• Advances in nano research
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• v.10 no.5
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• pp.461-470
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• 2021

Infection is one of the major mortality causes throughout the globe. Nuclear medicine plays an important role in diagnosis of deep infections such as osteomyelitis, arthritis infection, heart valve and heart prosthesis infections. Techniques such as labeled leukocytes are sensitive and selective for tracking the inflammations but they are not suitable for differentiating infection from inflammation. Anionic linear-globular dendrimer-G₂ was synthesized then conjugation to gemifloxacin antibiotic. The structures were identified by FT-IR, ¹H-NMR, C-NMR, LC-MS and DLS. The toxicity of gemifloxacin and dendrimer-gemifloxacin complex was compared by MTT test. Dendrimer-G₂-gemifloxacin was labeled by Technetium-99m and its in-vitro stability and radiochemical purity were investigated. In-vivo biodistribution and SPECT imaging were studied in a rabbit model. Identify and verify the structure of the each object was confirmed by FT-IR, ¹H-NMR, C-NMR and LC-MS, also, the size and charge of this compound were 128 nm and -3/68 mv respectively. MTT test showed less toxicity of the dendrimer-G₂-gemifloxacin than free gemifluxacin (P < 0.001). Radiochemical yield was > %98. Human serum stability was 84% up to 24 h. Biodistribution study at 50 min, 24 and 48 h showed that the complex is significantly absorbed by the intestine and accumulation in the lungs and affects them, finally excreted through the kidneys, biodistribution results are consistent with results from full image means of SPECT/CT technique.

• Hip & pelvis
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• v.35 no.4
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• pp.228-232
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• 2023

Purpose: Prosthetic joint infection (PJI) has an enormous physiological and psychological burden on patients. Surgeons rightly wish to minimise this risk. It has been shown that a standardised, evidence-based approach to perioperative care leads to better patient outcomes. A review of current practice was conducted using a cross-sectional survey among surgeons at multiple centers nationwide. Materials and Methods: An 11-question electronic survey was circulated to hip and knee arthroplasty consultants nationally via the BOA (British Orthopaedic Association) e-newsletter. Results: The respondents included 56 consultants working across 19 different trusts. Thirty-four (60.7%) screen patients for asymptomatic bacteriuria (ASB) preoperatively, with 19 (55.9%) would treating with antibiotics. Fifty-six (100%) screen for methicillin-resistant Staphylococcus aureus and treat if positive. Only 15 (26.8%) screen for methicillin-sensitive S. aureus (MSSA) or empirically eradicate. Zero (0%) routinely catheterize patients perioperatively. Forty-one (73.2%) would give intramuscular or intravenous gentamicin for a perioperative catheterisation. All surgeons use laminar flow theatres. Twenty-six (46.4%) use only an impervious gown, 6 (10.7%) exhaust pipes, and 24 (42.3%) surgical helmet system. Five different antimicrobial prophylaxis regimens are used 9 (16.1%) cefuroxime, 2 (3.6%) flucloxacillin, 19 (33.9%) flucloxacillin and gentamicin, 10 (17.9%) teicoplanin, 16 (28.6%) teicoplanin and gentamicin. Twenty-two (39.3%) routinely give further doses. Conclusion: ASB screening, treatment and intramuscular gentamicin for perioperative catheterisation is routinely practiced despite no supporting evidence base. MSSA screening and treatment is underutilised. Multiple antibiotic regimens exist despite little variation in organisms in PJI. Practice varies between surgeons and centers, we should all be practicing evidence-based medicine.

• Hip & pelvis
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• v.34 no.4
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• pp.236-244
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• 2022

Purpose: The most recent diagnostic criteria for periprosthetic joint infection (PJI) include the use of the alpha-defensin (AD) lateral-flow (LF) test, but hip and knee arthroplasties were usually combined in previous studies. This prospective study was designed to examine the accuracy of the AD-LF test for diagnosis of PJI in chronic painful total hip arthroplasties (THA). Materials and Methods: Patients with chronic painful hip arthroplasties were prospectively enrolled between March 2018 and May 2020. Exclusion criteria included acute PJI or an insufficient amount of synovial fluid. The modified Musculoskeletal Infection Society (MSIS) criteria were primarily used for PJI diagnosis. Fifty-seven patients were included in the analysis group. Revision surgery was not performed in 38 patients, for different reasons (clinical group); these patients remain "Schrödinger's hips": in such cases PJI cannot be excluded nor confirmed until you "open the box". Results: The result of the AD-LF test was positive in nine patients and negative in 48 patients. Six patients were diagnosed with PJI. AD-LF sensitivity (MSIS criteria) was 83% (95% confidence interval [CI] 36-100%) and specificity was 92% (95% CI 81-98%). The positive and negative predictive value were 56% and 98%, respectively. Conclusion: The AD test is useful in addition to the existing arsenal of diagnostic tools, and can be helpful in the decision-making process. Not all patients with chronical painful THA will undergo revision surgery. Consequently, in order to determine the reliable diagnostic accuracy of this test, future PJI diagnostic studies should include a second arm of "Schrödinger's hips".

