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Objective@#The nationwide rehabilitation at-home care pilot program aims to provide medical services such as education, counseling, and remote management to patients who require continuous medical management after surgery. This study aims to retrospectively analyze the medical records of patients who participated in the project after knee arthroplasty to investigate the effectiveness of rehabilitation education in home-based care. Method: Data for analysis were collected from the evaluation form which is completed by the physician immediately after surgery and outpatient follow-up. The collected data included the patient’s sex, age, pre-operative functional level, surgical site, and scores on the berg balance scale (BBS) and visual analogue scale (VAS) for evaluating pain. If patients were re-admitted to other medical institutions for rehabilitation, data on the duration of their stay were collected for further analysis. @*Results@#A total of 234 patients were selected and their data were analyzed. The average change in the BBS (ΔBBS) between immediately after surgery and outpatient follow-up was 43.34 ± 5.51, while the average change in the VAS (ΔVAS) was −0.77 ± 2.27. A significant positive correlation (p=0.001) was found between pre-operative functional level and ΔBBS or ΔVAS. However, no significant correlation (p=0.554) was observed between the duration of stay in other medical institutions and ΔBBS or ΔVAS. @*Conclusion@#The home care pilot program is effective in promoting functional recovery and pain relief after knee arthroplasty. It is expected that appropriate rehabilitation education, remote management, and follow-up observation for up to 6 months will sufficiently replace long-term inpatient treatment after knee arthroplasty.

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Patellofemoral pain syndrome, one of the most common knee problems, is diagnosed by excluding other diseases that can cause similar pain or symptoms. The authors have been wondered about why patellofemoral pain syndrome can cause severe pain even when there are no structural abnormalities in the knee. For these reasons, if there are no structural abnormalities in the knee itself, the authors have strongly suspected referred pain due to injury of the surround structures, especially quadriceps femoris. Therefore, the authors want to report the successful experience in reducing knee pain and improving symptoms by performing extra-corporeal shockwave treatment in a patient who is concurred with diagnosis of patellofemoral pain syndrome and is suspected of having myofascial pain syndrome or chronic muscle injury of quadriceps femoris.

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A 62-year-old male presented with a longstanding right scrotal skin lesion. After a skin biopsy, the lesion was proven to be extramammary Paget's disease. The right scrotal skin was excised and a split thickness skin graft performed. After 16-months of follow up, the patient visited again, this time complaining of abdominal pain. On abdominal computerized tomography (CT) and whole body bone scans, the presence of a solid renal mass at the upper pole of the left kidney, with multiple metastatic lesions in the liver, bone and lymph nodes, were found. Under the impression of a malignant primary renal tumor, a radical nephrectomy was performed. A histological examination showed a conventional type renal cell carcinoma, with malignant Paget cells infiltrating and residing within the tumor mass. The patient died on the 50th postoperative day due to acute respiratory distress syndrome (ARDS) caused by aspiration pneumoniae.

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PURPOSE: Non-heart-beating liver transplantation has been accepted as a substitute to overcome the donor shortage problem. However, prolonged warm ischemia during liver procurement remains a obstacle to widespread use of non- heart-beating transplantation. Therefore, experimental studies to ameliorate graft injuries have been conducted, but, their clinical applications are not satisfactory yet. The aim of this study is to test our experimental model as a pertinent non- heart-beating transplantation model. METHODS: We designed porcine non-heart-beating liver transplantation model by simultaneous liver procurement of donor and recipient. Cardiac death was induced by direct cardiac injection of potassium chloride. Perfusion of normothermic hypertonic saline started after 30-min (group A, N=5), 1-hour (group B, N=4). Orthotopic liver transplantation with perfused donor liver was performed and we compared the perioperative laboratory parameter, histologic findings and survival between two groups. RESULTS: Only one (11.1%) death occurred among the nine transplant pigs. 2-day survival rates of group A and B were 60%, 50%, respectively. Group A showed a relatively acceptable posttransplant laboratory findings including liver function test and normal-looking histologic feature at the time of reperfusion and 24 hours after reperfusion. Group B showed more deranged liver function test and ischemic liver cell morphology at 24 hours after reperfusion. CONCLUSION: Our results suggest that this porcine non-heart-beating transplantation model may be the safe and suitable method. This model will be useful in further study for testing the perfusate and drugs to ameliorate the warm ischemia-induced hepatic injury.

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BACKGROUND: The survival in patients with hepatocellular carcinoma (HCC) has recently been improved by the advancement in the early detection of HCC. Among the various treatment modalities, the surgical resection has been considered as the most effective for small HCC, and the clinical course of patients with small HCC who underwent curative resection is known to be dependent on the etiology of HCC. Since the differences in the etiology of HCC depend on the different geographical area, it is necessary to verify the clinical outcomes and their affecting factors in patients with small HCC after curative resection in Korea, one of the hepatitis- B-virus(HBU)-endemic areas. METHODS: A total of 89 patients with small HCC (or=50 years old), Child's classification and vascular invasion were factors affecting the rate of recurrence. CONCLUSION: These results verify that the clinical outcomes of patients with small HCC after curative resection in Korea are similar to those of patients with different etiology of HCC in other geographic areas. To improve the prognosis of patients with small HCC after curative resection, strict preoperative evaluation of the presence of vascular invasion and postoperative preservation of liver function are necessary as well as the close postoperative follow-up for the early detection of recurrence.

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A 46-year-old woman presented with multiple purpuric skin rashes together with splenomegaly and thrombocytopenia. The resected spleen weighed 720 gm, and contained multiple, discrete, dark red, bulging nodules throughout the entire splenic parenchyma. Microscopically, the nodules revealed various range of endothelial cell proliferation which included cavernous vasculature, anastomosing vascular channels, papillary intravascular growth and solid pattern. Intrasinusoidal sequestration of platelets along with extramedullary hematopoiesis was present in the neoplastic vascular spacws. Neither exposure to thorotrast nor vinyl chloride was nonfirmed. Ultrastructurally, the tumor cells demonstrated a row of pinocytotic vesicles, occasional intercellular junctional structures, and the paucity/absence of filamentous structures or Weibel-Palade bodies supports origin of sinus lining type cells. After splenectomy, the thrombocyte count returned to normal. We conclude this is the first case of primary splenic angiosarcoma with Kasabach-Merritt syndrome in Korean literature.

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