PURPOSE: We intended to investigate the spontaneous healing response of the posterior cruciate liga-ment(PCL) of the knee to the location of injury in a mature rabbit model. MATERIALS AND METHODS: In the group I(30 rabbits), PCLs were transected at femoral insertion site and in the group II(30 rabbits), they were transected at mid-substance. Subsequent changes were investigated by histological examination with Hematoxylin-Eosin(HE) staining, immunohistochemical analysis for growth factors and biomechanical test with Instron machine(model 4206). Sham operation was performed on the contralateral side, which was used as the control. RESULTS: On gross inspection, significant difference was not observed between the two groups but scar tissue was thicker in group II than group I. On histological examination and immuno-his-to-chem-i-cal study, there was no significant differnce too. On tensile stress test with Instron machine, ultimate tensile strength steadily increased with time, but it was significantly lower than control in both groups. The length of healed ligaments also increased with time in both groups. CONCLUSION: The spontaneous healing of the PCL can occur in the mature rabbit, yet there were no significant differences of healing characteristics between group I and II. The healed ligaments were elongated and biomechanical properties were far inferior to those of control. We expect the further study on spontaneous healing of PCL with more researches on the other factors which are not considered in this
Cicatrix ; Exercise Test ; Intercellular Signaling Peptides and Proteins ; Knee ; Ligaments ; Posterior Cruciate Ligament* ; Tensile Strength

A 67-year-old male patient came to the hospital due to lung cancer and mediastinal cystic mass which was suspected to be esophageal duplication cyst. Video-assisted thoracoscopic surgery (VATS) was performed and intra-operative finding suggested it as a cystic mass along the thoracic duct. Thoracic duct was ligated and the cyst was completely resected. A 48-year-old female patient visited the hospital for dysphagia. Mediastinal cystic mass was suspected to be an esophageal duplication cyst. Intraoperative finding suggest a thoracic duct lymphangioma. After thoracic duct ligation, the mass was completely resected with VATS. Postoperative chylothorax did not develop in both cases.
Aged ; Chylothorax ; Deglutition Disorders ; Female ; Humans ; Ligation ; Lung Neoplasms ; Lymphangioma* ; Male ; Mediastinal Cyst ; Middle Aged ; Thoracic Duct* ; Thoracic Surgery, Video-Assisted

BACKGROUND: Robotic surgery is an alternative to minimally invasive surgery. The aim of this study was to report on current trends in robotic thoracic and cardiovascular surgical techniques in Korea. METHODS: Data from the National Evidence-based Healthcare Collaborating Agency (NECA) between January 2006 and June 2012 were used in this study, including a total of 932 cases of robotic surgeries reported to NECA. The annual trends in the case volume, indications for robotic surgery, and distribution by hospitals and surgeons were analyzed in this study. RESULTS: Of the 932 cases, 591 (63%) were thoracic operations and 340 (37%) were cardiac operations. The case number increased explosively in 2007 and 2008. However, the rate of increase regained a steady state after 2011. The main indications for robotic thoracic surgery were pulmonary disease (n=271, 46%), esophageal disease (n=199, 34%), and mediastinal disease (n=117, 20%). The main indications for robotic cardiac surgery were valvular heart disease (n=228, 67%), atrial septal defect (n=79, 23%), and cardiac myxoma (n=27, 8%). Robotic thoracic and cardiovascular surgeries were performed in 19 hospitals. Three large volume hospitals performed 94% of the case volume of robotic cardiac surgery and 74% of robotic thoracic surgery. Centralization of robotic operation was significantly (p<0.0001) more common in cardiac surgery than in thoracic surgery. A total of 39 surgeons performed robotic surgeries. However, only 27% of cardiac surgeons and 23% of thoracic surgeons performed more than 10 cases of robotic surgery. CONCLUSION: Trend analysis of robotic and cardiovascular operations demonstrated a gradual increase in the surgical volume in Korea. Meanwhile, centralization of surgical cases toward specific surgeons in specific hospitals was observed.
Adenosine-5'-(N-ethylcarboxamide) ; Delivery of Health Care ; Esophageal Diseases ; Heart Septal Defects, Atrial ; Heart Valve Diseases ; Korea* ; Lung Diseases ; Mediastinal Diseases ; Myxoma ; Robotics ; Surgical Procedures, Minimally Invasive ; Thoracic Surgery

