Free Semitendinosus Tendon Graft in Re-ruptured Achilles Tendon / 대한족부족관절학회지

The acute Achilles tendon rupture usually occurs to the people who participate in sports-related activities between 30 and 40 years of age. Recently surgical repair is the standard treatment in acute Achilles tendon rupture. After the Achilles tendon rupture in the left ankle, a 30-years old young man had been suffered from re-rupturing within three months after the primary repair. 2 years later, right-side Achilles tendon was reruptured after primary repair consequently. In the revision surgery, we performed V-Y advancement of the gastrocnemius-soleus fascia and reinforcement of the semitendinosus tendon. None of the English-literature was reported about using the semitendinosus tendon in revision surgery of the Achilles tendon retear previously. Therefore, we report this case and surgical technique because of the simple technique and the excellent results.

Influence of Routine Intraoperative Ventricular Drainage on the Incidence of Aneurysmal Rebleeding

OBJECTIVE: Although there are several risk factors to which related intraoperative aneurymal bleeding, the relationship between ventricular drainage to aneurysmal rebleeding is still controversial. We investigate to define the relationship of an immediate ventricular drainage after craniotomies in predissection stage rerupture of aneurysms. METHODS: Randomized prospective and retrospective analyses were performed on 197 consecutive patients with confirmed aneurysmal subarachnoid hemorrhage(SAH) who underwent aneurysmal clipping in acute stage during 5 years. The aneurysmal SAH patients were divided into two groups according to the use of intraoperative ventricular cerebrospinal fluid(CSF) drainage. Various variables including Hunt-Hess grade, Fisher grade, Glasgow coma scale, Glasgow outcome scale, location of aneurysms, and the presence of a "daughter" aneurysm and hydrocephalus were analyzed. RESULTS: Regardless the drained CSF amount, the incidence of the intraoperative aneurysmal rerupture in predissection stage during aneurysmal clipping has not showed any difference in both groups. Depending on the presence of the acute hydrocephalus, the rerupture incidence in dissection stage during aneurysmal surgery was not statistically significant. However, the frequency of rebleeding in patients with ventriculostomy(66% of 24) was significantly higher than in hydrocephalic patients without ventriculostomy(25% of 27) and patients without acute hydrocephalus(22% of 110). CONCLUSION: Routine intraoperative ventricular drainage does not increase the incidence of aneurysmal rebleeding and the more extensive arachnoid dissection is not necessary even during an early surgery. Moreover, it obtains an adequate intraoperative brain relaxation, which resulted in the decrease of retraction injury.

Rerupture of Cerebral Aneurysms during Angiography: Report of 3 Cases

Rerupture of intracranial aneurysms during cerebral angiography is a rare complication and it usually occurs with in 24 hours after initial bleeding. We experienced three cases of aneurysmal rerupture during cerebral angiography, and in each case, angiography was performed after 24 hours from the initial attack. We have noticed extravasation of contrast medium to subarachnoid space or intraventricular space during angiography. In result, two patients died and one patient was disabled moderately.

Re-repture after primary flexor tendon repair of the hand / 대한정형외과학회잡지

In the treatment of flexor tendon injury of the hand, re-rupture after primary tendon repair is one of complications which occurs occasionally and so impose burden on both the patient and the surgeon. Authors experienced twelve cases of re-rupture after primary flexor tendon repair of 274 patients from Mar. 1989 to Mar.1996. The incidence of re-rupture after primary flexor tendon repair was 4.4% in author's series. One case happened with slip down injury, and in six cases re-rupture occurred during physical therapy with snapping click sound. However in five cases, the patients conldnt recognize any related causes. In majority of cases, re-ruptures were identified between three and five weeks after primary repair by the surgeon and the patient, so it could be suggested that the attention should be paid for the high possiblity of re-rupture during this period. Operative findings were the resorption and friability of repaired end with insecure suture fixation in two cases, rupture of suture material in four cases and loosening of the knot in six cases. From this study, the authors suggest the importance of knot, and recommend to make more than four knots on suture tie with attention to the tie direction, and advise careful physical therapy according to each patients' different situation. In the treatment of re-rupture, end-to-end re-anastomosis was available in seven cases (59%). In five cases (41%), tendon graft was needed. The clinical result of the re-rupture cases was evaluated by the Stickland evaluation method, and it was satisfactory in 67% of the patients who had the complication of re-rupture.

Aneurysmal Rerupture During Cerebral Angiography: Report of Two Cases

We report two cases of reruptured anterior communicating artery aneurysm during cerebral angiography in one aged 80 years and the other aged 59 years. Both patients had emergency angiography on Day 0, within 5 hours of the latest rupture. The prognosis was very poor. We stressed the importance of the time interval between the latest rupture and angiography.