Arthroscopic Assessment of Intra-Articular Lesion after Surgery for Rotational Ankle Fracture

BACKGROUND: The purpose of this study was to report findings of exploratory arthroscopic assessment performed in conjunction with removal of internal fixation device placed in the initial surgery for rotational ankle fracture. METHODS: A total of 53 patients (33 male, 20 female) who underwent surgery for rotational ankle fracture between November 2002 and February 2008 were retrospectively reviewed. All patients gave consent to the exploratory arthroscopic surgery for the removal of internal fixation devices placed in the initial surgery. Lauge-Hansen classification system of ankle fractures was assessed for all patients. Intra-articular lesions (osteochondral lesion, loose body, and fibrosis) were evaluated via ankle arthroscopy. Comparative analysis was then performed between radiological classification of ankle fracture/patient's symptoms and arthroscopic findings. RESULTS: Lauge-Hansen classification system of ankle fractures included supination-external rotation type (n = 35), pronation-external rotation type (n = 9), and pronation-abduction type (n = 9). A total of 33 patients exhibited symptoms of pain or discomfort while walking whereas 20 exhibited no symptoms. Arthroscopic findings included abnormal findings around the syndesmosis area (n = 35), intra-articular fibrosis (n = 51), osteochondral lesions of the talus (n = 33), loose bodies (n = 6), synovitis (n = 13), and anterior bony impingement syndrome (n = 3). Intra-articular fibrosis was seen in 31 of symptomatic patients (93.9%). Pain or discomfort with activity caused by soft tissue impingement with meniscus-like intra-articular fibrosis were found in 19 patients. There was statistical significance (p = 0.02) between symptoms (pain and discomfort) and the findings of meniscus-like fibrosis compared to the group without any symptom. CONCLUSIONS: Arthroscopic examination combined with treatment of intra-articular fibrosis arising from ankle fracture surgery may help improve surgical outcomes.

The Effect of Autotransfusion System in Minimally Invasive Total Knee Arthroplasty

PURPOSE: To evaluate the effect of autotransfusion system in minimally invasive total knee arthroplasty (TKA). MATERIALS AND METHODS: Seventy-one patients who underwent unilateral minimally invasive TKA between October 2009 and June 2010 were selected. The first group included 36 patients who received standard vacuum drainage and the second group, 35 patients who underwent autologous retransfusion drainage. In the first group, allogeneic blood transfusion was performed if the postoperative hemoglobin level was <7.0 g/dL or 7.0-8.0 g/dL with the presence of a medical complication and an anemic symptom. The second group received autotransfusion and allogeneic transfusion additionally according to the same criteria. Changes in the pre- and postoperative hemoglobin level, amount of auto- or allotransfusion, and frequency of allogeneic transfusion were assessed. RESULTS: Allogeneic transfusion was required in 13 patients (36.1%) in the first group and four patients (11.4%) in the second group. The mean allogeneic transfusion volume was significantly low in the second group compared to the first group (64.4 mL vs. 278.9 mL; p<0.05). The hemoglobin level on the 1st postoperative day compared to the preoperative level decreased by 22.6% in the first group and 11.7% in the second group. The postoperative hemoglobin level was higher in the second group (p<0.05). CONCLUSIONS: Minimally invasive unilateral TKA with an autotransfusion system can be beneficial in patients with no medical complications because of the decreased allogeneic transfusion.

A Comparison of Standard Laparoscopic Surgery and Hand-Assisted Laparoscopic Surgery in Patients with Diverticular Diseases of the Large and the Small Bowel

