BACKGROUND: The Multicenter Orthopaedic Outcomes Network (MOON) group recently reported that medial meniscus (MM) repairs are associated with more frequent re-operations when compared to lateral meniscus (LM) repairs. The purpose of this study was to compare the meniscal healing and the incidence of subsequent re-operation of medial and lateral meniscal tears that occurred concurrently with anterior cruciate ligament (ACL) injuries. METHODS: We retrospectively reviewed patients who underwent second-look arthroscopy after primary ACL reconstruction (ACLR) between June 2005 to December 2016. The healing of meniscal tears following repair or left in situ, and re-tear following partial meniscectomy, were evaluated via second-look arthroscopy and compared between medial and lateral meniscus. Moreover, the incidence of subsequent meniscal re-operation after the index ACLR were investigated and compared between medial and lateral meniscus. Subsequent meniscal re-operation was performed in cases of the following three symptomatic meniscus tears: re-tears at the meniscectomy site; new tears; and failed healing of repaired or left in situ meniscus. RESULTS: There were 148 meniscal tears in 121 patients at index ACLR. There were 62 MM tears, 38 LM tears, and 24 bilateral meniscus tears. At second-look arthroscopy, the “successful healing” rate for tears following repair was higher in LM tears (91.2%) compared to MM tears (80.0%), although it was not statistically significant (p > 0.05). No significant differences were observed in the healing of left in situ tears or re-tear of meniscectomy site between medial and lateral meniscus. Patients with MM tears combined with ACL injuries had a higher incidence of subsequent meniscal re-operation compared to patients with LM tears (25.6% vs 16.1%, p = 0.025). CONCLUSIONS There was a trend for the successful healing rate to be higher in LM repairs than MM repairs. Subsequent meniscal re-operations after ACLR were more frequent in patients with medial meniscal tears concurrently with ACL injuries in comparison to patients with lateral meniscal tears.LEVEL OF STUDY: Level IV, retrospective case series.

Metastatic colorectal cancer is rare and its origins are difficult to define if the gross features of colorectal cancer mimic primary colorectal cancer. However, accurate diagnosis is essential because the treatment and prognosis may vary depending on the origin of the cancer. This report is about a 74-year-old female patient with metastatic sigmoid colon cancer of ovarian origin that mimicked primary sigmoid colon cancer. She spent a 3-year period disease-free from ovarian cancer after surgery and adjuvant chemotherapy. At the time of initial diagnosis, the cancer was diagnosed as a primary sigmoid colon cancer, because the cancer appeared to be a solitary intra-luminal fungating mass. However, the final pathologic result showed that the cancer was metastatic sigmoid colon cancer of ovarian origin and it was confirmed by immunohistochemical staining of cytokeratins-7, -20, and Wilms tumor-1. Therefore, even if colorectal cancer is a single intra-luminal lesion, patients should be suspected of having metastatic colorectal cancer if they have other cancer histories. At this time, immunohistochemical staining using various cancer markers may be a useful tool to distinguish the origin of cancer.
Aged ; Chemotherapy, Adjuvant ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms ; Diagnosis ; Female ; Humans ; Immunohistochemistry ; Neoplasm Metastasis ; Ovarian Neoplasms ; Prognosis ; Sigmoid Neoplasms

BACKGROUND: Patients with decompensated liver cirrhosis usually resulted in admission to the intensive care unit (ICU) during hospitalization. When admitted to the ICU, the mortality was high. The aim of this study is to identify multiple prognostic factors for mortality and to analyze the significance of prognostic survival model with each scoring system in patients with decompensated liver cirrhosis who was admitted to the ICU. METHODS: From January 2008 to December 2008, 60 consecutive patients with decompensated liver cirrhosis were admitted in the ICU and retrospectively reviewed. Prognostic models used were Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), model for end-stage liver disease with incorporation of serum sodium (MELD-Na), acute physiology and chronic health evaluation (APACHE) II, and sequential organ failure assessment (SOFA). The predictive prognosis was analyzed using the area under the receiver's operating characteristics curve (AUC). RESULTS: The median follow up period was 20 months, and ICU mortality was 17% (n = 10). A total of 24 patients (40%) died during the study period. The average survival of five prognostic models was related with the severity of the disease. All of the five systems showed significant differences in the cumulative survival rate, according to the scores on admission, and the MELD-Na had the highest AUC (0.924). Multivariate analysis showed that bilirubin and albumin were significantly related to mortality. CONCLUSIONS: The CPT, MELD, MELD-Na, APACHE II, and SOFA may predict the prognosis of patients with decompensated liver cirrhosis. The MELD-Na could be a better prognostic predictor than other scoring systems.
APACHE ; Area Under Curve ; Bilirubin ; Follow-Up Studies ; Hospitalization ; Humans ; Critical Care ; Intensive Care Units ; Liver ; Liver Cirrhosis ; Liver Diseases ; Multivariate Analysis ; Prognosis ; Retrospective Studies ; Sodium ; Survival Rate

