A Case Report of Under-Recognized Conditions in Pulmonary Embolism: Patent Foramen Ovale and Right Ventricular Thrombus.

Pulmonary embolism (PE) is a potentially life-threatening condition that presents with a spectrum of clinical symptoms ranging from asymptomatic to hemodynamic instability. The early diagnosis in the emergency department is often challenging. Although the association between patent foramen ovale (PFO) and thromboembolic events in patients with PE is well-documented, the significance of the presence of PFO in patients with PE may be underrecognized. In addition, the occurrence of right ventricular thrombus (RVT) in PE is a rare but significant complication with implications for disease management. We report a case of acute-on-chronic PE with concurrent bilateral renal infarction due to a paradoxical embolus, alongside RVT. A 35-year-old male presented at our emergency department with complaints of sudden onset abdominal pain. Bilateral renal infarction was identified on a contrast-enhanced computed tomography (CT). Point-of-care ultrasound showed suggestive findings of PE and RVT. Subsequently, a pulmonary CT angiography confirmed bilateral PE, a PFO, and RVT. The patient was effectively managed with thrombolytic therapy, with extracorporeal membrane oxygenation on standby. This case highlights the need to recognize the diverse clinical manifestations of PE and the importance of considering coexisting PFO and RVT in affected patients. The diagnosis of PE can be complex when symptoms overlap with arterial thrombosis, such as renal infarction secondary to a PFO. In addition, RVT, although uncommon, is a serious complication in patients with PE that may require careful evaluation for thrombolytic or anticoagulant therapy. It is critical to consider the possibility of a PFO in all cases of PE, even in the absence of arterial embolism, and to promptly evaluate for RVT prior to initiating treatment.

Stem/progenitor cells in closed suction drainage fluid after hip arthroplasty.

BACKGROUND AND PURPOSE: Drainage after surgery is commonly used, and the contents are generally discarded as clinical waste. We analyzed closed suction drainage fluid from hip arthroplasty patients to determine whether any multipotent stem cells were present that could be used as a source of cells for tissue regeneration. METHODS: Drainage fluid was obtained from 14 patients after hip arthroplasty on the day of surgery, the next day, and 2 days after surgery. Peripheral blood and bone marrow from the iliac crest were also obtained from the same patients during surgery. These samples were examined using regular flow cytometric profiling, and we performed quantitative immunoassays of stromal-derived factor-1 (SDF1) levels in the plasma. Mononuclear cells (MNCs) from these samples were also isolated and cultured. Fibroblastic adherent cells from MNC fractions were cultured in an osteogenic and a chondrogenic differentiation medium and were then evaluated for multipotentency. RESULTS AND INTERPRETATION: Fibroblastic adherent cells were isolated from the mononuclear cell fraction of bone marrow and drainage fluid on the day of surgery, but they were not present in either the mononuclear cell fraction of the peripheral blood or the drainage fluid on the next day and 2 days after surgery. The cells from the drainage fluid on the day of surgery could differentiate in vitro into osteogenic and chondrogenic cells. SDF1 was elevated on the day of surgery, while CXCR4 was elevated on that day and the next day. This suggests that locally-induced SDF1 contributes to the mobilization of circulating CXCR4-positive cells. These results show that the drainage fluid collected on the day of surgery contains stem/progenitor cells that could be used for autologous cell-based therapy.

Repair of a large osteochondral defect in the knee joint using autologous and artificial bone graft combined with motion preserving distraction arthroplasty: a case report.

The biological reconstruction of a large osteochondral defect in the weight-bearing area of the knee joint has long been a challenge to orthopedic surgeons. We present a case of a large posttraumatic defect in the weight-bearing area of knee joint treated with a novel distraction arthroplasty device after reconstruction of the joint surface using combined autologous and artificial bone graft.

A minimum 2-year follow-up after selective anteromedial or posterolateral bundle anterior cruciate ligament reconstruction.

PURPOSE: The purpose of this study was to investigate the 2-year follow-up clinical results of 45 patients who had undergone our anterior cruciate ligament (ACL) augmentation procedure using an autogenous semitendinosus tendon and the EndoButton CL (Smith & Nephew, Andover, MA). METHODS: We followed up 45 patients for more than 2 years after their ACL augmentations. Of these, 37 were anteromedial (AM) bundle reconstructions and 8 were posterolateral (PL) bundle reconstructions. They were assessed using a KT-2000 knee arthrometer (MEDmetric, San Diego, CA) at 30 lb by joint position sense, Lysholm knee score, and magnetic resonance imaging (MRI). RESULTS: The mean side-to-side difference of anterior displacement measured by the KT-2000 knee arthrometer at 30 degrees of knee flexion preoperatively was 3.3 +/- 2.4 mm, significantly improving to a mean of 0.5 +/- 2.7 mm 2 years after surgery. The preoperative joint position sense inaccuracy was 1.6 degrees +/- 1.8 degrees , which improved significantly to 0.3 degrees +/- 2.0 degrees after surgery. The median Lysholm knee score significantly improved from 74 (range, 44 to 95) to 100 points (range, 81 to 100) after surgery. In 20 of 29 patients who had the postoperative MRI examination, the augmented ACL resembled 1 bundle on the sagittal planes of the postoperative MRI. CONCLUSIONS: Selective AM or PL bundle reconstruction showed improved joint stability, joint position sense, and Lysholm scores postoperatively. This procedure can be a treatment option for patients whose ACL remnants are left in certain conditions.