PURPOSE: In complicated diverticular disease, hand-assisted laparoscopic surgery (HALS) has been considered as a useful alternative treatment to standard laparoscopic surgery (SLS) and open surgery. As compared with standard laparoscopic surgery, HALS offers advantages such as tactile sense, better exposure, and shorter learning curve. Minimally invasive surgery is another advantage of HALS. The aim of this study was to compare SLS to HALS in patients with diverticular diseases of the small bowel and the colon. METHODS: We retrospectively reviewed the records of 32 patients who had undergone SLS and HALS for diverticular disease between February 2002 and March 2009. RESULTS: Of the 32 patients, 20 patients (62.5%) were in the SLS group, and 12 patients (37.5%) were in the HALS group. The mean maximal incision length was longer in the HALS group (SLS group vs. HALS group, 4.5 vs. 7.4 cm, P<0.001). However, the mean operating time, the time to flatus, the time to diet, the mean duration of narcotic analgesia, the length of hospital stay, and the postoperative complications were similar. There was no mortality in either group. CONCLUSION: The longest incision length for the HALS group was longer than that for the SLS group, but HALS could reduce the conversion rate and has the many advantages of minimally invasive surgery. For complicated diverticular disease, HALS may be considered as a useful alternative treatment.

Clinical Analysis of Acalculous Cholecystitis

PURPOSE: Acalculous cholecystitis (ACC) is a rare, but potentially lethal disease, which occurs in critically ill patients and those recovering from non-biliary tract operations. Recently, an increase in the presentation of mild form ACC was noted to occur in outpatients. This study was performed to assess the clinical features and prognosis of ACC. METHODS: One thousand consecutive laparoscopic cholecystectomies, performed by a single surgeon at the Eulji Medical Center, between September, 2001 and May, 2005, were retrospectively analyzed. According to the clinical data, the preoperative findings, operative results and pathology reports, 35 patients were diagnosed with acalculous cholecystitis. RESULTS: No significant differences were found in the age and sex distributions, laboratory findings between ACC and calculous cholecystitis (CC) or incidence of associated diseases. The number of cases undergoing PTGBD, or with an inflammatory grade score during the operation, were higher for those with an ACC, but the operative times and conversion rates to open cholecystectomy were no different. Of the 35 ACC patients, only 20 had the true criteria of acute acalculous cholecystitis. However, the other 15 patients showed no strong evidence typical of acalculous cholecystitis. CONCLUSION: We experienced acalculous cholecystitis different from rare and lethal form of acalculous cholecystitis. But diagnosis of this mild form of ACC is also delayed due to lack of objective findings. High suspicious index of these diagnostic entities should be kept in mind and we should rule out other disease entities as soon as possible if ACC is questionable, so we can perform laparoscopic cholecystectomy safely on these mild forms of ACC.

Wound Healing Effect of the Chitosan Sponges Containing the T-CAM or Regenin

Tetra cell adhesion molecule(T-CAM) is a new recombinant mixture of fibronectin and ig-h3. Fibronectin and ig-h3 are extracellular matriprotein involved in each phase of wound healing, and the combination of these materials may generate a synergistic effect in wound healing. Regenin is easily attainable from protein recombination. It can be developed as wound healing material, and also it has a good effect in cell adhesion and proliferation. We combined the chitosan with regenin or T-CAM at different concentration, which are gene recombination material. They were applied to the artificial wound of white rabbit to compare the healing effect in each group. Round full thickness skin defects, 3 cm in diameter, were made bilaterally on the dorsolateral aspect of New Zealand white rabbit. Experimental group was divided into 6 groups, according to concentration of T-CAM and regenin with chitosan-based dressing materials as followings; Group C: control group - oint material dressing, Group Ch: chitosan base only, Group T1: chitosan base in combination with 25 microgram/ml of T-CAM, Group T2: chitosan base in combination with 625 microgram/ml of T-CAM, Group R1: chitosan base in combination with 25 microgram/ml of Regenin, Group R2: chitosan base in combination with 625 microgram/ml of Regenin. Gross findings by means of percentage of wound contraction, percentage of wound epithelization and percentage of total wound healed area were compared with surface tracing of the remained wound area at the time of 7, 14, 21 days after wound formation. Wound biopsy were performed at the time of 7, 14, 21 days after wound formation. T1, T2 group and R1, R2 groups have less infiltration of inflammtory cell, fast appearance of new vessels, fibroblast, increased volume of collagen fiber comparing to C and Ch group. there's more statistical significance between T1 and T2 group. The same results were shown in Regenin group. In conclusion, our results suggest that T-CAM and Regenin have good effect in wound healing and higher concentration of T-CAM and Regenin is more effective in wound healing than lower concentration. In addition, comparision of same concentration of T-CAM and Regenin group presented almost same results.