생체공학 - 의학과 공학의 만남

( W. Mark Saltzman ) 한국공업화학회 2018 공업화학전망 Vol.21 No.2

Free Vascularized Fibular Strut Autografts to the Lumbar Spine in Complex Revision Surgery: A Report of Two Cases

Bryan M. Saltzman,David M. Levy,Venus Vakhshori,Christopher J. DeWald 대한척추신경외과학회 2015 Neurospine Vol.12 No.3

This case report presents two patients who underwent fibular strut grafting for complex revisions of previous lumbar spine arthrodeses. A case review of the Electronic Medical Record at the index institution was performed to evaluate the timeline of events of the two patients who underwent fibular strut grafting for complex revisions of previous lumbar spine arthrodesis, including imaging studies, progress notes, and laboratory results. One patient had developed chronic L3 vertebral body osteomyelitis from a prior fibular allograft and instrumentation placed for a traumatic burst fracture. The second patient had a severe scoliosis recalcitrant to prior arthrodeses in the context of Marfan syndrome and a persistent L4-5 pseudarthrosis. Both patients underwent free vascularized fibular autograft revision arthrodeses. At most recent long-term follow-up, both patients had improved clinically and neither had required further revision. The use of free vascularized fibular grafting is an excellent option for a variety of spinal indications, and these two reports indicate that the technology may have an indication for use after multiple failed surgeries for osteomyelitis or correction of a multi-level large spinal deformity secondary to Marfan syndrome.

Treatment of Isolated Ankle Osteoarthritis with Arthrodesis or the Total Ankle Replacement: A Comparison of Early Outcomes

Charles L. Saltzman,,Robert G. Kadoko, MD,서진수 대한정형외과학회 2010 Clinics in Orthopedic Surgery Vol.2 No.1

Background: Ankle arthrodesis and replacement are two common surgical treatment options for end-stage ankle osteoarthritis. However, the relative value of these alternative procedures is not well defi ned. This study compared the clinical and radiographicoutcomes as well as the early perioperative complications of the two procedures. Methods: Between January 2, 1998 and May 31, 2002, 138 patients were treated with ankle fusion or replacements. Seventy onepatients had isolated posttraumatic or primary ankle arthritis. However, patients with infl ammatory arthritis, neuropathic arthritis,concomitant hind foot fusion, revision procedures and two component system ankle replacement were excluded. Among them,one group of 42 patients had a total ankle replacement (TAR), whereas the other group of 29 patients underwent ankle fusion. A complete follow-up could be performed on 89% (37/42) and 73% (23/29) of the TAR and ankle fusion group, respectively. Themean follow-up period was 4.2 years (range, 2.2 to 5.9 years). Results: The outcomes of both groups were compared using a student’s t-test. Only the short form heath survery mental componentsummary score and Ankle Osteoarthritis Scale pain scale showed significantly better outcomes in the TAR group (p < 0.05). In theradiographic evaluation, there was no signifi cant difference in preoperative and postoperative osteoarthritis between the TAR and fusiongroups. Conclusions: The clinical results of TAR are similar to those of fusion at an average follow-up of 4 years. However, thearthroplasty group showed better pain relief and more postoperative complications that required surgery.

족관절 인공관절 치환술 후 족관절 운동범위의 변화

서진수,Suh, Jin-Soo,Saltzman, Charles L. 대한족부족관절학회 2006 대한족부족관절학회지 Vol.10 No.1

Purpose: Ankle fusion that is operated on severe ankle arthritis has its weakness in that normal walking is impossible, even though the result is pretty good. As a alternative choice, total ankle replacement pursues the longer survivorship with material improvement. However, it is not yet known how much range of motion is possible after the replacement, or how it has changed overtime. Therefore, we need an analyzation for that. Materials and Methods: A retrospective review of sixty-seven patients undergoing STAR total ankle replacement at our institution between 1998 and 2002 was conducted. Of those, twenty-six (39%) had complete sets of full dorsiflexion and plantar flexion lateral radiographs both between "immediate" postop and at a minimum of 2-years follow-up and no revision procedure during that time. The mean age of these patients was 63.2 years when the surgery was done; the etiology of arthrosis was 21(81%) post-traumatic/degenerative, 4 rheumatoid and 1 psoriatic. Results: Average "immediate" ankle range of motion was $15.9^{\circ}$, and total foot (non-ankle) motion was $20.6^{\circ}$. At one, two, and three years the average ankle and total foot ranges of motion were $17.4^{\circ}$, $17.6^{\circ}$, $15.6^{\circ}$ and $21.0^{\circ}$, $22.0^{\circ}$, $21.2^{\circ}$ respectively. Statistically there was no significant difference between "immediate" postop motion and one to three years postop (all p>0.05). Conclusion: The range of motion after the STAR total ankle replacement is maintained from the "immediate" postoperative range of motion, but not increased, in the 1-3 year post replacement period.

