methods

PURPOSE: To investigate the differences in the cancer detection rate and pathological findings on a second prostate biopsy according to benign diagnosis, high-grade prostatic intraepithelial neoplasia (HGPIN), and atypical small acinar proliferation (ASAP) on first biopsy. MATERIALS AND METHODS: We retrospectively reviewed the records of 1,323 patients who underwent a second prostate biopsy between March 1995 and November 2012. We divided the patients into three groups according to the pathologic findings on the first biopsy (benign diagnosis, HGPIN, and ASAP). We compared the cancer detection rate and Gleason scores on second biopsy and the unfavorable disease rate after radical prostatectomy among the three groups. RESULTS: A total of 214 patients (16.2%) were diagnosed with prostate cancer on a second biopsy. The rate of cancer detection was 14.6% in the benign diagnosis group, 22.1% in the HGPIN group, and 32.1% in the ASAP group, respectively (p<0.001). When patients were divided into subgroups according to the number of positive cores, the rate of cancer detection was 16.7%, 30.5%, 31.0%, and 36.4% in patients with a single core of HGPIN, more than one core of HGPIN, a single core of ASAP, and more than one core of ASAP, respectively. There were no significant differences in Gleason scores on second biopsy (p=0.324) or in the unfavorable disease rate after radical prostatectomy among the three groups (benign diagnosis vs. HGPIN, p=0.857, and benign diagnosis vs. ASAP, p=0.957, respectively). CONCLUSIONS: Patients with multiple cores of HGPIN or any core number of ASAP on a first biopsy had a significantly higher cancer detection rate on a second biopsy. Repeat biopsy should be considered and not be delayed in those patients.
Aged ; Biopsy, Needle/methods ; Humans ; Kallikreins/blood ; Male ; Middle Aged ; Neoplasm Grading ; Precancerous Conditions/*pathology/surgery ; Predictive Value of Tests ; Prostate-Specific Antigen/blood ; Prostatectomy ; Prostatic Intraepithelial Neoplasia/*pathology/surgery ; Prostatic Neoplasms/*pathology/surgery ; Retrospective Studies

BACKGROUND: Although patients with tuberculous-destroyed lung (TDL) account for a significant proportion of those with chronic airflow obstruction, it is difficult to distinguish patients with airway obstruction due to TDL from patients with pure chronic obstructive pulmonary disease (COPD) on initial presentation with dyspnea. We investigated clinical features differing between (i) patients with TDL and airway obstruction and (ii) those with COPD admitted to the intensive care unit (ICU) due to dyspnea. METHODS: We reviewed the medical records of patients with TDL who had a forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) of <70% on a pulmonary function test (PFT; best value closest to admission) and patients with COPD without a history of pulmonary tuberculosis (TB) who were admitted to the ICU. Ultimately, 16 patients with TDL and 16 with COPD were compared, excluding patients with co-morbidities. RESULTS: The mean ages of the patients with TDL and COPD were 63.7 and 71.2 years, respectively. Mean FVC% (50.4% vs. 71.9%; p<0.01) and mean FEV1% (39.1% vs. 58.4%; p<0.01) were significantly lower in the TDL group than in the COPD group. More frequent consolidation with TB (68.8% vs. 31.3%; p=0.03) and more tracheostomies (50.0% vs. 0.0%; p=0.02) were observed in the TDL than in the COPD group. CONCLUSION: Upon ICU admission, patients with TDL had TB pneumonia more frequently, more diminished PFT results, and more tracheostomies than patients with COPD.
Airway Obstruction ; Dyspnea ; Forced Expiratory Volume ; Humans ; Intensive Care Units ; Lung ; Lung Diseases, Obstructive ; Medical Records ; Pneumonia ; Pulmonary Disease, Chronic Obstructive ; Respiratory Function Tests ; Tracheostomy ; Tuberculosis, Pulmonary ; Vital Capacity

Isolated pancreatic trauma and secondary obstructive jaundice in the pediatric population is unusual. Biliary tract obstruction can be a major cause of acute pancreatitis. We report a case of obstructive jaundice secondary to isolated traumatic acute pancreatitis in a previously healthy 32-month-old girl. In our case, secondary obstructive jaundice aggravated the pancreatic inflammation and was successfully treated with percutaneous transhepatic biliary drainage (PTBD).
Biliary Tract ; Drainage ; Inflammation ; Jaundice, Obstructive ; Pancreatitis ; Preschool Child

Isolated pancreatic trauma and secondary obstructive jaundice in the pediatric population is unusual. Biliary tract obstruction can be a major cause of acute pancreatitis. We report a case of obstructive jaundice secondary to isolated traumatic acute pancreatitis in a previously healthy 32-month-old girl. In our case, secondary obstructive jaundice aggravated the pancreatic inflammation and was successfully treated with percutaneous transhepatic biliary drainage (PTBD).
Biliary Tract ; Drainage ; Inflammation ; Jaundice, Obstructive ; Pancreatitis ; Preschool Child