PURPOSE: To introduce the results of surgical methods in tibial avulsion fracture of the posterior cruciate ligament (PCL) and arthroscopic exam as useful therapeutic one. MATERIALS AND METHODS: 32 cases with tibial avulsion fracture of the PCL were received surgical treatment and followed up at least 12 months. Clinical results were evaluated with IKDC score and posterior laxity test with Telos device. The posterior approach was performed in 31 cases (19 screw fixation, 12 pullout suture) and arthrosco-pic reduction and fixation in one. Since 1995, arthroscopic exam was performed on the beginning of operation in all cases and combined injury was treated simultaneously. RESULTS: The IKDC scores were A (normal) in 8, B (nearly normal) in 21, C (abnormal) in 2, D (severe abnormal) in 1 and two of C and D showed posterior instability. 7 of 17cases from 1995 had a combined injury and all revealed above B. The result of compar-ison of screw fixation and pullout suture technique showed no difference between them. CONCLUSION: The results were favorable regardless of surgical methods and arthroscopy was useful in diagnosis and treatment of combined injury.
Arthroscopy ; Diagnosis ; Posterior Cruciate Ligament* ; Suture Techniques

PURPOSE: The LCS (low contact stress) mobile bearing knee replacement has been used extensively. The purpose of this study was to report at least five-year clinical results of a primary total knee replacement performed with LCS mobile bearing design. MATERIALS AND METHODS: From January 1992 to October 1997, author performed 80 total knee arthroplasties in 59 patients with LCS mobile bearing knee replacement. At the final follow-up, one patient had died, and ten patients had been lost to follow-up. The patients were evaluated with HSS (Hospital for Special Surgery) knee rating system and radiographic analysis. RESULTS: The fifty-six knees in the forty-two patients were examined for final clinical and radiographic analysis at five to ten years. The average active range of knee flexion was from 5 degrees to 112 degrees preoperatively and 0 degrees to 123 degrees at the final follow-up evaluation. The average HSS score was 60.7 points preoperatively and 88.9 points at the final follow-up evaluation. Of the 56 knees, none had a dislocation of the mobile bearing prosthesis, one case had a traumatic periprosthetic fracture and four cases required reoperation, one for infection, one patellar revision for patellar polyethylene breakage, one rotating platform change to thicker one for posterior instability during flexion and one meniscal bearing change for medial meniscal bearing wear. There was no significant progressive periprosthetic osteolysis on follow-up radiographs. CONCLUSION: After five to ten years of follow-up, the LCS knee replacement was found to be performing well, with durable clinical and radiographic results.
Arthroplasty ; Arthroplasty, Replacement, Knee* ; Dislocations ; Follow-Up Studies ; Humans ; Knee ; Lost to Follow-Up ; Osteolysis ; Periprosthetic Fractures ; Polyethylene ; Prostheses and Implants ; Reoperation

PURPOSE: We assessed prospectively the results of acute, isolated, posterior cruciate ligament injuries treated conservatively. MATERIALS AND METHODS: Between August 1999 and December 2001, the study population consited of 11 patients. The patients were treated conservatively and were prescribed full extension long leg splint with posterior tibial support for 6 weeks and then posterior tibial support brace for another 6 weeks. Patients completed a subjective and objective evaluation at 6 weeks, 3 month, 6 month and each year for an average of 17.5 months. RESULTS: Two patients underwent reconstructive surgery because of combined posterolateral rotatory instability. The nine patients were treated conservatively, the mean Orthopadishe Arbeitsguppe Knie score was 93.2 points, International Knee Documentation Committee score in 5 patients was A and 4 patients was B. CONCLUSION: Our study suggests that patients with acute, isolated posterior cruciate ligament injuries treated conservatively may get good clinical results, but we are planning a long term follow-up evaluation to reveal change in laxity, incidence of arthrosis and their correlation.
Braces ; Follow-Up Studies ; Humans ; Incidence ; Knee ; Leg ; Posterior Cruciate Ligament* ; Prospective Studies* ; Splints

PURPOSE: The purpose of this study was to compare the results of posterior cruciate ligament retention and sacrificed total knee arthroplasties with mobile bearing design. MATERIALS AND METHODS: Between January 1992 and October 1997, the study consisted of two types of low contact stress(LCS) implants: a meniscal bearing implant(Group I) that retained the posterior crucaiate ligament(n=31), and a rotating platform implant(Group II) requiring sacrifice of this ligament(n=25). All patients were evaluated with pre-and postoperative range of motion and HSS(Hospital for Special Surgery)knee rating system and radiographic analysis at least five years following the knee replacement. RESULTS: The average active range of knee motion was 4 degrees-113 degrees (Group I), 5 degrees-109 degrees (Group II) preoperatively and 0 degrees-127 degrees (Group I), 0 degrees-118 degrees (Group II) at the final follow-up evaluation. The average HSS score was 61.7(Group I), 56.0(Group II) preoperatively and 90.1(Group I), 88.2(Group II) at the final follow-up evaluation. In group I, one patellar revision for patellar polyethylene breakage and one meniscal bearing change for medial meniscal bearing wear had been performed. In group II, one revision for infection and one rotating platform change had been performed for posterior instability during flexion. we had no dislocation of mobile bearing prosthesis, but 2 cases was required reoperation because of one traumatic periprosthetic fracture(Group 1) and one post. instability(Group 2). There was no significant progressive periprosthetic osteolysis on last follow-up radiographs in both groups. CONCLUSION: After five to ten years of follow-up, we found no signigicant difference between group I and II. However, it might be that subjective symptom is excellent in group I and surgical technique remains an important element of success with mobile bearing implants regardless of posterior cruciate ligament.