BACKGROUND: We wanted to explore performing hepatic arterial reconstruction in living donor liver transplantation (LDLT) using right lobe liver grafts and cadaveric liver transplantation (CLT) in a single center. METHODS: Thirty five LDLTs were performed from April 2005 to August 2009. The back wall support suture without twisting was used in most cases. A single RHA was anastomosed to the RHA in 24 patients, to the proper HA in 2 patients, to the RAHA in 4 patients, to the LHA in 2 patients and to an aberrant RHA arising from the SMA in 3 patients. The diameter of the donor RHA was between 1.5 mm and 3.0 mm (mean: 2.5 mm). In the 34 patients who underwent CLT, most of the arterial anastomoses were usually performed using two cuffs at the recipient HA and the GDA bifurcation and a branching point on the donor CHA with running and intermittent stay suture. RESULTS: The total incidence of HA complication was 4.34% (3/69): 1 HAT (2.85%) occurred in a case of LDLT and 2 HAS (5.88%) occurred in a case of CLT. HAT occurred in 1 recipient on the 1st day following LDLT and 2 HAS occurred in CLT recipients at one and two months, respectively, following LDLT. CONCLUSIONS: HA complications occurred as a mild type of late complication and these complications might not be fatal in CLT. A low incidence of HAT can be achieved with using non-twisting method-guided microsurgical techniques for creating hepatic arterial anastomosis in LDLT. When early HAT occurs, early surgical reconstruction is mandatory for preventing the loss of the graft. Back wall sutures with only single needle suture might be a feasible method for HA microsurgical reconstruction.
Arterial Occlusive Diseases ; Cadaver ; Hepatic Artery ; Humans ; Incidence ; Liver ; Liver Transplantation ; Living Donors ; Needles ; Running ; Sutures ; Thrombosis ; Tissue Donors ; Transplants

Saphena varix is very rare disease that characterized by isolated distention of the saphenous vein below the sapheno-femoral junction. Saphena varix must be differentiated from other medical problems that can cause a groin mass. A 49-year-old man presented with a palpable mass on the right upper thigh and he'd had the mass for 6 months. There was no history of trauma, and the mass was especially noticeable when he was standing. On the physical examination, a 5 cm-sized soft, nontender, compressible mass was detected at the right upper medial thigh near the femoral foramen. Doppler sonography showed a saccular venous dilatation of the great saphenous vein just below the saphenofemoral junction. On computed tomography, there were superficially dilated veins in the right thigh and calf, a focal saccular aneurysm at the proximal segment of the right greater saphenous vein and no evidence of deep vein thrombosis. Aneurymal excision and stripping of the greater saphenous vein were performed. No complication was observed at the 2 week follow-up.
Aneurysm ; Dilatation ; Follow-Up Studies ; Groin ; Hernia, Femoral ; Humans ; Middle Aged ; Physical Examination ; Rare Diseases ; Saphenous Vein ; Thigh ; Varicose Veins ; Veins ; Venous Thrombosis

Abdominal vascular injury after blunt trauma does not occur very frequently. Penetrating trauma is the most common cause (90%) of abdominal vascular injury. A 57-year-old male presented with abdominal pain and color change of the right lower leg after blunt trauma. The physical examination showed rigid tenderness in the entire abdomen and no pulse in the right femoral artery. Computed Tomography (CT) demonstrated the acute aortic dissection, which extended from the infrarenal aorta to the iliac artery and there was embolic occlusion below the right common iliac artery. He underwent endarterectomy after thrombectomy, fasciotomy and small bowel segmental resection. A 65-year-old male presented with abdominal pain after an auto-bicycle crash. On the physical examination, there was tenderness and rebound tenderness noted on the entire abdomen. The CT done outside our hospital demonstrated an intramural hematoma around the descending aorta. He underwent small bowel and sigmoid segmental resection and S-colostomy. On day 1 after operation, he complained of sudden abdominal pain. He then developed the signs of acute liver and renal failure. His condition deteriorated rapidly with conservative management, and he died on day 2.
Abdomen ; Abdominal Pain ; Aged ; Aorta ; Aorta, Thoracic ; Colon, Sigmoid ; Endarterectomy ; Femoral Artery ; Hematoma ; Humans ; Iliac Artery ; Leg ; Liver ; Male ; Middle Aged ; Physical Examination ; Renal Insufficiency ; Thrombectomy ; Vascular System Injuries

