Influence of previous abdominal surgery on clinical outcomes of patients undergoing total laparoscopic hysterectomy

OBJECTIVE: To evaluate the potential effects of previous abdominal surgery on post-operative outcome and incidence of complications after total laparoscopic hysterectomy (TLH). METHODS: Between June 2008 and December 2016, 331 patients who underwent TLH were retrospectively reviewed. Participating patients were divided into 2 groups according to previous abdominal surgery. We compared the 2 groups based on estimated blood loss, operation time, hospital stay, surgery-related complications, and conversion to laparotomy rates. RESULTS: Group 1 included patients without a history of abdominal surgery (n=186), group 2 included patients with a history of abdominal surgery (n=145). The complication rate was 3.2% in group 1 and 2.8% in group 2. Other post-operative outcome and complications such as estimated blood loss, hospital stay and conversion to laparotomy rates did not differ significantly between groups. Adhesiolysis was significantly more common in group 2 (P < 0.001) and operation time was significantly longer in the group 2 (P=0.004). The rate of conversion to laparotomy was higher in group 2, but this difference was not significant (P=0.115). Group 2 patients were divided into subgroups according to the number of surgery. In subgroups analysis of group 2, there were 70 patients who had one previous abdominal surgery and 75 patients who had 2 or more previous surgeries. Moreover, there were significant differences in adhesiolysis (P=0.004) and conversion to laparotomy (P=0.034). There were no significant differences in other complications observed upon subgroup analysis. CONCLUSION: TLH can be conducted successfully regardless of previous abdominal surgery. Patients with previous abdominal surgery are suitable and feasible candidates for TLH.

The Effect of Umbilical Cord Blood Derived Mesenchymal Stem Cells in Monocrotaline-induced Pulmonary Artery Hypertension Rats

Pulmonary arterial hypertension (PAH) causes right ventricular failure due to a gradual increase in pulmonary vascular resistance. The purposes of this study were to confirm the engraftment of human umbilical cord blood-mesenchymal stem cells (hUCB-MSCs) placed in the correct place in the lung and research on changes of hemodynamics, pulmonary pathology, immunomodulation and several gene expressions in monocrotaline (MCT)-induced PAH rat models after hUCB-MSCs transfusion. The rats were grouped as follows: the control (C) group; the M group (MCT 60 mg/kg); the U group (hUCB-MSCs transfusion). They received transfusions via the external jugular vein a week after MCT injection. The mean right ventricular pressure (RVP) was significantly reduced in the U group after the 2 week. The indicators of RV hypertrophy were significantly reduced in the U group at week 4. Reduced medial wall thickness in the pulmonary arteriole was noted in the U group at week 4. Reduced number of intra-acinar muscular pulmonary arteries was observed in the U group after 2 week. Protein expressions such as endothelin (ET)-1, endothelin receptor A (ERA), endothelial nitric oxide synthase (eNOS) and matrix metalloproteinase (MMP)-2 significantly decreased at week 4. The decreased levels of ERA, eNOS and MMP-2 immunoreactivity were noted by immnohistochemical staining. After hUCB-MSCs were administered, there were the improvement of RVH and mean RVP. Reductions in several protein expressions and immunomodulation were also detected. It is suggested that hUCB-MSCs may be a promising therapeutic option for PAH.

Detection of Heparin in the Salivary Gland and Midgut of Aedes togoi

Mosquitoes secrete saliva that contains biological substances, including anticoagulants that counteract a host's hemostatic response and prevent blood clotting during blood feeding. This study aimed to detect heparin, an anticoagulant in Aedes togoi using an immunohistochemical detection method, in the salivary canal, salivary gland, and midgut of male and female mosquitoes. Comparisons showed that female mosquitoes contained higher concentrations of heparin than male mosquitoes. On average, the level of heparin was higher in blood-fed female mosquitoes than in non-blood-fed female mosquitoes. Heparin concentrations were higher in the midgut than in the salivary gland. This indicates presence of heparin in tissues of A. togoi.

Large Forefoot Schwannoma: A Case Report / 대한족부족관절학회지

A schwannoma is a benign neurogenic tumor derived from Schwann cells. A rare case of a large painful schwannoma in the foot with metatarsal deformity was presented. Due to suspicion of malignancy, amputation had been recommended previously. We report on a rare case of a large forefoot schwannoma causing pain and paresthesia of the forefoot.

The Clinical Results of the Proximal Opening Wedge Osteotomy Using a Low Profile Plate in Hallux Valgus: Comparison with Proximal Chevron Osteotomy Fixed with K-wires / 대한족부족관절학회지

PURPOSE: To present clinical results of proximal first metatarsal opening wedge osteotomy and low profile plate fixation in hallux valgus deformity. MATERIALS AND METHODS: Thirty-two patients (39 feet) underwent surgery for hallux valgus deformity. Fourteen patients (18 feet; Group A) underwent proximal first metatarsal opening wedge osteotomy fixed with low profile titanium plate (Arthrex(R)), and 18 patients (21 feet; Group B) underwent proximal chevron osteotomy with two K-wires. Improvement in hallux valgus angle (HVA), 1, 2 intermetatarsal angle (IMA), range of motion of 1st metatarsophalangeal joint, VAS score, and the length of first metatarsal on weight-bearing radiograph were evaluated preoperatively and at final follow-up. RESULTS: HVA improved from 36.2+/-6.6 degrees to 11.7+/-5.1 degrees, and 1, 2 IMA improved from 15.7+/-2.6 degrees to 7.2+/-1.9 degrees. VAS score improved from 7.2+/-1.2 to 1.4+/-0.9. There were no significant differences clinically and radiologically. CONCLUSION: Proximal first metatarsal opening wedge osteotomy with stable fixation using low profile plate may be an effective surgical option for correction of hallux valgus deformity.