• Korean Journal of Bronchoesophagology
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• v.4 no.2
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• pp.177-181
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• 1998

Provox is now widely used for voice rehabilitation for total laryngectomized patient because of its low airway resistance and easiness for phonation. This study was designed to reveal the influence of radiation therapy on Proven complications. Forty-four patients who underwent total laryngectomy were grouped into group A (no radiation), group B(radiation and then Provox insertion), group C(Proven insertion and then radiation). Provox complications were leakage, granulation tissue formation, malfunction and infection. The average survival time of Provox was longer in group C (9.2 me) than group A(8.6 m) or group B (7.3 me), but no statistical significance was found. The first time of Provox change was 10.2, 8.6 and 9.7 months respectively. The incidence of complication was not significantly different among groups. The cases of Provox remeval due to shunt failure were 5, 4 and 2 respectively. Even though a significant statistically difference was not found partialy due to the small numbers of patients, a special caution should be exercised in inserting Provox to prevent a serious complication for the patients who had a history of previous radiation.

• Hip & pelvis
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• v.35 no.4
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• pp.277-280
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• 2023

Dislocation after a total hip arthroplasty occurs in approximately 1% of patients; however, the frequency is much higher after revision surgery. To prevent dislocation, use of a larger femoral head is recommended, and a dual mobility femoral head has been introduced. However, reducing the dual mobility femoral head to the acetabular component is difficult in cases involving contracture in the soft tissue around the joint. A 72-year-old male patient who developed a periprosthetic joint infection underwent two-stage revision surgery using MUTARS^®. Two months after the revision, the hip joint became dislocated and manual reduction was attempted; however, dislocation occurred again. During another revision using a dual mobility bearing, the soft tissue around the hip joint was too tight to reduce. The problem was overcome by first repositioning the dual mobility head into the acetabular socket, followed by assembly of the diaphyseal portion of the implant.

• Archives of Plastic Surgery
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• v.46 no.6
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• pp.550-557
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• 2019

Background In recent years, breast implants have been frequently placed in the subcutaneous pocket, in the so-called prepectoral approach. We report our technique of prepectoral implant-based breast reconstruction (IBR), as well as its surgical and aesthetic outcomes, in comparison with subpectoral IBR. We also discuss relevant considerations and pitfalls in prepectoral IBR and suggest an algorithm for the selection of patients for IBR based on our experiences. Methods We performed 79 immediate breast reconstructions with a breast implant and an acellular dermal matrix (ADM) sling, of which 47 were subpectoral IBRs and 32 were prepectoral IBRs. Two-stage IBR was performed in 36 cases (20 subpectoral, 16 prepectoral), and direct-to-implant IBR in 43 cases (27 prepectoral, 16 subpectoral). The ADM sling supplemented the inferolateral side of the breast prosthesis in the subpectoral group and covered the entire anterior surface of the breast prosthesis in the prepectoral group. Results The postoperative pain score was much lower in the prepectoral group than in the subpectoral group (1.78 vs. 7.17). The incidence of seroma was higher in the prepectoral group (31.3% vs. 6.4%). Other postoperative complications, such as surgical site infection, flap necrosis, implant failure, and wound dehiscence, occurred at similar rates in both groups. Animation deformities developed in 8.5% of patients in the subpectoral group and rippling deformities were more common in the prepectoral group (21.9% vs. 12.8%). Conclusions The indications for prepectoral IBR include moderately-sized breasts with a thick well-vascularized mastectomy flap and concomitant bilateral breast reconstruction with prophylactic mastectomy.

• Journal of Chest Surgery
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• v.31 no.6
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• pp.624-628
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• 1998

Postpneumonectomy syndrome is a rare and delayed complication of left pneumonectomy in most patients with normal mediastinal vascular anatomy. This syndrome is characterized by dyspnea and recurrent pulmonary infection in the remaining right lung that typically occur within the first postoperative year. The condition is believed to be secondary to postsurgical changes that include a marked shift of the mediastinum to the left, clockwise rotation of the heart and great vessels, and herniation of the right lung into the left anterior thorax. These changes lead to compression of the trachea or right main bronchus among the thoracic spine and the right pulmonary artery. We report a case of postpneumonectomy syndrome in 15 year-old girl that followed by left pneumonectomy for bronchiectasis 6 years ago. We have inserted an expandable prosthesis in the left thoracic cavity posterior to the heart. After implantation of an expandable prosthesis, an anatomic reposition of the shifted mediastinum was achieved, which resulted in instantaneous and sustained relief. The post-operative course was uneventful and the patient was followed in OPD from after discharge to now.

