Transition from Secondary Blood Test to Nucleic Acid Amplification for Safe Allograft Transplantation

Background@#Given the incubation period of viral diseases, a secondary blood test should be performed at least 3–6 months after the first test to ensure the safety of allogenic bone grafts obtained from living donors in some tissue banks. The allograft is discarded if a secondary blood test was unavailable. The secondary blood test can be replaced with a nucleic acid amplification test (NAT) to reduce the discarded allograft. The purpose of this study was to analyze the comparative efficiency of secondary blood test and NAT to determine the donor suitability of allogenic bone grafts. @*Methods@#Allogenic bones were retrieved from 452 living donors between January 2013 and December 2019. A secondary blood test was conducted in 182 patients and NAT was performed in 270 patients. The average age of donors was 69 years (range, 33– 87 years). They included 86 men and 366 women. The initial blood tests including hepatitis B, hepatitis C, AIDS, and syphilis were conducted before retrieving grafts. The results were analyzed after the secondary blood test was performed at least 3 to 6 months after the first test because of the incubation period of the viral diseases. NAT was performed within 2 months after the first blood test. @*Results@#Sixty-seven of the 452 cases (14.8%) were discarded. In the secondary blood test group, 50 out of 182 cases (27.4%), and in the NAT group, 17 out of 270 cases (6.3%) were discarded. None of the 132 donors tested positive in the secondary blood test after testing negative in the first test. @*Conclusions@#It is extremely rare that the secondary blood test yields positive results in donors who tested negative in the initial test. However, quite a few grafts are discarded only because the secondary blood test is not available. In terms of economics and ethics, the secondary blood test may not be necessary or if required, a single test such as NAT for infectious diseases may be performed to determine donor suitability of allogenic bone.

Radiologic Results of Three-Dimensional Templating for Total Shoulder Arthroplasty

Background@#The purpose of this study was to evaluate the radiologic results of total shoulder arthroplasty using computerized three-dimensional (3D) templating in preoperative planning. @*Methods@#Ten patients who underwent total shoulder arthroplasty using 3D templating preoperatively were enrolled in this study. A specialized computer program was used to reconstruct the 3D images of the shoulder from the computed tomographic images. The 3D images of various sizes of prostheses were used as the template in surgical planning of the shoulder arthroplasty. The size of the glenoid, humeral head, and stem measured in 3D templating were compared with those used in actual operation. Anatomical parameters, such as humeral head size, radius of curvature, and greater tuberosity to humeral head distance of the replaced shoulder, were measured and compared with those of the contralateral normal shoulder. @*Results@#The agreement rates between the glenoid size, head size, head thickness, and stem size estimated preoperatively by 3D templating and those measured in operation were 100%, 100%, 100%, and 80%, respectively. The difference in humeral head size, radius of curvature, and greater tuberosity to humeral head distance between the replaced shoulder and contralateral shoulder was 1.31 mm, 0.87 mm, and 1.17 mm, respectively. @*Conclusions@#In total shoulder arthroplasty, 3D templating seems to enable accurate prediction of sizes of the prostheses to be inserted and thus replication of normal anatomy.

Revisional Rotator Cuff Repair / 대한정형외과학회잡지

Most patients experience pain relief and functional improvement after arthroscopic rotator cuff repair. In some patients, however, symptoms still remain after surgery. Failed rotator cuff repair is a complex outcome of biological, technical, and traumatic factors. Moreover, re-tears might or might not be the main cause for patients with persistent pain after rotator cuff repair. Therefore, a thorough understanding of the patient's history, physical examination, and appropriate imaging studies will be needed to evaluate and manage these patients. The patient's age, functional requirement, quality of the rotator cuff, preoperative range of motion, quality of the deltoid, and glenohumeral arthritis are factors to consider before performing revisional rotator cuff repair. Preoperative patient education is as important as the surgical technique for successful revisional rotator cuff repair.

