Anterior cruciate ligament (ACL) injury is one of the most common ligament injuries of the knee joint, especially in athletes. ACL reconstruction has been widely performed for many years. There have been many innovations of surgical instruments and improvements in surgical techniques, such as the single-incision endoscopic transtibial approach. Recently, many surgeons have focused on anatomic double-bundle ACL reconstruction. Anatomical graft position is one of the most important issues in ACL reconstruction, and it does not matter whether single- or double-bundle ACL reconstruction is performed. As clinicians we recommend anatomical ACL reconstruction for both athletes and non-athletes as a way of reducing the risk of knee osteoarthritis for ACL injured patients.
Mature adipocyte-derived dedifferentiated fat (DFAT) cells exhibit high proliferative activity and multi-lineage differentiation potential similar to mesenchymal stem cells (MSCs). In the present study, we examined the efficacy of angiogenic activity and safety of autologous DFAT cell transplantation in rabbits with hindlimb ischemia. The number of microvessel branching points in the ischemic area in the DFAT group was significantly greater than in the Control group. Autologous DFAT cell transplantation was performed easily and safely without any adverse effects up to 4 weeks after injection. DFAT cells may be an attractive cell source for therapeutic angiogenesis.
A 87-year-old man was admitted to our hospital because of right hypochondralgia and fever. He was diagnosed as acute moderate cholecystitis and required drainage of the gallbladder. Percutaneous drainage was not indicated, since he was being treated with low dose aspirin for lacunar infarction. Therefore, we performed endoscopic naso-gallbladder drainage (ENGBD) and the patient subsequently recovered. ENGBD is useful for acute cholecystitis, when the US guided percutaneous route is not indicated due to ascites or hemorrhagic tendency, despite the fact that ENGBD is technically more difficult than the percutaneous route.
We present a case of idiopathic ventricular fibrillation (VF) associated with J wave. A 27-year-old man fainted while fishing in the daytime. An automatic external defibrillator identified VF, which was successfully terminated. Twelve-lead electrocardiography (ECG) at the emergency room showed prominent J waves in the inferior and lateral leads. Ventricular late potential was shown by signal-averaged ECG and sustained VF was induced by programmed ventricular stimulation during an electrophysiological study. He was diagnosed as having idiopathic VF related to J wave, and underwent implantation of an implantable cardioverter-defibrillator.
A forty year-old man was admitted to our hospital complaining of right anterior chest pain. Chest computed tomograms showed a 10 X 10-mm mass in the right middle lobe of the lung. Positron emission tomography (PET) showed hot regions (SUV MAX 6.28 and 4.35, respectively) in the right middle lobe of the lung and in the sixth rib on the right side. We suspected primary lung cancer with a rib metastasis. The patient underwent bronchoscopic examination and rib biopsy. However, a definitive diagnosis was not established. Because there were no obvious metastatic lesions in any other organs, right middle lobectomy and costectomy of the sixth rib were performed to establish the diagnosis. The pathologic findings were compatible with coexistence of pulmonary cryptococcosis and eosinophilic granuloma of the rib. After the operation, the clinical course was uneventful without antifungal prophylaxis. Ten months after the operation, the patient has shown no signs of recurrence.
Laparoscopic myomectomy (LM) is widely performed due to its lower invasiveness, reduced postoperative adhesion, and better postoperative appearance compared to abdominal myomectomy (AM). Thus, cases of pregnancy and delivery after LM are likely to increase, along with an older maternal age at child birth due to later marriages. Uterine rupture is a major complication of pregnancy after myomectomy. Here, we report our experience of a patient who underwent LM at our hospital and then became pregnant and delivered by Cesarean section. Based on this experience, we compared the effects of pregnancy on the surgical wound site after laparoscopic and abdominal myomectomy. The risk of uterine rupture caused by pregnancy may be higher in LM compared to AM, but this risk can be decreased by improved suturing techniques and avoidance of excessive use of diathermy for hemostasis in LM, as currently performed for AM.
We report a case of a huge splenic cyst with a high concentration of carbohydrate antigen (CA) 19-9 in the cystic fluid. A 35-year-old woman, who first noticed an abdominal mass 5 months prior, was referred to our hospital due to anemia and an enlarged spleen that were observed during routine physical examination. All laboratory results were normal, except for the presence of anemia (hemoglobin, 5.6 g/dl) that was noted during her initial visit. Serum levels of carcinoembryonic antigen and CA19-9 were within the normal range. Abdominal computed tomography revealed a huge cystic lesion (20 X 17 X 14 cm) in the spleen. The patient underwent splenectomy. The spleen weighed 1.4 kg, and 2670 ml of cystic fluid was recovered. The CA19-9 concentration in the cystic fluid was markedly elevated to 34751.0 U/ml. The cystic lesion was histopathologically diagnosed as a true cyst with no evidence of malignancy. True cysts account for approximately 20% of all splenic cysts and are usually idiopathic. Herein, we report a case of a true cyst, with a brief review of the literature.
A 61-year-old female with an abnormal shadow on chest radiography was admitted to our hospital. Chest radiography and computed assisted tomography showed a 4.5 cm tumor with an irregular margin penetrating the right seventh intercostal muscle. The image showed tumor invasion to the chest wall. We performed complete resection of the tumor and partial resection of the ribs. The pathology revealed that it was a lipoma, and was diagnosed as an hourglass transmural lipoma. The patient’s postoperative course was uneventful, and she was discharged from the hospital on postoperative day 7. She has since been undergoing follow-up as an outpatient, with no signs of recurrence to date.