PURPOSE: Failure of hemodialysis access is the main medical problem in chronic renal failure patients. This resulted from complications such as thrombosis, infection, pseudoaneurysm, steal syndrome and so on. This study was undertaken in an attempt to describe the clinical characteristics and significances of dialysis failure due to iatrogenic fistula between prosthetic graft and native vein at puncture site. METHODS: During 5 years between Feb. 2005 and Feb. 2009, five Iatrogenic fistulas were identified in a retrospective review of 133 patients performed 220 times fistulography due to dialysis failure in PTFE (polytetrafluoroethylene) graft. RESULTS: Overall incidence is 3.8 % in PTFE graft cases. Mean age is 50 (28~75) years, male to female ratio 2:3. Median 1st patency period is 20 months (6~36). All iatrogenic fistula is usually located in not venous but arterial limb of forearm loop, combined with the stenosis in venous limb and anastomosis site. More than 70% venous anastmotic stenosis in 4 cases (80%) and diffuse stenosis of venous limb in 3 cases (60%), revised concomitantly either by patch angioplasty or ballooning. Medial follow-up period is 8 months (5~12), graft occlusion occurred in one case. CONCLUSION: All iatrogenic fistula usually occurs in not venous but arterial limb of forearm loop graft. Most iatrogenic fistula is combined with the stenosis in venous limb and anastomosis sites, must be revised concomitantly either by patch angioplasty or ballooning. Close assessment to superficial vein and graft is needed for early detection. Fistulography is the most useful diagnostic tool. Careful cannulation method is required to prevent the occurrence of iatrogenic fistula in chronic renal failure patients.
Aneurysm, False ; Angioplasty ; Catheterization ; Constriction, Pathologic ; Dialysis ; Extremities ; Female ; Fistula ; Follow-Up Studies ; Forearm ; Humans ; Incidence ; Kidney Failure, Chronic ; Male ; Polytetrafluoroethylene ; Punctures ; Renal Dialysis ; Retrospective Studies ; Thrombosis ; Transplants ; Veins

True aneurysm of the radial artery is very rare, and the false aneurysms are more common. True aneurysms of the radial artery are usually secondary to trauma or iatrogenic injury. A 71-year-old male presented with a several year history of a left forearm-pulsating mass. He suffered from a brain infarct and had received acupuncture for his hemiplegia for the previous year. The physical examination revealed two pulsating masses on the left forearm. The left ulnar and radial arteries were palpable. The laboratory values were normal. Computerized tomography showed two 40x25 and 37x20 mm-sized saccular true aneuryms containing mural thrombosis in the left proximal radial artery with atherosclerotic change. The aneurysms were resected with reconstruction by using the cephalic vein. Distal flow was reestablished by using end-to-end anastomosis. No complications have been observed during the 4 weeks of follow-up.
Acupuncture ; Aged ; Aneurysm ; Aneurysm, False ; Brain ; Follow-Up Studies ; Forearm ; Hemiplegia ; Humans ; Male ; Physical Examination ; Radial Artery ; Thrombosis ; Veins

PURPOSE: The aims of this study were to assess the oncologic safety of laparoscopic colorectal surgery compared to that of conventional open surgery and to compare the disease-free survival (DFS) rates between laparoscopic and open colorectal surgery for radical treatment of colorectal cancer. METHODS: From January 2001 to December 2005, 583 patients underwent laparoscopic or conventional open surgery. To address only radical treatment of colorectal cancer, we excluded subjects who had undergone emergency or palliative operation. Four hundred ninety patients were identified for this study. The laparoscopic (LG) and open group (OG) had 74 and 166 patients, respectively, for colon cancer, and 92 and 158 patients, respectively, for the rectal cancer. RESULTS: No difference was noted in the lengths of the distal margins of the resected bowels between the LG and the OG for rectal cancer (P>0.05). In addition, no significant difference was found in DFS rates between the LG and the OG for both colon and rectal cancer (P>0.05). CONCLUSIONS: The laparoscopic technique does not seem to present any disadvantages and is safe and feasible for the treatment of colorectal cancer. No difference was found between laparoscopic and open surgery in terms of DFS for colorectal cancer.
Colon ; Colonic Neoplasms ; Colorectal Neoplasms ; Colorectal Surgery ; Disease-Free Survival ; Emergencies ; Humans ; Laparoscopy ; Rectal Neoplasms

PURPOSE: This study was undertaken to describe the clinicopathologic characteristics and evaluate the appropriate management of appendiceal tumors. METHODS: During 5 years between Sep. 2000 and Sep. 2005, 28 appendiceal tumors were identified in a retrospective review of 3,744 cases of appendectomy or right hemicolectomy pathology. RESULTS: Carcinoids were found incidentally as appendicitis. Mucinous cystadenomas were common in women older than 50 aged; half of the cases presented with appendicitis and the other half presented with non-specific abdominal symptoms such as palpable mass, intestinal obstruction and intussusception. Carcinomas were common in the older patients (mean age: 62.8 years) and this presented as periappendiceal abscess. Right hemicolectomy was undertaken when there was evidence of tumor spread beyond the resection margin, and carcinoma and tumors were located in the appendiceal base. Recurrence and metastasis were identified only in the carcinoma cases. CONCLUSION: Most appendiceal tumors presented with appendicitis and periappendiceal abscess. One stage curative resection was possible in more than 76% of the patients, and the prepoperative diagnosis rate was less than 35%. The preoperative diagnosis did not have much impact on the clinical course, and the postoperative pathology was important in determining the additional treatment. Close follow-up is needed for the early detection of recurrence, and all the carcinomas that were advanced as serosal involvement, peritoneal seeding and liver metastasis.
Abscess ; Appendectomy* ; Appendicitis ; Appendix ; Carcinoid Tumor ; Cystadenoma, Mucinous ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Intestinal Obstruction ; Intussusception ; Liver ; Neoplasm Metastasis ; Pathology ; Recurrence ; Retrospective Studies