• Journal of Korean Foot and Ankle Society
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• v.5 no.1
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• pp.55-61
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• 2001

Purpose: To evaluate the clinical and functional results of ankle arthroplasty and to analyze the complications in total ankle arthroplasty. Materials and Methods: Between October 1988 and October 1991, the total ankle arthroplasty had been performed in eight ankle joints of seven patients.. There were five patients with rheumatoid arthritis, one with osteoarthritis and one with traumatic arthritis. One patient had bilateral replacement. New Jersey type of prosthesis was used in six patients and one patient was performed with Odland type of prosthesis. The average age at surgery was 42.3 years (range, 33-54 years). The average follow-up period was 8.2 years (range, 6-10.5 years). Clinical evaluation was assessed according to the Ankle-Hind Foot Scale of American Orthopedic Foot and Ankle Society. Results: The average score was 81.4 (range, 76 - 90) at the most recent follow-up. All patients were satisfied with their clinical results. Relief of pain was excellent in most patients, but postoperatively there was no significant improvement in range of motion. One patient had arthrodesis at three year six months after total ankle arthroplasty due to deep infection. Conclusion: This study shows total ankle arthroplasty is a good alternative treatment in selected cases of osteoarthritis and rheumatoid arthritis.

• Archives of Plastic Surgery
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• v.37 no.6
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• pp.749-757
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• 2010

Purpose: Since skin sparing mastectomy removes the mammary gland and the nipple-areolar complex preserving all mammary skin, it makes the widespread use of implants in immediate reconstruction. This article reports our experience in immediate breast reconstruction after skin sparing mastectomy by using the silicone implants in patients especially who have small to moderate sized and minimal ptotic breast. Methods: From September of 2007 to July of 2009, we performed breast reconstruction for 44 breasts of 40 women with silicone implant after mastectomy. Tumors were divided into 5 malignant types (21 IDC, 18 DCIS, 2 ILC, 2 phylloides tumor, 1 mucinous carcinoma). The implant is placed in a submuscular pocket or in a submuscularsubfascial pocket depending upon the condition of the muscles and skin flaps after mastectomy. Results: The mean age was 47 years and the average follow-up period was 11 months. Cosmetic outcome was assessed by evaluation of photographs and assessment of breast volume and shape, breast symmetry, and overall outcome. About 80% of each of these parameters was scored as good or excellent. Breast complication was developed in a total of 6 cases including 2 capsular contracture, 2 partial skin necrosis due to blue dye injection and 2 implant infection. Conclusion: The use of definitive implants in a skin sparing mastectomy is a one-stage immediate breast reconstruction with low morbidity and acceptable result. This method is considered reliable with favorable aesthetic result.

• The Journal of the Korean bone and joint tumor society
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• v.1 no.2
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• pp.133-144
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• 1995

After resection of intraarticular, periacetabulum(P2) and pubic rami(P23) and extraarticular, proximal femur(P2-H12) by Enneking classification, reconstruction is very difficult. We experienced three cases of saddle prostheses for reconstruction after P2, P23, and P2-H12 resection in pelvic malignancies. Case 1 was a high grade chondrosarcoma in 36 year-old-man and P2 resection was done. But he died of disease 19 months after operation. Case 2 was a malignant giant cell tumor in 32 year-old-woman. P23 resection was given and she is disease-free 32 months after operation. Case 3 was an osteosarcoma of 27-year-old-man and P2-H12 resection was performed and he is disease-free postoperative 12 months now. According to MSTS functional evaluatin system, all three patients showed no pain(5), intermediate function(2), emotinally satisfied(3), one cane or crutch supported(1), limited walking(3), and minor cosmetic gait(3). There was no significant complication and no dislocation except intermittent inguinal hernia in case 2. All patients started crutch walking 3 weeks after operation. Around 6 months postoperatively, the preserved iliac wing(P1 component) was hypertrophied enough to endure the full weight bearing. All could have squating and kneeling positions. In conclusion, saddle prosthesis would be a very useful method of reconstruction after P2, P23, and/or H1-2 resection to shorten the operation time and to reduce the infection rate without significant loss of function.