Efficacy of Extramedullary Femoral Component Alignment Guide System for Blood Saving after Total Knee Arthroplasty

PURPOSE: To compare the extramedullary femoral alignment guide system with the conventional intramedullary alignment guide system for bleeding and transfusion rate after total knee arthroplasty (TKA). MATERIALS AND METHODS: Forty-nine female TKA patients were randomized into two groups: intramedullary (IM) group vs. extramedullary (EM) group. Drained volume of blood, hemoglobin concentration, hemoglobin drop, and transfusion rate were compared between the two groups. Wound problems, bleeding-related problems and thromboembolic complications were collected. RESULTS: The mean drained volume via vacuum drainage was less in the EM group than that in the IM group (482.9 mL vs. 266.8 mL, p=0.001). Hemoglobin at 5 days after surgery was higher in the EM group (9.3 g/dL vs. 9.9 g/dL, p=0.002) than that in the IM group. The drop in hemoglobin after 5 days was smaller in the EM group (3.5 g/dL vs. 2.9 g/dL, p=0.003) than that in the IM group. The EM group had a lower prevalence of allogeneic transfusion (45.0% vs. 20.5%, p=0.026) than that in the IM group. No significant complications developed in either group. CONCLUSIONS: The results suggest that the extramedullary femoral alignment guide technique is an advantageous method that can reduce the drained volume of blood and the allogeneic transfusion rate.

Cement Leakage into Disc after Kyphoplasty: Does It Increases the Risk of New Adjacent Vertebral Fractures?

PURPOSE: This study aims to investigate the relationship between cement leakage into the disc during percutaneous balloon kyphoplasty and subsequent compression fractures in adjacent vertebrae during treatment of osteoporotic vertebral compression fracture. MATERIALS AND METHODS: 103 patients (118 vertebrae) who have been treated with balloon kyphoplasty due to osteoporotic compression fracture from June 2007 to July 2010 were retrospectively analyzed. The group was composed of 13 males and 90 females. The mean age was 75 years (57~95 years). The mean follow-up period was 10 months (6~30 months). Patients were divided into two groups; one with cement leakage into the disc and the other without cement leakage into the disc. The study was performed to determine whether subsequent compression fractures in adjacent vertebrae were related to several factors. RESULTS: The cement leakages into the disc occurred in 16 of 118 vertebrae. Of the 16 vertebrae with cement leakage into the disc, 5 (31%) had subsequent adjacent vertebral compression fractures; however, of the 102 vertebrae in which cement leakage did not occur, only 11 (11%) had subsequent adjacent vertebral compression fractures (p<0.05). Of the 16 vertebrae with cement leakage into the disc, subsequent adjacent vertebral compression fractures occurred 1 vertebrae of 10 vertebrae with definite trauma history. Out of the 6 vertebrae with cement leakage and no definite trauma history, 4 vertebrae (67%) had subsequent adjacent vertebral compression fractures (p<0.05). CONCLUSION: The cement leakage into the disc significantly increases the incidence of subsequent adjacent vertebral compression fractures. Most of the subsequent fractures occurred in the early post-operative period. When cement leakage into the disc occurred in patients with no definite trauma history such as slip down, the incidence of subsequent adjacent vertebral compression fracture increased significantly.

Inter- and Intra-observer Reliability of MRI for Lumbar Lateral Disc Herniation

BACKGROUND: The authors analyzed inter- and intra-observer agreement with respect to interpretation of simple magnetic resonance T1- and T2-weighted axial and sagittal images for the diagnosis of lumbar lateral disc herniation, including foraminal and extraforaminal disc herniations. METHODS: Forty-two patients in whom lumbar lateral disc herniation was suspected or confirmed by simple magnetic resonance imaging at one institute between May 2003 and December 2004 were included. The magnetic resonance images consisting of T1- and T2-weighted axial and sagittal images, and these were reviewed blindly and independently by three orthopaedic spine surgeons in a random manner. The images were interpreted as positive or negative for lateral disc herniation on 2 different occasions 3 months apart. Results were analyzed using Cohen's kappa statistic, and strengths of agreements were determined using the Landis and Koch criteria. RESULTS: The kappa values for inter-observer agreement averaged 0.234 (0.282, 0.111, and 0.308 respectively) on the first occasion, and 0.166 (0.249, 0.111, and 0.137 respectively) on the second occasion, with an overall mean value of 0.200. Thus, the strength of agreement was only slight-to-fair according to the Landis and Koch criteria. Kappa values for intra-observer agreement averaged 0.479 (0.488, 0.491, and 0.459 respectively), indicating moderate agreement. CONCLUSIONS: The present study indicates that simple magnetic resonance imaging is not a reliable imaging modality for diagnosing lumbar lateral disc herniation. Another imaging study with improved diagnostic values should be developed to diagnose this pathologic finding.