COVID-19 Endothelial Dysfunction Can Cause Erectile Dysfunction: Histopathological, Immunohistochemical, and Ultrastructural Study of the Human Penis

Kresch Eliyahu,Achua Justin,Saltzman Russell,Khodamoradi Kajal,Arora Himanshu,Ibrahim Emad,Kryvenko Oleksandr N.,Almeida Vania Wolff,Firdaus Fakiha,Hare Joshua M.,Ramasamy Ranjith 대한남성과학회 2021 The World Journal of Men's Health Vol.39 No.3

Purpose: A pilot study to describe histopathological features of penile tissue of patients who recovered from symptomatic COVID-19 infection and subsequently developed severe erectile dysfunction (ED). Materials and Methods: Penile tissue was collected from patients undergoing surgery for penile prosthesis for severe ED. Specimens were obtained from two men with a history of COVID-19 infection and two men with no history of infection. Specimens were imaged with TEM and H&E staining. RT-PCR was performed from corpus cavernosum biopsies. The tissues collected were analyzed for endothelial Nitric Oxide Synthase (eNOS, a marker of endothelial function) and COVID- 19 spike-protein expression. Endothelial progenitor cell (EPC) function was assessed from blood samples collected from COVID-19 (+) and COVID-19 (-) men. Results: TEM showed extracellular viral particles ~100 nm in diameter with peplomers (spikes) near penile vascular endothelial cells of the COVID-19 (+) patients and absence of viral particles in controls. PCR showed presence of viral RNA in COVID-19 (+) specimens. eNOS expression in the corpus cavernosum of COVID-19 (+) men was decreased compared to COVID-19 (-) men. Mean EPC levels from the COVID-19 (+) patients were substantially lower compared to mean EPCs from men with severe ED and no history of COVID-19. Conclusions: Our study is the first to demonstrate the presence of the COVID-19 virus in the penis long after the initial infection in humans. Our results also suggest that widespread endothelial cell dysfunction from COVID-19 infection can contribute to ED. Future studies will evaluate novel molecular mechanisms of how COVID-19 infection leads to ED.

Primary versus revision total shoulder arthroplasty: comparing relative value and reimbursement trends

John Joseph Carney,Erik Gerlach,Mark Plantz,Peter Raymond Swiatek,Jeremy Marx,Matthew Saltzman,Guido Marra 대한견주관절학회 2022 대한견주관절의학회지 Vol.25 No.1

Background: Total shoulder arthroplasty (TSA) has been demonstrated to be an effective treatment for multiple shoulder pathologies. The purpose of our study was to compare the relative value units (RVUs) per minute of surgical time for primary and revision TSA. Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients that underwent primary TSA, one-component revision TSA, and two-component revision TSA between January 1, 2015 and December 31, 2017 using current procedure terminology codes. RVUs were divided by mean operative time for each procedure to determine the amount of revenue generated per minute. Rates were compared between the groups using a one-way analysis of variance with post-hoc Tukey test. Statistical significance was set at p<0.05. Results: When dividing compensation by surgical time, we found that two-component revision generated more compensation per minute compared to primary TSA (0.284±0.114 vs. 0.239±0.278 RVU per minute or $10.25±$4.11 vs. $8.64±$10.05 per minute, respectively; p=0.001). Conclusions: The relative value of revision TSA procedures is weighted to account for the increased technical challenges and time associated with these procedures. This study confirms that reimbursement is higher for revision TSA compared to primary TSA.