Anesthetic management of an 8-month-old infant with osteogenesis imperfecta undergoing liver transplantation: a case report / 대한마취과학회지

Anesthetic management of pediatric liver transplantation in a patient with osteogenesis imperfecta (OI) requires tough decisions and comprehensive considerations of the cascade of effects that may arise and the required monitoring. Total intravenous anesthesia (TIVA) with propofol and remifentanil was chosen as the main anesthetic strategy. Malignant hyperthermia (MH), skeletal fragility, anhepatic phase during liver transplantation, uncertainties of TIVA in children, and propofol infusion syndrome were considered and monitored. There were no adverse events during the operation. Despite meticulous precautions with regard to the risk of MH, there was an episode of high fever (40degrees C) in the ICU a few hours after the operation, which was initially feared as MH. Fortunately, MH was ruled out as the fever subsided soon after hydration and antipyretics were given. Although the delivery of supportive care and the administration of dantrolene are the core principles in the management of MH, perioperative fever does not always mean a MH in patients at risk for MH, and other common causes of fever should also be considered.

Acute exacerbation of cold agglutinin disease during operation / 대한마취과학회지

No abstract available.

Acute exacerbation of cold agglutinin disease during operation / 대한마취과학회지

No abstract available.

Shoulder Prosthesis Mechanics

PURPOSE: The goal of prosthetic replacement of the shoulder is the restoration of the normal anatomy of the joint. MATERIALS AND METHODS: The physician should review the variations in normal anatomy because it does vary widely and the placement of the prosthetic needs to be modified to accommodate the variations. RESULTS AND CONCLUSION: Several factors including anatomic, prosthetic and surgical ones can lead to the best clinical results, and these are described.

The Inhibitory Effect of Methotrexate-Layered Double Hydroxide (LDH) Hybrid on Osteosarcoma Cell Lines / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to observe and analyze the effect of Methotrexate-Layered Double Hydroxide (LDH) hybrids on growth inhibition and the apoptosis of human osteosarcoma cell lines (SaOS-2, MG-63) and normal fibroblasts. MATERIALS AND METHODS: FITC-LDH hybrids were added to the cells and incubated for 2, 4, 6, and 8 hours. The samples were examined by fluorescence microscopy. SaOS-2 and MG-63 cells, and a normal fibroblast cell line (Detroit 551) were treated with 500 g/mL MTX and 500 g/mL MTX-LDH hybrids for 24, 48, 72, and 96 hours, respectively. The proliferation was measured by using the MTT assay. Apoptosis was determined by DNA fragmentation analysis. RESULTS: The hybrids with LDH entered the cells effectively in a time- and dose-dependent manner. The proliferation of SaOS-2 cells in a culture treated with 500 g/mL of MTX-LDH hybrids for 24 hours was significantly inhibited (37% more) compared to those treated with MTX. MG-63 cell growth was inhibited 20% more than SaOS-2 cell growth. However, the difference in the degrees of inhibition of cells treated with MTXLDH hybrid or with MTX alone reduced with time. DNA ladders appeared in cells treated with 500 g/mL MTX-LDH hybrid for 24 hours but not in those treated with MTX and LDH alone. CONCLUSIONS: The results of this study suggest that MTX-LDH hybrid more effectively enters cells and inhibits their proliferation than MTX alone.

Expression of Inducible Nitric Oxide Synthase (iNOS, NOS2) in Osteosarcoma Correlates with Prognosis / 대한정형외과학회잡지

PURPOSE: This study was performed to investigate the expression pattern of inducible nitric oxide synthase (iNOS) in osteosarcoma and to determine whether its expression correlates with metastatic potential and prognosis. MATERIALS AND METHODS: Pathologic tissues obtained from 48 patients with primary osteosarcoma were examined immunohistochemically.Stained tissues were categorized into three groups (negative, mild, strong), according to expression intensity, and matched with clinical data. Results were analysed statistically. RESULTS: iNOS was expressed in 18 of 48 samples (38%). Among the iNOS positive cases, mild expression was observed in 9 patients (18%). There was statistically significant correlation between mild iNOS expression and metastasis (p=0.019). By multivariate analysis mild iNOS expression turned out to be a significant prognostic factor for reduced survival (Risk ratio 4.399, 95% CI 1.694-11.421: p=0.02). CONCLUSION: Mild expression of iNOS was significantly related to metastasis in osteosarcoma and can be considered a significant prognostic factor.