BACKGROUND: We present our 12-year experience of pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension. MATERIALS AND METHODS: Between January 1999 and March 2011, 16 patients underwent pulmonary thromboendarterectomy. Eleven patients (69%) were classified as functional class III or IV based on the New York Heart Association (NYHA) classification. Seven patients had a history of inferior vena cava filter insertion, and 5 patients showed coagulation disorders. Pulmonary thromboendarterectomy was performed during total circulatory arrest with deep hypothermia in 14 patients. RESULTS: In-hospital mortality and late death occurred in 2 patients (12.5%) and 1 patient (6.3%), respectively. Extracorporeal membrane oxygenation support was required in 4 patients who developed severe hypoxemia after surgery. Thirteen of the 14 survivors have been followed up for 54 months (range, 2 to 141 months). The pulmonary arterial systolic pressure and cardiothoracic ratio on chest radiography was significantly decreased after surgery (76+/-26 mmHg vs. 41+/-17 mmHg, p=0.001; 55%+/-8% vs. 48%+/-3%, p=0.003). Tricuspid regurgitation was reduced from 2.1+/-1.1 to 0.7+/-0.6 (p=0.007), and the NYHA functional class was also improved to I or II in 13 patients (81%). These symptomatic and hemodynamic improvements maintained during the late follow-up period. CONCLUSION: Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension shows good clinical outcomes with acceptable early and long term mortality.
Anoxia ; Blood Pressure ; Endarterectomy ; Extracorporeal Membrane Oxygenation ; Follow-Up Studies ; Heart ; Hemodynamics ; Hospital Mortality ; Humans ; Hypertension, Pulmonary ; Hypothermia ; New York ; Pulmonary Artery ; Survivors ; Thorax ; Thromboembolism ; Tricuspid Valve ; Tricuspid Valve Insufficiency ; Vena Cava Filters

A 44-year-old pregnant female patient gave stillbirth while being treated for pneumonia. She developed acute respiratory failure, which resulted in mechanical ventilator support. Diagnostic lung biopsy revealed a cryptogenic organizing pneumonia. The patient's condition deteriorated and a venous-venous extracorporeal membrane oxygenation was placed. She was listed for lung transplantation. Because of her worsening condition lung transplantation was performed despite positive cross matching result. She was treated with rituximab, intravenous immunoglobulin, and plasmapheresis and recovered without event. There is no sign of rejection at the time of last follow-up.
Adult ; Biopsy ; Cryptogenic Organizing Pneumonia ; Extracorporeal Membrane Oxygenation ; Female ; Follow-Up Studies ; Histocompatibility Testing ; Humans ; Immunoglobulins ; Lung ; Lung Transplantation* ; Plasmapheresis ; Pneumonia ; Respiratory Insufficiency ; Stillbirth ; Ventilators, Mechanical ; Rituximab

BACKGROUND: We investigated the surgical outcomes of patients who underwent therapeutic surgery for malignant pleural mesothelioma (MPM) at a single center. METHODS: A retrospective review of 21 patients who underwent therapeutic surgery for MPM from January 2001 to June 2015 was conducted to assess their outcomes. The patients' characteristics and postoperative course, including complications, mortality, overall survival, and recurrence-free survival, were analyzed. RESULTS: Of the 21 patients who underwent therapeutic surgery, 15 (71.4%) underwent extrapleural pneumonectomy, 2 pleurectomy (9.5%), and 4 excision (19.1 %). The median age was 57 years (range, 32–79 years) and 15 were men (71.4%). The mean hospital stay was 16 days (range, 1–63 days). Median survival was 14.3 months. The survival rate was 54.2%, 35.6%, and 21.3% at 1, 3, and 5 years, respectively. In patients' postoperative course, heart failure was a major complication, occurring in 3 patients (14.3%). The in-hospital mortality rate was 2 of 21 (9.5%) due to a case of severe pneumonia and a case of acute heart failure. CONCLUSION: A fair 5-year survival rate of 21.3% was observed after surgical treatment. Heart failure was a major complication in our cohort. Various surgical methods can be utilized with MPM, each with its own benefits, taking into consideration the severity of the disease and the comorbidities of the patient. Patients with local recurrence may be candidates for surgical intervention, with possible satisfying results.
Cohort Studies ; Comorbidity ; Heart Failure ; Hospital Mortality ; Humans ; Length of Stay ; Male ; Mesothelioma* ; Mortality ; Pneumonectomy ; Pneumonia ; Recurrence ; Retrospective Studies ; Survival Rate